Angel of Death: The Story of Smallpox

Visiting the Temple of Vaccinia in the huge garden of Edward Jenner's house in Berkeley, Gloucestershire, is a delightful experience today. The rustic little building still stands where Jenner vaccinated hundreds of poor folk, keen to try his cowpox vaccination rather than risk death from smallpox.

Jenner had amalgamated an old technology and a folk remedy and, in a celebrated experiment of 1796, had shown that a mild infection with cowpox was sufficient to protect a person against the full-blown killer disease.

The old technology was inoculation, made fashionable in the 1720s, by Lady Mary Wortley Montagu, wife of the British ambassador to Turkey. She and Jenner were each motivated to prevent further ravages of the disease by bad personal experiences.

In 1716, Lady Mary had lost her brother and almost died from smallpox herself, surviving disfigured; 40 years later, the young Jenner had been subjected to a seven-week ritual (involving bleeding and purging as a prelude to inoculation) that was the medical elaboration of the simple folk process Lady Mary had brought back from Constantinople.

The long story of smallpox is global and devastating but - remarkably - appears to have a happy ending, being the only killer disease to have been eradicated from the world by human effort. This book endeavours to tell the tale, and would have been a tolerable popular history of smallpox had it been allowed to be simply that; but it is marred by weak editing and a grating kind of gimmickry: smallpox is referred to throughout as the "Angel".

Historically, the Angel of Death was (like the Grim Reaper) a metaphorical personage: never a mere cause of death, but a personification of Death itself. Of this Gareth Williams seems only half aware; but in his enumeration of the many descriptive names the disease historically acquired, he offers no source whatever for the "Angel of Death", an omission that reveals the questionability of his perseverated alias for the disease. The book's opening epigraph is equally doubtful: a striking quote from Richard Bright refers not to the ravages of smallpox at all, but to the carnage of the Crimean War.

The author is a professor of medicine, and his medical insights occasionally come in handy, for example, in explaining the cause of the disease (a virus) and its varieties (mild or malignant).

But there is little of much originality, and in too many cases the book's insights are a salmagundi at second or third hand. Entire chunks are in effect summaries of other people's work - the treatment of Mary Wortley Montagu for example from Isobel Grundy, and that of John Hunter from Wendy Moore.

The book's index is excellent, but its chronology is problematic and real howlers have slipped through: Jenner is said to have undergone his inoculation ordeal in 1739, when he had not yet been born; and sentences such as the following promote bemusement: "Spanish soldiers stood amazed at the wonders of the Aztecs but this did not stop them from invading and killing them."

The recent measles-mumps-rubella (MMR) vaccine debacle looms uncomfortably behind the story, and although Williams more or less equates modern parents' fears of MMR damage with the resistance of Victorian parents to compulsory vaccination, he is not such an apologist for vaccination as to overlook the real dangers of arm-to-arm transmission of the smallpox virus.

He is good on the devastating impact of smallpox in the Americas, using recent sources well, and on the eradication programme. The book deals fairly with Benjamin Jesty and other vaccinators predating Jenner, and makes clear that Jenner's fame was less for a new discovery than for persuading his own profession that a folk remedy really worked.