My house is currently a petrie dish with three out of the four of us ill with strep throat. I’m essentially a waking Lysol machine right now. It seemed fitting to do this month’s Throwback Thursday on the advent of the smallpox vaccine which predates antibiotics by nearly two hundred years.
I have been interested in the history of the smallpox vaccine for a few years. In 2016, I began an original Regency Romance in which the heroine’s sisters were smallpox victims. When Clara Lumley has to leave her vacation early to help tend to her sick sisters, it creates an obstacle and a massive miscommunication between her and the love of her life. The story is set several years after the illness and is a second chance for the hero and heroine.
Clara maintained her happy disposition, however. Taking an interest in medicine and the science of preventive disease, she counseled her step-father on the importance of smallpox variolation but he desired to wait until the children were older as many still became sick with a weaker version. Disaster struck the family when Clara was seventeen and on a holiday from the family. Dottie and Esther became ill with the pox. Seven year old Dottie’s rash remained flat, unlike the normal course of the disease, and her fever was very high and raged for days. When at last it broke, her senses remained addled.
The illness caused Clara to cut her holiday short. She would never regret coming home to assist Dottie and Esther, she only hated how faithless her one suitor proved. Refusing to understand her reasons for departure, he broke their engagement and then left the country for duties in India.
Smallpox is caused by a virus and was, finally, globally eradicated in 1980. Its origins are unknown but the earliest evidence uncovered is from 3rd century BC Egyptian mummies. It’s highly infectious and occurred in outbreaks. In 18th century Europe, about 400,000 people died from smallpox each year, including five reigning monarchs.
The first signs of the infection are fever and vomiting. Then, mouth sores and a rash follow. Soon the rash turns to fluid-filled bumps with a tell-tale dent in the middle. If you survived the infection, you would often be left with scars and nearly one-third of survivors lost
Before the vaccine was discovered, some societies practiced variolation. It was also called inoculation. Variolation came to England after Lady Mary Wortley Montagu returned from Turkey where her husband was ambassador. It was common practice there as a way to prevent smallpox. She had her five year old son inoculated. Upon returning to England in 1721, she also did so to her daughter. Intrigued, the Royal Family inoculated prisoners at Newgate and the following year Augusta, Princess of Wales, inoculated her children. From there it spread among the population.
Variolation uses pustules from an active infection. This differs from most contemporary vaccines which are dead viruses. Africa and China each had their own traditions. The form that became common in England is a variation on the technique Lady Mary witnessed in Turkey. It involved a shallow scratch made on the arm of a healthy person and pustules from mild cases. Less credible physicians encouraged extreme bloodletting and cut deeply.
After inoculation, a person would contract a mild case of smallpox. However, the survival rate was astronomically higher than untreated cases. A standard smallpox epidemic took between 20-35% of its victims. Variolated persons had only a 0.5-2% mortality rate. Still, people were growing sick with smallpox.
Early studies by James Jurin, Daniel Bernoulli, and John Fewster encouraged physician Edward Jenner to consider the immunity cowpox offered against smallpox. We know now that cowpox is closely related to the virus which causes smallpox. However, its host of choice is not human. We can grow sick from it but it is seldom fatal. What observers in the 18th century knew was that the pustules looked similar. There also may have been a general observance that those who had been infected with cowpox did not acquire smallpox. However, this was before any ideas of germ study and Newtonian science was still in its infancy.
Jenner went about conducting a few studies on the relationship. What he saw encouraged him to conduct trials on humans. He purposefully infected them with cowpox. The most famous case was James Phipps, the eight year old son of his gardener. In 1796, James was inoculated with cowpox and suffered from a mild fever and a few local lesions at the site of the inoculations (one on each arm). He did not have a full blown cowpox infection, just as those who were inoculated from a smallpox lesion seldom acquired a bad infection. A few months later, Jenner inoculated James with smallpox and the boy had no reaction. He was completely immune to the virus. James was later challenged with smallpox and again produced no reaction.
Jenner’s greatest contribution to the science behind the smallpox vaccine is not just that he injected a few people with cowpox. It’s that he recorded and tracked his data. He intentionally challenged the patients with smallpox material rather than merely noting they never acquired the infection naturally in the course of their life. Additionally, he demonstrated that the cowpox pus could create an inoculation from person to person instead of the source needing to be an animal.
He continued his studies and published a paper which was initially rejected by the Royal Society. Undeterred, Jenner conducted more studies and revised his paper. He even inoculated his 11 month old son with cowpox. Slowly, Jenner’s method, which he began to call vaccination, was accepted in the medical community. The Royal College of Physicians confirmed the efficacy of his practice in 1807.
While the vaccination was slow to catch on with official physician recommendation, it was very popular among the general public. Even Napoleon had his troops vaccinated, awarded Jenner with a medal, and released two English prisoners at Jenner’s request. Edward Jenner became so well-known for his vaccine that he could not return to regular medical practice and had to petition Parliament for support in 1802 and again in 1807.
In 1840, the United Kingdom outlawed variolation with smallpox and provided the cowpox vaccines free of charge to the public. In 1853, it became compulsory to vaccinate infants in England. In the US, vaccination requirements were managed by each state. The result was a hodge-podge situation. I believe the first time I ever heard of the disease beyond learning of Jenner’s vaccination was while reading All the King’s Men by Robert Penn Warren. His character Sadie Burk has smallpox scars. During World War I, many US soldiers had never been vaccinated. Dr. Louis T Wright, an African American and Harvard graduate, introduced vaccination for soldiers.
Obviously, through the years, the method of vaccination evolved. Arm to arm vaccinations carried risks of erysipelas, tetanus, septicaemia, tuberculosis, and, especially, syphilis. Various scientists discovered new ways to keep bacterial growth off the sample as well as improved delivery systems. A worldwide endeavor to eradicate smallpox began in 1967 and was realized in 1979. Ending an ancient disease which has claimed the lives of billions and plagued our ancestors year after year is nothing short of a medical marvel.