title: Smallpox inoculation (variolation) in East Africa with special reference to the practice among the Boran and Gabra of Northern Kenya.
abstract: Smallpox inoculation (variolation) was widely reported in sub-Sahara Africa before, during, and after the colonial era. The infective smallpox materials and techniques used, as well as the anatomical sites for inoculation, varied widely among different ethnic groups. The practice among the Boran and Gabra pastoralists of northern Kenya resembled that which was prevalent in a number of areas of Ethiopia. This is not surprising as the Boran also live in southern Ethiopia, and Gabra herdsmen frequently cross the border into this region. The Boran and Gabra technique for smallpox inoculation consisted of taking infective material from the vesicles or pustules of those with active smallpox, and scraping it into the skin on the dorsum of the lower forearm. Although the intent was to cause a local reaction and at most a mild form of smallpox, severe cases of the disease not infrequently resulted. Also, variolated individuals were capable of infecting others with smallpox, thereby augmenting outbreaks and sustaining them. The limited known reports of smallpox inoculation among the Boran and Gabra are presented in this communication. The expansion of vaccination with effective heat stable vaccines, the development of medical and public health infrastructures, and educational programs all contributed to the eventual disappearance of the practice among the Boran and Gabra.
authors.affiliation: School of Public Health, MSC 43, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA, pascal.imperato@downstate.edu.
authors.forename: Pascal James
authors.initials: PJ
authors.lastname: Imperato
authors.forename: Gavin H
authors.initials: GH
authors.lastname: Imperato
mesh_terms: D005260:Female; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007114:Immunization / Q000266:history* / Q000379:methods; D007630:Kenya; D008297:Male; D008519:Medicine, Traditional / Q000266:history; D012899:Smallpox / Q000266:history* / Q000517:prevention & control; D012900:Smallpox Vaccine / Q000266:history*
chemical_list: D012900:Smallpox Vaccine
references.citation: J Afr Hist. 1975;16(4):539-59
references.pmid: 11636788
references.citation: N Engl J Med. 1996 Dec 19;335(25):1924-5
references.pmid: 8965913
references.citation: East Afr Med J. 1960 Oct;37:670-5
references.pmid: 13750482
references.citation: East Afr Med J. 1957 May;34(5):157-81
references.pmid: 13447833
references.citation: East Afr Med J. 1983 Jun;60(6):367-73
references.pmid: 6370657
references.citation: Trans R Soc Trop Med Hyg. 1945 Jul;38(6):445-60
references.pmid: 20293969
references.citation: Soc Sci Med Med Anthropol. 1979 Dec;13B(4):245-50
references.pmid: 395652
references.citation: Trans R Soc Trop Med Hyg. 1968;62(6):868-73
references.pmid: 5729574
references.citation: J Trop Med Hyg. 1971 Mar;74(3):57-9
references.pmid: 5551013
references.citation: Trop Geogr Med. 1974 Dec;26(4):429-40
references.pmid: 4456704
references.citation: Med Hist. 2009 Apr;53(2):193-227
references.pmid: 19367346
references.citation: Br Med J. 1950 Apr 1;1(4656):756-61
references.pmid: 20787831
references.citation: Am J Epidemiol. 1971 Oct;94(4):341-7
references.pmid: 5110550
references.citation: Med Hist. 1965 Oct;9(4):343-55
references.pmid: 5323754