Inoculation
Inoculation, originally Variolation, is a method of purposefully infecting a person with smallpox (Variola) in a controlled manner so as to minimise the severity of the infection and also to induce immunity against further infection. It preceded vaccination and is separate from it, though today the terms inoculation, vaccination and immunisation are used more or less interchangable and popularly refer to the process of artificially inducing immunity against various infectious diseases. The microorganism used in an inoculation is called the inoculant or inoculum.
Inoculation in the East was historically performed by blowing smallpox crusts into the nostril, but in Britain, Europe and the American Colonies the preferred method was rubbing material from a smallpox pustule from a selected mild case - Variola Minor - into a scratch between the thumb and forefinger. [1] This would generally be performed when an individual was in normal good health, and thus at his peak resistance. The recipient would develop smallpox; however, presumably because of the inoculated individual's preexisting state of good health, the small inoculum, and the single point of initial infection, the resulting case of smallpox was generally milder than the naturally-occurring form, produced far less facial scarring, and had a far lower mortality rate. As with survivors of the natural disease, the inoculated individual was subsequently immune to re-infection.
Origins and Importation to Christendom
The Lady Mary Wortley Montagu (May 26, 1689-August 21, 1762), brought Variolation to England. The earliest use of the practice remains unknown. It had occurred in various manners in East Africa, India and in China for centuries, but documentation exists of its adoption in western Europe. In the early 18th century, Lady Mary Wortley Montagu, whose husband Edward Wortley Montagu served as the English ambassador to the Ottoman Empire from 1716 to 1717, witnessed inoculation in Constantinople. The process impressed her greatly: she had lost a brother to smallpox and bore facial scars from the disease herself. In March 1718 she had the embassy surgeon, Charles Maitland, inoculate her five-year-old son. In 1721, after returning to England, she had her four-year-old daughter inoculated. She invited friends to see her daughter, including Sir Hans Sloane, the King's physician. Sufficient interest arose that Maitland gained permission to test inoculation on six condemned prisoners at Newgate prison, witnessed by a number of notable doctors. The trial succeeded; the prisoners gained their freedom, and in 1722 the Prince of Wales' daughters received inoculations.
The practice of inoculation slowly spread amongst the royal families of Europe, usually followed by more general adoption amongst the people.
As early as 1732 the practice is documented in America. Fearing the outbreak of an epidemic, the editor of the South Carolina Gazette published a detailed description of the innoculation process in the April 22 issue. In Boston there was argument with churchmen on both sides "...within a year or two after the first experiment nearly three hundred persons had been inoculated by Boylston in Boston and neighbouring towns, and out of these only six had died; whereas, during the same period, out of nearly six thousand persons who had taken smallpox naturally, and had received only the usual medical treatment, nearly one thousand had died."A HISTORY OF THE WARFARE OF SCIENCE WITH THEOLOGY IN CHRISTENDOM Andrew Dickson White.
| Total | Died | Mortality % | |
| Variolated | C 300 | 6 | C 2% |
| Unvariolated | C 6000 | C 1000 | "about 14%" |
(The 14% figure rather than 17% comes from
"Edward Jenner and Vaccination. Harris[2])
J.Z. Holwell described the Ayurvedic system of inoculation against smallpox to the Royal College of Physicians in London in 1767 in a tract called An account of the manner of inoculating for the small pox in the East Indies. He based his account on observations made during his residence in Bengal.
In France considerable opposition arose to the introduction of inoculation: Voltaire, in his Lettres Philosophiques wrote a criticism of his countrymen for having so little regard for the welfare of their children (English translation on-line[3]).
Given the prevalence of smallpox in the 18th century (60% incidence of first infection, 20% mortality 20% severe scarring. Voltaire), one could expect almost inevitably to become infected by it sooner or later. The advantages of inoculation seemed so evident that parents would pre-empt the dangerous natural infection by the less risky use of inoculation; but Edward Jenner's introduction of the far safer cowpox in vaccination after 1796 eventually led to the smallpox inoculation falling into disuse, and being banned in England in 1840.
See also
References
- US National Library of Medicine
- Lettres Philosophiques. Voltaire (English translation.
- An account of the manner of inoculating for the small pox in the East Indies. Holwell, J Z. RCP
- Edward Jenner and Vaccination. Harris
- A HISTORY OF THE WARFARE OF SCIENCE WITH THEOLOGY IN CHRISTENDOM Andrew Dickson White.