Voltaire on Vaccines

In Voltaire's Letters on England, he writes up an interesting story on the pre-history of vaccination. (Bear in mind this is written in 1733, and I haven't checked the accuracy of his claims). It begins:

It is whispered in Christian Europe that the English are mad and maniacs: mad because they give their children smallpox to prevent their getting it, and maniacs because they cheerfully communicate to their children a certain and terrible illness with the object of preventing an uncertain one.

Voltaire is pro-vax (or rather, pro-variolation, the precursor to vaccines), and tells the story of a people called the Circassians. It's a disturbing story, but I think an interesting one. Basically:

The Circassians are poor and their daughters are beautiful, and so they use them as their chief export. They supply beauties to the harems of the Grand Turk, the Sophy of Persia and those who are rich enough to buy and keep this precious merchandise.

With the most honourable intentions they train these girls to perform dances full of lasciviousness and sensuousness, to rekindle the desires of the high and mighty masters for whom they are destined.

What does this have to do with variolation? Well:

It often happened that a father and mother, having taken a great deal of trouble to give their children a good upbringing, suddenly saw their hopes frustrated. Smallpox came into the family, one daughter died of it, another lost an eye, a third recovered but with a swollen nose, and the poor folk were ruined, with no resources.

So Voltaire's claim is that the Circassians were early to figuring out variolation because their "commercial interest" (in selling off their daughters) was dependent on it. The Circassians noticed that serious smallpox "never occurs twice in a lifetime" and that if "the outbreak finds only a delicate and thin skin to pierce, it leaves no mark upon the face," such that "if a child of six months or a year had a mild attack it would not die and would not be marked, and would be immune from the disease for the rest of its days."

So they began deliberately giving smallpox to their babies,

by making an incision in the arm and inserting into the incision a pustule that they have carefully removed from the body of another child. This pustule works in the arm where it is inserted like yeast in a piece of dough; it ferments and spreads its own qualities through the blood-stream.

(Incidentally, I was quite confused at "inserted like yeast in a piece of dough", but it seems perhaps that in those days they would take a piece of fermented dough from one batch to start the next one?)

Voltaire then makes this entirely unnecessary dig at Benedictines:

Some people maintain that the Circassians originally took this custom from the Arabs, but we leave this historical point to be cleared up by some learned Benedictine, who will doubtless compose several folio volumes on the subject, with proofs.

Incidentally, he has very positive views of the Chinese:

I understand that the Chinese have had [variolation] for a hundred years. The example of a nation that passes for the wisest and most strictly governed in the universe is a great thing in its favour. It is true that the Chinese set about it in a different way; they don’t make an incision but make the subject take in smallpox through the nose, like snuff. This is a more pleasant way.

How did variolation get to England? Well, a certain Lady Wortley Montagu was "living with her husband at the Embassy in Constantinople", and decided to follow the locals and give her child smallpox. "In vain did her chaplain point out that this procedure was not Christian and so could only succeed on infidels" – I would love to dig deeper on the model of health/sickness that produced this statement. The chaplain was wrong about the religion-specific properties of medicine, and the child thrived.

Lady Montagu "mentioned her experiment to the Princess of Wales," who became Queen Caroline. In 1721, the Princess "tried it out on four criminals condemned to death" [Wikipedia says it was seven], and therefore "saved their lives twice over," that is, from smallpox and from the gallows.

Per Voltaire, the burden of smallpox at the time was crushing:

Out of a hundred people in the world at least sixty have smallpox, and of these sixty, twenty die of it in the flower of their youth and twenty keep the unpleasant marks for ever. That makes one fifth of all human beings that this disease kills or permanently disfigures.

If variolated, "not one dies unless he is infirm and predisposed to die anyway, nobody is disfigured, nobody has smallpox a second time, assuming that the inoculation was properly done." If the French had adopted variolation as early as the British did, "twenty thousand people who died in Paris in 1723 would still be alive." Alas, it wouldn't become accepted in France until the 1770s – just before Voltaire's death.