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Smallpox, Mary Montagu, and Edward Jenner: Immunization History

Linda Crampton is an experienced teacher with a first-class honors degree in biology. She writes about the scientific basis of disease.

The Smallpox Virus and the Disease

Smallpox is a historically devastating disease that has probably been eliminated in nature. The virus that causes the disease still exists in laboratories, however, so we mustn't become complacent. 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 it's not impossible that the disease will one day appear again.

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. Mary Montagu (1689 to 1762) and Edward Jenner (1749 to 1823) are important names in the history of immunization against smallpox.

Types of Smallpox and Symptoms of Disease

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 often 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.

Mary Montagu discovered variolation, and Edward Jenner discovered vaccination. The term "discovered" isn't completely accurate, since both techniques had been used to prevent smallpox before Montagu and Jenner publicized their discoveries.

Variolation and 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 genus 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 one, 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 one. The vaccinia virus produces a mild disease and gives immunity to smallpox. It's used in the modern smallpox vaccine. It may have developed from the cowpox virus, but if this is the case the moment in history when it happened is unknown.

A smallpox virus particle as seen under an electron microscope

A smallpox virus particle as seen under an electron microscope

Mary Wortley Montagu Facts

Lady Mary Wortley Montagu was born in 1689. Different sources have different dates for her death. I've seen a date as early as 1751 and as late as 1762. 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 playwright 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 at the royal court. 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 apparently 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 Engrafting

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 seemed obvious that the risk of death from variolation was much lower than the risk of death from smallpox.

The Promotion of Variolation in England

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.

Edward Jenner Facts

Dr. Edward Jenner (1749–1823) 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 that 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 that 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

Public Outrage About 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.

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 which have been approved by 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 any disease outbreak. Hopefully, these plans will never have to be put into action. Nevertheless, some countries are taking the potential threat seriously.

A New Drug to Fight the Illness

In 2021, the Food and Drug Administration (FDA) in the United States approved the use of a new drug to fight smallpox. Tembexa (or brincidofovir) has been approved as a treatment after tests in animals. The FDA says that these tests are acceptable when research in humans would be unethical. The animals were infected with a virus that closely resembles the smallpox one. The drug has been used in humans for other illnesses and has shown that under specific conditions it's safe for us.

Using animals in medical research is a controversial topic. It is good that researchers are thinking about a smallpox epidemic in the future, however. It would be a great shame if people died from the illness again after the successful discoveries made by Mary Montague and Edward Jenner.


  • Google Books provides extracts from the Turkish Embassy Letters by Mary Montagu.
  • The Encyclopedia Britannica contains a short biography of Lady Montagu.
  • The BBC gives some facts about the life of Edward Jenner.
  • The CDC has a web page about smallpox and discusses the vaccine.
  • The Nature website describes the hidden and forgotten stock of the smallpox virus.
  • The FDA has made an announcement about a drug approved for fighting smallpox in the United States.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2013 Linda Crampton


Linda Crampton (author) from British Columbia, Canada on February 02, 2020:

Thank you very much, JC Skull.

JC Scull on February 02, 2020:


As always an excellent read.

Linda Crampton (author) from British Columbia, Canada on February 18, 2018:

Thanks for the comment, Adrienne. I think it's great that vaccinations can be so helpful.

Adrienne Farricelli on February 18, 2018:

Interesting information. I never saw before a picture of a child with smallpox or cowpox. Glad that vaccination has helped decrease the incidence of so many scary diseases.

Linda Crampton (author) from British Columbia, Canada on February 18, 2018:

Thank you very much, Manatita. Once again, I appreciate your kind comment!

manatita44 from london on February 18, 2018:

A fascinating look at smallpox and the variolation and vaccine therapy. Amazing!

Glad you touched on the conspiracy theories at the end. Many believe this. Thank you so much for a truly fascinating Hub.

Linda Crampton (author) from British Columbia, Canada on December 31, 2013:

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!

Sarah Wingate from Tel Aviv, Israel on December 31, 2013:

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

Linda Crampton (author) from British Columbia, Canada on April 25, 2013:

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.

StellaSee from California on April 25, 2013:

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!

Linda Crampton (author) from British Columbia, Canada on March 10, 2013:

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.

Helen Murphy Howell from Fife, Scotland on March 10, 2013:

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!

Linda Crampton (author) from British Columbia, Canada on March 09, 2013:

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!

epigramman on March 09, 2013:

.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

Linda Crampton (author) from British Columbia, Canada on March 07, 2013:

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

Martie Coetser from South Africa on March 07, 2013:

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!

Linda Crampton (author) from British Columbia, Canada on March 05, 2013:

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

Eiddwen from Wales on March 05, 2013:

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

Enjoy your day.


Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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

DragonBallSuper on March 04, 2013:

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

informative post.

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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.

moonlake from America on March 04, 2013:

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.

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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.

Deb Hirt from Stillwater, OK on March 04, 2013:

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

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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.

drbj and sherry from south Florida on March 04, 2013:

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.

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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

torrilynn on March 04, 2013:

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

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

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.

Deborah L. Osae-Oppong from Chicago, IL on March 04, 2013:

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!

Linda Crampton (author) from British Columbia, Canada on March 04, 2013:

Thank you for the comment, Bill!

Bill Holland from Olympia, WA on March 04, 2013:

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