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The medical crank who saved millions Today's vaccine scientists owe a debt to eccentric smallpox survivor Mary Montagu

Gillray nails it. A cartoon on vaccination from 1802. Photo by Universal History Archive/Getty Images

Gillray nails it. A cartoon on vaccination from 1802. Photo by Universal History Archive/Getty Images


December 14, 2020   5 mins

As vaccines start to be rolled out, the sceptics abound. Governments, pharmaceutical companies and the medical profession are distrusted by an often vocal minority. Yet, curiously, it was a very similar kind of distrust of authority that led to the spread of inoculation in the first place.

The story begins with smallpox, humanity’s deadliest ever enemy. It has claimed hundreds of millions of lives, having afflicted Eurasia and Africa since before the pyramids, and absolutely devastated the native populations of the Americas and Siberia when they came into contact with Europeans. In the 20th century alone, it killed an estimated 300 million people before its final eradication in 1979 — and those who were lucky enough to survive it were usually left permanently scarred. In many cases blind.

Yet for centuries, we also had a solution. Inoculation, or “variolation” (from the Latin for smallpox, variola) involved first collecting the fluid from the pustules of a smallpox victim, or crushing up the material from their scabs. The material was then either snorted as a powder, or rubbed into a scratch using a small knife — the lancet that gives its name to the now-famous medical journal.

The variolated person would still get smallpox, but their infection would usually be milder, and hopefully less deadly. It appears to have been used in India and China by the mid-16th century — it was in China where it was snorted — and in North Africa and the Ottoman Empire by the end of the 17th century, and even in parts of Wales since as early as 1600.

But it had not been adopted systematically. It was a sort of latent innovation, present among the folkloric, rural traditions of much of Eurasia and Africa, but often ignored by their official, urban medical professions. Part of the problem was that it was still dangerous. Variolation, unlike vaccination, still had some risk of death. It was generally practised as a last resort, to be used only in case of severe smallpox outbreaks. What would make Edward Jenner’s later discovery of vaccination so important was that he instead used the pus from non-lethal cowpox (variolae vaccinae), meaning that the word vaccination comes from the Latin for cow. Think vache in French, or vaca in Spanish.

Many of the 19th-century vaccinations should more accurately have been called equinations, as they often used horsepox instead, but when Louis Pasteur invented ways to immunise against anthrax and rabies, he named them vaccinations in honour of Jenner’s discovery. Vaccination was thus the name that stuck, and became more widely applied to methods of immunisation in general.

Of course, even non-lethal vaccines like Jenner’s, or those of Pfizer or Moderna today, face their challenges in gaining social acceptance and trust, despite all the evidence in their favour and the significantly more careful and rigorous testing (Jenner began by simply vaccinating his gardener’s son, and then tried to infect him with smallpox. He survived, luckily). Just as the MMR vaccine was infamously blamed for autism, even some doctors in the late 19th and early 20th centuries blamed smallpox vaccines for causing leprosy, cancers and miscarriages. But for still-lethal variolation, the climb to social acceptance was even steeper.

Enter Lady Mary Pierrepont, woman of letters, celebrated poet, anonymous journalist and aristocrat, whose elopement in 1712 may have been the most important marriage in human history. For her new husband, Edward Wortley Montagu, soon became the ambassador to the Sublime Porte of Constantinople, taking her and their young son with them.

It was in the Balkans, Greece and Turkey, that Lady Mary observed the practice of inoculation, and having once experienced the horrors of smallpox herself, had her son inoculated there. Her son, incidentally, would later become an adventurer extraordinaire, running up debts across Europe, getting involved with highwaymen, running a gambling extortion racket, probably doing some spying both for and against France, distinguishing himself in a major battle, helping negotiate the end of the War of Austrian Succession, converting to Islam, becoming an influential scholar of Middle Eastern customs and languages, committing bigamy twice — even tricking his third wife into committing accidental bigamy herself, by convincing her that her actual husband had died — and, of course, being elected an MP.

In Turkey, Lady Mary decided that she would make it her patriotic mission “to bring this useful invention into fashion in England”. She was not the first westerner to have a child inoculated in Turkey, nor was she the first person to send word of the procedure back to Britain. The country’s premier scientific organisation — the Royal Society — had received word of the practice a few years before her trip.

But when an especially bad smallpox epidemic swept into Britain in 1721, Lady Mary was the one who introduced inoculation into wider practice. She arranged for her daughter to be inoculated in England by the surgeon who had accompanied her husband’s embassy, Charles Maitland — who, significantly, insisted that it be done in the presence of a few medical experts.

Needless to say, the daughter thrived — indeed, she would grow up to be the wife of a prime minister, the Earl of Bute. But the hallmark of early 18th-century science was a healthy dose of distrust; one successful case and a few reports of inoculation abroad was not enough. The Royal Society had been founded a few decades earlier on the basis that all prior knowledge should be put to the test, and the old authorities rigorously interrogated. It was not enough to take Aristotle’s word for things, and certainly not Turkish folklore. Nullius in verba, went the society’s motto: take nobody’s word for it. Knowledge thus had to be confirmed by experiment, in the presence of witnesses, before it could be granted the authority of “fact”.

Using her court connections, Lady Mary interested Princess Caroline, the wife of the heir to the throne, who arranged for an experiment to be performed on prisoners in Newgate gaol. Six people destined for the gallows were offered their lives and a pardon in exchange for undergoing inoculation — all six survived, with one of them turning out to already be immune, and the other five experiencing only a mild form of the disease.

It was promising initial evidence, and inspired local doctors around the country to begin inoculating their patients. Meanwhile, an American clergyman named Cotton Mather arranged for hundreds of inoculations as smallpox swept Boston. So the Royal Society began to gradually build a more convincing set of statistics on inoculation’s effectiveness, which yielded clear results: albeit still potentially fatal, the risk of death was very much lower than from contracting the disease normally. Initially about one in fifty, compared to one in six.

It still took decades for inoculation to become acceptable. Mather’s home was attacked with a grenade, and Lady Mary Wortley Montagu had abuse hurled at her in the newspapers and in the streets. Her own distrust of authority — she suspected that doctors might oppose inoculation on the grounds that it would “destroy such a considerable branch of their revenue” — may also have got in the way of her mission. In print, she criticised the way English physicians conducted the operation. But on the whole, she succeeded. In 1722, Princess Caroline became fully convinced and had the royal princes and princesses inoculated, with many aristocrats following suit.

George I even wrote to a daughter back in Germany, to try and persuade her to inoculate the future Frederick the Great of Prussia. And the growing statistical evidence collected by the Royal Society helped gradually confirm the belief in inoculation’s relative safety, converting it into established fact. It was thanks to the scientist’s inherent scepticism, tempered by the search for better evidence, that inoculation gained approval, became more common, was later improved in its safety, and ultimately led to the invention of non-lethal vaccinations. Hundreds of millions of lives have been saved as a result.

 


Anton Howes is a historian of invention. His book Arts and Minds: How the Royal Society of Arts Changed a Nation is published by Princeton University Press

antonhowes

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Muscleguy
Muscleguy
3 years ago

I bear a smallpox vaccination scar on my left shoulder from being inoculated in 1972 as a 6yo. We were emigrating from Scotland to New Zealand via Singapore where smallpox still existed. We also decamped from the plane into Calcutta airport while it was being cleaned, refuelled and reprovisioned.

The elimination of it in the wild, cemeteries excepted. Is a shining example of what medical science can achieve when public acceptance and fear are strong.

People today have little idea of the fear diseases such as smallpox, polio etc used to cause. The Norfolk marshes used to host malaria as well remember.

Vaccination is credited with hard numbers to have saved more human lives than any other medical intervention. Those who live comfortable lives in the modern world who think vaccines are dangerous are dangerously complacent.

Those of us who grew up in a world where travel meant possible exposure to nasty diseases (we caught bad gastroenteritis in Singapore, I ended up in an isolation room in a NZ hospital as my initial introduction to the country).

Adrian
Adrian
3 years ago
Reply to  Muscleguy

I don’t think vaccines are more dangerous than smallpox, but I do think vaccinations are more dangerous than the common cold.

I’m glad that all of the oldies are getting the vaccine, because life will return to normal, but I’d much rather have the virus proper. As for children we don’t know if the chances of illness from the vaccine are lower than the smaller than 1 in a million chance of dying from the virus.

I’m all for the major vaccines, because they tend to target the nastiest stuff first. Coronavirus has been targetted not because it is nasty, but because it is new.

On the flipside, if the novel approaches to vaccine science pan out as intended, they may save us all sorts of trouble in the future, should something nastier come along.

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Adrian

Covid is not the common cold – yet. I dare say it will be. I have only once in my lifetime (58) known of a person (a peer) who had the flu which knocked her for 6 but has been otherwise unscathed. As for Covid! The number of people I know who have been hospitalised or who gave had it or who gave lost relatives – well would you like a list? I don’t doubt in time that it will learn to live with us like a lot of viruses. But please stop disrespecting the people who are dealing with this and inferring they are liars.

Michael Dawson
Michael Dawson
3 years ago
Reply to  Adrian

The common cold barb is a bit silly. Covid-19 is not a common cold. As I understand it, children are not being vaccinated anyway.

Ian Perkins
Ian Perkins
3 years ago
Reply to  Adrian

Children have a less than one in a million chance of dying?
“On Sep 10, children made up only about 1.7% of total COVID-19 hospitalizations, with roughly 2.0% of infected children requiring hospitalization. Similarly, children accounted for 0.07% of total deaths, and their death rate was only 0.01%.” – CIDRAP, University of Minnesota
Small numbers, which could be even smaller once asymptomatic infections are factored in, but less than one in a million?

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Ian Perkins

Kind of old numbers. The second wave infections would not be be included in your numbers.

Ian Perkins
Ian Perkins
3 years ago

Children and COVID-19: State-Level Data Report, American Academy of Pediatrics, data up to December 3.
Hospitalizations (24 states and NYC reported)*
Children were 1.1%-3.0% of total reported hospitalizations, and between 0.3%-4.9% of all child COVID-19 cases resulted in hospitalization
Mortality (43 states and NYC reported)*
Children were 0.00%-0.23% of all COVID-19 deaths, and 15 states reported zero child deaths
In states reporting, 0.00%-0.11% of all child COVID-19 cases resulted in death.

Chris Milburn
Chris Milburn
3 years ago
Reply to  Ian Perkins

Whatever the exact death rate it’s far less than Influenza, RSV, and all of the other common childhood bugs. In Canada, more kids have died of being struck by lightning than have died of COVID, and the lightning victims were not severely compromised when they were electrocuted.

Adrian
Adrian
3 years ago
Reply to  Ian Perkins

I’ll have to check those stats out. But given that the WHO was saying roughly 0.2% infection fatality overall, and IFR falls by a factor of 10 per decade 0.11% for children seems extreme. I suspect “0.00%-0.11% of all child COVID-19 cases” refers to the CFR not the IFR. When comparing dangers of vaccination (which are likely to be low but not noexistent) the IFR would be the more useful statistic.

0.002%for children aged 10 according to:

Assessing the AgeSpecificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications

That is 1 in 50000, so not 1 in a million, but I imagine that number will come down, as IFRs always do for some reason

Ian Perkins
Ian Perkins
3 years ago
Reply to  Adrian

Without checking, I think you’re quite right, especially regarding IFR/CFR.
But as you say, 1 in 50,000 still isn’t 1 in a million.

vince porter
vince porter
3 years ago
Reply to  Muscleguy

A vaccine for Covid-19 is a vaccine for the health systems as much as for the individual. Without lockdowns, closures, masks, and, ultimately, vaccines, the health systems would collapse. ICU beds filled with Covid-19 patients displace the cancer patients. When all the ventilators are keeping Covid patients alive, the child with an asthma attack is out of luck. That, not the kill ratio or the infection rate, is what keeps doctors awake at night.

Annette Kralendijk
Annette Kralendijk
3 years ago

Every vaccine has some number of people opposed to taking it. With Covid, it may actually be helpful to have some fairly large number of people willing not to take it and to make way for those who do want it. No one should be forced to take the vaccine.

Drahcir Nevarc
Drahcir Nevarc
3 years ago

What I really don’t understand at all is the overlap between opposing lockdown and opposing vaccination. Basic reasoning tells us that successful vaccination militates against the need for lockdown. Surely – surely! – if you oppose lockdown, you should want vaccines to succeed. Right?

Michael Hanson
Michael Hanson
3 years ago
Reply to  Drahcir Nevarc

Not necessarily: Covid-19, by many accounts, is similar to other coronaviruses and therefore lockdowns and vaccines are not needed.

Ian Perkins
Ian Perkins
3 years ago
Reply to  Michael Hanson

Of all the known human coronaviruses, COVID-19’s is most similar to SARS. I guess all the lockdowns and disruptions to international travel were unnecessary in dealing with that too.

Adrian
Adrian
3 years ago
Reply to  Ian Perkins

SARS seems to have just disappeared. Oddly we don’t actually know how deadly SARS is, because we have no idea how many people got it. At the time we assumed that SARS was transmissable only by symptomatic people, but we were probably wrong.

Michael Hanson
Michael Hanson
3 years ago
Reply to  Ian Perkins

I would agree that they too were unnecessary. These coronaviruses seem to have a similar pattern of peaking then tapering off and becoming part of the background – whatever we do.

Drahcir Nevarc
Drahcir Nevarc
3 years ago
Reply to  Michael Hanson

Even supposing your premise is sound, your conclusion doesn’t follow from your premise.

Moreover, you’re missing my point. It’s highly arguable that the lockdown cure is worse than the Covid disease. This being so, surely we should support a measure i.e. vaccination which militates against the need – whether genuine or merely perceived – for lockdown.

Michael Hanson
Michael Hanson
3 years ago
Reply to  Drahcir Nevarc

O.K. I see now – vaccinating would be a way of curing lockdown not Covid. I like it – but not enough to take the vaccine myself.

Ian Perkins
Ian Perkins
3 years ago
Reply to  Drahcir Nevarc

I don’t think basic reasoning really enters into it. COVID vaccinations/lockdowns are a bad idea because A and B, links provided. So you check out the links, and A doesn’t back up what they’re saying, while the links in B don’t back B up. Aha, comes the reply, ignoring and moving on from A and B, but what about C and D, links provided. And so on and so on. And half the links are to a single doctor with a dodgy reputation, hardly a conclusive guarantee that what they’re saying is good science.
It truly seems to me that many have decided, for whatever reasons, that both lockdowns and vaccinations are wrong, and then trawled the internet for anything that might at first glance appear to justify their stance. Of which there is plenty if you’re not too bothered whether it does, since there’s plenty more where it came from.
Which isn’t to say either lockdowns or vaccinations are without problems, but this phenomenon of furiously opposing both, and seeing malign intentions and conspiracies behind them, often seems based on something entirely other than reason.

Drahcir Nevarc
Drahcir Nevarc
3 years ago
Reply to  Ian Perkins

Well said, especially your description of the A-B-C-D phenomenology of anti-vaccine apologetics.

Jules jules
Jules jules
3 years ago
Reply to  Ian Perkins

Why on earth would anyone be skeptical of lockdowns and the novel Rna vaccine? mmmhhh let’s see: Maybe because the 2.2 million Covid deaths (United States) and 500,000 (U.K) projected by Ferguson’s model, which were instrumental in governmental policy decision-making, were massively downgraded half way into march, while the policies weren’t. Whoops!
If lockdowns are so efficient how do you explain that some of the countries that had the most authoritarian lockdowns, also have the highest rate of death per million? how do you explain that most asian countries that didn’t enforce any lockdowns have very low casualties and other like Sweden had a peak in mortality but are still faring way better than the UK/France/Belgium for instance? Those mitigated results are obviously a sign that locking down people is not significant enough of a measure in itself when it comes to preventing death and propagation. Exploring other avenues would be vital but as long governments and “health experts” are double downing on this single approach, all other avenues are shut down.
And let’s examine the vaccination. Problem is that the defenders of the Covid-19 vaccination keep pretending we are just talking about a regular vaccine instead of a novel technology. First, 99.6% of the pop survives Covid-19 when infected. Despite this optimistic number, governments are planning on inoculating millions of otherwise healthy people with a vaccine that is completely experimental, that will interfere with the coding of your immune system on the RNA level. It has never been done before on that scale and the trials were rushed. Cherry on top, pharmaceutical compagnies are waiving any liabilities, governments will be responsible in case of lawsuits i.e the taxpayer. And they are thinking of ways to mandate it. That’s just the tip of the iceberg.
How can you pretend those above mentioned “ABCD” don’t add up?Where is your”basic reasoning”? Good reasoning involves observing an issue from different angles, but how can you pretend to reason if you dismiss the legitimacy of a proper debate by shrugging the other side off? I am afraid you may yourself be guilty of seeking out the information that will comfort your biased perception.

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Jules jules

New Zealand doesn’t have a high death rate. Neither does Finland or Norway or Denmark. Australia? Which Asian countries are you referring to? You have no data to back up your opinion.

Adrian
Adrian
3 years ago

Japan I think. 2000 deaths despite 49% of Tokyo showing antibodies at a single point in time during the Summer – I think they reckoned 61% had had the virus in Tokyo.

New Zealand and Australia had warning, on account of it striking Italy during their Summer. If I had my way, after vaccinating the vulnerable here, I’d ship all the rest of vaccine supplies over to New Zealand and Oz, where it’ll save the most lives.

Ian Perkins
Ian Perkins
3 years ago
Reply to  Adrian

Russia and China mightn’t be too happy about their vaccines being shipped off to two Five Eyes countries.

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Adrian

Good idea.

Jules jules
Jules jules
3 years ago

Oh my, Do you want to go through all the countries in the world? I didn’t speak of New Zealand nor Norway nor Denmark. I have data, it’s readily available for everyone to see the number of deaths/million on Worldometer. As for the Asian countries: Hong Kong, Japan or South Korea didn’t lock their people down, to name a few. What I pointed to is the simple fact that there are mixed results with countries who imposed a lockdown= some have a high rate of death and some don’t, which suggests that this single approach isn’t effective in preventing the spread. A lot of pandemic specialists and health workers have justifiably noted that targeted tests and an earl/easily accessible protocole to treat the most vulnerable (way before hospitalization with combo of antiviral + vitamins+Zinc) has been a successful approach in many of those countries with low death rates. This strategy was crucially absent in many of the countries that have had a heavy death toll. See? There are many other ways to handle a sanitary crisis than locking your people down until you develop a half assed vaccine.

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Jules jules

I agree we are not treating the virus more effectively before hospitalisation takes place – a many pronged approach could work. I and my family have taken all the recommended vits from the outset – unfortunately it didn’t stop us getting the virus but they may have helped in fighting it off. I don’t like lockdowns but am not vehemently against them. Sadly the UK has done little or nothing to protect the vulnerable which is why they resort to these measures – also there are too many people who refuse to alter any part of their behaviour to avert spread of disease. Lack of cooperation all around I feel.

Jules jules
Jules jules
3 years ago

Thanks for the reply. It seems to me that the governments that put tremendous pressure on their people, create irrevocable economical damage, aggravate toxic social tensions, by elevating the docile citizens and blaming the skeptics for their failed strategy, have to be denounced. It’s not fair to constantly ask for the working class and the poorest to bear the brunt of this crisis and also demand absolute subservience when you haven’t done anything to deserve it.

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Jules jules

I agree that new/different solutions need to be looked at as a way forward. And we can only do that after seeing what has worked and what has failed.

Chris Milburn
Chris Milburn
3 years ago
Reply to  Drahcir Nevarc

As a doc who is first on the list to get the new mRNA vaccine (probably in a few weeks here in Canada), I am nervous for the first time about getting a vaccine. I prefer not to be a guinea pig. There is a saying by one of the fathers of vaccinology: “I don’t breathe a sigh of relief until the first 30 million doses have been given”. ie: we don’t know the real side effect profile until a few years, and many millions of patients, into a program. Particularly with this being an mRNA vaccine as opposed to a typical attenuated virus/virus fragment vaccine, there is real cause for vaccine hesitancy. I will dutifully get mine, but were I not a frontline healthcare worker I would likely be waiting a bit. “Be not the first to try new things, nor the last to discard the old”

Claire Olszanska
Claire Olszanska
3 years ago
Reply to  Chris Milburn

You don’t have to take it.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris Milburn

Step aside then and let the line through.

Adrian
Adrian
3 years ago
Reply to  Chris Milburn

I wish the pro-vaccine propaganda machine wasn’t going into action, it’s likely to scare people off. By the time the 25% of super willing have had the vaccine the rest will be able to make up their minds, and as for the 2% anti-vaxxers, you can’t win ’em all.

I am glad I’m last on the list though. I suspect that both Covid and the vaccine are rather low risk as far as I’m concerned, but since I think I had Covid, I’m in no great hurry to get vaccinated.

Let them vaccinate the old, give them an extra 5 years of life, with no fear of long term harm.

Drahcir Nevarc
Drahcir Nevarc
3 years ago
Reply to  Chris Milburn

Fair enough, you have some doubts about the vaccine’s effectiveness, but you’re not simultaneously opposed to lockdown and opposed to vaccination as a point of principle – you still WANT it to succeed, right?

Ian Perkins
Ian Perkins
3 years ago

Some things don’t change much. “Mather’s home was attacked with a grenade, and Lady Mary Wortley Montagu had abuse hurled at her in the newspapers and in the streets.”

Michael Hanson
Michael Hanson
3 years ago

So, listen to the cranks and be suspicious of the medical establishment!

Ian Perkins
Ian Perkins
3 years ago
Reply to  Michael Hanson

If only every crank turned out to be right.

Michael Hanson
Michael Hanson
3 years ago
Reply to  Ian Perkins

That’s silly – they can’t all be right.
Evidently some are right and we have sensible theories about evolution and the spherical nature of the Earth.

Luis Vassallo
Luis Vassallo
3 years ago

To complement this article may be good to remember the Balmis Expedition from 1803 to 1806. Organized and funded by Charles IV of Spain. In this voyage Dr. Balmis took 22 orphans as successive carriers of the virus, and launched a massive vaccination campaign in America and the Philippines that saved millions of lives. They even went into some cities in China. On his way back to Spain in 1806, Balmis offered the vaccine to the British authorities in Saint Helena, despite the ongoing conflict between Spain and Great Britain.

https://en.wikipedia.org/wi

Chris Milburn
Chris Milburn
3 years ago

Great article. As a doc I am always fascinated by the history of medicine.
I had forgotten the root of “vaccination” was the same as “vache”. I can’t hear the word “vache” without thinking of Monty Python’s Quest for the Holy Grail, with the famous “fetcher la vache” scene.

Penny Gallagher
Penny Gallagher
3 years ago

Thanks just from a historical point of view a fascinating article.