quack doctors, notions would not stipulate any particular resting conditions (such as "hot-treatment" – heating the ill patient in front of a fire, covering them with blankets and allowing them no fresh-air),: 398 nor would he administer any other medicines during the period of infection and recovery.: 571 notions' variolation bears a strong similarity to the suttonian method. how notions became aware of this method of variolation is unclear – it may have been through written account, or through discussion with someone else aware of the technique, such as another physician or a member of the clergy.: 401 widespread recognition "queens" of mysore: left, krishnaraja wadiyar iii's first wife, devajammani has a discoloration around the mouth, thought to be due to the blowing of variolation dust in the nose ("nasal insufflation"). right, his second wife shows the discrete mark left by vacccination under her saree. thomas hickey, 1805. in 1738, variolation was added to the second edition of chambers' cyclopædia, which in its time was an authority of knowledge for the literary class. later in 1754, variolation received the sanction of the royal college of physicians.: 47 all of this made england the international center of variolation, attracting visitors from all over the world to explore this "new" method of prevention. the nation also acted as a magnet for those who sought to introduce the benefits of variolation to their own countries. a remarkable example of this is the introduction of variolation into russia. thomas dimsdale, a prominent banker, politician, and physician, was invited to visit st petersburg to variolate catherine the great. in 1769, he variolated catherine, her 14-year-old son grand duke paul, and over 140 prominent members of the court. the results were successful. dimsdale was created a baron of the russian empire, and awarded £10,000, with £2000 for expenses and an annuity of £500. his son, who accompanied him, was also rewarded. in case dimsdale's variolations had ended badly, catherine had arranged a relay of horses to carry them safely out of the country. france was the last european country to embrace variolation. it was not until an outbreak of smallpox in paris in 1752 nearly killed the heir to the french throne that the public embraced the practice after seeing the prince variolated.: 102 similarly in japan, chinese merchant li jen-shan proposed the method of traditional chinese intranasal variolation after a severe smallpox outbreak in nagasaki in 1744. this led japanese physician ogata shunsaku to variolate children using a human smallpox vaccination method during an outbreak in chikuzen province from 1789 to 1790.: 95 there were no deaths among the children, and they all appeared to be protected. by the end of the eighteenth century, variolation had gained widespread global respect and was thought to be one of the greatest medical successes of its time. it had become the subject of serious medical study, leading physicians like john haygarth from chester, england, to explore its application on a larger scale. in 1793 he published a sketch of a plan to exterminate the small-pox from great britain. this relied on rules summarised by donald hopkins;: 77 systematic inoculation throughout the country, isolation of patients, decontamination of potentially contaminated fomites, supervised inspectors responsible for specific districts, rewards for observation of rules for isolation by poor persons, fines for transgression of those rules, inspection of vessels at ports, and prayers every sunday. its implementation at the time was impractical for logistical reasons and the risk that variolation would spread smallpox. however, with suitable modifications, such as the substitution of vaccination for variolation, it was remarkably similar to the strategy adopted during the world health organization's smallpox eradication campaign. spread into america documentation of variolation in the americas may be traced back to 1706 in boston, where puritan minister cotton mather learned of the technique from his west african slave onesimus.: 45 further research into the matter revealed to mather that several other slaves had too been variolated. in 1714, he came across timoni's article in philosophical transactions, in which he described methods of variolation found in turkey. mather was able to implement this new method in 1721 when boston suffered a smallpox outbreak, although others such as william douglass strongly opposed the idea. the main arguments against variolation were on religious grounds. because religion was never far from any aspect of life in eighteenth-century boston, several wondered how this new method would coincide with religious teachings. the simplest debate argued that variolation was ungodly because it was not mentioned specifically in the bible. inoculation was also viewed by some as a direct affront to god's innate right to determine who was to die, and how and when death would occur. several believed smallpox outbreaks were well-merited punishments for the sins of those who contracted the disease. those who were empirically minded saw the notion of using the products of such a deadly disease to prevent said disease as being an insult to logic.: 142 despite these persistent arguments, mather also gained several supporters. among this group of followers was surgeon zabdiel boylston, who urged mather to further promote the procedure. with the support of mather, boylston went on to successfully variolate 300 patients, with only six of them dying. by contrast, 1,000 of the 6,000 people who acquired smallpox naturally died during the same period. boylston traveled to london in 1724. there he published his results and was elected to the royal society in 1726.: 144 from boston, the practice spread throughout the colonies. in 1775, george washington ordered that the continental army be variolated. by the end of the american revolutionary war, variolation had gained widespread acceptance in the larger cities and towns of the united states.: 47 transition into vaccination the success of variolation led many, including medical professionals, to overlook its drawbacks. variolation was practiced on the basis that it protected against smallpox for life, and was far less likely to kill than natural infection. in some cases however, natural smallpox or variolation failed to protect from a second attack. these cases were a result of a lapse of immune "memory", while others may have been misdiagnosed (experts often confused smallpox with chickenpox). variolation also required a level of skill and attention to detail which some physicians lacked. many physicians failed to take note of local redness and discharge to assure the variolation had taken, resulting in inadequate treatment. however, it was its great risk to others that led to the end of the practice. the collateral smallpox cases spread by variolated subjects shortly after variolation began to outweigh the benefits of the procedure. from the 1760s, a number of individuals, including john fewster, peter plett, benjamin jesty, and particularly edward jenner, were interested in the use of material from cowpox, an animal infection, to protect against smallpox. in 1796, jenner vaccinated james phipps, did more vaccinations in 1798, and was the first to publish evidence that cowpox protected against smallpox, was safer than variolation, and that his vaccine could be maintained by arm-to-arm transfer. the use of variolation soon began to decline as the smallpox vaccine became widely used and its benefits appreciated. various countries made variolation illegal, starting with russia in 1805.: 246 variolation served as a natural precursor to the discovery of vaccination. the major differences between the two were that in vaccination, material from cowpox, an animal disease, was used, but particularly that it was far safer to those vaccinated and was far more rarely transmitted to their contacts. vaccination offered the public a less-harmful method of preventing smallpox. vaccination would revolutionize the control of smallpox, leading to its eventual eradication. the extension of the principle of vaccination by pasteur and his successors would lead to the development of vaccines for diseases such as diphtheria, measles, mumps, rubella, and influenza, and make the eradication of infectious diseases, particularly poliomyelitis, a realistic prospect. decline although variolation eventually declined or was banned in some countries, it was still practiced in others. "buying the smallpox" was still practiced in sudan until the late nineteenth century.: 159 however, variolation survived longer elsewhere. during the world health organization's smallpox eradication campaign, vaccination teams came across variolators in remote areas of pakistan and afghanistan and their samples were confiscated. in the early stages of the campaign, live virus was detected in some, but as the campaign progressed variolators could not replenish their stocks, and although virus particles were detected in some samples, very few contained live virus.: 683–85 our knowledge about the survival of smallpox virus suggests that passage of time makes it extremely unlikely that any infectious samples have survived.: 1173–77 other diseases although variolation has ceased, it has influenced the concept of other traditional practices, such as "pox parties", in which children are intentionally exposed to diseases like chickenpox, measles and rubella, in an attempt to gain immunity. although strongly discouraged by public health officials, the practice persists.: 73 while intentional exposure has been rejected as a strategy to combat covid-19 because of the risks involved, there is also a hypothesis that widespread to universal use of face coverings is associated with a higher proportion of asymptomatic or relatively mild infections because of the decreased dose of viral particles expelled or received by the wearer, as a welcome addition to their primary purpose of significantly reducing transmission by asymptomatic wearers.