Lady Montagu
One woman's resolve to turn the tide of smallpox
Happy 4th of July, American readers! May this post inspire the same distinctive spirit of innovation and independent thinking that gave rise to our nation.
On the first of April, 1717, the wife of the British Ambassador sits down at her writing desk in Adrianople, a city on the far eastern edge of the Ottoman Empire.1 A warm breath of air drifts through the open window. Lady Mary Wortley Montagu takes up her paper and quill, grateful for the moment of peace. Writing to Miss Sarah Chiswell, a childhood friend back in England, she offers reassurances that “those dreadful stories you have heard of the Plague, have very little foundation in truth.” But she is eager to share news of another deadly disease that is hounding her native Britain: smallpox. “A propos of distempers,” she writes, “I am going to tell you a thing that will make you wish yourself here.”
In the 18th century, smallpox killed a whopping 30 percent of those who caught it, wiping out roughly 400,000 Europeans per year.2 In crowded London it was a relentless and deadly tide, sweeping in and out in repeated epidemics. Particularly fatal to children, it was responsible for 20 percent of the city’s burials of young people.3 Yet, as Lady Mary gushes excitedly to Miss Chiswell, a practice known as “engrafting” has rendered it “entirely harmless” in the Ottoman Empire.
There is a set of old women, who make it their business to perform [this] operation, every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox: they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nutshell full of the matter of the best sort of small-pox, and asks what vein you please to have open’d. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can ly upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell; and in this manner opens four or five veins.
Lady Mary’s interest was piqued. She may have already caught wind of the procedure back in England, where she’d lost her brother to the disease.4 With a beautiful face marred by her own bout with smallpox, she was eager to learn, and her position allowed her to travel and take prolific notes. Smart and fiercely independent, she was not the type to just go along. As a young woman she had refused the marriage arranged by her father, the 5th Earl of Kingston, to elope with the man she loved; a Whig politician later named Ambassador to Turkey.5
As she tells her dear Miss Chiswell, the Turkish children who received the strange treatment played for the rest of the day, in fine health, and later developed a fever that confined them to bed for two or three days. But the pox that appear on their skin are relatively few, and leave no marks. “In eight days time they are as well as before their illness.” Thousands of Turkish children were thus treated each year, she adds, prompting the French ambassador to quip that the Turkish take the smallpox as casually “as they take the waters in other countries.” Lady Mary has not heard of a single death from smallpox; a record so convincing that “I intend to try it on my dear little son.”
And so she did.
She launched a campaign to spread this time-tested practice of Turkish “old women,” using her celebrity status to push back against a medical system she already mistrusted. As she tells Miss Chiswell, “I am patriot enough to take pains to bring this useful invention into fashion in England; and I should not fail to write some of our doctors very particularly about it, if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue, for the good of mankind.”
So Lady Mary saw her greatest adversary not as the disease, itself, but the doctors tasked with treating it. “Perhaps, if I live to return, I may […] have courage to war with them,” she writes.6
This bleak pessimism about medicine may be striking, but it is not particularly surprising coming from an educated woman of her time. In 18th century England, women’s health care was largely handled by other women. Midwives and literate ladies received training from each other and maintained an ongoing exchange of recipes (or what they called “receipts”) and recipe books used for cooking, medicine and other domestic duties. Many bought published books, such as those by Hannah Woolley (see my Rooted Resolve, Hannah), and used them in combination with books they had compiled or inherited from their own mothers, friends or neighbors.
Largely hidden from male eyes, this dynamic network of information and learning was cherished among women and vital to their health. When a gentlewoman married, she often brought with her a family book of recipes that had been passed down for generations. Unlike the culinary recipes, directions for preparing medicines remained highly consistent across manuscripts. Though a few of these remedies appear to have come from doctors, the vast majority came from other women.7
One of the most popular recipe books in 17th and 18th century England was The Queens Closet Opened, which invites readers in on “incomparable secrets” culinary, surgical and medicinal.
In addition to recipes for painful breasts, provoking the terms (menstruation), speeding birth, expelling afterbirth and many other ailments, it includes several medicines for the treatment and prevention of smallpox. For example, “Dr. Eaglestones Cure for the Small Pocks or Measles”:
Take a quart of Ale or Beer, and seethe it in a skillet, and put thereto a good handful of Fennel, and six or seven Figs scraped, and cut it in pieces, two good spoonfuls of Aniseeds, and a little Saffron, put all these to the drink, and let them seethe together till the liquor be more than half consumed, and in the seething scum it clean, and strain it into a bason, and when it is cold, make a posset of the same drink, and use to drink this often warm, and it will cause the disease to come forth.8
In a matter of decades, the need for this treatment became obsolete thanks to an admittedly icky bit of Turkish folk medicine and the intrepid English gentlewoman willing to believe in it.
On Sunday, March 23, Lady Mary wrote to her husband that their son had been “engrafted last Tuesday, and is at this time singing and playing, and very impatient for his supper. I pray God my next may give as good an account of him.” It is unclear how much her husband had to do with this decision, but his absence suggests Lady Mary was the one to take the initiative. “I cannot engraft the girl,” she explains, because “her nurse has not had the smallpox.”9
Back in England, Lady Mary’s campaign to spread the Turkish practice of smallpox inoculation helped to turn the tide against this devastating disease. In 1721 her young daughter became the first person inoculated against the smallpox on British soil, a procedure witnessed by a group of distinguished ladies and British doctors.
In reality the West was a latecomer to the party. Inoculation was already familiar to many regions of the world, including China, India and West Africa, by the time the British Royal Society first learned of it in 1699.10 Two decades later, Lady Mary’s involvement finally spurred the adoption of the practice by popularizing its use among the nobility and rendering it less foreign and strange.
Ever an outlier in her suspicions of conventional medicine, she became an outlier in her willingness to believe in foreign methods. She was certain the Turkish practice was perfectly effective on its own. She had seen it, first hand. But British physicians trained to understand our health in terms of bodily humors were unconvinced. They insisted on crafting a uniquely English method where a surgeon would not only introduce smallpox pus to fresh cuts on the skin, but subject the patient to a lengthy regimen of dieting, sweating, blistering, bleeding, purging and vomiting; a process intended to create the ideal bodily conditions for overcoming the disease.
One of the doctors who attended the inoculation of little Mary Wortley had lost all but one of his children. To Lady Mary’s dismay, his sole remaining son became the first patient to receive this new treatment.11 In the years that followed she fulfilled her own prophecy by warring with the doctors. She saw her own nephew die after her sister refused her offer to inoculate him, and she lamented the “fools who had rather be sick by the doctor’s prescriptions, than in health in rebellion to the college.” In a tragic twist Miss Chiswell, the very same friend who read Lady Mary’s news of this innovative treatment in 1717, refused to be inoculated and succumbed to smallpox in 1726.12
Critics labelled Lady Mary an “unnatural mother” who risked the lives of her own children just to prove a point. Exhausted by the attention, both positive and negative, she took refuge in the country. For a woman whose reputation and good breeding was paramount, her fight to change the medical establishment came at serious personal cost. She was especially frustrated by her failed attempts to fully convert people to the Turkish method. But she successfully spread the practice of inoculation like few others could.
Lady Mary mobilized a whole social strata, swaying those in power toward a different way of thinking. The majority of her female peers and the nobility, in general, endorsed the British form of inoculation. Queen Caroline, Princess of Wales had the whole royal family inoculated. Although it was not entirely without risk, the procedure changed the calculus of childhood mortality. While 30 percent of those who caught smallpox naturally died, only 1 to 2 percent of the inoculated succumbed to the disease.13 By the late 18th century, thanks in part to those Turkish grandmas and Lady Mary’s willingness to believe in them, whole communities were being inoculated and smallpox epidemics were a rarity in England’s most densely populated areas.14
Known today as Edirne, Turkey.
Abbas M. Behbehani, “The Smallpox Story: Life and Death of an Old Disease,” Microbiology Reviews 47, no. 4 (1983): 455-509; and “Smallpox: A Great and Terrible Scourge,” National Institutes of Health, March 5, 2024, https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html.
Romola Jane Davenport, Max Satchell, and Leigh Matthew William Shaw-Taylor, “The geography of smallpox in England before vaccination: A conundrum resolved,” Social Science & Medicine 206 (2018): 75-85.
Helen Esfandiary, “‘A thankless enterprise’: Lady Mary Wortley Montagu’s campaign to establish medical unorthodoxy amongst her female network,” The Royal Society Notes and Records 77, no. 2 (2023): 235-250.
The Editors of Encyclopaedia Britannica, “Lady Mary Wortley Montagu,” Britannica, https://www.britannica.com/biography/Lady-Mary-Wortley-Montagu.
All quotes from Lady Mary are taken directly from her letters as published in Lady Mary Wortley Montagu, The Letters and Works of Lady Mary Wortley Montagu, ed. by Lord Wharncliffe and W. Moy Thomas (London: Henry G. Bohn, 1861), 307-8.
Erin Sunshine Allaire-Graham, “A Collection of Choise Receipts: Networks of Recipe Sharing in Early Modern England,” M.A. Thesis (Bard College, 2012).
W.M., The Queens Closet Opened (London: J.G. and Nathaniel Brook, 1663), 136-7.
The Letters, 352-3.
John B. Blake, “The Inoculation Controversy in Boston: 1721-1722,” The New England Quarterly 25, no. 4 (1952): 489-506.
Esfandiary 2023.
The Letters, 471, 499.
Esfandiary 2023; and Smallpox: A Great and Terrible Scourge.
Davenport et al. 2018.
Beautiful, Emily!