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The Speckled Monster: A Historical Tale of Battling Smallpox
http://www.100md.com 《新英格兰医药杂志》
     The severe epidemics of smallpox that swept through London and Boston in 1721 and 1722 caused scarring, blindness, and death. In Boston, almost 6000 people (out of a total population of 11,000) contracted smallpox, and more than 800 died. Doctors battled hopelessly against "the speckled monster" and applied the humoral therapies of bloodletting, blistering, and the so-called cool regimen, advocated by the distinguished English physician Thomas Sydenham. Into these geographically separate but similar scenes of chaotic misery stepped two unlikely heroes: Lady Mary Wortley Montagu, a highly intelligent, beautiful but pockmarked, English aristocrat, and Zabdiel Boylston, a locally trained colonial doctor. Lady Mary and Boylston promoted the new, exotic, and potentially dangerous practice of inoculation.

    (Figure)

    Lady Mary Wortley Montagu.

    Courtesy of the Mary Evans Picture Library.

    Inoculation was a folk practice that had been learned from Turkish women and African slaves, two groups generally deemed unreliable by both Europeans and colonial Americans. The practice involved taking a small amount of matter from a pustule of an infected person and inserting it into a scratch made in the skin of a healthy person. Usually a mild case developed and the infected person was thus protected for life from a severe case of natural smallpox. But the procedure was risky: contemporaries calculated that 1 of 91 persons infected in this manner died from the disease. Worse still, inoculated smallpox was contagious, something early inoculators soon discovered. But the horrible symptoms and the risks of dying from natural smallpox led Lady Mary and Boylston, among others, to try inoculation. Their conviction that this new procedure was safe and efficacious was dramatically demonstrated by their courage in administering it first to their own children.

    Numerous historians have written about this momentous revolution in medical practice. Inoculation laid the groundwork for vaccination, immunology, and medical statistics. Carrell's book, The Speckled Monster, adds a new twist to the topic; it is a fictional account based on extensive historical research (the subtitle of the book is "a historical tale"). Her narrative begins slowly but quickly picks up the pace as it interweaves events on both sides of the Atlantic and suggests their mutual influence. It is unapologetically heroic: Lady Mary and Boylston triumphed despite the substantial odds and obstacles against them. Lady Mary took on the formidable London medical establishment, whereas Boylston contended with providential clerics and foreign-trained physicians (particularly the cantankerous Scot, William Douglass). Both were threatened with mob violence. In sweeping and dramatic strokes, Carrell paints the ostracism Boylston endured as he made his rounds through colonial Boston; in England, Lady Mary suffered public criticism for daring to put her children deliberately in harm's way.

    The advantage of historical fiction is that it allows the author to recreate private conversations and psychological motivations that are often unavailable to historical analysis. Carrell has done this well, vividly reconstructing the horrors of smallpox and the hostility that often attends innovation. Her descriptions of sights, sounds, and smells envelop the reader in a tangible and immediate past. That said, Carrell freely admits to fabricating events and dialogue for which there is no evidence — the most extreme instance (but one befitting a heroic narrative) is the contrived meeting and friendship between her two heroes, Lady Mary and Boylston, in London. The result is an enjoyable tale, but the historical truth is buried in the endnotes.

    Andrea Rusnock, Ph.D.

    University of Rhode Island

    Kingston, RI 02881(By Jennifer Lee Carrell. )