The First Vaccine — The Art of Chinese Viriolation
Smallpox was one of the worst diseases to ever afflict mankind, claiming hundreds of millions, if not billions of lives throughout all of history. Thus, it is no wonder that the first vaccines were developed to guard against smallpox. The first proto-vaccines were practiced in China in the 15th century, perhaps as early as the 10th century. The Chinese method was nothing like modern vaccination methods, but was an early form of viriolation (inoculation against smallpox), a method first coined by the English physician Edward Jenner. The early Chinese method of viriolation was to take the dried out scabs of smallpox victims. The scabs would then be ground into a powder, then blown through a pipe into the nostrils of the patient. There was a bit of ceremony behind the act; typically viriolation was done with a decorative silver pipe, and boys were viriolated through the right nostril while girls were viriolated through the left nostril.
While the Chinese at the time had no knowledge of germ theory and little knowledge of immunology, the purpose of this was to infect the patient with a mild form of smallpox. Indeed, the dried out scabs would contain weakened or dead smallpox virus, which the human immune system could easily fight off or at least obtain an immunological memory from its antigens. Viriolation became popular in China, especially among nobles and the upper class. One doctor named Zhang Yan boasted that he had successfully viriolated up to 9,000 people. In the 18th century a Japanese physician reported that around 80%-90% of China’s upper class families had their children viriolated.
The practice of Chinese viriolation was not without risks, as the virus could mutate and the patient become infected with full blown smallpox. However, the benefits far outweighed the risks in an age when smallpox decimated entire societies. Over time the Chinese would perfect their technique, finding easier and safer ways to infect patients. Their methods would spread across the Silk Road, being adopted in India, the Middles, and by the 18th century in Europe. It was then that Dr. Edward Jenner would experiment with various viriolation methods. It was in 1796 that he would develop the first modern vaccine by inoculating patients with cowpox, a disease similar to cowpox but much less deadly, and thus make them immune to smallpox. Today, the use of vaccines are a staple of modern society. The last case of smallpox occurred in 1977.
Part of the human stomach dissected by Edward Jenner (1749-1823). The stomach has been flattened & injected with wax to highlight veins and arteries and the stomach wall, likely to be used as a teaching aid. (c.1790-1823).
It’s been said that English physician Edward Jenner (May 17,1749-Jan. 26,1823) saved more lives than any other human. Jenner developed the smallpox vaccine – the first successful vaccine – in 1798. In the late 18th century, smallpox cases were increasing and had a mortality rate of 40%. Through interviews and experiments with local farmers, Jenner observed that milkmaids who had been infected by cowpox – a milder form of the often deadly smallpox disease – during milking were immune to smallpox. The resemblance of the ulcer shape between the cowpox and smallpox viruses led to the discovery. Culled from our collections, here we have an original copy of Jenner’s “An Enquiry into the Causes and Effects of Variolae Vaccinae, known by the name of Cow Pox” (1798).
Top: Edward Jenner performing his initial inoculation experiments in 1796 Bottom: Typical presentation of vaccination site when successfully inoculated.
You know those shots and nasal sprays you get for vaccinations these days? Well, it wasn’t always like that. Though the practice of intentionally infecting people with Variola minor (much less fatal) to avoid Variola major goes back all the way to ancient China, Edward Jenner performed the most well-documented trials of using inoculation with Vaccinia virus (cowpox), in order to avoid later infection from smallpox.
Jenner, and many other physicians of the period, noticed that milkmaids and other farm-hands who had close contact with cows almost never became infected with smallpox during outbreaks, and hypothesized that the reason was due to the fact that they’d previously been infected by cowpox. To prove this fact, Jenner actually used his own children as guinea pigs, and inoculated them with the fluid from a cowpox sore on a milkmaid. To do this, he had to puncture the dermis with the infectious agent, and the child would contract a generally mild cowpox infection several days later.
As you can see on the lower image, the effects on the skin were not pretty, and the virus often caused substantial scarring, which can still be seen on most people who received the vaccines - just ask any relative growing up before the 1950s, and they probably still have that scar!
The method of Vaccinia virus inoculation to prevent serious smallpox infection was also much more dangerous than vaccination methods we have today. Approximately 1 in 1000 people would die from the initial methods , and approximately 1 in 75,000 people would die from the last methods used before we discontinued routine vaccination. This is because the virus was not attenuated (weakened) at first, and even when it was, you still had to have the body react as if it were infected in order to receive any immunity. It was a lot worse than the acute soreness some of today’s vaccinations give us, but it still saved thousands of lives - Variola major had a 35% mortality rate in unvaccinated people.
Top: “The Vaccination (1796)” by Gaston-Theodore Melingue, 1879. Bottom: Pediatrics: The Hygienic and MedicalTreatment of Children. Thomas Morgan Retch, 1906.
Edward Jenner (1749-1823) was the pioneer of vaccination but was also known for his delicate dissections. Here, the section of the stomach has been flattened and injected with wax to show the veins and arteries as well as the delicate membrane of the stomach wall.