Smallpox, inoculation and the historic practice or variolation

In 1796, an English physician and scientist, Edward Jenner, recorded proof that inoculation using cowpox (vaccinia virus) could provide immunity against smallpox. He was interested in how milk maids were immune to smallpox. He wasn’t the first to observe the phenomena. Jenner proved that exposure to cowpox was responsible for their immunity to smallpox, a disease that in the 18th century in England had a fatality rate of between 20 to 60 per cent with devastating impact on survivors including disfiguring scarring.[i]

It is estimated that in the 20th century alone, 300 to 500 million people died from smallpox.[ii] [iii] For that reason, the smallpox vaccine has been credited with saving more lives than any other single medical intervention.

Smallpox has plagued the planet since pre-history, with evidence found in Egypt around 3000 BC.[iv] To combat smallpox, inoculation by variolation was used in China in the 15th century but may date back to the 10th century. The practice was referred to by cultures in Africa and India but evidence of the practice was documented in India, Turkey, West Africa and Europe in the 18th century.[v]

In the quest for a cure variolation, a type of inoculation, was used. Variolation was a method of inserting smallpox into a small incision or incisions, usually in the arm or between thumb and forefinger. Up to four per cent of recipients died from the practice but, in most cases, what followed was a mild form of the disease and, weeks later, protection against smallpox.

Mary Wortley Montagu witnessed variolation in practice in the Ottoman Empire. In 1721, she brought it to England and was such an influential advocate for the practice that after the King’s physician saw Montagu’s daughter inoculated, the Prince of Wales followed the example and inoculated his two children.[vi]

As a child in Gloucester, aged eight, Jenner was inoculated against smallpox along with thousands in England.[vii] But it was Jenner’s study in 1796 that exposed participants to cowpox, then tested them against smallpox repeatedly, that proved this safer method of inoculation provided immunity.

The discovery was considered a leap forward for medicine and quickly replaced variolation. Soon after, among the scientific community in the west, Jenner became known as a founding father of immunology.

Smallpox vaccination was introduced in Australia in 1804 [viii]

By 1950, smallpox was almost eradicated thanks to vaccination, but it wasn’t until 1980 that the 33rd World Health Assembly announced that the long-held dream, of smallpox eradication, had been achieved.[ix]

Watch more videos in our vaccination facts series.

[i] Riedel, S, Edward Jenner and the history of smallpox and vaccination,

[ii] Our work in data, Smallpox,

[iii] American Society of Microbiology, What does it take to Eradicate a disease,,the%20rinderpest%20virus%20(RPV).

[iv] CDC, CDC, History of smallpox,

[v] College of Physicians of Philadelphia, History of Vaccines Timeline,

[vi] Riedel, S, Edward Jenner and the history of smallpox and vaccination,

[vii] Riedel, S, Edward Jenner and the history of smallpox and vaccination, https

[viii] Vic Health, Vaccine History Timeline,

[ix] CDC, History of smallpox,


Cows, Denmark. By Jonas Koel

An old couple lie in their sick bed receiving alms from a girl with the encouragement of her mother and a nun. Pen and ink drawing after J.B. Greuze. Wellcome Collection. Public Domain Mark

Smallpox vial in test tube rack. By Alexey Novikov

Hampstead Smallpox Hospital, London. Wellcome Collection. Public Domain Mark

Chinese C18: Paediatric pox – ‘Dry and Wizened’ pox. Wellcome Collection. Public Domain Mark

Ch’iu-Hsu, Yin-tou lueh. Chinese tract on vaccination. Wellcome Collection. (CC BY 4.0)

Vaccination during the epidemic of smallpox, 1921 Palestine. Wellcome Collection. (CC BY 4.0)

A man vaccinating a young child held by its mother, with other members of the household looking on. Oil painting by L.-L. Boilly, 1807(?). Wellcome Collection. (CC BY-NC 4.0)

Vaccination: “Dr Jenner performing his first vaccination, 1796”.
Oil painting by Ernest Board. Wellcome Collection. Public Domain Mark

A niece visits her smallpocked uncle and gives him presents.
Coloured engraving by Gautier. Wellcome Collection. Public Domain Mark

Edward Jenner. Mezzotint by J. R. Smith, 1800, after himself.
Wellcome Collection. Public Domain Mark

Edward Jenner vaccinating his son, held by Mrs Jenner; a maid rolls up her sleeve,
a man stands outside holding a cow.
Coloured engraving by C. Manigaud after E Hamman. Wellcome Collection. Public Domain Mark

A milk maid shows her cowpoxed hand to a physician, while a farmer or surgeon offers to a dandy inoculation with cowpox that he has taken from a cow.
Coloured etching, ca. 1800. Wellcome Collection. Public Domain Mark

Edward Jenner vaccinating a boy.
Oil painting by E.-E. Hillemacher, 1884. Wellcome Collection. Public Domain Mark

Definition Vaccination. By DNA Motion Pictures

Woman pointing to chart on blackboard explaining inoculations in 1961.
From Babies and Breadwinners (Part I). By U.S. Department of Health

Vaccinations given to crowd on street 1949. Source: Internet Archives. Public Domain.

A boy is vaccinated against smallpox and diphtheria. By Rick Ray

Man being vaccinated in upper arm. Source: BBC Archive

1980 photograph taken at the Centers for Disease Control (CDC), depicting three former directors of the Global Smallpox Eradication Program, as they read the good news that smallpox had been eradicated on a global scale. Source: Public Health Image Library

Nurse in medical control room. By Irwan Iwe

Rinderpest. Copyright held by Dr. Rajnish Kaushik. (CC-by-sa-2.5.)

Cow eating fresh green grass on lawn. By Oleh Slepchenko


Inspirational Piano Arpeggios (Aspire). By marcozannone



Video editor: Grace O’Connell

This video is intended for educational purposes only and not for commercial profit. All images and footage have been selected to represent a concept or time in history and have been chosen to be as accurate as possible.

Back To Top