The 18th-century aristocracy and an early experiment in immunology

This year there will be much talk of vaccinations, a word derived from Edward Jenner’s use of cowpox to immunize humans against smallpox, but the groundwork for the science of immunology in Britain was laid 300 years ago by Lady Mary Wortley Montagu and her noble patrons of the new practice of inoculation. Dr Charles Littleton investigates further…

The New Year will see a large-scale vaccination programme in Britain in order to develop immunity to the COVID-19 virus among the population. By a coincidence, the first major immunization campaign in Britain began 300 years ago, this one promoted not by government, but by the country’s royalty and nobility. In 1721 an outbreak of smallpox ravaged England, and fell unusually heavily on the country’s elite. In February 1721 the secretary of state James Craggs the younger died of the disease. It felled the duke of Rutland, at the end of that month, and a few days later took his daughter as well. Both the duke of Dorset and the earl of Nottingham also lost daughters to the disease.

Lithograph of Lady Mary Wortley Montagu by A. Deveria after C.F. Zincke (c) Wellcome Collection (CC BY 4.0)

Lady Mary Wortley Montagu also knew well the ravages of smallpox. Her younger brother, William Pierrepont, earl of Kingston, had died of the infection in 1713. She herself, originally celebrated for her beauty, had been disfigured by it two years later. In Turkey, where her husband Edward was ambassador, she wrote in 1717 of her observations of the practice of smallpox inoculation. Fluid was taken from a smallpox pustule, of the less virulent form of the disease, and introduced into a scratch in the limb of an uninfected person. The subject (usually) recovered from the infection and in the process gained immunity from the disease’s more deadly variant. She was so impressed that in March 1718 she had her five-year-old son Edward inoculated while still in Turkey. She was determined to promote the procedure upon her return to England later that year:

I am Patriot enough to take 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 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 for them. [Complete Letters, i. 338-9]

In April 1721, during the smallpox epidemic, Wortley Montagu had her two-year old daughter inoculated publicly, with prominent physicians present, the first documented instance of this procedure in England. This attracted the attention of Caroline, Princess of Wales, as her two younger daughters fell ill of the contagion. In order to be fully certain of its efficacy, Caroline sponsored a trial in August in which six Newgate prisoners were inoculated. They obtained their freedom upon their survival, although one found himself back in Newgate within a matter of weeks, after being caught stealing periwigs. News of the success of this experiment, performed under royal patronage, ensured that ‘several Gentlemen and others… have resolved to undergo an Inoculation’. [London Journal, 2 Sept. 1721] In November ‘The Eldest Son of a Noble Duke in Hanover-Square had the Small-Pox inoculated’ [Daily Journal, 12 Nov. 1721]. Caroline, however, was not fully convinced and in February 1722 she arranged for another trial involving eleven young children. Their survival allayed her doubts and on 17 April 1722 she oversaw the inoculation of her two daughters, Amelia and Caroline.

This public royal patronage of the procedure opened the floodgates and soon more members of the nobility were eager to have their children inoculated. Lady Mary wrote in May 1722 of ‘the growth and spreading of the Inoculation of the small pox, which is become almost a general practice’. [Complete Letters, ii. 15] A manuscript newsletter also reported that ‘several of the children of the nobility’ were to be inoculated. [Bodleian Library, MS Eng. Hist. c.1041, f.56v] The duke of Dorset ensured that his male heir was inoculated, as did the earl of Berkeley, while Lord Bathurst arranged for all six of his children to undergo the treatment.

As Wortley Montagu had predicted, there was opposition among the medical profession. The battle became intense after some inoculations went wrong and resulted in death. A servant in Bathurst’s household succumbed, but even more damaging was the death in April 1722 of the earl of Sunderland’s two-year old son. To compound the tragedy, Sunderland himself died, albeit not through smallpox, just two days later. In May an alarmed pamphlet begged Parliament, which was scheduled to meet in October, to pass legislation ‘for the regulation of that dangerous experiment’ by the established medical institutions.

No such legislation came before Parliament in its 1722-3 session, and Wortley Montagu continued with her campaign, even responding anonymously to the anti-inoculation pamphlets. She reported to her sister in June 1723 that another noblewoman had had her children inoculated and ‘Since that Experiment has not yet had any ill effect, the whole Town are doing the same thing’ [Complete Letters, ii. 25-6]. There were, however, some personal setbacks. In July 1723 Wortley Montagu regretted the death of her nephew, a son of Lord Gower, because her sister, the boy’s mother, had never accepted the open invitation to have him inoculated. Further, it was not until March 1725 that her father Kingston ensured the inoculation of her half-sister Carolina and her 14-year old nephew, the marquess of Dorchester, heir to the dukedom.

Overall the inoculation campaign was a great success. Between 1721 and 1728, 897 people were inoculated, of whom only 17 died of the operation. [Thomas Frewen, The Practice and Theory of Inoculation (1749) p. 46] Wortley Montagu’s contribution was lauded at the time, but her efforts were made easier by the support and patronage she received from those within her own aristocratic social circles. This early campaign of immunology made it easier for the British public to accept the more startling development of vaccination by Edward Jenner at the end of the century.

CGDL

Further Reading:
The Complete Letters of Lady Mary Wortley Montagu, ed. Robert Halsband
Robert Halsband, ‘New Light on Lady Mary Wortley Montagu’s Contribution to Inoculation’, Journal of the History of Medicine, viii (1953)
Isobel Grundy, Lady Mary Wortley Montagu: Comet of the Enlightenment (Oxford University Press, 2001)

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