Array ( [0] => {{short description|Method of inducing immunity against disease}} [1] => {{for multi|the metallurgical strengthening process|Grain refinement|the communication and psychological theory|Inoculation theory}} [2] => {{Redirect|Inoculator|the EP|Inoculator (EP){{!}}''Inoculator'' (EP)}} [3] => {{lead too short|date=April 2020}} [4] => '''Inoculation''' is the act of implanting a pathogen or other [[microbe]] or [[virus]] into a person or other organism. It is a method of [[artificial induction of immunity|artificially inducing immunity]] against various [[infectious disease]]s. The term "inoculation" is also used more generally to refer to intentionally depositing microbes into any [[growth medium]], as into a [[Petri dish]] used to [[Microbiological culture|culture]] the microbe, or into food ingredients for making cultured foods such as [[yoghurt]] and [[fermentation|fermented]] beverages such as beer and wine. This article is primarily about the use of inoculation for producing [[immunization|immunity]] against [[infection]]. Inoculation has been used to [[Eradication of infectious diseases|eradicate]] [[smallpox]] and to markedly reduce other infectious diseases such as [[polio]]. Although the terms "inoculation", "[[vaccination]]", and "immunization" are often used interchangeably, there are important differences. Inoculation is the act of implanting a pathogen or microbe into a person or other recipient; vaccination is the act of implanting or giving someone a [[vaccine]] specifically; and immunization is the development of disease resistance that results from the [[immune system]]'s response to a vaccine or natural infection. [5] => [6] => ==Terminology== [7] => Until the early 1800s inoculation referred only to [[variolation]] (from the Latin word ''variola'' = smallpox), the predecessor to the [[smallpox vaccine]].{{Cite web |title=Pox Britannica |url=https://archive.nytimes.com/www.nytimes.com/library/magazine/millennium/m1/groopman.html |access-date=2022-04-23 |website=archive.nytimes.com |archive-date=2022-04-23 |archive-url=https://web.archive.org/web/20220423175705/https://archive.nytimes.com/www.nytimes.com/library/magazine/millennium/m1/groopman.html |url-status=live }} The smallpox vaccine, introduced by [[Edward Jenner]] in 1796, was called [[cowpox]] inoculation or vaccine inoculation (from Latin ''vacca'' = cow). Smallpox inoculation continued to be called variolation, whereas cowpox inoculation was called vaccination (from Jenner's term ''variolae vaccinae'' = smallpox of the cow). [[Louis Pasteur]] proposed in 1861 to extend the terms [[vaccine]] and vaccination to include the new protective procedures being developed. Immunization refers to the use of vaccines as well as the use of [[antitoxin]], which contains pre-formed [[antibodies]] such as to [[diphtheria]] or [[tetanus]] [[exotoxin]]s.{{Cite web |date=2022-03-15 |title=ACIP Appx 1: Glossary for Guidelines for Immunization {{!}} CDC |url=https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/glossary.html |access-date=2022-04-23 |website=www.cdc.gov |language=en-us |archive-date=2022-04-23 |archive-url=https://web.archive.org/web/20220423181558/https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/glossary.html |url-status=live }} In nontechnical usage inoculation is now more or less synonymous with protective injections and other methods of immunization.{{cn|date=October 2022}} [8] => [9] => Inoculation also has a specific meaning for procedures done ''[[in vitro]]'' (in glass, i.e. not in a living body). These include the transfer of [[microorganism]]s into and from laboratory apparatus such as test tubes and [[petri dish]]es in research and diagnostic laboratories, and also in commercial applications such as brewing, baking, oenology (wine making), and the production of [[antibiotics]]. For example, [[blue cheese]] is made by inoculating it with ''[[Penicillium roqueforti]]'' mold, and often certain bacteria.{{Cite web |title=Guidance for Industry: Characterization and Qualification of Cell Substrates and Other Biological Materials Used in the Production of Viral Vaccines for Infectious Disease Indications {{!}} FDA |website=www.fda.gov |url=https://www.fda.gov/media/78428/download |access-date=2022-10-10 |archive-date=2022-10-06 |archive-url=https://web.archive.org/web/20221006193339/http://www.fda.gov/media/78428/download |url-status=live }}{{failed verification |date=October 2022 |reason=No mention of "cheese" in the document. I checked all the cites currently in the "Blue cheese" article regarding this, in hopes of finding a replacement, but none of the open-access ones establish *inoculation* (and I don't have access to the rest).}} [10] => [11] => == Etymology == [12] => The term [[:wikt:inoculate#English|''inoculate'']] entered medical English through horticultural usage meaning [[grafting|to graft]] a bud from one plant into another. It derives from Latin ''in-'' 'in' + ''oculus'' 'eye' (and by [[metaphor]], 'bud').{{cite web|title=Inoculate|url=http://www.thefreedictionary.com/Inoculate|publisher=The Free Dictionary|access-date=12 April 2014|archive-date=12 October 2019|archive-url=https://web.archive.org/web/20191012183048/https://www.thefreedictionary.com/inoculate|url-status=live}} (The term [[:wikt:innocuous#English|''innocuous'']] is unrelated, as it derives from Latin ''in-'' 'not' + ''nocuus'' 'harmful'.) [13] => [14] => == Origins == [15] => {{main|Variolation}} [16] => {{Further|Vaccine#History|Vaccination#History}} [17] => Inoculation originated as a method for the prevention of [[smallpox]] by deliberate introduction of material from smallpox pustules from one person into the skin of another. The usual route of transmission of smallpox was through the air, invading the [[mucous membrane]]s of the mouth, nose, or respiratory tract, before migrating throughout the body via the [[lymphatic system]], resulting in an often severe disease.{{cn|date=October 2022}} [18] => [19] => In contrast, infection of the skin usually led to a milder, localized infection{{snd}}but, crucially, still induced [[immunity (medical)|immunity]] to the virus. This first method for smallpox prevention, smallpox inoculation, is now also known as [[variolation]]. Inoculation has ancient origins, and the technique was known in India, Africa, and China.{{cite journal | title=[A brief history of vaccines & vaccination in India] |journal=The Indian Journal of Medical Research |volume=139 |issue=4 |pages=491–511 |publisher=Indian Journal of Medical Research | author=Chandrakant, Lahariya | year=2014 |pmc=4078488 |pmid=24927336 }} [20] => [21] => ===China=== [22] => The earliest hints of the practice of inoculation for smallpox in China come during the 10th century.{{Cite book |last=Needham |first=Joseph |url=https://books.google.com/books?id=6bEZ8Hp8h5sC |title=Science and Civilisation in China, Part 6, Medicine |date=2000-04-13 |publisher=Cambridge University Press |isbn=978-0-521-63262-1 |pages=154 |language=en}} A [[Song dynasty]] (960–1279) [[chancellor of China]], [[Wang Dan (Song dynasty)|Wang Dan]] (957–1017), lost his eldest son to smallpox and sought a means to spare the rest of his family from the disease, so he summoned physicians, wise men, and magicians from all across the empire to convene at the capital in [[Kaifeng]] and share ideas on how to cure patients of it until an allegedly divine man from [[Mount Emei]] carried out inoculation. However, the [[sinologist]] [[Joseph Needham]] states that this information comes from the ''Zhongdou xinfa'' (種痘心法) written in 1808 by Zhu Yiliang, centuries after the alleged events. [23] => [24] => The first clear and credible reference to smallpox inoculation in China comes from [[Wan Quan]]'s (1499–1582) ''Douzhen Xinfa'' (痘疹心法) of 1549, which states that some women unexpectedly menstruate during the procedure, yet his text did not give details on techniques of inoculation. Inoculation was first vividly described by Yu Chang in his book ''Yuyi cao'' (寓意草), or ''Notes on My Judgment'', published in 1643.{{citation needed|date=April 2020}} Inoculation was reportedly not widely practiced in China until the reign of the [[Longqing Emperor]] (r. 1567–1572) during the [[Ming dynasty]] (1368–1644), as written by Yu Tianchi in his ''Shadou Jijie'' (痧痘集解) of 1727, which he alleges was based on Wang Zhangren's ''Douzhen Jinjing Lu'' (痘疹金鏡錄) of 1579.{{Cite book |last=Needham |first=Joseph |url=https://books.google.com/books?id=6bEZ8Hp8h5sC |title=Science and Civilisation in China, Part 6, Medicine |date=2000-04-13 |publisher=Cambridge University Press |isbn=978-0-521-63262-1 |pages=134 |language=en}} From these accounts, it is known that the Chinese banned the practice of using smallpox material from patients who actually had the full-blown disease of ''Variola major'' (considered too dangerous); instead they used proxy material of a cotton plug inserted into the nose of a person who had already been inoculated and had only a few scabs, i.e. ''Variola minor''.{{Citation needed|date=May 2017}} This was called "to implant the sprouts", an idea of transplanting the disease which fit their conception of [[Mung bean|beansprouts]] in [[germination]]. Needham quotes an account from Zhang Yan's ''Zhongdou Xinshu'' (種痘新書), or ''New book on smallpox inoculation'', written in 1741 during the [[Qing dynasty]] (1644–1912), which shows how the Chinese process had become refined up until that point: [25] =>
[26] => Method of storing the material. Wrap the scabs carefully in paper and put them into a small container bottle. Cork it tightly so that the activity is not dissipated. The container must not be exposed to sunlight or warmed beside a fire. It is best to carry it for some time on the person so that the scabs dry naturally and slowly. The container should be marked clearly with the date on which the contents were taken from the patient. [27] => [28] => In winter, the material has ''yang'' potency within it, so it remains active even after being kept from thirty to forty days. But in summer the ''yang'' potency will be lost in approximately twenty days. The best material is that which had not been left too long, for when the ''yang'' potency is abundant it will give a 'take' with nine persons out of ten people{{snd}}and finally it becomes completely inactive, and will not work at all. In situations where new scabs are rare and the requirement great, it is possible to mix new scabs with the more aged ones, but in this case more of the powder should be blown into the nostril when the inoculation is done.
[29] => [30] => 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 [[Clopton Havers]]. But no action was taken. [31] => {{cite book|title=A History of Immunology|first=Arthur M. |last=Silverstein|page=293|publisher=Academic Press|year=2009|edition=2nd|url=https://books.google.com/books?id=2xNYjigte14C|isbn=9780080919461 }} [32] => [33] => [34] => ===Circassia=== [35] => According to [[Voltaire]] (1742), the Turks derived their use of inoculation from neighboring [[Circassia]]. [36] =>
[37] => The Circassian women have, from time immemorial, communicated the small-pox to their children when not above six months old by making an incision in the arm, and by putting into this incision a pustule, taken carefully from the body of another child. This pustule produces the same effect in the arm it is laid in as yeast in a piece of dough; it ferments, and diffuses through the whole mass of blood the qualities with which it is impregnated. The pustules of the child in whom the artificial small-pox has been thus inoculated are employed to communicate the same distemper to others. There is an almost perpetual circulation of it in Circassia; and when unhappily the small-pox has quite left the country, the inhabitants of it are in as great trouble and perplexity as other nations when their harvest has fallen short...{{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=2001-06-14|archive-date=2018-10-16|archive-url=https://web.archive.org/web/20181016221306/https://www.bartleby.com/34/2/11.html|url-status=live}}
[38] => [39] => Voltaire does not speculate on where the Circassians derived their technique from, though he reports that the Chinese have practiced it "these hundred years". The Turkish practice was presented to the Royal Society in 1714 and 1716, when the physicians [[Emmanuel Timoni]]{{cite journal|first=Emmanuel|last=Timoni|title=An account of procuring Smallpox by incision or inoculation, as it is practised in Constantinople|year=1714|journal=Philosophical Transactions|url=https://books.google.com/books?id=iOg_AAAAYAAJ&pg=PA88}} and [[Giacomo Pylarini]] independently sent letters from Istanbul.{{cite journal|title=The Myth of the Medical Breakthrough: Smallpox, Vaccination, and Jenner Reconsidered|first1=Cary P.|last1=Gross|first2=Kent A.|last2=Sepkowitz|journal=International Journal of Infectious Diseases|volume=3|issue=1|pages=54–60|date=July 1998|url=http://www.ijidonline.com/article/S1201-9712%2898%2990096-0/abstract|doi=10.1016/s1201-9712(98)90096-0|pmid=9831677|doi-access=free|access-date=2014-06-03|archive-date=2023-02-02|archive-url=https://web.archive.org/web/20230202091629/https://www.ijidonline.com/article/S1201-9712%2898%2990096-0/fulltext|url-status=live}} [40] => [41] => ===India=== [42] => Inoculation is mentioned in the [[Ayurveda|Ayurvedic]] text ''Sact'eya Grantham''. The outside world was exposed to it later on, as evidenced by the French scholar Henri Marie Husson, who noted it in the journal ''{{lang|fr|Dictionaire des sciences médicales}}''.{{Cite book |last1=Chaumeton |first1=F. P. (François Pierre) |url=http://archive.org/details/dictionairedessc25chau |title=Dictionaire des sciences médicales |last2=Mérat |first2=F. V. (François Victor) |last3=Renauldin |first3=Léopold Joseph |date=1812 |publisher=Paris : C.L.F. Panckoucke ... |others=Fisher - University of Toronto}} However, the idea that inoculation originated in India has been also taken in account, as few of the ancient [[Sanskrit]] medical texts described the process of inoculation.Wujastyk, Dominik; (1995) "Medicine in India," in ''Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing'', 19–38, edited by Serindia Publications, London {{ISBN|0-906026-36-9}}. p. 29. [[Variolation]] is documented in India from the eighteenth century, thanks to the 1767 account by the Irish-born surgeon [[John Zephaniah Holwell]].{{cite book|last=Holwell|first=John Zephaniah|title=An Account of the Manner of Inoculating for the Small Pox in the East Indies with ... Observations on the ... Mode of Treating that Disease in those Parts|year=1767|publisher=T. Becket & P. A. de Hondt|location=London|url=https://archive.org/details/accountofmannero00holw}} Holwell's extensive 1767 description included the following, that points to the connection between disease and "multitudes of imperceptible animalculae floating in the atmosphere": [43] =>
[44] => They lay it down as a principle, that the immediate cause of the smallpox exists in the mortal part of every human and animal form; that the mediate (or second) ''acting'' cause, which stirs up the first, and throws it into a state of fermentation, is multitudes of imperceptible animalculae floating in the atmosphere; that these are the cause of all epidemical diseases, but more particularly of the small pox. [45] =>
[46] => Holwell ascribes this account to his Brahman informants. However, such a theory has not yet been discovered in any Sanskrit or vernacular treatise.{{cite book|last=Meulenbeld|first=Gerrit Jan|title=A history of Indian medical literature|year=1999–2002|publisher=Egbert Forsten|location=Groningen}} Doctors who performed variolation were known as ''Tikadars''.{{Cite news |date=19 September 2020 |title=The Indian queens who modelled for the world's first vaccine |language=en-gb |work=BBC News |url=https://www.bbc.com/news/world-asia-india-53944723 |access-date=21 September 2020 |archive-date=20 September 2020 |archive-url=https://web.archive.org/web/20200920173003/https://www.bbc.com/news/world-asia-india-53944723 |url-status=live }} [47] => [48] => By the 18th century, variolation was widely practiced in India. Several historians have suggested that variolation may be older than the 18th century in India.E.g., {{cite web|url=http://www.indianscience.org/dyk/t_dy_Q14.shtml|title=Did you know that smallpox inoculation started in India before the West?|last=Agrawal|first=D.P.|author-link=D. P. Agrawal|author2=Tiwari, Lalit|publisher=HIST: History of Indian Science and Technology|access-date=2009-11-06|archive-date=2017-11-07|archive-url=https://web.archive.org/web/20171107011728/http://www.indianscience.org/dyk/t_dy_Q14.shtml|url-status=live}} Oliver Coult in 1731 wrote that it had been "first performed by Dununtary a physician of Champanagar". However these reports have been called into question. [49] => [50] => [[Vaccination|Vaccinations]] were introduced to India in 1802, when 3-year-old girl in Mumbai received a [[smallpox vaccine]], making her the first person to take a vaccine in India.{{cite journal |last1=Lahariya |first1=Chandrakant |date=1 April 2014 |title=A brief history of vaccines & vaccination in India |url=http://www.ijmr.org.in/text.asp?2014/139/4/491/134094 |journal=Indian Journal of Medical Research |language=en |volume=139 |issue=4 |pages=491–511 |issn=0971-5916 |pmc=4078488 |pmid=24927336 |access-date=27 May 2023 |archive-date=15 July 2021 |archive-url=https://web.archive.org/web/20210715032146/https://www.ijmr.org.in/text.asp?2014/139/4/491/134094 |url-status=live }} The widespread rumour since the nineteenth century that vaccination was documented in India before the discoveries of [[Edward Jenner]] can all be traced to propaganda tracts written in Sanskrit and the Indian vernaculars by colonial officers, in the hope of convincing pious Indians to accept the newly discovered Jennerian procedure and abandon older variolation practices.{{cite book|last=Wujastyk|first=Dominik|title=Studies in Indian Medical History|year=2001|publisher=Motilal Banarsidass|pages=121–54|chapter-url=https://www.academia.edu/451964|edition=2|editor=G. J. Meulenbeld and Dominik Wujastyk|access-date=3 January 2014|language=en, sa|chapter=`A Pious Fraud': The Indian Claims for Pre-Jennerian Smallpox Vaccination|archive-date=15 December 2019|archive-url=https://web.archive.org/web/20191215085351/https://www.academia.edu/451964/_A_Pious_Fraud_The_Indian_Claims_for_pre-Jennerian_Smallpox_Vaccination|url-status=live}}{{cite journal|last=Boylston|first=Arthur|title=The origins of inoculation|journal=Journal of the Royal Society of Medicine|date=July 2012|volume=105|issue=7|pages=309–13|doi=10.1258/jrsm.2012.12k044|pmid=22843649|pmc=3407399}} A landmark anthropological study by Ralph Nicholas described the mid-twentieth century rituals of appeasement to [[Shitala|Śītalā]], the Indian goddess of smallpox, in Bengal.{{cite journal|last=Nicholas|first=Ralph|title=The Goddess Śītalā and Epidemic Smallpox in Bengal|journal=Journal of Asian Studies|year=1981|volume=41|pages=21–44|doi=10.2307/2055600|pmid=11614704|jstor=2055600|issue=1|s2cid=8709682 }} [51] => [52] => ===Ethiopia=== [53] => Early travellers to Ethiopia report that variolation was practiced by the [[Amhara people|Amhara]] and [[Tigray people]]s. The first European to report this was [[Nathaniel Pearce]], who noted in 1831 that it was performed by a ''[[debtera]]'' who would collect "a quantity of matter" from a person with the most sores from smallpox, then "cuts a small cross with a razor in the arm" of his subject and puts "a little of the matter" into the cut which was afterwards bound up with a bandage. Subsequent visitors who described this practice included the British traveller [[William Cornwallis Harris]] and Dr. Petit of the French scientific mission of 1839–1841.[[Richard Pankhurst (politician)|Richard Pankhurst]], ''An Introduction to the Medical History of Ethiopia'' (Trenton: Red Sea Press, 1999), pp. 26ff [54] => [55] => ===West Africa=== [56] => Inoculation against smallpox seems to have been known to West Africans, more specifically the [[Ga-Adangbe people|Ga-Adangbe people of Accra]].{{Cite book|last=Meredith|first=Henry|url=https://archive.org/details/anaccountgoldco01meregoog/mode/2up|title=An Account of the Gold Coast of Africa|publisher=Longman et al|year=1812|isbn=0469096918|location=Oxford University|pages=194}} An enslaved African named [[Onesimus (Boston slave)|Onesimus]] in the [[Province of Massachusetts Bay]] explained the inoculation procedure to Cotton Mather during the 18th century; he reported to have acquired the knowledge from Africa.Waldstreicher, David. Runaway America: Benjamin Franklin, Slavery, and the American Revolution. Macmillan; p. 40, {{ISBN|0-8090-8314-0}} [57] => [58] => =={{anchor |Introduction in Europe}}Introduction in Europe and North America== [59] => [[Image:Mary Wortley Montagu by Charles Jervas, after 1716.jpg|left|upright|thumb|Mary Wortley Montagu, by [[Charles Jervas]], after 1716]] [60] => In January 1714 the ''[[Philosophical Transactions of the Royal Society]]'' published an account of a letter John Woodward had received from Emmanuel Timonius in [[Istanbul]].{{cite journal|first=Emmanuel|last=Timonius|title=An account of procuring Smallpox by incision or inoculation, as it is practised in Constantinople|year=1714|journal=[[Philosophical Transactions of the Royal Society]]|volume=29|issue=338–350|pages=72–82|url=https://books.google.com/books?id=iOg_AAAAYAAJ&pg=PA88|doi=10.1098/rstl.1714.0010|doi-access=free}} Smallpox inoculation was advocated as a proven method of curbing the severity of the disease.{{cn|date=October 2022}} [61] => [62] => The practice was introduced to England by [[Lady Mary Wortley Montagu]].{{cite web | last=Ferguson | first=Donna | title=How Mary Wortley Montagu's bold experiment led to smallpox vaccine – 75 years before Jenner | website=the Guardian | date=28 March 2021 | url=http://www.theguardian.com/society/2021/mar/28/how-mary-wortley-montagus-bold-experiment-led-to-smallpox-vaccine-75-years-before-jenner | access-date=11 July 2022 | archive-date=11 July 2022 | archive-url=https://web.archive.org/web/20220711092547/https://www.theguardian.com/society/2021/mar/28/how-mary-wortley-montagus-bold-experiment-led-to-smallpox-vaccine-75-years-before-jenner | url-status=live }} Lady Montagu's husband, [[Edward Wortley Montagu (diplomat)|Edward Wortley Montagu]], served as the British ambassador to the [[Ottoman Empire]] from 1716 to 1718. She witnessed firsthand the Ottoman use of inoculation in [[Istanbul]],{{cite news|url=https://www.independent.co.uk/news/science/how-islamic-inventors-changed-the-world-469452.html|title=How Islamic inventors changed the world|date=11 March 2008|work=[[The Independent]]|access-date=17 February 2012|location=London|archive-date=25 September 2015|archive-url=https://web.archive.org/web/20150925153204/http://www.independent.co.uk/news/science/how-islamic-inventors-changed-the-world-469452.html|url-status=live}} and was greatly impressed:Donald R. Hopkins, ''Princes and Peasants: Smallpox in History'' (University of Chicago Press, 1983) she had lost a brother to smallpox and bore facial scars from the disease herself. When a smallpox epidemic threatened England in 1721, she called on her physician, [[Charles Maitland (physician)|Charles Maitland]], to inoculate her daughter. She invited friends to see her daughter, including Sir [[Hans Sloane]], the [[George I of Great Britain|King]]'s physician. Sufficient interest arose that Maitland gained permission to test inoculation at [[Newgate Prison]] on six prisoners due to be hanged in exchange for their freedom, an experiment which was witnessed by a number of notable doctors.{{cite book [63] => | last = Wooton [64] => | first = David [65] => | title = Bad Medicine: Doctors Doing Harm Since Hippocrates [66] => | publisher = Oxford University Press [67] => | year = 2006 [68] => | location = Oxford, England [69] => | page = 153 [70] => | isbn = 978-0-19-921279-8}} All survived, and in 1722 [[George II of Great Britain|the Prince of Wales']] daughters received inoculations.{{cite book | last=Strathern | first=Paul | year=2005 | title=A Brief History of Medicine | publisher=Robinson | location=London | isbn=978-1-84529-155-6 | page=179 }} [71] => [72] => The practice of inoculation slowly spread amongst the royal families of Europe, usually followed by more general adoption amongst the people.{{cn|date=October 2022}} [73] => [74] => The practice is documented in America as early as 1721, when [[Zabdiel Boylston]], at the urging of [[Cotton Mather]], successfully inoculated two slaves and his own son. Mather, a prominent [[Boston]] minister, had heard a description of the African practice of inoculation from [[Onesimus (Boston slave)|Onesimus]], an enslaved man in his household, in 1706 and later from Timoni's report to the Royal Society.{{harvnb|Gross|Sepkowitz|1998|p=56}} However, Mather had been previously unable to convince local physicians to attempt the procedure.Silverman, Kenneth. ''The Life and Times of Cotton Mather'', Harper & Row, New York, 1984. {{ISBN|0-06-015231-1}}, p. 339. Following this initial success, Boylston began performing inoculations throughout Boston, despite much controversy and at least one attempt upon his life. The effectiveness of the procedure was proven when, of the nearly three hundred people Boylston inoculated during the outbreak, only six died, whereas the mortality rate among those who contracted the disease naturally was one in six.{{Cite book | publisher = D. Appleton and Company | volume = 2 | last = White | first = Andrew Dickson | title = A History of the Warfare of Science with Theology in Christendom | location = New York | year = 1896| author-link = Andrew Dickson White | page = [https://archive.org/details/cu31924022599330/page/n7 57] | url = https://archive.org/details/cu31924022599330}} Boylston traveled to London in 1724. There he published his results and was elected to the Royal Society in 1726. [75] => [76] => {| class = "wikitable" style = "float:right; font-size:85%; margin-left:15px" [77] => |- [78] => | colspan="4" style="text-align:center;"|[http://ganfyd.org/index.php?title=Natural_experiments_in_medicine Natural experiment] in inoculation
around Boston, 1721 [79] => |- [80] => !  !! Total !! Died !! % Mortality [81] => |- [82] => | Variolated || c. 300 || 6 || c. 2% [83] => |- [84] => | Unvariolated || c. 6000 || c. 1000 || "about 14%"{{cite web|title=Edward Jenner and Vaccination |author=Harris DF |url=http://www.worldwideschool.org/library/books/tech/medicine/EdwardJennerAndVaccination/chap1.html |archive-url=https://web.archive.org/web/20010708050608/http://www.worldwideschool.org/library/books/tech/medicine/EdwardJennerAndVaccination/Chap1.html |url-status=dead |archive-date=2001-07-08 |access-date=2007-03-04 }} [85] => |} [86] => [87] => In [[France]], considerable opposition arose to the introduction of inoculation, and it was [[Joseph Omer Joly de Fleury#Opposition to inoculation|banned by the Parlement]]. [[Voltaire]], in his ''Lettres Philosophiques'', wrote a criticism of his countrymen for being opposed to inoculation and having so little regard for the welfare of their children, concluding that "had inoculation been practised in France it would have saved the lives of thousands."Lettres Philosophiques. Voltaire. (English translation on-line [http://www.bartleby.com/34/2/11.html] {{Webarchive|url=https://web.archive.org/web/20181016221306/https://www.bartleby.com/34/2/11.html |date=2018-10-16 }}) [88] => [89] => Likewise, in the United States, the [[Continental Congress]] issued a proclamation in 1776 prohibiting Surgeons of the Army from performing inoculations. However, in 1777, [[George Washington]], witnessing the virulent spread of smallpox, and fearing the likelihood of mass transmission of the disease throughout the [[Continental Army]], weighed the risks and overruled this prohibition, conducting smallpox inoculation of all troops. He wrote, "Should the disorder infect the Army in the natural way and rage with its usual virulence, we have more to dread from it than from the sword of the enemy." This was the first mass inoculation of an army, and was successful, with only isolated infections occurring, and no regiments incapacitated by the disease.{{cite web |title=Gen. George Washington Ordered Smallpox Inoculations for All Troops |first=Janet A. |last=Aker |website=www.health.mil |url=https://www.health.mil/News/Articles/2021/08/16/Gen-George-Washington-Ordered-Smallpox-Inoculations-for-All-Troops |date=2021-08-16 |access-date=2022-10-11 |archive-date=2022-10-11 |archive-url=https://web.archive.org/web/20221011074532/https://www.health.mil/News/Articles/2021/08/16/Gen-George-Washington-Ordered-Smallpox-Inoculations-for-All-Troops |url-status=live }}{{cite web |title=George Washington and the First Mass Military Inoculation (John W. Kluge Center, Library of Congress) |first1=Amy Lynn |last1=Filsinger |first2=Raymond |last2=Dwek |website=www.loc.gov |url=https://www.loc.gov/rr/scitech/GW&smallpoxinoculation.html |url-status=dead |archive-url=https://web.archive.org/web/20211119220659/https://www.loc.gov/rr/scitech/GW&smallpoxinoculation.html |archive-date=2021-11-19 |date=2021-11-19 |access-date=2022-10-11}} [90] => [91] => Inoculation grew in popularity in Europe through the 18th century. Given the high prevalence and often severe consequences of smallpox in Europe in the 18th century (according to Voltaire, there was a 60% incidence of first infection, a 20% mortality rate, and a 20% incidence of severe scarring),In fact, the mortality rate of the ''Varoiola Minor'' form of smallpox then found in Europe was 1–3% as opposed to 30–50% for the ''Variola Major'' type found elsewhere; however, blindness, infertility, and severe scarring were common. Figures from "The Search for Immunisation", ''In Our Time'', BBC Radio 4 (2006). [http://www.bbc.co.uk/radio4/history/inourtime/inourtime_20060420.shtml] {{Webarchive|url=https://web.archive.org/web/20190403083552/http://www.bbc.co.uk/radio4/history/inourtime/inourtime_20060420.shtml |date=2019-04-03 }} many parents felt that the benefits of inoculation outweighed the risks and so inoculated their children.{{cite web|author=David V. Cohn, Ph.D.|title=Lady Mary Montagu|url=http://www.foundersofscience.net/lady_mary_montagu.htm|publisher=Founders of Science|archive-url=https://web.archive.org/web/20040102183753/http://www.foundersofscience.net/lady_mary_montagu.htm|archive-date=January 2, 2004|quote=In England in 1718 she wrote to various influential persons urging inoculation and sent essays to subject to magazines. She had both her children inoculated – one in Turkey and one in England. Despite opposition from religious and medical groups, inoculation caught on. It was the primary defense against death and serious debilitation by smallpox for the next 80 years until the discovery of vaccination by Jenner.}} [92] => [93] => == Mechanism == [94] => Two forms of the disease of smallpox were recognised, now known to be due to two strains of the [[Variola virus]]. Those contracting ''Variola minor'' had a greatly reduced risk of death – 1–2% – compared to those contracting ''Variola major'' with 30% mortality. Infection via inhaled viral particles in droplets spread the infection more widely than the deliberate infection through a small skin wound. The smaller, localised infection is adequate to stimulate the immune system to produce specific immunity to the virus, while requiring more generations of the virus to reach levels of infection likely to kill the patient. The rising immunity terminates the infection. This ensures the less fatal form of the disease is the one caught, and gives the immune system the best start possible in combating it.{{cn|date=November 2022}} [95] => [96] => Inoculation in the East was historically performed by blowing smallpox crusts into the nostril. In Britain, Europe and the American Colonies the preferred method was rubbing material from a smallpox pustule from a selected mild case (''Variola minor'') into a scratch between the thumb and forefinger.{{cite web |url=https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html |title=Smallpox: Variolation |publisher=Nlm.nih.gov |date=2003-10-18 |access-date=2009-11-02 |archive-date=2019-05-02 |archive-url=https://web.archive.org/web/20190502065059/https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html |url-status=live }} This would generally be performed when an individual was in normal good health, and thus at peak resistance. The recipient would develop smallpox; however, due to being introduced through the skin rather than the lungs, and possibly because of the inoculated individual's preexisting state of good health, the small inoculum, and the single point of initial infection, the resulting case of smallpox was generally milder than the naturally occurring form, produced far less facial scarring, and had a far lower [[mortality rate]]. As with survivors of the natural disease, the inoculated individual was subsequently immune to re-infection.{{cn|date=November 2022}} [97] => [98] => == Obsolescence == [99] => [[File:Inoculation day 16.png|thumb|A 1802 comparison of smallpox (left) and cowpox (right) inoculations 16 days after administration]] [100] => In 1798, British physician [[Edward Jenner]] published the results of his experiments and thus introduced the far superior and safer method of inoculation with [[cowpox]] virus, a mild infection that also induced [[immunity (medical)|immunity]] to [[smallpox]]. Jenner was the first to publish evidence that it was effective, and to provide advice on its production. His efforts led to smallpox inoculation falling into disuse, and eventually being banned in England in 1840.{{cite journal|last=Wolfe|first=Robert M|author2=Sharp, Lisa K|date=24 August 2002|title=Anti-vaccinationists past and present|journal=[[British Medical Journal]]|location=London|pages=430–32|doi=10.1136/bmj.325.7361.430|pmid=12193361|pmc=1123944|volume=325|issue=7361}} [101] => [102] => ==See also== [103] => * [[Psychological resilience]] (also known as ''stress inoculation'') [104] => [105] => ==References== [106] => {{reflist}} [107] => [108] => ==Further reading== [109] => * {{cite book | title=The Greatest Killer: Smallpox in History | url=https://archive.org/details/greatestkillersm0000hopk | url-access=registration | publisher=University of Chicago Press | author=Hopkins, Donald R. | year=2002 | location=Chicago | isbn=978-0226351681 | oclc=49305765}} [110] => * {{cite book | title=The New Method of Inoculating for the Small-Pox | publisher=Parry Hall | author=Rush, Benjamin | year=1792 | location=Philadelphia | oclc=55833664| title-link=:s:The New Method of Inoculating for the Small-Pox }} [111] => * {{cite book | title=A Recommendation of Inoculation According to Baron Dimsdale's Method | publisher=J. Gill | author=Morgan, John | year=1776 | location=Boston | oclc=62815748| title-link=:s:A Recommendation of Inoculation }} [112] => [113] => == External links == [114] => {{Wiktionary}} [115] => * [https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html US National Library of Medicine] [116] => [117] => {{Vaccines}} [118] => [119] => [[Category:Immunology]] [120] => [[Category:Smallpox vaccines]] [121] => [[Category:Chinese inventions]] [122] => [[Category:Smallpox]] [] => )
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Inoculation

Inoculation, a method of preventing infectious diseases, is the introduction of a pathogen or its antigens into a living organism to stimulate an immune response and develop immunity against the specific disease. The practice has been employed for centuries, with historical evidence of variolation, an early form of inoculation against smallpox, dating back to ancient China and India.

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The practice has been employed for centuries, with historical evidence of variolation, an early form of inoculation against smallpox, dating back to ancient China and India. Inoculation was gradually adopted in Europe and the Americas, leading to the development of smallpox vaccine by Dr. Edward Jenner in the late 18th century. The process of inoculation involves the deliberate exposure of an individual to a weakened or dead form of the disease-causing agent, such as a virus or bacterium. This exposure triggers the body's immune system to produce antibodies, which provide protection against future infections. Over time, different techniques and approaches have emerged, including the use of attenuated live vaccines, inactivated vaccines, subunit vaccines, and more recently, mRNA vaccines. Throughout history, inoculation has significantly contributed to the control and elimination of various infectious diseases. The widespread use of vaccines has led to the eradication of smallpox, the near-elimination of polio, and the reduction of other diseases such as measles, mumps, and rubella. In addition to individual protection, inoculation plays a crucial role in achieving herd immunity, reducing the overall transmission and spread of diseases within a population. Inoculation has not been without controversy and opposition. Vaccine hesitancy, misinformation, and myths have led to pockets of vaccine refusal, resulting in localized outbreaks and increased public health risks. However, the scientific consensus overwhelmingly supports the safety and effectiveness of vaccines, and numerous studies have demonstrated their significant impact on public health. As research continues to advance, newer vaccines are being developed to combat an expanding range of diseases. Inoculation continues to be a vital tool in disease prevention, promoting public health, and saving countless lives throughout the world.

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