Lady Mary Wortley Montagu and the Controversy over Smallpox Inoculation

Eric Koch is spending two weeks in Europe. A number of his regular readers have generously volunteered to compose guest-postings – this one is from Carol Kushner.

Sir Edward Jenner (1749–1823) is usually credited as the first to prevent smallpox through vaccination. Using a different method, however, Lady Mary Wortley Montagu (1689–1762) actually predated his success by more than 70 years.

Lady Mary had a remarkable life, eloping to escape a marriage arranged by her father (“I prefer liberty to chains of diamonds.”), she was a voracious reader (“No entertainment is so cheap as reading, nor any pleasure so lasting.”) and well known for her satirical poetry, her political writings, and most particularly for her letters about the mysterious east (the Turkish Embassy letters), considered to be the most entertaining travel literature ever written by a woman. She got into many scrapes in her lifetime, including the South Sea Bubble, which led to blackmail from an angry French suitor who lost heavily as the result of her investment advice and a famous war of words with the poet Alexander Pope when her close friendship with him turned decidedly sour. Among her closest friends and allies were Caroline, the Princess of Wales, Mary Astell, the proto-feminist, and Lord Hervey about whom Lady Mary once wrote: “There are three sexes: men, women and Herveys.” She was largely self-educated, having schooled herself in Latin at an early age, and extremely well-read having made great use of her father’s extensive library as a girl. Some years after her daughter’s marriage to Lord Bute, Lady Mary also became the Prime Minister’s mother-in-law.

While in Turkey, where her husband was the British Ambassador from 1717–1718, she directly observed a practice she called engrafting used on children to prevent them from catching smallpox. This involved introducing under the patient’s skin, a small amount of matter from a smallpox blister. This method generally caused a much milder infection than breathing in infected droplets. The brief illness that ensued from engrafting conferred lifelong immunity and usually very few scars.

Lady Mary had good reason to be interested in this procedure. Having already lost a brother to the disease, she, herself, had suffered a bad case of smallpox at the age of 26 and was left with severe facial scars and no eyelashes, which marred her beauty. Convinced that the practice was safe, while still in Turkey, she decided to have her 5-year-old son inoculated by Dr. Charles Maitland, the Embassy surgeon and later back in England convinced him to engraft her 3-year-old daughter during a smallpox epidemic in 1721. Both children survived the brief illnesses that followed and both evidently achieved the desired immunity to smallpox, a disease that was very contagious and typically killed 30% of its victims.

This did not remain a private matter very long, however, because by then Lady Mary had embarked on a campaign to popularize inoculation by writing about it and promoting it to the leading aristocrats of the day. The medical profession was outraged and leading physicians discounted her evidence on the grounds it was “oriental” in origin, and because she was a woman. She herself attributed the fierce opposition by organized medicine to their pecuniary interests. She would have appealed to physicians she said, “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.”

Lady Mary, with her connections at the court of George I, and her considerable persuasive charm (“Civility costs nothing and buys everything.”), was able to convince Caroline, the Princess of Wales, to arrange for a test of the procedure. Seven condemned men at Newgate prison were offered the option of hanging or their freedom if they agreed to be engrafted. They all chose to be inoculated and all survived to be released. (Perhaps this is one of the first clinical trials ever conducted although without any control group.) Then six orphans were tested and they too survived. These proofs convinced King George I to have two of his grand-children inoculated and after his high-profile example, engrafting began to spread rapidly.

Then disaster – Dr. Maitland inoculated a child and the servants in the house came down with smallpox. This gave Lady Mary’s opponents enough ammunition to resume their attacks on her ideas, with clergymen insisting that engrafting was against God’s will and physicians arguing that it actually spread disease.

Nevertheless, the innovation introduced to Britain by Lady Mary did become general practice, until it was ultimately replaced by the equally effective but much safer vaccination developed by Jenner. The last recorded case of smallpox occurred in 1978 after a laboratory accident in the University of Birmingham Medical School.

In 1754, Lady Mary was finally recognized for her contribution and praised publicly for “bringing into her own country a practice of which, ages to come will enjoy the benefit.” Her last words, uttered on her deathbed in 1762 were: “It has all been very interesting.”

Sources:
Case, Christine L., King-Thom, Chung, “Montagu and Jenner: The Campaign against Smallpox,” SIM News, 47(2):58–60, 1997.
Halsband, Robert, The Life of Mary Wortley Montagu, Oxford: Clarendon Press, 1956.
Quotations accessed May 25, 2011.
Portrait of Lady Mary Wortley Montagu attributed to Charles Jervas.