Archaic smallpox innoculation

[robby]

Accidentally hit the "post" button...OP to follow.

[robby]

In the HBO miniseries John Adams, they show people being inoculated for the "bloody pox" by slicing their arm and rubbing in pus from a victim. Wouldn't this just simply infect the person with the disease?

I thought that people were inoculated from smallpox by using the less virulent "cowpox," or today, by using a weakened or killed virus.

Was this depiction in the miniseries accurate? How is this exactly an "inoculation"? There didn't seem to be any effort into inoculating with a weakened or killed virus; instead they seemed to be inoculating with full strength, live virus. How is this any different from intentionally infecting somebody?

[robby]

I'm going to partially address my own question. From this link (http://www.doctorzebra.com/prez/z_x02smallpox_g.htm):

Inoculation is different from vaccination. Inoculation introduces smallpox virus into the recipient. Vaccination introduces vaccinia virus into the recipient. Vaccinia confers protection against smallpox infection, but with far fewer side effects, since it is a much less virulent virus.

I had been under the impression that "inoculation" and "vaccination" were synonyms.

I'm still wondering what the point of "inoculation" is, though. How is it any different from intentionally transmitting the disease?

[robby]

Rest of the answer from wikipedia (http://en.wikipedia.org/wiki/Inoculation):

Infection via inhaled viral particles in droplets spread the infection more widely than the deliberate infection through a small skin wound. The smaller, localised infection is adequate to stimulate the immune system to produce specific immunity to the virus, while requiring more generations of the virus to reach levels of infection likely to kill the patient. The rising immunity terminates the infection. So the twofold effect is to ensure the less fatal form of the disease is the one caught, and to give the immune system the best start possible in combating it.

...In 1796, Edward Jenner introduced the far safer method of inoculation with the cowpox virus, a non-fatal virus that also induced immunity to smallpox. This led to smallpox inoculation falling into disuse and eventually being banned in England in 1840.

[Great Dave]

This is why I love the Dope- get real answers to your questions, fast.

[Bob55]

The infectious dose (ID50) for smallpox that is inhaled is 10-100 viruses. I'm guessing the ID50 for an injection is much larger than that, and can thus allow an immune response while not turning into a massive infection.

[Hello Again]

I had been under the impression that "inoculation" and "vaccination" were synonyms.

I'm still wondering what the point of "inoculation" is, though. How is it any different from intentionally transmitting the disease?

They would select the "donor" carefully - someone who had a mild form of the disease which was not "confluent" (the pox so numerous they merged into one poxy wound all over the body). The "right" donor would have eruptions that were few in number and distinct. Actually, the John Adams series showed this -- the Doctor selected a patient who had "the right kind" of small pox.

So they were intentionally transmitting the mildest form, and only a very tiny bit so that ideally, the patient would have only a very mild attack and recover. This would confer permanent immunity. In the show, everyone except the oldest daughter had a mild case -- and even her more serious case did not become confluent.

So, they are intentionally transmitting the disease, but in a controlled way designed to reduce the chances of very serious infection.

Edited to add: there's an excellent book on the history of innoculation, called "The Speckled Monster."

[Baldwin]

I was intending to ask this exact question after watching John Adams. It's great to actually understand something I didn't before.

[John Mace]

From the wikipedia article:

Infection via inhaled viral particles in droplets spread the infection more widely than the deliberate infection through a small skin wound.
But why is that? Seems like both methods get the little buggers into your blood stream.

[KGS]

Actually, the John Adams series showed this -- the Doctor selected a patient who had "the right kind" of small pox. For real? Because that poor kid looked to be on death's door! :eek:

So...was this type of treatment actually useful, or was it another "snake oil" cure, like exsanguination?

[John Mace]

For real? Because that poor kid looked to be on death's door! :eek:

So...was this type of treatment actually useful, or was it another "snake oil" cure, like exsanguination?
Read the wikipedia article. It was pretty useful if done right, and was used for hundreds of years (first in the east, and later in the west).

[Malienation]

I've been wondering about this too. In a recent book (http://www.amazon.com/What-Would-Founders-Do-Questions/dp/B0012O2KDI/ref=pd_bbs_1?ie=UTF8&s=books&qid=1206388046&sr=8-1) I read, smallpox killed 1 in 12 during Colonial times, whereas inoculation killed only 1 in 40. Not a bad risk, if smallpox was genuinely running rampant.

[Omniscient]

But why is that? Seems like both methods get the little buggers into your blood stream.

Yeah, but inhaling something distributes it across the entire body very quickly. Infecting a small spot on the arm will have a slower dispersion throught the body and the bodies immune system will have already begun to respond to it by the time it's distributed.

Think of it as poisoning a cities water supply. It's much faster and more efficient to dose the water treatment plant and pumping station than to toss it into a single water main.

[Omniscient]

I've been wondering about this too. In a recent book (http://www.amazon.com/What-Would-Founders-Do-Questions/dp/B0012O2KDI/ref=pd_bbs_1?ie=UTF8&s=books&qid=1206388046&sr=8-1) I read, smallpox killed 1 in 12 during Colonial times, whereas inoculation killed only 1 in 40. Not a bad risk, if smallpox was genuinely running rampant.

I think it's a little more nuanced than that. From the Wiki link above:

Two forms of the disease of Smallpox were recognised, now known to be due to two strains of the Variola virus. Those contracting Variola Minor had a greatly reduced risk of death — 1-2% — compared to those contracting Variola Major with 20% mortality.

I don't think that inoculation itself is dramatically safer than infection but instead the selective infection of the Minor strain versus the Major one.

[Jackmannii]

Inoculation was a risky practice - obviously the amount of infectious agent to be given varied widely (no standardization was available) and you could get quite sick, as well as transmitting full-blown smallpox to someone else.

Still preferable to taking your chances of succumbing to epidemic smallpox.