It is 328 years ago today, that Lady Mary Wortley Montagu (born Mary Pierrepont) was baptized in London (Nottinghamshire) on 26 May 1689. She was an English aristocrat, letter writer and poet. Lady Mary is today chiefly remembered for her letters, particularly her letters from travels to the Ottoman Empire, as wife to the British ambassador to Turkey, which have been described by Billie Melman as "the very first example of a secular work by a woman about the Muslim Orient". Aside from her writing, Lady Mary is also known for introducing and advocating for smallpox inoculation to Britain after her return from Turkey. [1]

The Encyclopedia Brittanica describes her as colourful. The daughter of the 5th Earl of Kingston and Lady Mary Fielding (a cousin of the novelist Henry Fielding), she eloped with Edward Wortley Montagu, a Whig member of Parliament, rather than accept a marriage that had been arranged by her father. In 1714 the Whigs came to power, and Edward Wortley Montagu was in 1716 appointed ambassador to Turkey, taking up residence with his wife in Constantinople (now Istanbul). After his recall in 1718, they bought a house in Twickenham, west of London. For reasons not wholly clear, Lady Mary’s relationship with her husband was by this time merely formal and impersonal. [2]

Life in Turkey

In 1716, Edward Wortley Montagu was appointed Ambassador at Istanbul. In August 1716, Lady Mary accompanied him to Vienna, and thence to Adrianople and Istanbul. He was recalled in 1717, but they remained at Istanbul until 1718. While away from England, the Wortley Montagu's had a daughter on 19 January 1718, who would grow up to be Mary, Countess of Bute. After an unsuccessful delegation between Austria and Turkey/Ottoman Empire, they set sail for England via the Mediterranean, and reached London on 2 October 1718.

The story of this voyage and of her observations of Eastern life is told in Letters from Turkey, a series of lively letters full of graphic descriptions; Letters is often credited as being an inspiration for subsequent female travellers/writers, as well as for much Orientalist art. During her visit she was sincerely charmed by the beauty and hospitality of the Ottoman women she encountered, and she recorded her experiences in a Turkish bath. She also recorded a particularly amusing incident in which a group of Turkish women at a bath in Sofia, horrified by the sight of the stays she was wearing, exclaimed that

"the husbands in England were much worse than in the East, for [they] tied up their wives in little boxes, the shape of their bodies".

Lady Mary wrote about misconceptions previous travellers, specifically male travellers, had recorded about the religion, traditions and the treatment of women in the Ottoman Empire. Her gender and class status provided her with access to female spaces, that were closed off to males. Her personal interactions with Ottoman women enabled her to provide, in her view, a more accurate account of Turkish women, their dress, habits, traditions, limitations and liberties, at times irrefutably more a critique of the Occident than a praise of the Orient.

Lady Mary returned to the West with knowledge of the Ottoman practice of inoculation against smallpox, known as variolation.

Immigrating the concept of variolation

Lady Mary Wortley Montagu defied convention most memorably by introducing smallpox inoculation to Western medicine after witnessing it during her travels and stay in the Ottoman Empire. In the Ottoman Empire, she visited the women in their segregated zenanas, making friends and learning about Turkish customs. There she witnessed the practice of inoculation against smallpox—variolation—which she called engrafting, and wrote home about it a number of her letters, the most famous being her 1 April 1 1717 "Letter to a Friend". Variolation used live smallpox virus in the pus taken from a smallpox blister in a mild case of the disease and introduced it into scratched skin of a previously uninfected person to promote immunity to the disease. Lady Mary's brother had died of smallpox in 1713 and her own famous beauty had been marred by a bout with the disease in 1715.

Lady Mary was eager to spare her children, thus, 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 an Oriental folk treatment process.

In April 1721, when a smallpox epidemic struck England, she had her daughter inoculated by Maitland, the same physician who had inoculated her son at the Embassy in Turkey, and publicised the event. This was the first such operation done in Britain. She persuaded Princess Caroline to test the treatment. In August 1721, seven prisoners at Newgate Prison awaiting execution were offered the chance to undergo variolation instead of execution: they all survived and were released. [3] Controversy over smallpox inoculation intensified, however, Caroline, Princess of Wales was convinced. The Princess's two daughters were successfully inoculated in April 1722 by French-born surgeon Claudiius Amyand. In response to the general fear of inoculation, Lady Mary, under a pseudonym, wrote and published an article describing and advocating in favor of inoculation in September 1722.

In later years, Edward Jenner, who was 13 years old when Lady Mary died, developed the much safer technique of vaccination using cowpox instead of smallpox. As vaccination gained acceptance, variolation gradually fell out of favour.

References:

1. Lady Mary Wortley Montagu, in: Wikipedia. Accessed on 26 May 2017
2. Lady Mary Wortley Montague, in: The Encyclopedia Brittanica, Accessed on 26 May 2017
3. Art Boylston. The Newgate Guinea Pigs. http://www.londonhistorians.org/index.php?s=file_download&id=65

It was 268 years ago today, on 17 May 1749, that Edward Anthony Jenner was born in Berkeley, Gloucestershire, as the eighth of nine children. His father, the Reverend Stephen Jenner, was the vicar of Berkeley, so Jenner received a strong basic education.

He went to school in Wotton-under-Edge and Cirencester. During this time, he was inoculated for smallpox, no doubt by a method close to the one propagated by Lady Mary Wortley Montagu.

At the age of 14, he was apprenticed for seven years to Daniel Ludlow, a surgeon of Chipping Sodbury, South Gloucestershire, where he gained most of the experience needed to become a surgeon himself. In 1770, Jenner became apprenticed in surgery and anatomy under surgeon John Hunter and others at St George's Hospital. William Osler records that Hunter gave Jenner William Harvey's advice, very famous in medical circles (and characteristic of the Age of Enlightenment):

Don't think; try.

Hunter remained in correspondence with Jenner over natural history and proposed him for the Royal Society. Returning to his native countryside by 1773, Jenner became a successful family doctor and surgeon, practising on dedicated premises at Berkeley. He also became a master mason on 30 December 1802, in Lodge of Faith and Friendship #449.[1]

Like any other doctor of the time, Edward Jenner carried out variolation to protect his patients from smallpox. However, from the early days of his career Edward Jenner had been intrigued by country-lore which said that people who caught cowpox from their cows could not catch smallpox. This and his own experience of variolation as a boy and the risks that accompanied it led him to undertake the most important research of his life. Cowpox is a mild viral infection of cows. It causes a few weeping spots (pocks) on their udders, but little discomfort. Milkmaids occasionally caught cowpox from the cows. Although they felt rather off-colour for a few days and developed a small number of pocks, usually on the hand, the disease did not trouble them.[3]

Working on protection against smallpox

By 1768, English physician John Fewster had realised that prior infection with cowpox rendered a person immune to smallpox.[22] A similar observation had also been made in France by Jacques Antoine Rabaut-Pommier. In the years following 1770, at least five investigators in England and Germany successfully tested a cowpox vaccine in humans against smallpox. For example, Dorset farmer Benjamin Jesty successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner's work that the procedure became widely understood. Jenner may have been aware of Jesty's procedures and success.

Noting the common observation that milkmaids were generally immune to smallpox, Jenner postulated that the pus in the blisters that milkmaids received from cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox.[1]

In May 1796 a dairymaid, Sarah Nelmes, consulted Jenner about a rash on her hand. He diagnosed cowpox rather than smallpox and Sarah confirmed that one of her cows, a Gloucester cow called Blossom, had recently had cowpox. Edward Jenner realised that this was his opportunity to test the protective properties of cowpox by giving it to someone who had not yet suffered smallpox.

He chose James Phipps, the eight-year old son of his gardener. On 14th May he made a few scratches on one of James' arms and rubbed into them some material from one of the pocks on Sarah's hand. A few days later James became mildly ill with cowpox but was well again a week later. So Jenner knew that cowpox could pass from person to person as well as from cow to person. The next step was to test whether the cowpox would now protect James from smallpox. On 1st July Jenner variolated the boy. As Jenner anticipated, and undoubtedly to his great relief, James did not develop smallpox, either on this occasion or on the many subsequent ones when his immunity was tested again.[3] So, in addition to the name of Edward Jenner,  we also need to acknowledge the following names for their contribution to this success: Sarah Nelmes (the milkmaid), James Phipps (the child - guinea pig), The gardner Mr Phipps (for allowing this experiment on his son), and Blossom, the Gloucester Cow, for donating the virus. You can still have a look at Blossom, by the way. Her hide is on display at Saint George's University. [2]

Phipps was the 17th case described in Jenner's first paper on vaccination. Donald Hopkins has written,

"Jenner's unique contribution was not that he inoculated a few persons with cowpox, but that he then proved [by subsequent challenges] that they were immune to smallpox. Moreover, he demonstrated that the protective cowpox pus could be effectively inoculated from person to person, not just directly from cattle.

Jenner successfully tested his hypothesis on 23 additional subjects.[1]

Convincing establishment and translation into legal acts

Jenner continued his research and reported it to the Royal Society, which did not publish the initial paper. After revisions and further investigations, he published his findings on the 23 cases. Some of his conclusions were correct, some erroneous; modern microbiological and microscopic methods would make his studies easier to reproduce. The medical establishment deliberated at length over his findings before accepting them. Eventually, vaccination was accepted, and in 1840, the British government banned variolation – the use of smallpox to induce immunity – and provided vaccination using cowpox free of charge.[1]

Later life and death

In 1803 in London, he became president of the Jennerian Society, concerned with promoting vaccination to eradicate smallpox. The Jennerian ceased operations in 1809. In 1808, with government aid, the National Vaccine Establishment was founded, but Jenner felt dishonoured by the men selected to run it and resigned his directorship. Jenner became a member of the Medical and Chirurgical Society on its founding in 1805 (now the Royal Society of Medicine) and presented several papers there. Jenner was also elected a foreign honorary member of the American Academy of Arts and Sciences in 1802, and a foreign member of the Royal Swedish Academy of Sciences in 1806. Returning to London in 1811, Jenner observed a significant number of cases of smallpox after vaccination. He found that in these cases the severity of the illness was notably diminished by previous vaccination. In 1821, he was appointed physician extraordinary to King George IV, and was also made mayor of Berkeley and justice of the peace. He continued to investigate natural history, and in 1823, the last year of his life, he presented his "Observations on the Migration of Birds" to the Royal Society.

Jenner was found in a state of apoplexy on 25 January 1823, with his right side paralysed. He never fully recovered and eventually died of an apparent stroke, his second, on 26 January 1823, aged 73. He was buried in the Jenner family vault at the Church of St. Mary's, Berkeley, Gloucestershire. Jenner was survived by one son and one daughter, his elder son having died of tuberculosis aged 21.[1]

References

1. Edward Jenner, in Wikipedia (accessed 17 May 2017)
2. Saint George's, University of London Alumni Magazine. Issue 17, July 3, 2014. 
3. About Edward Jenner. The Jenner Institute Webpages. Accesses 17 May 2017