Inoculation, this word, synonym of "insertion," came into use to designate the process by which an individual is artificially infected with smallpox to prevent the danger and ravages of this disease when it is contracted naturally.

History of inoculation until 1759. One does not known of the origin of this use, of which early Arab physicians might be the inventors. It endures since immemorial times, in the lands around the Caspian Sea, and particularly in Circassia, from where the Turks and the Persians get their most beautiful female slaves. La Motraye, a French traveler, saw it used there in 1712. It is from there that in all likelihood it moved to Greece, Peloponnesus and Dalmatia, where it has been used for over 200 years. Its beginning in Africa, its Mediterranean coast, Senegal, or its interior is not known, nor is it for Asia, in diverse places in India, in particular Bengal, finally China, where it took a special form. It was known in ancient times in the Western parts of Europe, mainly in the Wales Principality of England; Dr. Schwenke found it being use among the population in 1712, in the Meurs Earldom and the Kleve Duchy in Westphalia. Bartholin speaks of it in a letter printed in Copenhagen in 1673. Vestiges of it are found in some provinces of France, in particular Perigord.

It has been more than 80 years since inoculation was brought or renewed in Constantinople by a woman from Thessalonica, who was still operating at the beginning of the present century, in about the same manner as in Circassia. This woman and another Greek female from Philippolis have inoculated several thousand of persons in the same Capital with very happy results. Emmanuel Timoni and Jacques Pilarini, also from Greece, the former first physician of the grand-lord, the latter had been Czar Peter’s, were both doctoral graduates from the University of Padua and the first in that of Oxford. Both were witnesses during several years of the Greek women’s constant successes, they adopted this practice and made it known to the rest of Europe. Timoni by diverse Latin writings published in the Philosophical Transactions in December 1713, in the actes des savans de Leipzig in 1714, the Ephemerides des curieux de la nature in 1717; one instance is reported in La Moraye after his travel as having got it from Timoni in May 1712; and Pilarini by a small Latin work printed in Venice in 1715. Antoine Le Duc, another Greek physician, born in Constantinople, where he had been himself inoculated , defended a thesis in favor of inoculation at Leyden 1722, which conferred upon him the degree of medical doctor at this university, and he published a dissertation on the same matter. All of them attested that they never saw an example of an inoculated person who since had caught smallpox.

As early as February 1717, Mr. Boyer, the actual dean of the Paris Faculty, in a thesis defended at Montpellier, had dared to say and prove, that it was more proper to provoke by the art a benign smallpox than to abandon to nature such a dire affair in which this tender mother seems to conduct herself as a cruel one, etc.

The same year, Lady Wortley Montagu, the English ambassador’s wife at the Ottoman Porte, had the courage to have her six-year-old only son inoculated in Constantinople by Maitland, her surgeon, and later her daughter after her return to London in 1721. Then the College of Physicians of this city requested that inoculations had to be tried on six criminals who had been condemned to death. After the successful outcome of this experiment and another one on five children of Saint-James Parish, the Princesse of Wales had her two daughters inoculated in London under the direction of Doctor Sloane. One is now the Queen of Denmark, the other the princesse of Hesse-Kassel. A few years later the late Prince of Wales was inoculated at Hanover. Yet while Drs. Sloane, Fuller, Broady, Schadwel, the bishop of Salisbury and several other doctors of medicine and of theology trusted the lives of their children to inoculation, an obscure physician and an apothecary disparaged it in their writings, and a theologian preached that it was an invention of the Devil who had made his first attempt on Job. Dr. Arbuthnott, under the name of Maitland , refuted the first with a very strong and measured work. Scorn and silence answered the fanatic theologian.

Mr. Jurin, doctor of medicine, secretary of the Royal Society, carefully collected and published over several years in a very impartial manner in the Philosophical Transactions the results of the new method’s experiments done in Great Britain as well as in New-England. Discouraged by the contestations he suffered, he charged Mr. Scheuchzer to continue this work consisting of a large collection of data gathered in diverse sites, vouched for by known witnesses, and carefully discussed in long lists of inoculated individuals as well as of those dead or sick from natural smallpox in well-thought-out comparisons from the inoculated and the un-inoculated . These authentic pieces and the parallel drawn from them on the effects of artificial and natural smallpox can by themselves provide solid principles to serve as a guide in research in which theory alone could lead us astray. The time has not come yet to draw theoretical consequences.

The already cited work by Timoni on inoculation had been brought to France in 1718 or 1719 by Sir Sutton, a former ambassador of England to the Porte, and its translation had been read at the Regency Council. However, the successes of the new method became well known among us only in 1723, through a printed letter addressed to Mr. Dodard, first physician of the King, by Mr. de la Coste, a French physician, who had just arrived from London. Besides a very well-done extract of the data and calculations published so far in England, this letter mentioned a consultation of nine Sorbonne doctors in favor of the experiments of inoculation which the author proposed to do in Paris. The consent of Mr. Dodard, the suffrage of Messrs. Chirac, Helvetius and Astruc, quoted in the same letter; the thesis of Mr. Boyer, now Dean of the Faculty, defended in Montpellier as early as 1717 ought to be enough to clear the French physicians of the criticism that they had always opposed inoculation , when since this time Mr. Senac, first physician; Mr. Falconet, consulting physician of the King; the celebrated Mr. Vernage; Mr. Lieuthaud, physician of His Royal Highness the Duke of Burgundy; and several others publicly approved of this method. By what right could one attribute to the whole body the opinion of some of its members who feel obliged to ban without examination every thing that appear new to them?

A few excesses done by newly inoculated young people, who in 1723 paid with their life for their imprudence, provided a specious pretext to the clamoring of the enemies of the new method, which stopped its progress in London and in the English colonies. The rumor which spread to France and the death of the Regent Duke of Orleans that same year stopped the planned experiments. No sooner had this prince closed his eyes that in the Paris Schools of Medicine a thesis full of invectives against inoculation and its advocates was presented in which the conclusion was purely theological: Ergo variolas inoculare nefas. Soon afterwards, Mr. Hecquet, sworn enemy of any novelty in medicine, published an anonymous tract titled: Raisons de doute contre l’’ inoculation, Paris 1724. Under this mild title, the author blindly flew into a rage against the new practice; his respect for antiquity is his strongest argument, and his greatest grievance against the operation he banned is that it does not resemble anything in Medicine, but rather, he added, to magic. The reporting of the new method’s success by Mr. Jurin was the best answer given to Mr. Hecquet’s ranting. Its translation by Mr. Noguet, physician in Paris, appeared only in 1725, preceded by an apology of inoculation . The Journal des Savants published only a very superficial and unfavorable extract, and that same year spoke with disdain and briefly of the letter of Mr. de la Coste, published two years earlier. Mr. de la Coste passed away about that time and Mr. Noguet was sent as physician of the King in Santo-Domingo, where he still resides. Inoculation was forgotten in France.

However, it made new conquests in Asia. A letter from Father Dentrecolles, a Jesuit missionary in Beijing, printed in the compendium of edifying and curious letters, tome XX , informs us that in 1724 the emperor of China sent out some of his palace’s physicians to seed artificial smallpox in Tartary where natural smallpox was doing great damages, and that they came back loaded with gifts. Mr. de La Condamine reports, in his travel on the Amazon River, that at about the same time a Portuguese White Friar, a missionary on the banks of this river, seeing Indians perish from a smallpox’ epidemic, which was almost always deadly, turned to insertion which he knew about only from newspapers, and saved the remnant of his flock. His example was followed no less successfully by one of his brothers, a missionary in Rio-negro and by a surgeon from the Portuguese colony of Para. Since then some of its inhabitants have turned to the same expedient in another epidemic.

In 1728, Mr. de Voltaire, in one of his English Letters, treated inoculation in a few words, with the energy and charm that his pen sheds on everything it touches. The timing was not favorable: this procedure was then neglected, even in England.

A violent epidemic brought back its usage in the Carolinas in 1738, and soon after in Great Britain, where it has since progressed with giant steps.

In 1746, some zealous citizens of London organized one of these associations that can only have as goal the love of the public well-being, and from which so far only England has given the example. They founded with their own money a charitable house to treat the poor suffering of natural smallpox and for inoculating those willing. Since this house was founded and since the foundlings of the Capital are inoculated the advantages of this method have become clear. The successes of Mr. Ramby, first surgeon His Royal British Highness, and those so numerous and so well-known of several famous inoculators ensure that this method does not have any contradictor in London among the practitioners of the Art.

In 1748, Mr. Tronchin, inspector of the college of Physicians of Amsterdam, introduces inoculation in Holland and first used it on his own son. He recommended its use in Geneva, his fatherland, where it was adopted in 1750. Two of the primary magistrates of this republic led the example by inoculating their sixteen years old daughters. Their fellow citizens followed suit, and since that time insertion became common there. The public was made aware of its success in 1725 by the treatise of Mr. Butini, doctor of medicine from Montpellier, aggregated in Geneva, and in 1753 by a report of Mr. Guizot in the second volume de l’Académie de Chirurgie . This same year, in October, Mr. Gelee, doctor of medicine, defended in Caen a thesis in favor of artificial smallpox.

Also in 1750 inoculation made its way to the heart of Italy. At the time, there was a violent epidemic at the border of Tuscany with the Papal State. All the children were succumbing. Dr. Perevini, physician in Citerna, risked inoculation on a little five-year-old almost consumptive girl, covered by scabs, fed by a woman infected with a venereal disease. The matter for the inoculation had been taken from a confluent smallpox from which the infected had died. The girl recovered. Four hundred children from the same county were saved by the same means. Their mothers inoculated them while they were asleep, unknown to their fathers, with a pin dipped in the fluid of a mature variolous pox. Several colleagues of Dr. Perevini, among them Dr. Lunadei, now first physician of Urbino, followed his example, and the latter inoculated his own children.

At the beginning of the year 1754, Dr. Kirkpatrick published in London his analysis of inoculation .

The following April 24, Mr. de La Condamine, by reading a report on this matter to a public meeting of the Parisian Academy of Science, pulled it out of the deep oblivion in which it seemed to have rested in Paris for thirty years.

At about the same time, Mr. Chaix, evangelical minister at The Hague, published his Essai apologetique sur l’inoculation printed in Harlem; and the following Fall, Mr. Tissot, from the Montpellier Faculty, published his Inoculation justifiée .

In Lausanne, in the course of a few months, four publications on the same subject, of which three were in French, were published, their abstracts spread through newspapers finally focussed the public attention on an important object for humanity’s well-being. In France, inoculation became the news of the day. It acquired partisans; in Paris the same year, a thesis in its favor was defended on the same benches where it had been so maltreated in 1723.

On October 30, 1754, two princesses of the royal-electoral house of Hanover were inoculated in London. The following November, Mr. Maty, today warden of the British Ministry’s Library, in inoculating himself, gave a new proof that insertion has no effects on those who had the smallpox naturally.

The doctrine of inoculation had in France been treated only as speculatively or as a manner of controversy; and so far no body had used the new preservative. The first Frenchman who willingly trusted his life to it was the twenty-two-year-old Chevalier de Chatelus. He was inoculated in May 1755. Mr. Tenon, master in surgery, today of the Academy of Science, performed the operation. It was preceded and followed by a few other inoculations that the Chevalier de Turgot, by zeal for the good of humanity, had done by the same surgeon on children of common people with their parents’ consent.

Soon afterwards, Mr. Hofty, doctor-regent of the Paris Faculty, came back from London, where he had gone with recommendations from the Minister of France, to learn by himself of the details of the preparation and treatment of the inoculated . His account, published in several literary newspapers, included a great numbers of new facts, fit to extinguish all doubts. At that time, criticism began to be voiced, most of them based on lightly guessed data, and since then debunked by diverse works and by the certification of the College of Physicians of London.

Inoculation continued in Paris during the Fall of 1755; and one was already talking to introduce this practice in the Foundlings Hospital, the only way to render it general, and to have the people shared its fruits, when its nascent progress was halted by the death of the youngest of two sisters who had been inoculated . This accident was even more unfortunate that one ought to have foreseen it; it was the result of a circumstance which the inoculator was not told of. Nevertheless, the following November 13, a new medical thesis in favor of inoculation was defended.

At the beginning of the following year, 1756, Mr. Tronchin was called from Geneva by the Duke of Orleans, who on his own had chosen to have the princes, his children, inoculated . The insertion done on March 12 was very successful. This illustrious example was followed by a large number of other inoculations on highly distinguished persons, children as well as adults. Among them three ladies, who had a double advantage to reap from inoculation , were the first to avail themselves of it. They made a great number of proselytes among their sex. It was then that the anti-inoculators re-doubled their clamors: one in a thesis full of indecent personal remarks, another in a work in which the author seriously bestows inoculation to bishops, priests, and magistrates of the kingdom. The thesis was disavowed by the censor of the Faculty; the denunciation appeared only as ridicule.

The new method made progress in a few French provinces, in particular in Nimes and in Lyon. More than a hundred people were inoculated in this last city, of whom none died. However the progress of inoculation in France is nothing comparable to its progress in the North, since the work of Mr. de La Condamine, translated in most of the languages of Europe, convinced people’s mind. One inoculates in Copenhagen, one sets up hospitals for inoculation in Sweden, and this practice does not have any more contradictors than in England; it is today very common in Westphalia and in the whole of the electorate of Hanover. It is gaining ground in Berlin since it was recognized through observation that natural smallpox there is not always as mild as one had thought. As early as 1753 the same method had passed from Geneva to Switzerland, where Mr. de Haller and Mr. Bernoulli increased its reputation by using it on their families and Mr. Tissot by his writings. Mr. de La Condamine in his travels in Italy made new proselytes for inoculation. It is through his persuasion that the Count of Richecour, president of the Tuscan Council, established it the same year in the hospital of Sienna and had ordered experiments made in Florence that Dr. Targioni published. Since then it is practiced with success in Lucca. The British merchants had brought it long before in Leghorn, but it was practiced only within their families.

Until 1757, no Italian author had written against artificial smallpox. That year it was attacked in Rome in two Italian moral and theological dissertations by an anonymous author, and in Vienna, Austria in four Latin questions by Mr. de Haen, a Dutch physician, doctor in the University of Vienna. The questions were re-printed and translated into French in Paris in 1758 and added to a work on smallpox, a new edition of a dissertation published in 1755 by a physician of the Paris Faculty, who claimed to have practiced inoculation with happy results and who since then has renounced it on hearsay, most of them debunked.

In November 1758, at the public assembly of the Academy of Science Mr. de La Condamine read a second work, since then printed in Geneva, composed of the continuation of the history and progress of inoculation since 1754. In it he responded succinctly to the preceding critics, and particularly to the questions of the Doctor of Vienna, to whom Mr. Tissot had answered at length and very soundly in 1759. Several polemical tracts for or against appeared and are appearing daily in the Mercure de France and in diverse newspapers.

In the preceding history of inoculation , we have been concerned only by the facts of public notoriety, of which none can be contested, and we did not allow any comments.

Practice of inoculation. The insertion of smallpox is done in different manners in different countries. La Motraye, who saw this operation done in Circassia in 1712 on a young girl of four or five years of age, reports that the operator, who was an old woman, used three needles tied together with which she pricked the child at the stomach, at the left breast, at the navel, at the right wrist, and the left ankle. The Greek women, one of whom had practiced in Constantinople for 30 years, and who had inoculated several thousands subjects, used a triangular sharp needle with which she made small wounds in different parts of the patient’s body adding to it some superstitions. Their operations’ main point consisted in mixing blood of the pricks with liquid matter recently taken from poxes of a natural and mild case of smallpox. In Bengal, the skin was pierced between the thumb and the index-finger with a threaded needle filled of variolous pus. At Tripoli in Barbaria, the surgeon makes an incision on the back of the hand between the thumb and the index-finger and introduces there a little bit a matter extracted from the biggest and fullest poxes from another smallpox case. In Wales, children scratch the top of their hand until blood appears, rub it against that of an actual sick of the smallpox and so contract the disease. Mr. Tronchin just breaks down the skin with an irritating plaster and place on the wound a thread which has been through a ripe pox of smallpox.

All these means seem equally proper to introduce the virus into the blood, which is the goal of the operation; yet the contact alone suffices: the disease transmits itself just by holding in one’s hand for a few moments matter taken from a suppurating pox. A surgeon from Padua, named Betri inoculated his daughter by applying to her a parchment spread with this matter under her arms, under the back of her knees and on her wrists. In China, perfumed cotton sprinkled with dried-out variolous crusts is introduced in the nose. This method is recognized in England as dangerous: it was tried in 1721 on an eighteenth-year-old girl from the group of six criminals chosen to submit to the ordeal of inoculation ; she had violent headaches, and was sicker than any of the others. The incision, which Timoni had already substituted for pricks, prevailed. Experience also showed that it is not really important whether the matter is taken from a minor or major smallpox case and that just one cut is enough, although two are ordinarily done, either to the arms or legs, as much to be sure that the procedure will produce the desired effect as it is to open a double channel for the exit of the variolous matter, and to render by this means that which forms the poxes less abundant, less acrid and less corrosive. What the Chinese had already recognized, that proper inoculation ’s matter keeps its potency for several months and whether taken from a natural or artificial smallpox gives the expected effect, was tested through experiment.

Here is the method used by M. Ramby, first surgeon to the King of England, the most celebrated and fortunate of inoculators . It is also the one followed the most commonly in Geneva.

The children need only a mild preparation, just a few days of diet and one or two purgations; rarely blood-letting. As for the adults, their bodies are to be prepared to deal with an inflammatory disease; therefore the healthier and vigorous subject, the more need generally to abate his/her strength through blood-letting, diet, the use of refreshing remedies. One adds some purges and sometimes baths. It is important to consult a wise physician who knows the temperament of the person he will prepare for inoculation and who can prescribe the suitable regimen.

As for the operation, one makes an incision of less than one inch in length and so shallow that it just cuts the skin on the two arms in the external middle part, below the attach of the deltoid muscle, in order not to impede the freedom of motion. A thread of the same length as the wounds impregnated with the matter of a mature pox without redness at its base taken from either a natural or artificial smallpox cases of a healthy child, is introduced in the wounds and covered with a shredded linen elongated pad, a plaster of diapalma, and a compress secured with a bandage. This apparel is removed about forty hours later and changed about once every twenty-four hours.

Although in the first few days after the operation the subject is able to go out, he/she is kept inside and on the regimen. When the symptoms begin to appear, usually after after six or seven days, he/she stays in bed; is disallowed meat and prescribed the same diet as in acute diseases. All the symptoms cease with the eruption; the wounds’ inflammation decreases and they discharge more matter. The number of poxes is usually not considerable, reaching rarely to two or three hundred on the whole body. They leave no marks. The tenth day after the eruption the wounds begin to fill; the fifteenth to heal; they often close by the twentieth. If one sees that they continue to discharge, one should not hasten to plug them.

Sometimes the venom escapes almost completely through the wounds; so that the patient has only one or two poxes; sometimes even none. One has recognized that he/she is nonetheless sheltered from contracting smallpox naturally, even when inoculated again which has been tested several times. The obvious proof that it is variolous virus which is coming out through the incisions is that when this matter is inserted in another body it produces an ordinary case of smallpox. Mr. Maty witnessed this experiment.

One chooses to inoculate in a season which is neither too cold nor too warm. Spring and Fall appear equally proper. One usually prefers Spring, because Summer helps the convalescence, but there are numerous examples of inoculation which succeeded in any season. The Greek operators inoculated in Winter in Constantinople. Summer, from general consent, is the least convenient season, yet one inoculates with success in Jamaica, which is located in the torrid zone. In Geneva in August 1759, Mr. Tronchin inoculated , a lady from Paris who wanted to be able to return there in September; it is true that with extraordinary precautions he managed to keep her room’s temperature between fifteen and seventeen degrees of a Reaumur thermometer, while in the outside air it did rise to twenty-three and twenty-four degrees.

The success of this operation is particularly remarkable for the circumstances that preceded it. The person who was subjected to it was of a very delicate health, weakened by ten years of infirmities and remedies, to which an ulcer to the kidneys was added. The physician had to start with curing her of all her troubles. There was still despair about her life a few months after her inoculation . Today, she enjoys good health.

At the London Hospital, adults over thirty-five years of age are hardly inoculated . This shows that one has perhaps more regard for keeping the method’s reputation than for serving the general good.

Advantages of inoculation. Danger of the natural smallpox. Some advantages of inoculation are immediately obvious; others need to be recognized through examination and comparison of facts.

One sees first that one has mastery over the choice of the age, the place, the season, the time, the disposition of the body and of the mind, the physician and the surgeon in whom one has the most confidence. Outside accidents, epidemics, complication of aches, which are probably the whole danger of smallpox are prevented by the preparation. The fermentation begins in the external parts: the artificial wounds ease the eruption in giving to the virus an easy exit.

What is the comparison between a premeditated disease and one contacted haphazardly, while traveling, in the military, in critical circumstances, mostly for women; in a time of epidemics which multiples the accidents, which transports the seat of the inflammation in the internal parts of a body perhaps already exhausted by lack of sleep or hard work?

What is the difference between an expected illness and one that surprises, that dismays, of which the sure fright it provokes may prove fatal; or showing equivocal symptoms inducing even the best physician in the wrong, making the disease worst by the one in whom there was hope for a remedy? Here is what dictates good sense and the simplest reasoning. Experience is even more decisive: it proves that the matter for inoculation , taken from a complicated, confluent, even fatal case of smallpox, almost always communicates a simple, discrete, without fever or suppuration one, always milder that the natural, so often deadly, finally a smallpox which leaves no marks.

Yet to estimate more exactly the advantages of inoculation , one ought to assess the danger of ordinary smallpox and compare it to that of inoculated smallpox. It can only be done with the help of Dr. Jurin’s lists, the surest guide and almost the only one we have on this matter. Smallpox exhibits very unequal ravages. In 1684 in London, from a thousand dead, only seven were from this disease, that is 1 per 149. In 1681 and in 1710, the proportion of dead from smallpox to other dead was 125 and 127 per 1000, or one eighth; in a usual year it is 72 per 1000, or one fourteenth. This result is drawn from the London death lists during forty-two-years which list more than 900,000 dead. These same lists extended over a twenty-four-year period by a society of physicians and surgeons in Rotterdam give also the same proportion.

With other accounting of dead and sick of smallpox, not in London but in diverse provinces of England where smallpox is said to be milder than in the Capital, culled by the same Mr. Jurin and adding to more than 14,500 cases, he found that from six sick of smallpox, one usually died from it. From these first listings on 4,600 persons, he initially found the ratio from sick to dead as 5 to 1, and Mr. Schultz, a Swedish physician who wrote two years ago, established the same proportion. It was estimated in Geneva, yet rather vaguely and without producing a list, that the danger of smallpox was usually in this city as 1 to 10, so less than half the Swedish rate. However, Geneva preceded Stockholm by several years in accepting artificial smallpox. We are writing principally for Paris, where smallpox is said to be very deadly. We suppose that it takes one out of seven sick, which is about the middle between the results in Geneva and in Sweden.

It would be misleading to say that the preceding accountings are only good for England. The limits from the greatest to the least mortality due to smallpox, varying in London from 7 to 127 per 1000, it can be seen that sometimes this disease is less fatal in this city than in countries where it passes for the mildest, and at other times it is as dangerous in this city as in other places reputed the worst; so its mean rate of mortality, drawn from the London death lists over seventy years, and which encompass more than fifteen hundred thousand dead, cannot be very different than in other regions of Europe. We therefore will assume as our principles from experience: 1. that the fourteenth part of the human race perished sooner or later from smallpox; 2. that from seven persons attacked naturally from this disease, usually one infected dies from it. Let us see now what kind of risk one runs with inoculation .

When this operation was first known in England and in the English colonies, it was soon practiced it with a kind of enthusiasm founded on the steady successes it had in Constantinople, where, from the testimony of three physicians -Timoni, Pilarini, Le Duc- one scarcely knew of any example of accident; but the ordinary way of life of the English, who eat succulent meat and drink lots of wine and fermented liquors, required without doubts more preparation than the simple and frugal life style of most of the modern Greek. Insertion was practiced nevertheless in London and even more in America with much imprudence on people of every age, any temperament; on children in cradles, pregnant women, infirm, white and black of very suspected mores, and this with almost no precautions. Mr. Jurin, by comparing lists which were sent to him and which he rendered public, found that in America one person died out of sixty inoculated and that in London one out of ninety-one, without distinguishing between foreign accidents from those of which inoculation was the presumed cause. The adversaries of the method pretended that one out of forty-nine or fifty had died. Their exaggeration, if taken literally, is the most evident proof of inoculation’s advantages; this is an admission torn from the anti-inoculators that the inoculated smallpox is still seven times less dangerous that the natural, from which for the same number seven at least would have succumbed. However since the method has been perfected and inoculators have become more circumspect on the choice of subjects, instead of losing one out of fifty, there is an inoculator who has not lost one out of one thousand. Mr. de La Condamine could say so with reason: Nature decimated us, inoculation vintages us . This success is not greater than one might rightly expect today, as in the Inoculation Hospital of London, where the sick, whatever attention one gives them, cannot hope for the same care a well-off private person in his/her own house will get. From five hundred ninety-three inoculated , most of them adults, only one died in four years, expiring on December 21, 1755. This we learned from the list published in 1756 by this hospital’s administrators; and this is at the same time proof that no choice is make of who is admitted, as in the same number of people taken at random, more than one, without going through the operation, would have paid his/her tribute to nature during a month which we take as the term of the convalescence. It is therefore not proven that one can attribute legitimately to the well-directed operation the death of one inoculated out of six hundred. Still to dispel any contestations, we will admit the possibility of an accident, not only in six hundred operations, but on one out of two hundred; and that is in starting from this really false supposition, we are according to the adversaries of the method three times more than they may request, that we will compare the risk of natural smallpox to that of the artificial.

With the former, at least one out of ever seven sick people dies. With the latter, 200 inoculations saves at least 199; and of this number ordinary smallpox in removing from it one seventh would have chosen more than twenty-eight victims. We suppose here that inoculation calls one to itself, the sick with natural smallpox therefore runs at least twenty-eight times more risk to his/her life than the inoculated , without speaking of the other advantages that we have exposed previously, of which one alone, that of preserving from ugliness, is for half of the human race also more valuable than conserving life.

So this is the direct consequence of the two principles of experience that we stated; but it is not the only one; there are others that we will elaborate upon that are not perceived at first sight; they will shed light on a question until now abandoned to conjectures, and on which even physicians are themselves divided; that is whether smallpox is universal, or at least almost universal, or whether a large part of the human race escapes this tribute.

It may be that some people, physicians even, persuade themselves that smallpox is not as frequent as is commonly believed, and that a large number of human beings reach old age without getting this disease. This is an error that we will destroy, about which one might had have illusions. It may be that others believe that smallpox is not very dangerous, because one observes some epidemics which are mild from which almost nobody dies; this error can be forgiven to anybody except a physician; however, upholding at the same time that smallpox is far from being universal and that it is not very dangerous is a contradiction reserved to those that prejudice or passion blind toward inoculation ; and the title of doctor of Medicine makes this contradiction even more humiliating.

As smallpox takes away the fourteenth part of the human race, it is clear that the more one will suppose people exempt from this fatal tribute the more fateful it will be for the small number of those that will stay to pay it. Conversely, the less smallpox will be supposed dangerous, the more people will be attacked by it without dying from it, and more general it will be. One therefore cannot sustain both that smallpox is not very dangerous and that it is not very common, as from fourteen humans who are born one has to die from smallpox if thirteen are spared, the only one of the fourteenth that would catch this disease would die unfailingly; it would always be fatal; which is visibly false. On the contrary, if from fourteen smallpox cases one only was deadly, none would die, unless thirteen others were sick from it; whereas one fourteenth part of humans dies from it; therefore, the thirteen others will get the disease; all human beings without exceptions would be attacked by it; which is no less wrong as one sees many die before catching it. Be consistent with yourself , said Mr. de La Condamine to the anti- inoculators . Conceive that if smallpox is less common that I have supposed it, it is even more fatal for the small number that got it; if it is rarely deadly, convene that almost no one is exempt of it. Choose at least between two incompatible suppositions: tell us, if you want, insults, but do not say absurdities.

It is therefore demonstrated that the rarity and mildness of smallpox cannot subsist together; however, which of the two opinions is the true one? If the question is not yet clarified, it is because one has not yet pondered enough on two principles of experience that contains the solution. Our goal is to be useful; allow us to bring to any attentive reader an important truth for humanity.

Smallpox kills one fourteenth of humankind and the seventh of those that it attacks; therefore, the fourteenth of the totality of humans and the seventh of the smallpox sick are exactly the same thing: besides the fourteenth of one number cannot be the seventh of another, only if the first number is the double of the second; thus the totality of humans is the double of the totality of the smallpox sick; therefore, half of humankind has this disease; thus the other half dies without ever having it. All these consequences are evident and are confirmed by other observations and census completely different from the preceding.

In fact, Mr. Jurin informs us that according to the careful searches he has done, miscarriages, worms, rickets, several kinds of cough, and convulsions kill two fifths of the children in the first two years of their lives; adding those who die later without having had smallpox, one will see that at least half of human beings perishes before catching it. It is therefore on the half which survives that falls the fatal tribute of the fourteenth of the whole; so of one hundred children who are born, about forty die from miscarriages or childhood diseases in the first two years of their lives and most without having encountered smallpox. Suppose that ten others died further without having paid this tribute, there will be fifty left all of whom will be subjected to it; and from whom one has to take the seven, which gives the fourteenth of the total number of one hundred: behold the seven dead out of fifty sick, according to our evaluation. If you increase the number of exempts, say to sixty only, there will only be forty of the one hundred left to bear the tribute of the seven dead; which would be more than one dead for six sick. So if more than half of humans dies without having gotten smallpox, it is fatal for more than one sick out of seven; and if it spares a larger number of sick, one ought to have more than one half of humans catching this disease sooner or later.

As a large number of authors, among whom one counts most of Arabic physicians, wrote that either smallpox is an universal disease or that almost no one is exempt of it. As more modern famous physicians, among them Riviere and after fifty years of practice Mead, claimed that just about one out of one thousand avoided it, they ignored that a number of children and young persons succumb before getting it, so by affirming that it was quasi universal, they could only mean that it was practically impossible to dodge it for those not taken away by a premature death. This is what the preceding calculations exhibit. If one objets that a few human beings reach old age without getting smallpox, one has to recall that one has observed more than one time, eighty-years-old persons catching it. Therefore one should not hasten to conclude that one is sheltered from this scourge; it strongly appears that all human beings are subject to it, like all horses to strangles, that one escapes smallpox only for failing to live long enough.

It is true that, from Mr. Jurin’s observations, there are four persons out of one hundred on whom inoculation seemed not to have taken; yet of this number one has recognized on several the marks of the disease of which they believe themselves to be exempt; others were suspected to have paid its tribute; others may have had it without apparent eruption, and from the kind which after the first symptoms follows their course through evacuations, and that Boerhaave calls morbus variolosus sine variolis ; a process of nature of which one knows a few examples, perhaps more frequent than one thought, and that art has not been able to imitate safely until now. Any physician who has not seen one of these examples may, in similar cases, misjudge the disease’s nature, and the sick, with even more reason, ignore that he/she had smallpox. Finally, insertion may not always produce its effect, sometimes by the fault of the inoculator , sometimes for reasons which are unknown to us; such accidents could be common to inoculation , and to all other most well-tried remedies. One sees now that is very possible, even very likely, that in conformity with the doctrine of several great physicians, all people, almost without exceptions, are susceptible to smallpox if they do not die prematurely and that among the persons of a certain age who are supposed to have not yet paid the tribute there are deductions to take tending to diminish their number considerably.

In all of the preceding calculations, we always have supposed that inoculation is not without risks to avoid lengthy discussions; and it was enough to prove that the risk, if there is one, is not as great than those to which one exposes oneself every day voluntarily and without necessity, often by pure curiosity, as a past-time, as a fantasy, in violent exercises, such as the hunt, real tennis, pall-mall, postal horse drawn carriage to travel a long distance, etc. While we have not dismissed the idea of danger in well-administrated inoculation , in accordance with what skilled practitioners think, we will at least recall for our readers that it is right to take away from the number of the alleged victims of this operation all of those who evidently died of extraneous accidents, breast-fed children passing away quickly in the course of an inoculated very mild smallpox, because of convulsions or diarrhea, as it happens to others of the same age that appear to be in perfect health; those that in time of epidemics had already gotten the ill by natural contagion; those of which intemperance or other excesses, before being inoculated , visibly caused their death. Join to all these outside causes the imprudence of some inoculators in the beginnings of the method’s introduction, we have no more than one death that can legitimately be attributed to inoculation .

Here is the place to examine what age is the most proper for this operation. Children being exposed to smallpox from their birth on, sometimes even before seeing daylight, it seems that one cannot show too much haste in shielding them from this danger. However out of five children, according to the already cited observations of Mr. Jurin, two will die in the first two years from the usual diseases of this age, and on whose all the art of physicians fails most often. The fits of convulsion, the colics, the teething pains, etc. could show up during the course of the artificial smallpox, render it more dangerous, and perhaps fatal; and often these deaths due to accidents would be unjustly imputed to inoculation . It is in all likelihood that for this unique reason one has ceased in England to inoculate nursing children, and that ordinarily one waits for them to be four years old, but one cannot accuse on account of this the inoculators to have less at heart the public good than their honor or their own interest, as the discredit of inoculation would become a loss for humanity. Some thought that the most proper time for insertion was at three weeks or one month old, a time in which the children have escaped the ordinary accidents of life’s first days and are not yet subjects to the larger number of those that threatens their lives several months later.

What is now left to determine is until what age it is beneficial to get inoculated . On one side the probability of escaping the tribute to smallpox increases with the passing years, on the other the danger of dying of it increases likewise, and perhaps in a greater ratio. We are lacking data to assign exactly a time limit when inoculation would cease to be beneficial. It is usual that 35-year-old individuals present themselves at the London Hospital to be inoculated . It appears that we have ample proof that one can do it safely much later: there are examples of 70-year-old patient to whom this ordeal was a success. This success is less extraordinary than their resolution, as one has seen older persons get over natural smallpox, which is always more dangerous than the inoculated one.

The detail in which we have entered on estimating the frequency and danger of natural smallpox and on the advantages of inoculation prepares us for responding to the objections that are made against this method. We will answer only those that present some real difficulties, and will deal lightly with those that even the anti-inoculators have let go.

Objections . Physical objections. First objection. Is the disease communicated by inoculation a true smallpox case? This objection is destroyed by another one, to which we will respond at its proper place. Here we will only note that it is strange that Wagstraffe, who is the first to have doubted that the disease communicated by insertion is smallpox, is also the first to say that this operation would carry contagion and death everywhere it would be practiced. He admitted that the inoculated disease can transmit ordinary smallpox and wanted to appear to doubt that the inoculated subject had a true smallpox. This objection is today abandoned.

Second objection. Is inoculated smallpox less dangerous than natural smallpox? One can no longer seriously hold this objection; it is wholly refuted by the history of the facts and the comparison made in the preceding article on natural smallpox’ danger with that of inoculation . It has been proven that smallpox commonly kills one sick out of seven, and that one could not, without falling in contradiction, suppose it generally less dangerous. The public lists of the London’s Inoculation Hospital have proven that only one died out of 593, whereas in that same hospital two out of nine sick died or more than one out of five from smallpox. When one would suppose, against truthful facts, that natural smallpox is only deadly for one sick out of ten and that the artificial is fatal for one out of one hundred, the natural smallpox would still be ten times more dangerous that the inoculated .

Third objection. One can have smallpox several times. So inoculation do not prevent the return of this disease. Thus inoculation is a waste. This argument, which has been renewed recently, is the one that makes usually the most impression. It contains a question of rights and a question of facts. Let us see what the Inoculators respond.

It is not proven, and many physicians still deny that one can get smallpox more than once.

When one would catch it twice naturally, it would not follow that one could catch it again after inoculation ; experience proves the contrary.

When there were any example, which is denied, of an inoculated individual catching a second smallpox, it would not follow that inoculation is useless.

An elaborated discussion of these three points would furnish the matter of as many dissertations. We will try to be brief.

1. [ First Objection ] For twelve hundred years, smallpox has been known in Europe, and for twelve hundred years it has been disputed whether or not one can have it twice: if this is not the proof that the fact is wrong; it is at least this, that it is not indubitably proven. In fact, most of the Arabic physicians and a great number among the moderns deny that one can catch smallpox twice. Mr. Tissot, in his response to Mr. de Haen, gives a long list that could easily be increased. Among the presumed second smallpox cases, none are cited in which a physician not suspected of prejudice has treated the same sick person twice and certified as a visual witness the truthfulness of the two real smallpox cases in the same person; lacking such circumstance the witness loses much of its weigh. Besides, the illustrious Dr. Mead, who has written so much on this disease, asserts positively after fifty years of practice, that one cannot re-catch this disease. The great Boerhaave affirms the same thing. Paris is still full of living witnesses, who have heard Messrs Chirac and Molin , two of our greater practitioners, dead at a very advanced age, say that they have never seen such a case arise. If it is true as some presume, that Mr. Molin, in the last days of his life, had seen an example of recurrence, that would make one out of more than forty thousand smallpox cases that ought to have passed under the eyes of these four celebrated doctors during the course of a long life, in large cities such as London, Paris, and Amsterdam.

Every year in Paris more than twenty thousand persons die, of which the fourteenth part or 1428 die from smallpox. Each death from this disease requires seven sick, as we suppose it deadly only for one out of seven; thus seven time 1428 persons, that is ten thousand catching smallpox in Paris in a normal year. If out of these ten thousand one only was attacked by a well-verified second case of smallpox, one would have every year in Paris a new evident proof of this fact, and if just someone known to have been mistreated by smallpox came to catch it a second time, the thing would no more be problematic; such a case of public fame has yet to take place since one still argues about it. Therefore, there is not yet evident proof that one can have more than once a true case of smallpox in one’s lifetime.

A large number of examples proves the contrary that even inoculation was unable to renew this disease in those who had it a first time without equivocation. Richard Evans, one of the six criminals inoculated in London in 1721 and the only one among them who had had smallpox, was also the one on whom insertion had no effect. Many more experiments have proven the same thing: the best known is that of Dr. Maty which we have reported in the history of inoculation . Paris witnessed a similar case in Miss d’ Etancheax in 1757. All the newspapers have talked about it. If the variolous virus introduced in the wounds and carried by the circulation in all the veins cannot renew smallpox in a body already purged of its venom, all the more reason will it not be produced by the ordinary means of contact and of respiration.

2. [ Second Objection ] Whereas it would be true that a natural smallpox case would not purge fully the body of the variolous leaven and that enough is left to produce a new fermentation, it would not follow that the leaven of smallpox activated by a virus of the same nature introduced directly in the blood by several incisions could not develop so fully as to leave no matter for a second development. Artificial smallpox could drain off the leaven that natural smallpox could not accomplish and, therefore, there would be nothing to conclude of a second natural smallpox against the efficacy of inoculation to prevent another real case; but letting go of the purely theoretical reasonings, we stick with experience.

Inoculated individuals have been put through all kinds of ordeals to get them to catch smallpox again without ever succeeding. One has housed or put to bed inoculated children with others suffering from smallpox without having any catch it a second time. One has repeated inoculation several times on different subjects; the wounds under the virus saturated thread healed as light cuts. This is what happened to the son of Lord Hardewick , great chancellor of England, who was again inoculated because he had no eruption the first time, the wounds having only suppurated. Note in passing that this suppuration of the wounds is equivalent to an ordinary smallpox’ eruption as several experimentations have proved and moreover that the matter which flows from the incisions, even with no eruption, can be used with success for insertion as Mr. Maty has observed.

Dr. Kirkpatrick reports that an inoculated and well healed 12-year-old girl, secretly cut herself, put variolous matter in her wounds three times on three different days, and that her new wounds dried up without suppuration. A 28-year-old officer inoculated very recently (1759) in Gotha by Mr. Soulzer, first physician of the reigning duke, with the matter of a young prince’s artificial case; one of the duke’s sons wanted to have it done a second time with matter from a case of natural smallpox. The new wounds, added Mr. Soulzer in his letter to Mr. de La Condamine, healed under the thread. There are a numerous similar cases, which prove that inoculation shelters individual from a second smallpox, and none of the so-called contrary examples have sustained verification.

At the time of the first experiments in London, Dr. Jurin invited publicly during several years all of those who might have known of any repeated smallpox after inoculation to communicate them to him. None could be attested: all the alleged facts were either denied or labeled as false by the disavowal of the concerned persons. Dr. Kirpatrick reports in his book the letter of a surgeon named Jones whose son had been said to be in this case. Dr. Nettleton belied publicly such a promoted case from one of his own inoculated . Similar slanders have since been renewed in Holland about Mr. Tronchin’s inoculated and of Mr. Schwenke’s and the echoes repeated them from Paris. One alleged, one circumstantiated second smallpox; one rumored that Mr Schwenke had inoculated the same person up to seven times; one claimed publicly that his inoculated were at death’s door; one cited eyewitnesses who since then have denied categorically these facts ( Bibliotheque anglaise September and October 1756) . As for the pretended repeated smallpox after inoculation , what may serve as base to these rumors is that among the diverse cutaneous eruptions, completely different from that of smallpox and which do not preserve from it, there are some that begin with symptoms that are the same as in ordinary smallpox. However, the essential and characteristic of this eruption is that the poxes are clear, transparent and filled of serosity, that they vanish, subside, and dry the third day without suppuration. This disease has been known and was described a century ago in Italy, in France, in Germany, and in England. It has been recognized and distinguished from true smallpox before one knew in our Europe what it was to inoculate . It has different names, such as verolette , lymphatic, serous, crystallin, flying, false smallpox. The Germans called it shesh-blattern (sheep-poxes); the English chickenpox , the Italians ravaglioni . Yet all agree that it has nothing in common with smallpox, which it does not protect against, nor safeguard from either and which by itself is not dangerous. It is epidemic and more common in children than in adults. Most countryside’s care-givers, surgeons, and pharmacists identify or feign to identify it as true smallpox to give more importance to their care, some physicians may have mistaken it by lack of experience. There are examples in England and in Holland of inoculated individuals who caught this disease and other persons have been willing to try to identify these cases as smallpox. One such case is that of Baron de Louk, who to destroy this rumor, believed himself obligated to publish in the already cited newspaper his disease’s history. He kept to his room only one day and appeared immediately at the court in The Hague; it was the same with his cousins, daughters of the Countess of Athlone. Another example is the young son de la Tour, inoculated in 1756 by Mr. Tronchin, who has been the subject of so much gossiping in Paris. The anti-inoculators published that this child had a second smallpox in 1758. It was proven that on the fourth day he was up and playing with his friends. The nature of his disease had been made quite clear by a report of four physicians - Mrrs. Vernage, Fournie, Petit senior, and Petit junior; Messrs Bourdelin and Bouvard bore the same judgement. Such are the examples on which the anti-inoculators lean to prove inoculation’s uselessness .

As for the case of the famous Timoni’s own daughter, dead in Constantinople in 1741 from natural smallpox, after being, it was said, inoculated by her father. It has been proven that Timoni, before departing for Andrinople from where he never returned, had instructed his 15-year-old wife to inoculate his daughter; but the testimonies on this order’s execution have widely varied and are even more diverse on the effect produced by this so-called inoculation. The fact therefore stayed doubtful and buried under clouds that cannot be entirely dissipated. Mr. de La Condamine recently received a letter dated in Constantinople from ... October 1758 which he showed us in the original, from Mr. Angelo Timoni, interpreter of His Britannic Majesty at the Ottoman Porte, brother of the dead girl. It reports that Cocona Timoni, his sister, was inoculated in 1717 at the age of five months by an apothecary of Scio who was known for his immoderate wine drinking and was new to the practice of this operation; that the incision made with a lancet to only one arm left no scar any different than that of a small blood-letting mark, that his mother then only fifteen-year-old, was unable to make any observation, whether the operation was followed by a skin eruption, or whether the wound dried by itself ; that his still alive uncle and brother of the famous Emmanuel Timoni attributed the whole fault to the inoculator and judged that the matter had been taken from a false smallpox; that the local people and the physicians, from whom Mr. Angelo Timoni got his information, do not know of any such accident before or after as that of his sister, an accident that might not be unique , he added, (in a country where in a century one must have had more than a hundred thousand inoculations ) if the persons inoculated were amenable to catch smallpox twice ; that furthermore this incident did not prevent the continuation inoculation in Pera; that he himself had this operation done on his five children two years ago , and that he counts on repeating it on his youngest who was only 40-day-old and on whom insertion produced nothing. So, it is not certain that Miss Timoni had been correctly inoculated , that the inoculation had produced its effect, nor that the wounds had suppurated. Yet supposing true everything that is doubtful, let us see what consequences might be drawn for inoculation ; that is what is left to us to examine.

3. [ Third Objection ] Although Boerhaave, Mead, Chirac, in 50 years have never observed a second smallpox in the same subject, and Mr. Molin has seen at most one in the period the others saw none, we will suppose that there exits one example for ten thousand natural cases of smallpox. The repeated cases, if they exist, ought to be even rarer after inoculation , which seems to be of all means the most proper to activate the fermentation in all the parts susceptible to the virus’ action. Yet, giving on this point no prerogative to artificial smallpox, it follows only that out of ten thousand inoculated , there might be one able to contract a second smallpox. This one, from the avowal of several anti-inoculators , ought to be so much less dangerous, since one cannot deny that a part of the venom had been purged by the preceding case. Still let us suppose again that the second be as perilous as the first, at least it will not be worst. Therefore, there will be one fatal out of seven; but it is necessary to have at least ten thousand smallpox cases to encounter one repeated: thus it will be necessary to have seven times ten thousand cases to get one to be deadly: thus out of seventy thousand inoculated , there might perhaps be one to die from a second smallpox case. It is all that one might conclude from the preceding, freely admitted, suppositions.

If one would hold that it was impossible that inoculation was never followed by any deadly accident, just one example would suffice to destroy this claim; but the question between the two parties is to determine out of which number of inoculations one ought to fear such event; is it, for example, one out of 500, 300, 200, or 100 inoculated . The anti-inoculators , to weaken the advantages of the method, have pretended at the time of the first trials, that one inoculated out of fifty died; but they did not include in their computations those who, according to them, died from a second smallpox. We have just shown that the number cannot be raised further than one out of 70,000. Instead of 1400 dead that they would have counted out of 70,000 inoculated , at the rate of one dead out of each fifty, one should count 1401. Could one ask that the inoculators see their method as pernicious because it may result in one more accident out of 70 thousand than they had presumed? And would their adversaries declare the question settled in their favor, when they would have proven that instead of 1400 dead out of 70,000, one must count 1401?

Fourth objection. Can the pus transmitted in the blood of the inoculated individual communicate other ills than smallpox, such as scurvy, scrofula, etc.? Not only there are no examples that neither natural smallpox nor inoculation has communicated other diseases than smallpox itself; yet one has factual proofs that the variolous matter taken from a body infected with venereal virus gave only a simple and benign smallpox case. The first experiment was done at random; Dr. Kirpatrick reports it in his book. It has since then been repeated: it is therefore useless to elaborate on the theoretical reasons that refute this objection. Besides since one is the master of the matter’s choice for the inoculation , nothing forbids it to be taken from a very healthy child, and in whom no other ills than smallpox are suspected.

Fifth objection. Inoculation leaves sometimes unfortunate sequels, such as wounds, tumors, etc. These very frequent accidents after natural smallpox are extremely rare following an inoculation. This latter one is often so mild that one may doubt that it was a true smallpox. The symptoms, the accidents, and the sequels of these two diseases keep the same proportion. Mr. Randy attests that of one hundred inoculations , scarcely there is one which brings an abscess out. A simple bloodletting causes sometimes greater and more dangerous accidents: so this remedy should be proscribed before putting inoculation on trial.

Sixth objection. Inoculation does violence to nature. As much may be said of all remedies. Why blood-let or purge? Why not wait until nature reliefs itself by a hemorrhage and by a diarrhea. See on this objection l’ Inoculation justifiee of Mr. Tissot.

Moral objections. Seventh objection. It is to encroach upon the rights of the Divinity to give a disease to someone who does not have it or to attempt to prevent someone to catch it who in the order of the Providence was naturally fated to it. If this objection had not be done in good faith by pious persons, it would not merit a response. Does trust in Providence excuse us from preserving ourselves from ills that we anticipate when one knows from experience that they can be prevented? Do we have to imitate the Turks who by fearing to counteract the views of Providence die by the thousand in plague epidemics so common in Constantinople while they see the French living in the middle of them escape it by evading its transmission? If inoculation , as proven by experience, is a way to protect oneself from the fatal ills of smallpox, does the Providence that offers us the remedy forbid us to use it? Would all the preservatives, the remedies of precaution be hereafter illicit? We refer those on whom authority seems to have more weight than evidence to the already cited decision of the nine doctors of the Sorbonne consulted by Mr. Coste; to the diverse consultations of several Italian theologians; to the treatise on inoculation sanctioned by inquisitors; to the arguments of the celebrated Bishop of Worcester; to the books of Drs. Some and Doddrige, noting in the present case that the suffrage of the protestant physicians ought to have even more weight with the Catholic theologians, in that we do not differ from them on moral principles and that their opinions on absolute predestination lean toward the objection that we are refuting. Mr. Chais has responded to it in the strongest and most satisfying manner in his Essai apologetique .

Eighth objection. It is not allowed to give a cruel and dangerous disease to someone who may perhaps never get it . We have proved in the article on the advantages of inoculation that artificial smallpox is neither cruel nor dangerous. Therefore, only the second part of the objection is left to destroy. Although inoculation is less painful than bloodletting, and whatever small be the danger that accompanies it, it would be extravagant to submit to it someone who would be sure never to have smallpox. Yet, as it is impossible to reach this safety, and on the contrary as anyone who has never had this disease runs a very great risk of catching it and of dying from it, it is not only allowed, but also very prudent to take all of the surest means to escape this danger as much as possible; and there is none better known for efficacy than inoculation.

But, one may say, it is still disease: why give it gratuitously to someone who might perhaps never have it? Firstly, one does not give the disease to whom would never have it: experience has shown that there are a few persons who do not catch smallpox by inoculation ; it is more than probable that they are the ones who would never catch it. Secondly, as says the Bishop of Worcester, it is less about giving a disease to a body exempt from contracting it, than choosing the most favorable time and circumstances to free from an almost always inevitable ill which issue is often very dangerous without it. Thirdly, inoculation is to give a small ill to prevent a much larger. It is to transform a danger from which nothing can preserve into an infinitely less dangerous one, as not to say absolutely null.

If right now I had a case of smallpox would say someone, I convene that there is only six against one to bet for my life; yet I hope to be in the number of those who never catch it, and this hope diminishes considerably the danger than I run. Yes, answers Mr. de La Condamine, the hope of never catching smallpox decreases the danger which threatens you; but from so small an amount that your risk to die from it someday, you who enjoy good health right now, differs very little from a sick in whom smallpox just appears. The difference between these two risks is just one seventieth. Here is the proof. Let us now take 70 persons infected with smallpox. We have proven that at least one seventh of them will die of it, that is ten: let take another 70 healthy of any age, who never having had this disease, we may presume that three at most will be exempt from it, as one counts only four out of one hundred on whom inoculation is without effect, and perhaps this number is too large by one half; however, in order not to have to quibble, let us suppose six out of the seventy, instead of three that would never have smallpox, let us suppose even ten, visibly too large a number, of those will run no risks, yet the 63 left will certainly have the disease, one out of the seven will succumb from it, so nine out of the 63 will die. Therefore, from 70 actually sick ten will die and from 70 healthy nine will die. The difference of the two risks is just one seventieth. There is thus six to one to bet that the person actually sick of smallpox will recover from it, and six seventieths to one that the healthy person who waits for this disease will not die from it. The hope that this person has to evade it thus diminishes only the risk of dying of it sooner or later by one seventieth. The real difference just stands in that one danger is right now and the other is perhaps further away.

Ninth objection. A person who may not have died from smallpox before being fifty years old, who had children, who served usefully his/her country, will be lost to society if dying in childhood from inoculated smallpox. This objection, as several preceding others, borrows all of its strength from the gratuitously granted fact to our adversaries that inoculation is not exempt from perils. But it is not necessary to retract ourselves to respond to them. The three fourths of those who get smallpox suffer this disease while in an age in which they are more a charge on society than useful to it. As for the other fourth, as the danger of smallpox increases with age, if the inoculated runs a very little risk of dying sooner, he/she is free of a much greater of dying later, which does more than pay back. Finally, supposing that one fatal event out of three hundred, two hundred, even for a smaller number might abridge a citizen’s days, the State would be largely compensate of this loss by the preservation of all of those whose lives would be prolonged by inoculation.

Tenth objection. Inoculated smallpox will multiply smallpox cases by scattering contagion everywhere. Someone loudly claimed this objection in London in 1723. The epidemics was very deadly. Some pretended that the artificial smallpox had increased the danger. Mr. Jurin proved that the large mortality of that year, which one named the year of inoculation, was during January and February and that inoculation began only on March 27. Wagstrasse had made the most ridiculous calculations to prove that inoculation would in no time infect the whole kingdom. Dr. Arbuthnott refuted them under the name of Maitland . They were still repeated in a thesis defended in Paris the same year, and several anti-inoculators still use them as their main objection. However it leaps to the face that it is much easier to preserve oneself from an artificial disease given on a fixed day in a known place than from an unforeseen epidemics that attacks indistinctly all kinds of subjects at the same time and in all places. In the first case, no persons are taken by the contagion except those willingly exposing themselves to it. In the second case, no persons, even with the upmost attention, can guarantee escaping it. This is a fact and only experience will decide. The physicians of London bear witness that inoculation never spread the epidemics. There was no evidence of this in Paris, Lyons, Stockholm, in the land of Hanover, in Geneva, and diverse Swiss cities, in the ecclesiastic state, where 400 children were inoculated in 1750. The pretended danger of contagion is therefore imaginary.

Eleventh objection. What kind of preservative is it which gives a disease that one does not have, while one is not allowed to give a small ill to procure a larger one! Here one visibly abuses the idea, in extending to physical ills what can only be true for moral ills. How many physical ills tolerated, allowed, sanctioned by the laws, and which often do not even produce the good one expects of them? Ones demolishes a house to stop a fire, one floods a province to stop the enemy, ones refuses port-entry to a vessel about to sink under the suspicion that it carries contagion. On such occasions, one builds barriers and one shoots at those who trespass them. This argument, if it deserves that name, would tend to ban all of the surgical operations and even blood-letting, a physical ill greater than inoculation . The objection does not deserve that we spend more time on it. We will only note, following Mr. Jurin, that one persists to regard as a singularity, for inoculation , the circumstance of giving an ill one does not have, although it is common to this preservative and to most other remedies that medicine uses; since all or almost all are artificial ills and sometimes dangerous, such as blood-letting, purgative, cautery, vesicatory, vomitory, etc.

Twelfth objection. Inoculation is a moral wrong. Some inoculated died: the success is not infallible. One cannot thus assent to it without exposing one’s life, which one has no rights to dispose of. Inoculation thus offends the principles of morality. One would knock down this objection in proving that inoculation is never fatal by itself and that it may turn fatal by the fault or the imprudence of the sick or the physician. One might also retort the argument against blood-letting, which is never without peril. When one only counts the artery’s pricks, one cannot deny that blood-letting has been the direct cause of a rather large number of deaths. Those who have blood-letting done on their arm thus expose their lives. That one cannot evidently assure from inoculation . However, no casuists carried the scruple as far as to forbid blood-letting, even as precaution. Yet let us move to the direct answer and combat the objection with the same principles that it supposes.

Whoever exposes his/her lives without necessity sins, you say, against morality. Well now those who assent to inoculation sin against morality. Here is the argument in all its strength and in its rigorous form according to the School. Let us examine all of the propositions.

It is not necessary to note that your principle that it is not allowed to expose one’ s life without necessity needs to be restrained to be true. Morality does not prohibit a charitable person from visiting the sick in time of contagion, to separate people who fight, to save his furnishings or that of the neighbor from fire, etc. Well now, in all these cases, there is no necessity so to speak of, to expose one’s life. Thus be content to assure that good morality does not allow to expose one’s life needlessly and we will agree. But, one adds, those who submit to inoculation expose their lives needlessly. The falsehood of this proposition jumps to the face, as they expose themselves to a very small danger (that we are willing to suppose as such) in order to escape to a much larger one. Far from sinning against morality, they conform to its principles. They know that their lives are a deposit and that they should aim at preserving it: they take the surest means to safeguard it from the danger it is threatened with.

Thirteenth objection. As small as might be the risk of inoculation, even be it of one out of one thousand, should a father expose his son to it? If the operation had never been followed of any accident, the father would not hesitate, yet he knows that sometimes an accident occurs. He fears that his son be the victim of a unhappy hazard. Could one blame him to want to take no risks? It is to this so-loving and so-apprehensive father that Mr. de La Condamine speaks and from whom we will borrow the expressions.

“Your intentions are very laudable. You only want, you say, to leave nothing to chance: I would advise you of it, if that was possible; yet you need here to run the risk in spite of yourself. There is no middle ground between inoculating your son or not inoculating him; one ought either to prevent smallpox or to wait for it. These are two risks to run, of which one is inevitable: you are only left with the choice.”

“Here are one hundred children, and your son is one of them. One divides them in two groups. Fifty will be inoculated , the fifty left will wait for the event. Of the first fifty, none will die; yet by the most unlucky circumstance, it would be possible that one might die; from the leftover fifty, smallpox will choose for itself at least six victims and several others will be disfigured. Your son must absolutely enter one of these two groups. If you love him, will you leave him enter the second? Will you bet six instead of one, on this so-precious life, you who do not want to run any risk at all?”

However, what would be the despair of this father, if in spite so pleasing expectations, his son succumbed to inoculation ? “Chimeric fear! As inoculated smallpox is infinitely less dangerous than the natural one, and besides for that one who would never have caught it naturally will not get it by inoculation : yet even when this cherished son should die against all odds, the father would have nothing to reproach himself. Born tutor of his son, he was obligated to choose for his charge, and this caution dictated his choice. In what does this prudence consist: if it is not to weigh the inconveniences and advantages, to judge well of the largest degree of probability? While a blind instinct held back the father, the evidence cried out to him: of the two dangers between which one must opt, choose the least. Should he, could he resist to this voice. Fate has betrayed his expectation, should he be responsible for it? Another father yells to his son: the earth is shaking, the house is crumbling, get out, flee ... the son exits; the earth opens and swallows him. Is this father guilty? Ours is in the same case. If his daughter had died giving birth, would he accuse himself of her death? It would be more appropriate: it was not to save the life of his daughter that he exposed her to the perils of birthing, and nonetheless he threatened more her days in marrying her than his son’s in submitting him to inoculation. ”

Mr. de La Condamine presents diverse descriptions to render more vivid to his readers the different risks of the two smallpox. Here are the most stunning:

“You are compelled to cross a deep and fast river with an evident risk of drowning if you pass it swimming: one offers you a boat. If you say that you would rather not cross the river, you do not understand the situation: you cannot dispense with crossing to the other side, you are only left with the means to do it. Smallpox is inevitable for the general population, when they are not taken away by a premature death; the number of the exempt amounts to less than one exception, and nobody is sure to be in that small number. Whoever has not passed the river has the cruel expectation of seeing oneself compels at any time to cross it. Long experience proved that of seven who try to pass it swimming, one and sometimes two are carried away by the current: of those who pass it by boat, not one out of three hundred perishes, sometimes not one out of one thousand: do you still hesitate on the choice?”

“So is the fate of humanity: more than a third of those born are destined to die in their first year of life by incurable ills or at the least not identified ones: escaping from this first danger, the risk of dying from smallpox becomes inescapable for those left; it stays during their whole life and increases at each instant. It is an imposed lottery in which we find ourselves interested in spite of ourselves: each of us has his/her ticket, the longer it takes to draw our number, the greater the danger. In Paris for a usual year, there are fourteen hundred black tickets for which the prize is death. What does one do in practicing inoculation? The rules of this lottery are changed; the number of fatal tickets are decreased: from one out of seven and in the best climate from one out of ten deadly, to only one out of three hundred, five hundred, and soon to only one out of one thousand; we already have many examples. All of the future centuries will envy ours for this discovery: Nature decimated us, the art aged us.”

To whom does it belong to answer the question: if inoculation in general is useful and salutary?

Physicians on one side and theologians on the other side have claimed that inoculation was of their competence. Let try to recognize and fix the limits of the province of these two jurisdictions in the present question.

Among those who are tempted, on the public noise, to test the efficacy of artificial smallpox; some consult their physician, the others their confessor. To know to whom one should turn, it is necessary to determine the predicament of the question.

If inoculation had never been practiced, and if someone proposed to make its first trial, this idea would appear very odd, bizarre, repulsive, of very doubtful success, a fool-hardy and dangerous experiment. The physician, lacking data to lean on, could only formulate vague conjectures, too meager to re-assure the scrupulous conscience of a charitable theologian who would fear to play with human lives. Perhaps physician and theologian might concur to find no sufficient motives to attempt this trial on criminals. Today we have under our eyes 40 years of thousands after thousands experiments done under all kinds of climates, on all kinds of subjects from all ages and health conditions; the state of things has changed greatly: yet before getting to the moral question, we have another one to resolve.

Which of the twos runs the most risk with his/her life, either the one who waits in full health for smallpox to seize him/her or the one who prevents it by being inoculated? This question is today the first one to come forth and the most important of all. From this the resolution all of the others depends. It belongs, as one may see, to neither medicine nor theology. It is a question of fact, yet complicated, and which may only be resolved by comparing a great number of facts and experiments from which to draw the rate of the highest probability. The risk of the person who waits for smallpox is in a compounded ratio of the risk to catch this disease one day and of the risk to die from it if attacked by it. This risk as compounded as it is may be estimated and its determination rests on probability calculus which is, as one knows, a branch of mathematics.

Above all, note that in the proposed question the alternative to wait for or to prevent smallpox admitted no middle ground. This question, once settled by comparing the two risks (and it belongs only to a mathematician to solve it), will lead to another of law that we do not dare call theological , that is, if of two uneven risks, of which one is inevitable, it is permissible to choose the least? It does not appear that it be necessary to consult theology to answer. The question would become more serious and more deserving of a moralist theologian if the matter were to decide if from two perils, of which one is inevitable, do not reason, conscience, christian charity compel us to choose the least? If the affirmative prevailed and if it would be shown that there is more risk to wait in full health for smallpox to strike than to prevent it by inoculation , one may conclude that this operation ought to be not only recommended but also prescribed.

Until now, we have only considered the general usefulness of the method: as for its application to particular cases, the physician would regain the decision. Does so and so subject has some troublesome dispositions that do not make him/her a good candidate for inoculation? What is the season, what is the moment for the most favorable outcome? What are the necessary preparations and precautions for the different temperaments? On all these points and on the treatment of the disease, a physician who joined experience to ability is to be consulted. Thus, both theologian and physician will here have their functions; however, in the present case, and I am repeating it, it is up to mathematics to prepare the way to settle the true state of the question.

Consequences of the established facts. We will end this article by the considerations that conclude the first work of Mr. de La Condamine and his wish to see among us the establishment of inoculation , a so-proper means to conserve the life of a great number of citizens.

Prudence would have to give in not too rapidly to the appeal of novelty; one ought to give time to new lights on its usefulness. Thirty years of experiments have cleared up all the doubts and perfected the method. The lists of the deaths due to smallpox have decreased by on fifth in England since the practice of inoculation has become more common; the eyes have finally opened. This a truth that is no longer contested in London, inoculated smallpox is infinitely less dangerous than the natural one and that it protects from it: at last in a country where for a long time one has forcefully argued against the operation, not one enemy is left to dare to attack it openly. The evidence of facts and above all the shame of sustaining a desperate cause have closed the mouths of its most passionate adversaries. It is our turn to open our eyes; it is essential that we look at what is happening so close to us and that we put it to good use.

What the fable tells us of the Minotaur and the shameful debt of which Theseus freed the Athenians seems to have been realized in our days among the English. A monster thirsty of human blood drunk some for twelve centuries, who, out of one thousand citizens escaping from the early dangers of childhood, often choose from the elite of humankind two hundred victims, seemingly showing mercy when it restrained itself to less. From now on the monster will only be left with those who will hand themselves imprudently to its attention or will not approach it with enough caution. An educated nation, our neighbor and our rival, has not scorned to learn from an ignorant people the art of taming and becoming familiar with this monster; it managed to transform it into a domesticated animal which it uses to preserve the days of even those that were its prey.

Yet smallpox goes on among us with its ravages, and we are the unmoved spectators as if France with more hindrances to its population growth needed fewer inhabitants than England. Even though we did not have the glory to show the way, let have at least the courage to follow it.

It is proven that one fourteenth of humankind dies yearly from smallpox. Out of twenty thousand persons who die yearly in Paris, this terrible disease takes away fourteen hundred and twenty-eight of them. Seven times this number or more than ten thousand is the number of the smallpox sick in Paris in a normal year. If every year one would inoculate in this city ten thousand persons, perhaps thirty would die from it, in a ratio of three to the thousand; yet supposing against all probability that two inoculated out of one hundred would die instead one out of three or four hundred, it would never account for more than two hundred persons that would die every years from smallpox instead of fourteen hundred and twenty-eight. It is therefore proven that establishing inoculation would save the life of twelve or thirteen hundred citizens per year in just one city, and of more than twenty-five thousand in the kingdom, supposing, as one presumes it, that the Capital has one twentieth of the inhabitants of France.

We read with horror that in the dark centuries, those we call barbarous, the Druids' superstition immolated human victims blindly to its gods; and in this so-polite century, so full of lights that we call it the Century of Philosophy , we do not perceive that our ignorance, our prejudices, our indifference to the well-being of humanity consigns stupidly to death every year in France alone twenty-five thousand subjects who would depend only on us to preserve for the state. Let us agree that we are neither philosophers nor citizens.

While it is true that the public good requires inoculation to be established, must one have a law to compel fathers to inoculate their children? It does not belong to me to decide on this question. In Sparta, where children were deemed to belong to the state, this law without doubt would have been passed; but our mores are as different of those of Lacedaemon as the century of Lycurgus is far from ours: besides it would not be necessary in France; encouragement and example would suffice and perhaps would have more power than the law.

Let us look into the future. Will inoculation establish itself among us one day? I have no doubt about it. Let us not degrade ourselves to the point of despairing of the progress of human reason; it proceeds slowly: ignorance, superstition, prejudice, fatalism, indifference for the good hinder its march, and step after step dispute its ground; but after centuries of fighting at last comes the moment of its triumph. The greatest of all the obstacles it has to surmount is this indolence, this insensitivity, this inertia for anything that does not interest us actually and personally; indifference often raised as a virtue, that a few philosophers have adopted as the result of a long experience and under the specious pretext of humankind’s ingratitude, of the uselessness of efforts made to cure them of their errors, of the misfortunes set on oneself by fighting their prejudices, the contradictions to expect at the risks to loose ones peace, the greatest of all goods. One must admit that these considerations are proper to moderate the most ardent zeal; yet to the wise is left a possible way to follow, that of showing from afar the truth, to try to make it known, to sow if possible its seed and to wait patiently that time and conditions made it come forth.

As useful as an establishment may be, one ought to have a conjuncture of favorable circumstances to ensure its success; the public well-being alone is nowhere a strong enough spring.

Is it the love of humankind that spread inoculation in Circassia and among the Georgians? We should get red in the face of the shameful motif, for they use that fortunate preservative purposely for the most vile interest, for the desire to keep the beauty of their daughters to sell them more dearly and to prostitute them in Persia and in Turkey. What causes the introduction or brought back inoculation in Greece? The skills and the cupidity of a clever woman who knew how to manipulate the fear and superstition of her fellow citizens. I saw in Constantinople natives of Marseilles have their children inoculated with the best success: upon returning in their country, they dropped the salutary practice. Was it paternal love or strong example that determined their decision? In Geneva, that of an enlightened magistrate would not have been enough without a cruel epidemics that spread terror and desolation among the foremost families. In Guiana, the fear, maybe the despair of seeing all of the Indians die one after the other without help alone could determine a shy friar to try a method that he knew badly and that himself thought was dangerous. A more noble motive, one cannot deny, incited the courageous woman who brought inoculation to England: nothing draws more honor to the English nation, to the College of Physicians of London, and to the King of Great-Britain, than the insights that allowed it to be adopted, and the wise precautions with which it was received; yet did it not endure thirty years of contradiction?

Even though all of France might be persuaded of the importance and usefulness of this practice, it cannot be introduced among us without the protection of the government; and would the government ever bring itself to recommend it without consulting the most peremptory testimonies in such matter?

It is therefore to the Faculties of Theology and of Medicine; it is to the Academies; it is to the leaders of the Magistrature, to the learned, to the literati, that belong the banning of qualms fed by ignorance and to make the people recognize that its own usefulness, that Christian charity, that the well-being of the state, that the preservation of human beings have a stake in establishing inoculation . When the concern is the public good, it is the duty of the thinking part of the nation to enlighten those who may see the light and to gain over by the weight of authority the crowd on which evidence has no grasp.

Do we need more experiments? Are we not enough instructed? So instruct hospitals to distinguish carefully in their yearly lists the numbers of sick and of deaths in each kind of diseases as it is practiced in England; over time the usefulness of this sorting will be recognized. Order that in one of these hospitals the experiment of inoculation be done on one hundred subjects who would volunteer for it and that another hundred of the same age suffering from natural smallpox be treated; that everything takes place with the collaboration of different masters in the art of healing, under the eyes and the direction of an administration whose enlightenment equals its zeal and good intentions. Then have the comparison of the list of dead in either groups published. It will give the public the means of clarifying and of resolving their doubts; if any would be left, nothing will be lacking, when with power, there will be will.

Inoculation , I repeat, will come some day to France and one will wonder why it was not adopted sooner; but when will that day arrive? Will I dare say it? It will perhaps only be when an event like the one in 1752, which spread among us so much dread and change itself in bursts of joy (the smallpox of the Dauphin), will awake the public awareness; or, of which Heavens protects us, will a disastrous time such as the calamity that plunged the nation in mourning and appeared to shake the throne in 1711. If at the time inoculation had be known, the recent pain from the strike that had just hit us, the fear of which still hangs over our dearest hopes, would have us received as a git from Heavens this preserver of life that is neglected today. To the shame of our proud reason, that does not always distinguish us enough from the brute, is that the past or the future leaves little impression on us, the present only affects us. Will we ever become wise only because of ill fate? Will we built a bridge at Neuilly only after Henri IV have risked his life in using the ferry-boat? Will we widen our streets only after he had dyed them with his blood?

Some may perhaps still treat as a paradox what should have lost that name thirty years ago: but I have nothing to fear from this objection in the midst of this Capital and even less from this Academy. To the contrary, one might with much more reason accuse me of having given only banal truth, known to everyone able to think and to have said nothing new to an assembly of enlightened persons. May this work attract only this reproach! Far from fearing it, I welcome it: and above all may one place in the number of these common truths which I may have dispensed to recall, that if the use of inoculation had been generalized in France since the English royal family had been inoculated , one would have already saved the life of close to one million human beings, without counting their posterity!

Although we tried in this article to leave out nothing essential concerning inoculation , we will indicate to satisfy the readers what are the sources we drew from. We regret that the Refutation of the Letter of Wagstrasse to Dr. Freind by Dr. Arbuthnott, under the name of Maitland (London 1723); the Analysis of Inoculation by Dr. Kirkpatrick (London 1754); the Dutch treatise on the advantages of this method by a society of physicians and surgeons in Rotterdam were not translated into French. The best works on inoculation in our language and which we advice reading to those who want to learn more fully on this matter, are Lettre of Mr. de la Coste to Mr. Dodart ( Paris 1723 ); recueil des pieces concernant l’’ inoculation (Paris 1756) by Mr. de Montucla, author of the Histoire des Mathematiques; one will find in it the translation of the Latin works of Timoni and Pilarini; of those in English recounting the successes from 1721 to 1729 of artificial smallpox by Messrs. Jurin and Scheuchzer; and an account of most for and against inoculation works, etc. Another collected work published at The Hague in 1756; Traite de l’ Inoculation of Mr. Butini Paris 1752; the report of Mr. Guyot, tome II des memoires de l’Academie de chirurgie; Essai apologetique of Mr. Chais The Hague 1754; L’ Inoculation justifiee of Mr. Tissot Lausanne 1754; finally the two works and the printed letters of Mr. de La Condamine, which we used the most in this article.

As for the writings against inoculation , we have mentioned them in the history that we have given of the method; yet once one have read the letter of Wagstrasse, dean of the anti -inoculators, to the Dr. Freind, which has been printed several times in French, one cannot find anything new in the works of others, who have only repeated the objections and concealed the responses that have been given.