BEST MEDICAL INSIGHT
Pox Britannica

How a case of smallpox led to the most modern of medicines.
By JEROME GROOPMAN

Healing hand: A 1796 drawing of the milkmaid's cowpox blisters that were used to make the first smallpox vaccine.

n early 18th-century English society, the beauty and intelligence of Lady Mary Wortley Montagu inspired the admiration of royals and the poetry of Alexander Pope. In 1717, she fell ill with smallpox while living in Constantinople with her husband, England's ambassador to Turkey.

Highly contagious, the smallpox virus killed up to 40 percent of those infected and, since the time of the Roman legions, had ravaged armies, cities, entire populations. Lady Montagu survived, but her beauty did not: her face was severely scarred.

Soon after she recovered, Lady Montagu gave birth to a daughter. Assisting at the delivery was a Turkish physician, Dr. Emmanuel Timoni. Struck by his patient's disfigurement, he told her about a Turkish folk practice popular among women healers: they scratched young children with fluid from smallpox-infected blisters in order to induce lifelong immunity. Lady Montagu allowed Dr. Timoni to immunize her older child, a son, and upon her return to England, she had her daughter immunized as well. The new procedure was called variolation, from the Latin word for smallpox, variola.

Lady Montagu encouraged the Princess of Wales to variolate her two daughters. To assure herself of the safety of the procedure, the Princess first forced disenfranchised subjects -- several prisoners and an orphan -- to be variolated. When nothing untoward happened to them, she went ahead with the royal children. Over the next two decades, more than 800 people in Britain underwent variolation, including an 8-year-old boy named Edward Jenner.

Jerome Groopman is a physician and professor at Harvard Medical School.

About 10 percent of those variolated developed full-blown smallpox and died, and as a result, the procedure was not widely adopted; it was actually outlawed in several American colonies.

About half a century later, Jenner, by then a physician, turned his attention to a cure for smallpox. He was well aware of Lady Montagu and her experiments. Indeed, he was obsessed with the disease, having been traumatized by his variolation as a youngster.

Jenner did his surgical apprenticeship in the English countryside, where he heard anecdotes about milkmaids who had cowpox blisters on their hands and never caught smallpox.

In 1796, Jenner tried the first smallpox vaccine using pustular material from the palm of a milkmaid infected with the bovine virus. He first tried out the vaccine on his servants' children -- whom he then exposed to smallpox -- knowing that if the experiment failed and they became ill, he would suffer no retribution.

Jenner's experimental success signaled the first step in medicine's control over the microbial world -- one that led to the discovery of safe, inexpensive and effective vaccines. Progress in medical ethics, unfortunately, would be longer in coming.