Variolation in Egypt

Although Clot recorded the introduction of smallpox immunization in 1827 as his own personal accomplishment,^[5] there is evidence that both variolation and vaccination were practiced earlier in Egypt. The loose use of the term "vaccination" generically for all types of immunization has obscured the fact that it was variolation—the transfer of smallpox matter, variola, from one person to another—that stimulated the study of this preventive procedure and launched the science of immunology.^[6]

Variolation was an ancient folk medicine practice common in Asia, Africa, and Europe; historians have identified it in China as early as the sixth century of the Christian era and have postulated that it existed in India perhaps even earlier. From China, nomad merchants passed on the practice to Circassians in Georgia, who transmitted it into Anatolia, Armenia, Persia, the Levant, Arabia, Egypt, and the Balkans. The Chinese method, called "sowing the pox," consisted in inserting a scab from a smallpox pustule into the nose. Circassians caused an irritation on the skin and applied a thread soaked with variolic pus to the affected area. A third method, making a wound in the skin with a needle, knife, or lancet dipped into purulent matter from a smallpox sufferer, was widespread. Seventeenth-and eighteenth-century travelers reported the custom of "buying the pox" by such procedures in rural communities in nearly every country of Europe, in the Caucasus, in the Balkans, and among the nomads

of the Arabian and Saharan deserts. The Turkish method of variolation by small incisions or punctures on the upper arm was the procedure imported into England early in the eighteenth century. Italian physicians had adopted it somewhat earlier, and from those two countries the practice spread throughout Europe.^[7] From such wide distribution, it appears that variolation arose spontaneously, out of empiric observation, wherever the need for it occurred.

At the time of the French expedition in Egypt, Napoleon's surgeon-general, Dominique Larrey, reported that inoculation with smallpox was known and practiced up to the sources of the Nile. He described the procedure, which was called "finishing with smallpox" ("tikhlyseh el-gidry," i.e., takhilis al-jadari ), as follows. "Midwives take a small band of cotton, apply it to suppurating smallpox pustules, then place it on the arm of the child they wish to inoculate." Larrey admitted that the practice usually succeeded but expressed fear that smallpox so transmitted might become dangerous in adverse environmental conditions.^[8]

Another French observer, who served as medical officer in Upper Egypt in the 1840s, reported that the nomads of the deserts and oases vaccinated themselves with cowpox. Acquaintance with this folk custom might have accounted for their ready response to the government's vaccination campaign; they accepted it with enthusiasm, he wrote, unlike the fallahin who feared that their children were being marked for conscription into service. Visitors also mentioned that the fallahin resisted vaccination, whereas the Bedouin had no objection to it and even came to town to ask for the vaccine.^[9]