Today's vaccines are the result of centuries of experimentation
Smallpox inoculation was practised in China at least as early as the 16th century
This column is an instalment in our series Apocalypse Then, in which cultural historian Ainsley Hawthorn examines the issues of COVID-19 through the lens of the past.
Modern vaccines seem like the epitome of scientific achievement.
Viruses or bacteria are grown in a lab, purified and stabilized, combined with other ingredients to provoke an immune response, then shipped out in carefully measured doses.
This high-tech approach, though, is the fruit of centuries of experimentation with inoculation, the artificial creation of immunity to contagious disease.
The first major attempts at inoculation began in response to smallpox. A severe illness with a risk of death around 30 per cent, smallpox often left even survivors with deep scars, blindness and bone deformities.
Those who came through the infection reaped one major benefit: they were immune to smallpox for the rest of their lives. If this feature of the disease could be harnessed, if patients could be infected with smallpox in a controlled way and thereby immunized, the illness could be prevented from exacting such a devastating toll on the body.
Smallpox inoculation was practised in China at least as early as the 16th century and was popularized by the Kangxi emperor, who ruled from 1661 to 1722.
His father, the Shunzhi emperor, had died of smallpox at the age of 22. The Kangxi emperor was only eight years old at the time and was possibly chosen as the successor, despite being a younger son, because he had already survived the disease.
The Kangxi emperor had the longest reign in China's history and is widely considered one of the country's greatest rulers. One of his most cherished accomplishments seems to have been his contribution to safeguarding the health of his subjects through inoculation.
He had his own children inoculated at an early age and, in later years, wrote them a letter, saying: "The courage which I summoned up to insist on its practice has saved the lives and health of millions of men. This is an extremely important thing, of which I am very proud."
LISTEN | Ainsley and Andrew Hawthorn take a look at the history of inoculations in the latest instalment of Apocalypse Then:
These early inoculations weren't injected — hypodermic needles wouldn't be invented until 1844. Instead, Chinese doctors collected scabs from smallpox sufferers, dried them out, ground them into a fine powder and blew them up patients' noses.
It may not sound appealing, but there was wisdom in this method.
Doctors collected their smallpox samples from people experiencing the mild form of the disease (variola minor), and the drying process would have killed most of the virus. The fairly inactive dosage left to be inhaled by the patient would usually have resulted in a brief sickness that still led to immunity.
Inoculation in Britain
Smallpox inoculation was practised not only in China, but in India, the Ottoman Empire, West Africa, Ethiopia and parts of Wales. In most of these other locations, the disease was transmitted by rubbing pus from a smallpox pustule into an incision.
The smallpox virus normally enters the body through the respiratory tract. Transmission through the skin, like blown powder through the nose, results in a milder course of illness.
When aristocrat Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire, observed the procedure in Istanbul, she was immediately convinced of its value. She had lost her brother to smallpox and suffered severe scarring from the disease herself.
"I am going to tell you a thing, that will make you wish yourself here," she wrote to a friend in 1717. "The smallpox, so fatal, and so general amongst us, is here entirely harmless, by the invention of engrafting, which is the term they give it.
"You may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son. I am patriot enough to take the 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."
Not only did Montagu have her six-year-old son inoculated as planned, after her return to England she had her younger daughter inoculated as well.
In an example of the many unethical human experiments that dot medical history, she convinced the Princess of Wales to authorize a test of the Turkish inoculation method on prisoners and abandoned children. When these test subjects were deliberately exposed to smallpox patients months later and none contracted the disease, inoculation was deemed safe for the upper classes and the royal family.
Still, the procedure wasn't without risk. Somewhere between two and four per cent of people who underwent inoculation died, and, although that was a far cry from the 30 per cent fatality rate of the disease in the wild, people continued to search for a safer alternative.
Several different individuals observed that farmers and milkmaids who caught cowpox, a virus found in European cows, were afterwards immune to smallpox as well. Since cowpox is a much less serious disease, it suggested itself as an ideal candidate for use in inoculation.
English physician Edward Jenner demonstrated that cowpox pus could safely be used to immunize patients against smallpox, dubbing his new inoculation procedure "vaccination" from the Latin word vacca, meaning "cow."
After Jenner's death, as an honour to him, all the new developments in the field of inoculation were called vaccines.
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