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The global eradication of smallpox is viewed as one of the major achievements of twentieth century medicine. However, the history of inoculation against smallpox is much older. The technique of inoculating against the disease by using a small amount of bodily fluid from an infected person was well known in China and India for many centuries and had reached modern Turkey by the seventeenth century.

From: Library of Zhongguo zhongyi yanjiu yuan (China Academy for Traditional Chinese Medicine), Sun Shi yi’an (Doctor Sun’s Casebook)
By: Sun Qishun (Qing period, 1644-1911)
Published: 1817
Collection: Wellcome Images
Library reference no.: External ReferenceWang Shumin II 659, External ReferenceShen 13/1817 Qiu 659 and External Reference Vivienne Lo

The technique of inoculation against smallpox came late to Europe, where it was first promoted by Lady Wortley Montague who had seen women in the marketplace in Constantinople (Istanbul) practicing it and had her own children inoculated. Her espousal of the technique on returning to England caused controversy among her peers, many of whom argued that not only was deliberately infecting someone with a virus dangerous, but that attempts to prevent the disease were unchristian.

The Royal Society made extensive investigations into the novel technique. As Dr Rim Turkmani noted in her recent talk on Arabic in Britain, the Society consulted one of their fellows with first hand experience; the Ambassador of Tripoli, Cassam Aga. The response from the Ambassador, translated from the original Arabic and read to the Society in 1729, gives a brief overview of the technique: “If any one hath a mind to have his children inoculated, he arrives them to one that lies ill of the smallpox all the time when the pustules are come to full maturity. Then the surgeon makes an incision upon the back of his hand between the thumb & forefinger, and puts a little of the matter, squeezed out of one of the largest & fullest pustules into the wound. This done, the child’s hand is wrapt around with a handkerchief to keep it from the Air, and he is left to his liberty till the fever arising confines him to his Bed, which commonly happens at the end of three or four days. After that, by God’s permission, a few pustules of the smallpox break out upon the child.” He then recounts his own experience of being inoculated as a child, concluding that this practise is “so innocent, & so sure, that out of an hundred persons inoculated not two die, whereas on the contrary out of a hundred persons, that are infected with the smallpox in the natural way there die commonly about thirty”.

The origins of the technique in Constantinople are unclear. A 1713 report from Emanuel Timonius dated its introduction to about forty years previously and ascribed its introduction to ‘the Circassians Georgians and other Asiaticks’. On the other hand, the Ambassador’s account indicates that inoculation had been practiced for a longer period: “It is withall so ancient in the kingdoms of Tripoly, Tunis and Algier, that no body remembers its first rise, and it is generally practised not only by the inhabitants of the Towns but also by the wild Arabs.”

The Royal Society also monitored the progress of inoculation in England: Hans Sloane was present when the Royal Surgeon Claud Amyand administered infected matter to the young Princesses Amelia and Carolina in 1722. Amyand was clearly convinced of the efficacy of inoculation, as the next subject appearing on his list appears to be his own son. Others were less impressed, however. Volume 23 of the Classified Papers of the Society, into which statistics and case reports on inoculation were gathered contains a letter from the Mayor and Corporation of London explaining that the practice was being banned because it was thought to spread smallpox.

The technique would also prove a contentious issue in India. The first report of inoculation there reached the Society in 1731 in a letter preserved among the Royal Society’s papers in the British Library from Robert Coult giving an ‘account of the diseases in Bengal’ and by 1767 J Z Holwell was reporting widespread inoculation in Bengal. However, as in England the practice also tended to be regarded as a public health risk, and there were some attempts to suppress it under colonial rule.

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