Over the next few weeks a million Americans will be vaccinated against smallpox, a disease that was driven from the face of the Earth more than two decades ago. Smallpox was defeated by a global programme of vaccination. But fears that samples of virus held in labs in the US and Russia might have fallen into the wrong hands has triggered a new round of vaccination. Few people in developed countries have ever seen a case of smallpox, yet its reputation places it alongside cholera and plague in the ranks of dread diseases.
Three centuries ago, people had every reason to fear the 鈥渟mall pox鈥�, a disease they were all too familiar with. During the 18th century, smallpox killed an estimated 60 million people. It was responsible for one in ten deaths in Europe. Rich, poor, young and old: the virus did not discriminate. Those who survived were left weakened, blind or crippled, not to mention disfigured by pockmarks. So when Lady Mary Wortley Montagu, satirist, poet and wit, introduced an early form of immunisation to England in 1721, you might think that the medical establishment would have taken up the practice with enthusiasm. It didn鈥檛. Opponents condemned inoculation as the devil鈥檚 work. But Lady Mary set in motion events that led to the invention of vaccination and the eradication of one of the world鈥檚 greatest scourges.
SMALLPOX was sent by God to punish sinners and to encourage everyone else to stick to the path of righteousness. In early 18th-century England, that was a perfectly reasonable point of view. Not everyone shared it. Lady Mary Wortley Montagu, for one, believed that any parent who declined to have their children inoculated had only themselves to blame when smallpox carried them off.
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Lady Mary knew all about smallpox. In 1713, her younger brother died suddenly from the disease. Two years later she was struck down. She was 26, married to a promising politician, and mother of a baby boy. She was also a society beauty, renowned for her sparkling wit and scandalous poems. She had the best of doctors but was convinced she would die. She didn鈥檛, but her face was pocked and her eyelashes were gone for good.
A few months later her husband Edward was appointed ambassador to Turkey. Mary was excited by the prospect of a trip to the East and in August 1716 the family set out for Constantinople. During a stop at Adrianople, Mary watched as a small child was inoculated, or 鈥渆ngrafted鈥�, with smallpox, a common practice in those parts. 鈥淭he Small Pox, so fatal and general amongst us, is here entirely harmless by the invention of engrafting,鈥� wrote Mary in one of her many letters home. 鈥淓very year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries.鈥�
The operation was simple. An old woman made small cuts in the skin with a needle and inserted a tiny amount of matter collected from the pustules of a patient with a mild dose of the disease. Assured that no one ever died from the procedure, Mary decided to have her son inoculated at the first opportunity. She also resolved to 鈥渢ake pains to bring this useful invention into fashion in England鈥�.
Lady Mary had probably heard of inoculation, or variolation as it became known, before she left London. Her doctors had almost certainly read descriptions of it published a few years earlier in the Transactions of the Royal Society of London, but no English doctor had been bold enough to try it. One report had come from Emanuel Timoni, a physician in Constantinople. Following her own instincts, and perhaps encouraged by Timoni, in March 1718 Lady Mary had her five-year-old son inoculated. Her husband was away, attempting to mediate between the warring Turks and Austrians, but the embassy鈥檚 surgeon Charles Maitland was on hand to supervise.
Lady Mary sent for an old Greek woman, who came bearing a nutshell filled with poxy fluid. Maitland watched as the woman scratched at the boy鈥檚 arm with a rusty needle, her hands shaking badly. Horrified, he finished the job himself with his own instruments. Lady Mary waited five days before writing to her husband. 鈥淭he boy was engrafted last Tuesday, and is at this time singing and playing and very impatient for his supper鈥︹�� Maitland reported later that the boy had developed about a hundred pustules, but that they healed without leaving a mark.
Smallpox inoculation did not begin in Turkey but in China. By the 10th century, the Chinese were familiar with the concept that exposure to a mild dose of smallpox protected against a more violent attack. Their method was to insert poxy material 鈥� usually ground up scabs from healing pustules 鈥� into the nose on a cotton wad. The Chinese avoided triggering a severe case of smallpox by inoculating only 鈥渕ild鈥� forms of poxy material. These were collected from people who had themselves been inoculated rather than those suffering from the disease itself. Later, the scabs were 鈥渨eakened鈥� by storage in a bottle until they had dried out. This would have ensured that most of the virus was killed before use.
Three months after the Wortley Montagus鈥� son was inoculated, Edward was recalled to London. His peace mission had failed. Lady Mary鈥檚 mission to introduce inoculation to England also got off to a slow start. In 1718, there was an outbreak of smallpox 鈥� but she did nothing. In 1721, a new epidemic raged in London. Mary decided it was time to persuade the English to do as the Turks did and protect themselves by inoculation.
Mary now had a small daughter. The child was born in Turkey but had not been inoculated there. Mary decided it was now the time to do it. But this was not the exotic land of the Ottomans where people went in for strange and heathen practices. This was England, where physicians had their reputations to maintain. Even Maitland, who had been perfectly willing to perform the operation in Constantinople, jibbed at the idea now he was home. Eventually he agreed, provided there were other doctors as witnesses. Mary鈥檚 daughter was the first person in England ever to be inoculated against any disease.
All went well and word of Mary鈥檚 鈥渆xperiment鈥� soon spread. Friends and acquaintances began to follow her lead. Mary advertised the benefits of inoculation by taking her daughter to visit smallpox patients, confident that she would be safe. The evidence in favour of inoculation was compelling enough for Princess Caroline, wife of the future King George II, to think about protecting her children. She wanted more assurance that the procedure was safe and persuaded her father-in-law, George I, to allow experiments on half a dozen condemned prisoners in Newgate prison. Prisoners who volunteered and survived would be pardoned. All six walked free. The next spring, the trial was extended to 11 orphan children from the parish of Westminster. They suffered no harm and two princesses were inoculated shortly after.
With the Princess of Wales backing inoculation, the practice spread among the well-to-do. Nevertheless, there was plenty of opposition. The newspapers carried regular diatribes on the evils of inoculation. The Reverend Edmund Massey attacked it as an attempt to escape God鈥檚 punishment. Fear of smallpox helped to prevent immorality and vice, he declared, for healthy people had less reason to fear God.
Some physicians were just as violently opposed. Dr William Wagstaffe claimed it was 鈥渁n artful way of depopulating a country鈥�. There was a grain of truth to this. One genuine criticism of inoculation was that it could set off smallpox epidemics as easily as it prevented them. Working with live virus was risky, and unless inoculated patients were isolated they could pass on the infection to others.
Inoculation did claim some lives and the anti-inoculation lobby jumped on any suspicious death to back their case. When one young aristocrat died 19 days after his inoculation a newspaper reported that he had died 鈥渙f the innoculations, a new kind of Distemper not known in former Days, and an Unhappy Experiment to the young Nobleman鈥�. The post-mortem, however, attributed the death to fits from other causes.
But the facts began to speak for themselves. By 1730, 845 people had been inoculated, of whom 17 had died of the disease. Over the same period, 18,000 people had died from smallpox. In 1756, the Royal College of Physicians came down in favour of variolation as 鈥渁 practice of the utmost benefit to mankind鈥�. Inoculation became widespread, although the debate rumbled on until the end of the century when Edward Jenner famously proved that a small dose of cowpox offered a much safer form of protection. Jenner鈥檚 鈥渧accination鈥� was quickly accepted and Lady Mary鈥檚 variolation consigned to the history books.