Page 4 - Pharmacy History 37 Nov 2009

Cow bells and cold chains
The spread of smallpox vaccine and vaccination before refrigeration
Geoff Miller, pharmacist and historian
The histories of transmissible diseases that have afflicted mankind and their containment do not have the happy ending that we can attribute to the history of smallpox, and this is what makes it unique.
When I first started my career in pharmacy in the 1950s, the concept of a ‘cold chain’ for all perishable medicinal products hadn’t really been thought of.
One exception however was
the recognition of the special arrangements required to
handle smallpox vaccine, as the Commonwealth Serum Laboratories in Australia insisted that to preserve potency, the vaccine had to be stored in the frozen state, at as low a temperature as possible.1
Wholesalers despatched the boxed capillary tubes wrapped in layers of newspaper and the parcel was kept apart from other goods in an insulated box in the delivery van.
In those days a dispensary refrigerator was a rarity, and most pharmacies stored this vaccine in the freezer of
a neighbouring butcher’s shop or ice cream parlour.
With such specific storage directions for smallpox vaccine, I began to wonder how this product was transported around the world in the days before refrigeration, and on voyages through the tropics often lasting over three or four months.
The surgeons of the First Fleet that was sent from England in 1788 to establish a colony in NSW and a new convict settlement, are said to have brought out ‘variolous matter’ with them. Exactly what ‘variolous’ matter means is not clear, but in any case there is no record of their ever having made use of it.
Smallpox was the first disease to which an artificial immunity was created by deliberate inoculation with
the causative organism, obtained
from the skin blisters of mild cases. This was known as variolation, a process which originated in Asia in ancient times, and by this deliberate inoculation of smallpox material into a human arm it was hoped that a mild form of smallpox would develop to give immunity in the patient.
Edward Jenner
The role of Dr Edward Jenner in the smallpox story is well known, as he was the first to prove scientifically that vaccination (vacca - Latin for cow) with cowpox gave protection from smallpox, and he also demonstrated that cowpox could be transmitted artificially from one human to another, so vaccination was not dependent on the existence of cowpox in a community. He made these observations public in 1797, only nine years after the colony of NSW was established.
Transporting the
vaccine
Although Jenner’s publications and ideas were spread relatively quickly, there were some difficulties in
exporting the vaccine even over short distances or in cool climates. 2
The commonest methods used in the 19th century included:
(1) Drying the vaccine on points
Lancets made of silver, gold
or ivory. Sometimes the liquid lymph on the ivory point was enclosed within a wax ball, and in some eastern countries, the dried thorns of a bush were used instead of ivory points.
(2) Drying the vaccine and sealing it between small glass plates
A pool of vaccine was dried
on a glass plate and when it
was perfectly dry a thin coat of mucilage of gum Arabic was applied. Alternatively another glass plate was placed over the dried vaccine and the edges sealed with wax.
Dried vaccine on threads in sealed glass tubes
(3) Using lengths of thread to soak up the vaccine, which were then dried
Initially this was the commonest method, and it was similar to
the variolation process using
4 Pharmacy History Australia
volume 5 no 37 NOVEMBER 2009