Secondary Resources 4 - Smallpox in the 18th Century

A sick man in bed, attended by a physician, and surrounded by members of his family weeping and praying

The Speckled Monster

By the 18th century, smallpox in Britain was at its height.

The great Victorian historian Lord Macaulay described smallpox as “the most terrible of all the ministers of death”:

“The smallpox was always present, filling the churchyards with corpses, tormenting with constant fear all who it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden the objects of horror to the lover.”

Two examples illustrate the severity of the disease. In London, in the decade from 1760 to 1770, 25,000 people died of smallpox, out of a total death toll of 250,000 – which means that smallpox accounted for a tenth of all deaths.

(Right) A sick man in bed, attended by a physician, and surrounded by members of his family weeping and praying. © The Wellcome Library, London In Glasgow, from 1783 to 1800, the figures are even moredramatic. Smallpox accounts for 6,000 out of 31,000 deaths,almost a fifth of the total.


Queen Mary II, who died of smallpox in 1694

Royal victims

Smallpox was famously a disease of ‘princes and paupers’, and the royal dynasties of Europe were particularly badly hit. In the first eight decades of the 18th century, smallpox killed an Austrian emperor, a king of Spain, a tsar of Russia, a queen of Sweden, and a king of France.

In 1721, the Princess of Wales, Caroline of Ansbach, inoculated the royal children against smallpox (see module ‘Experiment in Newgate’). It was a risky thing to do. But Caroline was all too aware of the devastating impact of smallpox on England’s ruling elite. During the previous six decades, Charles II’s brother and sister were both killed by smallpox. His nephew, King William III, suffered smallpox; and William’s wife, Queen Mary, died of it. William’s successor Queen Anne caught smallpox and survived, but her son Prince William, the heir to the throne, died – bringing the Stuart line to a close.

(Right) Queen Mary II, who died of smallpox in 1694. Oil painting by Sir Peter Lely. © unknown



Sir Hans Sloane, 1660-1753.

Treating the Speckled Monster

By the early 18th Century, a range of treatments existed for smallpox, reflecting the contrasting ideas in circulation as to what caused the disease. Smallpox was blamed on ‘miasma’ – bad air. It was blamed on excessive diet. It was blamed on ‘animalculae’, or venomous corpuscles.

(Right) Sir Hans Sloane, 1660-1753. © Lodestar Sir Hans Sloane, the Chairman of the College of Physicians, treated smallpox by proscribing crabs’ eyes, oil of scorpions, or fifty live millipedes in a glass of water.

More effectively, isolation and quarantine became common. Ships arriving from distant ports would often be carefully inspected before crew and cargo could disembark, and sick passengers were segretated. Townspeople tried to avoid, or even expel, smallpox-infected people from their midst, trying to cut short the disease cycle. But such attempts at public health enforcement were erratic and mostly ineffective.




Lady Mary Wortley Montagu and her son Edward, in Turkey

Lady Mary Wortley Montagu

In 1716, Lady Mary Wortley Montagu travelled to Turkey as wife of the British Ambassador, and she published a series of letters describing her experiences there. Letter 36 describes the Turkish practise of inoculating against smallpox by ‘engrafting’ - inserting a small dose of smallpox matter into the arm:

“… People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) 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. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can lie upon the head of her needle…”

Lady Mary Wortley Montagu and her son Edward, in Turkey, with attendants. © National Portrait Gallery Inoculation – deliberately inducing a mild form of the disease, in order to build up the body’s immunity system – was a widespread treatment for smallpox in ancient Chinese, Indian and African cultures. In China, a dried powder composed of smallpox skin crusts harvested from a current disease victim was inhaled by others, like taking snuff.

Lady Mary was the first to introduce the practise into Britain. She inoculated her own children, and influenced the Princess of Wales to do the same.



Sir Robert Blackmore’s dissertation on “the modern practice of inoculation”

Inoculation in 18th century Britain

Despite the success of the first trials of inoculation in Newgate Prison in 1721 (see module ‘Experiment in Newgate’), inoculation (or ‘variolation’) was not widely adopted in Britain until the 1750s.

The practice was slow to catch on because it was so risky. The Royal Society ran trials from 1721 to 1728, resulting in 17 deaths in 858 successful inoculations. That’s a death rate of one in fifty. Far better odds than defeating full-blown smallpox caught naturally – but a serious risk for a voluntary medical procedure.

Sir Robert Blackmore’s dissertation on “the modern practice of inoculation”, 1723. © The Wellcome Library, London The most successful ‘variolators’ in the second half of the 18th century were the Suttons, father Robert and son Daniel. Robert opened an ‘Inoculation House’ in Ignatestone in Essex, which became a centre for inoculations in England.

They were great self-publicists, so it’s hard to trust their word, but Robert claimed to have inoculated 2514 patients in eleven years without ever losing a case. He was dismissed as a quack, but actually did well out of sound sense and good medical practise. He selected persons who were fit and well as subjects for inoculation; he built up their resistance and reserve by a period of rest and diet before the operation, and the conservation of that reserve by a period of good care afterwards; he used only a minute amount of the virus, from the vesicle rather than the pustule; and he lessened the risk of secondary infection by inserting the virus obliquely between the epidermis and true skin, not cutting into true skin or drawing blood.

When others began copying his techniques he made a fortune by selling his know-how in a franchise operation, claiming a half-share of the profits of doctors using his techniques.




The Reverend Cotton Mather, the first enthusiastic advocate of inoculation in the North American colonies.

Inoculation in North America

The first smallpox inoculations in North America were carried out in the same year as the Newgate experiment in Britain.

The Reverend Cotton Mather learnt of the practise from his African slave, Onesimus. Mather promoted the idea vigorously during the Boston smallpox epidemic of 1721. But he encountered strong opposition. The fear was that inoculation would cause the disease to spread even more widely, because for a fortnight after inoculation the patient is contagious, and can pass on full-blown smallpox to others. Without a period of enforced quarantine, inoculation can do more harm than good.

The Reverend Cotton Mather, the first enthusiastic advocate of inoculation in the North American colonies. © Lodestar Many of the American colonies passed laws to prohibit or tightly regulate inoculation, so the practise was less common than in Britain. In the Revolutionary Wars, smallpox became a serious problem for the colonial troops, and George Washington (himself a victim of smallpox) overcame his scruples against inoculation and instituted a wide-scale programme of inoculation for all new recruits.