Monday, March 29, 2021

The Observer Vaccines and immunisation


How Mary Wortley Montagu's bold experiment led to smallpox vaccine -
 75 years before Jenner

A new book celebrates the trailblazing work of the English aristocrat, who successfully inoculated her daughter


Edward Jenner administering a smallpox vaccine. He himself had been inoculated as a child by doctors following Lady Mary Wortley Montagu’s ideas. Photograph: Getty


Donna Ferguson
Sun 28 Mar 2021 

It was a daring and dangerous experiment that paved the way for the development of the first safe vaccine and saved countless lives. Yet when Lady Mary Wortley Montagu deliberately infected her own daughter with a tiny dose of smallpox – successfully inoculating the three-year-old child in 1721 – her ideas were dismissed and she was denounced by 18th-century society as an “ignorant woman” .

Three hundred years later, on the anniversary of that first groundbreaking inoculation on English soil, a new biography will aim to raise the profile of Wortley Montagu and reassert her rightful place in history as a trailblazing 18th-century scientist and early feminist.

“If she had not inoculated her daughter, we would not then have gone on ultimately to find a cure for smallpox,” said Jo Willett, author of The Pioneering Life of Mary Wortley Montagu, which will be published on Tuesday. “She should be heralded for that – yet she’s not really well known, and I think partly that’s because she was a woman.”

Wortley Montagu, a smallpox survivor with a disfigured face, took the risky decision to inoculate her daughter by making tiny cuts on her daughter’s skin and rubbing in a small amount of pus from a live smallpox sore.
If Wortley Montagu hadn’t inoculated her daughter, we may never have gone on to find a cure for smallpox.Jo Willett, author

This gave the child, known as “young Mary”, a very mild dose of the disease, Willett said. “Normally, with smallpox, you might have several thousand spots on your body. An inoculated child would probably have about 30 spots and then a few days later they’d be absolutely fine again, running around and having fun.”

Wortley Montagu had learned about the practice of inoculation in Turkey, where her husband had worked as the British ambassador. “When she got there, she went to Turkish baths and saw women without any smallpox marks on their skin. That was a wake-up call.”
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In 18th-century Turkey, inoculation was a common “folk practice”, typically carried out by “illiterate old Greek and Armenian women”, Willett said. “She asked them about it and analysed it, and decided it was worth the risk.”

She managed to successfully inoculate her son while she was there, but her daughter was too young. The family then returned to England, where Wortley Montagu’s enthusiasm for inoculation was met with suspicion and strong resistance from the medical establishment. “When Lady Mary first came back, she didn’t dare do anything [to her daughter]. But there was such a severe outbreak in 1721, she thought she had to take action.”

She then invited highly respected physicians and “ladies of distinction” round to witness young Mary’s speedy recovery from the infection. One of the physicians who visited was so convinced, he decided to inoculate his own son, which also went well. Young Mary soon became famous. “News reached Princess Caroline, who was the Princess of Wales at the time. She took up the cause and eventually the royal children were inoculated. Word spread that it was a good thing to do.”


However, not everyone was convinced. “The Whigs were pro-inoculation but the Tory party was really against it – a lot of Tories wrote about how it was interfering with nature and it was dangerous. It became very politicised.”

Lady Mary Wortley Montagu, painted by Joseph Highmore,
 got the idea for inoculation after seeing the practice in Turkey. Photograph: Getty

Sometimes people died from smallpox after the procedure, which had to be carried out very carefully to ensure only a small dose was administered. “Often the gashes were too big.” In Turkey, people knew they needed to self-isolate for a period after an inoculation, but in England the process was ‘medicalised’ by ill-informed physicians. They pointlessly purged and bled their patients during the inoculation, and then allowed people to walk around while they were infectious, unwittingly spreading the disease. “There was a lot of misinformation.”

As controversy mounted, Wortley Montagu’s reputation suffered and her argument – that the inoculation process should not be medicalised – was dismissed. One prominent physician, William Wagstaffe, bemoaned the fact that a practice performed by a “few ignorant women” was being adopted in the royal palace, while Alexander Pope wrote venomous poems about Wortley Montagu, describing her as “poxed”. “He knew people would know she was connected to smallpox, but by using the word ‘pox’, he was implying that she had syphilis. So that didn’t help her reputation.”
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Young Mary wrote that she remembers servants giving her “dark looks” and acting as if they were repulsed by her when she visited aristocratic families with her mother to inoculate the household.

When Edward Jenner invented the smallpox vaccine in 1796, by taking fluid from a cowpox vaccine and scratching it on to the skin of a young boy, he was building on Wortley Montagu’s discovery, Willett said. “She brought a cure to the west. And that cure was developed into what we now think of as vaccination.”


Rare letter by Mary Wortley Montagu, pioneering travel writer, up for sale
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As a child, Jenner had himself been inoculated against smallpox by doctors following in Wortley Montagu’s footsteps. “He went through the whole purging and bleeding process and had such a grim experience that I think he thought: ‘there has to be an easier way of doing this’.”

When he realised that dairymaids never got smallpox, he “made the leap” and thought of introducing cowpox pus into a scratch instead of smallpox pus. “If he hadn’t been inoculated, then I don’t think he would have gone on to think about vaccination,” says Willett.

Jenner had discovered a much safer way to confer immunity – and, unlike Wortley Montagu, as an educated male physician, he could publish scientific papers about his discovery and be taken seriously. He was later credited by Louis Pasteur as the discoverer of the first vaccine. “Often in the canon of the history of science, women get overlooked,” said Willett. “Lady Mary is one of those women.”

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