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medicine in literature BOOK CLUB

ANGEL OF DEATH
The story of smallpox
by Gareth Williams
MACMILLAN

Summary
The story of smallpox is a tale usually told in two halves: the first tells of
millennia of fear and suffering during which the violent and deadly disease
killed as many as 1 in 12 people in some parts of the world and left many
more pockmarked and disfigured; followed by two centuries of indomitable scientific progress that
begins with Jenner’s inoculation of James Phipps and concludes with a WHO-led global eradication
of the disease. But, as always with grand narratives, the beauty is in the detail.
In his book, Gareth Williams has effortlessly pieced together an enormous variety of original sources
– snippets of diaries, medical records, letters and articles – bringing to life the characters that make
this story. Jenner plays a central role, of course, but as a convivial country doctor, bon viveur and
hopeless procrastinator, rather than a driven medical investigator. Other characters play important
parts as well, including the indomitable Lady Mary Wortley Montagu, who ‘goes native’ in Turkey
and returns to the West with knowledge of the Ottoman practice of inoculation, and the fire-and-
brimstone puritan preacher Cotton Mather (of Salem witch trial fame), who tries to strongarm the
Bostonian medical establishment into introducing variolation during a smallpox outbreak, only to
find himself the recipient of a death threat attached to a grenade that’s lobbed through his window.

About the author

Gareth Williams is Professor of Medicine and Dean of Faculty at the University of Bristol. He has contributed
to over 30 books, and has authored or co-authored over 20 others, including the Textbook of Diabetes
(BMA Book of the Year 1997), described as “the best large general text available on diabetes” by leading
journal the Endocrinologist. It remains the only book to have won all of the UK’s major medical book awards.
The judges of the 2005 BMA Medical Book Competition awarded his Handbook of Diabetes First Prize in
Endocrinology, crediting it as “mandatory reading for all clinicians involved with diabetes and also a must for
many expert patients”.
Though he is no longer active in research – his post as Dean of Medicine and Dentistry is a full-time job
– Gareth keeps in touch with his old research group in Liverpool and retains an interest in the advances
of diabetes.
Gareth also writes regularly for mainstream media readerships (newspaper and magazine) and has
appeared on national TV and radio.
Watch a video of Gareth at www.meettheauthor.co.uk/bookbites/1903.html.

www.wellcomebookprize.org
 Questions
• Did you find this story inspiring? Did you know how recent the elimination of smallpox was?
• Do the roots of ‘variolation’ in peasant practice in Turkey, for example, suggest we should be ready to
pay more attention to traditional healers?
• Who are the book’s most memorable characters? What did you think of Lady Mary Wortley
Montagu? Reverend Cotton Mather? Dr Edward Jenner?
• What did this book reveal about the medical profession?
• Were the ‘heroes’ (the innovators and proselytisers of vaccination) ever wrong? Were the ‘villains’
(those who refused to see the obvious benefits of variolation and vaccination) ever right? Is it harder for
the highly educated to admit fallibility or ignorance?
• How, if at all, would you apply what you learned from this book to contemporary decisions
about vaccination?

Passage
A response to Cotton Mather’s call for inoculation:
Meanwhile, Mather was facing horrors of his own. He was tougher than Boylston and his reputation,
and respect for the Mather dynasty probably shielded him to some degree. Nonetheless, he must have
been shaken to find himself facing death threats and a narrow escape from a violent end. In the small
hours of 14 November, a grenade was thrown through his window. It may have been intended to terrify
rather than kill and anyway failed to explode because the fuse fell out – which meant that the note tied
to it, ungrammatical but with unmistakable intent, could be read: Cotton Mather, you Dog. Damn you! I’ll
inoculate you with this a pox to you.

Further reading
Expunging Variola: The control and eradication of smallpox in India, 1947–1977
by Sanjoy Bhattacharya (2006).

www.wellcomebookprize.org
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