A tale of diversity in scientific innovations

A brief history of the small pox vaccine

It was excellent to see Lady Mary Wortley Montagu in the news this week. Why you may ask- well the Sun Monument, an obelisk in Wentworth Castle in South Yorkshire UK is being upgraded to a Grade II* monument due to its historical significance. This monument is a large obelisk that was erected in the 18th century to commemorate Lady Mary Wortley Montagu for her pioneering work with small pox and specifically her contributions to vaccination. Edward Jenner is known as the father of vaccination but actually, like all the best discoveries, his work came after many other’s pioneering efforts. Read more to find out a brief history of the small pox vaccine….

Small pox

Small Pox is a viral infection caused by the variola virus that caused severe infections that was often fatal (in roughly 1 in 3 to 1 in 4 people). Survivors were often left scarred and even blinded. There is evidence of this infection dating back to Egyptian mummies where for example images of Pharaoh Ramses V (died in 1157BC) show scars on his face that are typical of smallpox.

Variolation

The earliest accounts of trying to protect against smallpox are found in the mid-1500s in China. The process was known as insufflation which is as grim as it sounds- the scabs on the smallpox pustules were dried and ground up before being blown into the nostril using a pipe! Decidedly grim snuff (sorry).

A similar approach was taken in countries in Africa- only these were even more visceral. The pustules were scratched using a sharp lancet and the resulting pus- filled -ooze then scratched into a recipient- the process was known as variolation. Most typically these treatments were given to small children as children were most vulnerable to the infection.

Countries such as the UK and America, however, were much slower to take up variolation.

Lady Mary Wortley Montagu

Lady Mary was an English beauty, aristocrat and smallpox survivor. She had been infected whilst a relatively young woman and was left scarred as result. Her brother though was less fortunate and sadly succumbed to the disease. Upon travelling to the Ottoman empire in 1716, she became aware that the Turkish women had their children variolated to protect against smallpox. Fearful that her children might suffer the same fate as her brother, she took the brave but risky step of having her son variolated. The process was a success and upon her return to the UK she set about introducing the practice. An ally was recruited- Charles Maitland- a Scottish surgeon. Charles agree to variolate her daughter which was done in front of witnesses from the Royal College of Surgeons. The process was a success and she set about persuading people within her circle to take up the procedure- most famously the then Princess of Wales- Caroline, who had her two daughters inoculated.

In America, variolation was also introduced by someone outside the establishment in perhaps an even more remarkable story. There was a significant smallpox epidemic in Boston in 1721 and a local Puritan minister called Cotton Mather introduced the practice of variolation in an effort to limit the effects the epidemic was ravaging upon the population. Mather however had learned of variolation several years previously via his North African slave who was known as Onesimus. Onesimus had told Mather he was protected from smallpox and described how he had been variolated as a child. Onsemus later, as a consequence of this knowledge, was able to purchase his freedom in 1716.

Tweaking the formula

Variolation was often successful but such a crude technique was risky and some who were inoculated went on to develop full blown smallpox. As such, the process was greeted with some degree of justified scepticism, and did not become that widespread.

The next great pioneer was, again from relatively humble origins, a farmer named Benjamin Jesty. In 1774, there was another smallpox epidemic. Frightened for his family, Jesty took the bold step of having his children variolated- but- not with smallpox. Instead, Jesty used a related but milder infection called cowpox (vaccinia). He scraped some pustules from one of his infected cow’s udders and inoculated his wife and children. Incredibly, the family survived- both the procedure and the epidemic. This was potentially the first known “vaccination” Tales of the procedure reached London where Benjamin was invited to repeat the procedure. His achievement was documented in the “Edinburgh Medical and Surgical Journal” some 30 years later and a painting commissioned to commemorate him.

Of course, it was Edward Jenner that then really pioneered the process, writing it up in scientific journals. He was a surgeon and had carried out variolation using smallpox to protect his patients. He had hear tales of people catching cowpox and being protected from smallpox so he started experimentation. In 1796, infamously inoculated the young James Phipps using material scraped from the cowpox infected-hand of a dairymaid Sarah Nelmes. The experiment worked, Jenner documented the results and went on to publish several more related papers. The term vaccination was subsequently coined from vaccinia- the cowpox virus.

This early form of vaccination was met with some scepticism in certain quarters due to fears it would cause people to become cow-like. Nonetheless, the risks of smallpox were so severe that ultimately, in the 1840s and 1850s, mandatory smallpox vaccination was brought into effect in Britain and other parts of the world. Smallpox vaccination certificates became required for travel encouraging further take-up. The original vaccine design was modified in the 1950s to enable it to become more stable and the WHO lead a campaign to eradicate smallpox. Finally, in 1980, smallpox was officially eradicated.

Most people now no longer need this ancient type of vaccine but stocks have been kept and this was vital in fight against the related virus- monkey pox- in 2022.