Smallpox -it sounds innocuous enough, particularly when the great pox was syphilis, but historically, depending upon which population it affected it killed between a third and a quarter of its victims. Today we know it to be an infection but in the 17^th century even this simple fact was not recognised. The fact it was caused by a virus had to await until the 20^th century.[1]

The disease was characterised by the appearance on the skin of red spots which rapidly formed into pus filled ‘vesicles’. These could be so extensive that they could coalesce into massive blistered areas into which bleeding would occur, the skin’s normal functions would then cease and, as the disease also affected the internal organs, the patient would succumb.

Those that survived were usually scarred for life although they could not then catch the disease again. In a previous era death was not the worst thing that could happen to you , one of the principal concerns was that young men and women who survived the disease would be pock marked and this would affect their marriageability.

One woman, Lady Mary Wortley Montagu, was keenly aware of the problems of smallpox. Although she had married she had lost a brother to smallpox and had herself been pockmarked. Thus when on her travels in the middle east, she witnessed the Turkish practice of variolation, what we know call inoculation, she became immediately interested in it.

The process was not new and relied on the fact that the virulence of viruses can sometimes be attenuated or reduced by it’s passage through humans. What this meant was that the virus obtained from the pustules on an infected patient when introduced into the body of another person, resulted in a much milder disease.

The earliest use of this technique was known to the Chinese in the 10th century and was widely practised everywhere – except in Europe. Although it was safer than the natural disease inoculation had a potentially serious side effect in that in some people the virus was not attenuated and they developed full blown smallpox. The risk of this happening was low, about one in fifty recipients and was considerably lower than the risk of catching the natural disease. However there was a problem with inoculation as we will see.

The Overseer’s accounts book at Evershot records smallpox on several occasions,

Jane survived and appears in the records again in 1717 [the year when Mary Montagu witness inoculation in Turkey] when she was paid 10s 6d for her horse in another connection. 1715 was a bad year for smallpox in Evershot and several other individuals were affected,

Smallpox outbreaks tended to be episodic and so it is not until 1821 that the next outbreak occurred.

In this outbreak the fact that families were specifically mentioned makes you wonder whether this was in fact chickenpox or even measles with which smallpox was frequently confused. There was a then a 17 year gap before the next case but only ten years until the one after that. We must assume it was a different William Groves to the one above.

The final entry in the 18^th century accounts comes from 1785.

Precisely where James Pitcher was expected to go is not clear and if the reaction of the vestry seems harsh it is worth remembering the possible consequences of introducing the disease into the village. In 1818 a young woman was travelling from Yorkshire to Norwich when she caught the disease just before she entered the town. Norwich had been smallpox free for over 5 years when in account of the outbreak published in the Dorset County Chronicle,“it crept from house to house like a spark of fire along a trail of gunpowder.” Three thousand people caught the disease and five hundred died from it. What would you have done had you been the Evershot vestry?

There is now a thirty four year gap in the Overseer’s records which recommence in 1819. In March 1821 the following note was made in the records of the Overseer’s of the Poor. As it happened John Martin was one of the Overseers.

It has to be remembered that in the context of the 18^th and 19^th centuries the terms inoculation and vaccination apply specifically to attempts to prevent smallpox. The wider use of the word vaccination was as yet not known. To understand the difference we must turn to one of Dorset’s unsung hero’s, Benjamin Jesty.

Benjamin Jesty Snr. Wellcome Collection / CC BY (https://creativecommons.org/licenses/by/4.0)

Benjamin Jesty [Snr.] was born in Yetminster, Dorset in 1736 where he grew up and eventually owned a dairy farm.

At the time cattle occasionally suffered from another pox virus known as cowpox. This affected the cow’s udder but could be caught by a dairymaid when hand milking the cow. Fortunately, although it could cause a nasty localised disease, it did not produce the a generalised disease as was seen with smallpox. At some time in his career Jesty observed that two of his dairymaids, who had previously contracted cowpox, failed to develop smallpox when they nursed ill relatives with the disease. He was almost certainly not the first person to recognise this fact as a report in the Devizes and Wiltshire Gazette from 1829 noted that “In all the dairy counties, such persons were selected to attend as nurses those patients who were ill and dying of small pox it having been traditionally known that they were invulnerable to variolation [2]”. [my emphasis].

This fact had been noted and announced publicly in a talk ‘Cowpox and its ability to prevent smallpox’ given to the London Medical Society in 1765 by a doctor, John Fewster. The talk was never published and nothing very much happened amongst the medical fraternity until late in the 18^th century.

Jesty therefore has a claim to be one of the first, if not the first, people to conduct an experiment into the protective effects of cowpox.

In 1774 a smallpox epidemic broke out in the vicinity of Yetminster. He must have been aware of the principles of inoculation, even though it was not known how, or why, it worked. He was certainly aware of the hazards attendant on the procedure however, because instead of inoculating his son with smallpox fluid he chose instead to use the fluid from a cowpox blister.

His reasons for choosing to do this were not simply about concerns over the development of smallpox. He argued that by using cowpox material, “he avoided engrafting various diseases of the human constitution such as the evils, madness, “lues” and many bad humours.” In his views he was remarkably modern in his outlook, for there is of course a risk of transferring disease from one person to another. The reasons that he gives however – the bad humours- date back to the days of Aristotle and Galen in ancient Greece.

Using a darning needle Jesty scraped away some of the content of one of the blisters on a cows teat and inoculated himself, his wife and his sons Benjamin [Jnr] who was two years old and Robert who was three. None of them developed smallpox although all had sore inflamed arms. In many respects this was a remarkable experiment, not the least for the fact that a smallpox epidemic occurred at the same time as an outbreak of cowpox. The latter was a rare disease, Jesty himself “had only seen the complaint [cowpox]three times during his life” and he reckoned on an outbreak occurred every twenty three years or so.

When people learned of his experiment, Jesty was subject to much abuse and he was later to say, “That he was so laughed at and ridiculed by the inhabitants of the village for introducing a bestial disease into his family that he gave it up and thought no more about it.” Indeed he felt it necessary to move to Worth Matravers on the Isle of Purbeck.

Meanwhile in 1798 Edward Jenner published “An inquiry into the causes and side effects of the variolae vaccinae”. He had in effect repeated Jesty’s experiment – some 25 years later – and, as he got into print first, this traditionally marks him down as the inventor of vaccination against smallpox. The word vaccination now enters the language – the latin for cow is ‘vacca’ and vaccination was [at that time at least] the introduction of material from the cow into a human being. Jenner of course went on to fame and fortune by being considered the inventor of smallpox vaccination. Unlike inoculation vaccination now became fashionable and in 1803 Jenner established his own society, ‘The Royal Jennerian Society’ to promote the virtues of vaccination. He had a rival however. Dr George Pearson, at the time a famous London physician, was intensely jealous of Jenner so that when, in 1803, he learned of Jesty’s experiment from Jesty’s local vicar , the Revd. Andrew Bell, he leapt at the chance to do Jenner down. In 1805 Pearson brought Jesty and his son to London to the, ‘Original Vaccine Pock Institute” which he had established in opposition to Jenner.

Pearson now undertook his own experiment taking the opportunity to inoculate small pox in them both . Neither caught smallpox. Pearson reported this to the Edinburgh Medical Society who awarded Jesty a “pair of gold-mounted lancets, a testimonial scroll and 15 guineas for his expenses and commissioned the famous artist Michael Sharp to paint his portrait.”

Jenner meanwhile , having made smallpox vaccination his life’s work, went on to win a grant from parliament for his efforts of £30,000, or nearly £1.5m in today’s money,

Benjamin Jesty Snr. died in 1816 aged 79 and his wife Elizabeth erected a tombstone in Worth Matravers churchyard with the following inscription: “Sacred to the memory of Benjamin Jesty of Downshay who departed this life April 16th 1816 aged 79 years. He was born at Yetminster in this county and was an upright and honest man: particularly noted for having been the first person know that introduced the cowpox inoculation and who from his great strength of mind made the experiment from the cow on his wife and two sons in the year 1774.”

Meanwhile we must return to John Martin’s year in office as Overseer and the entry from April 1821.

Nearly a quarter of a century after Jenner wrote his paper on vaccination with the cowpox virus, English country doctors, it seems, were still using inoculation with smallpox. This was incredibly dangerous and was generally frowned upon.

In the middle east it had been found that dried scabs from survivors of smallpox was as effective as fresh pus in producing immunity. Moreover inoculaters had become highly skilled at introducing just the right amount of material to provoke an immune response but not to cause the disease. In the east smallpox was more or less endemic, minor outbreaks were common in most years, and there was a degree of what we now call ‘herd immunity’. Moreover because dried scabs [which could be stored] were used inoculation was carried out on a regular basis even when there was no general outbreak of the disease. As a result the risk of severe outbreaks of the disease following inoculation was reduced.

In Britain outbreaks of smallpox were sporadic and inoculation was often done by the untrained and on an irregular basis. As the material had to be introduced into small cuts in the patients skin we find, rather oddly, blacksmiths and “old women with their stocking needles” undertaking inoculation well into the 19^th century. Even when vaccination became available the uptake was limited and a correspondent to the Dorset County Chronicle in March 1828 lamented that the lower orders “hesitate and procrastinate until the smallpox surround their dwellings”. Moreover “at a moment so critical, mis-statements, ignorance and danger all combine to interrupt his [the vaccinators] progress by inflaming the slumbering prejudice of parents.”

One can only presume that this prejudice which did not seem to apply to inoculation, stemmed from the fact that the material used was derived from an animal. Inoculation survived despite the safer alternative and thus we find that at Poole in 1826 a major outbreak of smallpox occurred “in consequence of an unprincipled female having inoculated a great number of children”. Children were banned from the streets and the local elections were postponed because of the outbreak which seems to have lasted several months.

Doctor Hodges was not the only person to continue to inoculate. The Dorset County Chronicle was particularly outraged at an outbreak of the disease by the “improper practice of some gentlemen of the medical profession” who “cannot be too severely reprobated” by continuing the practice when a safer procedure [vaccination] was available. As late as 1838 non medical people continued to inoculate as in the case of a child who died at Askerwell in March of that year following inoculation by a blacksmith in February 1838. In 1842 during an outbreak at Salisbury several women were prosecuted for allowing material [pus] to be taken from their children to be used for inoculation.

In 1853 Smallpox vaccination of children was made compulsory in Britain but it would be another two hundred and twenty four years before the disease was abolished worldwide through a concerted vaccination programme. As smallpox only affects humans the disease has died out and cannot reappear. Unless of course the reserve stock of virus retained in the USA or Russia is ever accidentally or deliberately released back into the human population.

Categories: In Depth