Lady Mary Wortley Montagu and Immunization Advocacy

Today’s guest post is written by Lisa Rosner, Ph.D., Distinguished Professor of History at Stockton University. Recent publications include The Anatomy Murders (University of Pennsylvania Press, 2009) and Vaccination and Its Critics (ABC-Clio, 2017). She is the project director and game developer for The Pox Hunter, funded by an NEH Digital Projects for the Public grant.  On Thursday, April 6, Lisa will give her talk, “Lady Mary’s Legacy: Vaccine Advocacy from The Turkish Embassy Letters to Video Games.” To read more about this lecture and to register, go HERE.

In a letter dated April 1, 1717 – 300 years ago — Lady Mary Wortley Montagu (1689–1762), the wife of the British ambassador to Turkey, provided the first report from an elite European patient’s perspective of the middle-eastern practice of inoculation, or ingrafting, to prevent smallpox. She wrote to her dear friend, Sarah Chiswell:

“I am going to tell you a thing that will make you wish yourself 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. 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 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 nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. 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 lie 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…

The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Then the fever begins to seize them, and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty in their faces, which never mark, and in eight 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 relief to it. Every year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it, and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son.”


Mary Wortley Montagu with her son Edward, by Jean-Baptiste van Mour. Source: Wikimedia Commons.

This is probably the most famous passage in all Lady Mary’s voluminous correspondence. It deserves even more attention than it usually gets, because it is the first example, in the western history of medicine, of a mother’s perspective on the practice of immunization. We tend to hear a great deal from scientists like Jenner about their discoveries, but much less from mothers who adopted their techniques for children.

But Lady Mary was not just a mother, she was also an acute observer with an inventive and inquisitive mind, and a particular interest in what we would now call public health practices. She had lost a beloved brother to smallpox; she had also contracted the disease, and though she survived, she carried the scars for the rest of her life. As she traveled from London to Constantinople, she was particularly interested in innovations and cultural attitudes toward hygiene and domestic health, especially as they affected women’s lives.

Her enthusiasm for light, clean, airy environments comes through in her very first letter, written from the Netherlands. She wrote:

“All the streets are paved with broad stones and before many of the meanest artificers doors are placed seats of various coloured marbles, so neatly kept, that, I assure you, I walked almost all over the town yesterday, incognito, in my slippers without receiving one spot of dirt; and you may see the Dutch maids washing the pavement of the street, with more application than ours do our bed-chambers.”

For that reason, she noted:

“Nothing can be more agreeable than travelling in Holland. The whole country appears a large garden; the roads are well paved, shaded on each side with rows of trees.”

She was much less pleased with Vienna, for though there were certainly many magnificent sights, the city itself was dark and crowded. She complained:

“As the town is too little for the number of the people that desire to live in it, the builders seem to have projected to repair that misfortune, by clapping one town on the top of another, most of the houses being of five, and some of them six stories … The streets being so narrow, the rooms are extremely dark; and, what is an inconveniency much more intolerable … there is no house has so few as five or six families in it.”

As her travels continued throughout the fall and winter, another custom, neglected in England, caught her attention: the stove, valuable for warmth and for lengthening the growing season. At one of the formal dinners she attended, she was offered oranges and bananas and wondered how they could possibly be grown in Austria. She wrote:

“Upon inquiry I learnt that they have brought their stoves to such perfection, they lengthen their summer as long as they please, giving to every plant the degree of heat it would receive from the sun in its native soil. The effect is very near the same; I am surprised we do not practise [sic] in England so useful an invention. This reflection leads me to consider our obstinacy in shaking with cold, five months in the year rather than make use of stoves, which are certainly one of the greatest conveniencies [sic] of life.”


Mary Wortley Montagu in Turkish dress. Souce: Wikimedia Commons.

When she arrived in Constantinople and spent time with ladies of the court, both Turkish and European, Lady Mary continued to pursue her interest in gardens, in baths, in the light airy spaces found in both European and Turkish households. She was not the first European to report on the practice of “ingrafting”: her family physician in Constantinople, Dr. Emmanuel Timoni, had previously sent a report to the Royal Society of London. But seeing a disease, so dangerous in Europe, treated as an excuse for a children’s party turned her into an advocate. As she wrote:

“I am patriot enough to take the pains to bring this useful invention into fashion in England, and I should not fail to write to 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. But that distemper is too beneficial to them, not to expose to all their resentment, the hardy wight that should undertake to put an end to it. Perhaps if I live to return, I may, however, have courage to war with them. Upon this occasion, admire the heroism in the heart of your friend.”

After she returned to London, she kept her promise “to war” with the physicians in support of inoculation. When smallpox broke out in her social circle in 1722, she decided to inoculate her daughter, and the operation was performed with great success. Physicians who visited her found “Miss Wortley playing about the Room, cheerful and well,” with a few slight marks of smallpox. Those soon healed, and the child recovered completely. The visiting physicians were impressed, and they began to incorporate inoculation into their own practices.

As the epidemic raged, Lady Mary convinced her most prominent friend, Caroline, Princess of Wales, to inoculate the two royal princesses, Amelia and Caroline. Having received the royal seal of approval, smallpox inoculation became fashionable practice among British elites throughout the 18th century.


Memorial to the Rt. Hon. Lady Mary Wortley Montague erected in Lichfield Cathedral by Henrietta Inge. Source: Wikimedia Commons.

In 1789, Mrs. Henrietta Inge, Lady Mary’s niece, erected a memorial to her accomplishments in Litchfield Cathedral. The text reads:

“[She] happily introduc’d from Turkey, into this country the Salutary Art Of inoculating the Small-Pox. Convinc’d of its Efficacy She first tried it with Success on her own Children, And then recommended the practice of it To her fell-w-Citizens. Thus by her Example and Advice, We have soften’d the Virulence, And excap’d the danger of this malignant Disease.”

We can recognize in Lady Mary – and in Mrs. Inge — advocates of a kind met with very frequently in the history of vaccination: mothers whose personal experience led them to champion the discoveries that preserved their family’s health and well-being.


  1. Grundy, Isobel. Lady Mary Wortley Montagu. Oxford: Oxford University Press, 1999.
  1. Montagu, Lady Mary Wortley. Letters of Lady Mary Wortley Montagu. Written during her travels in Europe, Asia, and Africa. Paris: Firman Didot, 1822. Available in many editions online.
  1. Rosner, Lisa. Vaccination and Its Critics. A Documentary and Reference Guide. Santa Barbara, CA: Greenwood, 2017.

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Edward Jenner and the Development of the Smallpox Vaccine

By Rebecca Filner, Head of Cataloging

Smallpox was one of the leading causes of death in 18th-century Europe, killing about 400,000 people annually and leaving many more disfigured or blind. Epidemics in major cities routinely killed 20% or more of those infected, and this case-fatality rate rose to 80% for infants.

Variolation, a process through which people were deliberately infected with mild strains of smallpox in an effort to shield them from catching a more virulent form of the disease, was first used in England by Lady Mary Wortley Montagu in 1721 and became increasingly common later in the 18th century. However, 0.5 to 3% of variolated patients still died of smallpox, and there was always the risk that a variolated person would infect others with the disease.1

Engraving of Edward Jenner by William Ridley from an original painting by James Northcote.

Engraving of Edward Jenner by William Ridley from an original painting by James Northcote.

Enter Edward Jenner, an English doctor working in Gloucestershire in the late 18th century. Jenner was interested in testing the commonly held rural belief that dairy maids exposed to cowpox were no longer susceptible to the disease.2 He first heard this theory in 1770,3 and he began compiling case studies to test it in the 1780s and 1790s. On May 14, 1796, Jenner performed the first documented cowpox inoculation, taking a sample from a cowpox pock on the hand of a dairy maid named Sarah Nelmes and deliberately inserting the cowpox material into the arm of James Phipps, an eight-year-old boy. Phipps developed a cowpox lesion that healed within two weeks. When Jenner later exposed Phipps to smallpox through variolation, the boy was immune to the disease. Jenner was so confident that cowpox infection was a safe and effective method to prevent smallpox that he inoculated his infant son.

Jenner wrote a paper about his findings and submitted it to the Royal Society in 1797. The paper was not accepted for publication, however, because the reviewers found it had insufficient data. Undeterred, Jenner conducted additional trials and in 1798 published An Inquiry into the Causes and Effects of the Variolae Vaccinae, a Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of the Cow Pox. He wrote three additional books on the same subject by 1801. Shown below is the title page from the first edition of the Inquiry, Jenner’s description of Sarah Nelmes’ case, and a detail from one of the color plates showing the cowpox on Nelmes’ hand.

The title page of the first edition of Jenner’s Inquiry, 1798.

The title page of the first edition of Jenner’s Inquiry, 1798.

Jenner’s description of Sarah Nelmes’ cowpox infection in Inquiry, 1798.

Jenner’s description of Sarah Nelmes’ cowpox infection in Inquiry, 1798.

Color engraving of Sarah Nelmes’ cowpox pocks from the first edition of Jenner’s Inquiry.

Color engraving of Sarah Nelmes’ cowpox pocks from the first edition of Jenner’s Inquiry.

Early reactions to the Inquiry from the medical community and the general public were mixed. A cartoon by the famous caricaturist James Gillray, shown below, plays on the fear that using animal matter on people would cause the patients to assume animal characteristics. Members of the medical community, especially those with investments in the practice of variolation, tried to discredit Jenner’s discovery or stake their own claim to it. Jenner had especially acrimonious feuds with two London physicians, Dr. George Pearson and Dr. William Woodville. Pearson even gave evidence against Jenner’s 1802 petition to the House of Commons for recognition of his work on vaccination.

James Gillray’s “The Cow Pock – or – the Wonderful Effects of the New Inoculation,” published June 12, 1802, by H. Humphrey, St. James’s Street. Image courtesy of the Library of Congress.

James Gillray’s “The Cow Pock – or – the Wonderful Effects of the New Inoculation,” published June 12, 1802, by H. Humphrey, St. James’s Street. Image courtesy of the Library of Congress.

The New York Academy of Medicine holds a number of Edward Jenner’s autograph letters. In them, he rails against the misguided opposition to his discovery. On June 30, 1806, he writes to the Rev. Mr. Joyce:

“How wonderful that this horrid pestilence should at this time even have an existence in our island . . . A Physician from Copenhagen call’d on me today, and express’d his astonishment at an opposition to vaccine Inoculation, as by that means only the smallpox was completely extinguish’d in that City.”

Writing to a Mr. Phillips on Jan. 16, 1807, Jenner notes that the College of Physicians:

“[Has] not yet finished this Inquiry, which will, when completed, be laid before the House [of Commons]. This Inquiry will lay all those troublesome ghosts which have so long haunted the Metropolis with their ox-faces, & dismal hootings against Vaccination. However, tis all for the best – you may depend upon it the new Investigation will prove the touchstone of the vaccine discovery.”

Jenner also offers advice about his smallpox vaccine:

“A word more respecting your little one. Altho’ I should be happy to shield it myself from the speckled Monster, yet I would advise you not long to risk my coming to Town. I will just add that I consider the Vaccine Lancet in the hand of [Dr.] John Ring, just as safe as in my own.”4

In an autograph letter signed to Mr. Phillips, dated Jan. 16, 1807, Edmund Jenner discusses the ongoing vaccination controversy and offers advice for vaccinating Phillips’ new baby.

In an autograph letter signed to Mr. Phillips, dated Jan. 16, 1807, Edmund Jenner discusses the ongoing vaccination controversy and offers advice for vaccinating Phillips’ new baby. Click to enlarge.

Despite some people’s doubts about the safety and efficacy of Jenner’s smallpox vaccine, there was great demand for cowpox samples to conduct vaccinations in England and abroad. Jenner and other practitioners in England sent dried cowpox specimens sandwiched between glass to Europe and the United States. The hand-colored drawing below presumably accompanied cowpox samples sent from England to America; the drawing shows the difference between cowpox pustules (on the left) and smallpox pustules (on the right) at 6, 8, 10, 12, 14, and 18-20 days after infection. Also shown below is an example of printed “Instructions for Vaccine Inoculation” from an “Extract of a Letter from Dr. Jenner, dated London, February 24, 1802.”

The New York Academy of Medicine holds this hand-colored drawing that shows the difference between cowpox and smallpox pustules at various stages of infection.

The New York Academy of Medicine holds this hand-colored drawing that shows the difference between cowpox and smallpox pustules at various stages of infection.

This broadside shows what kind of instructions were available for people interested in administering the smallpox vaccine.

This broadside shows what kind of instructions were available for people interested in administering the smallpox vaccine.

The smallpox vaccine became more common during the 19th century, but smallpox epidemics continued to occur, at least partly because people did not yet fully appreciate the need for re-vaccination. In the 20th century, smallpox continued to plague third-world countries. Finally, a global eradication campaign organized by the World Health Organization (WHO) in 1967 succeeded in eliminating smallpox. The last naturally occurring case was in Somalia in 1977.5 Thanks to Edmund Jenner’s research and his efforts to promote smallpox vaccination, one of the world’s most feared diseases is now a historical curiosity instead of an ongoing deadly threat.


1. These statistics are from Abbas M. Behbehani’s “The Smallpox Story: Life and Death of an Old Disease” in Microbiology and Molecular Biology Reviews, v. 47, no. 4 (Dec. 1983), p. 455-509. Available online at See also Stefan Riedel’s “Edward Jenner and the history of smallpox and vaccination” in Baylor University Medical Center Proceedings, v. 18, no. 1 (Jan. 2005), p. 21-25. Available online at

2. The Jenner Museum gives a good summary of Jenner’s interest in cowpox as a way to prevent smallpox infection. See

3. Behbehani, p. 468.

4. The quotations in this paragraph are from MS 1155 (Edmund Jenner, autograph letter signed: London, to the Revd. Mr. Joyce, 1806 June 30; first quote) and MS 59 (Edmund Jenner, autograph letter signed: Cheltenham, to [Mr. Phillips], 1807 Jan. 16; second two quotes.)

5. See the World Health Organization’s page on smallpox, available online at

What a Boy Scout Merit Badge Tells Us About the History of Public Health

By Johanna Goldberg, Information Services Librarian

This month, the Boy Scouts of America celebrated its 106th birthday. To mark the occasion, we are featuring at a pamphlet from our collection, called simply Public Health.

In 1922, the Boy Scouts published the pamphlet as one of a series designed for scouts to study in order to receive merit badges. Though as the pamphlet states:

“It would defeat one of the purposes of these merit badge tests if any attempt were made in a pamphlet of this character to so completely cover the requirements as to remove the necessity for the boy to use his own initiative and show his resourcefulness in seeking sufficiently complete information and practical experience to enable him to successfully pass the test.”1

What was on the test? The cover explains:

The cover and inside cover of Public Health, 1922.

The cover and inside cover of Public Health, 1922. Click to enlarge.

We can’t resist a close up of the cartoon at the bottom of the cover, showing how boy scouts with knowledge of public health best practices chase away causes of disease, from bad sanitation and drainage to flies and mosquitoes to “general disorder and filth.”1

A close-up of the cartoon on the cover of Public Health, 1922.

A close-up of the cartoon on the cover of Public Health, 1922.

The Boy Scouts of America still offer a merit badge in public health. Interestingly, many of the requirements are strikingly similar to their 1922 counterparts. Today’s scouts must explain disease transmission (though diseases have changed from tuberculosis, typhoid, and malaria to E. coli, tetanus, AIDS, encephalitis, salmonellosis, and Lyme disease). Instead of drawing a house-fly and showing how it carries disease, boy scouts today have to discuss how to control insects and rodents to prevent them from introducing pathogens.2

The major difference between today’s test and that of 1922 is the addition of a question about immunization. Today’s scouts must define the term and discuss diseases that can and cannot be prevented through immunization. In 1920, 7,575 Americans died of measles, 13,170 died of diphtheria, and 5,099 died of pertussis.3 In 1922, the only vaccine recommended for universal use in children was smallpox. By the end of the 1920s, diphtheria, pertussis, and tetanus joined that list, followed by polio, measles, mumps, and rubella in the 1960s and 70s.3 Today, there are 15 vaccine-preventable childhood diseases.4

While many of the same public health issues have remained at the forefront since 1922, our means of responding to them have progressed. If there is still a test for a public health merit badge in another 94 years, one hopes that the questions will reflect even more advances in prevention and control of disease.


1. Public Health. Boy Scouts of America; 1922.

2. Public Health. Available at: Accessed February 10, 2016.

3. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children — United States, 1990-1998. MMWR Wkly. 1999;48(12):243–248. Available at: Accessed February 10, 2016.

4. Vaccines: VPD-VAC/Childhood VPD. Available at: Accessed February 10, 2016.

Coughing, Sneezing, or Spitting Will Not Be Permitted

By Johanna Goldberg, Information Services Librarian

As the United States experiences high flu activity, we thought we’d look back on the 1918 flu pandemic, which lead to the deaths of 50 million people worldwide, including nearly 675,000 people in the United States.1

The first case of the so-called Spanish Influenza in the United States originated at Boston’s Commonwealth Pier on August 28, 1918.2 On September 3, it landed in nearby Brockton, Mass., where the disease became widespread by the middle of the month.

Brockton’s Volunteer Leaders

Ernest A. Burrill detailed the efforts of the city in Brockton’s Fight Against Influenza. One problem faced was a lack of food—sick parents could not cook for children, and residents were afraid to enter infected homes. A well-organized food department came to the rescue, preparing food at a community kitchen and delivering it to 388 sick people at its peak on October 10.2

Brockton officials established a field hospital to centralize medical staffing. “A tented city grew up over night,” and within days of its opening, patients moved from area hospitals to the tents. During its two weeks of operation, the field hospital treated more than 300 patients. The food department provided the makeshift hospital with “5 dozen ham sandwiches, 3 quarts chicken stew, 2 dozen cakes, 32 quarts of gruel, 27 quarts of broth, 35 quarts of milk, 9 loaves of bread, in addition to jellies, preserves, etc.”2

Brockton’s Field Hospital

The flu peaked in Chicago in mid-October. A month earlier, an ambitious public health campaign instructed residents to cover their mouths when sneezing and coughing.  In a 1918 report, Commissioner of Health John Dill Robertson wrote, “The danger of uncovered coughing and sneezing has probably been so thoroughly impressed upon the people of the City of Chicago that fruit will be borne from this source for years to come.”3 (Chicagoans, is this fruit still being borne?)

A poster from Chicago’s Public Health campaign, presumably released prior to the Health Department closing the theaters.

In Chicago as in much of the country, “places of amusement were closed” at the peak of the pandemic. “This included theaters of all kinds, cabarets, dance halls, athletic meets, and everything of this kind. People were advised to go home and to get nine hours of sleep, on the theory that rest was the best preventive medicine that could be had. In fact, by cutting out all these night assemblages there was no place for the people to go and they had to remain home.”3

In addition, Chicago and other cities banned public funerals. In Chicago, only 10 mourners, not including clergy, could attend for fear of spreading the disease from the family of the deceased and through contact with infected premises.

Chicago churches, schools, and workplaces remained open, although clergy were instructed to keep services short and officials closely monitored school conditions. “Nothing was done to interfere with the morale of the community,” wrote Dill.  The Health Department did require closing, thorough cleaning, and subsequent inspection of places of public assembly.3

A selection of captions from Chicago newspapers.

Scientists had developed a vaccine for pneumonia, which often co-occurred with the flu in 1918, and health officials distributed 174,264 doses in Chicago once determining the severity of the pandemic.3  The Brockton report indicates that the New York City Health Department prepared a vaccine for the flu strain, but it was not yet available to them.2

While the current flu outbreak does not compare to the 1918 pandemic, we can learn from earlier experiences. Cover your mouth, do what you can to avoid contact with sick people, and be grateful that you can get vaccinated.

For more on the 1918 flu, visit


1. (n.d.). Pandemic Flu History. Retrieved January 17, 2013, from

2. Burrill, E. A. (1918). The story of Brockton’s fight against influenza. Brockton: Press of Nichols & Eldridge.

3. Robertson, J. D. (1918). A report on an epidemic of influenza in the city of Chicago in the fall of 1918. Chicago: Dept. of Health.

Pox and Politics

By Rebecca Pou, Project Archvist

Arm with pustules

Edward Jenner. An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ. London:1798.

Edward Jenner’s An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ was published in 1798 and organizations encouraging inoculation were quick to form. In 1802, the New York Institution for the Inoculation of the Kine-Pock was established. The Institution issued documents on the advantages of inoculation with cowpox and created a clinic, “a main object whereof is to disseminate the blessings of this disease, free of cost, to the indigent members of the community.”

image of text

New York Institution for the Inoculation of the Kine Pock. Facts and Observations Relative to the Kine-pock. New York: 1802.

Despite massive efforts, smallpox persisted well into the 20th century. It took global vaccination to eliminate the disease in 1977. The story of vaccination programs is as much a political one as a medical, around balancing public health with individual choice. We are pleased to be welcoming Michael Willrich, PhD, to NYAM on Nov 29 to explore the tensions between compulsory vaccination and civil liberties brought into sharp focus in the smallpox epidemics of the late 19th and early 20th centuries. The lecture is free and open to the public. Register here.

Mad Cows and Caricatures

By Lisa O’Sullivan, Director

Image of monster being fed infants and excreting them with horns.

Charles Williams caricature c.1802.

This early anti-vaccination caricature shows a monster being fed baskets of infants and excreting them with horns. In the background, four prominent anti-vaccine campaigners, Benjamin Moseley, Robert Squirrell, William Woodville and William Rowley, approach with “swords of truth”. This unusual colored version of the print was originally bound as a frontispiece to the 3rd edition of William Rowley’s 1805 Cow-pox inoculation no security against small-pox infection: with above 500 proofs of failure. One of Rowley’s “above 500 proofs of failure” was the case of a boy whose face, Rowley claimed, was assuming the character of a cow.

Vaccination Williams detail

Horned baby

Next week we look forward to welcoming Mark Largent to explore more recent controversies about childhood vaccination as part of our history of medicine series. Register for this free October 17 event here.