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Inoculation is the act of implanting a pathogen or other microorganism. It may refer to methods of artificially inducing immunity against various
infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
s, or it may be used to describe the spreading of disease, as in "self-inoculation," the spreading of disease from one part of the body to another, or even to the spreading of bacteria in a Petri dish for culturing purposes. The terms "inoculation", "
vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
", and "
immunization Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent (known as the immunogen). When this system is exposed to molecules that are foreign to the body, called ''non-se ...
" are often used synonymously, but there are some important differences among them. Inoculation is the act of implanting a disease inside a person or
animal Animals are multicellular, eukaryotic organisms in the Kingdom (biology), biological kingdom Animalia. With few exceptions, animals Heterotroph, consume organic material, Cellular respiration#Aerobic respiration, breathe oxygen, are Motilit ...
, vaccination is the act of implanting or giving someone a vaccine specifically, and immunization is what happens to the
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
as a result.


Terminology

Until the early 1800s inoculation referred only to
variolation Variolation was the method of inoculation first used to immunize individuals against smallpox (''Variola'') with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result. Var ...
(from the Latin word ''variola'' = smallpox), the predecessor to the
smallpox vaccine The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox ...
. The smallpox vaccine, introduced by
Edward Jenner Edward Jenner, (17 May 1749 – 26 January 1823) was a British physician and scientist who pioneered the concept of vaccines, and created the smallpox vaccine, the world's first vaccine. The terms ''vaccine'' and ''vaccination'' are derived f ...
in 1796, was called
cowpox Cowpox is an infectious disease caused by the ''cowpox virus'' (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more ...
inoculation or vaccine inoculation (from Latin ''vacca'' = cow). Smallpox inoculation continued to be called variolation, whereas cowpox inoculation was called vaccination (from Jenner's term ''variolae vaccinae'' = smallpox of the cow). Louis Pasteur proposed in 1861 to extend the terms
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...
and vaccination to include the new protective procedures being developed. Immunization refers to the use of vaccines as well as the use of
antitoxin An antitoxin is an antibody with the ability to neutralize a specific toxin. Antitoxins are produced by certain animals, plants, and bacteria in response to toxin exposure. Although they are most effective in neutralizing toxins, they can also ...
, which contains pre-formed
antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...
such as to
diphtheria Diphtheria is an infection caused by the bacterium '' Corynebacterium diphtheriae''. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die. Signs and s ...
or
tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
exotoxins. In nontechnical usage inoculation is now more or less synonymous with protective injections and other methods of immunization. Inoculation also has a specific meaning for procedures done ''
in vitro ''In vitro'' (meaning in glass, or ''in the glass'') studies are performed with microorganisms, cells, or biological molecules outside their normal biological context. Colloquially called "test-tube experiments", these studies in biology an ...
'' (in glass, i.e. not in a living body). These include the transfer of
microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...
s into and from laboratory apparatus such as test tubes and
petri dish A Petri dish (alternatively known as a Petri plate or cell-culture dish) is a shallow transparent lidded dish that biologists use to hold growth medium in which cells can be cultured,R. C. Dubey (2014): ''A Textbook Of Biotechnology For Class- ...
es in research and diagnostic laboratories, and also in commercial applications such as brewing, baking, oenology (wine making), and the production of
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
. For example, blue cheese is made by inoculating it with '' Penicillium roqueforti'' mold, and often certain bacteria.


Etymology

The term "inoculation" entered medical English through horticultural usage meaning to graft a bud (or eye) from one plant into another. It is derived from the Latin ''in + oculus'' (eye). Though "innoculation/innoculate" (with a double "nn" rather than a single "n") is sometimes seen, this is incorrect, possibly erroneously thought to be related to "innocuous", which is derived from the Latin ''in + nocuus'' (not harmful).


Origins

Inoculation originated as a method for the prevention of
smallpox Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
by deliberate introduction of material from smallpox pustules from one person into the skin of another. The usual route of transmission of smallpox was through the air, invading the
mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It i ...
s of the mouth, nose, or respiratory tract, before migrating throughout the body via the
lymphatic system The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid o ...
, resulting in an often severe disease. In contrast, infection of the skin usually led to a milder, localized infectionbut, crucially, still induced
immunity Immunity may refer to: Medicine * Immunity (medical), resistance of an organism to infection or disease * ''Immunity'' (journal), a scientific journal published by Cell Press Biology * Immune system Engineering * Radiofrequence immunity desc ...
to the virus. This first method for smallpox prevention, smallpox inoculation, is now also known as
variolation Variolation was the method of inoculation first used to immunize individuals against smallpox (''Variola'') with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result. Var ...
. Inoculation has ancient origins, and the technique was known in India, Africa, and China.


China

The earliest hints of the practice of inoculation for smallpox in China come during the 10th century.Needham, Joseph. (2000).
Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine
'. Cambridge: Cambridge University Press. p. 154
A
Song dynasty The Song dynasty (; ; 960–1279) was an imperial dynasty of China that began in 960 and lasted until 1279. The dynasty was founded by Emperor Taizu of Song following his usurpation of the throne of the Later Zhou. The Song conquered the rest ...
(960–1279)
chancellor of China The grand chancellor (''zaixiang, tsai-hsiang''), also translated as counselor-in-chief, chancellor, chief councillor, chief minister, imperial chancellor, lieutenant chancellor and prime minister, was the highest-ranking executive official in t ...
, Wang Dan (957–1017), lost his eldest son to smallpox and sought a means to spare the rest of his family from the disease, so he summoned physicians, wise men, and magicians from all across the empire to convene at the capital in
Kaifeng Kaifeng () is a prefecture-level city in east-central Henan province, China. It is one of the Eight Ancient Capitals of China, having been the capital eight times in history, and is best known for having been the Chinese capital during the Nort ...
and share ideas on how to cure patients of it until an allegedly divine man from
Mount Emei Mount Emei (; ), alternately Mount Omei, is a mountain in Sichuan Province, China, and is the highest of the Four Sacred Buddhist Mountains of China. Mount Emei sits at the western rim of the Sichuan Basin. The mountains west of it are know ...
carried out inoculation. However, the sinologist
Joseph Needham Noel Joseph Terence Montgomery Needham (; 9 December 1900 – 24 March 1995) was a British biochemist, historian of science and sinologist known for his scientific research and writing on the history of Chinese science and technology, in ...
states that this information comes from the ''Zhongdou xinfa'' (種痘心法) written in 1808 by Zhu Yiliang, centuries after the alleged events. The first clear and credible reference to smallpox inoculation in China comes from
Wan Quan Wan Quan (1495–1585), also known as Wan Mizhai, was a Ming dynasty pediatrician. He was the third in his family to practice medicine. He advocated that children be frequently exposed to sunlight and fresh air and trained to resist cold. He also ...
's (1499–1582) ''Douzhen Xinfa'' (痘疹心法) of 1549, which states that some women unexpectedly menstruate during the procedure, yet his text did not give details on techniques of inoculation. Inoculation was first vividly described by Yu Chang in his book ''Yuyi cao'' (寓意草), or ''Notes on My Judgment'', published in 1643. Inoculation was reportedly not widely practiced in China until the reign of the
Longqing Emperor The Longqing Emperor (; 4March 15375July 1572), personal name Zhu Zaiji (朱載坖), was the 13th Emperor of the Ming dynasty, reigned from 1567 to 1572. He was initially known as the Prince of Yu (裕王) from 1539 to 1567 before he became th ...
(r. 1567–1572) during the
Ming dynasty The Ming dynasty (), officially the Great Ming, was an Dynasties in Chinese history, imperial dynasty of China, ruling from 1368 to 1644 following the collapse of the Mongol Empire, Mongol-led Yuan dynasty. The Ming dynasty was the last ort ...
(1368–1644), as written by Yu Tianchi in his ''Shadou Jijie'' (痧痘集解) of 1727, which he alleges was based on Wang Zhangren's ''Douzhen Jinjing Lu'' (痘疹金鏡錄) of 1579.Needham, Joseph. (2000).
Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine
'. Cambridge: Cambridge University Press. p. 134.
From these accounts, it is known that the Chinese banned the practice of using smallpox material from patients who actually had the full-blown disease of ''Variola major'' (considered too dangerous); instead they used proxy material of a cotton plug inserted into the nose of a person who had already been inoculated and had only a few scabs, i.e. ''Variola minor''. This was called "to implant the sprouts", an idea of transplanting the disease which fit their conception of beansprouts in
germination Germination is the process by which an organism grows from a seed or spore. The term is applied to the sprouting of a seedling from a seed of an angiosperm or gymnosperm, the growth of a sporeling from a spore, such as the spores of fungi, fer ...
. Needham quotes an account from Zhang Yan's ''Zhongdou Xinshu'' (種痘新書), or ''New book on smallpox inoculation'', written in 1741 during the
Qing dynasty The Qing dynasty ( ), officially the Great Qing,, was a Manchu-led imperial dynasty of China and the last orthodox dynasty in Chinese history. It emerged from the Later Jin dynasty founded by the Jianzhou Jurchens, a Tungusic-speak ...
(1644–1912), which shows how the Chinese process had become refined up until that point:
Method of storing the material. Wrap the scabs carefully in paper and put them into a small container bottle. Cork it tightly so that the activity is not dissipated. The container must not be exposed to sunlight or warmed beside a fire. It is best to carry it for some time on the person so that the scabs dry naturally and slowly. The container should be marked clearly with the date on which the contents were taken from the patient. In winter, the material has ''yang'' potency within it, so it remains active even after being kept from thirty to forty days. But in summer the ''yang'' potency will be lost in approximately twenty days. The best material is that which had not been left too long, for when the ''yang'' potency is abundant it will give a 'take' with nine persons out of ten peopleand finally it becomes completely inactive, and will not work at all. In situations where new scabs are rare and the requirement great, it is possible to mix new scabs with the more aged ones, but in this case more of the powder should be blown into the nostril when the inoculation is done.
Two reports on the Chinese practice were received by the
Royal Society The Royal Society, formally The Royal Society of London for Improving Natural Knowledge, is a learned society and the United Kingdom's national academy of sciences. The society fulfils a number of roles: promoting science and its benefits, re ...
in London in 1700; one by Dr.
Martin Lister Martin Lister FRS (12 April 1639 – 2 February 1712) was an English naturalist and physician. His daughters Anne and Susanna were two of his illustrators and engravers. J. D. Woodley, ‘Lister , Susanna (bap. 1670, d. 1738)’, Oxford Dic ...
who received a report by an employee of the
East India Company The East India Company (EIC) was an English, and later British, joint-stock company founded in 1600 and dissolved in 1874. It was formed to trade in the Indian Ocean region, initially with the East Indies (the Indian subcontinent and Southea ...
stationed in China and another by Clopton Havers. But no action was taken.


Circassia

According to
Voltaire François-Marie Arouet (; 21 November 169430 May 1778) was a French Age of Enlightenment, Enlightenment writer, historian, and philosopher. Known by his ''Pen name, nom de plume'' M. de Voltaire (; also ; ), he was famous for his wit, and his ...
(1742), the Turks derived their use of inoculation from neighboring
Circassia Circassia (; also known as Cherkessia in some sources; ady, Адыгэ Хэку, Адыгей, lit=, translit=Adıgə Xəku, Adıgey; ; ota, چرکسستان, Çerkezistan; ) was a country and a historical region in the along the northeast ...
.
The Circassian women have, from time immemorial, communicated the small-pox to their children when not above six months old by making an incision in the arm, and by putting into this incision a pustule, taken carefully from the body of another child. This pustule produces the same effect in the arm it is laid in as yeast in a piece of dough; it ferments, and diffuses through the whole mass of blood the qualities with which it is impregnated. The pustules of the child in whom the artificial small-pox has been thus inoculated are employed to communicate the same distemper to others. There is an almost perpetual circulation of it in Circassia; and when unhappily the small-pox has quite left the country, the inhabitants of it are in as great trouble and perplexity as other nations when their harvest has fallen short...
Voltaire does not speculate on where the Circassians derived their technique from, though he reports that the Chinese have practiced it "these hundred years". The Turkish practice was presented to the Royal Society in 1714 and 1716, when the physicians Emmanuel Timoni and
Giacomo Pylarini Giacomo Pylarini or Jacobus Pylarinus (Greek: Ιάκωβος Πυλαρινός; 1659–1718) was a Greek physician and consul for the republic of Venice in Smyrna. In 1716 he became the first person to have an account of the practice of inoculati ...
independently sent letters from Istanbul.


India

Inoculation is mentioned in the Ayurvedic text ''Sact'eya Grantham''. The outside world was exposed to it later on, as evidenced by the French scholar Henri Marie Husson, who noted it in the journal '. However, the idea that inoculation originated in India has been also taken in account, as few of the ancient
Sanskrit Sanskrit (; attributively , ; nominally , , ) is a classical language belonging to the Indo-Aryan branch of the Indo-European languages. It arose in South Asia after its predecessor languages had diffused there from the northwest in the late ...
medical texts described the process of inoculation.
Variolation Variolation was the method of inoculation first used to immunize individuals against smallpox (''Variola'') with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result. Var ...
is documented in India from the eighteenth century, thanks to the 1767 account by the Irish-born surgeon
John Zephaniah Holwell John Zephaniah Holwell (17 September 1711 – 5 November 1798) was a surgeon, an employee of the British East India Company, and a temporary Governor of Bengal (1760). He was also one of the first Europeans to study Indian antiquities and was ...
. Holwell's extensive 1767 description included the following, that points to the connection between disease and "multitudes of imperceptible animalculae floating in the atmosphere":
They lay it down as a principle, that the immediate cause of the smallpox exists in the mortal part of every human and animal form; that the mediate (or second) ''acting'' cause, which stirs up the first, and throws it into a state of fermentation, is multitudes of imperceptible animalculae floating in the atmosphere; that these are the cause of all epidemical diseases, but more particularly of the small pox.
Holwell ascribes this account to his Brahman informants. However, such a theory has not yet been discovered in any Sanskrit or vernacular treatise. Several historians have suggested that variolation may be older than the eighteenth century in India, but historical evidence for this assertion is lacking. The widespread rumour since the nineteenth century that
vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
was documented in India before the discoveries of
Edward Jenner Edward Jenner, (17 May 1749 – 26 January 1823) was a British physician and scientist who pioneered the concept of vaccines, and created the smallpox vaccine, the world's first vaccine. The terms ''vaccine'' and ''vaccination'' are derived f ...
can all be traced to propaganda tracts written in Sanskrit and the Indian vernaculars by colonial officers, in the hope of convincing pious Indians to accept the newly discovered Jennerian procedure. A landmark anthropological study by Ralph Nicholas described the mid-twentieth century rituals of appeasement to Śītalā, the Indian goddess of smallpox, in Bengal.


Ethiopia

Early travellers to Ethiopia report that variolation was practiced by the Amhara and
Tigray people Tigrayans ( ti, ተጋሩ) are a Semitic-speaking ethnic group indigenous to the Tigray Region of northern Ethiopia. They speak the Tigrinya language, an Afroasiatic language belonging to the Ethiopian Semitic branch. The daily life of Tigra ...
s. The first European to report this was
Nathaniel Pearce Nathaniel Pearce (14 February 1779 – 12 August 1820) was an explorer who spent many years in Abyssinia (present-day Ethiopia) and wrote a journal of his experiences. Early life Pearce was born in East Acton near London, and was educated at pri ...
, who noted in 1831 that it was performed by a ''
debtera A debtera (or dabtara; Ge'ez/Tigrinya/Amharic: ደብተራ (''Däbtära)''; plural, Ge'ez\Tigrinya: ''debterat'', Amharic: ''debtrawoch'' ) is an itinerant religious figure among the Beta Israel and in the Ethiopian and Eritrean Orthodox Tewahe ...
'' who would collect "a quantity of matter" from a person with the most sores from smallpox, then "cuts a small cross with a razor in the arm" of his subject and puts "a little of the matter" into the cut which was afterwards bound up with a bandage. Subsequent visitors who described this practice included the British traveller
William Cornwallis Harris Major Sir William Cornwallis Harris (baptised 2 April 1807 – died 9 October 1848) was an English military engineer, artist and hunter. Life and career Early life The son of James Harris of Wittersham, Kent, he entered Addiscombe Milita ...
and Dr. Petit of the French scientific mission of 1839–1841.


West Africa

Inoculation against smallpox seems to have been known to West Africans, more specifically the Ga-Adangbe people of Accra. An enslaved African named
Onesimus Onesimus ( grc-gre, Ὀνήσιμος, Onēsimos, meaning "useful"; died , according to Catholic tradition), also called Onesimus of Byzantium and The Holy Apostle Onesimus in the Eastern Orthodox Church, was probably a slave to Philemon of Colo ...
in the
Province of Massachusetts Bay The Province of Massachusetts Bay was a colony in British America which became one of the Thirteen Colonies, thirteen original states of the United States. It was chartered on October 7, 1691, by William III of England, William III and Mary II ...
explained the inoculation procedure to Cotton Mather during the 18th century; he reported to have acquired the knowledge from Africa.


Introduction in Europe and North America

In January 1714 the ''
Philosophical Transactions of the Royal Society ''Philosophical Transactions of the Royal Society'' is a scientific journal published by the Royal Society. In its earliest days, it was a private venture of the Royal Society's secretary. It was established in 1665, making it the first journa ...
'' published an account of a letter John Woodward had received from Emmanuel Timonius in
Istanbul Istanbul ( , ; tr, İstanbul ), formerly known as Constantinople ( grc-gre, Κωνσταντινούπολις; la, Constantinopolis), is the List of largest cities and towns in Turkey, largest city in Turkey, serving as the country's economic, ...
. Smallpox inoculation was advocated as a proven method of curbing the severity of the disease. The practice was introduced to England by
Lady Mary Wortley Montagu Lady Mary Wortley Montagu (née Pierrepont; 15 May 168921 August 1762) was an English aristocrat, writer, and poet. Born in 1689, Lady Mary spent her early life in England. In 1712, Lady Mary married Edward Wortley Montagu, who later served a ...
. Lady Montagu's husband, Edward Wortley Montagu, served as the British ambassador to the
Ottoman Empire The Ottoman Empire, * ; is an archaic version. The definite article forms and were synonymous * and el, Оθωμανική Αυτοκρατορία, Othōmanikē Avtokratoria, label=none * info page on book at Martin Luther University) ...
from 1716 to 1718. She witnessed firsthand the Ottoman use of inoculation in
Istanbul Istanbul ( , ; tr, İstanbul ), formerly known as Constantinople ( grc-gre, Κωνσταντινούπολις; la, Constantinopolis), is the List of largest cities and towns in Turkey, largest city in Turkey, serving as the country's economic, ...
, and was greatly impressed: she had lost a brother to smallpox and bore facial scars from the disease herself. When a smallpox epidemic threatened England in 1721, she called on her physician, Charles Maitland, to inoculate her daughter. She invited friends to see her daughter, including Sir
Hans Sloane Sir Hans Sloane, 1st Baronet (16 April 1660 – 11 January 1753), was an Irish physician, naturalist, and collector, with a collection of 71,000 items which he bequeathed to the British nation, thus providing the foundation of the British Mu ...
, the
King King is the title given to a male monarch in a variety of contexts. The female equivalent is queen, which title is also given to the consort of a king. *In the context of prehistory, antiquity and contemporary indigenous peoples, the tit ...
's physician. Sufficient interest arose that Maitland gained permission to test inoculation at
Newgate Prison Newgate Prison was a prison at the corner of Newgate Street and Old Bailey Street just inside the City of London, England, originally at the site of Newgate, a gate in the Roman London Wall. Built in the 12th century and demolished in 1904, t ...
on six prisoners due to be hanged in exchange for their freedom, an experiment which was witnessed by a number of notable doctors. All survived, 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. The practice is documented in America as early as 1721, when
Zabdiel Boylston Zabdiel Boylston, FRS (March 9, 1679 – March 1, 1766) was a physician in the Boston area. As the first medical school in North America was not founded until 1765, Boylston apprenticed with his father, an English-born surgeon named Thomas Boyls ...
, at the urging of
Cotton Mather Cotton Mather (; February 12, 1663 – February 13, 1728) was a New England Puritan clergyman and a prolific writer. Educated at Harvard College, in 1685 he joined his father Increase as minister of the Congregationalist Old North Meeting H ...
, successfully inoculated two slaves and his own son. Mather, a prominent
Boston Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...
minister, had heard a description of the African practice of inoculation from
Onesimus Onesimus ( grc-gre, Ὀνήσιμος, Onēsimos, meaning "useful"; died , according to Catholic tradition), also called Onesimus of Byzantium and The Holy Apostle Onesimus in the Eastern Orthodox Church, was probably a slave to Philemon of Colo ...
, an enslaved man in his household, in 1706 and later from Timoni's report to the Royal Society. However, Mather had been previously unable to convince local physicians to attempt the procedure. Following this initial success, Boylston began performing inoculations throughout Boston, despite much controversy and at least one attempt upon his life. The effectiveness of the procedure was proven when, of the nearly three hundred people Boylston inoculated during the outbreak, only six died, whereas the mortality rate among those who contracted the disease naturally was one in six. Boylston traveled to London in 1724. There he published his results and was elected to the Royal Society in 1726. In
France France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
, considerable opposition arose to the introduction of inoculation, and it was banned by the Parlement.
Voltaire François-Marie Arouet (; 21 November 169430 May 1778) was a French Age of Enlightenment, Enlightenment writer, historian, and philosopher. Known by his ''Pen name, nom de plume'' M. de Voltaire (; also ; ), he was famous for his wit, and his ...
, in his ''Lettres Philosophiques'', wrote a criticism of his countrymen for being opposed to inoculation and having so little regard for the welfare of their children, concluding that "had inoculation been practised in France it would have saved the lives of thousands." Likewise, in the United States, the
Continental Congress The Continental Congress was a series of legislative bodies, with some executive function, for thirteen of Britain's colonies in North America, and the newly declared United States just before, during, and after the American Revolutionary War. ...
issued a proclamation in 1776 prohibiting Surgeons of the Army from performing inoculations. However, in 1777,
George Washington George Washington (February 22, 1732, 1799) was an American military officer, statesman, and Founding Father who served as the first president of the United States from 1789 to 1797. Appointed by the Continental Congress as commander of th ...
, witnessing the virulent spread of smallpox, and fearing the likelihood of mass transmission of the disease throughout the
Continental Army The Continental Army was the army of the United Colonies (the Thirteen Colonies) in the Revolutionary-era United States. It was formed by the Second Continental Congress after the outbreak of the American Revolutionary War, and was establis ...
, weighed the risks and overruled this prohibition, conducting smallpox inoculation of all troops. He wrote, "Should the disorder infect the Army in the natural way and rage with its usual virulence, we have more to dread from it than from the sword of the enemy." This was the first mass inoculation of an army, and was successful, with only isolated infections occurring, and no regiments incapacitated by the disease. Inoculation grew in popularity in Europe through the 18th century. Given the high prevalence and often severe consequences of smallpox in Europe in the 18th century (according to Voltaire, there was a 60% incidence of first infection, a 20% mortality rate, and a 20% incidence of severe scarring), many parents felt that the benefits of inoculation outweighed the risks and so inoculated their children.


Mechanism

Two forms of the disease of smallpox were recognised, now known to be due to two strains of the
Variola virus Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
. Those contracting ''Variola minor'' had a greatly reduced risk of death – 1–2% – compared to those contracting ''Variola major'' with 30% mortality. Infection via inhaled viral particles in droplets spread the infection more widely than the deliberate infection through a small skin wound. The smaller, localised infection is adequate to stimulate the immune system to produce specific immunity to the virus, while requiring more generations of the virus to reach levels of infection likely to kill the patient. The rising immunity terminates the infection. So the twofold effect is to ensure the less fatal form of the disease is the one caught and to give the immune system the best start possible in combating it. Inoculation in the East was historically performed by blowing smallpox crusts into the nostril. 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. This would generally be performed when an individual was in normal good health, and thus at peak resistance. The recipient would develop smallpox; however, due to being introduced through the skin rather than the lungs, and possibly 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 Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of de ...
. As with survivors of the natural disease, the inoculated individual was subsequently immune to re-infection.


Obsolescence

In 1798, British physician
Edward Jenner Edward Jenner, (17 May 1749 – 26 January 1823) was a British physician and scientist who pioneered the concept of vaccines, and created the smallpox vaccine, the world's first vaccine. The terms ''vaccine'' and ''vaccination'' are derived f ...
published the results of his experiments and thus introduced the far superior and safer method of inoculation with
cowpox Cowpox is an infectious disease caused by the ''cowpox virus'' (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more ...
virus, a mild infection that also induced
immunity Immunity may refer to: Medicine * Immunity (medical), resistance of an organism to infection or disease * ''Immunity'' (journal), a scientific journal published by Cell Press Biology * Immune system Engineering * Radiofrequence immunity desc ...
to
smallpox Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
. Jenner was not the first person to inoculate with cowpox, nor the first to realize that infection with cowpox gave immunity to smallpox. However, he was the first to publish evidence that it was effective, and to provide advice on its production. His efforts led to smallpox inoculation falling into disuse, and eventually being banned in England in 1840.


See also

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Psychological resilience Psychological resilience is the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly. The term was coined in the 1970s by a psychologist named Emmy E. Werner as she conducted a forty year long study o ...
(also known as ''stress inoculation'')


References


Further reading

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External links


US National Library of Medicine
{{Vaccines Immunology Smallpox vaccines Chinese inventions Smallpox