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Lady Mary Wortly Montagu – The Scourge of Smallpox

Lady Mary Wortley-Montagu

Lady Mary Wortley Montagu (née Pierrepont (15th May 1689 – 21st August 1762) was an English aristocrat, writer, and poet. Whilst Mary may have been born into privilege, her gender meant that she could take little credit for her scientific breakthrough in first combating and ultimately eradicating smallpox. Her gender also barred her from membership of the Royal Society, England’s famed academy of sciences.

In 1712, Lady Mary married Edward Wortley Montagu, who later served as the British ambassador to the Sublime Porte[1]. Lady Mary joined her husband in the Ottoman excursion, where she spent the next two years of her life. During her time there, Lady Mary wrote extensively on her experience as a woman in Ottoman Istanbul. After returning to England, Lady Mary devoted her attention to her family’s upbringing before dying of cancer in 1762.


Portrait of Lady Mary Wortley Montagu (1689-1762) by Jonathan Richardson the younger.In the Public Domain, via Wikimedia Commons
https://commons.wikimedia.org/wiki/File:Jonathan_Richardson_d._J._001.jpg

Lady Mary’s Pain
She was a young, bright, attractive, witty and wealthy woman indulged by her family, but she was in agony. She tossed in her elegant bed, gasping for air, her fever spiking, her skin spattered with a shotgun pattern of deep, suppurating pustules. She was in an itching, inflamed delirium. Her physicians told her husband to prepare for the worst.

Lady Mary Montagu was suffering from smallpox, also known as “the speckled monster,” a disease that was the deadliest on earth in her day (the early 18th century), killing more people than the Black Plague[2]. But, as a result of her actions, the disease was wiped out. Mary threw off her infection and emerged alive. This paper explains what she did.

What is Smallpox?[3]
Smallpox was an infectious disease caused by one of two virus variants, Variola major and Variola minor[4]. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) certified the global eradication of the disease in 1980. The risk of death after contracting the disease was about 30%, with higher rates among babies. Often those who survived had extensive scarring of their skin, and some were left blind.

The initial symptoms of the disease included fever and vomiting, followed by mouth ulcers and a skin rash. In a few days, the skin rash turned into characteristic fluid-filled blisters with a dent in the centre. The bumps then scabbed over and fell off, leaving scars. The disease was spread between people or via contaminated objects. Prevention was achieved mainly through the smallpox vaccine.

The origin of smallpox is unknown. However, the earliest evidence of the disease dates to the 3rd century BC in Egyptian mummies.

Inoculation for smallpox appears to have started in China around the 1500s[5]. Europe adopted this practice from Asia in the first half of the 18th century.

Smallpox first appeared in Europe during the early Middle Ages, and bit by bit, it became more and more deadly. It has been estimated that it killed 60 million Europeans between 1700 and 1800 alone. People who caught it and survived were often left scarred and with long-term health conditions, including blindness. Whether you were young or old, rich or poor, the ‘speckled monster’ (as it was later called) was indiscriminate. Lady Mary’s medical breakthrough, which she promoted widely (later superseded by Edward Jenner’s vaccination), was the first time in Western medicine that antibodies were created to secure immunity from disease.

The condition historically occurred in outbreaks. In 18th century Europe, it is estimated that 400,000 people died from the disease a year and that one-third of all cases of blindness was due to smallpox. Smallpox is estimated to have killed up to 300 million people in the 20th century and around 500 million people in the last 100 years of its existence. Earlier deaths included six monarchs[6]. As recently as 1967, 15 million cases occurred a year.

Education
Mary Wortley Montagu’s education was divided between a governess and the use of the library at the family property, Thoresby Hall. According to Lady Mary, the governess gave her “one of the worst [educations] in the world” by teaching Lady Mary “superstitious tales and false notions“. To supplement the instruction of her despised governess, Lady Mary used the well-furnished library to “steal” her education.

By the time she was 16, Lady Mary had written two volumes of poetry, a short novel, and taught herself Latin.

Inoculation
Aside from her writing, Lady Mary is also known for introducing and advocating smallpox inoculation[7] to Britain after returning from Turkey. Her papers address and challenge the hindering contemporary social attitudes towards women and their intellectual and social growth.

In the 18th century, Europeans began an experiment known as inoculation or variolation to prevent (but not cure) smallpox.  Lady Mary Wortley Montagu defied convention by introducing smallpox inoculation to Western medicine after witnessing it during her travels and stay in the Ottoman Empire.

Previously, Lady Mary’s brother had died of smallpox in 1713, and although Lady Mary herself recovered from the disease in 1715, it left her with a disfigured face. In the Ottoman Empire, she witnessed the practice of inoculation against smallpox (variolation) – which she called engrafting and wrote home about it in a number of her letters. Variolation used live smallpox virus taken from a mild smallpox blister and introduced it into scratched skin of the arm or leg (the most usual spots) of a previously uninfected person to promote immunity to the disease. As a result, the recipient would develop a milder case of smallpox than the one they might have otherwise contracted.

Lady Mary was keen to spare her children: in March 1718, she had her nearly five-year-old son, Edward, inoculated with the help of Embassy surgeon Charles Maitland.  On her return to London, she enthusiastically promoted the procedure but encountered a great deal of resistance from the medical establishment because it was regarded as a folk treatment process. Opponents of the treatment derided it as oriental, irreligious, and a fad of ignorant women.

In April 1721, after a smallpox epidemic struck and killed people in Britain and as far away as Boston, Massachusetts, Lady Mary had her daughter inoculated by surgeon Charles Maitland and publicised the event. It was the first such operation done in Britain. Convinced of its efficacy, Lady Mary persuaded Caroline of Ansbach, Princess of Wales, to test the treatment.

In August 1721, seven prisoners at Newgate Prison awaiting execution were offered the opportunity to undergo variolation instead of execution: they all survived and were released. Despite this, controversy over smallpox inoculation intensified. However, Caroline, Princess of Wales, was convinced of its value, and two daughters were successfully inoculated in April 1722 by French-born surgeon Claudius Amyand. Later, other royal families followed Montagu’s act.

Nevertheless, inoculation was not always a safe process; some inoculates developed a real case of smallpox and could infect others. The inoculations resulted in a “small number of deaths and complications, including serious infections.” Subsequently, Edward Jenner developed the much safer technique of vaccination using cowpox instead of smallpox. As a result, and somewhat unfairly, he and not Lady Mary Montagu received the credit for beating smallpox.

Lady Mary’s Legacy
In May 1958, during the 11th World Health Assembly at WHO Headquarters in Geneva, V.M. Zhdanov, a well-known virologist and epidemiologist who was the Deputy Minister of Public Health of the Soviet Union, proposed a program for global smallpox eradication and substantiated its feasibility.

In 1967, WHO embarked on a worldwide campaign to eradicate smallpox which they certified as achieved in 1979. Lady Mary Wortley Montagu’s introduction of smallpox inoculation had ultimately led to the development of vaccines and the later eradication of smallpox.

Humanity won its battle against smallpox arguably due to the resilience of Lady Mary Montagu, who pioneered inoculation in 18th century Britain and Europe, despite tremendous resistance. The medical breakthrough, which Lady Mary promoted widely (later superseded by Edward Jenner’s vaccination), was the first time in Western medicine that antibodies were created to secure immunity from disease. Although only published after her lifetime, her Embassy Letters remain an important source for historians of the period[8].

Quotations by Lady Mary Montagu

“No art can give me back my beauty lost.”

“It is 11 years since I have seen my figure in a glass [mirror]. The last reflection I saw there was so disagreeable I resolved to spare myself such mortification in the future.”

“Civility costs nothing and buys everything.”

“True knowledge consists in knowing things, not words.”

“Nature is seldom in the wrong, custom always.”

“You can be pleased with nothing if you are not pleased with yourself.”

“There is no remedy so easy as books, which if they do not give cheerfulness, at least restore quiet to the most troubled mind.“

“Life is too short for a long story.”

“Forgive what you can’t excuse.”

“Whatever is clearly expressed is well wrote.”

Sources and Further Reading
  1. Sublime Porte: The name has its origins in the old practice in which the ruler announced his official decisions and judgements at the gate of his palace. This was the practice in the Byzantine Empire and it was also adopted by Ottoman Turk sultans since Orhan I, and therefore the palace of the sultan, or the gate leading to it, became known as the “High Gate”. This name referred first to a palace in Bursa, Turkey. After the Ottomans had conquered Constantinople, now Istanbul, the gate now known as the Imperial Gate, leading to the outermost courtyard of the Topkapı Palace, first became known as the “High Gate”, or the “Sublime Porte”. Source: https://en.wikipedia.org/wiki/Sublime_Porte#History ↑
  2. Source: https://time.com/5542895/mary-montagu-smallpox/ ↑
  3. Source: Mainly from: https://en.wikipedia.org/wiki/Smallpox ↑
  4. See: Ryan KJ, Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 525–28. ISBN 978-0-8385-8529-0. ↑
  5. Sources: (1) Needham J (2000). Science and Civilisation in China: Volume 6, Biology and Biological Technology, Part 6, Medicine. Cambridge University Press. p. 134. ISBN 978-0-521-63262-1. (2) Silverstein AM (2009). A History of Immunology (2nd ed.). Academic Press. p. 293. ISBN 978-0080919461. ↑
  6. Source: http://www.who.int/mediacentre/factsheets/smallpox/en/ The monarchs were Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrika Elenora of Sweden, and King Louis XV of France. ↑
  7. Inoculation is a set of methods of artificially inducing immunity against various infectious diseases. The terms “inoculation”, “vaccination”, and “immunisation” are often used synonymously, but there are some important differences among them. Source: https://en.wikipedia.org/wiki/Inoculation ↑
  8. The Turkish Embassy Letters are a letter collection of Lady Mary Wortley Montagu’s reflections on her travels through the Ottoman Empire between 1716 and 1718. She collected and revised them throughout her life, circulating the manuscripts among friends, and they were first published in 1763 after her death. Source: Wikipedia at https://en.wikipedia.org/wiki/Turkish_Embassy_Letters ↑

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Martin Pollins

Martin Pollins is a Chartered Accountant and MBA with wide experience in corporate finance and business management. He has served on the boards of several companies, including those listed on the London Stock Exchange, AIM and OFEX. He is the Chairman and Founder of OneSmartPlace and was a Council member of the Institute of Chartered Accountants in England and Wales from 1988 to 1996. He was managing partner of PRB Martin Pollins, based in Sussex, the first Accountancy firm to advertise on British television. He went on to create and launch the CharterGroup Partnership (the UK’s first Accountancy network) and then LawGroup UK (at the time, one of the largest networks of lawyers in the UK). In recent years, he helped to raise several £millions to fund British films such as The Da Vinci Code, Bridge of San Luis Rey, Head in the Clouds and Merchant of Venice with actors such as Charlize Theron, Robert De Niro, Al Pacino, F. Murray Abraham. Kathy Bates, Gabriel Byrne, Geraldine Chaplin, Tom Hanks, Ian McKellen, Audrey Tautou, Penélope Cruz, Steven Berkoff, Lynn Collins, Jeremy Irons, Joseph Fiennes and many more. He has written several business publications (see https://onesmartplace.com/resources/)

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