Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Lecture 13.  Smallpox.

An Account, or History, of the Procuring the SMALL POX by Incision, or Inoculation; as it has for some time been practised at Constantinople.  Being the Extract of a Letter from Emanuel Timonius, Oxon. & Patav. M.D. S. R. S. dated at Constantinople, December, 1713.  Communicated to the Royal Society by John Woodward, M. D. Profes. Med. Gresh. and S. R. S.  Philosophical Transactions of the Royal Society, Volume 29, Number 339 (1714), pp. 72-92.

Lady Wortley Montagu (1689-1762)

Dec 1715
  • struck by smallpox;
  • badly scarred;
  • brother dies from the disease
Apr 1717
  • writes letter describing Turkish practice of inoculation
Mar 1718
  • has six-year-old son inoculated
Spring 1721
  • has daughter inoculated
  • inoculation tested on six condemned criminals in Newgate Gaol
    • orchestrated by Caroline, Princess of Wales [1683-1737; wife of the future George II]
    • prisoners are offered freedom as their reward if they survive the procedure
    • five came down with a mild attack of the disease
    • sixth, who had already had smallpox, showed no change
    • all six were freed
Spring 1722
  • inoculation successfully performed on orphan children of St. James's Parish
  • Princess Caroline has two of her own daughters inoculated
Summer 1722
  • two individuals die after inoculation leading to escalation of controversy over the practice

Edward Jenner (1749-1843)

After a lengthy series of experiments, Jenner published his results in An Inquiry into the Causes and Effects of the Variolae Vaccinae.... (1798).  The public responded with a mixture of enthusiasm and fear!

"Vaccine in Conflict with the Medical Faculty" (Paris, c. 1800)
An assertive cow charges threateningly at the wary medical establishment depicted by an ass with reins belonging to Galen and Hippocrates.

"Cow Pock ... or ... the Wonderful Effects of the New Inoculation!" (1802) by James Gillray
Edward Jenner inoculates a fretful woman with "Vaccine POCK hot from ye cow" while cows erupt from the pustules on others who have already been vaccinated.  A picture on the back wall shows people bowing down in adulation before a statue of a cow on a pedestal.

Vaccination in the US:  The North Carolina Accident
Nov 5
Thomas Jefferson describes his own successful program of vaccination conducted at Monticello
Mar 23
Dr. James Smith of Baltimore writes to US Congress; introduces plan to safely inoculate people against smallpox using Jenner's method of vaccination
Feb 27
US Congress passes "An Act to Encourage Vaccination"
Nov 1
Smith, now "Agent of Vaccination" of the National Vaccine Institution, sends out samples of "kine pox scabs" to Drs. John Ward and Benjamin Hunter in North Carolina urging them to use it to vaccinate their patients
Dec 29
Ward writes to Smith; reports 12 out of 15 vaccinated
have become ill with what seems like smallpox
Jan 10
Smith replies to Ward; requests detailed information on situation
Jan 14
Smith writes to Hunter; inquires about status of his vaccination program
Jan 16
Hunter confirms smallpox outbreak among Ward's patients; reports that it has spread by contact to others; two fatalities
Jan 19
Hunter adds that scabs he was sent seem to have had no effect on his patients
Jan 28
Ward writes to Smith; reports 5 fatalities; 40-50 victims ill
Mar 20
Smith expresses concern that Congress may repeal the Vaccination Act, thus ending US vaccination program
Apr 10
John Quincy Adams (Secretary of State) writes to Smith revoking his commission
Apr 13
House of Representatives discusses repealing the vaccination law
Apr 29
HR votes to repeal law (102-57)
May 1
Senate votes to repeal law (29-6)

Medical practitioners' opinions regarding the best way to prevent the transmission of infectious disease depended on the theory of disease to which they subscribed:

Humoralists Keep the body's humors in balance:
  • perform routine blood-letting
  • administer medicines that cause sweating, urination, bowel evacuation
Contagionists Restrict contact:
  • leave the disease-ridden area
  • impose quarantine
  • remove sources of fomites
Miasmatists Cleanse the air:
  • remove sources of foul smells 
  • flush the air with smoke
  • breathe in aromatic substances
In 1798, Edward Jenner introduced a new way to control the spread of a dangerous disease (smallpox):
  • purposefully infect the population with another, less virulent, disease (cowpox).

Incidents like the unfortunate "accident" in North Carolina raised many questions and concerns over the safety and value of vaccination.

Dr. C. G. G. Nittinger's Evils of Vaccination (1856)

Doctor.--Bring your babe now for vaccination!
Mother.--How you have frightened me, I tremble all over!
Doctor.--Why? what is the matter?
Mother.--Pardon me; but I feel a perfect horror creeping over me at the mere thought on vaccination, since my poor Charles has died in consequence of it.
Doctor.--O nonsense!  Charles did not die on vaccination; do not believe such a thing.  He got dysentery while teething.
Mother.--I beg you to wait another year; Tom is now very delicate indeed.
Doctor.--Only the better! and I have this very moment excellent, fresh vaccine-lymph.
Mother.--In God's name be it done!  But, doctor, the responsibility rests on your shoulders!

Nine days after this conversation and following vaccination, Tom was a corpse, with two vaccine-blisters on each arm.

A mighty and horrible monster, with the horns of a bull, the hind hoofs of a horse, the jaws of a krakin, the teeth and claws of a tyger, the tail of a cow, all the evils of Pandora's box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body, and an atmosphere of accumulated disease, pain and death around him, has made his appearance in the world, and devours mankind,--especially poor helpless infants,--not by scores only, or hundreds, or thousands, but by hundreds of thousands of thousands.

This monster has been named vaccination; and his progressive havoc among the human race, has been dreadful and most alarming.

Yet, strange to tell, this monster has found not only a multitude of friends but worshipers, who prostrate themselves before him, and encourage his voracious appetite.

Do not the men, the heroes--who first dared to stand forth to arrest the progress, and stop the fatal havoc of this most dreadful and destructive monster, and at length have bravely subdued and put him to flight with all his mighty host, merit an obelisk erected to their fame, with their names inscribed upon it, in indelible characters, to be held in grateful rememberence through all future generations?

And are not these names [Dr. Benjamin] MOSELEY, [Dr. William] ROWLEY, [Dr. John] BIRCH, SQUIRRELL, LIPSCOMB?

Testimonies of Medical Authorities on Vaccination
London Society for the Abolition of Compulsory Vaccination

DR. SQUIRRELL, of the London Small-Pox Hospital, a Contemporary of JENNER,

Opposed vaccination on the ground that we have already too many maladies; that it affords no security against small pox; and that it was frequently followed by injurious consequences, in support of which conclusions he instanced thirty-nine cases....

JOHN BIRCH, Surgeon Extraordinary to the Prince of Wales, and Surgeon to St. Thomas's Hospital, 1804-7[:]

I have thought it a duty to publish my answer to the questions of the College of Surgeons, and my letter to the College of Physicians.  In the last of these I have adduced no less than seven cases of death caused by vaccination.  I could add more, but the cases adduced are enough to refute the assertions made to the House of Commons, that vaccination might be safely adopted because it was never fatal.

I have known several bad effects occur in consequence of vaccination.  The case of REBECCA LATCHFORD is published:  spring and fall she is usually visited with some eruption or suppuration about the face or arm.  I have also seen more than two cases similar to that of JOWLES, in which the face has been principally attacked.  By some vaccinators these eruptions are called scrofula [tuberculosis of the neck]:  but how can this be reconciled with the positive assurance of a justly celebrated surgeon, on which parliament relied; that neither scrofula, nor any other disease, was excited by vaccination.

Besides the singular eruptions above mentioned, I have seen many others of a very itching nature, and some shrivelled scaly skins consequent on cow-pox....

MR. BIRCH concludes as the result of observation and experience:

1.  That cow-pox has in more than one instance proved fatal.
2.  That cow-pox is productive of new appearances of disease, unknown before in the catalogue of human impurities.
3.  That cow-pox is not by any means to be depended on as a security against the natural small-pox.


WILLIAM ROWLEY, a Member of the University of Oxford, and of the Royal College of Physicians in London; Physician Extraordinary to Her Majesty's Lying-in-Hospital, 1805; Public Lecturer on the Theory and Practice of Medicine, &c.

In 1805, wrote :--It results from the general resume of all these authentic facts, that out of 504 persons vaccinated in England, 75 died from the consequences, and almost all have had the small-pox, some sooner, some later, after their vaccination.  There is no question here of supposition or calculation of probability, it is truth!  It is evidence which seems to speak and leaves no doubt.  Now, if in the space of 7 or 8 years, (from 1798 to 1805,) vaccination has shown itself so grievous to society, what may we not fear for the future?  It will scarcely be imagined that the facts mentioned are all that might be cited to prove the inefficiency and dangers of the practice.  Alas! it is too certain that on all sides we meet with new instances of maladies such as those already detailed.  Consider England, France, Germany, Italy, and other countries, where vaccination has been received; penetrate into the interior of houses, into the bosom of families; interrogate fathers and mothers, and you will be surprised, shocked, and even enraged to see, not only tolerated but maintained, a murderous practice, which carries desolation into families, and compromises the reputation of those who protect or practise it.

Nevertheless, by the end of the nineteenth century--a century after Jenner published his report on vaccination, some were willing to accept vaccination as a major medical achievement.

The International Cyclopaedia: A Compendium of Human Knowledge (1898)


...The cause of small-pox is universally allowed to be a specific contagion, of whose nature we are in the most profound ignorance. There is probably no disease so contagious as this.... The contagion acts either through the air, or by contact with the skin, or by inoculation; and the disease may be caused by the dead body, even when it has not been touched. What products of the diseased body are contagious is not exactly known, but the contents of the pustules and the dried scabs certainly are so. Opinions are divided as to the period at which the disease begins and ceases to be contagious.... [T]he stability of the contagious principle may be inferred from the fact, that clothing will retain it for months, and it is said for years, when confined....

It is universally admitted that the discovery of vaccination, by which small-pox is deprived of its danger, is the greatest triumph of modern medicine....

The smallpox virus.
Ordinary smallpox ~20-30% fatal
  • Incubation period
10-14 days
  • Fever, backache, vomiting
sudden onset of symptoms marks end of incubation period
  • Rash
    • Spots turn into pustules
    • Pustules erupt
    • Skin tears away from its underlayers (very painful)
    • Pustules become hard, pea-sized sacs
    • Skin resembles cobblestone street
  • Recovery, or...
  • Breakdown of autonomic system: respiration, heart...
  • Death
2-3 days after first symptoms appear

Extreme smallpox (black pox) ~ 100% fatal
The Eradication of Smallpox
  • smallpox was killing 2 million people a year
  • eradication deemed unfeasible; control through vaccination more manageable
  • attention focused on malaria
  • USSR proposes program for global eradication of smallpox
  • US commits to smallpox eradication program in Africa
  • designed as an adjunct to measles vaccination program
  • World Health Organization [WHO] launches global vaccination program despite widespread concern for its success
Numbers of Reported Smallpox Cases (1967-1976)

  South America (1970)
  Western and central Africa (1971)
  Indonesia (Jan 1972)
  Pakistan (Oct 1974)
  India (May 1975)
  Bangladesh (Nov 1975)
  Eastern and southern Africa (1977)
  Ethiopia (Aug 1976)
  Somalia (Oct 1977)
  World (May 1980)

In November 1975, 3-year-old Rahima Banu of Bangladesh became the world's last case of naturally transmitted variola major.


In October 1977, 23-year-old Ali Maow Maalin of Somalia became the world's last case of naturally transmitted variola minor.


On May 8, 1980 the World Health Assembly formally declared:
[T]the World and all its peoples have won freedom from smallpox, which was a devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness, and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia, and South America.

Now what??

The U.S. Centers for Disease Control in Atlanta and Russia's Research Institute for Viral Preparations in Moscow contain the only known specimens of smallpox virus.

  • Should the last remaining samples of the organism responsible for the world's deadliest disease be destroyed?
  • Should smallpox vaccination once again be required of everyone?
  • What do experts believe the odds are for a laboratory accident?
  • Is smallpox a good candidate for use as a biological weapon?
  • Would wiping out a species, even one as despised as smallpox, set a dangerous precedent?
  • Will cracking the virus's genetic code tell researchers all they need to know, or will killing smallpox mean burying important scientific secrets forever?
  • Could there be some beneficial use for the virus that we cannot foresee?
  • How can you become more informed about these questions?
  • How do you think historians in 2502 will assess the wisdom of our deliberations, decisions, and actions with respect to the disposition of the smallpox virus?
Go to:
  • "Procuring the Small Pox," selected communications on the method of inoculation, from the Philosophical Transactions of the Royal Society of London (1714-1723);
  • An Inquiry into the Causes and Effects of the Variolae Vaccinae.... (1798) by Edward Jenner (1749-1843); and
  • A Short Account of the Malignant Fever Lately Prevalent in Philadelphia... (1794) by Mathew Carey (1760-1839);
  • a letter addressed to "My beloved Sister" (September 25, 1793) written by Margaret (Hill) Morris (1737-1816);
  • "An Account of the Bilious Remitting Yellow Fever, as it Appeared in Philadelphia, in the Year 1793," in Vol. III, Medical Inquiries and Observations, 4th ed. (1815) by Dr. Benjamin Rush (1746-1813);
  • An Enquiry into, and Observations Upon the Causes and Effects of the Epidemic Disease Which raged in Philadelphia from the month of August till towards the middle of December 1793 (1794) by Dr. Jean Devèze (1753-1829); and
  • "Yellow Fever," in Vol. XV, The International Cyclopedia (1898).
Weekly Readings
Lecture Notes