Earliest Record of Smallpox Inoculation in China

No one knows who first gave a child smallpox on purpose to protect it. The earliest written discussion of the practice in China appears in a book first published in 1549. Its author commented that inoculation might bring on menstruation, a remark that led the historian Joseph Needham to conclude that the practice was already well known, if seldom written about.

Chinese inoculators blew smallpox material up the child's nose. Some ground dry scabs to powder, some soaked the scabs in water, and some put fluid from a pustule on a cotton plug and placed it in the nostril. The child then had a mild form of smallpox and became immune. An essay published by the National Library of Medicine judges that this nasal method was probably no more dangerous than the skin inoculation used in Turkey and later in Britain, and notes that in China it met no opposition from the church or the medical profession.

Much of the early history stayed hidden. Later Chinese writers complained that inoculators would not reveal their secrets, and Needham recorded an oral tradition that a Taoist or Buddhist monk, or possibly a nun, invented the method around AD 1000. The James Lind Library concludes that it is difficult to establish what was happening in China, or when it began. It finds no evidence in ancient Indian texts for the claim that India practiced inoculation for thousands of years, and it argues that the similar methods used in India and the Ottoman Empire point to a shared origin, possibly Arab, before about 1550.

Europe learned the practice by another route and another technique. In Turkey inoculators scratched smallpox pus into the skin, and Europeans and Americans also inoculated through a puncture in the skin. The method had reached Constantinople by about 1650 and arrived in Britain and Massachusetts in 1721.