Sunday, 5 June 2022

William Blake and smallpox : the disease in Blake’s London and in Blake’s art

Smallpox was the single most lethal disease in eighteenth-century Britain, accounting for more deaths than any other infectious disease, even plague and cholera. In London, Europe’s largest city by 1700, smallpox increased from 4-6% of all burials in the mid-seventeenth century to over 10% in the third quarter of the eighteenth century, and the frequency of epidemics increased from roughly four-yearly to a biennial cycle over the same period.

Smallpox was an acute, highly contagious, and frequently fatal disease (killing one-seventh to one-quarter of its victims) but conferring lifelong immunity on survivors. It appeared initially as an infrequent epidemic disease affecting all ages, but as the frequency of epidemics increased, a growing proportion of the adult population acquired immunity to the disease, and smallpox was clearly a childhood disease in the London-born population of the eighteenth century, with children under five the main victims. Among those who survived it, morbidity from smallpox was severe in many cases; victims could be left blind or disfigured for life. Few native Londoners would have survived to adulthood without encountering smallpox.

[Indeed, are there any depictions of smallpox in Blake’s work?]

Treatment was non-existent in the early years of the eighteenth century and London’s few existing hospitals refused to accept patients with infectious diseases. The earliest attempts to reduce morbidity and mortality from smallpox were by a method known as inoculation, or sometimes by the more specialized term variolation. Inoculation involved deliberately infecting a healthy individual with virus taken from a scabbed pustule of a person suffering from smallpox. Lady Mary Wortley Montagu (1689-1762), who had learned of the procedure during her time in Constantinople (Istanbul) as wife of the British Ambassador, is credited with the introduction of smallpox inoculation to Britain and Western Europe. In Constantinople, the British Embassy’s surgeon had inoculated her young son, and she had her daughter (born in Turkey) professionally variolated in London in April 1721. This medical breakthrough, which she promoted widely (though it was later superseded by Edward Jenner’s vaccination), was the first time in Western medicine that antibodies were created to secure immunity from disease. Opponents of the procedure derided it as oriental, irreligious, and a fad of ignorant women.

The first English medical practitioners to implement variolation did so very crudely with deep incisions that could cause severe symptoms, morbidity, and a mortality rate of up to 2%. It was usually preceded by four to six weeks of preparation, which included purging, bleeding, and a restricted diet, as well as expensive aftercare. Only 857 people were variolated in the whole of Great Britain from 1721 to 1727 and only 37 in 1728, since only the rich could afford it.

The preparation period was shortened after Robert Sutton’s introduction of a safer and more effective procedure in 1762 using very light incisions. The “Suttonian method” dramatically decreased the severity of symptoms and risk, and reduced the cost. Poor Londoners could now be variolated through the Smallpox Charities. The charities performed public variolation in batches, separately for adult males and adult females, 8 to 12 times a year. The number of variolated individuals increased dramatically from 29 in 1750, to 653 in 1767, and 1084 in 1768.

In 1740 Dr Robert Poole raised the money to create the first specialist hospital, the London Smallpox Hospital. Originally a 13-bed hospital in Windmill Street, Fitzrovia (opposite where the Fitzroy Tavern now stands), it both treated smallpox patients and provided free inoculations for the poor. The Smallpox Hospital, like the charities, did not admit children under 7 years of age even though most smallpox cases at that time were in infants and young children.

[This is an area Blake would have known well. His early patrons the Mathews lived just a little way south in Rathbone Place, and the Rev. A.S. Mathew ministered at the Percy Street Chapel in the road parallel. It was at Mathew’s chapel, in 1785, that Richard Watson, Bishop of Llandaff, preached his notorious, if misunderstood, sermon “The Wisdom and Goodness of God in having made both Rich and Poor”.]

By 1750 the hospital was running premises at three locations: an inoculating-house in Old Street; a house in Frog Lane, Islington (now Popham Road), for receiving inoculated patients once symptoms had appeared; and a receiving-house nearby for patients afflicted with the full-blown disease, in Lower Street (now Essex Road). In 1752 the trustees of the institution acquired the lease of a property in Coldbath Fields. The new 130-bed hospital opened in March 1753, taking patients from both Frog Lane and Lower Street.

There was immediate opposition. The Clerkenwell Vestry filed a bill of injunction in Chancery to stop the hospital going ahead, citing the “terror” of the disease in the neighbourhood and threats by tenants to leave. Lord Hardwicke, presiding, refused an injunction, instead praising the new establishment and the appropriateness of its location. Opposition persisted once it had opened; discharged patients came in for abuse and were obliged to leave under cover of darkness for their safety.

[Redundant by the 1790s, the Coldbath Fields building was subsequently used for other commercial purposes, and eventually demolished in the 1860s for an extension to the nearby Coldbath Fields Prison, now under Mount Pleasant Postal Sorting Office. The prison was where Colonel Edward Despard of the London Corresponding Society, along with around thirty others, was detained without charge for three years (1799-1802). John Hunt was also imprisoned here for a libel, in the Examiner, 22 March 1812, on the Prince Regent, the “fat Adonis”, afterwards George IV. Unlike the cramped and squalid conditions suffered by Ned Despard, Hunt had a lofty and comfortable apartment at the top of the prison and the privilege of walking for a couple of hours daily in the governor’s garden. The Hunt brothers, Leigh, John, and Robert, are commonly identified with the villainous “Hand”, of Blake’s later mythology.]

There were, however, other institutions that did inoculate poor children. The Foundling Hospital was doing this already in 1743; in 1749 the governors advertised that all the children who had not had smallpox when at nurse would be inoculated on their return to London. William Blake’s home parish of St James, Westminster, sent its workhouse children to be fostered at Wimbledon, and entered in their standing orders in 1756:

All the Children are inoculated for the Small-Pox when deemed proper by the Surgeon, and he is paid Ten Shillings and Sixpence for each Child who survives that Disorder.

The Nurse is likewise paid Ten Shillings and Sixpence for every Child that has it in the natural Way, or is inoculated and survives, but not else.

The Vestry minutes, cited by Gardner, record the Surgeon, James Swift, living at Putney, recommending accommodation for the workhouse children at Holloways at Lord Spencer’s farm and taking them there ten at a time for inoculation.

[For many years, the Blake family shop provided haberdashery (worsted stockings and such) for the St James’s workhouse and charity school.]

View of the SMALL-POX HOSPITAL near St Pancrass.

By 1793, the Smallpox Hospital had moved again to a large purpose built hospital in Battle Bridge, St Pancras, where the Great Northern Hotel is currently located. In the early nineteenth century it played an important part in the development of vaccination as a replacement for inoculation.

[Blake would have been driven past the London Smallpox Hospital at Saint Pancras when visiting John Linnell and his family at Hampstead.]

The building of the railway station at Kings Cross forced the hospital to move again to Highgate Hill in 1850, to a building still existing as a wing of Whittington Hospital. Its final move was to South Mimms, now a UCL Biosciences Lab.

Smallpox epidemics in Europe in the late Middle Ages encouraged recognition of the disease in relation to the BOOK OF JOB, specifically the verses from chapter 2:

7. 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.
8. And he took him a potsherd to scrape himself withal; and he sat down among the ashes.
9. Then said his wife unto him, Dost thou still retain thine integrity? curse God, and die.

A long history of medical Job traditions has derived from these verses, the “sore boils” being interpreted as smallpox pustules. There was a St. Job hospital in Utrecht from the sixteenth century; Hamburg had a St. Job’s hospital, founded in 1505, specifically for smallpox patients; and another such hospital was established near the church of San Giobbe in Venice.

The name “small-pox” was first used in England at the end of the 15th century to distinguish it from syphilis, which was known as the “Great Pox”. Perhaps consequentially, there is an ambiguity in the possible representation of smallpox in Blake’s work. He writes in “Night the Third” of THE FOUR ZOAS

And Luvah strove to gain dominion over the mighty Albion
They strove together above the Body where Vala was inclos’d
And the dark Body of Albion left prostrate upon the crystal pavement
Coverd with boils from head to foot. the terrible smitings of Luvah.

William Blake’s preoccupation with the BOOK OF JOB extended throughout his creative life. Quotations from, and echoes of, the BOOK OF JOB abound in Blake’s works, as in the quoted lines identifying the sickness of Albion with the sickness of Job. The reference to Job’s sufferings here is obvious. But is Blake citing a venereal disease, as suggested by Damon, or the common epidemic?

Hans von Gerssdorff’s Feldtbuch der Wundartzney (Field Manual for Wound Doctors) of 1532 includes this image of Job, his wife, and a hovering Satan. I don’t know if Blake could have seen this, but it includes all the elements of the traditional iconography of Job on his dungheap with sores, very like the sores of smallpox, on his body. Blake’s wide if eccentric reading makes acquaintance with Gerssdorff’s book at least possible or even plausible. We do not know the extent of Blake’s reading; he presumably had access to William Hayley’s library from 1797; he probably had access to the remarkable libraries of those who interacted with Blake as friends and as collectors of his work.

What can be decried as parochial patterns of reading (for example, the survival of the emblem tradition outside the world of polite literature, of alchemical works in an age of science) might be in fact an essential strategy for survival, says Bernstein, to have a deep immersion in a contemporaneity and history that are difficult to locate.  Did Blake have access to the medieval manuscripts and oriental books in the Rebekah Bliss collection? Did friendship with Alexander Tilloch provide access to Tilloch’s alchemical books, theology, texts and editions of the Bible, and Greek and Hebrew dictionaries? Blake had access to a wealth of recondite materials that can illuminate his work, perhaps even the medical texts of his patron Dimsdale.

The illustration introduces the third “Tractat” of Gerssdorff’s work, in a section of the text dealing with leprosy, though actually showing the biblical Job as a victim of smallpox. He has no covering apart from a cloth draped across his loins, revealing his whole body covered with smallpox pustules. Above his head a cockatrice grasps in each hand a long, bifurcated whip. Job’s wife stands before him at the viewer’s left.

At the top of the engraving two couplets, inscribed in German confirm the identification of Job and smallpox.

Got gab, got nã huss, hoff, kind, gůt,
Und satzt mich unders teüfels růt
(God gave, God took away property, children, goods,
And set me under the devil’s rod.)—a loose translation of JOB 1:21.


Mein weyb, uñ blonẽ peingten mich,
Noch lyde ichs alles gdultigtlich.
(My wife and my blisters afflict me
Yet I suffer all things in patience.)

Let’s turn now to Blake’s Illustrations of the Book of Job, plate VI: “Satan smiting Job with Boils”, where he makes significant changes to the traditional iconography. Job, sick nearly to death, swoons. The sores and scabs of smallpox are barely visible. Satan stands on his body, pouring the pox on Job’s head. Satan is no longer a monstrous cockatrice but a heroic nude, given the halo that tells you he’s angelic, but with his genitals scaled over. He stands with joyful triumph on an anguished Job. Satan’s arms are extended in the cruciform position; Job’s god has become devilish. Job wears the sackcloth of which the Biblical Job speaks. His feet rest upon the knees of a grieving wife, who is no longer at his side for she is beyond being able to bring comfort to her husband.

Druidic ruins—”the Patriarchal courts ... ruined and deserted” (Wicksteed)—are scattered over the landscape, and the sun sets beyond black water (Wicksteed holds the setting sun to be emblematic of Job’s wife’s despairing soul). In the sky, the black and billowing clouds all centre on Satan; they look to be the clouds of fire that are being funnelled through Satan’s’ phial.

In Satan’s left hand is the phial with which he is smiting Job with sore boils. Behind Satan’s right hand are four flaming arrows, unquestionably the arrows of the Almighty later referred to by Job in reply to the comfort of Eliphaz: “The arrows of the Almighty are within me, the poison whereof drinketh up my spirit; the terrors of God do set themselves in array against me” (JOB 6:4).

In the lower border are a couple of steps leading nowhere, a broken shepherd’s crook, a grasshopper, and—in the centre—an earthenware pot from which a fragment has been broken, doubtless the potsherd used by Job to scrape himself in his agony, to relieve the pain of his boils. The fountain is now choked with rubbish and identifiable only by the frog still dwelling there. Bat-winged angels lower poisonous spiders. Damon points out that some of these symbols appear in ECCLESIASTES 12, where the preacher warns of the day when “the grasshopper shall be a burden, and desire shall fail … the pitcher be broken at the fountain, or the wheel broken at the cistern”.

The lines cited from The Four Zoas also appear with minor variations in Jerusalem, where they read

And Luvah strove to gain dominion over Albion
They strove together above the Body where Vala was inclosd
And the dark Body of Albion left prostrate upon the crystal pavement,
Coverd with boils from head to foot. the terrible smitings of Luvah.

Damon interprets this passage as implying that Albion is “coverd” with syphilitic sores. However, the words clearly echo the BOOK OF JOB’s “sore boils from the sole of his foot unto his crown” where the tradition is of smallpox. And when we also read in Jerusalem

The disease of Shame covers me from bead to feet: I have no hope
Every boil upon my body is a separate & deadly Sin

the boils may be each a “separate & deadly Sin”, but they are such spiritual sins as “Doubt” and “Shame”. Is it possible that Blake scholarship sees sexual imagery where none was intended? Sometimes a cigar is just a cigar.

Sources and further reading

Charles Bernstein.—A Poetics.—Cambridge MA : Harvard University Press, 1992.

Nick Black.—Walking London’s Medical History. 2nd ed.—London : Hodder Arnold, 2012

S. Foster Damon.—A Blake dictionary : the Ideas and Symbols of William Blake.—Providence RI : Brown University Press, 1965.

R. Davenport, L. Schwarz, J. Boulton.—“The decline of adult smallpox in eighteenth-century London 1”.— Economic History Review, 64, 4 (2011), 1289–314.

Eugenie R. Freed.—“‘In the Darkness of Philisthea’: The Design of Plate 78 of Jerusalem”.—Blake/An Illustrated Quarterly, Volume 32, Issue 3 (Winter 1998/99), 60-73.
My source for the Gerssdorf illustration.

Stanley Gardner.—Blake’s Innocence and Experience retraced.—London : Athlone Press, 1986.

Hans von Gerssdorff.—Feldtbuch der Wundartzney.—Strassburg : Joanne Schott, 1517.
2nd ed., 1532.
Facsimile of 1517 edition reproduced for Editions Medicina Rara Ltd. under the supervision of Agathon Presse, Baiersbronn, West Germany, 1970.

Peter Razzell.—“The decline of adult smallpox in eighteenth-century London: a commentary”.—Economic History Review, 64, 4 (2011), 1315-335.

Sketch of the state of the children of the poor in the year 1756 and of the present state and management of all the poor in the parish of Saint James, Westminster, in January 1797 .—s.p. : s.n., s.d.

Joseph Wicksteed.—Blake’s Vision of the Book of Job.—London : Dent, 1910.

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