Inoculation is the placement of something to where it will grow or reproduce, and is most commonly used in respect of the introduction of a serum,
vaccine, or antigenic substance into the body of a human or animal, especially to produce or boost immunity to a specific disease; but also can be used to refer to the communication of a disease to a living organism by transferring its causative agent into the organism, to implant microorganisms or infectious material into a culture medium such as a brewers vat or a petri dish, to safeguard as if by inoculation, to introduce an idea or attitude into someone's mind, any placement of microorganisms or viruses at a site where infection is possible such as to increase soybeans' nitrogen fixation one can treat soybeans at planting with Rhizobium japonicum inoculant. The verb "to inoculate" is from Middle English "inoculaten", which meant "to graft a scion (a scion is a plant part to be grafted onto another plant); which in turn is from Latin "inoculare", past participle "inoculat-". [ [http://www.yourdictionary.com/ahd/i/i0154600.html Your Dictionary] ] [ [http://en.mimi.hu/gardening/inoculation.html Inoculation entry at Gardening section of mimi.hu] ]
This article covers variolation, inoculation as a method of purposefully infecting a person with
smallpox(Variola) in a controlled manner so as to minimise the severity of the infection and also to induce immunity against further infection. See vaccinationfor post-variolation methods of safeguarding as if by inoculation by administering weakened or dead pathogens to a healthy person or animal with the intent of conferring immunity against a targeted form of a related disease agent.
Today the terms "inoculation", "vaccination" and
immunisationare used more or less interchangeably and popularly refer to the process of artificial induction of immunityagainst various infectious diseases. The microorganism used in an inoculation is called the inoculant or inoculum.
The earliest record of inoculation is thought to be found in 8th century India, when
Madhavwrote the "Nidāna", a 79-chapter book which lists diseases along with their causes, symptoms, and complications.Hopkins, page 140] According to Donald R. Hopkins (2002), Madhav included a special chapter on smallpox("masūrikā") and described the method of inoculation to protect against smallpox. Dominik Wujastyk (1995), however, argues that inoculation is not mentioned in any ancient Sanskrit medical treatises and that it was a rumor which began in the 19th century:
Inoculation was current in Turkey in the early eighteenth century; there is evidence that it may have been brought to Turkey from China. It is interesting, then, to find a detailed account by a renowned English surgeon in 1767, describing the widespread practice of inoculation in Bengal. There is also some evidence to push the Indian practice of inoculation back further, to 1731. Once again, there is a historical paradox here: there is not the slightest trace of this important and effective treatment in any of the Sanskrit medical treatises. Smallpox was certainly recognised in Ayurvedic texts, where it is called "masurika" ('lentil' disease) and was treated after a fashion. But of inoculation there is absolutely no mention. The link between theory and practice is broken once again.
After smallpox vaccination was introduced to India in 1802, a rumour was started in 1819 by an article in "The Madras Courier", a popular daily newspaper, to the effect that there existed in ancient Sanskrit text describing in detail the process of vaccination. This proved, it was argued, the superiority of ancient Indian science, and that 'there is nothing new under the sun'. Unfortunately, this rumour gained currency and was republished in books and encyclopedias across Europe all through the nineteenth century, and it even surfaces today. Careful literary research has shown, however, that no such Sanskrit text exists, and that the whole affair was almost certainly triggered by the excessive zeal of British vaccination propagandists, who composed tracts on vaccination in local languages and probably in Sanskrit too. [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: Serindia Publications. ISBN 0906026369. Page 29.]
Robert Temple writes that the practice of inoculation for smallpox began in China during the 10th century. [Temple, Robert. (1986). "The Genius of China: 3,000 Years of Science, Discovery, and Invention". With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 135.] A
Song Dynasty(960–1279) chancellor of China, 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 Kaifengand share ideas on how to cure patients of it. [Temple, Robert. (1986). "The Genius of China: 3,000 Years of Science, Discovery, and Invention". With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 135–136.] From Mount Emeiin Sichuan, a Daoist hermit, a nun known as a "numinous old woman" and "holy physician"—who Temple says was associated with the 'school of the ancient immortals' and thus most likely specialized in 'internal alchemy'—introduced the technique of inoculation to the capital.Temple, Robert. (1986). "The Genius of China: 3,000 Years of Science, Discovery, and Invention". With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 136.] However, 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.Needham, Joseph. (1999). "Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine". Cambridge: Cambridge University Press. Page 154]
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. 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.Temple, Robert. (1986). "The Genius of China: 3,000 Years of Science, Discovery, and Invention". With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 137.] Needham, Joseph. (1999). "Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine". Cambridge: Cambridge University Press. Page 134.] 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". This was called "to implant the sprouts", an idea of transplanting the disease which fit their conception of beansprouts in germination. Robert Temple 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:
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.
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—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. [Temple, Robert. (1986). "The Genius of China: 3,000 Years of Science, Discovery, and Invention". With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 136–137.]
As for other methods used in China, the technique of scratching the skin and putting pox onto the scab seems to have developed later than the first accounts made in China, and possibly came from
Central Asia—according to Temple.
Importation to the West
The practice was introduced to the west by
Lady Mary Wortley Montagu( May 26, 1689- August 21, 1762). Lady Montagu's husband, Edward Wortley Montagu, served as the British ambassadorto the Ottoman Empirefrom 1716 to 1717. She witnessed inoculation being practiced by physicians in Constantinople,Paul Vallely, [http://findarticles.com/p/articles/mi_qn4158/is_20060311/ai_n16147544 How Islamic Inventors Changed the World] , " The Independent", 11 March 2006.] and was greatly impressed: [Donald R. Hopkins, "Princes and Peasants: Smallpox in History" (University of Chicago Press, 2983)""] she had lost a brother to smallpox and bore facial scars from the disease herself. In March 1718 she had the embassy surgeon, Charles Maitland, inoculate her five-year-old son. In 1721, after returning to England, she had her four-year-old daughter inoculated [cite book | last=Strathern | first=Paul | year=2005 | title=A Brief History of Medicine | publisher=Robinson | location=London | isbn=1-84529-155-7 | pages=p. 179 ] . She invited friends to see her daughter, including Sir Hans Sloane, the King's physician. Sufficient interest arose that Maitland gained permission to test inoculation at Newgate prisonin exchange for their freedom on six prisoners due to be hanged, an experiment which was witnessed by a number of notable doctors. [cite book
last = Wooton
first = David
title = Bad Medicine: Doctors Doing Harm Since Hippocrates
publisher = Oxford University Press
date = 2006
location = Oxford, England
pages = p153
isbn = 978-0-19-921279-8] All survived, and in 1722 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=1-84529-155-7 | pages=p. 179 ] .
The practice of inoculation slowly spread amongst the royal families of Europe, usually followed by more general adoption amongst the people.
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 Bostonminister, had heard a description of the African practice of inoculation from his Sudanese slave, Onesimus, in 1706, but 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. [ [http://abob.libs.uga.edu/bobk/whitem10.html "A History Of The Warfare Of Science With Theology In Christendom"] by Andrew Dickson White.]
Franceconsiderable opposition arose to the introduction of inoculation. 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] )]
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] ] many parents felt that the benefits of inoculation outweighted the risks and so inoculated their children. [Letter of Lady Montagu reproduced at http://www.foundersofscience.net/lady_mary_montagu.htm viewed 18 March 2006]
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 20% 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. So the twofold effect is to ensure the less fatal form of the disease is the one caught, and to give the immune system the best start possible in combating it.
. As with survivors of the natural disease, the inoculated individual was subsequently immune to re-infection.
Supplanted by vaccination
Edward Jennerintroduced the far safer method of inoculation with the cowpoxvirus, a non-fatal virus that also induced immunity to smallpox. This led to smallpox inoculation falling into disuse and eventually being banned in England in 1840.
* Hopkins, Donald R. (2002). "The Greatest Killer: Smallpox in history".
University of Chicago Press. ISBN 0226351688.
* [http://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html US National Library of Medicine]
* [http://www.bartleby.com/34/2/11.html Lettres Philosophiques. Voltaire] (English translation)
* [http://www.indianscience.org/dyk/t_dy_Q14.shtml Inoculation in India] An account of the manner of inoculating for the small pox in the India. Holwell, J Z.
* [http://www.worldwideschool.org/library/books/tech/medicine/EdwardJennerAndVaccination/chap1.html Edward Jenner and Vaccination] . Harris
* [http://abob.libs.uga.edu/bobk/whitem10.html A HISTORY OF THE WARFARE OF SCIENCE WITH THEOLOGY IN CHRISTENDOM] Andrew Dickson White.
* [http://www.lewrockwell.com/orig2/miller6.html] Arm-to-Arm Against Bioterrorism by Donald W. Miller, Jr., MD
* [http://www.intxmicrobials.com/education.html The Science of Agricultural Inoculation by INTX Microbials]
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