Smallpox vaccination, the first successful vaccine in Western medicine’s toolkit, was developed by Dr. Edward Jenner in 1796 after he observed that milkmaids who had caught cowpox, or Variolae vaccinae, a much milder disease, never developed smallpox. Indeed, the term “vaccine” comes from the Latin word for cow. The term vaccine originally referred specifically to smallpox vaccination with the cowpox virus; in 1881 Louis Pasteur, to honor Jenner’s achievement, proposed applying the term generically to all protective inoculations.
But before there was Edward Jenner, there was Lady Mary Wortley Montagu.
Lady Mary, whose husband served as British ambassador to Constantinople, had occasion while living in Turkey to observe a practice called “variolation.” “Variolation” in some form - involving exposure to a weakened form of smallpox - had long been practiced in parts of China, India, Africa, and the Ottoman Empire, and it was clear to Lady Mary that the procedure was both safe and effective. Having lost a brother to smallpox, which claimed the lives of around 35% of its victims, and having herself been left severely and permanently scarred by the disease, she was prepared to use any means at her disposal to spare her children a similar fate. In 1718 she had her 5-year-old son variolated in Turkey; in 1721, after her return to England, she had her daughter variolated as well during a smallpox outbreak, thus introducing the practice to England.
I studied Lady Mary’s writings back in the 1970s, in the course of my research on autobiographies of 17th and 18th century English women. Lady Mary wasn’t a physician or a scientist, nor did she see herself as a medical pioneer. She was simply a devoted mother who used her keen powers of observation and the resources at her disposal to protect her children as best she could. She did exactly what most mothers, guided by the best information available to them, would do in her situation. As a noblewoman, she was also aware that her actions could influence British “fashion” and assumed her example would inspire other mothers to do the same in order to protect their own children - as indeed to some extent it did. (She was far less confident that the medical profession would adopt a practice that would reduce their revenue!)
Smallpox vaccination is one of the great successes of modern medicine. In fact, the last endemic case in the world occurred in Somalia in 1977, and no one in the US has been vaccinated since the early 1970s. This is one of the few instances in which not vaccinating is truly safer than vaccinating, since even the rarest or mildest of adverse reactions is unacceptable when the likelihood of anyone’s coming down with smallpox is essentially zero. So far smallpox is the only infectious disease ever to be eradicated. Other candidates such as measles and polio still elude eradication; unfortunately efforts to do so are hampered by campaigns inspired by politics, religion, or anti-science to undermine confidence in vaccination.
Selfie of my smallpox vaccination scar, almost faded but still visible on my upper arm. You will seldom see this telltale mark on people in their mid forties and under. Once my generation passes they will probably never be seen again.