THE DEVELOPMENT OF VACCINATION
The smallpox vaccine proved its mettle by eradicating the disease from the world
The noose was waiting for the six criminals being held in Newgate prison in 1722. Understandably, they jumped at the chance of being pardoned and released if they would take part in an experiment. Through a scratch on their arm, they would be inoculated with pus from the scabs of a smallpox victim and would later be exposed to the disease to see whether they had developed any immunity.
Dr. Charles Maitland had been granted a Royal Licence to perform the experiment at the urging of Caroline of Ansbach, then Princess of Wales. A year earlier, Caroline, along with three physicians, had been impressed as Maitland performed the procedure on the four-year-old daughter of Lady Mary Montagu, who had recently returned from Turkey, where she had spent several years as the wife of the British ambassador.
In Constantinople, Montagu had learned about the ancient practice of “ingrafting” to prevent smallpox. She famously described this in a letter to a friend in 1717. “The old woman comes with a nut-shell full of the matter of the best sort of smallpox, and asks what veins you please to have opened, and with a large needle puts into the vein as much venom as can lie upon the head of her needle; there is no example of anyone that has died.”
Montagu, who had been left with a severe case of facial scarring after having survived smallpox herself, was so taken by the possibility of preventing the disease that while still in Constantinople, she'd had her son inoculated under the supervision of Maitland, who had then been serving as physician at the British Embassy. The boy had no significant after effects, and upon their return to England, both Mary and Maitland became enthusiastic supporters of “ingrafting.” It was their advocacy that led to the Newgate experiment, in which all the prisoners survived.
Princess Caroline then suggested that six orphan children be given the same treatment as a further test, and the results were so satisfactory that Caroline had her children inoculated against smallpox. The royal family went on to promote the procedure throughout England.
In America, the practice of infecting a person with an exudate from a patient with a mild form of smallpox was introduced by Dr. Zabdiel Boylston, prompted by an outbreak of smallpox in Boston in 1721. He was convinced to try the procedure by Puritan minister Cotton Mather, who in turn had learned about it from his slave, Onesimus, who had been inoculated in Africa. Boylston's approach was not well received, with some opponents invoking Jesus's statement in the Bible that “It is not the healthy who need a doctor, but the sick.” There were even threats on the doctor's life, forcing him to visit his patients in disguise. But Boylston and Mather confronted the hostility with science. They collected information about the number of smallpox cases and showed that inoculation dropped the death rate significantly. After this, resistance faded, but did not disappear.
The idea of ingrafting traces back to the 10th century in China, where physicians introduced the practice of blowing dust made from the dried scabs of smallpox victims up the nose of healthy people. This was prompted by the observation that an individual who had survived smallpox did not contract the disease again. The process, and the ingrafting later introduced by the Turks, triggered, at least in most cases, a mild form of smallpox that resulted in immunity against the disease.
Today, we know smallpox is a viral disease and that exposure to a limited amount of virus prompts the body to form antibodies that destroy the virus on any subsequent exposure. Ingrafting was not risk-free. Some people did develop a serious case of smallpox, and even those who had only mild symptoms were still able to infect others, even though they went on to develop immunity. The treatment eventually faded when Edward Jenner, who himself as a boy had been subjected to ingrafting, discovered that inoculation with extracts of pustules from people who had contracted cowpox, a milder viral disease, offered safer and more effective protection against smallpox. Jenner's “vaccination” from the Latin for “cow” met with opposition, but eventually the smallpox vaccine proved its mettle by eradicating the disease from the world.
Once it was discovered that smallpox was a viral disease, and the virus responsible named “variola” from the Latin for “pox or pustule,” the process that had been referred to as “inoculation” or “ingrafting” was retroactively renamed “variolation.” Today, this term is being bandied about in conjunction with COVID-19 with some researchers proposing that the wearing of face masks is a form of variolation that may lead to a less severe form of the disease.
The argument is that a mask reduces the number of viral particles that may be inhaled to an extent that any disease triggered would be mild and likely asymptomatic. The case is bolstered with reference to a cruise ship where everyone was masked, and although there were some infections, 81 per cent of these were asymptomatic as compared with 20 per cent in cruise ship outbreaks without universal masking. While variolation via masking may be a tenuous contention, if it helps convince some people about the benefits of wearing masks, it is welcome. Of course, as we have seen for ingrafting and vaccination, masking meets opposition in spite of all the evidence that science can muster.