In the seventeenth century, smallpox ravaged Europe with a persistent ferocity beyond reckoning. At its height, it killed 400,000 Europeans a year, in a manner so painful and dehumanising that the modern mind can hardly encompass the scale of suffering. By the time vaccination had eradicated the disease in the late twentieth century, it had claimed upwards of 500 million lives, more than those lost in every war ever fought during the entire span of human history.
The story of Edward Jenner employing cowpox in 1798 to vaccinate against smallpox is justly one of modern science’s most oft-told tales, but what is less often remembered is that the road for Jenner’s success had been paved eighty years previously by a British woman who braved public ridicule to bring to Europe a practice of Ottoman origin: inoculation.
The woman was Lady Mary Wortley Montagu (1689–1762). The daughter of the Duke of Kingston-upon-Hull, she was born in the lap of unspeakable luxury. Her mother died when she was 3, and she lived with relatives until she rejoined her rakish father at the age of 9, where she had the opportunity to experience first hand the rowdy world of British letters. Her father was a member of the Kit Cat Club, a group of nobles who gathered for the express purpose of getting very drunk and writing poems about which eligible British women they thought were the most attractive. Thrust into this world of sparkling if superficial wit, and hailed for her beauty and mind alike, she resolved to become the centre of learned attention by devoting herself to study.
Her father possessed a large library and placed no restrictions upon her access to it, and she employed it to learn those things her teachers had refused her: Latin, classical studies and philosophy. She turned author herself and wrote poems depicting the mad pace and loose morals of British high society.
She developed a theory of romance inspired by the divisions of the Catholic afterlife and introduced her friends to her novel system. There were marriages of Paradise, cemented on a firm base of passionate intellectual and physical love, those of Hell, filled with grotesque and fearsome husbands, and those of Limbo, where the money was good enough to provide comfort and the husband bland enough to not be an active hindrance. As it happened, Lady Mary set her sights on Paradise, nearly tumbled into Hell, and landed firmly in Limbo.
Beautiful and witty, Lady Mary had no shortage of suitors but decided ultimately on Edward Wortley Montagu, a wealthy businessman and energetic MP eleven years her senior, whose circle of acquaintances included some of London’s greatest writers and satirists. He valued, or appeared to, her intellectual gifts, and soon the couple was secretly corresponding through a series of loyal intermediaries. In due course, Wortley entered into marriage talks with Lady Mary’s father, but refused her father’s terms as to how he was to dispose of his property in his will, and the negotiations broke down.
This was just as well from the point of view of Kingston (now marquess of Dorchester), as he had what was to his mind a superior match lined up with, and I promise I am not making this name up, the Honourable Clotworthy Skeffington, a non-intellectual bore who made Lady Mary’s blood run cold. Her father made her choice clear: marry Skeffington or be disinherited. She considered the matter, and opted against Hell; with her brother’s help, she eloped with Wortley in 1712 while on the road to meet Skeffington. True to his word, Kingston cut off all contact and support, but Wortley had more than enough money to make up the loss.
What he did not have, it turned out, was a loving heart. Soon after their wedding night, he slid into a profound indifference towards Lady Mary, spending as much time as possible away from her and their first son. He made his position clear: he would support her but he would not be a regular feature of her life.
As such, Lady Mary Montagu took her diversion where she could, finding favour in the eyes of King George I and his son as a sparkling addition to Court. Her position as a universally envied Court favourite, however, ran to little longer than a year, as in 1715 she caught smallpox. She survived, but the disease left her face and body a pitted husk of its former self. ‘Pitted and pitied’, the saying went, and it was a long time before she could bring herself to venture outside without her face hidden beneath a silk veil.
Her life, however, took on new direction suddenly in 1717 when her husband was appointed ambassador to the Ottoman Empire for the purpose of brokering peace between the Ottomans and the Austrians. Here, in addition to writing some of Europe’s first accounts of how women actually lived in Turkey, which would define a new genre of travel literature, she witnessed something truly remarkable: a ritual practised by the Turkish women that seemed to all but ensure immunity to smallpox.
Their practice was to lightly scratch the skin, apply some matter from the pock of a person who had one of smallpox’s mildest forms, and to cover the whole with a walnut shell. The people so treated developed a mild pox that passed without leaving any scars, and carried lifelong immunity to all forms of smallpox, including the confluent variety that caused bleeding from the eyes and virtually guaranteed death.
Transfixed by the simplicity and efficacy of the Ottoman women’s solution to a disease that had cut through Europe like an avenging angel, she ordered the process performed on her son. The procedure was a complete success, and Lady Mary knew at once news of it must be brought to England, if only the medical establishment there could look beyond its professional, racial and gender pride long enough to learn a new method from the traditional culture of a group of coloured, non-Christian, women.
Her homeland was, however, decidedly unreceptive to the notion of inoculation – using pox to cure pox sounded like irresponsible quackery to ears trained in the techniques of bleeding, purging and cold cures, and nobody was willing to take a chance on it. So, Lady Mary seized the initiative and convinced the physician who had travelled with her in Constantinople to perform the procedure on her daughter to prove its validity. This he did, accompanied by several learned English doctors. When the child, a child of the highest class, made a full recovery, word got around to the Royal family.
Smallpox had long been the scourge of royalty, upsetting carefully wrought lines of inheritance and the nations dependent upon them. King George soon gave his permission to have the process tested on six criminals who would be rewarded with their freedom for volunteering. These tests proving equally successful, British doctors began making inoculation their own, which is to say, very nearly ruining it.
Lady Mary watched in horror and rage as the simple, effective ‘Scratch & Apply’ process of the Turks warped in the hands of the British experts into a carnival of torture. Patients were purged (i.e., repeatedly and systematically induced to vomit) and bled before the procedure in order to ‘prepare’ them, and in place of the simple surface scratch the British medics used deep cuts which they stuffed with pock matter. Thinking that they had improved the process by introducing Western insights, they had in fact made it several orders more unnecessarily unpleasant, and even dangerous, for all concerned parties. Lady Mary took up her pen to write an anonymous letter calling her nation’s doctors to account, but was scoffed at by a medical establishment that refused to believe its instincts inferior to those of a gaggle of non-Christian Turkish women.
In spite of British improvements, inoculation continued to rack up a growing wave of victories, precipitating a low-key mania for the process amongst the nobility, particularly after the king approved the inoculation of his own grandchildren. To those households who received the blessing of inoculation, Lady Mary was a hero, an indispensable presence at their children’s procedures. But to many more, she was a pure villain – a woman promoting a procedure that infected perfectly healthy children with dreaded pox. They gathered in front of her house whenever she intended to attend an inoculation, throwing rotten fruit and eggs at her when she emerged, yelling insults at this woman had become, in their mob-addled minds, the very personification of smallpox itself.
She, however, took the abuse in her stride. As long as a family needed her, she would go, and if she had raw egg in her hair, and needed to wear red to match the colour of a hurled tomato, well, that was a small price to keep others from suffering as she had.
Once inoculation had become established, doctors felt less inclined to seek Lady Mary’s experience, and the remaining four decades of her life were spent trying to rein in her often-wayward offspring, composing philosophical and political letters, and rebuffing the advances of poet Alexander Pope only to fall in love with bisexual heart-throb Francesco Algarotti. She moved to France to live with him for three years, and remained in continental Europe for two decades, only returning to England upon hearing news of her husband’s death. The woman who brought Great Britain its first weapon in the war against smallpox returned to her country at last in 1762, and died there seven months later.
FURTHER READING:
The Speckled Monster: A Historical Tale of Battling Smallpox (2003) by Jennifer Lee Carrell is a work of history that reads like a grand work of literature. It is about Lady Mary but also about a parallel effort in the American colonies to introduce inoculation in Boston; both tales are gripping. Jo Willett’s The Pioneering Life of Mary Wortley Montagu (2021) is also a great source. Lady Mary’s sparkling form as a letter writer is well represented in a Penguin collection of her letters, and her Turkish Embassy letters are perennially in print. If you want to know more about her post-inoculation work and place in British literature, you will probably want to add either the Barry or Grundy biographies to your shelves.
Montagu's story is also one of 140 stories of women in Medicine I told in A History of Women in Medicine and Medical Research, available on Amazon and from Pen and Sword books US or UK!
