Louise Ryland-Epton is a Visiting History Fellow at The Open University. Louise's current research focuses on welfare legislation in a Georgian context and encompasses developments in local government and the interplay between the national and local state.
In this blog, Louise highlights the impact of smallpox in the eighteenth century, once the cause of around 400,000 deaths per year in Europe. She also shares the tale of how Edward Jenner, a doctor from Gloucestershire, discovered its vaccine.
Please be aware that this post contains a description of perinatal mortality, which some readers may find distressing.
One thing has not escaped my attention in researching the eighteenth century: the ever-present spectre of smallpox.
It was the most feared disease of the age, responsible for an estimated 400,000 deaths per annum in Europe, during a period when the population of the continent was only around 200 million. Smallpox was extremely contagious, and the risk of death once contracted was 1 in 3. Survivors could be made blind or at the very least extensively scarred.
While the disease is very different from COVID-19, there are also potential parallels. It was a constant presence and intermittent epidemic. It attacked both rich and poor. It had severe economic repercussions to individuals, families and the local resources of the state. There was no effective treatment, and it was recognised that the only way to defeat it was to stop people from contracting it in the first place.
In May 1785, during a sweltering summer, smallpox ‘raged with great violence’ through the area around the small Gloucestershire town of Painswick, in the south-west of England. The disease had already hit the town several times that century. Most significantly, this had occurred in 1714 and 1741, when those infected were consigned to a pesthouse at an extreme of the parish to try and stop them spreading the contagion further. It had also necessitated an overhaul in the organisation of the town’s local government to coordinate their response better. These measures had not proved satisfactory.
In 1785 the smallpox outbreak proved particularly virulent. Local people were fearful. To make matters worse, it followed a ‘contagious fever’ and ‘ague’ which had spread amongst the local population. This unidentified illness had caused the infected both fever and bouts of shivering. According to the local general practitioner, J.C. Jenner, it had made residents more susceptible to smallpox.
The vestry, a committee of local ratepayers responsible for the town’s local government, gathered on 22 May. They concluded it was ‘next to an impossibility to prevent contagion from spreading’. They, therefore, embarked on a courageous path, deciding ‘that it will be a public advantage to enter upon a general [mass] inoculation.’ The first vaccines had yet to be developed. Therefore, the method used by Jenner was to apply matter from the smallpox pustules of those who had fully contracted the disease to the skin or nasal passages of those who had not. The idea being the resulting infection would be milder than if the disease had been naturally contracted. The beneficiary would, after that, remain free from the disease for life.
This approach, which had been used by some English practitioners for several decades, had risks, not least the possibility of the recipient developing a severe case of the disease or passing the infection onto others. Consequently, after being inoculated, individuals needed to be quarantined. In other Gloucestershire towns, medical workers were discouraged or even prosecuted for inoculating their patients. But in Painswick people were desperate. Over a few weeks, Jenner inoculated 738 inhabitants against smallpox; both men, women and children, the old, sick, infants and heavily pregnant were among the number. In some cases, he was reticent because of the associated risk but administered the treatment.
Jenner was called on to provide medical assistance for the resultant fever and swellings of patients brought on by their inoculation, but just two individuals fully developed the disease. He reported that these patients had died, but in both instances, he ascribed this to other causes. The inoculation saved many potential lives that summer, but for one, the implications were lifelong.
Jane Parker was 27 and eight months pregnant. She was one of the first to undergo the treatment on 25 May. Despite some fever and swellings, Jane recovered well, and all seemed good. However, by July, she had not given birth, and Jenner became convinced her baby had died. A few days later, her baby was delivered, dead. Horrifically the infant's body was covered in gangrenous pustules; the inoculation may well have protected her against the disease, but it had been passed to her unborn child.
In the following decade, in another part of Gloucestershire, another general practitioner called Jenner was working. This doctor was Edward Jenner. Edward Jenner observed local milkmaids generally did not contract smallpox. They were, however, susceptible to cowpox, a similar disease which was much less virulent. He inferred that this provided crossover immunity to the smallpox virus. He successfully tested the hypothesis on the son of his gardener. This method of inoculation proved much safer than the traditional one, and the recipient was not required to quarantine themselves. Jenner’s discovery is the earliest example of a vaccination. In fact, the word ‘vaccine’ comes from the Latin word, vacca, meaning cow.
Smallpox was eradicated in the twentieth century, thanks to Edward Jenner’s vaccine. It has saved millions of lives. However, take-up was initially slow; then, as now, some doubted the effectiveness of such a practice or were fearful of its side-effects. Likewise, the elimination of COVID-19 will only be possible by the production of an effective vaccine. Thankfully, modern vaccines are developed much more quickly and effectively, and individuals no longer have to take risks, like Jane Parker, in trying to protect themselves. It is to be hoped the world does not have to wait much longer.
Most of the primary sources used for this piece are at the Gloucestershire Records Office. The records left by the Painswick vestry are very good and I was fortunate in that J.C. Jenner recorded his observations in The London Medical Journal, Vol. 7 1786, pp. 163-168. I have found no familial relationship between J.C. Jenner and Edward Jenner.
Photo credit: "File:Gloucester smallpox epidemic, 1896 Wellcome V0031470.jpg" licensed under CC BY 4.0