1. What were the factors which led to the development of
vaccines for the treatment of disease?
The first significant step in the fight
against infectious disease was made in
1796 with discovery of a vaccine to
prevent smallpox by Edward Jenner.
Jenner had become aware of the fact
that milkmaids who had suffered from a
mild illness, cowpox, were unlikely to
catch the much more serious smallpox
disease. Jenner experimented on a
child, introducing cowpox into the
bloodstream. Later, the child was
inoculated with smallpox, but did not
catch the
disease. Jenner’s method had proved much safer
than the fashionable technique of inoculation, which
had been brought to Britain from Turkey by Lady
Mary Wortley Montague. Despite opposition from
the medical establishment, many of whom made a
good income from inoculation, the government
backed Jenner’s claims; by 1853, vaccination had
become compulsory for infants.
Letter from Lady Montague in Turkey to a friend in
England in 1717:
There is a set of old Women, who make it their business to
perform the Operation. Every Autumn, in the month of
September, when the great Heat is abated, people send to
one another to know if any of their family has a mind to
have the small pox. They make partys for this purpose,
and when they are met (commonly 15 or 16 together) the
old Woman comes with a nutshell full of the matter of the
best sort of small-pox and asks what veins you please to
have open'd. 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 venom
as can lye upon the head of her needle, and after binds up
the little wound with a hollow bit of shell, and in this manner
opens 4 or 5 veins.

2. Louis Pasteur was a French chemist who in 1861 was able to
demonstrate for the first time that germs caused disease. Pasteur
went on to develop vaccines for chicken cholera, anthrax and
rabies.
The new science of bacteriology was advanced further by a
German scientist, Robert Koch. Using microscopes and
innovative methods of staining germs, Koch was able to identify
specific germs as being responsible for the cause of disease. In
1882-3, he identified the microbes responsible for tuberculosis
(TB) and cholera.
A rivalry developed between Pasteur and Koch, based
in part on the tension which existed following France’s
defeat in the Franco-Prussian ware of 1870-1. Both
scientists were recognised in their own countries for
their works, and set up with research centres. In 1881,
Pasteur, successfully trialled a vaccine which protected
against anthrax in animals. Koch, who quickly heard of
the breakthrough by telegram, attempted unsuccessfully
to discredit Pasteur. When, in the following year, he had
the opportunity to treat a boy with rabies called Joseph
Meister, Pasteur succeeded in developing a rabies
vaccine.
Think about this:
• Although rivals, Koch and Pasteur were helped by each other’s
discoveries
• There was a gap of nearly 100 years between the key discoveries of
Jenner and Pasteur
• Smallpox was an epidemic disease in the 18th century; now it has been
eradicated worldwide
A James Gillray cartoon from 1808,
showing Edward Jenner, working at the
Smallpox Inoculation Hospital in St
Pancras. The cartoon was entitled the
‘Wonderful Effects of Inoculation’.

3. The Fight Against Disease 1750-1900
How smallpox was wiped out
Context
Smallpox was a major killer disease. It was responsible for over 10% of all
deaths until the mid 18th century. It was highly contagious. Survivors were badly
disfigured by pockmarks and sometimes became blind, deaf or lame.
Tasks (based on pages 116-119 in the medicine Through Time text book).
1. Describe how inoculation was used to help protect people against
smallpox
2. Explain how Lady Mary Wortley helped to bring about medical change in
the 18th century Britain.
3. Explain why many doctors and the Royal Society at first opposed Jenner’s
findings when they were published in 1798 (page118).
4. Describe how the British government helped to support the work of
vaccination against smallpox, using the following dates 1802, 1806, 1840,
1853 and 1980.

4. Lady Mary Wortley Montague (1689-1762)
Most developments in medicine come about as a result of research or
observation by doctors over a period of time. But occasionally someone
completely outside the medicine plays an important part.
Who was Lady Montague?
Lady Montague was the wife of the British Ambassador
Extraordinary to the Turkish Court. She was a keen
writer of letters and in one of her letters to a friend in
England, she described the process of inoculation. This
was used to protect patients against smallpox in
Istanbul. On her return to England she helped
popularise this practice.
Why did she become well known?
Lady Montague had survived a dose of smallpox
herself – it left her face scarred and without eyelashes.
In 1718, while in Istanbul, she decided to have her three year old son inoculated
so that he would not suffer the same fate. Inoculation involved taking matter from
a smallpox scab and spreading it onto an open cut on the person being
inoculated. This would give them a mild dose of smallpox, but they would then be
protected from the full dose that could prove fatal. Three years later Lady
Montague returned to Istanbul and insisted that her English doctor inoculate her
five year old daughter.
How did she bring medical change?
Lady Montague was able to persuade friends, who were doctors in England, of
the benefits of inoculation. She was a leading member of London high society
and through her campaigning about the benefits of inoculation it became the
fashionable thing to do. During smallpox outbreaks in the 18th century
inoculations became common, although it was an expensive process and
therefore only available to the rich. Smallpox was still a fatal disease, but
inoculation reduced the likelihood of dying from it.
How important was Lady Montague?
Inoculation was bit the complete answer to smallpox this came about as a result
of compulsory vaccinations. The risks were great and many people died, but it
led people to think that maybe diseases could be defeated. Lady Mary Wortley
Montague was not a major pioneer in medicine, but she did show the medical
profession that progress could come from unlikely quarters.

5. Edward Jenner (1749-1823)
Smallpox took over from the bubonic plague as
the major killer disease in the 18th century.
Many died and those who survived were left
severely disfigured or blind. Inoculation was
used as a method for gaining immunity that
involved spreading matter from a smallpox
scab onto an open wound. This would result in
a mild dose of the disease that would give
immunity to any further attacks, this was first
promoted by Lady Mary Wortley Montague.
However, inoculation was not without risk as
some people died from this mild dose or
became carriers of the disease.
Who was Edward Jenner?
Edward Jenner worked as a doctor in the village of Berkeley in Gloucestershire.
He found that when he tried to inoculate some of the local people they refused.
This was because they believed that if they had suffered from a mild form of
cowpox, a disease that affected cattle, they would be immune from catching
smallpox.
A picture of the arm of Sarah Nelmes, a 13 year old
milk maid who was suffering from cowpox. Jenner
used pus from her sores to inoculate James Phipps an
8 year old boy.
What did Jenner discover?
By observing local milkmaids, Jenner tested
whether the belief that cowpox sufferers were
actually immune to smallpox was true. On 14th
May 1796 he conducted an experiment by
scraping pus from a cowpox sore on the arm of a
milkmaid and inserting it into two cuts on the arm
of a young boy. On 1st July 1796 he did exactly the same with pus from a
smallpox sore. The boy caught cowpox, but did not catch smallpox. After
conducting this experiment on 23 different cases he concluded that those who
had suffered cowpox were indeed immune to smallpox. Jenner called this new
method ‘vaccination’ which means ‘from a cow’ as a way of distinguishing it
from the process of ‘inoculation’.

6. What Medical changes did Jenner bring about?
In 1798 Jenner published his findings and submitted them to the Royal Society
who refused to publish them because of opposition to vaccination from doctors.
Doctors opposed vaccination because they were suspicious of new ideas and
were accustomed to using inoculation. However, Jenner did have some support
as members of the Royal Family were vaccinated and vaccination became widely
accepted abroad. In 1802 he was awarded a grant of £10,000 by the government
and then a further £20,000 in 1806. Vaccination became free for all infants in
1840 and became compulsory in Britain in 1853 and in 1980 the World Health
Assembly declared that smallpox had been eradicated throughout the world.

7. How was an effective way of preventing smallpox
developed?
Before Jenner
Smallpox was a terrible disease because…..
A way of preventing people getting smallpox had been around for
ages…..
The method worked because…..
In 1721 the method was introduced into England…..
People used to make money from it…..
But there were two problems with the method…..

8. Jenner’s Advance
Jenner was a doctor from Gloucester. He used to inoculate people
against smallpox he noticed that…..
This made him think that…….
Jenner did an experiment…….
Jenner’s idea worked because.. (though he did not know this)
Jenner called his new method……