Lady Mary Wortley Montagu and the Introduction of Smallpox Vaccination to England

This short article describes Lady Montagu's efforts in introducing a technique of vaccinating against smallpox; a technique that she learnt from Ottoman Turkey and transported, against some resistance, to the shores of Britain. It was from this knowledge, which had existed for some time in the Muslim lands, that Dr. Edward Jenner was able to develop modern methods of smallpox vaccination.

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A smallpox vaccine commemoration
stamp (Turkey: 1967)

Smallpox - "the most dreadful scourge of the human species" according to Edward Jenner - was declared to be eradicated in 1980 after its existence for thousands of years as a contagious and potentially fatal disease. The English doctor Edward Jenner is credited with discovering the vaccine for smallpox. Yet as with all great breakthroughs, it could not have happened had he not been standing on the shoulders of others who did their bit to reduce the dangerous impact of this illness.

Before Jenner's discovery, the usual method of immunisation from smallpox was variolation which is "the earliest known inoculation technique" and had been practiced for millennia throughout the world. Variolation involved "exposing a healthy person to infected material from a person with smallpox in the hopes of producing a mild disease that provided immunity from further infection."

By the later part of the seventeenth century, inoculation for smallpox was an established practice in several European countries at which the disease had arrived by the coast of the Bosporus via Constantinople. In the early part of the Eighteenth century, Doctor Timoni noted the method as he had observed in Constantinople. Other European doctors in Constantinople and a Reverend in America also raised awareness of the variolation process during this same period.

However, the person acknowledged with promoting variolation in England is Mary Wortley Montagu (1689-1762), otherwise known as Lady Montagu. She was the daughter of the Duke of Kingston and the wife of Edward Wortley Montagu, British Ambassador to the Court of the Ottoman Empire in Constantinople and representative of the Levant Company. Edward and Mary Montagu along with their young son arrived in what is now Turkey in 1717.

A James Gillray caricature of
Dr. Jenner vaccinating patients

Lady Montagu was renowned as a writer and her works are used by scholars in many disciplines for their comments on politics, diplomacy, music, health, art, medical history and social history. In her first year of living in the Ottoman Empire, Lady Montagu came across variolation (which she named ingrafting). She wrote to her friend Miss Sarah Chiswell and explained the process as she had seen it in Constantinople. She intended to introduce this knowledge to English physicians and campaigned enthusiastically for the launch of smallpox inoculation in England. Lady Montagu was especially interested in smallpox prevention as two of her relatives died from the illness and she herself had survived a childhood bout of the disease although it had left her face pockmarked (although, she managed to hide her marks and was considered quite beautiful).

In her letters to various influential people, Lady Montagu pushed for inoculation in England. So convinced was she of the efficacy of variolation in preventing the disease, that she had Edward, her only son inoculated at the British embassy with the assistance of an old Greek woman who had practiced inoculation for some years, and with the assistance of Dr. Maitland, surgeon to the embassy.

After her return to England in 1721, she urged for trials of the variolation method. Consequently a group of criminals under sentence of death in Newgate Prison were offered a full pardon if they would undergo inoculation. Six men agreed to this and none suffered from the medical procedure. Subsequently they were released. The method was also successfully practised on a number of orphans, and soon afterwards, the two children of the Princess of Wales were also inoculated. This latter royal approval ensured that variolation became rapidly acceptable amongst elite society. There was, however, scepticism and resistance amongst the general public, while the church condemned the practice as immoral.

However, despite the successes detailed above there was still a risk of fatality since variolation could potentially spread the disease as inoculated people were temporarily carriers of smallpox. But for at least another seventy years variolation was used as a form of immunisation against smallpox until Edward Jenner introduced his vaccine which involved the inoculation of humans with cowpox in order to prevent smallpox infection. (Incidentally, the term vaccine comes from the Latin word vacca which translates as cow).

In more recent times, it is estimated that 300 million people died from smallpox during the 20th century. Following mass vaccination programmes after 1966, the World Health Assembly announced, fourteen years later, that the world is free of small pox.

Image Sources:

Image 1 (Lady Mary Montagu) source: www.sheffieldgalleries.org.uk

Image 2 (Turkish stamp) source: www.adc.bmjjournals.com

Image 3 (A Caricature of Dr. Jenna): www.micro.msb.le.ac.uk

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