"An enlightened turn": how medicine (and the vaccination) developed in 18th-century Britain
With industrialisation making living conditions worse in the cities, the improvements to hospital provision, surgery and the care of the poor needed to gain apace. Emma Slattery Williams explores how healthcare in 18th-century Britain changed, and the pioneering preventative treatments that helped combat a killer disease...
By the late 18th century, Britain was seeing the beginnings of the Industrial Revolution, a process that eventually led to a huge migration of people to industrial cities, with widespread overcrowding and unsanitary living conditions. Drinking water was often contaminated with raw sewage, rubbish rotted in the streets, and crowded living conditions meant disease could easily spread. As many as one in five children died before their second birthday.
There was, however, growing institutional provision for curing the sick and the number of hospitals grew in Britain – some of these were run by local parishes, while others were founded by philanthropists wishing to help the poor and perhaps improve their own social position in the process. In return for an annual contribution, a benefactor could recommend a sick person for admission to hospital.
“The notion was that you could intervene and save working class people who might otherwise die for lack of healthcare,” explains Mary Fissell, professor of the history of medicine at Johns Hopkins University. “It was part of a larger, almost mercantilist, view of the health of the population being a significant variable for government.”
The 18th century also saw improvements in surgery. Surgeons such as William Cheselden, Percival Pott, and John Hunter delved into anatomical studies, diagnosing new diseases, and inventing new procedures. In 1745, the Company of Barber Surgeons was divided into two separate bodies by an act of Parliament, thus forming the Company of Surgeons, a body that formalised the training and licensing of surgeons and which today is known as the Royal College of Surgeons.
Dispensaries began to be established – these provided what we might today class as outpatient medical treatment and advice, solely for the poor and free of charge. By 1800, about 40 dispensaries had been founded across Britain. Professor Fissell explains: “In 18th-century Britain, we see a growth in the institutional provision of healthcare that simply hadn't been seen before. For the first time, working people who could never have afforded healthcare previously could now access it in a new way. We can also see something similar in the workhouse infirmaries of the Old Poor Law at this time.”
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It is this preventative rather than reactive approach to healthcare that remains a legacy of 18th-century medicine, Professor Fissell continues. “I see this as part of an enlightened turn towards the belief that things could be made better. It was a realisation that it was possible to prevent people from dying of disease and illness, and that's really radical.”
One of the deadly diseases that was rife in the early 18th century was smallpox, characterised by its distinctive, progressive skin rash; outbreaks killed millions of people all over the globe. In 1715, Lady Mary Wortley Montagu – one of the most celebrated aristocratic women of the time – caught smallpox but survived, although the disease left her scarred. Her brother William had died from the disease in 1713, aged just 20. The following year, Lady Mary and her husband, Britain's new ambassador to the Ottoman empire, moved to Constantinople.
There, she discovered the widespread use of variolation (inoculation): individuals were deliberately infected with smallpox (often by blowing dried smallpox scabs into the nose) after which they contracted a mild form of the disease. After recovering, the individual would usually be immune to smallpox – some estimates state that 1–2 per cent of those inoculated died, compared to 30 per cent who died after contracting the disease naturally.
Lady Mary's children were inoculated and once back in England, in 1721, she publicised the benefits, facing resistance and scepticism. Undaunted, she convinced Caroline, then Princess of Wales, of the value of inoculation and it was tested on prisoners, all of whom survived. Physicians began to inoculate their patients, but devised elaborate and costly procedures to make sure the body was prepared, ensuring that only the well-to-do were protected. By the late 18th century, mass inoculations with no preparation were on offer, and ultimately Lady Mary's efforts paved the way for the work of Edward Jenner.
Edward Jenner and the world's first vaccine
As a child, Edward Jenner (1749-1823) was inoculated against smallpox thanks to the work of Lady Mary Wortley Montagu and at 14 was apprenticed as a surgeon. In 1770, Jenner moved to London to train under renowned surgeon John Hunter before returning home to Gloucestershire and becoming a local practitioner.
Growing up in the country, Jenner was aware of an old wives' tale that said people who caught cowpox – a mild infection caught from cows – never caught smallpox. Inoculation, which Jenner carried out on his patients, still posed a risk, so he began to research alternatives.
In 1796, Jenner inoculated eight year-old James Phipps with pus from a cowpox sore; a few weeks later, he infected him with matter from smallpox pustules, but Phipps never went on to develop the disease. The following year, Jenner submitted his findings to the Royal Society, but his ideas were rejected as too radical. After experimenting on other children, including his own infant son, Jenner published his findings in 1798.
Jenner's methods were initially ridiculed and criticised, and his initial tests would be considered unethical today, but it soon became hard for anyone to deny the obvious protection vaccination offered. Nearly 200 years later, in 1980, smallpox was declared officially eradicated by the World Health Organization.
This article was first published in the February 2021 issue of BBC History Revealed
Emma Slattery Williams was <BBC History Revealed’s staff writer until August 2022, covering all areas of history – from Egyptian pharaohs and pirate queens to Queen Victoria and Marilyn Monroe. She also compiled HistoryExtra’s Victorian newsletter and interviewed historians on the HistoryExtra podcast.. She studied both History and English at Swansea University.
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