An alternate history of small pox innoculation

[Blue Dragonfly]

Because I have nothing better to do on a Sunday morning , I thought I would share this with you. I wrote this paper in university, and while it does not challenge the concept of vaccination (this was in my pre-thinking about vaccinating days), I think it is an interesting alternative history than what we usually read about Jenner.

The thing that made me think of this paper was a thread that is going on feminism. When I wrote this paper, I was taking a history of biology class, and of course you all know there have been no women who ever did biology. :

“‘From love and smallpox, few remain free’”(Parish 21).

Lady Mary Wortley Montagu fit this description of a British citizen of the eighteenth century. She was a poet, a feminist, a politician’s wife and a respected member of upper class British society. In 1715, she had smallpox and was scarred but this did little to dissuade her many admirers (Paston 212). However, rarely in current literature is she credited with helping to eliminate the scourge of smallpox in Europe.
In 1717, Montagu traveled to Turkey with her husband where he was posted as the English ambassador. She was a prolific letter writer to her many friends and acquaintances and made astute and detailed observations of all that she saw. Most of her letters described social practices and conventions of other cultures. In Turkey, she was exposed to the custom of smallpox inoculation. To her friend Sarah Chiswell she wrote, “I am going to tell you a thing that I am sure will make you wish yourself here. The small-pox, so fatal, so general among us, is here entirely harmless by the invention of ingrafting, . . .” She went on to describe the process, and made observations regarding the course of illness and the recovery.
“. . .[T]he old woman comes with a nut-shell 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 . . . and puts into the vein as much venom as can lie upon the head of her needle . . . The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Then the fever begins to seize them, and they keep their beds two days, seldom three. They have very rarely above twenty or thirty in their faces, which never mark; and in eighth days’ time they are as well as before their illness . . . Every year thousands undergo this operation . . . There is no example of anyone who has died in it . . . I am very well satisfied of the safety of the experiment, since I intend to try it on my dear little son.”


She continued her letter expressing her desire to return to England and bring this “invention into fashion” despite opposition she expected to encounter among doctors. “I may, however, have courage to war with them.” *
Montagu’s social position provided a solid platform from which to launch her campaign of inoculation. She was a friend of the Prince and Princess of Wales and it is quite likely because of this friendship that she received professional attention and public acceptance. Initially, four physicians were dispatched by the English government to observe the inoculation of Montagu’s daughter. These men were skeptical (Paston 304) but her daughter recovered.
Despite the success of this operation and before the royal couple allowed their own daughters to be inoculated, an experimental trial had to be performed. Seven condemned prisoners were used to test the practice of variolation under the supervision of Montagu. If they survived, they were to be pardoned of their crimes. Six of the prisoners developed the symptoms associated with inoculation (i.e., a mild case of smallpox) and all survived. The seventh prisoner was immune due to prior exposure (Parish 22). After that trial, six orphans also underwent the procedure and it was deemed safe for royalty.
Once word got out about the practice of inoculation, Montagu was besieged by people begging “for her advice and guidance” (23) in performing the operation, so much so that she was “‘forced to run into the country to hide’” (Paston 305). Despite this, Montagu was proud of introducing the practice of inoculation so that it became “‘almost a general practice attended with great success’” (Melville 137). By 1754, variolation was “commended by the College of Physicians” (Parish 22).

Despite its success, inoculation was not without its problems. Many people were variolated throughout the rest of the eighteenth century and of these two to three percent died of smallpox (compared to 20 to 30 percent death rate from naturally occurring smallpox) (Parish 23). It was known that the induced smallpox was also contagious. Montagu observed this and although she had her son inoculated in Turkey, her daughter was not inoculated until they returned to England as the child’s nurse had not yet had smallpox (Melville 135). However, this may not have been widely known as smallpox was sometimes spread after an inoculation procedure (Parish 23). In 1723, Montagu’s nephew died of the procedure performed by someone else. She wrote, “‘I would have inoculated him with the same care and safety I did my own. I know nobody that has hitherto repented the operation’” (Paston 305).
Although Montagu was not a trained scientist, she had an enquiring and analytical mind. Her letters were very detailed with rich observations she made on various subjects. Unfortunately for the scientific community, she wrote little about smallpox other than her letter to Sarah Chiswell and a few comments in other letters only mentioned the procedure. Therefore it must be inferred what details she knew about the disease. She obviously knew smallpox could only be contracted by people who had never had the disease, that it was contagious from a symptomatic variolated patient and the operation must be done in a safe manner. Montagu also recognized that smallpox acquired from variolation was far less severe than naturally acquired smallpox.

It must be noted here that Lady Mary was not the first person to introduce inoculation of smallpox to England. The practice of inoculation occurred in parts of Wales and Scotland in a ritualistic way. This was termed “buying the pox,” (Mettler 420) but was probably either unknown or ignored by the medical community. In 1713, Emanuel Timoni published an article discussing variolation (as did several others during that decade) (420). Inoculation also occurred frequently in other geographical areas including the Far and Middle East. Montague however, was likely the first European to actually test variolation in a publically acclaimed situation.
For the next eighty years, inoculation against smallpox using smallpox was the only protection available against the disease. After Edward Jenner published his papers on his vaccination experiments, he and his followers attempted to eradicate variolation calling it “‘the venomous of all weapons’”(Miller 51). It is however interesting to note that Jenner had a difficult time finding patients to vaccinate when doing his experiments. Most adults had either had smallpox or had been inoculated; therefore, many of his test subjects were children (Walsh 89).
Although variolation was not a complete cure for smallpox, it had a significant impact on the treatment of smallpox in the eighteenth century. Lady Mary Wortley Montagu’s most important contributions can be attributed to her social position and her passionate desire to rid England of smallpox. Both Montagu and Jenner initially observed “common” people preventing this disease but only within a local population. If Montagu had not popularized variolation, it is possible that Jenner may have studied variolation rather than vaccination and the scourge of smallpox may have continued for many more years.