• Fraser du Toit

The Dark History of the First Vaccination

Before we defeated things like measles and polio people used to just die when they got sick. Things like the seasonal Flu, Smallpox and a whole host of other viruses wrought havoc on hapless humans. That is until the process of Variolation was invented sometime in the fifteenth century in China. From the stab in the dark school of medicine to actual scientific practice.

Nothing Small about the Pox - What is Smallpox

Smallpox isn't only the first and only virus to ever be eradicated by humans. This infectious disease caused by the Variola virus was spread through the air. Once inhaled the virus multiplied in the throat and mouth before invading the lymph nodes. The virus would grow there for 12 days before lysis occurred - when the bloodstream would be riddled with the virus in what is known as Viremia. Variola would then multiply in the lymph nodes, spleen and bone marrow of its victim.

The earliest known description of a disease like Smallpox comes from Indian medical writings dated back to 1500BCE. This disease has been around for much of our history, endemic to such a degree that several cultures had gods dedicated solely to Smallpox.

Smallpox had a death rate of 30%. Survivors would be left scarred and potentially blinded by the disease. The early symptoms of a Variola infection are indistinguishable from the standard hangover fever and vomiting heralds its arrival. These would be followed by the development of sores in the mouth and a rash on the skin. Over the next few days, this rash would change into the characteristic fluid-filled bumps with an indentation in the center. The bumps would scab over and fall off, leaving scarring behind. These scabs would render whatever they stuck to contagious.

Death would claim the stricken human around the 16th day. Respiratory complications were a common cause of death, but general sepsis was also known to occur. We should all be thankful to the doctors and scientists that eradicated this apocalyptic disease.

Snortin' Scabs in 15th Century China

The oldest documented use of variolation comes from 15th century China. They practiced a ritualized method of nasal insufflation. This practice involved the crushing up of dried Smallpox scabs from patients with a mild form of the disease. These scabs were then blown up the nostril by what I'm hoping was some form of a doctor. Boys would receive their insufflation via the right nostril, and girls up the left. The pipes used in this procedure were made from silver.

Insufflated patients were treated as though they were infectious until the inevitable rash cleared. This approach is almost scientific but leaves you wondering who the first person was that suggested crushing up and snorting of the scabs.

Sudanese Smallpox Selling

During the late 18th to early 19th centuries, women living in the central Sudanese town of Sennar followed a practice called "Tishteree el Jidderi ". Literally translated to "buying the Smallpox". Sometimes this process involved gifts instead of a business transaction.

The mother of a healthy infant would tie a cloth around the scabby arm of an infected baby. She and the sick baby's mother would then proceed to haggle about the cost of each pustule. Once the mothers reached an agreement on the price of the sickly child's skin-fruit, the healthy baby's mother would untie the cloth and rush home to apply it to her own baby.

Hitting the Smallpox - Dak el Jedri

Another method that saw widespread use in Africa was known as "Dak el Jedri" or "Hitting the Smallpox". This was similar to the Turkish practice that would eventually make its way to England.

Hitting the Smallpox involved the taking of fluids from the pustules of an infected person and rubbing it into a cut on a healthy person. Just another reason to be glad that Smallpox is gone.

Lady Mary Wortley Montagu - Sick of Pox

Lady Mary Wortley Montagu contracted Smallpox shortly after her brother died of the very same disease. She survived the ordeal but was left with heavy scarring on her face. While visiting Constantinople (modern Istanbul/ancient Byzantium), Mary encountered the procedure. She wrote a letter to her friend, Sarah Chiswell, in April 1717 detailing the process. This form of Variolation was performed mainly by experienced older women and was very similar to "Hitting the Smallpox". One year later, Lady Mary, had the procedure done on her five-year-old son Edward Montagu. The Variolation was supervised by Dr. Charles Maitland of the British embassy. Lady Mary would later have the process repeated on her four-year-old daughter in 1721. This time the inoculation was done back in England, in the presence of royal court physicians. Both Variolations were successful.

Western Medicine - Bleed it Out

Doctor Charles Maitland performed an experiment on six prisoners later in 1721. The condemned souls were subjected to the experimental procedure, promised their freedom should they survive the experience. Dr. Maitland's experiment in Newgate Prison was a success and soon he drew the attention of the royal family.

The royal family promoted the use of Variolation for some time. There was still a risk involved as demonstrated by the death of Prince Octavius of Great Britain in 1783. Once again the royals provided an example to their subjects.

British doctors were concerned with the simplicity of the procedure. Much like the modern oil industry's opposition to renewable energy, they were worried about losing their source of income. They contrived to convolute the procedure by adding nothing other than bloodletting. Doctors would routinely bleed their victims to the point of faintness, claiming that this would purify the blood and prevent fever. Their method also involved deeper incisions in an effort to discourage amateurs.

Return to Reason - The Suttonian Method

Robert Sutton, a surgeon from Suffolk, started experimenting with the process of Variolation. The thought occurred to him after the failed Variolation of one of his sons in 1757. He began advertising his "new-method of inoculating for Small-Pox" in 1762. The Sutton family's method was kept a close family secret to ensure that only they could profit off of its use. These old-timey Martin Shkreli's kept their secret for 30 years until Daniel Sutton revealed it in his 1796 book The Inoculator. They set up a network of franchises during this time, sharing their secret only for a cut of the profits made from its use.

What was the Sutton Method you ask? Essentially they took Variolation back to its African roots by skipping all the blood-letting and deep incisions in favor of shallow scratches and using infected tissue from only the mildest cases of Smallpox. The Suttonian method was used to treat over 300,000 people.

Onesimus - One of the Best Bostonians of All Time

The man known as Onesimus was an African born slave owned by Puritan Minister, Cotton Mather. During 1706 Onesimus taught Mather about Variolation. Cotton Mather soon learned that several of the people he owned (slaves) had been Variolated before their displacement to North America. Mather later read Timoni's account of Turkish Variolation practices in the 1714 article Philosophical Transactions by the Royal Society of London.

Cotton Mather used his newfound knowledge during the 1721 Smallpox outbreak in Boston, Massachusetts, to perform Variolations. This was despite strong opposition from other Puritans. This classically American argument centered around the potential religious implications of practicing a form of medicine that wasn't mentioned in the bible (note: not a medical journal). Empirically minded individuals saw the logic of applying the life-saving technique while zealots argued that inoculation was an affront to god.

Mather managed to convince 300 people to get Variolated, with only 6 of his patients dying of Smallpox. Compared to the 1000 (out of 6000 infected) people that died naturally during the same period, Variolation proved its usefulness. The procedure spread out to other colonies from this first success.

George Washington Approved

Word of Variolation spread to the legendary first president of the United States, George Washington. He ordered the Variolation of the Continental Army in 1775. By the end of the American Revolutionary War Variolation had been widely accepted by Cities across the Union. This presidential endorsement led to the wild popularity enjoyed by the procedure. Medical practitioners were inclined to overlook the shortcomings of Variolation. One of the major drawbacks being that the process didn't provide lifelong immunity to Smallpox despite what doctors at the time believed.

Variolation is Dead - Long Live Vaccination

Due to the many cases of Smallpox inevitably caused by Variolation, the process began to fall out of favor in the late 18th century. Several people became interested in using Cowpox material instead of the more dangerous Smallpox-juice. Among these individuals, Edward Jenner stands out as a pioneer of this new method which he named Vaccination.

Jenner started performing this new procedure called Vaccination on James Phipps in 1796. Vaccination got its name from the Vaccinia virus, a close relative of the Cowpox virus. The principles of Vaccination would later be expanded by Louis Pasteur and his colleagues, leading to the development of vaccines for diseases like diphtheria, measles, mumps, rubella, and influenza.

1805 saw Russia banning the practice of Variolation, becoming the first nation to do so.


Smallpox's days were numbered thanks to the innovation of Vaccination. The deadly plague was declared eradicated by the World Health Organization in 1980 following an aggressive campaign of vaccinations. Teams of Vaccinators were sent all over the world, coming into contact with several Variolation practitioners in the process. Access to live Smallpox tissue declined as cases dwindled due to the vaccine's efficacy and Variolators were put out of business.

"Buying the Smallpox" was still practiced in Sudan until the late 19th century.

Variolation may have ended, but its legacy lives on in the form of "Pox Parties", where parents purposely expose their children to dangerous diseases like chickenpox, influenza, measles and more. The "logic" being that this is a way to build natural immunity by just getting it over with. Needless to say, this is a terrible idea and shouldn't be promoted by anyone anywhere.