A GIFT OF TREATMENT FROM THE EAST TO THE WEST: SMALLPOX VACCINATION AND ITS STORY
A GIFT OF TREATMENT FROM THE EAST TO THE WEST: SMALLPOX VACCINATION AND ITS STORY
Prof. Dr. Kadircan KESKİNBORA
Bahcesehir U. medical School
Let's talk about Smallpox, which is a historical phenomenon for today. Like many health problems, smallpox is one of those diseases that changed history. Queen Elizabeth II Elisabeth came to the English throne thanks to smallpox. Queen Elizabeth II Mary died of smallpox in 1694. When her son, the queen's only legal heir, died of the same disease in 1700, the throne remained vacant. Elisabeth's grandfather, George, was brought from Hanover and placed on the throne. With the transition to the next generation, granddaughter Elisabeth eventually ascended to the throne. Epidemic diseases such as plague, scarlet fever, measles, smallpox, and disasters such as famine and drought, which were considered as the wrath of God and a punishment sent to his sinful servants in ancient times, have caused the death of millions of people throughout history, stopped armies that were thought to be invincible, and shaped social relations and behaviors.
Smallpox "variola", one of the epidemic diseases, started in China in B.C. It was described in 1122. This disease is also mentioned in ancient Sanskrit texts in India. Traces of the disease were found in the mummified skull of the Egyptian pharaoh Ramses V (d. 1156 BC).
One of the most famous works of al-Razi, one of the great Islamic physicians, is his booklet titled "Kitab-ül-cüderi ve'l-hasbah" on smallpox and measles. In this famous work, he describes the differential diagnosis between smallpox and measles.
Smallpox first appeared in Europe before the 10th century, probably as a minor ailment like the common cold. It caused deaths in the 16th and 17th centuries, re-emerged at the end of the 17th century, and infected both children and adults in Europe. caused their deaths.
Smallpox is the common name for a series of infectious diseases caused by viruses from the"Poxviridae" family in humans and domestic animals. Blisters begin to appear on the skin two days after fever, which is the first symptom of the disease in humans. After the pus-collecting and bursting phases, they dry out and cause rashes. These rashes leave distinctive scars on the skin, called "pox", and can proliferate and spread, especially on the face.
Until recently, Smallpox was an almost ubiquitous disease and carried a significant mortality rate ranging from 5% to 20% depending on the circumstances.
Intercontinental Travel of the Smallpox Vaccine
The smallpox vaccine against the disease has been used in India and China since ancient times. Inoculation was a very old Eastern practice, in which infectious material caused by living organisms was transmitted to animals, either knowingly or accidentally. The Chinese implemented this practice by grinding the smallpox material into powder and snuffing it into the nose like snuff.
Ottoman physician Emanuel Timonius claims that it began to spread in Istanbul in 1673-74, via the Caucasus, as practiced in other Asian tribes. However, it is known from the pamphlet named Menafiü'l-etfal (Istanbul, 1846) that smallpox vaccination was used in the Ottoman Empire in earlier times. In this treatise, it is mentioned that a man who knew smallpox vaccination came to Istanbul and vaccinated 5-6 children. This vaccine, which was also made in Edirne at the beginning of the 18th century, was called telkîh-i cederî (smallpox vaccine), pox, variolation and inoculation: The pus taken from those who had mild smallpox was drawn on the skin of those who did not develop pox. This is a practice that has been done since much earlier times. In Turkey, the material was introduced into the body through a scratch on the skin; it is applied to the scratches created on the skin of the person to be vaccinated.
Lady Montagu and the Ottoman Smallpox Vaccine
The technique that Lady Mary Wortley Montagu (1689-1762) learned while she was in Istanbul as the wife of the British ambassador was the method described above. Convinced of the effectiveness of the vaccine, he vaccinated his children, who had not had smallpox, in this way, and the children had a mild disease.
Lady Montagu , had returned to England with a formula that would allow the Royal Family to breathe for the moment, but not the entire British Empire. During her husband's embassy duty, the Lady discovered that physicians in the Ottoman Empire had found a cure for smallpox. First, in a letter to his friend Sara, he asked about those who died from 'smallpox', the deadly disease of the period, and after a long correspondence, he wrote that the cure was found in the Ottoman Empire. The vaccination method used by the Ottomans against smallpox in the 18th century spread first to England and then to Europe, after it attracted the attention of Mary Montagu, the wife of the British ambassador who traveled to Edirne during her husband's duty. The vaccine contained “dried pus”. This was an inactivated cell culture. Montagu observed that the material obtained from these pustules (watery skin rashes filled with pus) was transmitted to children to be vaccinated. She observed that children developed fever after 8-9 days and that they later recovered. With this letter, Lady Montagu made one of the first records regarding vaccination in the history of world medicine.
Vaccination Midwives
In her letter dated April 1, 1717, written to a friend named Sarah Chiswell from Edirne, Lady Montagu was going to send information to England, the real consequences of which she could never have predicted: “In September, when the great heat has passed, the heads of families find out whether there is anyone in their families who has smallpox, and several families come together. is gathered together. The group, numbering 15-16, calls one of the grafting old wives. The woman brings the smallpox-causing substance stuffed into a walnut shell, and after opening the vein in whichever vein they want the vaccine to be opened with a needle and pouring the vaccine into it as much as the tip of the needle, she ties the wound and dresses it with a walnut shell. “Not the slightest pain is felt during all these procedures.” While Lady Mary was in the Ottoman lands in 1717, she also saw that the people there were injecting the fluids taken from the bodies of people who died of smallpox under the skin of healthy people. Montagu, who witnessed vaccination against smallpox in the palace in Edirne, is the person who brought the formula that saved England from this disease. In the letter, she explained that liquid was taken from the arms of people who had the disease, dried in the sun, and the dried liquid was diluted, scratched with a needle, and dropped on the skin..
From Inoculation to Vaccination
The comparison with flower parties, where parents bring their children together with another infected child in order to get over the disease as soon as possible, is only partially appropriate.
The scientific world learned about the vaccination against smallpox from the writings of two physicians named Emanuel Timonius (Istanbul) (1713) and Pylarini (Izmir) and Lady Mary Worthley Montagu, the wife of the British ambassador who was on duty in the Ottoman capital at the time. When her husband's duty was over, the Lady took the information about vaccines made by the method called "inoculation" to her country, England. This was the first time the vaccine passed from the Ottoman Empire to the West. The first document proving that it was the Turks who developed vaccine treatment is recorded with this story.
However, when Lady Montagu returned to London, a smallpox epidemic devastated the city. He barely found a doctor and persuaded him to vaccinate his 3-year-old daughter the Turkish way. While the boy's life was saved, other children were not as lucky. It turned out that the vaccine worked, but the British and their doctors did not dare to have this method done.
However, some British doctors administered the vaccine to children at the wrong time and several children died. Thereupon, a campaign against the smallpox vaccine began. In a ceremony held on July 8, 1722, Reverend Edmund Massey referred to smallpox vaccination as a "dangerous and sinful practice", a "diabolical practice"; He accused vaccinators of cutting off God's grace and promoting sin and immorality. In fact, a surgeon named Legard Sparham wrote a booklet called "Reasons against the application of smallpox vaccine" and argued that it was absurd to inject "poison" into smallpox wounds.
Thereupon, Lady Montagu felt the need to publish what she saw in Turkey in a separate book. Moreover, according to his granddaughter Louisa, he returned from Istanbul with such great scientific courage that he went from house to house in London and told the British about what he saw in Turkey, and even took his daughter with him and had her vaccinated many times in front of the British women, to prove that the vaccine did no harm. He struggled. Lady Montagu and the British Embassy physician eventually introduced this innovation in London.
Vaccine Experiments
It is said that during this smallpox epidemic in London in 1721, the royal family wanted to apply Lady Mary's method, but on the advice of doctors that "it could be dangerous", the vaccine was first tested on prisoners. The best thing to do is to say, "Let's use the prisoners as guinea pigs." The prisoners are promised their release and given vaccinations. How lucky are the prisoners that, while free people are dying in the epidemic, their health is preserved and they regain their freedom. Accordingly, when all the prisoners used as test subjects recovered thanks to the vaccine, the Royal family also tried the method and quickly recovered from the disease.
After England, the vaccine was also used in Germany, France, Portugal and Spain. It is a fact that until the modern smallpox vaccine was discovered in 1795, Turkish vaccination was considered the only hope of the world.
Like many other general practitioners, Edward Jenner (1749-1823) occasionally vaccinated his patients by inoculation. In the countryside where his practice was located, a rare form of smallpox in cattle was known to sometimes cause a single blister to appear on the hands of milking girls, and these girls apparently did not contract the more serious form of smallpox. Although a farmer named Jesty and others had previously injected cowpox material into people's bodies with the intention of preventing smallpox, Jenner performed his crucial experiment in 1796 and introduced the new measure. He took material from a cowpox lesion on the hand of a milking girl named Sarah Nelmes and injected it into the arm of James Phipps, a little boy who had never had natural smallpox before. Although the child developed pain and a scabbed wound on his arm, his condition did not worsen, except for a fever that lasted for a day. Six weeks later, Jenner inoculated the child with the usual floral material. The child did not develop disease; This showed that the child was immune.
Since the Royal Society refused to publish Jenner's first article, he published his own short book in 1798 on the practice, which he called 'vaccination', derived from the Latin word 'vacca', meaning cow. Unsurprisingly, there have been some negative comments about resistance to innovative approaches, and particularly about the 'contamination' of animal material to humans. Still, Jenner's work immediately garnered attention in the UK and other countries. Jenner received two large grants from the British parliament and was able to devote himself to furthering his work on indoctrination.
Although the smallpox saga finally ended in 1979, with the disease eradicated as Jenner himself had predicted, this was the exception rather than the rule. Prevention of disease has always been among the poor, like other forms of medical practice, despite the urgency of the situation in industrializing societies.
The future king Henry VII. "If it can be prevented, why isn't it prevented?" Edward asked his doctors. It was a fair question, but the annoying answer was that the cost might be too high, there might not be enough political or medical will, or that people (and their doctors) need to be educated about disease prevention, and education is never something that can happen everywhere. King II After George had his children inoculated with this technique by the royal surgeon, the practice continued to spread.
Smallpox Vaccination in France
Inoculation carried a risk that could not be ignored, but although the risk was great, the strategy was the same. Secondly, exposure to the disease once was known to provide lifelong immunity, and by selecting a mild case to provide material for inoculation, a life-long risk of death from the existing disease was avoided. probability was reduced.
- By the mid-18th century, inoculation was simplified and especially by King Louis XV of France. Louis died of smallpox and was succeeded by his ill-fated son, Louis XVI. It became even more widespread after Louis' successful inoculation in 1774. However, implementation was not without its difficulties. Patients sometimes died from this disease after inoculation, and in any case they became possible sources of transmission of the disease to others.
Smallpox Vaccine Applications in the Ottoman Empire after Vaccination
The first medical publication on Smallpox in the Ottoman Empire was the Smallpox Risalesi, published in 1801 by Hekimbaşı Mustafa Behçet Efendi (1774-1834), a translation of Edward Jenner's book Smallpox Vaccine, Reasons and Effects (1798). In the Ottoman Empire, a special effort was made regarding smallpox , and orders were sent all over the country to eliminate this disease, to administer smallpox vaccine (telkîh-i cüderi) to the sick adults and especially to children, and to take the necessary precautions by paying attention to their care. It is remarkable.
Over time, the European vaccine, which gave safer results, was appropriately dosed and produced in mass production, became preferred in the Ottoman Empire. However, bringing vaccines from Europe was financially costly and took a long time; These were among the factors that increased the spread of the disease. In addition, the recurrence of smallpox almost every year increased the demand for the vaccine and therefore the cost. Besides all these, another important problem was that the vaccines were spoiled while they were sent to places far from Istanbul. In this regard, instead of purchasing vaccines from Europe, it was decided to open vaccination centers within the empire. It is understood that, upon necessity, the first telkîhhane was opened in Istanbul in 1890.
After the telkîhhanes were opened, they played a major role in meeting the country's vaccine needs. Between 1892 and 1913, smallpox vaccine was prepared for 7,260,784 people. Between 1914 and 1919, vaccines were prepared for 27,688,499 people. After communication with Anatolia was cut off, vaccines were sent to 566,000 people in 1920, 1,770,000 people in 1921, and 1,283,000 people in 1922 through the Red Crescent. The telkîhhanes were closed on 31 June 1934 and the Refik Saydam Central Hygiene Institute was opened instead.
Eradication of Smallpox in the World
The serious and consistent efforts of the World Health Organization (WHO) to eradicate smallpox from the world were successful with the support of state and local governments and non-governmental organizations around the world.
Recently, there have been a few cases of Smallpox in the world. It was seen in Somalia in 1977. In 1979, a fatal case of smallpox was detected in a 7-month-old baby boy in California, USA. This baby was vaccinated at the beginning of June 1979, when he was 3 months old, because of suspicion of Herpes Simplex infection due to recurrent mouth sores. The baby later died on August 31, 1979, due to a severe lung infection.
The World Health Organization announced on October 26, 1979 that smallpox, which had caused deaths in the past, was eradicated from the world. Smallpox vaccination has been abolished in our country since 1980.
Production of vaccines for civilian use was discontinued in 1982, and vaccination of US soldiers was discontinued in 1990. Today, vaccine applications are limited to laboratory workers working with similar viruses.
Two potential sources remaining after the global eradication of the disease may be: first, accidental infection by virus in laboratory stocks; Secondly, poxviruses in animals cause infection.
Smallpox Vaccine is currently being used due to the bioterrorism threat caused by recent terrorist incidents.
has come to the fore again. Medical Historian, Erwin H. Ackerknecht, in his book A Short History of Medicine published in 1982, states that he found the WHO's declaration of October 26, 1979 premature because the statistics in underdeveloped countries could be unreliable. As we enter 2018, let's leave these evaluations to the readers.
Resources
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- Ackerknecht AW. A Brief History of Medicine. Baltimore: Johns Hopkins University Press, 1982, p.167.
- Unat EK. History and Control of Vaccines in Turkey. Vaccine Problem in Turkey, Istanbul 1989, p. 8-9.
- Unver AS. Smallpox Vaccination and History in Turkey. Istanbul: İsmail Akgün Printing House, 1948, p.154.
- Dinç G, Ülman YI. The introduction of variolation ‘A La Turca’ to the West by Lady Mary Montagu and Turkey's contribution to this. Vaccine 2007;25:4261–4265.
- Terzioğlu A. The Origin of Turkish Style Smallpox Vaccine and Its Spread to Europe. Turkish World History and Culture Magazine, issue: 239 (November 2006), p. 14-19.
- William H. McNeill WH. Plagues and Peoples. Anchor Books, 1989, s. 223.
- Behbehani The smallpox story: life and death of an old disease. Microbiol Rev 1983;47: 455–509.