Words: Joanna Nayler
Queen Mary II of England was widely considered to be in good health. She was unusually tall, standing at nearly 6ft, and was said to regularly walk the 4 miles between her palaces of Westminster and Kensington. Her husband, King William III, suffered from bad asthma and her sister, Anne (later Queen Anne), suffered from gout and general poor health; it seemed likely that Queen Mary would outlive them both. However, after several days of illness in late 1694, her condition quickly deteriorated, and she died on 28 December aged just 32. What killed her was ‘the most terrible of all the ministers of death’: smallpox.
The smallpox virus, or the ‘Speckled Monster’, devastated communities across eighteenth-century Europe, killing around 400,000 every year. The disease caused fever and a painful rash, and ultimately killed 30% of sufferers. Those who did survive were often left pockmarked or blind, but also had long-term immunity.
Edward Jenner is renowned for his work on smallpox vaccinations in the late eighteenth century, though medical procedures to create immunity actually began much earlier through variolation (also known as inoculation or engrafting). This had likely been practised for hundreds of years previously in parts of India, Africa and China, and involved taking scabs or pus of a smallpox sufferer and placing it under the skin of the non-immune to give them a (usually) mild form of the disease and immunity. While the practice had its risks, including the transmission of blood-borne diseases and full-blown smallpox, the survival rate was much higher than contracting the full disease.
Lady Montagu, the wife of an English ambassador, witnessed variolation taking place in Turkey, which she wrote made the ‘so fatal’ and widespread smallpox disease ‘entirely harmless’. Upon her return, she is widely credited with introducing and popularising the practice in England, which became the first country in Europe to fully embrace variolation. The practice increased further from the 1760s, when an easier and cheaper method became available.
On the other side of the Atlantic, on 14 November 1721—the same year that Lady Montagu variolated her daughter to widespread attention—Cotton Mather was awoken in the middle of the night in his Boston home. A bomb had been thrown through his window. Attached to the device (which failed to detonate) was a note: ‘Cotton Mather, you dog, dam you! I’ll inoculate you with this; with a pox to you.’
Mather was an influential Boston-based Puritan minister with a keen interest in medicine. In 1721, Boston was in the midst of a devastating smallpox epidemic, and Mather had been advocating for variolation. He is widely credited with introducing the procedure to the city, though he had learned about it from his African slave Onesimus, about whom, unfortunately, little is known.
What is known is the fierce and sometimes violent reaction Cotton Mather received from both the general public and the medical community. Reasons for protest included fears of acting against God’s will, the lack of research or scientific evidence for variolation and a (then valid) concern that it could be dangerous. Scepticism also had a racist element, based on a lack of trust in a medical procedure developed by or for black people.
The variolation campaign in 1720s Boston was ultimately successful in containing the epidemic, despite the criticism it faced. Dissent and criticism were also occurring back in England, though it was after the work of Edward Jenner that these intensified.
Edward Jenner began his vaccination experiments around 70 years after the Boston outbreak and the work of Lady Montagu. Some have downplayed Jenner’s precise role, but it’s widely recorded how he noticed that milkmaids suffered from the less deadly cowpox, though rarely contracted smallpox. He linked the two together, questioning whether cowpox could be transmitted from one person to another to provide protection from smallpox. In 1796, he took matter from a cowpox lesion and placed it under the skin of an eight-year-old boy, who went on to achieve smallpox immunity. Five years later, Jenner published his treatise ‘On the Origin of the Vaccine Inoculation’, and smallpox vaccinations began to be rolled out. Throughout the nineteenth century, the vaccine was obtained from cowpox and sometimes horsepox, and in the UK often was distributed through arm-to-arm transfer.
The backlash to this was swift. An 1802 engraving by the satirist James Gillray shows an image of a crowded, rowdy room, labelled ‘The Cow Pock or the Wonderful Effects of the New Inoculation!’ After undergoing the procedure, miniature cows grotesquely sprout from individuals’ mouths, arms and faces.
Rather like the disease, resistance came in various waves. Despite initially increasing after the publication of Jenner’s experiments, antagonism slowed in the following decades and peaked again with the introduction of mandatory vaccination in 1853 for infants in their first three months (extended to children of 14 years and under in 1867, with fines for those who did not comply), and rose again in the late nineteenth century.
Like today, protestors were not confined to any one group or background. Many advocated other movements as alternatives, such as ‘temperance’ or vegetarianism. Many activists were also working or lower-middle class, and felt unfairly targeted by the imposition of fines.
Critiques of the smallpox vaccination were also varied. The procedure itself was not particularly pleasant: while safer than variolation (which was outlawed in 1840), it was still invasive and could lead to disfiguration. An early twentieth century textbook described how the procedure involved scraping away the outer layers of skin, rubbing them with a quill or tube, and leaving behind a characteristic scar. Without good medical sanitation, this could also lead to other blood-borne diseases or infections, such as syphilis and hepatitis.
Others protestors were suspicious of state intervention. Vaccination was also seen as a way of ‘playing God’ to interfere with the natural course of life and death; diseases were punishments from God which should be allowed to run their course. Others were scientists or medical professionals such as prominent scientist Alfred Russell Wallace, who argued against smallpox vaccination, citing a lack of evidence.
Protestors were well-organised, and their actions included paying fines, publishing pamphlets, and lobbying parliament – tactics still used by protestors for all causes today. Actions could also be more militant, such as lynching effigies of doctors and burning laws in the street. Protests were often hyper-local, reflected in the numerous Anti-Vaccination Leagues which sprang up. The Leicester Anti-Vaccination League was particularly active and arranged a large-scale demonstration in 1885, attended by anywhere between 20,000 and 100,000 people.
In 1898, some of the protestors’ demands were met. The government removed cumulative penalties and created a clause that allowed ‘conscientious objection’ from mandatory vaccination. Mandatory vaccination remains a controversial topic today, with national governments divided over the best approach.
While smallpox has now been eradicated, resistance to other vaccinations remain. In 2019, the WHO counted vaccine hesitancy among the top ten global health threats. Anti-vaccine protests still focus on issues of personal freedom, bodily autonomy, and the public good – but there is one key difference.
Previously, a much higher percentage of people suffered from smallpox (and other infectious diseases, such as measles), making it far easier to see the positive effects of vaccination in controlling epidemics. This is a central paradox of vaccination; once a vaccine has been highly successful in reducing a disease, it appears less necessary, as the disease becomes less of an active threat, and is perceived to be confined to the past. The impact of the coronavirus pandemic, however, remains devastating, widespread, and obvious; perhaps its visibility will offer some encouragement to those concerned about the vaccine.
- WEBSITE: The History of Vaccines
- BOOK: The Speckled Monster: A Historical Tale of Battling Smallpox – Jennifer Lee Carrell
- PODCAST: Smallpox: The defeat of the speckled monster (BBC World Service)
Jo Nayler is a writer specialising in history, health, food and development. Follow her on Twitter.