Variolation

Child with smallpox courtesy of CDC/James Hicks

Variolation is a form of inoculating a person with the smallpox virus in an effort to minimize the severity of the disease. I first became intrigued by the concept when I was watching a movie about John Adams, the second president of the United States. To my surprise, I discovered the scene depicting Abigail Adams purposely having her children infected with smallpox had really taken place. But John and Abigail Adams lived during the 18th century. What about the 17th?

The technique predates vaccination as we know it, and apparently has its origin in 8th-century India. Records indicate that China used variolation by the 10th century. In the West, Lady Mary Wortley Montague is credited for bringing it to England in 1721 after witnessing the practice being used by a doctor in Constantinople.

Again, I thought this would be a plot point that I would have to bypass since The Dreaming: Walks Through Mist is 17th-century Virginia. Then, I did a little more reading. In Massachusetts, Cotton Mather had heard about variolation from a slave in 1706. The slave, from western Africa, had been inoculated as a child which according to him was common practice there. This gave me the lead I needed as the slave would have grown up during the 17th century.

According to medical historians, variolation made its way to Egypt during the 13th century. It is unknown exactly when the form of inoculation came about in North and western Africa, but it was definitely known by the late-17th century and most likely earlier.

With this knowledge, I reasoned, why couldn't I write such a scene? The circumstances were very similar in 17th-century Virginia as Massachusetts. Because my scene takes place during mid-century, the Africans were usually indentured servants, rather than lifelong slaves, but the knowledge could have been available. Even during the 18th century in the colonies, variolation was often thought of as African black magic, therefore frequently discredited among the medical community.

The technique consists of collecting the virus with a lancet from a pustule of an infected person and transferring it under the skin in the arm or leg of the person without the disease. Unlike modern vaccination, this procedure gives the non-infected person an active case of smallpox. However, with the use of variolation, the person, hopefully, contracted a milder form.

Death resulted in 2-3% of the cases where variolation was used. Whereas, the normal fatality rate was 20-30% with much higher percentages for children and Native Americans. Most survivors were left with disfiguring scars, while blindness and limb deformities were less common complications.

The obvious disadvantage to variolation was that people infected through this method could spread the natural severe form of the virus to others. In a time before routine vaccination, the risks seemed to far outweigh the consequences.

Kim Murphy

www.KimMurphy.net