The pandemic with the highest mortality rate in the era before the 18th century was smallpox. 

In England. 10% of deaths were due to the infection. 

It had been known in ancient China, India and Africa and may have reached Greece and Rome in classical times. It certainly affected the Crusaders, who brought it home to Europe in the 1100s, where it became endemic.

In the 1720s, Cotton Mather observed that one of his slaves was immune to the disease. The slave who originated from Libya explained that in Africa it was tribal custom to intentionally infect children with a small scratch on their arm applying with pus from an infected person to ward off the disease.

Almost simultaneously, Lady Mary Wortley Montagu, the wife of a British Ambassador to Turkey whose facial beauty had been destroyed when she survived the disease learned that the Ottoman Turks had adopted a similar practice that was equally effective.

She adopted the idea to protect her son, and a couple of years later persuaded Princess Caroline to try it on the royal children.

The disease is horrible and deadly, producing rashes, horrible seeping pustules across the face and body, dreadful cramps, blindness and often death. Survivors bore permanent scars. and were often mutilated and blind.

In Glasgow between 1783 and 1802 it accounted for a third of child deaths. The situation was at least as bad in Russia, and across the century in Europe alone it may well have accounted for sixty million deaths.

In China, India and Africa they had discovered that by giving someone a small dose of smallpox could bring on a mild attack, which would stop them getting the full-blown disease later.

The adoption the solution by the Royals generated controversy in Britain and America.

The inoculation was not foolproof and the mortality rate after treatment was 3-5 percent. 

English doctors and cartoonists mocked lady Mary claiming that is was a foreign plot to kill English babies. 

The mortality rate was exacerbated by the method of application. Sterilisation of instruments was yet to be discovered, and the preparation of children for inoculation included several weeks of starvation to weaken the constitution – the exact opposite of what we now know allows the immune system to work. 

One eight-year-old child who went through the ordeal in smallpox-ravaged Gloucestershire later complained that he had been reduced to a skeleton and never slept well afterwards. His name was Edward Jenner.

He became determined to become a doctor in Gloucestershire. 

During his rounds he was told of a local folk-tale. Apparently, milkmaids sometimes caught a bovine version of smallpox, called cowpox. Once they had been infected with this much milder disease, it was said, they were immune for life from the great scourge.

Hearing that a farmer’s daughter, a milkmaid called Sarah Nelmes, had contracted cowpox in the village of Berkeley in Gloucestershire, on 14 May 1796 Jenner persuaded her to let him take some matter from her sores, and keep it. He then cut the arm of a boy called James Phipps, the son of a local labourer, and infected him. Young Phipps duly went down with the milder disease. Once he had recovered, on 1 July Jenner cut him again and tried to infect him with the smallpox material. James failed to catch the disease.

He wrote up a pamphlet announcing the success of his experiment. Jenner was well connected the the news went viral – or at the least the 18th century equivalent.

in 1804 Napoleon had a medal cast to honour Jenner, then had his armies inoculated.

But the discovery was also attacked. Ignorant cartoonists mocked the notion of infecting people with stuff from cows. Doctors warned that nothing good would come of it. 

Another famous intellectual of the age, Thomas Malthus, included a blast against Jenner in the second, 1806, edition of his famous book warning against overpopulation. For Malthus, the death-toll caused by smallpox was a good thing, keeping the population numbers down naturally.

Arguments delayed the necessary legislation in many countries, including Britain, till later in the nineteenth century. Smallpox continued to kill, blind and maim people across the world well into the twentieth[1]Marr, Andrew. A History of the World (pp. 485-492). Pan Macmillan. Kindle Edition.

Fortunately at the time, there was no FDA, CDC, WHO, the FOPH, and Big Pharma. If they had existed then, the idea would never have seen light of day, and we would have a host of drugs with warning labels detailing the side effects, all claiming to have solved the pandemic.


1 Marr, Andrew. A History of the World (pp. 485-492). Pan Macmillan. Kindle Edition.