Leaving the Mainstream of Modern Medicine and Following Women’s Pathways: The Case of Smallpox Vaccination in the Ottoman Empire
By Nihan Bozok
This essay, which is based on a letter written by Lady Mary Wortley Montagu (1689 – 1762), tells the story of a group of elderly women who collaborated to vaccinate their communities against smallpox in the 17th century in the Ottoman Empire. Lady Montagu and her husband, an envoy, visited the Ottoman Empire in the early 1700s. From several towns in the Ottoman Empire, she corresponded with her friends back in England. In these letters, known as the Turkish Embassy Letters,[i] she wrote about women’s clothes, religious rites, the harem, daily life, and city designs. Although these letters are undoubtedly a part of the corpus of Orientalist literature, they also implicitly reflect a woman’s personal journey, particularly in regards to her experiences with smallpox and her feelings about inoculation. Her interest in smallpox sheds light on an alternative history of vaccination to that which is recorded in Western medicine. In this account, we learn how women in the Ottoman Empire helped to control smallpox outbreaks. After outlining the political history of smallpox, I will discuss the role attributed to Edward Jenner as the inventor of the vaccine. Then, focusing on Lady Montagu’s letter, I will discuss the alternative historical path of medicine paved by the women who introduced vaccines to the Ottoman geography.
Notes on Smallpox
One significant part of the history of medicine is how ordinary people fought back against epidemics. But patriarchy, a focus on the West, anthropocentrism, and the exclusion of the lower classes are flaws in mainstream medical history. Ordinary people who lived in the past, whose stories are rarely told because of systemic inequalities, did much to respond to epidemics. We rarely see ordinary people in the golden pages of medical history, while the innovations and rescues of male scientists adorn its pages. Their stories, while significant, overshadow the ordinary people, especially women,[ii] who persevered through illness, often with little or no medical support, but with valuable knowledge and experience.
Since people began to cultivate the land and turn it upside down, there have been several epidemics. Diseases such as plague, malaria, and cholera have caused epidemics that could last for centuries. One of these diseases, smallpox, has had a major impact on human history. The variola virus of the Orthopoxvirus family, which causes smallpox, is severe, deadly, and contagious. The variola virus has been responsible for more human deaths than any other microorganism in history as a result of smallpox epidemics.[iii] As with other infectious diseases, the history and spread of smallpox are socio-political. For example, some smallpox outbreaks served as effective tools of colonialism. The European colonists who moved to the Americas and Australia spread the disease to people already living there. As a result of this contact, the smallpox virus became a biological weapon and killed millions of indigenous people in the early 16th century.[iv] This smallpox epidemic, which decimated indigenous populations, had far-reaching consequences, leading to the displacement and resettlement of indigenous communities. Humans, on the other hand, became colonies of pathogens as they colonized the world. In the 18th century, smallpox killed an average of four hundred thousand Europeans a year.[v]
The “Invention” of the Smallpox Vaccine in the Late 18th Century and the “Achievements of Men”
The development of a smallpox vaccine has made the once common disease rare. The smallpox vaccine is credited with saving millions of lives and drastically reducing the number of cases worldwide. The discovery of the vaccine is an invaluable moment in human history. According to a widely accepted account of medical history, Edward Jenner (1749-1823), an Englishman, discovered the smallpox vaccine in 1796. Jenner was born in Gloucestershire, as one of nine children. Having lost his parents as a child, he was apprenticed to a local surgeon by his brother. He did not attend university because of his family’s financial situation. As an adult, he moved to London to complete his medical training. John Hunter, the prominent innovator and experimenter of his time, was his teacher. He became friends with Joseph Banks, the naturalist on Captain Cook’s first circumnavigation (and the future president of the Royal Society), while accompanying Hunter.[vi]
After working with Hunter for a while, Jenner returned to Berkeley. For many years, he served as a physician to the villagers of his town who were engaged in farming and animal husbandry. During his consultations, Jenner noticed that cow milkers did not die of smallpox.[vii] He realized that people who worked on dairy farms were immune because the pox entered their bodies through the cows’ udders. Armed with this knowledge, he resumed his research. He tried infecting the children with the smallpox virus and observed the results. Meanwhile, a milkwoman volunteered to be his patient. Jenner took a sample of smallpox from the woman’s hand and analyzed it. This examination led to a number of specific conclusions. He tested his findings on a sick child. Based on the results of this experiment, he successfully administered the smallpox vaccine to the child. At the end of this process, he reported on this discovery by listing experiments, findings, and evidence. He then informed the Royal Society of his “invention” and became known as the “founder of immunology” among the most prestigious scientists of the time.[viii]
An Early 18th Century Letter About Vaccinist Ladies from the Ottoman Empire
Almost a century before Jenner made his scientific discovery, elderly women in the Ottoman Empire were administering the smallpox vaccine. The letters of Lady Montagu provide us with this alternative historical narrative. In her letters, she wrote extensively about her experiences and the cultures she encountered in the Ottoman Empire. She sent a letter to her friend, Lady Sarah Chiswell, from Edirne (a city located west of Istanbul in the Thrace region) to London in 1717.[ix] In this letter Lady Montagu wrote about her own health and the health of those around her. She talked about the spread of the plague and how deadly it was. Most importantly for our current discussion, in this letter she described an invention that would have shocked the Western medical community if it had been heard at the time: she spoke in detail about the smallpox vaccination. She mentioned that smallpox vaccinations were carried out in Edirne. She even mentioned in her letter that her young son had been vaccinated against smallpox. Having noted this significant historical development, she declared her intention to introduce the vaccine in England. Montagu was scarred for life by smallpox. She lost her brother to the disease in 1713 and survived it herself in 1715. She was determined to save other families from the same grief she had experienced and wanted to spread the knowledge of vaccination as widely as possible. But she was also concerned about the commercialization of the vaccine, as the vaccination she had witnessed in the Ottoman Empire was free and collective.
In the letter, Lady Montagu gave a detailed account of how the vaccine was administered. According to the letter, a group of older women had taken on responsibility for vaccinating the children. They had met in September, when the summer heat had passed and the weather was beginning to cool. They had walked through the neighborhoods, looking for teenagers or young children who had not yet had smallpox or been vaccinated. An elderly woman had arrived with a nutshell full of smallpox germs as fourteen or fifteen people gathered to be vaccinated. The virus had previously been removed from a patient and stored for inoculation. It was claimed that rose water revived the virus before the vaccine was prepared, a technique known as valorization. This method of human-to-human transmission differed from Janner’s animal-to-human vaccination. An elderly woman, Montagu reported, used a large needle to make a small slit in the recipient’s arm. The microbe was introduced into the incision without any discomfort. The adults had planned entertainment for the time of the vaccination, and children and adults enjoyed themselves together. The children who had been vaccinated began to feel a bit feverish. Ten or fifteen smallpox spots appeared on their faces. After a maximum of three days of fever, they had recovered. Additionally, the wounds began to heal on their own, and eventually people developed immunity to the smallpox virus.
Whose history is deemed significant enough to write about?
Having learned about the smallpox vaccination of elderly women through the letter, we now have two stories from different geographical locations. The vaccination of elderly women shows that history is more than the story of just a few well-known men or a single place. A history of men and victories would, at best, be a history of war. There have been many turning points throughout history. Before Jenner “invented” smallpox vaccination, it was already being practiced in Africa and India. So, innovations, techniques, solutions, or medicines may have been developed simultaneously around the world.
Clearly, both stories contributed to the eradication of smallpox from history. But it is Jenner who is recorded in the history of medicine. His identity, early years, academic background, and career are all known. But who were the older women who administered the vaccinations in the Ottoman Empire? What were their names? How old were they? Who taught them how to vaccinate? None of this information is known to us. Today, we find it only in the writings of a few curious intellectuals. They are presented as “additions” to the “main” story. I argue that these old women have remained anonymous because they stand at a particular historical turning point, namely the transition of medicine into the modern capitalist era. The history of the old women was lost as modern capitalist medicine moved away from the path of “learning to heal” and towards the path of “medical education.”[x] Modernity’s principles of objectivity, demonstrability, rationality, and progressivism gave medicine its patriarchal style. Since ancient times, women have learned medical, botanical, and nursing skills by word of mouth and on the job. These skills were not written down, because they were not considered to be up to modern healthcare standards.
But women have been doctors for centuries.[xi] They have been midwives for ages. They were denied admission to medical schools and practiced medicine without a license. They cared for sick people and animals at home. They have acquired knowledge of plants and produced analgesics, diuretics, antiseptics, and emetics. They passed on their family recipes from one generation to the next. For centuries, they provided an invisible form of care. All these practices provided the opportunity to develop more festive, inclusive, and free medicine. Just as in Montagu’s vaccination story, women healers offered free health care. They provided medical care as a form of solidarity and strengthened social ties.[xii] Vaccination, healing, and neighborliness went hand in hand. Virtue and altruism were associated with medical knowledge. In the course of modern capitalist medicine, there was no room for this. In Ottoman geography, women who practiced healing were not labeled as witches and burned at the stake like their sisters in Europe. But their medical knowledge and experience was also ignored and destroyed. History has forgotten about them. There is no doubt that the history of modern medicine owes an undocumented and unwritten past to women!
[i] Lady Mary Wortley Montagu, The Turkish Embassy Letters (Virago Press:  1994).
[ii] Jeanne Achterberg, Woman as Healer (Shambhala: 2013), p. 14.
[iii] Mark Jackson (Ed.), The Routledge History of Disease (Routledge: 2017).
[iv] Roy Porter, Blood and Guts: A Short History of Medicine (Norton:2004).
[v] For more on the background of smallpox, see, Dorothy H. Crawford, Deadly Companions: How Microbes Shaped Our History (Oxford University Press: 2018).
[vii] Edward Jenner, The Origin of the Vaccine Inoculation (D.N. Shury: 1801), p. 4.
[ix] Lady Mary Wortley Montagu, The Turkish Embassy Letters (Virago Press:  1994).
[x] Mary Lindemann, Medicine and Society in Early Modern Europe (Cambridge University Press: 2010), p. 121.
[xi] Barbara Enrenreich and Deirdre English, Witches, Midwives, and Nurses a History of Women Healers (The Feminist Press, 1973).
[xii] Silvia Federici, Caliban and the Witch: Women, the Body and Primitive Accumulation (Autonomedia: 2009), p. 193.
About the Author
Nihan Bozok works on gender and ethnobotany, ecofeminism in Turkey, and the sociology of health and aging. She is a sociologist who studied postmodern medicine and the sociology of vitality with a focus on organ transplantation in her doctoral study, which she completed in 2015 at the Sociology Department of Middle East Technical University. She conducted field research with qualitative techniques and from feminist perspectives. She also conducted oral history research about the water memories of the elderly women and men in the eastern Black Sea region of Turkey in 2013. In 2016, she conducted field research in an Aegean village as a part of the “The Social Anthropological Research in Forest Villages in Turkey Project,” funded by TÜBITAK (The Scientific and Technological Research Council of Turkey). In 2021, she coordinated the forest fire disaster research project, “2021 Muğla Forest Fires – Baseline Assessment of Cooperation” with a research grant from UNDP GEF. Since 2022, she has been conducting an ecological literacy research project in the Muğla province of Turkey with a research grant from UNDP GEF. From 2022 to 2023, she was a visiting researcher at Utrecht University’s Department of Cultural Anthropology in Utrecht, the Netherlands. Currently, she works as an Assistant Professor at Beykent University, Istanbul.
Citation: Nihan Bozok, Leaving the Mainstream of Modern Medicine and Following Women’s Pathways: The Case of Smallpox Vaccination in the Ottoman Empire, in: TRAFO – Blog for Transregional Research, 09.11.2023, https://trafo.hypotheses.org/49236