Community Health Forum: History of Vaccines, Part I

Posted: February 18, 2013

Vaccination and control of infectious diseases are two of the great 20th century public health achievements cited by the Centers for Disease Control.

Smallpox, a disease that wreaked havoc worldwide for centuries, was the first immunization target in history.

More than nine centuries after the first evidence of smallpox inoculation, the World Health Organization certified smallpox eradicated in 1979, the only vaccine-preventable disease to be eliminated from the world to date.

Smallpox played a role in the Revolutionary War and in the lives and fortunes of early American leaders.

The story will be presented in two parts.

Special thanks to Karie Youngdahl, project director with the College of Physicians of Philadelphia, for permission to paraphrase and quote historical data from the “Timelines — History of Vaccines,” a fascinating website (historyofvaccines.org/content/timelines/all).

THE POX, Part One: From the Old World to Colonial Times

Variolation, the introduction of a small amount of active smallpox disease material into an opened skin wound of an uninfected person to produce a milder infection, followed by immunity, is documented as early as 100CE in China.

Variolation was risky, associated with fatal infection rates of 2 to 3 percent and the brief ability of variolated persons to spread smallpox to others, but safer by far than the risk of naturally acquired smallpox, with a death rate ranging from 20 to 50 percent.

Emperor K’ang, a smallpox survivor whose father had died of smallpox, took the bold public health measure of having all of his progeny and many of his subjects inoculated: “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.”

European explorers brought with them a variety of infectious diseases, and smallpox made its mark in North America. Smallpox wiped out up to 50 percent of the Cherokee population in the Carolinas. A Brief Rule to Guide the Common People of New England how to order themselves and theirs in the Small Pocks, or Measles, published by Thomas Thatcher in 1678, was the first medical work published in America.

In 1693, Virginia Gov. Edmund Andros proclaimed a “Day of humiliation and prayer” due to a large outbreak. Tragically, the year after Queen Mary II joined her husband, King William III, to charter the College of William and Mary in Virginia, she died of smallpox.

Lady Mary Montagu, disfigured by smallpox in 1715, had her 6-year-old son variolated in Constantinople (where her husband was ambassador) by Dr. Charles Maitland, who repeated the procedure for her 2-year-old daughter in England in 1721.

Some social consternation ensued, and Maitland was criticized by the medical community, but the practice began to spread in upper social circles.

In the U.S., Boston minister Cotton Mather noted a variolation scar on his Libyan-born slave Onesimus (who had been a gift) in 1706. He confirmed the African immunization practice by speaking with other slaves who bore the scars and began to read a few years later of the practice in Europe.

During a smallpox epidemic in Boston in 1721, Mather convinced Dr. Zabdiel Boylston to begin variolating patients, and, after performing the first 248 such American procedures, Boylston was forbidden to continue this practice by local officials despite the five-fold improved survival of his treated patients.

Mather was rewarded for his effort with a grenade tossed though his house window with a note: “COTTON MATHER, You Dog, Dam you. I’ll inoculate you with this, with a Pox to you.”

Personal relationships and observed improved survival began to prevail, and officials realized that the variolated had to be confined for a few days after inoculation to prevent accidental contagion.

In grief and regret after smallpox claimed his uninoculated 4-year-old son in 1736, Benjamin Franklin became an advocate. In 1759, at Franklin’s behest, British physician William Heberden defied physician tradition and distributed for free in the American colonies a pamphlet on variolation “with Plain Instructions By which any Person may be enabled to perform the Operation and conduct the Patient through the Distemper.”

John Adams joined his brother to be variolated during a Boston epidemic in 1764.

NEXT WEEK: THE POX, Part Two: From Revolutionary Times to the Close of the 20th Century