Hektoen International

A Journal of Medical Humanities

“God Helps Them That Help Themselves”: Poor Richard and the inoculation controversy

Stewart Justman
Missoula, Montana, United States

Poor Richard, 1739. An Almanack for the Year of Christ 1739. Benjamin Franklin Library of Congress Rare Book & Special Collections Division. Via Wikimedia.

Before vaccination there was inoculation, and long before opposition to vaccination for Covid-19 there was furious resistance to the practice of inoculating for smallpox.

Upon being introduced into Boston in 1721, in the midst of an outbreak of smallpox—exactly the wrong time and place for a dispassionate trial of a practice with obscure roots in remote traditions—inoculation was met with popular outrage. Incensed citizens believed it spread smallpox, and they had a point. Many must have felt, too, that it was tempting fate to implant such a dreaded disease as smallpox into the body in the name of prevention; after all, the traditional emphasis of medicine was on getting noxious matter out of the body by some route of evacuation. In the heavily theological atmosphere of Boston, inoculation might well have appeared a mad Faustian attempt to take control of an affliction beyond human measures—to play God. So it seemed to the anti-inoculation party, whose favored platform was the first newspaper in the colonies to address itself to a present controversy, the New-England Courant, owned and operated by James Franklin.1

When Franklin’s half-brother Benjamin—a proponent of inoculation—lost his young son Francis to smallpox in 1736, some believed the boy had been inoculated. Perhaps out of grief at seeing a beloved child transformed into an illustration of the dangers and impieties of playing with smallpox, Benjamin Franklin set the record straight in the Pennsylvania Gazette in December of the same year:

Understanding ‘tis a current Report, that my son Francis, who died lately of the Small Pox, had it by Inoculation; and being desired to satisfy the Publick in that Particular; inasmuch as some People are, by that Report . . . deter’d from having that Operation perform’d on their Children, I do hereby sincerely declare that he was not inoculated, but receiv’d the Distemper in the common way of Infection: And I suppose the Report could only arise from its being my known Opinion that Inoculation was a safe and beneficial Practice; and from my having said among my Acquaintance that I intended to have my Child inoculated, as soon as he should have recovered sufficient Strength from a Flux with which he had long been afflicted.

Tracing the progress of inoculation in 1750, Franklin, writing as Poor Richard, noted that the belief that the practice violated the precepts of religion had lost ground. “Tho’ at first it was reckoned by many to be a rash and almost impious Action, to give a Distemper to a Person in Health . . . it now begins to be thought rash to hazard taking it in the common Way, by which one in seven is generally lost; and impious to reject a Method discovered to Mankind by God’s good Providence, whereby 99 in 100 are saved.” With the evidence in favor of inoculation only beginning to sink in, much of the work of popularizing the procedure remained to be done. As Franklin observed in his foreword to a 1759 pamphlet by the English physician William Heberden explaining how to inoculate, “Notwithstanding the now uncontroverted success of Inoculation, it does not seem to make that progress among the common people in America, which at first was expected.”2

How, then, did Franklin advance the cause of inoculation in Poor Richard’s Almanac? He did so not by harping on statistics (and not everyone was enamored of statistics),3 not by lecturing the reader on the merits of inoculation, but by challenging the fatalism in which hostility to inoculation is rooted and encouraging the active prudence that nourishes the practice. He exhorts the reader to be the kind of person—foresighted, practical, self-improving—who would naturally seek to avert smallpox by inoculation. The battle over inoculation is also a battle of mentalities.

The first of the objections to inoculation cited by Franklin in his compelling 1759 foreword is “scruples of conscience.” To those who might argue that inoculation against smallpox is a dangerous act of presumption or a rebellion against Providence, Poor Richard replies, “God helps them that help themselves.” Speaking in a neighborly voice that is about as far from Faustian as can be imagined, he envisions God not as an avenger who sends smallpox to scourge the human race, but a merciful provider who has revealed the means of taming the disease. Poor Richard’s disciples diligently follow a way of life calculated to secure the blessing of the same Providence that has disclosed to humanity the secret of inoculation. They help themselves.

Scattered through Poor Richard’s sayings are barbs aimed at doctors, such as “God heals, and the Doctor takes the Fees” or “Many medicines few cures.” But it was exactly because medicine knew no cure for smallpox that preventing it was essential. “An Ounce of Prevention is worth a Pound of Cure.” While this maxim appeared in an article on fire prevention, it accords perfectly with the spirit of prudence that informs the sayings of Poor Richard from beginning to end, as well as their profound medical skepticism. That skepticism in turn allows for inoculation, a practice which was not dreamed up by doctors but imported from other cultures, and which does not even require a doctor or surgeon to administer, as Franklin came to believe. The 1759 pamphlet for which Franklin supplied a foreword bears the subtitle, “Plain Instructions, by which any Person may be enabled to perform the Operation and conduct the Patient through the Distemper.” (Sidestepping doctors and surgeons does away with the high prices that put the procedure out of reach for many.)4 Just as anyone can construct and install a lightning rod—as Poor Richard advises—so can anyone inoculate.

Poor Richard’s counsels of foresight, too, seem entirely consistent with the practice of defending against smallpox by taking action before the fact. “Look before, or you’ll find yourself behind”—a principle that came to life as people rushed to inoculate themselves or their children amidst the panic of a raging epidemic.5 Significantly, a defense of inoculation in the 1737 edition of the almanac blends right into advice on living thoughtfully and building wealth little by little. Immediately after “A penny sav’d is Twopence clear, A Pin a day is a Groat a Year, Save and have, Every little makes a mickle” comes the following rhyming polemic:

God offer’d to the Jews Salvation
And ‘twas refus’d by half the Nation:
Thus, (tho’ ‘tis Life’s great Preservation)
Many oppose Inoculation.
We’re told by one of the black Robe
The Devil inoculated Job:
Suppose ‘tis true, what does he tell:
Pray, Neighbours, Did not Job do well?

An age-old caricature of the Jews enables Poor Richard to brand the opponents of inoculation as perverse rejectionists. The wit of the concluding couplet is more like him.

Something of the same wit is at work in the observation that while it once seemed rash and impious to inoculate against smallpox, “it now begins to be thought” rash and impious not to. Such inversions are one of Richard’s pet tropes. “All things are cheap to the saving, dear to the wasteful.” “Tis easy to see, hard to foresee.” Indeed, “Many medicines few cures.” Symmetries like this are elegant to be sure, but they are also instructive, illuminating as they do our vulnerability to fallacy and folly (extravagance, myopia, belief in false cures) and capacity for overcoming them. This is to say that the adoption of the formerly “refused” practice of inoculation represents a sort of general version of the process of self-correction that Franklin records in his autobiography and that the readers of Poor Richard undergo when they learn to amend their errors and better their lot.6

The acquisition of a numerical mentality goes along with this process of improvement. Though Poor Richard’s populism rules out heavy use of numerical data like those of the inoculation literature associated with the Royal Society in England, his intended reader is not, in fact, numerically naïve. After all, he counts his pennies—literally. “Weigh every small Expence, and nothing waste, / Farthings long sav’d, amount to pounds at last.” “d. wise, £. foolish.” A reader with such numerical habits would presumably know what to make of a practice by which “99 in 100 are saved,” but without which “one in seven is generally lost.” The numbers are a word to the wise. Recall that the eulogy to inoculation as “Life’s great Preservation” follows a series of financial maxims without so much as a transition.

Shortly before Franklin launched the Poor Richard series, a number of investigators in England devised quantitative methods whereby “any rational individual following merchant’s logic (that is, a commercially-minded person)” could determine which posed the greater danger, inoculation or natural smallpox.7 Poor Richard was such a person, and so was his intended reader.


During the inoculation controversy, the claim that it was possible to combat the virulence of natural smallpox with a mild case of induced smallpox might well have seemed bizarre or paradoxical. But perhaps not to those who already believed it possible to tame dangerous passions like the pursuit of power with milder ones like the lawful pursuit of wealth. As documented by Albert O. Hirschman, the belief that we can do just that—“fight fire with fire,” in his words—ran like a strong motif through Enlightenment thinking.8 Not coincidentally, Hirschman’s study begins with Benjamin Franklin. Bearing out the Enlightenment theme of the civilizing influence of commerce, Poor Richard teaches the superiority of the disciplined pursuit of gain over the life of unregulated impulse. Commerce is a highly ingenious arrangement whereby we tame the unruliness of our own nature, an ingenuity reflected in Poor Richard’s most engaging quality, his wit. And if we can domesticate our worst enemy—ourselves—in this manner, then maybe the proposition that human ingenuity can domesticate smallpox is not an offense to reason but a possibility worth investigating.

That statistics like a far lower death rate did not settle the inoculation question, suggests that the mentality readers brought to the numbers mattered as much as the numbers themselves. Probably it is because controversies go deeper than statistics that Poor Richard does not much emphasize the statistics supporting inoculation, striking though they are. Instead he preaches a prudential ethos deeply concerned with the taming of danger and the control of risk—an ethos that would lead one as a matter of course to guard against smallpox with the help of a well-tried and rather homely technique.


  1. John Blake, “The Inoculation Controversy in Boston: 1721-1722,” New England Quarterly 25 (1952), 489-506; Laurence Farmer, “The Smallpox Inoculation Controversy and the Boston Press 1721-2,” Bulletin of the New York Academy of Medicine 34 (1958), 599-608.
  2. William Heberden, Some Account of the Success of Inoculation for the Smallpox in England and America. Together with Plain Instructions By which any Person may be enabled to perform the Operation, and conduct the Patient through the Distemper (London, 1759), p. 3. The emphasis of this pamphlet is on the inoculation of children, a topic that must have held special meaning for Franklin.
  3. “A Modest Proposal,” Swift’s comment on “political arithmetic,” appeared in 1729.
  4. Elizabeth Fenn, Pox Americana: The Great Smallpox Epidemic of 1775-82 (New York, 2001), 41-42. Franklin underwrote the distribution of the Heberden pamphlet to the needy of Philadelphia. See Stanley Finger, Doctor Franklin’s Medicine (Philadelphia, 2006), 63.
  5. See Franklin’s foreword to the Heberden pamphlet. A 1724 letter by James Jurin, secretary of the Royal Society, to Caleb Cotesworth describes an inoculation panic in Boston.
  6. Perhaps fittingly, it was in the “Improved” series of almanacs beginning in 1748 that Franklin introduced the statistics vindicating inoculation.
  7. Andrea Rusnock, “‘The Merchant’s Logick’: Numerical Debates over Smallpox Inoculation in Eighteenth-Century England,” in The Road to Medical Statistics, eds. Eileen Magnello and Anne Hardy (Amsterdam, 2002), 42.
  8. Albert O Hirschman, The Passions and the Interests: Political Arguments for Capitalism before Its Triumph (Princeton, 1977), 20.

STEWART JUSTMAN, PhD, Prof Emeritus of Liberal Studies at the University of Montana, has written extensively on literature and medicine. His recent publications have appeared in Medical Humanities; Perspectives in Biology and Medicine; and Journal of the Royal College of Physicians of Edinburgh. 

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