Caroline vs. Smallpox: How one woman defeated man’s greatest enemy

Luis Granados

Smallpox is caused by a virus with the scientific name of variola major. The virus affects only humans, not animals. Like the common cold, it spreads through sneeze and cough emissions, bedding and clothing, or direct contact. After it enters the nose or mouth, it heads for the lymph glands, whence it is given a free ride throughout the body. What happens then is catastrophic: fever, nausea, vomiting—then a rash of hundreds or thousands of blisters, frequently starting on the forehead before covering the entire body. Sometimes the blisters merge together into sheets, rotting off all the underlying skin when they harden. What the virus does inside the body is just as bad—some victims die of thirst when it becomes impossible for them to swallow. The eighteenth-century British noble Lord Dalkeith succumbed after just two days; his limbs fell off while his body was being placed in its coffin.

Like the common cold, smallpox is no respecter of class. It cut down nobles and even monarchs—five in the eighteenth century alone. Smallpox is by far the worst infectious disease humankind has ever known: hundreds of millions have died from it, more than from the Black Death and all the wars of the twentieth century combined. Surviving smallpox is no picnic either; it causes blindness, loss of limbs, and horrible deformity, especially of the face.

Smallpox’s Faithful Ally

Smallpox developed an important ally in the first century c.e.: the Christian church. Humans have powerful intellects; from smallpox’s perspective, it was critical that they not use them.

From earliest times, the Christian church taught that all useful knowledge was to be found in scripture and none in scientific research. Paul warned the Colossians: “Be on your guard; do not let your minds be captured by hollow and delusive speculations, based on traditions of man-made teaching centered on the elements of the natural world and not on Christ.” The story of Galileo is well-known: under threat of torture, he was forced to recant his discovery that the earth revolves around the sun. He spent the rest of his life under house arrest.

Knowing how the planets move satisfies our curiosity; knowing how the body works keeps us alive. Greek and Roman pagans from Hippocrates to Galen did make important progress in applying the scientific method to the study and treatment of disease. But nothing could be more unchristian than to focus on natural causes for alleged supernatural phenomena. The fourth-century church father Origen wrote: “It is demons which produce famine, unfruitfulness, corruptions of the air, pestilences; they hover concealed in clouds in the lower atmosphere, and are attracted by the blood and incense which the heathen offer to them as Gods.” St. Gregory of Tours stressed the sinfulness of resorting to medicine instead of trusting in the intercession of saints.

In 540, the church declared the entire field of Greek and Roman medicine to be heresy. On this point, Protestants and Catholics agreed. Martin Luther said that “Satan produces all the maladies which afflict mankind,” and that “he poisons the air.” According to John Calvin, no medicine could change the course of events that had already been determined by the Almighty. The Book of Chronicles tells the sad story of King Asa, who trusted to physicians rather than to the priests of Yahweh and therefore died.

Smallpox was further assisted by the Christian bias against hygiene. How better to express appropriate humility before God than by living a life of degradation and filth? So thought some of the most admired saints in the early centuries of the church. St. Hilarion was glorified for never washing his clothes or changing his shirt; his entire holy body was covered with scabs and mange. Abasement of the flesh was strictly enforced by the Portuguese Inquisition, which ranked “bathing the whole body” as a crime of the magnitude of bigamy, denying the virgin birth, and witchcraft. Catholics reproached Erasmus for “having betrayed the Christian norm in his pagan concern for the body” as they protested against his “proposal of washing oneself every day, a disgusting northern idea incompatible with human dignity.”

The Beginning of the End

Though few would have predicted it at the time, the death knell for smallpox sounded when the wars of the Reformation broke out in the 1520s. Though England was spared at first, a Calvinist rebellion led by Oliver Cromwell broke out against the moderate Stuart dynasty in the 1640s. The victorious Cromwell proceeded to impose on England a decade of Calvinist theocracy. He closed theaters, alehouses, and racetracks; knocked down maypoles; and ordered shopkeepers to stay open on all holidays that were pagan in origin, including Christmas. Adultery became punishable by death, and in at least four cases this sentence was actually imposed. Not caring for bishops, Cromwell appointed eleven regional military commanders known as the “Major Generals” to enforce “the suppressing of vice and encouragement of virtue” at the point of the bayonet.

Ten years of theocracy was all England could stand. When Cromwell died in 1658, virtually no one wanted his brand of government to continue, and the Stuarts were quickly restored to the throne. Cromwell’s corpse was dug up, and he was posthumously executed by hanging and then decapitation.

The reaction against Cromwell’s theocracy spawned a new school of thought called “deism,” whose adherents did not deny the existence of God but doubted how much the experts knew about him. A Christian clergyman put it aptly: “Deism is what is left of Christianity after casting off everything that is peculiar to it. The Deist is one who denies the Divinity, the Incarnation, and the Atonement of Christ, and the work of the Holy Ghost; who denies the God of Israel, and believes in the God of nature.”

One of the first published deists was the Englishman Charles Blount, who—starting in the late 1670s—kept up a barrage of criticism against all revealed religion and Christianity in particular. Blount argued that all true or correct belief has to be based on perceivable evidence. Though England’s deists were not a large group, they touched a nerve—one deist pamphlet aroused thirty-five indignant refutations. Thomas Woolston and Peter Annet were imprisoned for their freethinking pamphlets; Woolston, who branded England’s leading theologians “Gygantick Sons of Error, Nonsense, Incoherence and Confusion,” died in prison.

Enter Caroline

England was not the only country where religious warfare and its aftermath had exposed the moral bankruptcy of the God experts. Throughout Europe, doubt grew among readers of Erasmus, Spinoza, and others inspired by them. In Germany, freethinking prevailed at the salon of Sophie Charlotte, the first Queen of Prussia. Instead of jousting tournaments, she staged intellectual combats, with Jesuits pitted against Calvinists and agnostics against theologians, egging them on when the conversation became too agreeable. Drinking it all in was a young princess named Caroline from the tiny Bavarian state of Ansbach. Her father had died at the age of thirty-two—of smallpox. Her mother remarried, but her stepfather died a few years later—of smallpox.

Caroline blossomed into the most desirable princess of Europe. Not only was her intellect sharpened under the tutelage of Sophie Charlotte, but her long blond hair, fair skin, and what was described as “a bosom of exemplary magnitude” held a certain appeal as well. The Prussian king was thrilled when he made for her the best match imaginable: the Archduke of Austria, who was in line to become the Holy Roman Emperor. The Archduke was excited as well. All Caroline had to do was agree to become a Catholic.

This she would not do. Though an eminent Jesuit was dispatched to Berlin to persuade Caroline that Catholics did not have horns, the princess gave up her chance at empire rather than swear obedience to the pope. The King of Prussia was livid. Bad enough that anyone should thwart his will, but for a slip of a girl to do so for the most foolish of reasons was more than he could bear. Caroline, contemplating a bleak spinsterhood at age twenty-two, went back to Ansbach.

One day, a gentleman caller arrived bearing a letter of introduction identifying him as “Mr. de Busch.” He was duly entertained to music and elaborate suppers for several days. Caroline probably suspected the truth: Mr. de Busch was actually Prince George Augustus of Hanover, who if everything worked out right was third in line to the English throne. His claim traced back to his great-great-grandfather and was aided considerably by the proscription of the Catholic branch of the family after the Glorious Revolution of 1688 and by the effects of smallpox itself on the royal family. George was smitten and remained so for the rest of his life. He and Caroline wed.

It was not at all a foregone conclusion that George and Caroline would make it to the English throne. Had Queen Mary borne children rather than dying (of smallpox) in 1694, George would have remained in Hanover. Had the son of her successor Queen Anne not died (of smallpox) in 1700, the same result would have occurred. Nevertheless, Caroline’s luck held, and her father-in-law was crowned George I in 1714.

The Influence of Deists

Upon arriving in London, Princess Caroline took up where her mentor Sophie Charlotte had left off, discreetly encouraging freethinking. The political realities confronting a new dynasty with a tenuous hold on power constrained what she could do, but she pushed the envelope as far as possible. For example, she honored at court Isaac Newton, whose work was reviled by the Calvinists as “built on fallible phenomena and advanced by many arbitrary presumptions against evident testimonies of Scripture.”

Behind the scenes, Caroline worked assiduously to realign the Church of England along more deist lines by advancing the careers of clerics who advocated a milder, less intrusive religion in opposition to the fire-breathers. She especially took up the cause of Dr. Samuel Clarke, a heretic who questioned the existence of the Trinity itself. When she announced that “Dr. Clarke shall be one of my favorites; his writings are the finest things in the world,” the Bishop of London paid her a visit to acquaint her with the truth of England’s established religion. Furious, she told her assistant to “Send him away civilly: though he is very impertinent to suppose that I, who refused to be Empress for the sake of the Protestant religion, don’t understand it fully.”

She tried mightily to secure the repeal of the Test and Corporation Acts, which denied civil rights to those who failed to toe the proper theological line. Ultimately, church hierarchy prevailed and repeal was delayed for another century. Still, Caroline was one of the most influential royal spouses in English history; popular doggerel of the day ran: “You may strut, dapper George, but ‘twill all be in vain; We all know ‘tis Queen Caroline, not you, that reign.”

Inoculation Comes to Europe

Caroline’s main assignment, though, was producing offspring to ensure the continuance of the dynasty. At this she was quite talented. Her first child, born after only eighteen months of marriage, had the good sense to be a boy. Eight more children followed, only one of whom died at birth.

Bearing children was one thing; keeping them alive, especially faced with the menace of smallpox, was more difficult. Caroline had no need to experience smallpox’s horrors vicariously; she contracted the disease herself six months after her son was born. So did her solicitous husband, no doubt from her. Both survived the ordeal, though Caroline did so only barely, losing much of her physical beauty as a result.

Thus Caroline, always fascinated with new ideas, listened intently to the reports brought back by Lady Mary Wortley from Turkey. Lady Mary had been the great belle of George I’s court; rumor had her bedding the king himself. That is, until smallpox ate away most of her face, after which she wore a veil in public. Still, she married well and accompanied her husband when he was appointed ambassador to Constantinople.

There Lady Mary learned some interesting facts. Smallpox was not nearly as widespread in Turkey as it was in England because of the adoption of a peasant custom: deliberately infecting children with pus taken from smallpox sores in the hopes that they would contract a mild version of the disease. Everyone knew that smallpox never struck twice; surviving your first bout meant you were safe for life. After consulting an English physician, the headstrong Lady Mary decided in 1718 to try the procedure on her own son. An incision was made on his arm, and pus from a recovering victim was rubbed into it—a procedure that came to be known as “inoculation.” As hoped, he developed a minor rash that disappeared after a few days; the antibodies he developed protected him for the rest of his life. (The results were not entirely positive, though; once when he ran away from boarding school, the identifying scar of the inoculation helped the headmaster recover him.)

It wasn’t just Turkish peasants who practiced inoculation. In America, when smallpox ravaged a town, African slaves were often untouched. Upon questioning, they revealed that inoculation was widely practiced in Africa. Everyone knew about inoculation, it seemed, except for Europeans who lived under the thumb of the antiscience Christian church.

Caroline hesitated. But after her daughter Anne was stricken by smallpox and barely survived, she swung into action. Employing what she had learned of the scientific method, she conducted a field trial. Five prisoners from London’s Newgate prison who had never suffered from smallpox volunteered for the new procedure in the summer of 1721. All of them, as hoped, developed mild cases—so mild that some skeptics doubted they actually had smallpox. Five orphans were then inoculated, all of whom survived (though it later turned out that one had lied about not having smallpox before, in order to get a reward).

A sample size of ten, with one failure, would probably not satisfy today’s U.S. Food and Drug Administration. It was enough for Caroline, though. With the king’s approval and no public announcement, in April 1722 she had Lady Mary’s doctor perform the procedure on her other two daughters. When they responded as hoped, she sent the doctor to the heir to the throne, then living in Hanover, and had him inoculated as well.

There’s nothing like starting at the top. Royal acceptance gave inoculation the most tremendous head start imaginable. As experience grew, doctors learned that inoculation carried risks; 1 to 2 percent of those inoculated developed symptoms serious enough to result in death. Still, that was better than the 10 to 25 percent mortality rate smallpox normally carried, and demand for the procedure surged.

Incredibly, Religious Opposition

God experts quickly grew alarmed at this threat to their dominance. Typical was London’s Rev. Edmund Massey, who preached a sermon in 1722 charging that inoculation was the work of Satan. This was evident from the Book of Job: “So went Satan forth from the presence of the Lord, and smote Job with sore boils from the sole of his foot unto his crown.” Satan had deliberately infected Job with smallpox; any doctor who similarly infected his patient with smallpox was mimicking Satan.

Smallpox and other diseases were an earthly punishment for sin, a preview of the punishment sinners would receive in hell after death. “Diseases are sent, if not for the Trial of our Faith, for the Punishment of our Sins. Bad as the World is, it would be still worse, if the Wickedness of Mankind should be so successful as to meet with no more Rebuke than it would willingly suffer.”

Widespread inoculation would plunge the earth into a cesspool of sinfulness: “Should all Restraints of this Sort be taken away, were there no fear of Punishment in this Life, nor belief of any in the next . . . we may conjecture from present Disorders, how mightily they would encrease, and irremoveably be established; so that we have good Reason to bless and praise Almighty God for the wholesome Severities ordained for Offenders, without which, the World would be a much more uncomfortable Place to live in, than it is at present.”

At bottom, what Massey couldn’t abide was the thought of men relying on themselves rather than on God. “Do we provoke the Lord to Jealousy? Or are we stronger than he? Shall we presume to rival him in any instance of Providence, find Fault with his Administration, take the Work out of his Hands, and manage for our selves? A dangerous Experiment this! And not to be made with Impunity, unless we thus pretend to be wiser, we prove ourselves mightier than he.”

Massey damned doctor and patient alike: “Let the Atheist, and the scoffer, the Heathen and Unbeliever, disclaim a Dependance upon Providence, dispute the Wisdom of God’s Government, and deny Obedience to his Laws; Let them Inoculate, and be Inoculated, whose Hope is only in, and for this Life! . . . Let us not sinfully endeavour to alter the Course of Nature by any presumptuous Interposition. Let us bless God for the Afflictions which he sends upon us, and the Chastisements wherewith he intends to try or amend us; beseeching him to grant us Patience under them, and in his good Time a happy Deliverance from them.”

Massey lost his battle. The practice of inoculation mushroomed, despite formal condemnation by the Catholic theologians of the Sorbonne. In a few decades an even safer procedure was discovered—vaccination—using a bovine virus similar to smallpox that normally produced only weak symptoms in humans. The effects were dramatic: in Copenhagen, during twelve years before the introduction of vaccination, 5,500 persons died of smallpox; during the next sixteen years, only 158 persons died of smallpox throughout all of Denmark.

Caroline did not live to see the benefits of vaccination. In 1737, she died from the complications of a previously ruptured womb, after lingering for ten days in intense pain. At no point did she ask to see a priest, causing so much consternation in political circles that the prime minister had to beg to allow the archbishop to visit her, to preserve appearances. “Pray, Madam, let this farce be played. The Archbishop will act it very well. . . . It will do the Queen no hurt, no more than any good, and it will satisfy all the wise and good fools, who will call us all atheists if we don’t pretend to be as great fools as they are.” Visits were one thing, but she flatly refused to be subjected to any sacrament. George was shattered by her death: “I never yet saw a woman who was fit to buckle her shoe.”

Gone for Good?

Large portions of the clergy continued to resist; a clever inoculator in Thessaly persuaded the local priests that the Blessed Virgin had appeared and explained the procedure, making it acceptable as long as proper prayers were administered. In 1885, a smallpox epidemic broke out in Montreal. The Protestant community was largely spared because it was vaccinated; the Catholic population was decimated because the priests insisted that vaccination was sinful. Abbé Filiatrault declared that “If we are afflicted with smallpox, it is because we had a carnival last winter, feasting the flesh, which has offended the Lord; . . . it is to punish our pride that God has sent us smallpox.” Soviet efforts to vaccinate its population against smallpox in the 1920s were confounded by Russian Orthodox teaching that “vaccination is the seal of Antichrist.”

In 1967, the World Health Organization launched a massive campaign to render smallpox extinct, with great success. In 1974, a Hindu god expert in the Indian state of Bihar refused to allow his followers to be vaccinated on the grounds that smallpox was the rightful scourge of God; in the end, he and his family were vaccinated by force. Final extinction was declared on October 26, 1979.

So smallpox is vanquished. Or is it? Two small samples of the virus remain, one in the United States and one in Russia, under closely supervised conditions. In 2002, though, U.S. Vice President Richard Cheney convinced himself that Saddam Hussein had somehow obtained smallpox as one of his weapons of mass destruction and was preparing to devastate a now-vulnerable American population. Cheney strenuously advocated a crash program to prepare hundreds of millions of doses to vaccinate the entire country. When the doctors who had led the eradication program in the 1970s pointed out that even the minuscule proportion of vaccinations that resulted in complications would cost hundreds of lives and affect thousands of others, President George W. Bush took the rare step of overruling Cheney and limiting the program to the military and health-care workers. But by the time the doses were ready in 2004, it was clear that Saddam had no smallpox, so even that limited program was canceled. Bush himself was vaccinated, but Cheney chose not to be.

Some subjects are too horrific even for London bookmakers to take bets on. If smallpox ever does return, my money says that a God expert of some stripe will be involved.

Luis Granados

Luis Granados is an attorney in Washington, D.C., and a student of religious history. He is currently working on a book to be called The God Experts, which chronicles the scandals of organized religion.


Smallpox is caused by a virus with the scientific name of variola major. The virus affects only humans, not animals. Like the common cold, it spreads through sneeze and cough emissions, bedding and clothing, or direct contact. After it enters the nose or mouth, it heads for the lymph glands, whence it is given a …

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