report

Immunization History: Smallpox, Edward Jenner and Mary Montagu

A child with smallpox; the fluid-filled pustules with a dent in the middle are typical of the disease
A child with smallpox; the fluid-filled pustules with a dent in the middle are typical of the disease | Source

Smallpox Today

Smallpox is a historically devastating disease that has probably been eliminated in nature. The virus that causes the disease still exists in laboratories, however. The last case of smallpox produced by natural causes (as far as we know) was diagnosed on October 26th, 1977. A young man in Somalia developed the disease. Happily, he survived. In 1979, the World Health Organization declared that smallpox had been eradicated.

A chilling reminder that smallpox could appear again occurred in 1978 when a lab accident in England released the virus. One person died from the resulting infection, which was limited to a small number of people. Today the virus officially exists in just two laboratories - one in the United States and the other in Russia - and is kept under secure conditions.

The smallpox virus hasn't been destroyed, despite the potential dangers of its existence. Scientists want to have access to the virus so that they can study it and create a new vaccine if this is necessary. Hopefully no more infections will occur, but the possibility exists.

The smallpox virus
The smallpox virus | Source

In the past, the word "pox" referred to a disorder that caused skin eruptions. Smallpox was given its name in comparison to the great pox, or syphilis.

What is Smallpox?

There are two species of the smallpox virus. In the past, Variola major was the most common species in nature and caused the most serious form of the disease. The death rate from the infection was 30% to 35%. Variola minor was less common and caused a milder form of the disease. The death rate from an infection by this species was only 1%.

The first symptoms of smallpox appear ten to fourteen days after the initial infection. The person experiences a general feeling of being unwell and may also experience a backache, fever, a severe headache, vomiting, diarrhea and/or delirium. In addition, the virus causes fluid-filled pustules to appear on the skin. After about eight days the pustules develop crusts and begin to fall off. Most survivors of smallpox are left with scars on their skin. They may also suffer from complications such as blindness and arthritis.

A cowpox eruption on the forearm; cowpox is much less serious than smallpox
A cowpox eruption on the forearm; cowpox is much less serious than smallpox | Source

Mary Montagu (1689-1762) discovered the process of variolation while Edward Jenner (1749-1823) discovered vaccination. The term "discover" isn't completely accurate, however, since both variolation and vaccination had been used to prevent smallpox before Montagu and Jenner publicized their techniques.

Variolation Compared to Vaccination

Variolation is the process of infecting someone with a mild form of smallpox in order to give them immunity to a serious form of the disease. The name of the process comes from Variola, the scientific name of the smallpox virus.

In its original meaning, vaccination meant infection by materiał from pustules found on a cow. The Latin word for cow is "vacca", and the word "vaccinus" means "of the cow". These terms gave vaccination its name. The virus transferred from the cow pustules in the first vaccinations may have been the cowpox virus. This is a relative of the smallpox virus but causes a much milder disease. The cowpox virus stimulates the immune system to produce antibodies that also fight the smallpox virus, giving the person immunity.

Today it's uncertain whether the transferred virus in Edward Jenner's experiments was the cowpox virus or the very similar vaccinia virus. The vaccinia virus produces a mild disease and gives immunity to smallpox. It's used in the modern smallpox vaccine. The origin of this virus is unknown. It may have developed from the cowpox virus, but the moment in history when this happened is unknown.

Mary Montagu in Turkish dress
Mary Montagu in Turkish dress | Source

Mary Wortley Montagu

Lady Mary Wortley Montagu was born in 1689. Her father was Evelyn Pierrepont, 5th Earl and 1st Duke of Kingston-upon-Hull. Her mother, Lady Mary Fielding, was a relative of the novelist and playright Henry Fielding. Mary grew up with a great love of reading and writing as well as a belief in women's rights.

In 1712, Mary married Edward Wortley Montagu. She had a reputation for beauty and wit and was a popular visitor to the Royal court. However, in December 1715 she became infected with the smallpox virus. This left her with a severely scarred face. Her brother had already died from smallpox in 1713, so Mary was very familiar with the disease.

In 1716, Mary's husband became the ambassador to Turkey. Mary and her son (born 1713) accompanied Montagu on his journey to Turkey. Mary quickly began to explore her new home and was the first European woman to visit many of the areas that she investigated. She learned to speak some Turkish and studied the local culture with interest and respect. Her enthusiastic and careful observations of the lives of Turkish women were recorded in a series of letters. The letters were published and established her reputation as a great travel writer and observer.

What is Variolation?

Lady Mary Wortley Montagu and Variolation

Mary was very impressed with the way in which Turkish women protected their children from smallpox, a process which she called engrafting. The women took pus from a blister of someone with a mild form of the disease and then injected it into their children with a large needle. The children became sick, but not seriously so. When they recovered they were resistant to smallpox. Mary was so excited by the process that she had her son immunized in the same way.

In 1718, Mary gave birth to a daughter. She returned to England later that year. Smallpox was a common infection at that time and was one of the leading causes of death from infection. Mary asked Charles Maitland, an English doctor who she had met in Turkey, to immunize her daughter by engrafting. Reluctantly, he did so. The process was successful.

Some people developed a severe case of smallpox after variolation. The procedure became popular, however, because it was obvious that the risk of death from variolation was much lower than the risk of death from smallpox.

Promoting Variolation

Mary began a campaign to promote the use of variolation in England. She publicized the inoculations and the health of her children extensively. Members of the aristocracy became interested in the new procedure and some of them had their children variolated.

Mary obtained a powerful ally in the form of Caroline, Princess of Wales. The princess combined her efforts with Mary's in an attempt to test variolation on condemned prisoners, who were promised a pardon if they agreed to the test. The women achieved their goal and the prisoners became immune to smallpox. Variolation was then tested on orphan children and was found to be successful. In an amazing show of confidence, King George l allowed Dr. Maitland to variolate two of his grandchildren, who were the children of the Prince and Princess of Wales. The variolation was once again successful, as it was in many people who received the treatment.

A physician inspects cowpox pustules on a dairy maid's hand
A physician inspects cowpox pustules on a dairy maid's hand | Source

Edward Jenner

Dr. Edward Jenner spent most of his life practicing medicine in Berkeley, Gloucestershire. As a child he had received a variolation treatment at school, which had been a very unpleasant experience. The children went through a harsh preparation period before they were variolated. Jenner wanted to find a better way of preventing smallpox.

Jenner noticed that dairy maids and other people who regularly milked cows seemed to be immune to smallpox. He realized that people who had caught cowpox from the cows didn't get smallpox. Jenner's observations and deduction had been made by other people before him, and other people had transferred pus from cow pustules to humans to confer immunity to smallpox. It's unknown if Jenner had heard of the previous discoveries. He wanted to scientifically prove that a cowpox infection could prevent smallpox.

Edward Jenner's First Experiment

James Phipps and the Smallpox Experiment

To prove his hypothesis, Jenner performed an experiment which would never be allowed today. James Phipps was the eight-year-old son of a poor laborer who sometimes worked for Jenner. The doctor injected the boy with pus obtained from a cow pustule. Once the boy had recovered from the resulting infection, Jenner infected him with pus from smallpox blisters. Even after repeated tests, the boy didn't develop smallpox. By infecting James with the cow virus, Jenner had given him a vaccination against smallpox.

Jenner wrote a paper describing his research and tried to get it published by the Royal Society, a highly respected organization of scientists which still exists today. The society told him that more proof was needed. The thought that people would need to be injected with material from a cow in order to prevent smallpox was very unsettling for many people. The Society was almost certainly worried about the public's response. Jenner repeated his experiment with many more children. None of them developed smallpox. Jenner's research was finally published by the Royal Society.

A satirical cartoon showing the cowpox vaccination and its results
A satirical cartoon showing the cowpox vaccination and its results | Source

Public Outrage over the Cowpox Vaccine

Many people reacted to Jenner's publication in outrage. Clergymen said that the injection of pus from a sick cow was a repulsive idea. A popular cartoon of the time (shown above) depicted people changing into cows as they received a vaccination. Nevertheless, the huge advantage of preventing smallpox in a safer and more effective way than variolation eventually overcame people's objections. Today Edward Jenner is known as the Father of Immunology. Immunology is the study of the immune system.

Edward Jenner and His Smallpox Research

According to the CDC, vaccination with today's smallpox vaccine within three days of infection can prevent or significantly weaken the disease. Vaccination four to seven days after the time of infection "likely" offers some protection against the disease and may weaken the symptoms.

The Smallpox Vaccination Today

Routine smallpox vaccinations are no longer required. In the United States they were stopped in 1972. People who do research with the virus are still advised to get a vaccination, however. Military personnel, health care workers and aid workers may also receive the vaccination.

The remaining viruses are maintained in two labs under highly secure conditions that have been approved by the WHO (World Health Organization). There have been occasional rumors of hidden virus stocks kept in other labs. This seems to be true, at least in the case of forgotten cultures. One such culture was found in a National Institutes of Health facility in 2014.

There are two concerns relating to the continued existence of smallpox viruses: they could accidentally "escape" from a laboratory and they could be used as a biological weapon. Many countries maintain large stocks of smallpox vaccine and have created emergency plans to deal with a smallpox outbreak. Hopefully these plans will never have to be put into action.

Further Reading

  • A letter from Lady Mary Montagu describes the process of engrafting, or variolation.
  • The Nature website describes the hidden and forgotten stock of the smallpox virus.

© 2013 Linda Crampton

More by this Author


Comments 26 comments

billybuc profile image

billybuc 3 years ago from Olympia, WA

What a great history lesson. Thank you for this, Alicia.


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you for the comment, Bill!


osaeoppongde profile image

osaeoppongde 3 years ago from Chicago, IL

You made my day! This was such an interesting hub! The controversy over whether the smallpox virus should be destroyed has always fascinated me. As a scientist, I understand, but the entertainment industry has exploited the fear that the public has of the virus, making the story into a nightmare!


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Hi, osaeppongde. The story of the smallpox virus is a fascinating one. I too understand why there is a reluctance to destroy it. Once it's gone we will have no further chance of discovering its secrets. Understanding the structure and function of the virus may be not only useful but even essential in the future. I just hope that security remains extremely tight and that all samples of the smallpox virus are well protected and stay in laboratories! Thank you very much for the comment.


torrilynn profile image

torrilynn 3 years ago

Hi AliciaC,

thanks for sharing this story with me and others.

it was very interesting and i learned a lot about smallpox

and other things I did not know.

Voted up


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thanks for the comment and the vote, torrilynn! I appreciate them both.


drbj profile image

drbj 3 years ago from south Florida

Hi, Alicia, I knew about Edward Jenner and vaccinations, of course, but the information about variolations was new to me. Thanks for enlarging my sphere of knowledge.


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thanks for the comment, drbj. Mary Montagu and variolation aren't as well known as Edward Jenner and vaccination, but I think that both variolation and vaccination are interesting topics.


aviannovice profile image

aviannovice 3 years ago from Stillwater, OK

This was superb historical info. Why are these countries stockpiling smallpox? What do they hope to gain from biological warfare?


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you very much for the comment, Deb! The viruses in the two official labs are being kept for research purposes, not for use as weapons. Scientists don't completely understand the behavior of the smallpox virus yet.


moonlake profile image

moonlake 3 years ago from America

Our kid's doctor always thought it was a big mistake not vaccinating for smallpox. He said if children got smallpox many, many would die.

Very interesting hub. Voted up and shared.


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you very much for the comment, the vote and the share, moonlake! A smallpox epidemic would be scary. The vaccine is supposed to help in the early stages of the disease, but it would have to be distributed very quickly during an epidemic.


unknown spy profile image

unknown spy 3 years ago from Neverland - where children never grow up.

the picture gave me chills.. i had a smallpox when i was still a kid and its really....itchy..plus scary.

informative post.


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

I'm very glad that you recovered from smallpox, unknown spy. That must have been a very scary experience. Thank you for the comment.


Eiddwen profile image

Eiddwen 3 years ago from Wales

Thank you so much for this interesting hub;a wonderful history lesson. Here's to so many more to come.

Enjoy your day.

Eddy.


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thanks, Eddy. I appreciate the comment. Enjoy your day (or evening) too!


MartieCoetser profile image

MartieCoetser 3 years ago from South Africa

Very interesting and comprehensive article about smallpox. The vaccine was a major breakthrough, and how wonderful to know that all viruses, except those in the laboratory, were eventually destroyed. Such an interesting topic well-presented. Thank you, Alicia!


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you for the comment, Martie! It is good to know that the only smallpox virus particles left are under control in laboratories.


epigramman profile image

epigramman 3 years ago

.Good afternoon Linda from lake erie time 2:54pm where the cats and I had started out with a glorious sunny day but a fog rolled in and now it's cooler again. I love the work and effort you put into this educational and enlightening hub subject - it has been presented on a world class level and I appreciate what you have done here on a subject I knew very little about .

Hubbravo and sending you warm wishes from Colin, Tiffy and Gabriel


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you very much for the visit and the comment, Colin, Tiffy and Gabriel! It's noon here in British Columbia. It's a beautiful, sunny day where I live. Spring is coming and the early buds are opening up. Spring is my favourite time of year!


Seeker7 profile image

Seeker7 3 years ago from Fife, Scotland

What a fascinating hub! I only knew the Edward Jenner part of the story in relation to cowpox/smallpox so this was a real eye opener to learn of Lady Mary Wortley Montagu and her campaign - so basically this wonderful and intelligent woman could be called the 'Mother' of immunology if Jenner is regarded as the 'father'!

Thoroughly enjoyable hub + voted up!


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank for the comment and the vote, seeker7. The "mother of immunology" is a good name for Mary Montagu! It is a shame that her work isn't very well known today. Edward Jenner's efforts were very important, but so were Mary Montagu's.


StellaSee profile image

StellaSee 3 years ago from California

I read some of Mary Montagu's Turkish Embassy letters as part of my English lit class, but I had no clue she had a part in playing such an important role in the cure for small pox. That's fascinating!


AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Hi, Stella. I think that Mary Montagu was a fascinating person! What she did was so unusual for a woman of her time. Thank you very much for the visit.


Sarah Wingate profile image

Sarah Wingate 2 years ago from Tel Aviv, Israel

It must be stressed that today we encounter more and more people who do not appreciate the revolution in health brought by the appearance of vaccines object to any sort of vaccination


AliciaC profile image

AliciaC 2 years ago from British Columbia, Canada Author

Hi, Sarah. Yes, some people do object to vaccinations for humans and for pets. Vaccinations can be wonderfully effective, but as you say, they aren't always appreciated!

    Sign in or sign up and post using a HubPages Network account.

    0 of 8192 characters used
    Post Comment

    No HTML is allowed in comments, but URLs will be hyperlinked. Comments are not for promoting your articles or other sites.


    Click to Rate This Article