In The Principles and Practice of Medicine, William Osler¹ wrote that the patient with smallpox "presents a terrible picture, unequalled in any other disease; one which fully justifies the horror and fright with which small-pox is associated in the public mind." This terrifying image is supported by the World Health Organization's estimate that 10% of all human deaths have been caused by smallpox.² Accordingly, the eradication of this disease is hailed as one of the great victories of modern medicine.

Today, smallpox is a disease that we know only from history. Because we have no patients to remind us of its toll on individuals and societies, we surely have forgotten its full impact. However, because of current concern over a reappearance of the disease, it seems fitting to consider a world in which smallpox is not yet a memory. To do this, we turn to passages from great literature written during the smallpox era. These writings can help us to visualize the physical transformation caused by smallpox and to appreciate the emotional response to this dreaded disease. Herein, we present excerpts from 19th-century literature, written by authors who were alive during smallpox epidemics. We then examine how smallpox may have influenced the lives of each of these authors.