Globalisation of Variolation

The following sections are included:

• Acknowledgements
• Foreword
• Contents
• List of Figures
• List of Tables

Beijing was shrouded in darkness in the winter of February 1662 when the Qing Emperor Shunzhi lay dying from severe smallpox. The Dowager Empress was aware that many relatives aspired to this powerful position with a potential danger of internecine warfare that could destroy the new empire, only established for seventeen years. She discussed first with her son that the successor would be one of his six sons, then turned to a foreigner for suggestions, the Jesuit Father Johann Adam Schall von Bell (1591–1666), court astronomer and a trusted friend of the Emperor for many years, a man of probity whose advice had always been dependable. The sons were all under the age of 10, it was difficult to choose: the eldest was healthy but blind in one eye — subjects of a feudal ruler in China would refuse to acknowledge a ‘one-eyed dragon’ — and he had not had smallpox. Schall selected the future emperor, the second son Kangxi. Aged six, he was not the eldest son but was chosen because he had already survived smallpox, which ensured a life-long guarantee of immunity to the disease and thereby stability in the country…

The devastating epidemics of smallpox in the 18^th century, recurring on average every four years, caused not only deaths but dire disfigurements. Often dismissed as a mild ‘children’s disease’ up to the middle of the 17^th century, several poems attest to deaths of women during that early period, berating smallpox as ‘Thou that of faces hony-combes dost make’. It thereafter took a more virulent form and had replaced the plague as the leading infectious cause of deaths in adults in Europe. The affluent as well as the poor were affected causing the death of six reigning monarchs…

The following sections are included:

• 18^th Century Public Health and the General Medical Environment
• Background
• The Royal Experiment
• Why the Fallow Years?
• Sir Hans Sloane
• The Invisible Barrier
• Controversies
• Medical Variolation
• Further Medical Misconceptions
• Notes to Chapter 1

The widespread belief until the present that variolation was a common practice of the Turks in Turkey in the 18^th century was a premise leading to the inference that it was therefore a practice of the Muslims. During that century this fueled one aspect of religious controversy in England regarding the introduction and adoption of variolation, delaying a wider adoption of the technique. This chapter investigates whether the verbose and vitriolic opposition may have been entirely unnecessary, as there is cogent evidence that variolation in the 18th century in the Ottoman Empire was practised almost exclusively by non-Muslims…

A comparison of the early adoption and dissemination of variolation in England in 1721 with its late ‘toleration’ in France in 1765 following earlier banning reveals a variety of reasons for this. This time frame of forty-four years encompasses differing attitudes, the absence of a Royal Family example to emulate, institutional jealousy between two leading universities, professional animosity between the Faculty of Medicine at the Sorbonne and the King’s physicians, fundamentally different state structures affecting health and a purely theoretical approach as opposed to empirical clinical experiments for efficacy in prevention of smallpox. A study of developments in England, neither impeded nor assisted by professional associations or government intervention to ban or promote, demonstrates that the potential hiatus for implementation was filled there by private charitable initiatives, as exemplified by the Smallpox and Inoculation Hospital, a centre for free treatment and a magnet for international observers. The failure of individual dedicated French protagonists to force the variolation issue is contrasted with a nuanced version of two individuals in England: a reappraisal of both the ‘heroic’ Dr Thomas Dimsdale, and the ‘amateur quack’ Robert Sutton with his family franchises which fanned the influence of England in France.

The historiography of the adoption of variolation in Russia, often overlooked, has some generally accepted but questionable assumptions when contexualised with the political, economic, socio-cultural, medical and religious issues, many unique to Russia. Several opportunities were missed to implement variolation earlier than Czarin Catherine’s personal example, which was motivated by familial and dynastical fears combined with her adoption of the principles of the Enlightenment — the latter encouraged by her correspondence with Voltaire. The influence of England on early as well as late transmission of variolation to Russia emerges together with the undercurrent of a private political agenda of King George III.

Princess Hedwiga Sophia, sister of King Charles XII, happened to walk past the open door of an apartment where a patient was ill with smallpox, although she was not aware of this; as the pungent odour of putrefying flesh emanated she held a handkerchief to her mouth and nose — but too late — she herself was infected and died in 1708. This bereavement of Charles’ favourite sister, with whom he had copious correspondence, led to his interest in variolation and to an unfortunate lost opportunity, as had occurred in Russia, for its early adoption in Sweden…

The author of this letter must have tired of the theme very early as the first experiment had taken place only two months prior in Boston, thereby initiating some years of correspondence. While Lady Mary Wortley Montagu’s daughter was being observed by physicians in London following her variolation in mid-April, 1721, the HMS Seahorse sailed into Boston harbour on 22 April from the West Indies, and a crew member was later found to be suffering from smallpox. The spread of smallpox became evident by May and the fact that the first variolation was pioneered on 26 June, one month later, is a striking contrast to the twenty-one years in England during which accumulated knowledge of the technique was discussed but lay dormant. Of what Significance are most of our Speculations? EXPERIENCE! EXPERIENCE! Tis to THEE that the matter must be referr’d after all; a few Empericks here, are worth all our Dogmatists. …

The hypothesis is postulated that variolation was transmitted from China, where it had been practised for centuries, to the Anatolian area of the Ottoman Empire via the stepping stone of an intermediate country due to emigration and re-immigration of a nomadic horde from northern China. Four previous putative assumptions of diffusion are considered: via the Silk Road trading routes from China; from Russian students who had studied in Beijing; communicated by Muslims to Turks in Turkistan or originally from the Greek mainland…

The following sections are included:

• Conclusion
• Appendices
• Chronology
• Bibliography

The following section is included:

• INDEX