Voltaire on Circassian Medicine: ''Inoculation''
INOCULATION. - Voltaire, The Works of Voltaire, Vol. XIX (Philosophical Letters) 
The rest of Europe, that is, the Christian part of it, very gravely assert that the English are fools and madmen; fools, in communicating the contagion of smallpox to their children, in order to hinder them from being subject to that dangerous and loathsome disorder; madmen, in wantonly exposing their children to this pestilence, with the design of preventing a contingent evil. The English, on their side, call the rest of Europe unnatural and cowardly; unnatural, in leaving their children exposed to almost certain death by smallpox; and cowardly, in fearing to give their children a trifling matter of pain for a purpose so noble and so evidently useful. In order to determine which of the two is in the right, I shall now relate the history of this famous practice, which is in France the subject of so much dread.
The women of Circassia have from time immemorial been accustomed to give their children smallpox, even as early as at six months of age, by making an incision in the arm, and afterward inserting in this incision a pustule carefully taken from the body of some other child. This pustule so insinuated produces in the body of the patient the same effect that leaven does in a piece of dough; that is, it ferments in it, and communicates to the mass of blood the qualities with which it is impregnated. The pustules of the child infected in this manner serve to convey the same disease to others. This disorder, therefore, is perpetually circulating through the different parts of Circassia; and when, unluckily, there is no infection of smallpox in the country, it creates the same uneasiness as a dearth or an unhealthy season would have occasioned.
What has given rise to this custom in Circassia, and which is so extraordinary to other nations, is, however, a cause common to all the nations on the face of the earth; that is, the tenderness of mothers, and motives of interest. The Circassians are poor, but have handsome daughters; which, accordingly, are the principal article of their foreign commerce. It is they who furnish beauties for the seraglios of the grand seignior, the sufi of Persia, and others who are rich enough to purchase and to maintain these precious commodities. These people bring up their children in the nurture and admonition of the Lord; that is, in virtuous and honorable principles, which contain the whole science of wheedling the male part of the creation; the art of dancing, with gestures expressive of uncommon effeminacy and lasciviousness; and lastly, that of rekindling, by the most bewitching artifices, the exhausted appetites of those haughty lords to whom their fates have destined them. These poor creatures repeat their lesson every day with their mothers, in the same manner as our girls do their catechism; that is, without understanding a single syllable of what is taught them. Now it often happened that a father and mother, after having taken an infinite deal of pains in giving their children a good education, suddenly see their hopes frustrated. Smallpox getting into the family, one daughter perhaps died; another lost an eye; a third recovered, but with a disfigured nose; so that here was an honest couple hopelessly ruined. Often, too, an entire stagnation of all kinds of commerce has ensued, and that for several years running, when the disorder happened to be epidemic, to the no small detriment of the seraglios of Turkey and Persia.
A commercial people are always exceedingly vigilant with regard to their interest, and never neglect those items of knowledge that may be of use in the carrying on of their traffic. The Circassians found that, upon computation, in a thousand persons there was hardly one that was ever twice seized with smallpox completely formed; that there had been instances of a person’s having had a slight touch of it, or something resembling it, but there never were any two relapses known to be dangerous; in short, that the same person has never been known to have been twice infected with this disorder. They further remark, that when the disease is mild, and the eruption has only to pierce through a thin and delicate skin, it leaves no mark on the face. From these natural observations they concluded, that if a child of six months or a year old was to have a mild kind of smallpox, not only would the child certainly survive, but it would get better without bearing any marks of it, and would assuredly be immune during the remainder of its life. Hence it followed, that their only method would be to communicate the disorder to their children betimes, which they did, by insinuating into the child’s body a pustule taken from the body of one infected with smallpox, the most completely formed, and at the same time the most favorable kind that could be found. The experiment could hardly fail. The Turks, a very sensible people, soon adopted this practice; and, at this day, there is scarcely a pasha in Constantinople who does not inoculate his children while they are at the breast.
There are some who pretend that the Circassians formerly learned this custom from the Arabians. We will leave this point in history to be elucidated by some learned Benedictine, who will not fail to compose several volumes in folio upon the subject, together with the necessary vouchers. All I have to say of the matter is that, in the beginning of the reign of George I., Lady Mary Wortley Montague, one of the most celebrated ladies in England for her strong and solid good sense, happening to be with her husband at Constantinople, resolved to give smallpox to a child she had had in that country. In vain did her chaplain remonstrate that this practice was by no means consistent with Christian principles, and could only be expected to succeed with infidels; my lady Wortley’s son recovered, and was presently as well as could be wished. This lady, on her return to London, communicated the experiment she had made to the princess of Wales,1 now queen of Great Britain. It must be acknowledged that, setting crowns and titles aside, this princess is certainly born for the encouragement of arts, and for the good of the human race, to whom she is a generous benefactor. She is an amiable philosopher seated on a throne, who has improved every opportunity of instruction, and who has never let slip any occasion of showing her innate generosity. It is she who, on hearing that a daughter of Milton was still living, and in extreme misery, immediately sent her a valuable present; she it is who encourages the celebrated father Courayer; in a word, it is she who deigned to become the mediatrix between Dr. Clarke and Mr. Leibnitz. As soon as she heard of inoculation for smallpox, she caused it to be tried on four criminals under sentence of death, who were thus doubly indebted to her for their lives: for she not only rescued them from the gallows, but, by means of this artificial attack of smallpox, prevented them from having it in the natural way, which they, in all human probability, would have had, and of which they might have died at a more advanced age. The princess, thus assured of the utility of this proof, caused her own children to be inoculated. All England, or rather Britain, followed her example; so that from that time at least six thousand children stand indebted for their lives to Lady Mary Wortley Montagu, as do all the fair of the island for preserving their beauty.
In a hundred persons that come into the world, at least sixty are found to contract smallpox; of these sixty, twenty are known to die, in the most favorable times, and twenty more wear very disagreeable marks of this cruel disorder as long as they live. Here is then a fifth part of the human species assuredly killed, or, at least, horribly disfigured. Among the vast numbers inoculated in Great Britain, or in Turkey, none are ever known to die, except such as were in a very ill state of health, or given over before. No one is marked with it; no one is ever infected a second time, supposing the inoculation to be perfect, that is, to have taken place as it ought. It is, therefore, certain that, had some French lady imported this secret from Constantinople into Paris, she would have rendered an inestimable and everlasting piece of service to the nation. The duke de Villequier, father of the present duke d’Aumont, a nobleman of the most robust constitution, would not have been cut off in the flower of his age; the prince de Soubise, who enjoyed the most remarkable state of good health ever known, would not have been carried off at twenty–five; nor would the grandfather of Louis XV. have been laid in his grave by it in his fiftieth year. The twenty thousand persons who died at Paris in 1723 would have been now alive. What shall we say then? Is it that the French set a lower value upon life? or are the ladies of France less anxious about the preservation of their charms? It is true, and it must be acknowledged, that we are a very odd kind of people! It is possible, that in ten years we may think of adopting this British custom, provided the doctors and curates allow us this indulgence; or, perhaps, the French will inoculate their children, out of mere whim, should those islanders leave it off, from their natural inconstancy.
I learn that the Chinese have practised this custom for two hundred years; the example of a nation that has the first character in point of natural good sense, as well as of their excellent internal police, is a strong prejudice in its favor. It is true, the Chinese follow a method peculiar to themselves; they make no incision, but take smallpox up the nose in powder, just as we do a pinch of snuff: this method is more pleasant, but amounts to much the same thing, and serves equally to prove that had inoculation been practised in France, it must assuredly have saved the lives of thousands.
It is some years since a Jesuit missionary having read this chapter, and being in a province of America, where smallpox makes horrible ravages, bethought himself of causing all the Indian children he baptized to be inoculated, so that they are indebted to him not only for this present life, but also for life eternal at the same time; what inestimable gifts for savages!
The bishop of Worcester has lately preached up the doctrine of inoculation at London; he has proved, like a good citizen and patriot, what a vast number of subjects this practice preserves to a nation; a doctrine which he has also enforced by such arguments as might be expected from a pastor and a Christian. They would preach at Paris against this salutary invention, as they wrote twenty years ago against Sir Isaac Newton’s philosophy: in short, everything contributes to prove that the English are greater philosophers, and possessed of more courage than we. It will require some time before a true spirit of reason and a particular boldness of sentiment will be able to make their way over the Straits of Dover.
It must not, however, be imagined that no persons are to be met with from the Orkneys to the South Foreland but philosophers; the other species will always form the greater number. Inoculation was at first opposed in London; and a great while before the bishop of Worcester preached this gospel from the pulpit, a certain curate had taken it into his head to declaim against this practice: he told his congregation that Job had certainly been inoculated by the devil. This man spoiled a good Capuchin, for which nature seems to have intended him; he was certainly unworthy the honor of being born in this island. So we see prejudice, as usual, first got possession of the pulpit, and reason could not reach it till long after; this is no more than the common progress of the human mind.
INOCULATION. - Voltaire, The Works of Voltaire, Vol. XIX (Philosophical Letters) 
The Works of Voltaire. A Contemporary Version. A Critique and Biography by John Morley, notes by Tobias Smollett, trans. William F. Fleming (New York: E.R. DuMont, 1901). In 21 vols. Vol. XIX.
Variolation was known and practiced frequently in the Ottoman Empire, where it had been introduced by Circassian traders around 1670. Women from the Caucasus, who were in great demand in the Turkish sultan's harem in Istanbul because of their legendary beauty, were inoculated in childhood in parts of the body where scars would not be seen. These women must also have brought variolation to the court of the Sublime Porte. (Woodville W. The History of the Inoculation of the Smallpox in Great Britain. London: J Phillips; 1796)
Smallpox: The Triumph over the Most Terrible of the Ministers of Death, Nicolau Barquet, MD, and Pere Domingo, MD
Jenner was not the first to notice that contracting cowpox could save a person from getting a fatal version of smallpox later. It was part of local knowledge in rural Britain. Milkmaids routinely caught cowpox; afterward, they almost never contracted smallpox. But Jenner's experiments convinced the medical community that immunization was the best way of fighting smallpox and made cowpox the method of choice.
Inoculation with smallpox itself, also called variolation, appears to have been common for centuries among rural populations throughout Europe, Asia, and Africa. Correspondence in the archives of the Royal Society of London shows that English travelers had observed the practice in China before 1700. Several generations before Jenner's experiments, a furious debate had raged among physicians and town councils in Europe and America over whether inoculation with the "matter" of smallpox should be allowed. In the 1720s, in Boston and other New England towns, a war of pamphlets and posters was waged for and against the practice.
The Puritan minister and prolific writer Cotton Mather (1663-1728) learned of smallpox inoculation from a man named Onisemus, who had been brought as a slave from Africa. Mather asked other people brought from Africa about the practice and found that it was commonly done there. Given the tremendous threat of smallpox epidemics in the new American colonies, he became a strong proponent of inoculation with smallpox. In his small book titled An aacount of the method and successes of inoculating the Small-Pox, printed in London in 1722, he gave a step-by-step description of the procedure.
The dedication to Mather's book, written by J. Dummer, affirmed that the idea that inoculation with smallpox could prevent the disease was not at all new:
The practice of ingrafting the Small-Pox has been used from Time immemorial among the Circassians, and for many Years past in the Levant, yet it is a new Thing in these Parts of Europe, and still more so in America: And as all new Discoveries, however rational in themselves, and beneficial to Mankind, are receiv'd at first with Opposition, none has met with greater than this in New England. In the late 1600s, the practice of inoculation with smallpox had been described in Turkey and the eastern Mediterranean, and seems to have been widely used throughout Europe.
Peasants called the rather dangerous practice "buying the smallpox", and most contemporary accounts noted (with either praise or contempt) that old women were the ones who knew how to inoculate people. A highly respected London physician of the early eighteenth century, for example, wrote derisively that "posterity will scarcely be brought to believe that a method practiced only by a few Ignorant Women, amongst an illiterate and unthinking People should .. be received into the Royal Palace" (quoted in Sterns 1950)." It looks inoculation was widely in use in Europe dating to at least 17th century.
"The matter of Smallpox", 83-91, Samuel Wilson, The Emepror's giraffe and other stories of cultures in contact, Westview press, 1999.
(from Swaminathan Madhuresan)
Although the practice of inoculation was inveighed against on both religious and medical grounds, it did attain a degree of acceptance, especially in England, thanks to the example set by the Prince and Princess of Wales in 1722 in permitting their children to be inoculated. Inoculation proved especially popular during periods of epidemic smallpox, when the mortality rate often reached 15% to 20% of those infected and the rate of disfigurement was even higher. In contrast, inoculation protected well against reinfection, most frequently involved no facial scarring, and was accompanied by at most a 2% to 3% death rate. The famous Voltaire observed the practice during his travels in England and waxed enthusiastic about its efficacy in his Lettres Philosophiques, crediting (probably erroneously) Lady Mary Wortley Montagu with its introduction into England. Voltaire speculated that inoculation might have originated with the Circassians to protect the beauty of their daughters, whom they could not sell pock-marked into the harems of the Ottoman Empire.
(The History of Immunology, Chapter 2)
The pernicious aftereffects of vaccination upon the system are similar to those of the various serum and antitoxin treatments Jenner, an English barber and chiropodist, is usually credited with the discovery of vaccination. The doubtful honor, however, belongs in reality to an old Circassian woman who, according to the historian Le Duc, in the year 1672 startled Constantinople with the announcement that the Virgin Mary had revealed to her an unfailing preventive against the smallpox.
Her specific was inoculation with the genuine smallpox virus. But even with her the idea was not an original one, because the principle of isopathy (curing a disease with its own disease products) was explicitly taught a hundred years before that by Paracelsus, the great genius of the Renaissance of learning of the Middle Ages. But even he was only voicing the secret teachings of ancient folklore, sympathy healing and magic dating back to the Druids and Seers of ancient Britain and Germany.
The Circassian seeress cut a cross in the flesh of people and inoculated this wound with the smallpox virus. Together with this she prescribed prayer, abstinence from meat and fasting for forty days. As at that time smallpox was a terrible and widespread scourge, the practice of inoculation was carried all over Europe. At first the operation was performed by women and laymen; but when vaccination became popular and people were willing to pay for it, the doctors began to incorporate it into their regular practice.
Popular superstitions run a very similar course to epidemics. They have a period of inception, of virulence and of abatement As germs and bacteria become inactive and die a natural death in their own poisonous excreta, so popular superstitions die as a natural resultof their own falsities and exaggerations.
It soon became evident that inoculation with the virus did not prevent smallpox, but, on the contrary, frequently caused it; and therefore the practice gradually fell into disuse, only to be revived by Jenner about one hundred years later in a modified form.
He substituted cowpox virus for smallpox virus.
Nature Cure by Henry Lindlahr, Chapter 17