Śītalā, Goddess of Smallpox, is the preeminent tutelary deity of villages in southwestern Bengal, and a goddess of the same name has a prominent role in Hindu pantheons throughout northern India. Her rise to importance is closely related to the history of smallpox, which was not recognized, in Ayurvedic medical texts, as a serious or fatal disease before the seventh century A.D. There is no evidence of the Goddess of Smallpox before the tenth to twelfth centuries, and she appears to have attained her present special significance as goddess of the village in southwestern Bengal abruptly in the eighteenth century. Earlier Indian approaches to smallpox treatment were naturalistic; when Śītalā was added to the etiology of the disease, her worship was not seen as a replacement for the biologically based therapy, but as something different and complementary. The appearance of smallpox as an epidemic calamity, rather than as an ordinary disease, during a period of more general distress in rural Bengal, marked its goddess as a figure especially suitable for community worship.