page_title: History of smallpox
section_title: Europe
hierarchical_section_title: History of smallpox / Eradication / Variolation / Europe
caption_attribution_description: Detail of Lady Mary Wortley Montagu with her son, Edward Wortley Montagu, and attendants. See source website for additional information.
context_page_description: The history of smallpox extends into pre-history, with the disease probably emerging in human populations about 10,000 BC. The earliest credible evidence of smallpox is found in the Egyptian mummies of people who died some 3,000 years ago. Smallpox has had a major impact on world history, not least because indigenous populations of regions where smallpox was non-native, such as the Americas and Australia, were rapidly decimated and weakened by smallpox during periods of initial foreign contact, which helped pave the way for conquest and colonization. During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness. Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.
  During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths. In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year. As recently as 1967, the World Health Organization estimated that 15 million people contracted the disease and that two million died in that year.
context_section_description: In 1713, Lady Mary Wortley Montagu's brother died of smallpox; she too contracted the virus two years later at the age of twenty-six, leaving her badly scarred. When her husband was made ambassador to Ottoman Empire, she accompanied him to Constantinople. It was here that Lady Mary first came upon variolation. Two Greek women made it their business to engraft people with pox that left them un-scarred and unable to catch the pox again. In a letter, she wrote that she intended to have her own son undergo the process and would try to bring variolation into fashion in England.  Her son underwent the procedure, which was performed by Charles Maitland, and survived with no ill effects. When an epidemic broke out in London following her return, Lady Mary wanted to protect her daughter from the virus by having her variolated as well. Maitland performed the procedure, which was a success. The story made it to the newspapers and was a topic for discussion in London salons. Princess Caroline of Wales wanted her children variolated as well but first wanted more validation of the operation. She had both an orphanage and several convicts variolated before she was convinced. When the operation, performed by the King's surgeon, Claudius Amyand, and overseen by Maitland, was a success, variolation got the royal seal of approval and the practice became widespread. When the practice of variolation set off local epidemics and caused death in two cases, public reaction was severe. Minister Edmund Massey, in 1772, called variolation dangerous and sinful, saying that people should handle the disease as the biblical figure Job did with his own tribulations, without interfering with God's test for mankind.  Lady Mary still worked at promoting variolation but its practice waned until 1743.
  Robert and Daniel Sutton further revived the practice of variolation in England by advertising their perfect variolation record, maintained by selecting patients who were healthy when variolated and were cared for during the procedure in the Sutton's own hygienic hospital. Other changes that the Suttons made to carrying out the variolation process include reducing and later abolishing the preparatory period before variolation was carried out, making more shallow incisions to distribute the smallpox matter, using smallpox matter collected on the fourth day of the disease, where the pus taken was still clear, and recommending that those inoculated get fresh air during recovery. The introduction of the shallower incision reduced both complications associated with the procedure and the severity of the reaction. The prescription of fresh air caused controversy about Sutton's method and how effective it was in reality when those inoculated could walk about and spread the disease to those that had never before experienced smallpox. It was the Suttons who introduced the idea of mass variolation of an area when an epidemic broke out as means of protection to the inhabitants in that location.
  News of variolation spread to the royal families of Europe. Several royal families had themselves variolated by English physicians claiming to be specialists. Recipients include the family of Louis XV following his own death of smallpox, and Catherine the Great, whose husband had been horribly disfigured by the disease. Catherine the Great was variolated by Thomas Dimsdale, who followed Sutton's method of inoculation.
  In France, the practice was sanctioned until an epidemic was traced back to an inoculation. After this instance, variolation was banned within city limits. These conditions caused physicians to move just outside the cities and continue to practice variolation in the suburbs.
caption: Lady Mary Wortley Montagu with her son, Edward Wortley Montagu, who was variolated in March, 1718 by Dr. Charles Maitland[106]
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