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In 1767, Austrian Empress Maria Theresa contracted smallpox and survived, but the disease had already claimed the lives of several members of her family. These personal losses renewed her interest in preventive measures against smallpox. Although initially skeptical, she authorized her physician, Gerard van Swieten, to explore the emerging practice of variolation. In 1768, Habsburg children were variolated by Jan Ingen-Housz—a landmark event in Austrian public health. To commemorate these events, the empire issued medals that not only celebrate scientific progress but also promote the state's commitment to the well-being of its people. Variolation—the deliberate inoculation with smallpox matter to induce immunity—originated in Asia in the 16th century and spread through the Ottoman Empire before reaching Western Europe in 1721. Though often overshadowed in historical accounts by later developments, variolation was a crucial precursor to modern vaccination. In Austria, it paved the way for the first Jennerian vaccination (the inoculation of cowpox), administered in 1799 by Dr. Paskal Joseph Ritter Ferro—less than a year after Edward Jenner's groundbreaking publication in 1798. Smallpox was ultimately declared eradicated in 1980, but this achievement rested on earlier innovations, including variolation. •After recovering from smallpox in 1767, Austrian Empress Maria Theresa championed the use of variolation (the inoculation of smallpox) in Austria.•The variolation of two of her sons and granddaughter in 1768 set a precedent for others to follow.•Variolation paved the way for the eventual adoption of vaccination (the inoculation of cowpox) in Austria in 1799.

Sir Hans Sloane's account of inoculation as a means to protect against smallpox followed several earlier articles published in Philosophical Transactions on this procedure. Inoculation (also called ‘variolation’) involved the introduction of small amounts of infectious material from smallpox vesicles into the skin of healthy subjects, with the goal of inducing mild symptoms that would result in protection against the more severe naturally acquired disease. It began to be practised in England in 1721 thanks to the efforts of Lady Mary Wortley Montagu who influenced Sloane to promote its use, including the inoculation of the royal family's children. When Edward Jenner's inoculation with the cow pox (‘vaccination’) followed 75 years later as a safer yet equally effective procedure, the scene was set for the eventual control of smallpox epidemics culminating in the worldwide eradication of smallpox in 1977, officially proclaimed by WHO in 1980. Here, we discuss the significance of variolation and vaccination with respect to scientific, public health and ethical controversies concerning these ‘weapons of mass protection’. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.

Smallpox inoculation (variolation) was widely reported in sub-Sahara Africa before, during, and after the colonial era. The infective smallpox materials and techniques used, as well as the anatomical sites for inoculation, varied widely among different ethnic groups. The practice among the Boran and Gabra pastoralists of northern Kenya resembled that which was prevalent in a number of areas of Ethiopia. This is not surprising as the Boran also live in southern Ethiopia, and Gabra herdsmen frequently cross the border into this region. The Boran and Gabra technique for smallpox inoculation consisted of taking infective material from the vesicles or pustules of those with active smallpox, and scraping it into the skin on the dorsum of the lower forearm. Although the intent was to cause a local reaction and at most a mild form of smallpox, severe cases of the disease not infrequently resulted. Also, variolated individuals were capable of infecting others with smallpox, thereby augmenting outbreaks and sustaining them. The limited known reports of smallpox inoculation among the Boran and Gabra are presented in this communication. The expansion of vaccination with effective heat stable vaccines, the development of medical and public health infrastructures, and educational programs all contributed to the eventual disappearance of the practice among the Boran and Gabra.

Before the introduction of smallpox vaccine, variolation was practiced as a preventive measure (i.e., deliberate infection with smallpox to provide immunity), most commonly by inserting or rubbing material from smallpox lesions into the skin of uninfected persons. Most persons thus infected would get a milder case of smallpox as the virus was generally introduced via the skin rather than via the respiratory route, as is the case of natural exposure. Infection occurring in this manner could still be transmitted by droplets to others who could develop a full-blown case of smallpox. Variolation developed over several centuries in many different sites including China, India, Sudan, Asia Minor, and Britain. Because variolation was reputed to have risk of inducing severe disease, variolation hesitancy existed long before the smallpox vaccine and its associated vaccine hesitancy. Inoculation with materials putatively derived from cowpox lesions (vaccination) or from horsepox lesions (equination) was a welcomed advance because it was safer and did not present the hazard of onward transmission of smallpox to the contacts of recipients.

AbstractVariolation became a popular method in Europe in the eighteenth century. Sources from Gdańsk not only illustrate the guidelines that were used for these procedures, but also make it possible to compare that with the memories of the person on whom it was performed. In this case, the primary sources are: a 1772 work by physician Nathanael Mathaeus von Wolf, and the diaries of Johanna Henrietta Trosiener, mother of Arthur Schopenhauer. As the comparative analysis shows, the theoretical assumptions were sometimes changed during the practical implementation of variolation.

Vaccine hesitancy and opposition lacking empirical support represent significant threats to public health, particularly when amplified by public health officials. This commentary provides evidence-based refutation of such anti-vaccine arguments, including (i) the robust epidemiological data demonstrating vaccine efficacy in reducing disease incidence, mortality, and transmission; (ii) the comprehensive safety surveillance systems (VAERS, VSD, CISA) that monitor adverse events and consistently demonstrate favorable risk-benefit profiles; (iii) the biological mechanisms underlying both vaccine-induced immunity and rare adverse events; and (iv) the distinction between temporal association and causation in adverse event reporting. Thus it can be deduced that flawed logic and falsifications have been used to misrepresent the risks of vaccination. This endangers the lives and well-being of people who are susceptible to the diseases that vaccines can effectively prevent.

This paper shows that the history of clinical medicine in the eighteenth century supports Paul Hoyningen-Huene's thesis that there is a correlation between science and systematicity. For example, James Jurin's assessment of the safety of variolation as a protection against smallpox adopted a systematic approach to the assessment of interventions in order to eliminate sources of cognitive bias that would compromise inquiry. Clinical medicine thereby became a science. I use this confirming instance to motivate a broader hypothesis, that systematicity is a distinctive feature of science because systematicity is required by processes of knowledge generation that go beyond our everyday cognitive capacities, and these processes are required to produce knowledge of the kinds that science aims at.

This article examines the experiment conducted by Johannes Theodor Wilhelm Petruschky (1863–1945) on the eradication of tuberculosis using tuberculin. His research was inspired by the work of Robert Koch, who discovered the etiological agent of tuberculosis and conducted experiments using tuberculin as a therapeutic agent. Despite initial hopes, tuberculin proved ineffective in treating tuberculosis. Following Koch's ideas, Petruschky conducted studies in Gdańsk and later in the isolated community of Hel, where he attempted to eliminate tuberculosis through systematic diagnosis and prevention. He declared the experiment a success, claiming that Hel had become tuberculosis-free. However, his research faced criticism, particularly from Ernst Effler, who questioned the reliability of the epidemiological data. Ultimately, Petruschky's method did not stand the test of time, and his claims of successful eradication were discredited. Nevertheless, his model of patient surveillance contributed to the development of tuberculosis control systems.

En este artículo se analiza la epidemia de viruela de 1796-1797 en la parroquia de Teotitlán del Valle y en la ciudad de Antequera, bajo un enfoque social y demográfico, el cual permitirá conocer, por un lado, las acciones de las autoridades civiles, eclesiásticas y médicas para frenar el avance de la epidemia y las reacciones de la población ante estas y, por el otro, los efectos demográficos de la viruela, principalmente, en las personas que nacieron después de la epidemia de 1780. El discurso de las autoridades y la población se analizó a partir de documentos de archivo, mientras que la información parroquial que da sustento al trabajo demográfico con el método agregativo. Se pudo observar que la intensidad de la epidemia fue menos mortífera, en relación con la precedente, debido probablemente a la aplicación de medidas como la variolización y el aislamiento de los enfermos, pero estas no fueron del todo aceptadas y se suscitaron ciertas “reacciones” en contra.