Lady Mary Wortley Montagu, the pioneer woman of immunization forgotten by history

The remarkable progress in immunization against COVID-19 has focused the world’s attention on the brilliance of vaccines.

Many know the story of the discovery of Edward Jenner of smallpox vaccination in Gloucestershire, UK, almost 250 years ago.

But far fewer have heard of Lady Mary Wortley Montagu.

She was the high society woman whose pioneering inoculation experiments laid the groundwork for bases for Jenner’s discovery, but whose contribution is almost forgotten.

This year, which marks the 300th anniversary of his extraordinary human experiments, we have a great opportunity to revisit his astonishing contribution to public health.

Progressive views

Born Mary Pierrepont in 1689, she was a lively and headstrong woman who wrote poems and letters and had progressive views on the role of women in society.

To avoid an arranged marriage, she eloped when she was 23 years old and married Edward Wortley Montagu, grandson of the 1st Earl of Sandwich.

In 1716, Edward became England’s ambassador to Istanbul (or Constantinople as it was known back then), capital of the Ottoman Empire.

From there, Wortley Montagu wrote vivid descriptions of oriental life, especially of Turkish women, whose dress, lifestyle, and traditions intrigued her.

The most notable was about his inoculation method against the dreaded smallpox.

Treatment with “grafts”

It has long been known that people could only get this disease once.

If they survived, they were immune for the rest of their lives.

Rather than risk a natural infection that had a high mortality rate, older Turkish women sought to induce a mild case in children by what they called a “graft”.

Smallpox causes pustules and scabs on the skin of people affected by the disease.

Women took pus from a patient’s pustule and added it to an incision made in the arm of the person they wanted to protect.

This generally resulted in mild symptoms, followed by protection for life.

“There is a group of old women [aquí]”Wortley Montagu wrote,” who are engaged in performing the operation, every fall … thousands undergo this … [y no hay] just one example of someone who died from it. “

Wortley Montagu herself had survived smallpox, but was left with facial scars. His brother had succumbed to the disease.

She was eager to protect her young son from the disease and convinced the embassy surgeon to inoculate him.

“The child was grafted last Tuesday,” she wrote in a letter to her husband, “and at this moment he is singing and playing, and very impatient for his dinner.”

Wortley Montagu was determined to “make this useful invention fashionable in England.”

Experiment with your daughter

After a couple of years, he had returned home. In 1721, there was a smallpox epidemic, and Wortley Montagu asked the embassy doctor, who had come with her to London, to graft her young daughter who had not been inoculated.

Concerned about his reputation, the doctor asked several medical witnesses to observe the procedure.

In April 1721, the doctor inoculated young Mary Alice. It was the first time the procedure had been performed in the UK.

Although observers were impressed, others were skeptical of this dangerous and exotic practice.

Wortley Montagu and her daughter visited homes affected by smallpox to show that the girl was protected.

Still, many doctors remained cautious. Wasn’t this a risky procedure? What if it causes a serious or fatal illness?

Inoculation or death

In August 1721, an extraordinary experiment was conducted in London’s Newgate Prison that helped persuade people of the benefit of the smallpox vaccine.

Several prisoners awaiting execution were offered the opportunity to be vaccinated against smallpox, and the possibility of being released if they survived.

They all accepted the offer and lived to tell the tale.

To show that immunization really did protect against the disease, one of the prisoners was sent to care for a boy with smallpox, and she slept with him every night for six weeks without getting sick.

Although inoculation remained a controversial practice, with some medical and religious opposition, this prison experiment considerably strengthened the “variolation” campaign, as this procedure is now known.

Procedure that saved thousands of lives

The Princess of Wales, a friend of Wortley Montagu, was convinced and had her own children vaccinated.

Royalty throughout Europe followed suit, as did the wealthy in New England, where smallpox was wreaking havoc.

Despite the occasional serious illness after inoculation, and sometimes fatal, the procedure saved thousands of lives.

Wortley Montagu’s contribution was celebrated by the French poet Voltaire, among others, and the inoculation became a meeting point for the Enlightenment.

One more step

Seventy-five years later, British physician Edward Jenner, who had been vaccinated as a child, took the process one step further.

He realized that those who had suffered from cowpox, a cattle-related disease that is very mild in humans, they were later immune to smallpox.

Jenner then inoculated people with cowpox material and later showed that this was effective against smallpox (injecting them with smallpox using Wortley Montagu’s variolization approach).

Vaccination, as Jenner’s procedure was later known by the Latin name cow, proved to be safe and was subsequently adopted globally.

Jenner received many awards and honors, and her work led to the eventual smallpox eradication in 1976.

Every medical student in the world is now learning about Jenner; his portrait hangs in the Royal College of Physicians, London.

Even Blossom, the cow that provided the original cowpox material for Jenner’s experiment, is remembered.

His skin is in the St George Hospital School of Medicine, and his portrait hangs in the Royal College of Pathologists.

But Wortley Montagu, whose pioneering efforts laid the foundation for Jenner’s experiments, has fallen into oblivion.

Would we remember his work if it had been the work of a male doctor, rather than a high-society lady?

Now, 300 years later, the Royal College of Physicians in London is looking for the most appropriate way to recognize his contribution.

* Tom Solomon is Director of the Zoonotic and Emerging Infections Health Protection Research Unit at the National Institute for Health Research, and Professor of Neurology, University of Liverpool, UK.

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