Vaccination and Edward Jenner.
P.K.Ghatak, MD.
In 1980, the World Health Organization (WHO) declared Smallpox was eliminated from this earth forever. The world stopped to thank Edward Jenner for his gift, the Vaccine, to humanity.
It may seem strange but true that Dr. Edward Jenner was not the first person to notice having cowpox provided lifelong immunity to smallpox; nor was he the first to produce a vaccine against smallpox. That honor goes to ancient India, China and Africa.
People, from the beginning of human civilization, learned from experience that surviving a smallpox ordeal, protected them from the future smallpox.
In India:
They searched and found a way to introduce smallpox under a control condition. They called the process Tika and the court appointed people who administered Tika were called Tikadars. They collected pus from smallpox pustules of a patient and applied a drop of the material on the skin of the arm of an uninfected individual and made superficial cuts with a sharp scalpel in the skin, going through the pus. The process was not fully safe, some developed full-blown smallpox and died, however, the vast majority of vaccinated people were protected. The vaccination was only available for the royal family and high officials. Vaccination reached China through Tibet.
In China:
Chinese collected scabs from smallpox patients, dried and pulverized the scabs to a powder. They introduce this power in the right nostril of males by a silver blowpipe and in the left nostril of the females. The westerns called this a Variolation. China claimed variolation was an original Chinese invention.
In Istanbul, Turkey:
In 1718, Lady Mary W. Montague, the wife of British ambassador in the court of the Ottoman sultan in Istanbul, observed and was impressed with Variolation. She asked Dr. Charles Maitland, the embassy surgeon, to variolate her 5 year old son. This was effective. She wrote to her friends in England about variolation in order to protect people from smallpox.
In England:
Lady Montague returned to England and in 1721 she asked Dr. Maitland to variolate her 4 year daughter in the presence of royal physicians. This was also successful. Maitland was granted a license to practice variolation in England. In 1722, he successfully inoculated two daughters of the Prince of Wales. The process gradually spread all over Europe.
In a village in England:
In 1774, a farmer named Jesty, in Yetminster, knew from his own experience the protective property of cowpox. He deliberately infected his family with cowpox. Using the material from lesions on cow's udder and making scratches on the skin with a stocking needle and rubbing the material on the skin lesion. All of them survived the epidemic that was raging through the country.
An epithet is erected to memorialize the event, as shown below. [taken from BBC publication].
In another village:
In the 1760s, a country doctor, Dr. John Fewster, practiced vaccination in the village named Thronbury, Gloucestershire, England. His method of vaccination was almost similar to the one described earlier.
The virus:
The smallpox virus is known as Vaccinia. It belongs to Orthopoxvirus. Orthopox viruses are zoonotic (virus can infect humans from animals). There are 12 important orthopox viruses. Some of these viruses are species specific for one kind of animal, but most are infectious to wide varieties of mammals and birds.
Chickenpox, appears close to smallpox clinically, but in fact it is a completely different virus called Herpes varicella zoster virus.
Cowpox virus is known by CPXV.
Monkeypox virus is called Mpox virus.
Camel pox virus is called CMLV
Mice pox virus is called Ectromelia virus (ECTV).
Vaccinia virus is large, shaped like a brick, contains 170 to 230 genes. It is a double-stranded DNA virus. The centrally located gens are involved in replication within the cytoplasm of the cells, in contrast with most viruses which duplicate inside the nucleus. The peripherally located genes manipulate the victim's immune system and promote cell deaths.
Smallpox is called Variola in medical science. This term came from Switzerland in 570 AD, from a Latin word Varius or Varus meaning mark on the skin.
Chicken pox is called Varicella.
Dr. Edward Jenner:
Edward was born in 1749. Edward Jenner was Stephen Jenner's son, a priest in Berkeley, Gloucestershire, England. After completing his studies, at the age of 13, he went to work for a country surgeon. In there, he heard the story of dairymaids who had cowpox, did not contact smallpox and they had an unblemished face as a proof (in contrast with pox marked ugly face of survivors of smallpox). At age 21, he completed a two-year apprenticeship under the famous surgeon John Hunter and learned the systemic study of diseases. Thereafter, he returned to his own village and began a general practice. He studied the " mystery of cowpox in preventing smallpox." He understood the basic concept of immunity. He collected cowpox material and began inoculating people. Variolation and inoculation were often used interchangeably. [Inoculation a Latin word meaning graft, the term was derived from it]
He experimented on a 8 year old boy with pus obtained from lesions on the hand of a dairymaid. Two months later, in July 1796, he inoculated the boy again with pus obtained from a smallpox patient. The boy did not develop any illness. He wrote this case report and added his concept of immunity, and sent the paper to the Royal Society for publication. But the paper refused to publish it. He resubmitted the paper with additional cases. In 1797, the paper was published. He named his procedure as Vaccination.[vacca = cow, vaccinia = cowpox.]
He began publicizing and teaching doctors about vaccination, even to a point of ruining his own practice. In 1802, the British parliament granted him 10,000 pounds and again 20,000 pounds to compensate his time and materials. Jenner supplied anyone who requested the vaccine and often sent his assistants to teach the procedure. Jenner sent his vaccine to Benjamin Waterhouse of Harvard University. Dr. Waterhouse gave some of it to Thomas Jefferson. Due to Jefferson's efforts, the Institute of National Vaccine Program was set up in the USA.
In 1840, by the act of the British parliament, the following law was adapted:
I. Vaccination was official policy, and variolation was banned for smallpox inoculation.
Government provided vaccine, made from cowpox, free of charge to all.
In the subsequent years, the vaccination against smallpox reached most European countries and in the new world. And the WHO took the vaccine to every corner of the earth.
Jenner was the first person to use a scientific method to control an infectious disease by the use of a live agent. In the late 19th century, it became evident that immunity decline over the years and revaccination was necessary. Jenner suffered a stroke and died several months later in 1823 and was buried in a Berkeley church.
The WHO and Vaccinia Vaccine:
In 1959, the World Health Organization took up the challenge of eliminating smallpox. Soviet Union supplied the heat-stable, freeze-dried Vaccinia vaccine. On 8 May 1980, a little over 100 years after Jenner began vaccination in England, the WHO announced that the world was free of smallpox and recommended all countries cease vaccination.
No one knows:
Smallpox virus genome structure is deciphered and is utilized to trace interspecies migration of orthopoxvirus and mutations of the virus. It is a valuable tool for studying the source of an outbreak and how to start manufacturing vaccines. In 1939, scientists looked for the origin of the virus used for vaccination. To their surprise, they discovered that NONE of the 6 varieties of vaccine used in the worldwide vaccination program contained cowpox or horsepox virus. In fact, they have not come up with an answer as to when and how the switch of virus took place. However, the present vaccine has been found to be effective against Mpox. And new vaccines are on the way.
