Is it better to be a milkmaid?
By: Lisa M Lane
Tags: Feminism, Vaccines, History, Disease, Medicine

Is it better to be a milkmaid?

In the early 18th century, Lady Mary Wortley Montagu would discover the inoculation process for smallpox while she was living in Turkey. She had lost a brother to the disease, and barely survived it herself. Smallpox in the 18th century was particularly virulent; the CDC says it averaged a 30% death rate for those who got it.

The inoculation was done using actual scabs from people who had smallpox, inserted under the skin through a cut. Lady Montagu had her son inoculated while in Turkey, and her daughter in England when she returned in 1721. She then campaigned to popularize the method in Europe.

But Edward Jenner gets all the glory, even today, because he developed a vaccine to replace the inoculation. Inoculation is an old idea — you take some likely material from a living victim of the disease, and put it in a person who hasn’t had it (similar to the convalescent plasma being tried today). But there is always a danger of actually giving the healthy person the disease. A vaccine uses a more benign substance to achieve the same immunity.

Many are taught that the discovery of the smallpox vaccine came out of the realization that milkmaids didn’t get smallpox. This was apparently because in leaning their cheek on the cow while milking, they acquired cowpox, a very mild disease. The cowpox antibodies protected them from smallpox.

There is a wonderful mythology around Edward Jenner and his 1796 vaccine. It’s based on the story of a milkmaid he met when he was a boy. She was bragging about her lovely skin that would never be scarred by the pox. Rather like the story of George Washington and the cherry tree, this tale was created by a later biographer. The real story is more ordinary. Nevertheless, milkmaids didn’t get smallpox.

In the early days of Covid-19, it was thought that an old vaccine for tuberculosis may have some value in helping with the current virus. The New York Times article said:

The B.C.G. vaccine has an unusual history. It was inspired in the 1800s by the observation that milkmaids did not develop tuberculosis.

The active ingredient of the Bacillus Calmette-Guerin vaccine is Mycobacterium bovis, which was isolated from a cow in 1908. It was made into a proven vaccine by 1911, and is today used in areas with high tuberculosis danger.

John Frederick Herring Sr, A Chat with a Milkmaid (1854), National Trust

Unlike the Jenner/smallpox tale, the story of BCG inspiration and milkmaids is harder to track down. There is no verifiable source, just popular/journalistic websites copying each other’s phrasing, to confirm the background of the discovery. The closest might be a 2008 Russian article saying that milkmaids and others close to cattle could carry a latent infection that gives a false positive for a tuberculin skin test. Did milkmaids never get tuberculosis, or is this a case of people just mistaking one apocryphal tale for another?

But we do know that Mycobacterium bovis is to Mycobacterium tuberculosis as cowpox is to smallpox — a similar, less deadly disease that protects against a more virulent one. The Lancet warns that it might not be effective against the current virus, and there might not be enough available, but it has helped people with similar respiratory diseases recover faster.

At the moment the vaccine field for Covid-19 is dominated by new methods, which get the glory and the contracts. Rather like Jenner upstaging Lady Montagu, inventing something completely new can mean abandoning older methods. But doing so is unnecessary, and can cause us to overlook new applications of old ideas. People were surprised when an older class of drugs, steroids, were helpful in Covid-19. It’s possible that vaccines now being tested which are produced the old-fashioned way (inactivated virus) will prove successful, but will get little glory. Not every medical solution involves innovative techniques. Sometimes it just means thinking differently about how to apply older substances or methods.

In these times when we look aghast at diseases caused by close human-animal contact (including Covid’s possible origin in bats), it’s good to know there might be benefits to such associations. Hanging out with cows provides protection to at least one, and possibly two, diseases. One does have to wonder whether milkmaids are safer in today’s world too.