Whose heart was beating faster: the five year old boy holding his arm out to be stuck with a smallpox-laced needle, or his mother, looking on, whose idea all this was?

The boy, Edward, wasn't getting a vaccination. He was living in Turkey with his mother, Lady Mary Wortley Montagu, and father in 1718. Edward Jenner wouldn't inject his first patient with a cowpox vaccine until 1796. This was a variolation – the forerunner to vaccination. Instead of a being administered a dead virus, or a fragment of that virus, or a related but not illness-causing virus, variolation (sometimes called "inoculation" as well) gave a patient the genuine article. Edward got a shot of live smallpox (in one arm, he also got cut with a smallpox-laden scalpel on the other arm by the British embassy's doctor).

This practice had been documented since around the 16th or 17th century in places as far afield as China, Sudan, and Turkey, and was probably in use long before then. What was really happening inside the body wasn't known at the time. Today we know that instead of smallpox going in through the nasal passages, where it quickly multiples and overwhelms an immune system, entering through the bloodstream is a less than optimal method, from smallpox's point-of-view. Making the bacteria take the long way around to infection slows it down, and gives the immune system time to mount an adequate defense. Montagu learned about variolation while living in Turkey and was the first to bring the idea to England.

Montagu was born Mary Pierrepont on a date unknown. It was not recorded. Or, a lot of websites say it's May 15, 1689, but I couldn't find anything to corroborate that. Neither could Isobel Grundy, one of Montagu's biographers (Grundy said via email: "I'm sorry to say there is no more information on Lady Mary's birthday. From the baptism date of May 26 I've always hoped that she was born on the 23, my own birthday, but I was unable when writing her biography to come up with anything more precise. I can't imagine where May 15 comes from"). But, she was certainly baptized on May 26, 1689.

Her family almost diverted her away from Turkey and her encounter with variolation. The Pierreponts were minor nobility and her father had chosen a husband for her: another minor noble named Clotworthy Skeffington, which I'd like to emphasize is a real name. Mary did not like him. In a letter she referred to marrying with love, with indifference, and with hate as Paradise, Limbo, and Hell. Skeffington was Hell. She said that she would "rather give my hand to the Flames than to him." Instead, she chose Edward Wortley Montagu, whom she'd known for years (she expected him to be Limbo but found the marriage a surprising Paradise). 

In 1717, Lady Montagu accompanied her husband to Constantinople, where he had been appointed as British Ambassador to the Ottoman Empire. There, she learned Arabic and boasted that she was the first foreigner to be friends with Turkish women. 

On April 1, 1717, she wrote to a friend: 

"I am going to tell you a thing that I am sure will make you wish yourself here. The small-pox, so fatal, and so general amongst us, is here entirely harmless by the invention of ingrafting, 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 veins 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 venom as can lie upon the head of her needle, and after binds up the little wound with a hollow bit of shell; and in this manner opens four or five veins."

"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."

Lady Mary knew smallpox well. In 1715 she survived a brutal case herself, which left her with facial scarring. "She was the more interested [in variolation] because an attack of small-pox had somewhat dimmed her beauty," one book states. Her brother, William, also died of the disease.

Comments on Lady Montagu's appearance after her smallpox illness have been common. Even how people spoke about smallpox in those days was gendered. A man's brush with the disease risked the most important thing he carried: his life. A woman risked her most important possession too: her beauty. Grundy, Montagu's biographer,  said via email: "All the written commentary on smallpox emphasizes danger of death more in the case of men and danger to appearance in the case of women. And it was perfectly reasonable for a woman to fear that at a time when your face was your fortune." Montagu addressed in verse the temporary empire of a woman's beauty:

'Ye meaner beauties, I permit ye shine;
'Go, triumph in the hearts that once were mine;
'But midst your triumphs with confusion know,
''Tis to my ruin all your arms ye owe.
'Would pitying Heav'n restore my wonted mien,
'Ye still might move unthought-of and unseen.
'But oh ! how vain, how wretched is the boast
'Of beauty faded, and of empire lost!
'What now is left but weeping, to deplore
'My beauty fled, and empire now no more!

Montagu's views on things outside of inoculation were not far-seeing. She wrote approvingly of the treatment of slaves in the Ottoman Empire: "I know you'll expect that I should say something particular of [the market] of the Slaves, and you will Imagine me half a Turk when I don't speak of it with the same horror that other Christians have done before me, but I cannot forbear applauding the Humanity of the Turks to those Creatures. They are never ill us'd and their Slavery is in my Opinion no worse than Servitude all over the world." She also wrote about a Turkish man who told her that Islam's prohibition against alcohol was meant only for the people but not the ruling class, who were wise enough to handle drinking.

Inoculation was a huge leap forward for mainstream smallpox treatment in Britain, which had not been particularly scientific to that point (one contemporary doctor's treatment schedule included keeping the windows open and administering "twelve bottles of small beer every twenty-four hours"). But it took seeing to believe. That Edward, Lady Mary's son who was inoculated in Constantinople, never became ill wasn't enough. In 1721 another epidemic was cutting through the country. Lady Mary, who had been proselytizing to the royal family in favor of inoculation, insisted that Charles Maitland, the embassy doctor who helped inoculate Edward, inoculate Lady Mary's daughter, also named Mary. Maitland had medical professionals on hand to witness the inoculation (for the protection of his career), which was successful. One of the witnesses, James Keith, whose other children had died of smallpox, afterward had his sole surviving son inoculated as well.

From there, the idea of variolation took hold in Britain. Princess Anne, eldest daughter of the Prince of Wales became ill with smallpox, and discussions began about inoculating the Prince's younger daughters. Before royals could be inoculated, the treatment was tested on six prisoners at Newgate prison (some of whom were awaiting execution for such crimes as stealing a bolt of silk). The prisoners all survived, and were given a pardon and release for volunteering.

There are so many more interesting details I couldn't fit here. I could write a 10-piece series on Lady Montagu. She led an unbelievably full  life. She was a frequent and vocal critic of the allotted status of women in the 18th century. She wrote savage and clear-eyed poetry. Some of it was satirical: she wrote a poem to call Jonathan Swift both impotent and cheap, the kind of man who tries to get a refund from a sex worker. She was a longtime friend and contemporary of Alexander Pope. They had a falling out for reasons unclear, though it may have to do with Pope taking credit for a poem Montagu had written, or another occasion where Montagu broke into laughter after Pope proposed to her.