Apbil 2, 1915] 



SCIENCE 



503 



cian, lie said : " Tes, but all that is merely a 

 fragment of the huge literature of vaccina- 

 tion ! " not realizing that variolation and 

 vaccination are distinct and separate epi- 

 sodes in medical history. Variolation is pre- 

 ventive inoculation against smallpox by means 

 of virus taken from the human subject. In 

 vaccination, the virus is supposed to be modi- 

 fied or attenuated by transmission through the 

 body of the cow. The recent application of 

 such terms as " vaccines " or " vaccinotherapy " 

 to diseases other than smallpox, although now- 

 likely to remain current, is inexact and un- 

 scientific, since none of the non-Jennerian 

 " vaccines " are passed through the cow. 



Dr. Klebs, who has gone into this subject 

 more extensively than any one else, has, in 

 his memoir, amplified the admirable paper, read 

 at the Johns Hopkins Hospital in 1912, by an 

 examination of literature covering over 1,200 

 titles.^ Only von Pirquet has appreciated the 

 importance of this vast literature, which he 

 has declared to be too overwhelming and dis- 

 tracting for investigation. The object of 

 Klebs's memoir is to show the importance of 

 "historical medicine" in the illumination or 

 interpretation of present-day problems. For 

 instance, the extensive experiments in inocu- 

 lation of smallpox which Councilman, Brinker- 

 hoff and Tyzzer made upon anthropoid apes at 

 Manila, did not throw any such light upon the 

 subject as the thousands of successful inocu- 

 lations made upon man in the eighteenth 

 century. Dr. Klebs regards variolation as a 

 remarkable example of the value of folk intui- 

 tions in etiology and therapy. Many impor- 

 tant advances in practical medicine have un- 

 doubtedly come from the non-medical, but 

 these can hardly be said to have arisen from 

 the great mass of the people, rather, on the 

 primitive minds, adscripti glebes, whose 

 mental development was a little higher than 

 the average. The usual process in evolution 

 is that out of a vast number of people of 

 primitive minds, adscriptus glebw, whose 



1 A remarkably complete bibliography of vario- 

 lation, down to Jenner's time, and of vaccination 

 (1798-1861) was printed (not published) by Dr. 

 Ludwig Pfeiffer (of "Pestilentia in nummis") 

 about 1863. 



mental processes are nearly all exactly alike, 

 there arises occasionally one in whom a more 

 specialized type of mind is born, through suffer- 

 ing or other experience. Then, as Emerson 

 says, " all things are at stake." The inter- 

 esting thing about variolation is that, like 

 the primitive chipped flints all over the globe, 

 or the ever-recurring themata of folk-lore, 

 it seems to have arisen spontaneously among 

 different savage or semi-civilized races. In 

 this monograph it is shown that variolation 

 has been practised from a remote period in 

 China and India and among such African 

 tribes as the Somalis, Ashantis and Wagandas. 

 Cotton Mather is said to have first heard of 

 the practise from his African slave, Onesimus. 

 Baas's statement that inoculation is mentioned 

 in the Atharva Veda is, however, unverifiable. 

 In Germany and Russia, the custom of " buy- 

 ing the smallpox " was known from the seven- 

 teenth century on, variolation being produced 

 by bringing the scabs, purchased in open 

 market, or the pus in contact with the skin. 

 This was probably a phase of the ancient 

 superstition of the sympathetic transference of 

 disease. In 1713, smallpox inoculation was 

 brought to European attention from Oriental 

 sources by Emanuel Timoni, who had his 

 daughter inoculated in lYlY. Lady Mary 

 Montagu followed with the inoculation of her 

 infant daughter in April, 1721, and, on June 

 26, 1721, Zabdiel Boylston of Boston, Mass., 

 began his long series of inoculations in which, 

 by 1752, he had 2,124 cases, with only 30 

 deaths, while, in 1743, Kirkpatrick, in South 

 Carolina, had nearly 1,000 cases, with 8 deaths. 

 At this time the modus operandi was incision, 

 with sometimes a dietetic and depletory " prep- 

 aration," usually blood-letting and purging. 

 In 1760, Eobert and Daniel Sutton were in- 

 oculating by puncture, discarding the depletory 

 regimen for the more sensible strengthening 

 of the patient by dietetic and hygienic means, 

 and had some 30,000 cases, with about 4 per 

 cent, mortality. Attenuation of the virus was 

 attempted by passing it through several human 

 subjects (Kirkpatrick's arm-to-arm method), 

 by using very small quantities, by dilution 

 with water, calomel, etc., or by choosing the 

 virus at the crude or unripe stage. The author 



