Editing Smallpox vaccine (section)

===Variolation===
{{Main|Variolation}}
The mortality of the severe form of smallpox – ''variola major'' – was very high without vaccination, up to 35% in some outbreaks.<ref name=Sherris>{{cite book | veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | url = https://archive.org/details/sherrismedicalmi00ryan | url-access = limited | edition = 4th | pages = [https://archive.org/details/sherrismedicalmi00ryan/page/n542 525]–28 | publisher = McGraw Hill | year = 2004 |isbn = 978-0-8385-8529-0 }}</ref> A method of [[Artificial induction of immunity|inducing immunity]] known as inoculation, [[wikt:insufflation|insufflation]] or "[[variolation]]" was practiced before the development of a modern vaccine and likely occurred in Africa and China well before the practice arrived in Europe.<ref name="riedel2005">{{cite journal | vauthors = Riedel S | title = Edward Jenner and the history of smallpox and vaccination | journal = Proceedings | volume = 18 | issue = 1 | pages = 21–25 | date = January 2005 | pmid = 16200144 | pmc = 1200696 | doi = 10.1080/08998280.2005.11928028 }}</ref> It may also have occurred in India, but this is disputed; other investigators contend the ancient [[Sanskrit]] medical texts of India do not describe these techniques.<ref name="riedel2005"/><ref>{{cite book | vauthors = Van Alphen J, Aris A | year=1995 | chapter=Medicine in India | title=Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing | pages= 19–38 | location=London | publisher=Serindia Publications | isbn=978-0-906026-36-6}}</ref> The first clear reference to smallpox inoculation was made by the Chinese author [[Wan Quan]] (1499–1582) in his ''Douzhen xinfa'' (痘疹心法) published in 1549.<ref>{{cite book | vauthors = Needham J| year=1999 | title=Science and Civilization in China: Volume 6, Biology and Biological Technology | chapter= Part 6, Medicine | location=Cambridge|publisher= Cambridge University Press | page=134}}</ref> Inoculation for smallpox does not appear to have been widespread in China until the reign era of the [[Longqing Emperor]] (r. 1567–1572) during the [[Ming Dynasty]].<ref>{{cite book | vauthors = Temple R | year=1986 | title=The Genius of China: 3,000 Years of Science, Discovery, and Invention | location=New York | publisher= Simon and Schuster | isbn=978-0-671-62028-8| page=137}}</ref> In China, powdered smallpox scabs were blown up the noses of the healthy. The patients would then develop a mild case of the disease and from then on were immune to it. The technique did have a 0.5–2.0% mortality rate, but that was considerably less than the 20–30% mortality rate of the disease itself. Two reports on the Chinese practice of [[inoculation]] 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 [[Clopton Havers]].<ref>{{cite book|title=A History of Immunology|vauthors=Silverstein AM|page=293|publisher=Academic Press|year=2009|edition=2nd|url=https://books.google.com/books?id=2xNYjigte14C|isbn=9780080919461|access-date=6 July 2017|archive-date=3 August 2020|archive-url=https://web.archive.org/web/20200803070343/https://books.google.com/books?id=2xNYjigte14C|url-status=live}}.</ref> According to [[Voltaire]] (1742), the Turks derived their use of inoculation from neighbouring [[Circassia]]. Voltaire does not speculate on where the Circassians derived their technique from, though he reports that the Chinese have practiced it "these hundred years".<ref>{{cite book|author=Voltaire|year=1742|title=Letters on the English|chapter=Letter XI|chapter-url=http://www.bartleby.com/34/2/11.html|access-date=6 July 2017|archive-date=16 October 2018|archive-url=https://web.archive.org/web/20181016221306/https://www.bartleby.com/34/2/11.html|url-status=live}}</ref>

Variolation was also practiced throughout the latter half of the 17th century by physicians in [[Turkey]], [[Persia]], and Africa. In 1714 and 1716, two reports of the [[Ottoman Empire]] Turkish method of inoculation were made to the [[Royal Society]] in England, by [[Emmanuel Timoni]], a doctor affiliated with the British Embassy in [[Istanbul|Constantinople]],<ref name=Behbehani_1983>{{cite journal | vauthors = Behbehani AM | title = The smallpox story: life and death of an old disease | journal = Microbiological Reviews | volume = 47 | issue = 4 | pages = 455–509 | date = December 1983 | pmid = 6319980 | pmc = 281588 | doi = 10.1128/MMBR.47.4.455-509.1983 }}</ref> and [[Giacomo Pylarini]]. Source material tells us on Lady Mary Wortley Montagu; "When Lady Mary was in the Ottoman Empire, she discovered the local practice of inoculation against smallpox called variolation."<ref>{{cite journal | title = Smallpox inoculation and the Ottoman contribution: A Brief Historiography | vauthors = Aboul-Enein BH, Ross MW, Aboul-Enein FH | year = 2012 | journal = Texas Public Health Journal | volume = 64 | issue = 1 | page = 12 | url = https://cdn.ymaws.com/www.texaspha.org/resource/resmgr/docs/Journal_Files/TPHJ_Volume_64_Issue_1.pdf | access-date = 23 December 2018 | archive-date = 11 October 2021 | archive-url = https://web.archive.org/web/20211011061111/https://cdn.ymaws.com/www.texaspha.org/resource/resmgr/docs/Journal_Files/TPHJ_Volume_64_Issue_1.pdf | url-status = live }}</ref> In 1718 she had her son, aged five variolated. He recovered quickly. She returned to London and had her daughter variolated in 1721 by [[Charles Maitland (physician)|Charles Maitland]], during an epidemic of smallpox. This encouraged the [[British Royal Family]] to take an interest and a trial of variolation was carried out on prisoners in [[Newgate Prison]]. This was successful and in 1722 [[Caroline of Ansbach]], the Princess of Wales, allowed Maitland to vaccinate her children.<ref>Livingstone, N. 2015. ''The Mistresses of Cliveden. Three centuries of scandal, power and intrigue'' (p. 229)</ref> The success of these variolations assured the British people that the procedure was safe.<ref name=Behbehani_1983 />

{{quote box|align=right|width=40em|salign=right|...scarred the wrists, legs, and forehead of the patient, placed a fresh and kindly pock in each incision and bound it there for eight or ten days, after this time the patient was credibly informed. The patient would then develop a mild case [of smallpox], recover, and thereafter be immune.<ref>{{cite book | vauthors = Kennedy P | title = An Essay on External Remedies Wherein it is Considered, Whether all the curable Distempers incident to Human Bodies, may not be cured by Outward Means | year = 1715 | publisher = A. Bell | location = London }}</ref>|—Dr. Peter Kennedy}}

Stimulated by a severe epidemic, variolation was first employed in North America in 1721. The procedure had been known in Boston since 1706, when preacher [[Cotton Mather]] learned it from [[Onesimus (Boston slave)|Onesimus]], a man he held as a slave, who – like many of his peers – had been inoculated in Africa before they were kidnapped.<ref name=Willoughby_2004>{{cite web | title= Black History Month II: Why Wasn't I Taught That? | vauthors = Willoughby B | work=Tolerance in the News | url=http://www.tolerance.org/news/article_tol.jsp?id=942 | date=12 February 2004| access-date=4 December 2008|archive-url=https://web.archive.org/web/20090114071421/http://www.tolerance.org/news/article_tol.jsp?id=942|archive-date=14 January 2009}}</ref> This practice was widely criticized at first.<ref>{{cite web | title = Open Collections Program: Contagion, The Boston Smallpox Epidemic, 1721 | access-date = 27 August 2008 | url = http://ocp.hul.harvard.edu/contagion/smallpox.html | archive-date = 26 July 2018 | archive-url = https://web.archive.org/web/20180726145425/http://ocp.hul.harvard.edu/contagion/smallpox.html | url-status = live }}</ref> However, a limited trial showed six deaths occurred out of 244 who were variolated (2.5%), while 844 out of 5980 died of natural disease (14%), and the process was widely adopted throughout the colonies.<ref name = "Fenner_1988">{{cite book |vauthors=Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID |title=Smallpox and Its Eradication |series=History of International Public Health |issue=6 |publisher=[[World Health Organization]] (WHO) |location=Geneva |year=1988 |isbn=978-92-4-156110-5 | hdl=10665/39485 | hdl-access=free |url=https://apps.who.int/iris/bitstream/handle/10665/39485/9241561106.pdf |access-date=5 November 2013 |archive-date=25 May 2021 |archive-url=https://web.archive.org/web/20210525012647/http://apps.who.int/iris/bitstream/handle/10665/39485/9241561106.pdf |url-status=live }}</ref><!-- By 1777, [[George Washington]], who initially hesitated to have his [[American Revolutionary War|Revolutionary War]] troops inoculated during a smallpox outbreak, wrote, "should We inoculate generally, the Enemy, knowing it, will certainly take Advantage of our Situation;", and eventually ordered mandatory inoculation of all troops and recruits who had not had the disease.<ref>{{cite book |vauthors=Grizzard FE, Washington G, Chase PD, Twohig D |title= George Washington to Major General Horatio Gates, 5–6 February 1777. In: The papers of George Washington |publisher=University Press of Virginia |location=Charlottesville |year=1985 |volume=8 |isbn=0-8139-1787-5}}</ref>{{Clarify|date=July 2012}} INFO COMMENTED OUT : SEE TALK -->

The inoculation technique was documented as having a mortality rate of only one in a thousand. Two years after Kennedy's description appeared, March 1718, Dr. [[Charles Maitland (physician)|Charles Maitland]] successfully inoculated the five-year-old son of the British ambassador to the Turkish court under orders from the ambassador's wife [[Lady Mary Wortley Montagu]], who four years later introduced the practice to England.<ref>{{cite book | vauthors = Robertson P | title = The book of firsts | publisher = C. N. Potter : distributed by Crown Publishers | location = New York | year = 1974 | isbn = 978-0-517-51577-8 | url-access = registration | url = https://archive.org/details/bookoffirsts00robe }}</ref>

An account from letter by Lady [[Mary Wortley Montagu]] to Sarah Chiswell, dated 1 April 1717, from the Turkish Embassy describes this treatment:
{{blockquote|The small-pox so fatal and so general amongst us is here entirely harmless by the invention of ingrafting (which is the term they give it). There is a set of old women who make it their business to perform the operation. Every autumn in the month of September, when the great heat is abated, people send to one another to know if any of their family has a mind to have the small-pox. They make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nutshell full of the matter of the best sort of small-pox and asks what veins you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much venom as can lye upon the head of her needle, and after binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins. ... The children or young patients play together all the rest of the day and are in perfect health till the eighth. Then the fever begins to seize them and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty in their faces, which never mark, and in eight days time they are as well as before the illness. ... There is no example of any one that has died in it, and you may believe I am very well satisfied of the safety of the experiment since I intend to try it on my dear little son. I am patriot enough to take pains to bring this useful invention into fashion in England, and I should not fail to write to some of our doctors very particularly about it if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind, but that distemper is too beneficial to them not to expose to all their resentment the hardy wight that should undertake to put an end to it. Perhaps if I live to return I may, however, have courage to war with them.<ref>{{cite web |url=http://www.ic.arizona.edu/ic/mcbride/ws200/montltrs.htm |title=Montagu, Turkish Embassy Letters |access-date=4 December 2008 |archive-date=15 April 2013 |archive-url=https://web.archive.org/web/20130415065402/http://www.ic.arizona.edu/ic/mcbride/ws200/montltrs.htm |url-status=live }}</ref>}}