Inoculation. Term that usage has attributed to the operation by which one transmits smallpox to a healthy body by applying or inserting.

The oldest and best recognizable monuments to this operation are found in a people without art and in particular that of medicine. It is likely that the ravages of smallpox inspired in the Armenians the fear that accompanies and follows everywhere its fatal effects. A second interest joins that of life which is worth just a few pennies per day for one million of Europeans. The Armenians put in a shameful trade for humanity the women from Circassia and Georgia who are the most beautiful of the Orient; it is well known that they buy and sale them on account of their beauty. The loss that smallpox brought them, combined with a very simple observation that the ill effects of this disease on the life and beauty increase with age, drew their attention on an experiment that some lucky chances likely made them try. The spirit of gain, always clever, found its profit and sanctioned a method that without danger for the children insured their value in preserving the life and the beauty of the adults. This very simple and very informal method in its origin spread without much notice to Constantinople and Smyrna. The Armenians taught it to the Greeks who lived there, it seems, never knew its inventor nor its dating. One Italian named Pilarini , who was in Constantinople at the beginning of this century, was the first physician who did this lucky trial on four children of a Greek among his friends; he informed the Royal Society of London of it; and his letter, which is full of good sense and of truthfulness, was printed in the Philosophical Transactions in 1716. He affirmed that by now the success of this method was not contested anymore by the Greeks. There is no mention of the Turks who cannot inoculate.

Timoni, another Italian physician living in Constantinople, had addressed that same royal society two years earlier a report with about the same information, however less wise than the preceding. The little attention he pays to the preparation led some people to err in not imagining that persons who live to eat are not at all to be treated the same way that persons who eat to live. This latter case was that of the Circassians, the other unfortunately was too much that of the English and of many Europeans, for whom the precautions of preparation are all the more necessary as their customs are more corrupted.

On the solicitation of Sir Hans-Sloane and the famous Sherard, consul of England in Turkey, Timoni wrote his report. It was until then an object of curiosity for the English; but Lady Wortley-Montagu, ambassadress to the Porte, who had in 1717 her own six-year-old son inoculated there, had the nation’s gaze set on her, therefore preparing its mindset which she completely won over by having her daughter inoculated in London in 1727 . Thus, April of that year marked an era for inoculation in England.

The poor health of the Royal Princess, who was sick with a very bad case of natural smallpox, worried the Princess of Wales about her other children; through Sir Hans-Sloane, she sought from the King the permission to have them inoculated . The King consented and allowed Charles Maitland, Lady Montagu’s surgeon, to experiment it on six condemned-to-death malefactors. This operation took place on August 9, 1721 on three men and three women of different age and temperament.

Four days later Maitland worried of the effect of the operation, repeated it on the same criminals; Richard Evans was the only one not to be inoculated twice; his wounds were dry and closed on the sixth day; he had caught natural smallpox in prison in September of the preceding year. The five others had mild cases and got out of prison in good health on September 6. Elisabeth Harrisson was the sickest before the eruption; Maitland had done a double experiment on her, beside the ordinary operation he had put in her nose some variolous pus with a brush. This trial deemed insufficient, similar were done on five children of Saint-James Parish; the result were equally successful.

Two of the princesses were therefore boldly inoculated ; and out of 182 persons who also were that same year only two died. Out of 897 persons who had been inoculated by 1728 only 17 died, while it appeared from the bills of mortality of the same period that natural smallpox had killed one twelfth of the total of the dead.

These first trials were as successful in New England, only six died out of 282, who had been inoculated from the beginning until the end of 1722. In adding these two numbers, one sees that out of 1179 persons inoculated in Europe and in America, not even two hundred had died from it. Such great successes should have inspired confidence, yet the deaths of two young nobles intimidated to the point that inoculation was suspended for a while. Asia had given it to Europe, America gave it back. A very mean smallpox having been brought from Africa to South Carolina in 1738, out of one hundred sick twenty died. It was decided to inoculate ; and out of 800 sick only nine died. Inoculation was as successful in Pennsylvania; a gentleman of Saint-Christopher who had 300 hundred negroes inoculated did not lose one. Out of 2,109 inoculated individuals in New England in 1752 only 31 died. Therefore out of 3,209 inoculated in America, only 40 died, which amounts to one out of 80.

Such successes could not fail to make a great noise in England; inoculation re-establishes itself; more attention was given to it; the preparation was done with more care; experience made it safer. It was so well perfected that out of 15,000 inoculated persons only three have died; and out of one thousand, a master of the art (Mr. Randy) has not lost even one. Therefore, it appears that all depends on the choice of subjects and of preparation.

A method that has become so safe and that unites in it all the possible advantages naturally ought to spread by itself in Europe: however, only in 1748, did Mr. Tronchin, inspector of the College of Physicians in Amsterdam, and since then professor of Medicine in Geneva, inoculate in his eldest son in Amsterdam. The fear that he had to lose the youngest, who passed through all the horrors of natural smallpox, determined him. This inoculation was the first one seen in Christian Europe [1] outside of the British Islands. Mr. Tronchin inoculated nine other persons with the same success. The smallpox epidemic ceased, and the following year Mr. Tronchin, having travelled to Geneva, recommended inoculation there; his family gave the example; others followed it. This operation has sustained itself so well, that out of two hundred persons who had been inoculated only one died. Smallpox having re-appeared in Amsterdam in 1752, the following year inoculation began again; the most respectable families showed the example; others followed it in The Hague. Mr. Schwenke, professor of anatomy and renown physician, gave to this method all the credit that it could have. Its repeated successes sanctioned it and in turn spread it in the main cities of Holland, where it prevailed over the most stubborn and specious prejudices. Since then it has spread in Germany, in Sweden, and in Denmark. France still resisted in spite of the strength of example and the reasons that one of its most famous academicians had expounded with as much truth than wit and might: but his Royal Highness the Duke of Orleans, the most loving and the wisest of fathers, resolved to have his children inoculated . He trusted them to Mr. Tronchin and in 1756 gave to the whole of France an example of steadfastness and wisdom for which the country will always be beholden.

The inoculation of the Duke of Chartres and of Mademoiselle marked an era for this operation in France.

The first details of this operation, before what Timoni and Pilarini have said about it, got lost in the silence and the obscurity of time. It appears that insertion was only in the hands of a few Greek women and that its first successes were only owed to the constitution of the subjects, of whom the customs and the very simple and stable style of life required little preparation. Charlatanism almost as ancient as the dread of death, and which is born everywhere out of fear for some and the knavery of others, did not spare this operation. An old Thessalonican woman more skillful than the others found the means to persuade the Greeks that it was not a human invention; the Holy Virgin had revealed it to humans and to sanctify it she accompanied her operation of crossing signs and payers she muttered between her teeth, which gave her an air of mystery. Besides her salary, she always exacted a few candles she presented to the Virgin. This often-repeated gift pushed the Greek priests to favor her; they became her protectors, and to increase the illusion, she did her pricks on the forehead, the chin, and near the ears. This kind of cross impressed the people that always craves for marvels. The preparation reduced itself then to a purgation, no meat, no eggs, nor wine for a few days, and protecting oneself from open air and cold by staying inside. The variolous pus for inoculation was always taken from a healthy child, of whom the smallpox was indifferently from the best natural or artificial kind. It seems that at this time incisions were not used, one was satisfied with pricks done where one chose with a blunt silver needle. One mixed a little pus with the blood coming out and covered the small wounds to prevent rubbing to disturb the operation. That dressing was left on only five to six days, after which it was removed. For four to five weeks one fed the inoculated barley and wheat cream and some vegetables: this is what the first Greek operation was; nothing more was needed. Other precautions, which became absolutely necessary because of other mores and another lifestyle, were useless to a people of whom the simplicity of the diet was the same as that of earlier times; it seems that in all cases just a few pricks could have sufficed.

Timoni the First devised the incisions. Human beings liked to conceive changes in things even where they are not necessary. Timoni pretended, who knows why, that incisions had to be made in the most fleshy parts and decided on the arms. Maitland adopted this practice, brought it to London, and usage validated it. It nevertheless had serious drawbacks in children and in adults; the fear of the sharp instrument and the pain of the incision threw in the soul of children a terror that is renewed at each dressing by the fright that it inspires. One has seen more than once some who took to convulsing, always to be feared in a case in which it is of the upmost importance to maintain the most perfect calm. The irritation of the biceps on which the incision is made, irritation necessarily produced by the inflammation that follows the incision, very often increases the fever and causes as far as under the armpit a sometime sharp pain and an almost always distressing one. The artery and the axillary nerve are set on edge, and the irritation of this nerve passes into the nervous disposition; that of the artery, by the mean of the under-clavicular of which it is the continuation, moves step by step to the ascending aorta where it begins; all the ramifications, those of the under-clavicular artery and of the ascending aorta are more or less affected, the internal mammary, the mediastinum, the pericardial, the small diaphragmatic, also called the superior, the thymic, the tracheal, the vertebral, the cervical, and sometimes the upper intercostal, and finally the carotids, all leading to the head and the upper parts take part in the irritation. The ramifications of the axillary artery, which are the external mammary, the upper and lower thoracic, the internal and external scapulars, and the humeral, are even more exposed to it.

This mechanism explains how inoculation done in the arms increases the eruption to the head and the accidents that accompany it; in consequence Maitland decided for inoculating in the legs, where the remoteness from the head and of the nature of the parts which are affected by their proximity or their sympathetic structure give more advantages. Experience confirmed it, and several years ago Mr. Tronchin determined to let go of the ancient method and to inoculate on the legs. The whole strength of Mademoiselle of Orleans’ eruption was in the legs and it is very likely that without the tears that run very easily at her age, she would have had none on her eyelids.

Another disadvantage of inoculation on the arms is usually to oblige the patient to lay on his/her back and to stay that way for several days; the warming of the kidneys in particular and of the dorsal spine in general, that the masters of the art fear so much, is a more-than-enough sufficient reason to prefer a method which leaves freedom of motion to the body and which maintains in all its parts a steadiness of warmth and a temperature favorable to the eruption.

It is easy to conclude from what has been said, that it is indifferent for the adults that inoculation be done by vesicatories or by incision, provided that it is done to the legs. It is not the same for children, the easiest and softest method is not only preferable, but also necessary. The application and the dressing of small vesicatories is, so to speak a game; they have nothing to be frightened of and the treatment is done without pain: and perhaps the healing is faster, twenty-one days are enough.

Maitland transmitted to his successors, as he had received from his master Timoni, the way of insertion as well as the preparation before insertion: the compliance in adopting the one did not contradict itself in the other. Timoni was a confident master whose acuteness and stubbornness was not amenable to the easy defiance that characterized good guides. It is even possible that accustomed to the Greeks’ frugal and simple life which is in itself a diet, he did not imagine that inoculation brought to peoples whose ordinary life is full of excess required more precautions and it was above all the English who remarked it. But who does know that example easily seduces reason, that the greatest physicians are sometimes the dupes and that the sick are often the victims. One believed that one must to follow Timoni and one took neither account of the difference in climate, nor that of mores and of food. It is this lack of attention to which the first accidents of inoculation must be attributed and it is not the only time that one has put unjustly on the account of the art the mistakes of the artists. This reflection is so true that we have named a master of the art, who out of one thousand inoculated has not lost a lone one. We do not need that much to prove that such great successes of inoculation in the hands of skilled persons carried with them the characteristics of divine benediction.

So all of the objections that one have raised against inoculation entrusted to enlightened eyes and to wise hands are destroyed by facts, except those that mischief, ignorance, jealousy, or stubbornness dare to imagine; one gives them value in answering them; it is the only one that they might have.

Artificial smallpox preserves from contagion in the same manner as the natural does. And if it were true, and this has not yet been decided, that they were some exceptions to this general rule, one might at the upmost conclude that prudence take sometimes useless precautions. Inoculation does not communicate any other disease, although the proof is only negative; who is willing not be satisfy by it? The case is not susceptible to positive proof. [2] Thirty years of observations, none so far has invalidated it, must tranquilize us; where is anyway the wise physician who does not insist on paying attention to the choice of pus that will be used to inoculate? If after all that has been said and written on this matter, it was in need of encouragements, the natural smallpox would give it to us in loads. It is to the true physicians, and their number is quite small, to appreciate the compliments that the adversaries of inoculation lavish on them; they will tell with one voice that in great epidemics the resources of the art are very small, and the mortality bills are true witnesses to it. And what would it be if one added that maybe even the art renders the mortality greater and that, of all diseases, smallpox is that which has the worst treatment? Let us spare the reader such sad reflections, and to the physicians a so-mortifying account; each one may easily judge what is going on under his/her eyes; for which is the country, the city, the town, or the village where smallpox does not decimate its inhabitants? Montpellier, which passed in France to be one of the high places for the art, sadly experienced it in our own days; however not everybody knows that in Brazil smallpox is deadly for most of its inhabitants, that in Southern America it does as much as ravages as the plague; that in Barbary and the Levant, out of one hundred sick more than thirty die. Let us keep silent on the victims that it leaves languishing, robbed of sight and/or hearing, mutilated and covered in scars.

Notes

1. This fact is not entirely true; one had done several in Hanover: the late Prince of Wales had been inoculated there. Roncalli speaks of one inoculation done in Brescia in 1739 and which was successful.

2. The positive proof did not exist or had not yet been made public when this article was written.