As the plague left England and later Europe in peace, a new scourge afflicted rich and poor alike and this time royalty suffered as greatly as any other. Smallpox had always been around, but in the Medieval period it was considered a variation of measles. In 910 the Muslim physician Rhazes wrote that measles was “more to be dreaded than smallpox” and that the individual’s constitution determined whether the disease developed into measles or smallpox. However, we now know that smallpox occurs in four distinct forms: discrete, confluent, flat or malignant and haemorrhagic.

In the discrete form, the pustules are separate and the patient has a 75 per cent chance of survival. In the confluent form the pustules are so numerous they merge; in the flat or malignant form, the pustules submerge under the skin and in the haemorrhagic form the skin darkens as the patient bleeds internally and beneath the skin. It is these latter forms that cause the highest mortality rates of 95 per cent for the rare haemorrhagic cases. It seems that in the centuries preceding 1600, the discrete form was the most prevalent, but as the plague waned, the more dangerous forms of smallpox replaced it as the most widespread epidemic.

John of Gaddesdon was a royal physician during the late-13th and early-14th century. In his book, Rosa Medicinae, Gaddesdon describes his treatment when the king’s son fell ill with smallpox. Unfortunately, he describes the royal patient as simply “the king’s son” and, at the time of his writing in 1317, this could refer to Edward I (died 1307) or Edward II (abdicated 1327). Sources differ in the choice of both king and son: Edward of Caernarfon and Thomas of Brotherton (sons of Edward I) and John of Eltham (younger son of Edward II) have all been identified as the patient in question. Whoever it was, Gaddesdon encouraged his patient to suck on a red pomegranate – a foreign luxury – and to gargle with red mulberry wine. The patient was cocooned in red cloth, red draperies hung on the walls and covered the windows of the bedchamber and ‘only red things to be about his bed’. By this means, Gaddesdon wrote, “I cured him without leaving a trace of the smallpox pustules on him.” It is possible that the red curtains excluded ultra-violet light, which may increase the production of scar tissue.

Moving forward to the Tudor dynasty in England (1485-1603), in 1514 Henry VIII developed a skin rash over much of his body but without fever. Some sources suggest this may have been a mild case of smallpox. More definitely, despite the precautions that any member of the court who became unwell or had visited the unhealthy city of London must be quarantined before returning to the royal presence, in the spring of 1552 Edward VI’s doctors became concerned when he fell sick with both measles and smallpox. The illness was brief and he recovered but in October 1552, young Edward met the Italian physician, Hieronymus Cardano, who noted the king was both short-sighted and a little deaf – either or both problems could have resulted from his earlier illness.


In October 1562, 29-year-old Queen Elizabeth I was taken ill at Hampton Court Palace. At first, it was believed she had a nasty cold. However, she developed a violent fever and, as a rash developed, it became clear she had smallpox. Elizabeth was seriously ill and her ministers were frantic that she had no heir to the throne. Fortunately, Elizabeth recovered with relatively few disfiguring pock marks.

It was the subsequent Stuart dynasty that repeatedly suffered the trauma of smallpox. The death rate statistics for London suggest that the change from the milder to the more severe forms of smallpox was quite sudden: in 1633, 72 Londoners died of it but in 1634 there were more than 1,000 and this is reflected in the figures for Geneva in Switzerland for which data is available for those years. The future King Charles II and his sister Henrietta both contracted smallpox as children and recovered, but two of their siblings were less fortunate: Henry, duke of Gloucester, died of smallpox in 1660 aged 21, and his elder sister, Mary, died the same year. Mary was the widow of William II of Orange, the ruler of Holland, who had died of smallpox in 1650.

Of Charles II’s siblings, only his brother James, duke of York, later King James II & VII, is not recorded as having the disease, but he did not escape the misery when his son, Charles, died of smallpox at just a few weeks old. Little Charles’s elder sister, Mary, married her cousin, William III of Orange (whose parents had both died of smallpox) and in 1688 they became joint monarchs of England and Scotland. William would reign until 1702, but for Queen Mary II her life ended when she too caught smallpox aged 32.

In December 1694 at Kensington Palace, Mary felt unwell and discovered she had a rash on her arms. Fearing it might be smallpox, she sent away those of her staff who had never had the disease for fear they should catch it, and began putting her affairs in order. William was informed and rushed to her bedside. Her sister Anne, who was pregnant and had already lost two baby daughters to smallpox, wanted to see Mary. The queen would not allow it.


At first, Mary seemed to respond to treatment, able to sit up and eat, and her physicians hoped she had caught measles, not smallpox. Sadly, the pustules submerged beneath the skin – the queen had the malignant form. During the night of 28 December, Mary spoke to William, who slept on a small bed by her side, and then she died. William, who relied on Mary’s guidance to rule the English people, was devastated by her death and said that “from being the happiest” he was “now going to be the miserablest creature on Earth”.

The king was not alone. The people were distressed at losing her, now to be ruled by ‘the Dutchman’ alone. For the rest of the winter, the queen’s embalmed body lay in state and there is a story that a robin flew through an open door, into the hall where she lay and perched above her, singing daily his melodious requiem. Fine music of another kind was composed by Henry Purcell for Mary’s funeral on 5 March 1695 in Westminster Abbey, the first of any monarch to be attended by all members of both Houses of Parliament. The Music For The Funeral Of Queen Mary was used again at the end of November that year, this time for the burial of its composer, Purcell – the cause of his death is uncertain.

Mary’s sister, Anne, became queen in 1702 when William died after complications developed following a fall from his horse. But Anne had already lost her son and heir in 1700: 11-year-old William, duke of Gloucester, was yet another victim. Europe fared no better. The Hapsburg emperor, Joseph I, died during an epidemic during the year 1711 at the Hofburg Palace in Vienna, having promised his wife he would have no more affairs if he recovered.
Smallpox also carried off Tsar Peter II of Russia and King Louis XV of France. Louis XV’s grandson, Louis, le Grand Dauphin, died of ‘a severe smallpox’ in 1774 at the palace of Versailles. Unlike Queen Mary’s body in the previous century, Louis’s was not embalmed for fear of contamination. Instead, alcohol was poured into the coffin and his remains covered in quicklime. For the French king there was no lying in state nor exquisite music composed, as was the norm, but a hasty late-night funeral attended by a single courtier before he was laid to rest in Saint Denis.

Although the Englishman, Edward Jenner, published his discovery of vaccination against smallpox in 1798, heads of state did not rush to protect themselves, being wary of the innovation. Although George IV appointed Jenner as his physician, the king chose not to be the first royal to be protected: that accolade goes to his niece, the future Queen Victoria, who was vaccinated against the scourge of the royal houses of Europe in 1819.

Toni Mount is the author of Medieval Medicine: Its Mysteries and Science. For more of life in Medieval and Early Modern Europe, subscribe to History of Royals and get every issue delivered straight to your drawbridge.


  • B Gummer, The Scourging Angel: The Black Death In The British Isles, Vintage Books 2010
  • C Brewer, The Death Of Kings: A Medical History Of The Kings And Queens Of England, Abson Books 2000
  • I & J Glynn, The Life And Death Of Smallpox, Profile Books 2004
  • T Mount, Medieval Medicine: Its Mysteries And Science, Amberley 2016