en zh es ja ko pt

Volume 31, Number 4July/August 1980

In This Issue

Back to Table of Contents

The Pox Upon Her

Written by Susan McHenry
Illustrated by Michael Grimsdale

This May, in Geneva, the World Health Organization (W.H.O.) formally announced at the World Health Assqmbly that the disease called smallpox hap been finally, and totally, defeated; According to W.H.O; spokesmen, "There has not been a single confirmed case of smallpox found in the world since October 26, 1977."

One of the worlds most dreaded diseases, smallpox once killed up to'400,000 people a year and left hundreds of thousands blind, deaf or scarred. Caused by a virus, smallpox decimated Europe in 1614, accounted for half the deaths in London in 1629, and wiped out more American Indians than the repeating rifle.

"According to W.H.O., the origin of smallpox is unknown, but apparently it dates back to ancient times. Researchers, for example, have found what seem to be smallpox scars on the mummified face of the Egyptian pharaoh Ramses V, who ruled about 1000 B.C.

To this day, no specific treatment for small pox has ever been found—and, in fact, none is needed. W.H.O.’s victory, so triumphantly announced in Geneva May 8, was; based entirely on a massive, worldwide effort to stamp out the disease by prevention rather than cure: by inoculation.

Inoculation is the introduction of a mild case of smallpox—or a similar disease, like the harmless cowpox—into, the body, thus creating an immunity againsia serious case.

Supposedly introduced for the first, time in England by Edward Jenner in 1798, inoculation—in the form of variolation—was in use centuries before throughout the Ottoman Empire, and was introduced in England 79 years before Jenner by Lady Mary Wortley Montagu, one of the more remarkable women of her age

-- The Editors

On April 1, 1717, writing from the Ottoman Empire, Lady Mary Wortley Montagu made medical history with one short but tremendously important paragraph:

I am going to tell you a thing which I am sure will make you wish your selfe here. The Small Pox, so fatal and so general amongst us, is here entirely harmless by the invention of engrafting (which is the term they give it)... Every year thousands undergo this Operation, ... and you may believe I am very well satisfy’d of the safety of the Experiment since I intend to try it on my dear little Son.

It was important because Lady Mary's "engrafting" was nothing less than an inoculation - with dead smallpox virus - against smallpox, then one of the world's dreaded diseases; and the process she described, experimented with on her son, and later espoused vehemently in England, preceded Edward Jenner's development of cowpox inoculation by 79 years.

Because of Jenner, whose scientific development of cowpox inoculation was also rooted in variolation - the use of smallpox virus - neither the Turks, who apparently discovered the process centuries before, nor Lady Mary, who was among the first to bring the idea to the West, have ever received the credit due to them.

Lady Mary first went to Turkey in 1717 when her husband, Edward Wortley Montagu was appointed ambassador to the Ottoman Empire. An observant and perceptive woman, she almost instantly saw that smallpox - which was then ravaging Europe - was somehow kept at bay in Turkey. Perhaps because she herself had been cruelly scarred by smallpox, she began to make the inquiries that led her eventually to try "engrafting" on her own son and, later, to crusade for its use in England.

Her efforts, it is true, met with only moderate success. But the effects of her courageous and broadminded support for variolation paved the way for the change in society's attitude that almost certainly made a difference in the reception of Edward Jenner's cowpox inoculation 79 years later.

Inoculation against smallpox, however, was but one of many astute observations which Lady Mary made of Turkish life. In an age when there was little understanding, and much misunderstanding, between Christian Europe and the Muslim Middle East, Lady Mary was remarkable for her objectivity in her encounters with this new, strange culture. Curious and energetic, she pursued diverse aspects of Turkish social customs and recorded them in a collection of brilliant letters which provide a colorful, detailed and sensitive picture of Turkish life as she came to know it, and left an indelible mark on the literary history of her times.

In describing her first visit to a Turkish bath, for example, she not only described in detail the five domed rooms - "paved with Marble, and all round it rais'd 2 Sofas of marble, one above another"- but also included a charming summary of Turkish women "obliging civility" and an amusing description of their reaction to her "rideing dress" which, she said, "certainly appeared very extrordinary to them."

I beleive in the whole there were 200 Women and yet none of those disdain-full smiles or satyric whispers that never fail in our assemblys when any body appears that is not dress'd exactly in fashion. They repeated over and over to me, Uzelle, pek uzelle, which is nothing but charming, very charming. The first sofas were covered with Cushions and rich Carpets, on which sat the Ladys... but without any distinction of rank by their dress, all being in the state of nature ... without any Beauty or defect conceal'd, yet there was not the least wanton smile or immodest Gesture amongst 'em. They walk’d and mov’d with the same majestic Grace which Milton describes of our General Mother. There were many amongst them as exactly proportion'd as ever any Goddess was drawn by the pencil of Guido or Titian, and most of their skins shineingly white, only adorn'd by their Beautifull Hair divided into many tresses hanging on their shoulders, braided either with pearl or riband, perfectly representing the figures of the Graces... •

[There were] so many fine Women some in conversation, some working, others drinking Coffee or sherbet, and many negligently lying on their Cushions ... In short, tis the Women's coffee house, where all the news of the Town is told, Scandal invented, etc... The Lady that seem'd the most considerable amongst them entreated me to sit by her and would fain have undress'd me for the bath. I excus'd myselfe with some difficulty, they being all so earnest in perswading me. I was at last forc'd to open my skirt and shew them my stays, which satisfy'd 'em very well, for I saw they beleiv’d I was so lock'd up in that machine that it was not in my own power to open it, which contrivance they attributed to my Husband.

Being a woman, and the wife of a diplomat, worked very much to Lady Mary's advantage. She was admitted and invited to places that other European visitors to the Ottoman Empire had never seen: the women's section of private homes, and even the residences of the wives of the Grand Vizier. On one such visit - to the home of the "Fair Fatima" - the music and dancing provided for her entertainment resulted in this almost lyric description.

She made them a sign to play and dance. 4 of them immediately begun to play some soft airs on Instruments between a Lute and a Guitarr, which they accompany’d with their voices while the others danc’d by turns. This Dance was very different from what I had seen before. Nothing could be more artfull ... the Tunes so soft, the motions so languishing, accompany’d with pauses and dying Eyes, halfe falling back and then recovering themselves... I suppose you may have read that the Turks have no Music but what is shocking to the Ears, but this account is from those who never heard any but what is play’d in the streets, and is just as reasonable as if a Foreigner should take his Ideas of the English Music from the bladder and string, and marrow bones and cleavers. I can assure you that the Music is extremely pathetic. 'Tis true I am enclin'd to prefer the Italian, But perhaps I am partial. I am acquainted with a Greek Lady who sings better than Mrs. Robinson, and is very well skill'd in both, who gives the preference to the Turkish. Tis certain they have very fine Natural voices; these were very agreable.

Lady Mary, however, went much deeper into Turkish culture than that. In her pursuit of intercultural understanding she talked regularly with such personages as the Effendi Ahmet Bey who, she wrote,

gave me opertunity of knowing their Religion and morals in a more particular manner than perhaps any Christian ever did. I explain'd to him the difference between the Religion of England and Rome, and he was pleas'd to hear there were Christians that did not worship images or adore the Virgin Mary... He assur'd me that if I understood Arabic I should be very well pleas'd with reading the Alcoran,... tis the purest morality delivered in the very best Language. I have since heard impartial Christians speak of it in the same manner,...

Her conversations with the "Effendi Ahmet Bey" also dealt with Ottoman, Persian, and Arabic literature. To her friend, erstwhile admirer, and literary colleague Alexander Pope she wrote:

He had explain'd to me many peices of Arabian Poetry, which I observered are in numbers not unlike ours, gennerally alternate verse, and of a very musical sound. Their expressions of Love are very passionate and lively... I pass for a great Scholar with him by relateing to him some of the Persian Tales, which I find are Genuine. At first he beleived I understood Persian.

In an age when women's education seldom went beyond the niceties of social discourse and the skills of needlepoint, Lady Mary, clearly, was an exception. Although she had no formal education, she explored her father's vast libraries, reading plays and romances both in French and English. She also pursued the classics, taught herself Latin and, as the oldest daughter, helped her father entertain his intellectual friends, among whom were the noted writers Joseph Addison, Richard Steele, William Congreve and the physician and wit Dr. Samuel Garth. This exposure to some of the finest minds of the age undoubtedly played its part in developing her own exceptional talents.

Unfortunately, about this time, she was also exposed to smallpox, which had already taken her brother - in 1713, shortly after her marriage to Wortley - and now, two years later, would strike her too. Although she recovered, she sustained permanent scarring from her illness: the pitting of her face, and the loss of her eyelashes. For one who had been known from her childhood for her beauty as well as for her wit and intelligence, this disfigurement was a blow - as she made clear, after her recovery, in heroic couplets, the poetic form popularized by her poet friend Alexander Pope.

Beauty is fled, and spirit is no more!

Galen, the grave; officious Squirt, was there,

With fruitless grief and unavailing care:

Machaon, too, the great Machaon, known

By his red cloak and his superior frown;

And why, he cry’d, this grief and this despair?

You shall again be well, again be fair;

Believe my oath; (with that an oath he swore)

False was his oath; my beauty is no more!

Against this background it is easy to see why, when she discovered that the peoples of the Ottoman Empire could protect themselves against smallpox, she opened her campaign with this graphic description to her friend Sarah Chiswell:

The Small Pox, so fatal and so general amongst us, is here entirely harmless by the invention of engrafting (which is the term they give it). There is a set of old Women who make it their business to perform the 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 had a mind to have the small pox. They make partys for this purpose, and when they are met (commonly 15 or 16 together) the old Woman comes with a nutshell full of the matter of the best sort of smallpox and asks what veins 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 venom as can lye upon the head of her needle, and after binds up the little wound with a hollow bit of shell, and in this manner opens 4 or 5 veins. The Grecians have commonly the superstition of opening one in the Middle of the forehead, in each arm and on the breast to mark the sign of the cross, but this had a very ill Effect, all these wounds leaving little Scars, and is not done by those that are not superstitious, who chuse to have them in the legs or that part of the arm that is conceal'd.

The children or young patients play together all the rest of the day and are in perfect health till the 8th. Then the fever begins to seize 'em and they keep their beds 2 days, very seldom 3. They have very rarely above 20 or 30 [pustules] in their faces, which never mark, and in 8 days time they are as well as before their illness. Where they are wounded there remains running sores during the Distemper, which I don't doubt is a great releif’d to it. Every year thousands undergo this Operation, and the French Ambassador says pleasingly that they take the Small pox here by way of diversion as they take the Waters in other Countrys. There is no example of any one that has dy’d in it, and you may beleive I am very well satisfy'd of the safety of the Experiment since I intend to try it on my dear little Son.

Lady Mary was not, in fact, the first European to relay information on inoculation to England. Four years earlier, Dr. Emanuel Timoni, an Italian physician in Constantinople, had sent an extensive account of the practise of variolation to the Royal Society of Physicians and Surgeons in 1713, and it had been published in that organization's Philosophical Transactions. Two years later a physician who had acted as the Venetian Consul at Smyrna, Dr. Jacob Pylarini, sent another account to the Royal Society.

According to Robert Halsband's fine biography of Lady Mary, Dr Timoni's paper was probably not known to Lady Mary, although he was engaged by Wortley to attend his family when they arrived in Constantinople four years later. But it is likely that Dr. Timoni offered encouragement in the decision she made to inoculate her son - since he had inoculated his own daughter that same year.

From the perspective of 1980 this decision may not seem as courageous as it was. In 1717, however, when the concept of inoculation was totally unknown in the West - and when there was no guarantee that the smallpox virus injected was as mild as it had to be - Lady Mary was actually risking her son's life. Yet a letter to her husband, away on embassy business, gives little more than a hint of her anxiety:

The Boy was engrafted last Tusday 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 ... I cannot engraft the Girl; her Nurse has not had the small Pox."

It was not, however, quite as simple as those brief remarks indicate - as is clear in the account of Dr. Maitland, the British doctor who served as their embassy physician in Constantinople and performed the operation:

The Ambassador's ingenious Lady, who had been at some Pains to satisfy her Curiosity in this Matter, and had made some useful Observations on the Practice, was so thoroughly convinced of the Safety of it, that She resolv’d to submit her only Son to it, a very hopeful Boy of about Six Years of Age: She first of all order'd me to find out a fit Subject to take the Matter from; and then sent for an old... Woman, who had practis'd this Way a great many Years: After a good deal of Trouble and Pains, I found a proper Subject, and then the good Woman went to work; but so awkwardly by the shaking of her Hand, and put the Child to so much Torture with her blunt and rusty Needle, that I pitied his Cries, who had ever been of such Spirit and Courage, that hardly any Thing of Pain could make him cry before; and therefore Inoculated the other Arm with my own Instrument, and with so little Pain to him, that he did not in the least complain of it.

Apparently the course of the boy's reaction to the inoculation was similar to the reactions which Lady Mary had heard of and seen. The swellings on his arms were followed in a few days by red spots on his face. Fever and thirst occurred for a brief time several days later, and approximately 100 pustules appeared - the pustules which, when they break in a real case of smallpox, leave deep and ugly scars. But this time they simply formed crusts and fell off, leaving no scarring, the only trace of the operation was the marks on his arms.

Shortly afterward, Lady Mary and her husband returned to England. Then, in 1721, another smallpox epidemic swept England and two physicians mentioned variolation - in a pamphlet and in a speech. No action was taken, however, until Lady Mary decided to inoculate her daughter as well - and stirred up a controversy that would endure until Edward Jenner finally succeeded in proving the worth of the process.

As in Turkey, Lady Mary - alarmed at the epidemic - asked Dr. Maitland, who had retired to the country following his return with the Wortleys, to inoculate her daughter. Dr. Maitland agreed and the operation was successful. As Maitland wrote later, Lady Mary's daughter was "neither blooded nor purg’d before, nor indeed was it necessary, considering the clean Habit of Body, and the Very cool, regular Diet she had ever been kept to from her Infancy"

Furthermore, he added, three "learned Physicians of the College were admitted, one after another, to visit the young Lady ... and will on all Occasions declare, as they hitherto have done, that they saw Miss Wortley playing about the Room, chearful and well, and with the Small Pox rais'd upon her..."

There was another observer too: Caroline, Princess of Wales, Lady Mary's friend at court, who, in deciding to consider inoculation for herself, brought the process to the attention of the public - and touched off the controversy.

Still uncertain, Princess Caroline asked Maitland to perform the experiment on criminals, condemned to death at Newgate Prison, as an additional test - and six men volunteered. If they should survive, freedom was to be their reward.

Of the six, five inoculations ran the course as expected, and the sixth man had no reaction at all, since he had already survived the smallpox itself. The six were granted their freedom.

Still, Caroline was not totally convinced and in the spring of 1722 the experiment was performed again: on six orphans of the Parish of St. James and five hospital babies. As all the inoculations were successful, Caroline was persuaded and so was the King. He gave his permission and Caroline had two of her daughters, Princess Amelia and Princess Caroline, inoculated. When those inoculations were totally successful, other titled and noted families followed suit. Lord Bathurst, one of Lady Mary's friends, had all six of his children variolated. And Lady Mary wrote to her sister about "the growth and spreading of the inoculation of the small-pox, which is become almost a general practice, attended with great success."

Lady Mary spoke too soon. Shortly afterward a young servant in Lord Bathursfs household died after inoculation and so did the two-and-a-half-year-old son of the Earl of Sunderland. As a result variolation became the subject of a raging controversy with Dr. Maitland - for the defense - publishing a new edition of his pamphlet on variolation. Support also came from several eminent doctors in the United States; smallpox, and the controversy surrounding variolation, had spread to the New World too.

Among the opponents were both clergymen and doctors. The Reverend Edmund Massey, for example, wrote that inoculation was a "'dangerous practice' because it opposed the will of God, who visited disease upon the world either to try our faith, or to punish us for our sins."

William Wagstaffe, who issued a pamphlet on the subject concluded that:

Posterity perhaps will scarcely be brought to believe, that an Experiment practiced only by a few Ignorant Women, amongst an illiterate and unthinking People, shou'd on a sudden and upon a slender Experience, so far obtain in one of the Politest Nations in the World, as to be receiv'd into the Royal Palace.

Lady Mary also entered the fray - in an essay submitted anonymously, as befitted a titled lady. It appeared under the title, "An account of the inoculating the small pox at Constantinople, by a Turkey-Merchant," but as it was severely edited it wasn't until more than 200 years later that the original essay, and its authorship, were discovered by Lady Mary's biographer, Robert Halsband, and printed with all its original literate force intact.

Out of compassion to the numbers abused and deluded by the knavery and ignorance of physicians, I am determined to give a true account of the manner of inoculating the small pox as it is practised at Constantinople with constant success, and without any ill consequence whatever. I shall sell no drugs, nor take no fees, could I persuade people of the safety and reasonableness of this easy operation. Tis no way my interest (according to the common acceptation of that word) to convince the world of their errors; that is, I shall get nothing by it but the private satisfaction of having done good to mankind, and I know no body that reckons that satisfaction any part of their interest.

Mincing no words, Lady Mary explicitly blamed the physicians, rather than variolation, for the deaths and, with her usual perception and passion, attacked the heart of the issue. Calling it "murder," she clearly outlined the differences between the practical approach to variolation, as she had observed it in the Middle East, and variolation attended by bleeding and purging, as it was practiced in England.

The murders that have been committed on two unfortunate persons that have died under this operation has been wholly occasioned by the preparatives given by our learned physicians,... I believe 'tis much to be doubted if purges or any violent method ever brings the body into a moderate temper, which may always be done by a cool diet and regular hours,... their long preparation only serve to destroy the strength of body necessary to throw off the infection ... the cordials that they pour down their throats may increase the fever to such a degree as may put an end to their lives...

Though continuing to be controversial, the practice of inoculation grew in England and New England alike. Quoting a 1749 study by Thomas Frewen, Robert Halsband writes in the Journal of the History of Medicine:

Within seven years of the initial operation, statistics proved its overwhelming effectiveness. Between 1721 and 1728, 897 persons were inoculated, of whom only 17- two percent- died, presumably of the operation. In the same period, of a total of 218,000 deaths in England, over 18,000 (almost nine percent) died of the smallpox. As in Turkey, the best argument in favor of inoculation came from its practical success.

Sadly, some of Lady Mary's closest friends and relatives were among those who did not follow her example in the inoculation. When Lady Mary had the operation performed on her daughter, she had invited her sister, Lady Gower, to have her son inoculated at the same time. Lady Gower declined and the boy died two years later of smallpox. And so, in 1726, did Sarah Chiswell, the friend to whom Lady Mary had sent the letter from Turkey regarding the inoculation.

Inoculation, meanwhile, had spread to the continent as well as to the New World, and the great Voltaire suggested that, for the purposes of remaining alive and of keeping women beautiful, the French should adopt the practice. Although variolation was not adopted in France until 1750, it became a focal point for the philosophers of the Enlightenment in their opposition to conservative tradition, superstition and intolerance.

Lady Mary's embassy letters, published the year following her death in 1762, also became an acclaimed addition to the literature of the Enlightenment. In her own times, intellectual leaders such as Dr. Johnson and Voltaire praised them, Voltaire calling them "superior" because "they seemed written for all nations wishing to be instructed." In the 20th century, their contribution to the attitudes and literature of the Enlightenment is firmly established. "By virtue of their clearsighted observation, their expansive tolerance, and their candid sympathy for an alien culture, they are Lady Mary's valid credentials for a place in the European 'Enlightenment"," wrote Robert Halsband.

In sum, Lady Mary made two contributions to history. She introduced, and fought for, inoculation against a dreadful disease, and in her lively, perceptive letters bridged the gap of ignorance that divided Eastern and Western knowledge and philosophies from each other.

Susan McHenry, a teacher and a free-lance writer in Topeka, Kansas, lived and taught for two years in Turkey and is now working on a collection of Turkish proverbs.

The Pestilence of Abraha
Written by Caroline Stone

If few people today know that Lady Mary Montagu introduced smallpox inoculation to England 79 years before Edward jenner, even fewer know that the Arabs apparently identified smallpox as early as A.D. 570 and may even have developed a form of inoculation shortly afterwards.

Although unknown to the Greeks and Romans, smallpox is thought to be the disease that ravaged the Ethiopian armies during a siege of Mecca in A. D. 570—the year the Prophet Muhammad was born. The source is a Sura in the Koran which reads:

"Have you not seen how your Lord did with the possessors of the elephants? Did He not bring their stratagems into error? And He sent against them birds of Ababil, who threw upon them seal stones and made them like devoured grain"

The reference is to Abraha, the Ethiopian ruler of Yemen, and some commentators have interpreted the "seals" as the marks of smallpox. Later the famous Arab physician al-Razi provided what is probably the first clinical description of smallpox—but added that some of his information came from the work of Aaron of Alexandria, who practiced at the time of the Prophet. According to A History of Medicine, by Douglass Guthrie, al-Razi—usually called Rhazes—gives a clear description of both smallpox and measles, although he seems to make smallpox sound much less frightening than the appalling confluent smallpox of later centuries. His treatise was the standard work on the subject for almost 900 years, and as late as 1748, Thomas Stack of London wrote A Discourse on Small Pox and Measles To which is Annexed, a Treatise on the Same Diseases by the Celebrated Arabian Physician Abu-Beher Rhazes...

This was much more than historical courtesy. Stack had searched England's libraries for an Arabic copy of the treatise, and then, having failed to find one, wrote to a friend in Holland asking him to reach the University of Leiden, "which I knew to be very rich in Arabic manuscripts" And although "it proved to be full of faults" Stack's new work on smallpox was firmly based on the information provided by al-Razi's study nearly 900 years earlier.

Meanwhile, smallpox had become a grave problem. By 1614 it was spreading through Europe—in a much more virulent form—and by 1629 was said to be London's principal cause of death.

In seeking a cure against this new plague, England, early in the 18th century, tried an ancient Chinese method of inoculation which involved communicating smallpox by inhalation. It did prove effective, but as it was excessively dangerous the method was not adopted. But then neither was the Turkish inoculation introduced by Lady Mary Wortley Montagu.

Remembering that the Chinese and the Turks had both experimented with smallpox inoculation long before Jenner, it is obvious that the origins are unclear. Lady Mary certainly—and reasonably—elieved that the Turks developed it. In fact, there is a substantial body of evidence suggesting that the Arabs not only identified smallpox in the sixth century but developed a form of inoculation against it. In 1738, for example, Thomas Shaw, an Englishman, published a book on his travels in which he said inoculation was then known in North Africa. And in 1768 there emerged the memoirs of a Dutch pastor named Chais in which he wrote that an ambassador from Morocco had said publicly, in 1738, 60 years before Jenner, that inoculation against smallpox was common practice in Tripoli, Tunis and Algiers.

Perhaps the best evidence, however, comes from Patrick Russell, an English physician in Aleppo, who had thoroughly questioned Bedouins from throughout the Arab world and was convinced that inoculation had been common in the Arab East for centuries.

This article appeared on pages 12-21 of the July/August 1980 print edition of Saudi Aramco World.


Check the Public Affairs Digital Image Archive for July/August 1980 images.