Just then, the pages threw open the doors yet again and announced Mr. Craggs.
“Mais comment donc, Monsieur Craggs,” bristled the king, laying a possessive hand on Lady Mary’s shoulder, “est-ce que c’est l’usage de ce pays de porter des belles dames comme un sac de froment?” Is it the custom in this country to haul fair ladies about like a sack of wheat?
For an instant, Craggs was struck dumb, his expression frozen blank. Recovering, he bowed particularly low. “There is nothing I would not do for Your Majesty’s satisfaction,” he said smoothly.
The king decided to be pleased; after commending Mr. Craggs’s courage in daring to appear ungallant for the sake of still greater gallantry, he turned away again.
“Bloody hell!” Craggs swore in Lady Mary’s ear. “Do you possess so much as a single drop of discretion?” He had done her a great favor, he made it bitterly clear, keeping her in the king’s favor; in return, she had painted him to the king as a rival.
Lady Mary colored, but said nothing. I dared not resent it, she wailed to her diary later that night, for I drew it upon myself, and indeed I am heartily vexed at my own imprudence.
The king, thought Lady Mary, was a bit of a blockhead, but she liked him for all that. His son was another matter. George, Prince of Wales, she deemed a mean-spirited prig. “He looks on all the men and women he sees as creatures he might kick or kiss—for his diversion,” she sniffed to her sister. Soon, however, Lady Mary was drawing the prince’s eyes as well as the king’s.
One evening, the prince called his wife away from the card table to see how charmingly Lady Mary was dressed. Caroline of Ansbach, Princess of Wales, came as called, but failed to share his raptures. “Lady Mary always dresses well,” she observed dryly, returning abruptly to her cards. Soon after, the prince was made aware of Lady Mary’s regular attendance at his father’s supper parties. Directly, despite all her fine dressing, his ardor not only cooled but curdled; he could no longer see her without taunting her as a deserter gone over to the enemy’s camp: throughout the eighteenth century, Britain’s kings and their heirs competed jealously for power, splendor, loyalty, and sometimes women.
As her husband soured, the princess grew noticeably more friendly.
On the ninth of August, the day after Lady Mary’s sister Frances—now the countess of Mar—gave birth to their first child, the earl her husband disappeared, leaving her without money or any notion of where he might be going. On the tenth, Lady Mary’s father was promoted yet again, reaching the pinnacle of the peerage as the first duke of Kingston.
Frances was sworn by her husband’s family not to discuss any of her difficulties with her father, but, reduced to selling jewels, plate, gowns—everything of value—she had obviously been left penniless. The earl of Mar soon turned out to be far worse than a wayward husband: he had absconded for Scotland to head the Jacobite armies of the Pretender. The rebellion that had been festering since Queen Anne’s death at last broke into the open, and the new duke of Kingston found that instead of acquiring political insurance in the form of a Tory son-in-law, he had saddled the family with one of the chief Jacobite traitors.
In mid-November, Jacobite and loyalist armies clashed in Scotland at the Battle of Sheriffmuir. The Hanoverians claimed victory, but for all its ferocious slaughter, the battle was indecisive. Inept even in treason, Mar unintentionally helped his Hanoverian foes by failing to seize any of the many advantages his army had been left with. In the following weeks, however, the Pretender himself was expected to land any day and galvanize the rebel army into a far more dangerous force. All Britain hushed and hunched down, poised to leap into the carnage of another civil war.
The anxiety of it all exhausted Lady Mary. One afternoon in mid-December, she withdrew early to her chamber. Lying in her stately four-poster bed, canopied and draped in embroidered brocade, she was unable to sleep. The chambermaid must have stoked the fire with enough coal to heat all of Sweden. Tossing and turning, she kicked the bedclothes off. Directly, she shivered and pulled them back up. At last, her head pounding and her skin burning, she rose to drink in cold air at the window, but when she stood up, the room spun. She could barely stagger to the washbasin before she began vomiting.
Still reeling, she called her maid and had young Edward and his nurse packed out of the house without waiting for daylight. By morning, her fever had dipped a little, but her back throbbed dully and her headache intensified until she thought the front of her skull must be clapping open and closed like a loose shutter in a storm. As the sun climbed in the sky, her fever turned around and soared ever higher.
Richard Mead and Samuel Garth, both royal physicians and members of the Royal Society—and Dr. Garth a longtime friend in the bargain—were sent for. But Lady Mary guessed what was wrong long before she heard their coaches halt at her door. After all her running, the demon smallpox had finally caught up with her—as it happened, very close to the same day that it had caught Queen Mary, twenty-one years before.
The two doctors tended toward agreement, though they would confirm no diagnosis before the telltale rash. They ordered her bled, to which she submitted though she detested it, and prescribed both a “gentle” vomit to empty her stomach, and a purge, or laxative, to empty her bowels. Four times a day, they poured down her throat a medicine only a half-step away from magic: two parts powdered bezoar—or ground-up “stones” of calcified hair and fiber found in animal stomachs and valued since ancient times as an antidote to poison—and one part niter, or saltpeter—one of the chief ingredients of black gunpowder. This mixture, Dr. Mead intoned, leaning on his golden-headed cane, was “to keep the inflammation of the blood within due bounds, and at the same time to assist the expulsion of the morbific matter through the skin.”
Snow already blanketed the cobblestones of Duke Street below her window, but grooms padded them further with straw. Smallpox, Dr. Mead announced outside her door, was a dangerous effervescence of the blood. Lady Mary, advised Dr. Garth, his eyes fixed upon Wortley, was therefore to be kept from any commotion, confabulation, and passion—whether grief, love, or fear—that might further stir up the poison boiling inside her.
“How is my little boy?” she begged everyone who drew near. “He is well,” came the unvaried reply.
Despite the hushed tiptoeing around her bed, her mind grew restless with a strange, brilliant clarity, as if she had previously been imprisoned in a cloudy crystal ball that some unseen hand had suddenly wiped clean. She could not sleep, but the doctors refused her any opiates, so she chattered through the night, the nurses nodding off as the candles guttered in the darkness.
The next morning, the fever began to fall, though her skin was still hot to the touch. Soon, tiny red flecks no bigger than pinheads and smooth with the surface of her skin sprinkled across her forehead. Hour by hour, they flowed down her body from the top of her head to the tips of her toes, as if some fiery-eyed destroying angel stood caught out of time behind her bed, the hot wind from his wings blowing a slow-motion storm of red sand across her. Even as the flecks drifted downward, those that had appeared first began to rise into hard little bumps. They neither itched nor hurt, but when she rubbed them, they rolled like shot scattered beneath her skin. This time, no diagnosis of measles would rescue her. She most certainly had the smallpox; the only question was what kind.
The next day, the spots went on growing in size and deepening in color, gathering most densely on her face, forearms, and hands. All the while, her fever went on falling, until she felt almost well. Perversely, Dr. Mead and Dr. Garth grew graver with every visit. What they knew but did not tell her—still guarding against fear—was that her rash was already quite thick. At this early stage, that was a dangerous sign.
In the eighteenth century, as in the twentieth, doctors distinguished four main types of smallpox, though they labeled them with different names and distributed them with different logic across the branches of the smallpox family tree. Everyone who dealt with it realized tha
t the best of this bad disease was “distinct” or “discrete” smallpox, which presented a rash scattered thinly enough so that the pocks remained separate—or distinct—with patches of normal skin in between. In “confluent” smallpox, sometimes called “coherent,” the rash was so dense that across much of the body—especially the face, hands, and forearms, where it was always thickest—the pocks ran together into one huge festering sore; little to no normal skin was left. In everyday terms, these victims were said to be “very full.”
The remaining two types—flat and hemorrhagic—were once often lumped together (sometimes with confluent) as “malignant smallpox.” In “flat,” “crystalline,” or “warty” smallpox, the slow-growing blisters usually ran together, but never really rose much above the surface of the skin and did not fill with the same kind of thick yellow pus found in discrete and confluent pocks. Instead, shallow ripples spread across the skin’s surface, stretched over sores buried in its deepest levels; large strips of the top layer of skin, along with the delicate coverings of most mucous membranes (inner nose, mouth and throat, anus, vagina), eventually just sloughed off. Almost three quarters of these cases were children under fourteen.
Hemorrhagic smallpox was subdivided into two kinds, “early” and “late,” both marked by profuse bleeding at every orifice, as mucous membranes and blood vessels seemed to melt away. In the early type, once known as “the purples,” death came before any pocklike rash broke out, though the skin transformed to dark purple velvet. In late hemorrhagic smallpox, victims survived long enough for blisters—often flat in type—to appear, but they quickly filled with blood, darkening to bruised purple and black, ringed with red. In both kinds of hemorrhagic smallpox, it was not the bleeding, but heart failure or fluid in the lungs (pulmonary edema) that proved the immediate cause of death. Nearly all these cases were adults; two thirds were women.
These malignant cases were relatively rare (just over 9 percent of the total number of smallpox cases), but they were death sentences so terrible to behold that they loomed monstrous in the imagination. Flat smallpox carried about a 3.5 percent chance of survival; in late hemorrhagic smallpox it was 3.2 percent. Early hemorrhagic smallpox had no survivors.
Eighteenth-century doctors saw these malignant types as crop failures. Flat and purple smallpox did not ripen properly, while confluent cases quickly grew overripe. Twentieth-century doctors explained all three of these serious developments as the results of differing degrees of immunodeficiency; some people with otherwise healthy immune systems inexplicably had little to no power to fight back against the variola virus. As early as the seventeenth century, it was known that such weakness in the face of smallpox ran in families—the Stuarts, for example. Pregnancy was another high-risk factor, already obvious to early doctors.
In Lady Mary’s sickroom, the first days sped by in pairs. The first prerash fever had been much the most uncomfortable stage so far. As the red spots flowed down her body across the following two days, she began to feel better. With her fever still falling, she felt better still as the spots bubbled into blisters for another two days. “How is my boy?” she kept asking.
“Still unspotted,” came the answer.
The same could no longer be said for her. As she watched, the red bumps filled with a clear liquid that gradually thickened to opalescent grayish white; now they began to look like large flat pimples that might be called “pocks.” A ring of red circled the base of each one, while their centers sank in a small dimple.
At last she saw what the doctors had been quietly worried about: hour by hour, the pocks went on growing, running into each other until large sections of skin looked to be covered by a single marbled blister. She could not see it, but her face swelled so much that her finely carved features began to submerge, the skin pulling taut over nose, ears, chin, and cheeks; her eyes squeezed into slits. Those who did glance at her face thought she looked unnaturally old or young: the disease was transforming her into a grotesque gigantic changeling, wrapped in a tight gray caul that veiled all her features.
At last, the doctors issued a diagnosis: she had the confluent smallpox. The news skittered around London and winged north to the armies burning Scotland: Lady Mary is exceedingly full and will be very severely marked.
However much they irritated her, Lady Mary was lucky in having Dr. Mead and Dr. Garth at her bedside. Besides being known for compassion, they were both moderates in an age when medicine was unabashedly aggressive; in attempting to be heroic, it was more often horrific.
A very few practical men had begun systematically observing their patients and describing symptoms that clustered into specific maladies. The most eminent physicians of the day, however, were abstract philosophers who snipped and stretched experience to fit theory, in their case a modified version of the ancient Greek theory of the four humors. Good health, in this system, was a perpetual circus act, balancing ever-shifting quantities of blood, black bile, green bile, and phlegm, as well as the oppositions of hot and cold, moist and dry. Imbalances tipped people into the morass of sickness; restoring a patient to health meant bringing them back into balance.
To do so, doctors tried to relieve whatever the body was producing in too much abundance by either repressing or removing it, while nurturing the growth of whatever they judged to be lacking. It was the relief side of this equation into which medicine had long put most of its efforts and its faith—though relief proves a bizarrely inopportune word for their ministrations.
Any and all possible bodily emissions were sometimes thought necessary to force. The most commonly practiced “evacuation” was bloodletting: slitting veins open at the wrists, arm, groin, or in serious cases, the jugular, to let poisons escape with the blood. If all else failed—or, in the delicate cases of infants, right at the beginning—doctors applied leeches to the temples or behind the ears. They also induced sweating, salivating, and blistering, and they administered clysters, or enemas, and ferocious laxatives and diuretics. An unholy array of emetics produced immediate and sometimes prolonged vomiting. Many, if not most, of the medicines they put into a body were designed to send something else shooting out of it, making eighteenth-century medicine a leaky, spraying, spewing art.
It was an art, furthermore, divided into three territories with jealously—though often unsuccessfully—guarded boundaries. Physicians were university men with medical doctorates. High (and highly expensive) priests of the mysteries of diagnosis, they solemnly prescribed treatments but rarely provided them, though things were changing in progressive and ruthlessly practical places like Edinburgh, or the University of Leiden over in Holland. In London, any procedure, such as bloodletting, that involved cutting was still by law the purview of the surgeons—historically, a specialized branch of the razor-bearing brethren of barbers, with whom they shared a guild until 1745. In contrast to the learned doctors, a surgeon was a mere “Mr.” who learned his trade by apprenticeship. The men who concocted the potions and powders that physicians prescribed were the apothecaries, or pharmacists. Scurrying through the cracks in this system was an army of panacea-peddling quacks, mountebanks, and empirics.
Wealthy patients not only paid all three of the proper medical professions to dance attendance at their sickbeds: as a kind of status symbol of conspicuous consumption, they consulted multiple physicians. Poorer people made do with surgeons, apothecaries, local wisewomen or nurses, and the potions of the quacks: and were often better off for it.
Lady Mary was neither stifled with blankets, nor frozen with drafts of the bitterly cold December wind. Instead, her room was kept as pure and cool—but not frigid—as possible. She was fed a meager diet of oatmeal and barley-gruel. In the beginning, the cooks were directed to boil preserved figs, plums, and tamarinds with her gruel, to keep her “open and cool.” To drink, she had mild diuretics: small-beer “acidulated” with orange and lemon juice, and sweet German wine thinned with water.
Every two or three days, the surgeon arrived to bleed her: to rel
ieve the poison boiling over in her blood. Even this was moderate. Some physicians, sniffed Mead, were terrified to bleed at all, while others could not be stopped: when the virtually unkillable King Louis XIV of France had had smallpox, he was bled ten or eleven times in a matter of weeks.
A week after she had fallen ill, her fever was almost down to normal. Bored with illness and still fretting over her child, she claimed she felt fine, but the doctors would not let her get up. Across the next four days, the gray liquid inside the pocks went white and congealed to beeswax-yellow pus; the rosy rings around their bases faded. Still, though Lady Mary would not have thought it possible, the pocks went on growing. Her distended skin began to hurt. The sores glued her upper lip to her now bottle-shaped nose, and her face grew blank and bored as her features disappeared beneath the swelling. Her peglike fingers could no longer wield a pen. Her mouth, too, was filled with sores, along the tip and sides of her tongue, the roof of her mouth, and the back of her throat. Just as it became agony to swallow, saliva gushed out in rivers.
For a while, she managed the single rasping word, “Boy.” Then even that was scraped from her, and the world collapsed into a narrow battle to survive.
On the eighth day of the rash, the tenth of her illness, her period gushed out early, ruining the sheets in a flood more like a hemorrhage. Her fever spiked back up to the heights it had reached in the first two days. Worst of all, some of the pocks began to burst, emitting a cadaverous stench.
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