Lady Montagu, 18th Century British Aristocrat, Feminist, Smallpox Fighter and Public Health Heroine

The year is 1718. Smallpox inoculation is unknown in Western cultures, and vaccine is still decades in the future. Commoners and kings are powerless against the onslaught of the speckled monster.

How did one intrepid British aristocrat discover a practice in a far-off land, become an immunization pioneer and a heroine in the annals of public health?

Lady Mary Wortley Montagu. Poet, adventuress, travel writer – and smallpox fighter.

Back when she was a favorite guest at the supper parties of King George I, famed for her beauty and quick wit, who would have guessed she would change the smallpox story?

 

No Stranger to Smallpox

Smallpox was a disease Lady Mary (as she was commonly known) knew intimately. In 1713, it had taken the life of her brother. Two years later it stole her own legendary beauty, leaving her at age 26 with a face disfigured by deep pitted scars.

A silk mask became a staple item in her wardrobe.

The horrors of smallpox were known all over the globe and, although mortality rates differed around the world, it often killed a third of its victims.

In some areas it killed half.

 

Smallpox Leaves its Mark

If you survived smallpox you could be left:

• horribly disfigured
• socially isolated
• blind (smallpox was a major cause of blindness in many parts of the world)
• severely arthritic
• impotent

 

Discovering Smallpox Inoculation in Turkey

The year after Lady Mary’s illness, her husband Edward Wortley Montagu was appointed England’s ambassador to the Ottoman Empire. Living in Constantinople (now Istanbul), she discovered something surprising. The Turks had a way to protect against smallpox.

She was already quite the travel writer. Her lively letters introduced her English friends to the mysterious Middle East. Now she began to tell them about an amazing procedure the locals used.

It was inoculation or variolation, the startling practice of giving a person smallpox (variola) on purpose – a mild case, it was hoped. The goal was to make them immune from then on–immunization.  (See a clarification of terms at the end of this post.)

 

Variolation / Inoculation = Intentional Smallpox

A small bit of live variola virus from a pustule of someone with a mild case of smallpox was placed under the skin of a susceptible person. If all went well, the person developed no more than a mild case of smallpox and was immune ever after.

Lady Mary wrote to her father about the process in an April 1, 1717 letter, telling him that “the small-pox” that was so fatal and generalized in the English population, was, in Turkey, “rendered entirely harmless, by the invention of engrafting.” In that letter, and in similar letters to friends, she described the procedure.

 

You Are Cordially Invited to a Smallpox Party

“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 parties for this purpose, and when they are met (commonly fifteen or sixteen 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 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 lye upon the head of her needle, and after that binds up the little wound with a hollow bit of shell; and in this manner opens four or five veins. . . .”

The group stays quietly together the rest of the day, with the children playing, apparently no worse for the experience. She says that when the rash appears a few days later, there are no more than twenty or thirty eruptions on the face, and that those never leave a scar.

 

Protecting, Risking

Smallpox had burned a swath of devastation in Lady Mary’s life and among her friends. How could she not be impressed with what she saw with her own eyes?

She was so convinced, she had the procedure done on her son, 5-year-old Edward. The year was 1718.

A local woman came with her supply of that “best kind of small-pox.” She and a Scottish doctor who worked at the embassy, Charles Maitland, variolated the wailing, kicking, screaming boy, once they were able to catch him and hold him down. Thankfully, the procedure was successful. Edward later proved to be immune to smallpox.

Lady Mary and the family returned to England later that same year.

 

Bringing Smallpox Inoculation Home to England

In 1721, a smallpox epidemic hit London, and Lady Mary had Maitland, who by then had also returned to England, inoculate her 4-year-old daughter. He insisted that other doctors be present as witnesses.

Another successful inoculation against smallpox.

In the same letter as her first description of the practice, she had written:

I am patriot enough to take pains to bring this useful invention into fashion in England; and I should not fail to write to some of our doctors very particularly about it, if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind. But that distemper is too beneficial to them, not to expose to all their resentment the hardy wight that should undertake to put an end to it. Perhaps, if I live to return, I may, however, have courage to war with them.

And war she did.

 

Let the Battle Begin

Withering resistance would meet the push to adopt inoculation in England. After all. It meant:

• inserting live smallpox virus into a well person–with the possibilities of:
• infecting someone else
• triggering an outbreak
• debilitating, disfiguring result vs. the intended mild case
• death (1 in 100)

These were good odds compared to those of smallpox acquired in an epidemic, but the battle against fear and lack of knowledge would need a champion who had stared down the monster smallpox and had the tenacity to fight through to the end.

Lady Mary, an immunization pioneer, to be continued in future posts….

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Would you have done with/for/to your child what Lady Mary did?

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Clarification of terms: variolation, inoculation, engrafting, immunization.

It can get confusing when you do a search on the topic. In common usage you may see any one of these as names for the same procedure.

Inoculation is from a Latin word that means to graft into a plant a bud or eye from another. To be precise, inoculation is the means by which to accomplish variolation (introducing the live variola virus into the body).

Decades later, after vaccine comes on the scene, inoculation will be the means by which to accomplish vaccination. (Vaccination puts NO smallpox virus into the body. It will be the subject of a later post. You will see the term incorrectly applied to the much earlier practice of variolation, even in articles on some university sites.)

Immunization: Immunity is the intended result of all the above.