I am hurt.
A plague o’ both your houses! I am sped.
Is he gone and hath nothing?
What, art thou hurt?
Ay, ay, a scratch, a scratch. Marry, ’tis enough.
Where is my page?—Go, villain, fetch a surgeon.
-Romeo and Juliet
A pox on you! Possibly the most used insult of antiquity laid at the feet of enemies and rivals. While wishing it upon them rarely makes it so, such a curse embodies a terrifying and extremely real prospect; a malady that appears to strike indiscriminately and without warning. Commonly, it often takes the form of the invisible, contagious and ever lethal malady: smallpox.
Smallpox, known also as the variola virus, is a particularly virulent disease with the kind of death toll that makes the Black Death look like a common cold. Symptomatically characterized externally by the trademark blisters, sores and horrendous permanent scarring, the true damage is exacted within the body with severe internal bleeding, fluid accumulation and gradual but inevitable organ failure. Manifestations included blood saturated urine (hematuria) and hemorrhaging from the eyes, as well as blindness as the pox pitted and scarred the corneal tissue.
Described by scholars as far back as the Ancient Egyptian eras and proving devastating in Europe via a series of cascading epidemics, it is credited (along with other accompanying migrated ailments) with the destruction of the Mayan, Aztec and eventually the Incan people’s, shattering their populations with far more destructive force than Cortez and his guns.
Like all noteworthy afflictions, smallpox is an equal opportunity and democratic killer. It strikes down with equal vigor those from all echelons of society, from the most illuminated heads of state to the lowliest farm laborer. Notably infectees include Mozart, Peter II of Russia, Elizabeth I of England, Emperors of China and Japan, not to mention political powerhouses of the American colonies such as Washington, Jackson and Lincoln.
Within England’s upper crust, one such sufferer was the indomitable and remarkable Lady Mary Wortley Montagu, Daughter of the fifth Earl of Kingston, marquess of Dorchester. Paradoxically, and rather sadly for her, it was her excruciating experience with the malady that provided the 18th century medical world with a potent weapon in the fight against the pernicious virus.
Lady Mary, born in 1689 of English aristocracy, was a character of intelligence, wit and almost legendary beauty, and possessed of a rebellious and singularly independent nature, uncommon for the so called ‘proper’ social expectations of the time. Arranged to be married off to a promising and hilariously named suitor Clotworthy Skeffington, she instead eloped with Edward Wortley Montagu (I like to think it was at least a little bit to do with the other fellows name). Loved in English court and pursued with unrequited affection by intellectual luminaries as Alexander Pope, she meanwhile was a prodigious writer and talented poet, sparring in poetic and literary warfare with such respected writers as Jonathon Swift.
It was soon after the birth of her son in 1713 that Lady Mary experienced her first brush with the deadly disease, as in 1713 her brother contracted smallpox and died soon after. It was in 1715 that she contracted the disease herself, and while surviving, the effects on her were aesthetically devastating, scarring her severely and stripping her of her eyelashes. Pope, spurned in his romantic attempts towards Montagu, maliciously satirized and derided her changed appearance in several of his later works. Hell hath no fury like an childish writer scorned.
Upon her husbands appointment as British Ambassador in Constantinople in 1716, she had the opportunity to mingle with and befriend many of the local Turkish women who utilized a peculiar method of disease prevention. In her letters to Sarah Chiswell, she described an ancient and ritualized procedure by which:
“…[an] old Woman comes with a nutshell full of the matter of the best sort of small-pox 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 process being described, and what Lady Mary would eventually bring back and popularize in England, was variolation. Material is taken from a smallpox lesion and applied in tiny quantities to a small cut, effectively providing to the immune system a minor version of the condition and allowing it to steel itself against a more potent infection. Against the advice of her embassy chaplain who considered the procedure ‘unchristian and effective only for heathens’, she had her children inoculated, thus protecting them from the disease.
So impressed was Lady Mary by this that upon her return to England in 1718, despite opposition to her gender and the ‘oriental nature’ of the procedure, she encouraged many in her elevated social circles to have the procedure performed themselves.
It wasn’t until the smallpox epidemic of 1721 that the English aristocracy and medical elite began to take variolation seriously. In an effort to protect her young, Princess Caroline of Wales intended to have them inoculated, but not before a thorough, yet ethically dubious ‘experiment’ was carried out.
Dubbed ‘The Royal Experiment’, three men and three women, all convicted criminals awaiting execution in the infamous Newgate Prison, were granted the possibility of clemency and freedom: they would allow themselves to be inoculated with tiny quantities of the disease. Survival of the procedure meant a return to civilian life.
Supervised by 25 physicians, surgeons and apothecaries, the convicts were inoculated several times. All of the test subjects survived. One of the women, Elizabeth Harrison was to tend to and sleep in the same bed as a 10 year old orphan afflicted with the virus, in order to test her newly imbued immunity, which proved successful. The Royal Family were satisfied, the family underwent the procedure and the criminals were freed.
The procedure by no means guaranteed success however. Inaccurate dosages could inflict a full-blown hit of the disease, and usually the inoculations only worked for a short period of time. Additionally, physicians, eager to corner the variolation market for a procedure that could essentially be performed by anyone, regardless of medical training, insisted on accompanying the inoculation with damaging regimens of purging, fasting, and bleeding to the point of almost total exsanguination. Apparently no procedure of the time could ever be complete without a lot of intentional blood loss.
It wouldn’t be until the late 18th century when a young surgeon by the name of Edward Jenner would pioneer vaccination, distinct in the use of the less lethal cowpox disease as inoculation, which proved to be almost universally successful. However, countless people of the age have Lady Mary to thank for exemption from the disease, that Edward Jenner himself termed: “the most dreadful scourge of the human species”.