Smallpox Inoculation in England (1721): Lady Mary Wortley Montagu

Smallpox inoculation was introduced into England in 1721 largely through the efforts of Lady Mary Wortley Montagu, an English aristocrat and writer who had seen the practice in the Ottoman Empire. Inoculation, also called variolation, meant deliberately infecting a healthy person with material from a mild smallpox case to cause a light attack that gave lifelong immunity. Her advocacy, a controversial trial on prisoners at Newgate and the support of the royal family made it widely accepted in Britain, decades before Edward Jenner’s vaccine.

Smallpox in eighteenth-century Europe

Smallpox was one of the deadliest diseases of the age. In European towns it was endemic, and it is estimated to have killed around 400,000 Europeans a year in the eighteenth century. Many survivors were left scarred or blind. The disease had also devastated Indigenous populations in the Americas, as in the smallpox epidemic in Mexico of 1520.

Lady Mary Pierrepont, born in 1689, knew the disease personally. Her brother died of smallpox in 1713, and in 1715, three years after her marriage to Edward Wortley Montagu, she caught it herself. She survived, but lost her eyelashes and was left with facial scars.

Learning of “engrafting” in the Ottoman Empire

In 1716 Edward Wortley Montagu was appointed British ambassador to the Ottoman Empire, and Lady Mary travelled with him to Adrianople (Edirne) and then Constantinople (Istanbul). There she observed the local practice of inoculation, which was carried out by older women, often in social gatherings in the autumn.

In a famous letter to her friend Sarah Chiswell, dated 1 April 1717, she wrote that smallpox, “so fatal, and so general amongst us, is here entirely harmless, by the invention of engrafting”. She described how a woman opened a vein with a needle and inserted a little matter from a smallpox pustule, after which the patient usually suffered a short, mild fever.

The practice was not unknown to European scholars. The physicians Emanuel Timoni and Giacomo Pylarini had sent accounts of it to the Royal Society in 1714 and 1716. Similar methods were also used in parts of Africa, India and China.

In March 1718 Lady Mary had her five-year-old son, Edward, inoculated in Constantinople. The procedure was supervised by the embassy surgeon, Charles Maitland, and performed with the help of an elderly Greek woman. The boy recovered quickly.

The London trials of 1721

The Montagus returned to England in 1718. In the spring of 1721 a severe smallpox epidemic struck London, and in April Lady Mary asked Maitland to inoculate her three-year-old daughter, Mary. He did so in the presence of physicians from the royal court, who observed her mild illness and recovery.

The case attracted the interest of Caroline, Princess of Wales, but the royal family wanted further proof. On 9 August 1721 Maitland inoculated six condemned prisoners at Newgate Prison, three men and three women, who were offered a pardon in return. The trial was observed by court physicians including Hans Sloane. All six survived and were released. One of them, Elizabeth Harrison, was later sent to nurse smallpox patients in Hertford and did not catch the disease, which was taken as evidence of immunity.

A further trial on orphaned children of the parish of St James’s, Westminster, followed in early 1722. On 17 April 1722 Princess Caroline had her daughters Amelia and Caroline inoculated by Maitland, under the direction of the royal surgeon Claudius Amyand.

Debate and evidence

Inoculation provoked fierce opposition. Some physicians distrusted a folk remedy from the Ottoman world, especially one promoted by a woman. Some clergy argued that it was wrong to give a person a disease deliberately; the Reverend Edmund Massey preached a widely publicised sermon against it in 1722. Deaths of a few inoculated patients, and the fact that they could pass smallpox to others, fuelled the controversy.

James Jurin, secretary of the Royal Society, responded by collecting figures from across Britain in the 1720s. His work is an early example of statistics used to judge a medical treatment.

Meanwhile in Boston, the minister Cotton Mather, who had learned of inoculation from an enslaved West African man named Onesimus, persuaded the physician Zabdiel Boylston to inoculate during the epidemic of 1721. Boylston’s results, with a death rate of about 2 per cent among more than 240 people inoculated, matched the English experience.

Key people

Lady Mary Wortley Montagu (1689–1762) was a poet, essayist and letter writer, largely self-educated in Latin. Her letters from the Ottoman Empire, published in 1763 after her death as the Turkish Embassy Letters, became a classic of travel writing. In 1722 she defended inoculation in an anonymous newspaper piece written as “a Turkey Merchant”.

Charles Maitland (c. 1668–1748), a Scottish surgeon, performed the key inoculations in Constantinople and London. In 1722 he published an account of his work, and he later inoculated members of the royal family in Hanover.

Caroline of Ansbach, Princess of Wales and later Queen, was a patron of science. Her decision to inoculate her own daughters was the decisive endorsement that made the practice acceptable among the elite.

Sir Hans Sloane, physician to the royal family and later President of the Royal Society, oversaw the trials and advised the princess.

Myths and facts

Lady Mary invented inoculation. She did not; it was an established folk practice in the Ottoman Empire and elsewhere. Her role was as a witness, an early adopter and a determined campaigner.

Inoculation was the same as vaccination. Inoculation used real smallpox and carried real risks, including spreading the disease. Vaccination, using cowpox, came only at the end of the century.

Her contribution was quickly recognised. In fact, contemporary medical accounts often credited physicians and played down the role of a woman, and her importance was emphasised mainly by later historians.

Legacy

Inoculation spread slowly at first, then widely from the 1750s, especially after Robert and Daniel Sutton simplified the method in the 1760s. In 1768 the English physician Thomas Dimsdale inoculated Empress Catherine the Great of Russia. Smallpox hospitals and mass inoculations became common in Britain.

Edward Jenner, who was himself inoculated as a boy, introduced cowpox vaccination in 1796. Being safer, vaccination gradually replaced variolation, which was banned in the United Kingdom in 1840. The long effort to defeat the disease ended with the eradication of smallpox, certified in 1980.

Timeline

• 1689: Lady Mary Pierrepont is born in London (baptised 26 May).
• 1715: She survives smallpox, which scars her face.
• 1717, 1 April: She describes Ottoman “engrafting” in a letter from Adrianople.
• 1718, March: Her son Edward is inoculated in Constantinople.
• 1721, April: Her daughter Mary is inoculated in London.
• 1721, 9 August: Six Newgate prisoners are inoculated in a royal trial.
• 1722, 17 April: Princess Caroline’s daughters are inoculated.
• 1796: Edward Jenner performs his first cowpox vaccination.
• 1840: Variolation is outlawed in the United Kingdom.

Why it matters

Lady Mary Wortley Montagu’s campaign brought a proven folk practice from the Ottoman world into European medicine. Inoculation saved many lives in the eighteenth century, encouraged the use of statistics in medicine and created the knowledge and public acceptance on which vaccination was later built.