Elizabeth I and the Smallpox Epidemic of 1562
- thedudleywomen
- Oct 10
- 12 min read
In October 1562, less than three years after her accession to the throne, Elizabeth I contracted the highly-infectious smallpox virus, which led to her becoming critically ill, and subsequently raised questions in relation to the succession of the English monarchy.
Death and disease in medieval and early modern England was different to that of the modern day. People suffered and died from infectious diseases that no longer exist, including plague and 'sweating sickness', as well as illnesses as the result of poor sanitation and living conditions, such as dysentery, rickets, scurvy and tuberculosis (Mortimer, 2013).
In the 16th century, medical knowledge continued to be influenced by Ancient Greek teachings, including that illness, as well as personality, was significantly influenced by an imbalance of the body's four 'humours' or fluids: blood, phlegm, black bile and yellow bile, all of which were connected to the different organs in the body. This understanding of the human body was coupled with contemporary beliefs that illness and disease were punishments for a person's previous sins or transgressions; the approach to treating those suffering would often be to focus on absolving sins and achieving salvations, given the limited access to physicians and medications, and the overarching influence that religion had on the everyday life (Mortimer, 2013; wellcome collection, 2025).
In the 1560s, plague or 'pestilence' was the biggest killer in England, being responsible for up to 20% of all deaths in some areas; however, there were periods when outbreaks of the virulent bacterial infection increased the death rate, assisted by overpopulation, poor sanitation and warm weather. The outbreak which commenced in the summer of 1563, 17,404 of 20,372 of all recorded deaths in the city of London were attributed to plague (Mortimer, 2013).
Smallpox was another serious infectious disease that was prevalent during Elizabeth's early reign. An acute contagious disease caused by the variola virus, belonging to the orthopoxvirus family, smallpox caused the deaths of millions of people worldwide before a vaccine was developed in 1796; this was the first successful vaccine to be developed, which led to smallpox's elimination worldwide in 1980, the only infectious disease to have achieved this status. Smallpox's fatality rate has been estimated as being 30%, death, primarily being the result of cardiovascular or liver complications, although even in the 16th century, the risk of adult deaths from smallpox was lower than that infected children and the elderly. However, women were found to be at an increased risk of death from the disease, over their male counterparts (Weir, 1999; National Library of Medicine, 2024; World Health Organization, 2024).
Smallpox was transmitted through the respiratory tract, via infective droplets either during close contact with infected and symptomatic individuals, contact with infected skin lesions, or contact with contaminated clothing or bedding. The virus had an incubation period of 7-17 days, meaning that persons only became infectious once symptoms emerged; early symptoms of smallpox included:
fever
fatigue
severe back pain
abdominal pain
vomiting
Two to three days after these early symptoms presented themselves, only then would the characteristic rash synonymous with smallpox appear; it would normally begin on the infected person's face and hands, before spreading to the rest of the body (except on the palms or soles). Whilst initially red and flat, after a day or so, the rash would develop into blisters full of clear liquid, which would later fill with pus, known as pustules. After a further 8-9 days, during which time the body had started to produce an immune response, healing started to begin; the lesions would ulcerate, and a crust would form on top, drying out the wound. Individuals remained infectious until the last scabs would fall off, which would often leaving deep pitting scarring or 'pockmarks'. Lesions also developed in the mucous membranes, including on the tongue, larynx, upper trachea and oesophagus; these painful wounds would ooze profusely, prior to ulceration, making speech, fluid and dietary intake difficult (National Library of Medicine, 2024; World Health Organization, 2024).
The spread of smallpox during Elizabeth's early reign has been referred to as an epidemic, that being a widespread occurrence of a disease, in a particular community, at a particular time. In November 1562, English diplomat Sir Thomas Smith, gave a description of its spread, in particular amongst the ladies in Elizabeth's household and at court (Folgerpedia, 2025):
"Smallpox has vexed England these two or three years, having had no plague to speak of for twelve years....in England it took aged folks and ladies. The Duchess of Suffolk had it first, the Countess of Bedford died of it, and...ladies of 40, 50 and 55 years of age have died of it; this disease is best acquainted with Duchesses, Marchionesses, and Countesses,"
Whilst Katherine Bertie, Dowager Duchess of Suffolk, recovered after contracting smallpox in February 1562, the first high-profile victim of this epidemic that summer appears to have been Margaret St John, Countess of Bedford, the first wife of Francis Russell, 2nd Earl of Bedford, a popular and young member of Elizabeth's privy council (Folgerpedia, 2025). Despite having a large family (the couple had seven children over twelve years, who survived into adulthood), Margaret maintained her position within Elizabeth's household as a Lady of the Privy Chamber. This was the same position that her eldest daughter Anne, later Countess of Warwick, would later hold, with Anne's niece Lady Anne Clifford claiming that she was "more beloved and in greater favour with the Queen than any other woman in the kingdom" (Borman, 2009, p.265). Lady Russell appears to have contracted the illness at Greenwich Palace over the summer months, where it was known that the court was gathered. Likely showing symptoms of the disease, Margaret withdrew to Woburn Abbey, Bedfordshire, the former monastery which came into the possession of the Russell family following the Dissolution of the Monasteries. On 27 August 1562, the 29-year old Countess lost her fight against the disease, her death being immortalised over eighty years later in 'The Great Picture'. the ambitious portrait commissioned by her granddaughter Anne Clifford. After her death, her body was taken the thirty-five miles south back to the Russell family seat of Cheynes, Buckinghamshire, where her funeral was held on 10 September 1562 (Weir, 1999; Google Arts & Culture, 2024; Folgerpedia, 2025).
On 16 September 1562, Elizabeth and the court left Greenwich, and headed, via Lambeth, to Hampton Court Palace, an early 16th century royal residence, located on the riverbanks of the Thames, near Kew, Middlesex, which had been a favourite of the queen's late-father, Henry VIII. Once at Hampton Court, business within the court resumed as normal, including Elizabeth receiving foreign diplomats, in addition to her appointment on 01 October of Ambrose Dudley, 3rd Earl of Warwick, as Lieutenant-General. The queen had pledged her support for French Huguenots in Normandy, and she had nominated her Master of Ordnance as the trusted man whom she would send to garrison the town, at the head of 6000 troops (Weir, 1999; Russell, 2023; Folgerpedia, 2024).
It was on 10 October 1562, when the 29-year-old Elizabeth first started to 'feel unwell', likely showing the early (but undiagnosed) symptoms of smallpox, including a headache. The queen made attempts to shake off her ailments, including taking a bath, and then engaged in a 'bracing walk' out in the grounds of the palace. These attempts were unsuccessful, as within a matter of hours, Elizabeth had taken to her bed with a fever. Her German physician, Burchard Kranich, referred to as 'Dr Burcot' was immediately summoned; he had been recommended to her by her cousin, Henry Carey, 1st Baron Hunsdon, after successfully treating him of a 'dangerous illness'. Following his examination, Dr Burcot surmised that the queen was presenting with the early symptoms of smallpox. Refusing to acknowledge his diagnosis, in the absence of the characteristic rash, Dr Burcot was dismissed, although Elizabeth's health continued to deteriorate, her fever not abating (Weir, 1999; Whitelock, 2013; Folgerpedia, 2025). She was unable to receive an audience with Álvaro de la Quadra, the Spanish Ambassador on 13 October, and on 15 October, in her correspondence to Mary, Queen of Scots, written in French, Elizabeth ended her letter "the hot fever which is upon me prevents me writing more at present" (Folgerpedia, 2025).
By 16 October, Elizabeth's health deteriorated significantly, with increased difficulties in speaking, and fluctuating levels of consciousness, including a period of unconsciousness for 24 hours. Whilst there remained no evidence of rash or lesions, physicians were now confident in the diagnosis of smallpox. In response to her significant decline in health, Elizabeth's privy council, led by William Cecil, Secretary of State, gathered at Hampton Court, with Ambassador de la Quadra commenting that "If the Queen die it will be very soon, within a few days at latest, and now all the talk is who is to be her successor" (Weir, 1999; Folgerpedia, 2025).
Despite being unmarried, with no children, Elizabeth had not nominated a legal heir or successor. However, one of the queen's closest living relatives, Katherine Grey, Countess of Hertford, was viewed by many as being the queen's legitimate heir, having been named by Henry VIII in the line of succession, on account of her mother, the king's niece. Unlike her father and elder sister Jane, who had lost their lives as a result of treason charges in 1554, Katherine and her younger sister Mary, had been able to retain positions at the royal court, initially in the household of Mary I, and later in the household of their kinswoman Elizabeth (de Lisle, 2008; Borman, 2009).
Interest had remained on the beautiful and engaging Katherine after Elizabeth's accession to the throne, given that a male child of hers would be a potential strong candidate for Elizabeth's successor. Katherine, however, engaged in a secret (and often tumultuous) relationship with Edward Seymour, 1st Earl of Hertford, which culminated in a clandestine and unauthorised marriage in December 1560. When news of the union became known, a furious Elizabeth ordered a heavily-pregnant Katherine to be imprisoned in the Tower of London, perceiving her actions to be an attempt to usurp her from the thone (de Lisle, 2008).
At the time of Elizabeth's illness, Katherine remained imprisoned in the Tower. She had safely delivered her first son in September 1561, named after his father. However, young Edward's legitimacy was quickly brought into question, as was his parents' marriage. An ecclesiastical court hearing found that Katherine's marriage to Hertford was invalid, and therefore any children produced from their union would be deemed illegitimate, and therefore ineligible to be in line for the throne. Whilst there were those within Elizabeth's inner circle and Privy Council who continued to support Katherine's position, others, including the queen's 'favourite' Robert Dudley and new widower Francis Russell, loudly opposed this. Other suggested claimants included Mary, Queen of Scots, and Dudley's brother-in-law Henry Hastings, 3rd Earl of Huntingdon, with discussions taking place in and around Hampton Court, including Henry FitzAlan, 12th Earl of Arundel's home, likely nearby Nonsuch Palace. However, despite conversations between the different religious and political factions that had emerged, no final decision was ever reached regarding a successor (Whitelock, 2013; Paul, 2022).
Whilst the majority of those at Hampton Court remained preoccupied with potential arrangements in the event of her death, Elizabeth's maternal cousin Hunsdon's focus was on her survival, and so persuaded Dr Burcot to recommence his care and treatment of the queen. Following traditional curative methods, Dr Burcot ordered that the critically-ill Elizabeth be wrapped in red cloth, laid on a pallet by the fire and given a 'potion'; the intent of this treatment was to encourage the 'eruption' of the rash and subsequent lesions, which had not yet formed, and as such were felt to be putting her at greater risk. Within two hours of this treatment, the queen was awake and conscious, although remained gravely ill (Weir, 1999; Paul, 2022).
Elizabeth reportedly remained conscious for four hours, and aware of her serious made requests that Dudley, to be named as Lord Protector, accompanied by a generous salary, in the event of her death or ongoing incapacitation. The memory of his father John Dudley, 1st Duke of Northumberland in his role as Lord President of Edward VI's Regency Council lingered, with many, including Northumberland's fomer personal secretary Cecil, believing that another Lord Protectorship would cause division, if not the risk of civil war. However, the council gave their word to Elizabeth that they would carry out her wishes if she was not to survive. Dudley was subsequently admitted to the Privy Council on 20 October, cementing himself in the heart of her administration, although was joined by his greatest political rival, Thomas Howard, 4th Duke of Norfolk (Weir, 1999; Paul, 2022).
It was shortly after this gathering of privy councillors at her bedside, that Elizabeth, continuing to be attended to and treated by Dr Burcot, discovered that the rash was finally starting to appear on her hands. It had been felt that the delay in the rash presenting itself was the cause of her grave illness, and that "it was essential that the sickness exit her body through its characteristic lesions, or it would continue to torment and poison her" (Paul, 2022, p.301). The queen was now begrudgingly accepting of the diagnosis of smallpox, and in response to her bitter complaints, Dr Burcot reportedly replied “By God’s pestilence, which is better, to have the pox in the hands, in the face...or have them in the heart and kill the whole body?” (Folgerpedia, 2025). From then on, the disease progressed as expected, with the rash spreading across her body, pustules subsequently forming and then ulcerating and 'crusting'. Elizabeth remained in bed for a further six days, until she was able to resume her duties on 25 October, with Ambassador de la Quadra commenting that the queen ‘is now out of bed, and is only attending to the marks on her face to avoid disfigurement" (Folgerpedia, 2025).
During the queen's illness, she was treated by only a small number of attendants, in order to reduce the risk of further transmission. One of those select few was Dudley's sister, Mary, Lady Sidney, who had been appointed to the household as an unsalaried Lady of the Bedchamber. Being in continuous and close contact with the queen during the illness, including the highly-infectious window, in the queen's closely-confined bedchamber, Mary herself began to display symptoms. She quickly withdrew to the Sidney home of Penshurst Place, Kent, where she also successfully recovered from the disease. However, Mary's health had been significantly affected by her illness, described as a "great extreamyty of syknes", in addition to prolific scarring, which eventually led to her withdrawal from public court life (Borman, 2009; Paul, 2022). Her husband, Sir Henry Sidney, who had also been dispatched to France along with his brother-in-law Warwick, returned to find his wife's appearance significantly altered; years later he reflected on this, writing "I lefte her a full faire Ladye in myne eye at least the fayerest...and when I retorned I found her as fowle a ladie as the smale pox could make her...the skarres of which (to her resolute discomforte) ever syns hath don and doth remayne in her face" (Borman, 2009, p.333). Despite the long-lasting impact on her health, both Mary and Elizabeth were fortunate to have survived this particularly virulent strain of smallpox, as another of the queen's trusted ladies, Sybill Penn, died in November, after contracting the disease (Whitelock, 2013).
