Friday, September 25, 2020

The Romance of 18th Century Science: Smallpox!

 

"File:Portrait of Lady Mary Wortley Montague
Wellcome M0006755.jpg"
 is licensed under
CC BY 4.0
Smallpox was a dread disease in the eighteenth century. The fatality rate is estimated to have been between 20% and 60%, and higher still in infants. Those who survived were often scarred; some were blind. 

Dr. Parkins pretty much sums up the value of the treatments available for smallpox (The English Physician, 1810): Alkanet root “…is as gallant a remedy to drive out the small pox and measles as any is…” The practice of medicine still relied largely on the writings of the ancients, and trusted in the four bodily humors and astrology. 


But almost a century earlier, a woman contributed the first means of prevention of smallpox in England. Lady Mary Wortley Montagu is remembered for her letters and for pioneering smallpox inoculation. During a stay in Turkey with her husband, the British ambassador at Constantinople, Lady Mary learned of the Turkish folk medicine practice of inoculation for smallpox. Pus from a smallpox blister would be applied to a scratch on the arm or leg, resulting in a mild case of the disease. Lady Mary’s son was the first English person to undergo inoculation, Lady Mary having survived smallpox some years before. 

In 1721, she had her daughter inoculated during a smallpox outbreak in England, and Caroline, Princess of Wales, was persuaded to sponsor a test of the treatment. Seven condemned Newgate prisoners were offered the opportunity to accept inoculation to escape their sentence. All survived.

The same year, the Massachusetts Bay Colony city of Boston also suffered a smallpox epidemic. Cotton Mather, infamous for his role in the Salem witch trials, had read a journal article about inoculation, and had also heard about a slave’s boyhood inoculation. He convinced Dr. Zabdiel Boylston to perform an experiment in the practice, which was witnessed by Benjamin Franklin, who subsequently supported inoculation.

Jonathan Edwards, theologian and president of what would eventually be called Princeton University (best known for his sermon, Sinners in the Hands of an Angry God), underwent inoculation during the Princeton smallpox epidemic in 1757-1758. He was one of the unlucky ones whose resulting illness was severe and it led to his death.

In 1777, George Washington had all his soldiers inoculated as a precaution against the disease, typically a greater danger than the enemy—especially since the British troops had all been inoculated. Low Continental losses to smallpox may have contributed to the Revolution’s success.

Edward Jenner, born in 1749, was inoculated at the age of eight. At thirteen, he was apprenticed to a country surgeon and apothecary. Sometime during his training, he heard a dairymaid say, “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” 

Anecdotal reports among country folk had long held that dairymaids who had had cowpox did not get smallpox. Benjamin Jesty, a Dorset farmer, who vaccinated his wife and children during a smallpox epidemic in 1774 was only one of half a dozen amateur of science who had tested this idea. 

At the end of his apprenticeship, Jenner studied under a surgeon at St. George’s Hospital in London. John Hunter was interested in all forms of science and was an experimental scientist as well as being a respected surgeon. Jenner’s memory of the dairymaid’s words, and his training and friendship with Hunter very likely led to his experiment in May, 1796. He took matter from a dairymaid with fresh cowpox lesions and used it to inoculate a young boy, who contracted a mild case lasting for almost ten days. Two months later, the doctor inoculated the boy with fresh smallpox material. The child showed no effects, leading Dr. Jenner to conclude the cowpox inoculation was successful. 

In a letter of October 11, 1798, John Fewster, Surgeon, wrote to a fellow surgeon that during an attempt to inoculate for smallpox in his area thirty years earlier, he found a number of his patients could not be infected with even a mild case of the disease. After several attempts to inoculate him, a farmer who swore he had never had smallpox told Dr. Fewster, “I have had the Cow pox lately to a violent degree, if that' s any odds.” 

On further enquiry, Fewster found that those in whom inoculation had failed had all had cowpox, and he communicated this information to a medical society to which he belonged. An Inquiry Concerning the History of the Cowpox, Principally with a View to Supersede and Extinguish the Smallpox (London, England: J. Johnson, January, 1798).

In 1798, Jenner published An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox. His large scale 1799 survey connecting infection with cowpox to immunity to smallpox proved the efficacy of “vaccination” as he called it (from the Latin word vaccinus, meaning “from cows”). 
"Scalpels" by Thomas Fisher
Rare Book Library, UofT 
is licensed under 
CC BY 2.0

This was a significant step forward in medicine. Vaccination spread quickly in England and soon reached Europe as well. Of course, some opposed it as unnecessary, unsafe, or government interference. But between 1838 and 1842, deaths from smallpox plummeted from 1,064 deaths per million inhabitants to 168 deaths per million (https://www.statista.com/statistics/1107397/smallpox-death-rate-britain-historical/). Upticks and downticks in fatalities occurred throughout the rest of the nineteenth century, including a spike of 1,012 deaths per million in the epidemic of 1871. But with the exception of 1871, the trend was downward, until in 1900 there were only three deaths per million of population.

No comments:

Post a Comment