Vaccination versus variolation

DEAR DR. ROACH >> I recently watched a TV program about vaccines. I’ve always thought that vaccines dated to Jenner and his cowpox vaccine. The program pointed out that before Jenner started experimenting, some countries (the program mentioned Africa, India and China) had a tradition of cutting the arm of a healthy person and then smearing the cut with material from the sores of a person infected by smallpox. The healthy person would then contract smallpox but had milder symptoms, and the death rate was reduced by something like 90%.

Why the difference? With my medical background from watching hours of “General Hospital” during college, I would think that introducing the smallpox virus into a person through variolation wouldn’t have much of a different effect than catching it from an infected person. I was wondering if you could provide an answer.

— J.N.

DEAR READER >> This is indeed the history of smallpox prevention prior to vaccination, which was developed by Edward Jenner in 1796. Variolation (the name comes from “variola,” the Latin name for smallpox) uses infectious particles from a person with smallpox to deliberately infect another person, usually with a needle

— although in Asia and Africa, the dried smallpox scabs were sometimes blown into the nose. It’s critical to recall that variolation always had risks. Many people died, including two of the sons of King George III. The risk of death from variolation could be reduced by using a person with a very mild case of smallpox as the source of the virus; sometimes the material was treated with steam or herbs, reducing the number of virus particles and making the process safer — but never completely safe. The death rate from variolation was estimated to be 1% to 2%, compared with 15% to 30% from smallpox.

Jenner knew the common belief that dairy maids almost never got smallpox and hypothesized that the related disease cowpox might protect a person. Having found a dairymaid with active cowpox, he inoculated an 8-year-old boy, who got mildly sick nine days after inoculation. Two months later, an inoculation of smallpox into the boy produced no disease. Inoculation of cowpox proved to be effective. The Latin name for cow is “vacca,” so Jenner named his process “vaccination,” and by 1800, vaccination, which was much safer than variolation, had spread to many European countries, and to the United States, where President Thomas Jefferson set up a national vaccination program. Learning from informational shows about vaccines is great. I’m not so sure about the medical accuracy of “General Hospital.”

DEAR DR. ROACH >> I’ve had morning stiffness and a clicking sensation in my ring finger for about six weeks, which was diagnosed during my annual physical today as trigger finger. The ring finger is not painful, there is no nodule in the palm, and it doesn’t lock up. I’ve read about three treatments: steroid injection, percutaneous release with a needle and surgery. My symptoms are so slight that I feel silly going to a hand surgeon now. I’m a healthy 74-year-old woman, not diabetic. Will this inevitably get worse, and if yes, will an injection now, in the early onset stage, help to avoid surgery down the road?

— M.W.

DEAR READER >> It will not necessarily get worse, and surgery is by no means always required. Wearing a splint for three to six weeks may be all that’s needed to solve the problem, but an injection can be given if the locking persists. Anti-inflammatory medications can help if pain develops. Occasionally, the injection needs to be repeated, but only rarely have I sent a patient for surgery.