While the world awaits the rollout of the vaccines for COVID-19, it is interesting to consider how contagious diseases affected society in the past – and how popular imagery at the time reflected concerns surrounding new treatments.
Whereas the Black Death was the conduit to develop ideas on quarantine, smallpox was the first disease to be managed using vaccines. While the earliest known descriptions of smallpox are found in Indian texts from 1500 BC, the disease reached pandemic status – meaning it had spread almost everywhere in the world – by the mid-eighteenth century.
In Europe, smallpox was a leading cause of death, killing an estimated 400,000 people each year. Smallpox killed 30 per cent of those who caught it, and those who survived were sometimes left blind.
Browsing photographs and medical illustrations of sufferers, you can't help feel sympathetic itching – the final stages of the disease caused gruesome fluid-filled bumps on the skin with a hollow in the centre, which scabbed up and caused permanent scars. The first symptoms were fever and vomiting, followed by mouth sores and rashes.
Transmitted in a similar way as coronavirus, smallpox was spread through droplets sprayed from the nose and mouth, and it did not discriminate: it was highly contagious, impacting rich and poor alike.
One such sufferer, Lady Mary Montagu, daughter of the Duke of Kingston-upon-Hull, lost her brother to the disease prior to her own infection. Lady Mary survived, but the distinctive scars marked her face permanently (though these marks were not included in her portraits). Having first-hand experience of smallpox likely influenced Montagu's later work as a pioneering advocate for a process known as inoculation or variolation.
As described in detail in another story on Art UK, Lady Montagu and her husband spent time in Constantinople (modern-day Istanbul) as he was the British Ambassador to the Ottoman Empire. Her status and gender allowed Lady Montagu to socialise with women of the harem of Sultan Ahmed III.
Aside from learning their language and political gossip, Lady Montagu became aware of the Ottoman technique for managing smallpox, effectively introducing pus to a healthy patient's blood. She wrote in 1717:
'The small-pox, so fatal, and so general amongst us, is here entirely harmless by the invention of ingrafting... the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened.'
Lady Montagu was so impressed with the procedure that she had her own young son inoculated, and then her remaining children – including her daughter Mary as a demonstration back in London. Her campaigning served to popularise the process.
As a rare example of a woman making an impact in early medicine, we might lament that Lady Montagu isn't popularly remembered. Yet there are also examples of people that worked to fight 'the pox' who do not commonly get as much recognition as those who followed.
It is difficult to credit one single person with the discovery of inoculation. In centuries past, healthcare was not as restricted to 'professionals' only: housewives, barbers, clergymen and all kinds of people practised medicine.
John Williamson, or 'Johnnie Notions', as he was known, was a self-taught physician working in eighteenth-century Shetland – which was routinely ravaged by smallpox. The sparse population had little immunity, and so approximately every twenty years a returning plague would kill off huge quantities of them.
Held in the highest regard by his clients, Notions introduced inoculation to the islands, and apparently never lost a patient. His technique involved drying smallpox pus, burying it between glass sheets for up to eight years, and then placing the matter into a shallow cut on the patient's skin.
This head was made by Notions as a wig block, modelled on one of his patients – the wood he found was marked with facial scarring similar to that caused by the pox.
Another unsung pioneer in the battle against smallpox was a Dorset farmer, Benjamin Jesty.
This portrait was commissioned by a group of doctors in 1805 in honour of his work.
In eighteenth-century farming communities, it was commonly known that milkmaids, and other people who worked closely with cattle, could often nurse smallpox sufferers without becoming badly infected themselves. This knowledge may also have contributed to the prevailing stereotype that milkmaids were comely young maidens with fresh, rosy complexions.
Catching cowpox – from infected sores on cows – seemed to prevent a person from getting smallpox. The diseases were similar, but smallpox much more aggressive and deadly.
Benjamin Jesty and his staff had caught cowpox before, but his wife and sons had not. With the arrival of a smallpox outbreak in Dorset in 1774, Jesty took his family to a farm and scratched their arms with a darning needle that had been poked into cows' pox pustules. Though Jesty was reputedly mocked and harangued by his neighbours for this, his family never did catch smallpox.
Where inoculation was common in many cultures in history, it is still a fairly risky process – as it involves introducing live smallpox matter to the body of a healthy person. Jesty instead demonstrated the idea of vaccination as we know it: introducing a weakened version of the pathogen (such as cowpox). The immune system 'remembers' the virus, and so the body is better prepared to fight the deadlier version, if it comes along.
Popularly credited with developing vaccines as we know them today was Dr Edward Jenner, though Lady Montagu, Jesty and Williamson – and perhaps countless others – were working just before him.
Born in 1749 to a large family in Berkeley, Gloucestershire, Jenner had a good education, though he was orphaned at age five and sent to live with his brother. As a schoolboy, Jenner received the smallpox inoculation, and at 14 became apprenticed to a surgeon.
Jenner continued to improve his scientific knowledge and was elected to the Royal Society in around the age of 40 for his studies of nesting cuckoos. He proved that, after adult cuckoos lay their eggs in other birds' nests, the hatched young chicks have indentations on their backs which help them to push out the original eggs. While this study work seems surprisingly unrelated to vaccination, it demonstrates Jenner had a broad understanding of biology.
In 1796, approaching his 50s, Edward Jenner diagnosed milkmaid Sarah Nelmes to have contracted cowpox, from a cow called Blossom. (The painting above is possibly by Edward Jenner's elder brother, Reverend Stephen Jenner.)
He took pus from Sarah's hands and scratched the material into the eight-year-old son of his gardener, James Phipps, who became immune to smallpox.
Further tests proved successful, including those on Jenner's own son, and the surgeon promoted his findings and achieved significant fame for his vaccination technique.
The process was named vaccination, from the Latin for cow ('vacca') in Jenner's (or Blossom's?) honour. In the same year, in Russia, Catherine the Great bestowed the name 'Vaccinov' to the first child to receive the vaccine.
However, Jenner's life was not all smooth sailing after he published his discoveries. He faced some objection from fellow medical professionals, as many faced income loss if smallpox was to be completely cured. Also his cowpox samples were difficult to share (and often became contaminated).
As Jesty was targeted by his neighbours, Jenner and his 'Cow-Pock' treatment were often the subjects of rumour, ridicule or attack.
This print after the popular caricaturist James Gillray shows a chaotic scene of patients developing strange cow-like tumours, horns and even giving birth to calves. The image both conveys and ridicules the ill-informed worries surrounding the new procedure.
Members of the Berkeley local research ethics committee expressed their concern for 'interfering with the natural order' and injecting animal material into a person: 'It is unnatural and might it not introduce animal spirits?'
Despite this opposition, Jenner continued to work towards eradicating smallpox for the rest of his life, spending vast amounts of time as the 'Vaccine Clerk to the World', running a clinic housed in what was dubbed the 'Temple of Vaccinia', a hut in the grounds of his home (now a museum).
Jenner was compensated by the government with various grants and his hard work and recognition during his lifetime cemented his long-term status as the 'Grandfather of Vaccination'.
He was eventually appointed physician to George IV in 1821, and continued his natural history work too, presenting 'Observations on the Migration of Birds' to the Royal Society in 1823, the last year of his life.
In what is perhaps the most triumphant testament to the legacy of Jenner, and all those who worked tirelessly to combat the disease over centuries, smallpox was declared eradicated in 1980 by the World Health Organisation.
There are samples of the disease that exist in labs, forgotten archives and potentially underneath melting permafrost(!) – in March 2004, smallpox scabs were (rather disgustingly) found inside an envelope tucked into a book in Santa Fe. However, the last natural case of smallpox occurred in Somalia in 1977.
Visual culture relating to historic diseases can be nausea-inducing or lampoon silly ideas circulating at the time, but more often than not, it captures the celebratory thrill of scientific advances.
These images convey the reassuring belief that what seems incurable and devastating can one day be managed.
Today, the world waits, eager to celebrate the new scientific pioneers responsible for eradicating COVID-19.
Jade King, Head of Editorial at Art UK
Thomas Hager, 'How One Daring Woman Introduced the Idea of Smallpox Inoculation to England', Time, 2019
Stefan Riedal, 'Edward Jenner and the history of smallpox and vaccination', Proceedings (Baylor University, Medical Center), Vol. 18, 1, 2005, pp. 21–25