*How smallpox vaccinations used to go*
By: Alamoguy
27 November 2002

One warning before we start: I haven't read Demon in the Freezer yet (it's on my Christmas list). All of this stuff is probably in there, so I apologize in advance if it's redundant.

With all the talk about smallpox in the news, most of us have done a lot of research into the virus and its clinical course. With the announcement last week by President Bush of a plan to vaccinate some 500,000 health workers plus another 10 million first responders, a lot of us fear the vaccine and its effects. This article isn't taking a position on that, it's just a glimpse into the fascinating history about the methods to immunize against the virus before Jenners efforts led to a safer way of doing things, culled from my old Medical History and Immunology notes.


Smallpox has killed more people throughout history than perhaps any other infectious disease. It is believed to have originated in northwest Africa circa 10,000 BC, and spread rapidly amongst the trading cultures of Africa, the Mideast and the Orient. Smallpox-like lesions have been verified on mummies from as early as 1500BC, but historical records describe presentations similar to those of smallpox going back to that 10,000 BC date. It is in these trading cultures that the first attempts to confer immunity were attempted. Around 1000 AD, Chinese and Indian (subcontinental, not Native American) practitioners independently discovered techniques known that came to be known as variolation (after variola, the virus that causes smallpox). It has also been discovered that some African tribes practiced the same techniques long before they were embraced by Europe. Even today, these cultures are respected by medical historians for their effective methods, even if they originated in religious or empirical thought and not science.

Practitioners noticed that people who had the disease had immunity to later infections, and the healers at the time experimented and eventually deployed techniques to deliberately expose healthy individuals to infected ones by sleeping in the same room, much as some parents used to send their children to play with friends who have chickenpox in an attempt to "get over it." Other techniques included the ingestion or inhalation of scabs and crusts from smallpox lesions.

As experimentation continued, a technique very similar to that employed by 20th century smallpox vaccines was employed: pus from lesions were placed on the arm of the one being vaccinated, and needles or incisions were used to help the pus infiltrate their tissue.

This inoculation process gained widespread use in Asia, but was unheard of until the early 18th century, at which time rumors of the practice began to circulate in London. Emboldened by the discussion, Lady Mary Wortely Montagu, the wife of the British Ambassador to Turkey who had been fascinated by the local practice, had her family variolated. Practitioners in Britain began testing the procedure on inmates and orphans, and later the practice was wholeheartedly embraced. The revolutionary war brought news of the practice to America, where outbreaks were causing the armies to avoid key cities as well as incapacitating up to 50% of both British and American forces at one time or another. General George Washington, himself a victim of an earlier smallpox infection, during the course of the war mandated that all recruits in the Continental Army be variolated, a decision that probably saved more lives in preventing the disease than the total number killed in battle.

The practice was full of problems: as a live virus was used, up to 2% of those receiving it died and many more experienced full-blown infections, which often made their way into the general populace and started epidemics that killed hundreds. In a best-case scenario, the recipient was bedridden for a month with severe flu-like symptoms. Of course, the supportive care at the time didn't help much, focusing mainly on purging and bloodletting.

Even with the high mortality and morbidity, the process worked wonders in comparison to the rampant death and chaos in non-inoculated populations, and many people voluntarily received the inoculation when it appeared virulent epidemics were inevitable, and smallpox was starting to come under control for the first time in history.

It was not until the late 1700's that Jenner tested his cowpox vaccination program, "engrafting" pus from cowpox sores instead of smallpox, and setting the stage for vaccination (from the Latin for cow). Most credit him with the furthering of immunology that led to the eradication of smallpox two hundred years later. But for all he's been portrayed as, he was really rather late in the game. And if were afraid of the vaccines now, remember that the old way of doing things was much worse.

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