A POX ON YOU! A HISTORY OF THE SMALLPOX INOCULATION

A few days ago, in a rare moment of idleness, I decided to look through the reviews of my books. I leafed through them, delighted by the numbers of 5-star reviews from readers and the kind words of praise. But of a sudden I came upon a 3-star review that struck horror into my soul. What? I hear you say, a 3-star review? That’s not bad!

No, normally it wouldn’t be, but the reader went on to state that she would have given my book Mask of Duplicity five stars, were it not for my historical error. “One of the main characters refers to the death of his family and the wish that they would have received the smallpox vaccine” the reviewer stated. “The vaccine would not be administered until forty years after this book takes place.”

I was horrified. How could I have made such a mistake? It’s so long since I wrote Mask of Duplicity that I confess I couldn’t remember exactly when the vaccination came into use. But as I now have something of a reputation amongst my readers for historical accuracy, I resolved to find out, and address this terrible error if necessary.

A cursory search of the more common information websites seemed to reveal that my critic was right: it seemed that the smallpox vaccination was first introduced in 1796 by one Dr. Jenner. It took me all of thirty seconds to ascertain this, which made me even more puzzled as to why I would have made such a glaring error in my book.

Dredging the sludge of my long-term memory I had a vague recollection that the children of George II, including the Duke of Cumberland, were vaccinated as infants in the 1720s. Armed with this possible fact I dug deeper, and it was with great relief that I discovered I was in fact right. The smallpox vaccine, it seems, had been brought back to England by Lady Mary Wortley Montagu, who had had her own children inoculated in Turkey, and the Duke of Cumberland and two of his sisters were in fact inoculated in the 1720s.

Lady Mary Wortley Montagu

Phew! Vindicated! (although I do use the word ‘vaccinate’ in my book, instead of the more accurate ‘variolate’ or ‘inoculate’. But in my defence, although the term vaccinate originates from the word for cow, in reference to the cowpox which was used in Dr Jenner’s vaccinations, the term is now used to describe all inoculations).

However, whilst digging, I found out some interesting things, (well, I think they’re interesting, at any rate!) which I would like to share.

Smallpox is a very ancient disease. Egyptian mummies have been found to contain the marks of smallpox infection, and although it no longer concerns us, for centuries it was justifiably feared. It is difficult now to imagine the horror on finding that yourself or a loved one had become infected. There was no cure. In the 18^th century Voltaire claimed that 60% of British people contracted smallpox, with some 20% dying as a result. Those who did not die were often left blind or with hideous scarring as a result of the rash, which on healing left deep pits in the skin.

The horror of smallpox

Lady Mary Wortley Montagu is now best known for her letters when travelling in the Ottoman Empire as the wife of the British Ambassador to Turkey. Whilst there she discovered the practice of variolation, a form of inoculation using a small amount of the smallpox virus. Incisions were made in the legs, wrists and forehead of the patient, and then a live pock was placed under the skin and bound there for some days. This induced a mild version of the disease. Once recovered the patient was immune. This process of inoculation seems to have been in use in the East since at least the 15^th century, and Lady Mary, having suffered from smallpox herself which had left her disfigured, was impressed enough to bring the process back to England with her. There she had her two children, aged 4 and 5, inoculated. They recovered quickly. After this she fought for trials to be made, and in 1721, when an epidemic of smallpox hit London a royal licence was granted for trials on prisoners to be undertaken. They were offered a free pardon if they survived. They did, and as a result of this members of the British Royal family received the inoculation.

Prince William Augustus Duke of Cumberland, who received the smallpox inoculation as a child.

However, variolation wasn’t free of risk – variolated patients could pass the disease on to others causing an epidemic, and in addition some patients did die as a result of the inoculation (although far fewer than died of the full form of the disease), and it wasn’t a particularly pleasant procedure.

Enter the Sutton family. Robert Sutton improved the inoculation technique so that only a small stab in the skin with a lancet was needed, while his son Daniel set up a chain of businesses across Britain, Europe and North America, which inoculated over 22,000 people between 1763 and 1766 – only 3 people died as a result, and he made his fortune.

Although he had no formal medical education, Daniel refuted the commonly held belief that it was when smallpox infected the organs that death occurred. He proved by experiments that it was a disease of the skin. He also discovered that it could only be contracted by contact with the skin, not by inhalation or any other method. In this he was a pioneer, setting up hypotheses, then using experiments to prove or disprove them.

Unfortunately he delayed publishing his findings until 1796, by which time a new method of inoculation had been invented, and which means that in spite of his huge body of research, he is all but forgotten.

In 1757 at the age of eight, Edward Jenner had been inoculated against smallpox, and on being apprenticed at thirteen to a country surgeon, heard the common tale that dairymaids who had had cowpox were immune to smallpox. He concluded that cowpox could be transmitted from person to person, and would protect the sufferer from smallpox. As the Latin word for cowpox is vaccinia Jenner decided to call his new method vaccination. He made many experiments and published his findings, which eventually led to vaccination being scientifically recognised.

Dr Edward Jenner

Although he is often credited with discovering the cowpox vaccination, in fact it was already in use, and one Benjamin Jesty was possibly the first person to use the vaccination. However, it was due to Jenner’s extensive research and promotions that vaccination became widely used and respected in the medical community.

In the 19^th century, although deaths from smallpox had massively reduced it was discovered that vaccination did not confer lifelong immunity and that it was necessary to revaccinate people.

In 1967 a global campaign began to vaccinate every country in the world, and as a result of this, in 1980 smallpox was declared to be officially eradicated.

A disease that had killed probably millions of people over thousands of years, and disfigured or blinded many more, had finally been wiped off the planet, and for that we must give thanks to the many men and women devoted to scientific discovery and spreading the news of ways to prevent smallpox, of whom Lady Mary, the Suttons, Mr Jesty and Dr Venner are but a few.