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Sunday 27 January 2019

Variolation

Variolation is a method of inoculation against smallpox by deliberately causing a mild case of smallpox using material from a person with the same disease. (Variola is the medical name for smallpox.)

Variolation was first used in China in the fifteenth century. They implemented a method of "nasal insufflation" administered by blowing powdered smallpox material, usually scabs, up the nostrils. Variolation spread to the Ottoman Empire around 1670.

Lady Mary Wortley Montagu was the beautiful wife of Edward Montagu, the British ambassador to Turkey from 1716 to 1718. She contracted smallpox, which pockmarked her face, and as a result she became interested in the inoculation methods that the Turks used to deal with the disease. While there, she had the practice conducted on her five-year-old son, Edward Montagu. On her return to England, Lady Montagu had her four-year-old daughter inoculated in the presence of physicians of the royal court in 1721. Both variolations proved successful.

Lady Montagu in Turkish dress.

The following year, Caroline  of Ansbach, the  wife of King George II, no doubt alarmed by the prevalence of smallpox in London at the time, trialed six prisoners with variolation in return for commuting their death sentences. When this was successful, she inoculated her own children, popularising the process.

Variolation became a common procedure once it was observed how smallpox deaths in London amongst those who had been inoculated were a great deal less frequent than amongst those who had not been inoculated.

France was the last European country to embrace variolation. It was not until an outbreak of smallpox in Paris in 1752 nearly killed the heir to the French throne that the public embraced the practice after seeing the prince variolated. However, after an epidemic was traced back to an inoculation, variolation was banned within city limits. These conditions caused physicians to move just outside the cities and continue to practice variolation in the suburbs.

At the turn of the 18th century, African tribes were already carrying out variolation by means of the tribal doctor who would transfer fluid from the smallpox spots of an infected person to a non-infected person. Meanwhile in Massachusetts, the Reverend Cotton Mather, a Puritan minister who was interested in science was told about variolation in 1706 by his African slave Onesimus. He applied the technique to a son and several servants, thus becoming the first person in North America to practice inoculation.

Opponents to this method were concerned it would cause the rapid spread of smallpox and after Mather inoculated his own son, a bomb was thrown through his window.

George Washington the commander in chief of the continental army during the War of Independence had his entire army inoculated in 1777, a controversial decision, as few doctors at the time believed in variolation.


The term variolation refers solely to inoculation with smallpox virus. The latter term was first used in 1800 soon after Edward Jenner introduced the smallpox vaccine derived from cowpox, an animal disease distinct from smallpox. The term variolation was then used from the 19th century to avoid confusion with vaccination.

Edward Jenner's cowpox had a very low death rate and was also more effective than variolation. Also, unlike a variolated person, a vaccinated person could not spread smallpox to others. Moreover, his vaccine seldom left a rash.

Below are Watercolour drawings showing variolation on versos and cowpox inoculation (vaccination) on fourteenth day smallpox (left) and cowpox (right).


Variolation began to be replaced by this new vaccine, and was eventually outlawed in England in 1840.

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