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Variolation
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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. Only 1–2% of those variolated died from the intentional infection compared to 30% who contracted smallpox naturally. Variolation is no longer used today. It was replaced by the smallpox vaccine, a safer alternative. This in turn led to the development of the many vaccines now available against other diseases.
The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. The virus was normally spread through the air, infecting first the mouth, nose, or respiratory tract, before spreading throughout the body via the lymphatic system. In contrast, infection of the skin usually led to a milder, localized infection, but, crucially, still induced immunity to the virus. The patient would develop pustules like those caused by naturally acquired smallpox. Eventually, after about two to four weeks, these symptoms would subside, indicating successful recovery and immunity.[citation needed]
The method was first used in China, India, parts of Africa and the Middle East before it was introduced into England and North America in the 1720s in the face of some opposition. However, inoculation had been reported in Wales since the early 17th century.
The terminology used to describe the prevention of smallpox can cause confusion. In 18th-century medical terminology, inoculation refers to smallpox inoculation. Confusion is caused by writers who interchange variolation and vaccination through either mistranslation or misinterpretation. The term variolation refers solely to inoculation with smallpox virus and is related to but not interchangeable with vaccination. The latter term was first used in 1800 soon after Edward Jenner introduced 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. Most modern writers tend to refer to smallpox inoculation as variolation throughout without regard for chronology, as is used here. Further confusion was caused when, in 1891, Louis Pasteur honoured Jenner by widening the terms vaccine/vaccination to refer to the artificial induction of immunity against any infectious disease. Inoculation refers to intentionally exposing an individual to a virus, bacterium, other pathogen, or artificial vaccine that may induce active immunity, and inoculation can be done by any suitable route of administration. Many familiar vaccines are injected intramuscularly or swallowed.[citation needed]
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).
The Chinese practiced the oldest documented use of variolation, dating back to the 16th century, and according to some sources the 11th century. They implemented a method of "nasal insufflation" administered by blowing powdered smallpox material, usually scabs, up the nostrils. Various insufflation techniques have been recorded throughout the 16th and 17th centuries within China, most notably by Wan Quan. British sinologist Joseph Needham gives a date of the first variolation being dated to between 1567 and 1572. According to such documentation, mild smallpox cases were selected as donors in order to prevent serious attack. The technique used scabs that had been left to dry out for some time. Fresh scabs were more likely to lead to a full-blown infection. Three or four scabs were ground into powder or mixed with a grain of musk and bound in cotton. Infected material was then packed into a pipe and puffed up the patient's nostril. The practice of variolation is believed to have been ritualized by the Chinese. The blowpipe used during the procedure was made of silver. The right nostril was used for boys and the left for girls. Variolated cases were treated as if they were as infectious as those who had acquired the disease naturally. These patients were subsequently kept apart from others until the rash had cleared.
In the 18th century, two schools of inoculation developed, the Sung-chiang school used scabs from patients of only the mildest cases, while the Hu-chou school did not; the imperial editors of the Yuzuan yizong jinjian tended to favor the latter school. The practice of using scabs from epidemic patients was seen as beneficial by some, but others were convinced of its danger; the Kangxi Emperor approved of it and inoculated both his children and his regular troops. Two reports on the Chinese practice were received by the Royal Society in London in 1700; one by Dr. Martin Lister who received a report by an employee of the East India Company stationed in China, and another by the physician Clopton Havers, but no action was taken.
India has been suggested as another possible origin. There are two accounts from the 18th century of inoculations being performed by itinerant Brahmins: Oliver Coult wrote in 1731 that it had been "first performed by Dununtary a physician of Champanagar" about 150 years before that time (Dhanvantari being the name of the Hindu God of medicine, and a common name among physicians). In 1768, John Zephaniah Holwell wrote of its being practiced for many hundreds of years. Aspects of these accounts have been called into question, but by 1768, inoculation was reportedly being practiced in Bengal. The doctors who performed this procedure were known as Tikadars. The term tika is still in use now to mean 'vaccination' in many Indian languages. 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 18th century in India. However, these reports have been disputed. The original ancient text describing this method has not been found. A 2012 paper argued that "since the claim that it was an ancient practice in India has been rejected, there is no reason to assume that it began there". The idea that inoculation originated in India has also been taken into account, although there is little evidence in ancient Sanskrit medical texts clearly describing the practice. The rumor that vaccination was documented in India before the discoveries of Edward Jenner, widespread since the nineteenth century, can be traced to propaganda tracts written in Sanskrit and the Indian vernaculars by colonial officers, designed to convince pious Indians to accept the newly discovered Jennerian procedure and abandon older variolation practices.
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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. Only 1–2% of those variolated died from the intentional infection compared to 30% who contracted smallpox naturally. Variolation is no longer used today. It was replaced by the smallpox vaccine, a safer alternative. This in turn led to the development of the many vaccines now available against other diseases.
The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. The virus was normally spread through the air, infecting first the mouth, nose, or respiratory tract, before spreading throughout the body via the lymphatic system. In contrast, infection of the skin usually led to a milder, localized infection, but, crucially, still induced immunity to the virus. The patient would develop pustules like those caused by naturally acquired smallpox. Eventually, after about two to four weeks, these symptoms would subside, indicating successful recovery and immunity.[citation needed]
The method was first used in China, India, parts of Africa and the Middle East before it was introduced into England and North America in the 1720s in the face of some opposition. However, inoculation had been reported in Wales since the early 17th century.
The terminology used to describe the prevention of smallpox can cause confusion. In 18th-century medical terminology, inoculation refers to smallpox inoculation. Confusion is caused by writers who interchange variolation and vaccination through either mistranslation or misinterpretation. The term variolation refers solely to inoculation with smallpox virus and is related to but not interchangeable with vaccination. The latter term was first used in 1800 soon after Edward Jenner introduced 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. Most modern writers tend to refer to smallpox inoculation as variolation throughout without regard for chronology, as is used here. Further confusion was caused when, in 1891, Louis Pasteur honoured Jenner by widening the terms vaccine/vaccination to refer to the artificial induction of immunity against any infectious disease. Inoculation refers to intentionally exposing an individual to a virus, bacterium, other pathogen, or artificial vaccine that may induce active immunity, and inoculation can be done by any suitable route of administration. Many familiar vaccines are injected intramuscularly or swallowed.[citation needed]
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).
The Chinese practiced the oldest documented use of variolation, dating back to the 16th century, and according to some sources the 11th century. They implemented a method of "nasal insufflation" administered by blowing powdered smallpox material, usually scabs, up the nostrils. Various insufflation techniques have been recorded throughout the 16th and 17th centuries within China, most notably by Wan Quan. British sinologist Joseph Needham gives a date of the first variolation being dated to between 1567 and 1572. According to such documentation, mild smallpox cases were selected as donors in order to prevent serious attack. The technique used scabs that had been left to dry out for some time. Fresh scabs were more likely to lead to a full-blown infection. Three or four scabs were ground into powder or mixed with a grain of musk and bound in cotton. Infected material was then packed into a pipe and puffed up the patient's nostril. The practice of variolation is believed to have been ritualized by the Chinese. The blowpipe used during the procedure was made of silver. The right nostril was used for boys and the left for girls. Variolated cases were treated as if they were as infectious as those who had acquired the disease naturally. These patients were subsequently kept apart from others until the rash had cleared.
In the 18th century, two schools of inoculation developed, the Sung-chiang school used scabs from patients of only the mildest cases, while the Hu-chou school did not; the imperial editors of the Yuzuan yizong jinjian tended to favor the latter school. The practice of using scabs from epidemic patients was seen as beneficial by some, but others were convinced of its danger; the Kangxi Emperor approved of it and inoculated both his children and his regular troops. Two reports on the Chinese practice were received by the Royal Society in London in 1700; one by Dr. Martin Lister who received a report by an employee of the East India Company stationed in China, and another by the physician Clopton Havers, but no action was taken.
India has been suggested as another possible origin. There are two accounts from the 18th century of inoculations being performed by itinerant Brahmins: Oliver Coult wrote in 1731 that it had been "first performed by Dununtary a physician of Champanagar" about 150 years before that time (Dhanvantari being the name of the Hindu God of medicine, and a common name among physicians). In 1768, John Zephaniah Holwell wrote of its being practiced for many hundreds of years. Aspects of these accounts have been called into question, but by 1768, inoculation was reportedly being practiced in Bengal. The doctors who performed this procedure were known as Tikadars. The term tika is still in use now to mean 'vaccination' in many Indian languages. 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 18th century in India. However, these reports have been disputed. The original ancient text describing this method has not been found. A 2012 paper argued that "since the claim that it was an ancient practice in India has been rejected, there is no reason to assume that it began there". The idea that inoculation originated in India has also been taken into account, although there is little evidence in ancient Sanskrit medical texts clearly describing the practice. The rumor that vaccination was documented in India before the discoveries of Edward Jenner, widespread since the nineteenth century, can be traced to propaganda tracts written in Sanskrit and the Indian vernaculars by colonial officers, designed to convince pious Indians to accept the newly discovered Jennerian procedure and abandon older variolation practices.