Milkmaids held the key to the cure
Kate Colquhoun reviews The Life and Death of Smallpox by Ian and Jenifer Glynn
Kate Colquhoun
12:01AM BST 26 Jul 2004
Throughout the 19th century, controversy over whether to vaccinate against the lethal variola virus – the cause of smallpox – raged no less fiercely than the current debate over the MMR triple vaccine. But 200 years ago the very notion of vaccination was startlingly new. In their book, Ian and Jenifer Glynn have set out to chart the birth-to-death story of the virus as it crossed five continents, over thousands of years.
No one really knows exactly where or when the smallpox virus originated. It may have been the cause of the plague of Athens, as described by Thucydides, and it probably caused the death of Ramses V and, later, Marcus Aurelius. Killing, blinding and disfiguring countless millions worldwide, "the pox" defeated armies, ended dynasties and ruined economies. It decimated North American Indian communities in the 16th century, South American tribespeople in the 1700s, and Australian Aboriginals a century later. Elizabeth I, Voltaire, Mozart and Abraham Lincoln all survived both its ravages and the bleeding, purging, puncturing, sweating and other dangerous remedies of their day.
Described by Macaulay as "the most terrible of all the ministers of death", it was spread rampantly by colonialism, religious expansion, trade, exploration and war; epidemics ran rife. By the 17th century it had replaced the plague as the principal cause of death. Unsurprisingly, then, smallpox was feared above all other infectious diseases.
The Royal Society in London gathered differing accounts of inoculation against smallpox from around the world and in 1717 variolation – the practice of inoculation by using matter drawn from a smallpox pustule and inserting it under the skin of a healthy person – was introduced to Britain. It was vigorously promoted by the Turkish ambassador's wife, Lady Mary Wortley Montagu, who had witnessed the "folk practice" and had inoculated her own children.
Variolation usually produced a mild attack of smallpox, giving protection from future infection, but it was risky – and occasionally fatal – and, crucially, it actually assisted the spread of the disease since the recipient remained highly contagious yet was rarely quarantined. Nevertheless – after experimentation on several Newgate prisoners and on a handful of charity children proved to be effective – the practice began to be widely adopted among the nobility. A parallel process was enacted in America and parts of Europe: even Catherine the Great submitted herself to the needle.
Gradually refined, with gentler techniques obviating the earlier incisions, by the end of the century inoculation had become accepted practice among those who could afford it. But it had its detractors: many believed that it was illogical purposely to infect anyone and factions of the clergy argued forcefully against it.
In 1796 Edward Jenner, a Gloucestershire doctor, noticing that milkmaids who suffered from cowpox appeared resistant to smallpox, pioneered "vaccination", using material from the pustules of cows suffering from the related virus. It was the most significant breakthrough in the treatment and prevention of infectious disease that there had been and it was so at variance with established knowledge that Joseph Banks, then president of the Royal Society, advised against publication. Vaccination produced a mild, un-infectious reaction that also gave future immunity. It caught on. Jenner soon became the most famous (and wealthy) country doctor in the world.
The dramatic reduction in smallpox deaths wherever vaccination was introduced proved its efficacy, boosted its popularity and contributed to a decline in the practice of variolation. In order to transport vaccines to countries where they would have degenerated in heat and over time, and before the discovery of glycerine as a preserving agent, human "chains" were used through which vaccinations could be transferred "arm-to-arm", from one patient to the next.
In 1840 the Vaccine Act provided, in effect, the first free medical service in Britain, though compulsory vaccination remained highly contentious. Epidemics continued wherever there were mass movements of people but, after many further refinements and 200 years after Jenner's first vaccination, the World Health Organisation announced in 1979 that smallpox was the first (and still the only) infectious disease to have been effectively eradicated. Medically and politically, it was one of the most remarkable achievements of the century. Estimates suggest that it saves up to two million lives every year.
From an unwieldy mountain of material, the Glynns have written an engaging and succinct synthesis in which Jenner is the resounding hero. But in chronicling this absorbing story right up to the present, they caution against complacency: bio-terrorism remains an ever-present threat. During the Cold War, the Soviets stockpiled tens of tons of the virus; as recently as 1993 there were attempts to hybridise the variola and ebola viruses for use in germ warfare; and recently, perceiving a threat from Iraq, the British government ordered three million doses of the vaccine.
The Life and Death of Smallpox is a timely reminder of our vulnerability to a horrific disease for which there is still no effective cure.