Edward Jenner is well renowned for discovering the smallpox vaccine, but there is more to the history of smallpox. Wanting to understand the fight to protect ourselves from this disease, I called upon (the ghost of the) Lady Mary Wortley Montague, arguably an equally catalytic though lesser known figure in the history of smallpox and its vaccination. Lady Montague’s ‘contributions to English life’ extend beyond smallpox to include her staunch advocacy of feminism as well as her title as one of the ‘greatest of the English letter-writers of the century.” I prefer to translate Lady Montague’s legacy as the potential for a public health worker who is not medically licensed but understands the value in the fight against adversity to influence people and implement change. As we face a new frontier in the 21st century with the global spread of infectious diseases and potential biological warfare as public health concerns, I knew I could learn valuable lessons from Lady Mary (as she later asked that I call her). Thus, I was thrilled when she accepted my invitation for dinner and I knew exactly what would be on the menu: meatloaf.
As I chopped the vegetables, minced the garlic and tenderized the meat, I reflected upon the limited knowledge that I did have about Lady Mary. During the 18th century when she was alive, approximately 400,000 people died from smallpox each year. Lady Mary faced smallpox within her own family – she and her brother both had the disease - but only she lived to tell the tale and to change fate for many to come. Her story starts while traveling in the Ottoman Empirew when she was exposed to variolation, the process of infecting a person with a small amount of the smallpox virus in an attempt to prevent them from getting the full blown disease. This form of inoculation was common practice in Turkey at the time; however English physicians did not embrace it. Upon her return from Turkey, Lady Mary shamelessly promoted the inoculation in Europe, eventually inoculating both her son and daughter. These successes within the royal family spurred a subsequent wave of inoculations and eventually Europe and the New World would benefit from her work.
Lady Mary and I had a wonderful evening together and as she is famous for, she kindly wrote me a thank you letter (translated into current vernacular):
Dearest Colleen,
Thank you for a splendid evening. Although I didn’t exactly know what I was getting into when you invited me, I found that it was an emotional trip down memory lane for me and certainly a once in a lifetime glimpse into the future.
I was fascinated by our discussion on what you now call ‘clinical research,’ which we started discussing when I shared the details of the inoculation process I witnessed in Constantinople. The process of clinical research doesn’t sound as if it differs significantly from my efforts to convince the English to try the barbaric sounding idea of performing those first inoculations on patients. It was interesting to ponder with you when the true roots of testing medical hypotheses on humans began, but we both agreed it is never easy to involve a human life. I will never forget when I first had my son inoculated on my own initiative. I certainly feared the worst after 8 days when he was bedridden, covered in pustules and extremely feverish, but soon enough he was left with nothing but the scar on his arm where the inoculation had taken place. How would I ever forgive myself if he hadn’t survived that bout?
Consequently, you were right to ask if I considered it an ethical dilemma at the time when prisoners and orphan children were used as ‘guinea pigs’ in the inoculation process. Perhaps most revealing of my regrets of using those social outliers for the testing was my delight to hear that certain animals such as rats, mice and monkeys have since been discovered to share many of our human properties (did you call them genes?) and are now used in the clinical research process.
Another question that has stuck with me was about my personal struggle with the English physicians of the time and how I knew to not back down on my personal agenda for change. You were right that I was bold to counteract the established practice of the time without medical knowledge, but you should not underestimate the power of observational knowledge (as I acquired at the time in Constantinople) and if were able to collect these biostatistics that you referred to, I know that my case would have held all the more weight. I am encouraged by the fact that you are enabling yourself with such skills for your public health work.
I have to admit that I was quite surprised (perhaps even embarrassed) by the credit that you gave me for my actions and your claim that my efforts were so instrumental to public health. I was terrified to learn how widespread smallpox became, and how such a pattern of contagion and disease such is still a part of history, although greatly stunted by the vaccination process that I helped popularize. More disturbing was what you shared about how avant garde I was in my biological focus on disease. I cannot imagine how subsequent populations placed such weight on miasmas and vapors as the cause of illness. I return to my advice on the strength and value of observation as a method of understanding disease.
In closing, I would like to thank you for this opportunity to further validate what I knew was important for English society at the time – and I now know, humankind.
Sincerely,
Lady Mary
I eagerly responded:
Dearest Lady Mary,
Thank you for your kind letter. I, too, enjoyed your company and assure you that you fully deserve any and all accolades for your accomplishments and for the implications of your actions for the future. Since you left, my head has been swimming with all of the ways in which I realized that we have learned from your actions – and the ways in which our conversation enlightened how we should learn from you if we haven’t already.
As you are well aware, royalty set the standard for many fashions and customs during the 18th century – and inoculation was no exception. I struggle with the fact that our government doesn’t play the same role and although I don’t believe they should, I worry that we lack the role models and influential figures that are can be crucial in guiding health decisions. It was interesting to entertain the idea that pop culture has replaced the royal family in their influential role. Although the public health worker holds great potential, we still strive towards a cohesive effort around preventative measures of health. Your efforts to inoculate English society were advanced for that time since people mostly responded to health disasters as they ensued instead of preventing them in the first place. Sadly enough, we still struggle with implementing many simple measures of health prevention and have much to learn about how to influence people.
On a similar note, since our dinner I have realized some of the decisions that we now have to make to protect ourselves are similar to those that you had to make in the 18th century. With our increased understanding of biology, negative implications have been introduced alongside the positive advancement. The Russians introduced a whole new realm of manipulation with their demonstrated ability to create variola virus, the cause of smallpox. The idea of a disease being used as warfare threat probably sounds entirely foreign to you, but the threat of what we call bioterrorism has become a real worry for our society. The proposed solution will not sound quite as foreign – increased voluntary smallpox vaccination. Hence we have come full circle to your efforts to vaccinate the public, and I will be calling upon your methods of influence as a model for us now.
In closing, when you first wrote the following passage to your good friend Sarah Chiswell, I know that you had no idea of the string of events that would ensue in history:
“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 one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind…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.”
I can only say that your heroism is still being admired by women, students and public health professionals today. I hope that I will be able to look back on my public health work with the ‘private satisfaction of having done good to mankind’ as you once declared your intention.
Best regards,
Colleen
In conclusion, my dinner with Lady Mary and what I learned about the history of her actions and the smallpox disease itself proved to be more inspiring than I had hoped for. I wish I could say the same about the meatloaf…
No comments:
Post a Comment