Infectious and Epidemic Disease in History

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

Week 7.  Cure?

"The North Carolina Accident"
selections from The Vaccine Inquirer (1822-1823) (1752)
by Nicholas Rosén von Rosenstein (1706-1773)



NO. I. (1822)

(pp. 16-19)


AFTER various unsuccessful attempts to introduce the kine pock into the state, some genuine vaccine matter was procured through the kind attention of Messrs. William and John Taylor.  It was obtained by Mr. John Taylor, who was then in London, from one of the physicians of the inoculation hospital, at St. Pancras.  He forwarded it to his brother, William Taylor, Esq. merchant, of this city, who gave it to the late worthy Dr. Miles Littlejohn.

Dr. Littlejohn put the whole of it for trial into the hands of Dr. James Smith, who was then attending as physician to the alms house, in Baltimore county; having at that time, Dr. William H. Clendinen, of this city, for his assistant.  The vaccine virus received, was put up for its more certain preservation, in three different ways:  Some on the blade of a lancette, some between small plates of glass; and some on thread which was thoroughly charged with it; and the whole was confined in a vial well corked and sealed.

The use of this remedy was commenced with this virus in the state of Maryland, on the first day of May, 1801, with all possible care; and a regular history of every case was daily entered on the books of the institution, as they progressed.

The physicians of Baltimore generally, were invited to inspect these cases; and offers were made to furnish them with virus:  but no one could be prevailed on to make any use of it, beyond the walls of the alms house, during the whole summer; notwithstanding the small pox was then prevailing in the city.

After these cases were all completed, and the subjects of them were fully exposed to the small pox by inoculation, and to the variolous contagion in the natural way, without being injured thereby, many of our citizens began to make inquiry about this new thing that had come among us.

In the Telegraph, (a news paper printed in this city) of the 3d and 5th December, of the same year, a full history of the vaccine inoculation as far as it had then progressed, was laid before the public by Dr. Smith, and vaccination has been ever since continued here without any interruption.

The kine pock had been introduced in the neighbourhood of Boston, during the summer of the preceding year, by Dr. Benjamin Waterhouse, who, from this circumstance, has been called the "Jenner of America."  He succeeded in vaccinating his own family, and a few other persons, in August, 1800; but soon afterwards lost the infection, and had again to resort to another importation of it from England.

On the 9th Nov. same year, the vaccine infection was received in Philadelphia, by Mr. John Vaughan, from Mr. Jefferson, and was the first virus that was used successfully in the state of Pennsylvania.*  Genuine vaccination was not commenced in New York, until 1802:  during which year, viz. on the 25th March, 1802, Dr. James Smith proposed and established his vaccine institution in the city of Baltimore, for the preservation and distribution of the vaccine matter; and it was afterwards extended with unparalleled rapidity, over the whole of the United States.

*Washington, November 5, 1801.



I received on the 24th ult. your favor of the 22d. but it is not till this day that I am enabled to comply with your request of forwarding some of the vaccine matter for Dr. Coxe.  On my arrival at Monticello in July, I received from Dr. Waterhouse of Cambridge, some vaccine matter taken by himself, and some which he at the same time received from Dr. Jenner of London.  Both of them succeeded, and exhibited precisely the same aspect and affection.  In the course of July and August, I inoculated about seventy or eighty of my own family; my sons in law about as many of theirs, and including our neighbours who wished to avail themselves of the opportunity, or whole experiment extended to about two hundred persons.  One only case was attended with much fever and some delirium; and two or three with sore arms which required common dressings.  All these were from accidents too palpable to be ascribed to the simple disease.  About one in five or six had slight feverish dispositions, and more perhaps had a little head-ach, and all of them had swellings of the axillary glands, which in the case of adults disabled them from labour one, two, or three days.  Two or three only had from two to half a dozen pustules on the inoculated arm, and no where else, and all the rest only the single pustule where the matter was inserted, something less than a coffee-bean, depressed in the middle, fuller at the edges, and well defined.  As far as my observations went, the most premature cases presented a pellucid liquor the sixth day, which continued in that form the sixth, seventh, and eighth days, when it began to thicken, appear yellowish, and to be environed with inflammation.  The most tardy cases offered matter on the eighth day, which continued thin and limpid the eighth, ninth, and tenth days.  Perceiving therefore that the most premature as well as the tardiest cases embraced the eighth day, I made that the constant day for taking matter for inoculation, say, eight times twenty-four hours from the hour of its previous insertion.  In this way it failed to infect in not more I think than three or four out of the two hundred cases.  I have great confidence therefore that I preserved the matter genuine, and in that state brought it to Dr. Gantt of this place on my return, from whom I obtained the matter I now send you, taken yesterday, from a patient of the eighth day.  He has observed this rule as well as myself.  In my neighbourhood we had no opportunity of obtaining variolous matter, to try by that test the genuineness of our vaccine matter; nor can any be had here, or Dr. Gantt would have tried it on some of those on whom the vaccination has been performed.  We are very anxious to try this experiment, for the satisfaction of those here, and also those in the neighbourhood of Monticello, from whom the matter having been transferred, the establishment of its genuineness here will satisfy them.  I am therefore induced to ask the favor of you to send me in exchange, some fresh variolous matter, so carefully taken and done up, that we may rely on it; you are sensible of the dangerous security which a trial with effete matter might induce.  I should add that we never changed the regimen nor occupations of those inoculated; a smither at the anvil continued in his place without a moment's intermission, or indisposition.  Generally it gives no more of disease than a blister as large as a coffee-bean produced by burning would occasion.  Sucking children did not take the disease from the inoculated mother.  These I think are the most material of the observations I made in the limited experiment of my own family.  In Aikin's book which I have, you will find a great deal more. 

I pray you to accept assurances of my esteem and respect. 


(pp. 35-37)

(Published in the [Baltimore] Telegraph, December 5th, 1801.)

Of the many discoveries which the ingenuity of man can boast of, to facilitate his progress through life, or to remove the dangers which continually surround him, there are few, when considered in their whole extent, that can be placed in competition with the advantages which bid fair to rise from Dr. Jenner's discovery of the cow pock.  Although indeed, the inoculation for the small pox, had long since disarmed this worst of pestilential diseases, of many of its terrors; yet there are none among us who have not witnessed its destructive ravages, among our own friends, or at our own doors; and there are few who have not experienced much trouble, pain, anxiety and distress, even when the disease was communicated to us in the mildest manner, and under every prospect of success.  To remove these dangers, and to avoid all the distress, I would now recommend the adoption of the vaccine inoculation to all who never having had the small pox justly regard their own safety or that of their children and friends.  But lest any one may be deceived by the flattering success which the first cases in this city have afforded, I feel it incumbent on me to accompany the statement just given, with some account of the difficulties which yet seem to be inseparable upon the nature of the disease, and from which much danger may arise, if the subject should be too negligently attended to.

A considerable obstacle attending the new inoculation, appears to arise from the difficulty of procuring and preserving genuine matter:  and it is to be feared, that we shall be occasionally, under the necessity, when we lose the matter, to resort to its first source in England:  and it has been found by experience, that the virus will seldom preserve its efficacy a sufficient length of time to perform so long a voyage.

Another obstacle seems to arise from the difficulty of communicating the disease, when we are possessed of good matter.  In my first essay, only one out of nine, took the disease, and many of the same patients were inoculated several times, and in the most careful manner:  this might have been owing in a great measure, to the age of the matter used, but I have found the same difficulty when I had kept it but a short time, and even when I made use of it on the instant it was taken, so that in completing the few cases just laid before the public, fifty or more inoculations have been performed.

Again, when the genuine disease has been communicated, it sometimes produces so slight an indisposition, (only a local affection,) that the negligent practitioner may be easily misled, and sometimes induced to believe he has given the true vaccine disease, in cases where his patient has not actually underwent that degree of specific fever, if I may be allowed the expression, which must necessarily take place from the genuine disease, before the disposition of the human body to receive the small pox can possibly be destroyed.

I shall mention only one other difficulty at this time--a difficulty which threatens not a little danger, to the unguarded extension of the new inoculation.  It arises from our liability to make use of spurious matter; and this may happen not only when we take matter from a different or spurious disease, but, if we are to give credit to the opinions of the illustrious discoverer of vaccination, even when it is procured from the genuine cow pox itself, should the matter be taken at an improper time.  In this way a spurious disease, it is said, has been in some places already communicated, and has not only brought the whole discovery into disrepute where it has happened, but has been productive of very serious and evil consequences.


Lemmon street, Baltimore, 3d Dec. 1801

(p. 38)
(From the Federal Gazette, of May 19th, 1810.)
Extract of a letter from Mr. Price, of Virginia, to Dr. James Smith, of Baltimore, dated
ROMNEY, April 18th, 1810.
VACCINATION has been prevailing here by a gentleman of the faculty, whose experience I fear will not enable him to discriminate between the genuine and spurious pock.  The matter he uses I am firmly of opinion is of the latter kind.  I will explain the manner in which it affects, from which you will probably be enabled to judge.  In three or four or sometimes not till six or seven days, it affects the arm with inflammation, which is immediately succeeded by a yellowish hard pock, which remains for three or four days; it then scabs and affords a purulent matter until the end of ten or twelve days or later; then the ulcer becomes cicatrized.  Although through the whole course it never exhibits a vesicle of limpid matter, which I have always understood to be a criterion of the genuine pock.  However not having confidence from my own experience, and being well aware of the necessity and importance of propagating the genuine kind, I have therefore in preference sent to you, whose experience, with the trouble and pains you have taken to obtain and preserve it genuine, will enable you to furnish me with some that is good.  Any information you can furnish me with will be gratefully received and acknowledge, with a desire to compensate you for any trouble or expense that you may be at.
(pp. 38-40)
Extract of a Letter from Dr. Smith, in answer to the above, dated 28th April, 1810.

I yesterday received your letter, and enclosed, I forward you some genuine vaccine matter, some on thread, some on glass, and a part of a fresh crust or scab.

Your apprehensions concerning the introduction of a spurious disease into your neighborhood, are I am of opinion, too well founded, and unless early apprized of this danger, I am afraid those who have taken it, will suffer severely by placing their dependence on it....

It is very unfortunate that persons entirely ignorant of the subject, and who cannot distinguish a vaccine vesicle from a common sore, should so often undertake the business of inoculation, without any instruction, and often without knowing whether the matter they are using is vaccine matter or not.  The frequent mistakes made by inoculators of this description, have been attended with such fatal consequences, as have put an entire stop to the use of the kine pock in many places.

(p. 41)

Copy of a Circular letter, addressed to the several Members of the Fifteenth Congress of the United States, dated
Baltimore, 23 March, 1812.


I hope you will excuse the liberty I take, to inclose you the copy of a plan which I have devised, to detect any mistake which may be hereafter made in vaccination, and to render this practice more universal in the United States.  Herewith, also, you will find enclosed some genuine vaccine matter, which it is my wish you should dispose of in any useful manner that may not be inconvenient to yourself.

The natural small pox is now taking a wide range through this and the adjacent states, and many thousand lives may be reasonably expected to fall a sacrifice to it during this spring and the ensuing summer, unless those who are liable to take it, can be generally persuaded to adopt the use of the kine pock--a remedy which, however inscrutable may be its operation, ought certainly to be considered by a grateful people, as the wonderful Dei Donum, which if duly appreciated and not abused, has power to rescue the human race from the most destructive pestilence which has ever afflicted them.

I have the honor to be,
with great respect,
your obedient servant,
(pp. 45-47)

In the town of Tarborough, in North Carolina.

A NUMBER of papers relating to the unfortunate introduction of the small pox into the town of Tarborough, in North Carolina are on hand.

The whole difficulty which has occurred, has finally resolved itself into the fact, that the true small pox matter was sent by Dr. James Smith, to Dr. John F. Ward, a resident physician in Tarborough, by mistake, instead of the genuine vaccine matter, as intended.

This matter was forwarded by mail, about the beginning of November.  Dr. Ward's letter, acknowledging the receipt of it, bears date 29th of December, 1821, in Bertie county, some distance from Tarborough.

Dr. Ward does not state when he first commenced using the matter, but in his letter to Dr. Smith he informs "that the VACCINE MATTER received, had a very different effect upon those he vaccinated, than could have been expected.  Twelve out of fifteen, in whose cases the matter was used, he states, had a crop of pustules."  The disease produced by this matter did not prove fatal to any of the persons inoculated with it; but the contagion produced by these operations, was soon communicated to others, and proved fatal to a considerable number of persons who had not been vaccinated.

In his letter to Dr. Smith, Dr. Ward advises, that "although he had never seen a case of variolous disease, he was under the necessity of stating to his friends, that he believed this to be a disease of the kind."  And he concludes by asking Dr. Smith "to give him what information he could on the subject."

Dr. Smith's reply to Dr. Ward, seems to have been written on the instant he received the above information, viz.: on the 10th January, 1822.  He begs Dr. Ward "to continue to investigate the nature of the disease which had been produced by the vaccine matter he sent, and to communicate with him again on the subject, as soon as possible."

A few days after this, viz.:  on the 14th January, Dr. Smith (fearing that Dr. Ward might possibly be still absent from home,) wrote to Dr. Hunter, to engage him to investigate the business, and to state to him more particularly the several points on which he wanted information.

Dr. Smith writes to Dr. Hunter, that "he was fearful lest the persons from whom he procured this matter might possibly have had their systems infected with the contagion of small pox previous to their vaccination.  He urges Dr. Hunter therefore, to investigate the whole business promptly, while the first cases that had occurred could be most easily examined."

Dr. Ward had unhappily omitted to give any description of the packet of matter he had been using; so that Dr. Smith had no reason to suspect he had sent him any other than a packet of vaccine matter, of the same parcel out of which he had sent to Dr. Hunter, and many others in North Carolina.

The public are much indebted to Dr. Hunter, who first discovered the nature of the mistake that had been made; or at least he furnished Dr. Smith with such information respecting the packet of matter that had been sent on there, as enabled him at once to unravel the whole mystery, and to account satisfactorily for every difficulty that has presented itself.

Dr. Smith had fortunately marked the paper which contained the matter he sent to Dr. Ward, with the word " Variol:" (the latin term contracted) that signifies small pox.  To this he also added his own private mark, [•] which he uses for "perfect crust," or scab. He also wrote on it the name of the person "Whitfield" from whom he took these scabs, and the time, ("4th Oct. 1821,") when he got them.

By accident, this paper (after having been kept nearly a month by Dr. Smith) became mislaid; and by some fatal mischance it was folded with some papers that were enclosed to Dr. Ward, and sent to him instead of a packet of vaccine matter, as was intended.

If Dr. Ward had been at all conversant with either the kine pock or small pox scabs, he could not have failed to have detected this mistake, and to have certainly prevented all the injury that has happened.  A small pox scab differs as much from a vaccine crust, as a grain of rye does from a grain of wheat, or a potatoe from a turnip.  No moral guilt however, should attach to Dr. Ward, in consequence of his being deceived.  Neither can any good or charitable person, we presume, entertain the thought for a moment, that either Dr. Ward or Dr. Smith would wantonly destroy the lives of their fellow creatures to their own certain injury, and without the possibility of any good to themselves or others.

Comparison of pustules formed following vaccination (inoculation with cow pox, left) and variolation (inoculation with small pox, right).



NO. III. (1823)

(pp. 109-112)

After the full developement of facts, relative to the late introduction of the small pox into North Carolina, made by Dr. Smith to the Speaker of the House of Representatives, and the lucid report of the first Committee of Congress appointed on this subject, (see Vaccine Enquirer No. 2) it was presumed the public excitement with this accident had occasioned, would have been suffered to subside, and that no further obstruction would be thrown by government in the way of the free and general distribution of the vaccine matter contemplated by the agent of vaccination.  But in this reasonable expectation the friends of vaccination have been greatly disappointed; and it is with no small degree of surprise and regret we find that an extreme advantage has been taken of this accident to cut the public off suddenly from the only source generally known to the citizens of the United States, as properly prepared to furnish them with genuine vaccine matter, and directions for its use.

Twelve or fifteen individuals, it seems, were inoculated for the small pox, in North Carolina, by Dr. John F. Ward, with the true variolous matter, instead of "the vaccine matter," as he at first stated he had used.  The chief part of those who were inoculated with this variolous matter had the small pox in so mild a form that the true nature of this disease was not suspected at first; and although it did not prove fatal to any of them, others caught the disease from them and died.

The variolous matter with which these persons were inoculated, had been procured by Dr. Smith to prove the efficacy of the vaccine matter he was using, and which had not been tested by him for two or three years, in consequence of the continued absence of the small pox from the United States:  an absence that has been occasioned more by his own exertions, it is believed, than by the exertions of any other individual in our country.  But, by some unhappy mistake, the small pox matter that he had procured for his own use only was sent by Dr. Smith to Dr. Ward, instead of the packet of vaccine matter he intended; and which he was afterwards induced, by Dr. Ward himself, to believe had been received by him and used.

Dr. Smith had put up the variolous matter first in a piece of newspaper, and afterwards in an envellope that was blank on one side, but printed on the other, being part of a waste copy of obsolete regulations of the vaccine institution, dated January, 1817.  On this paper, after folding, Dr. Smith had written, distinctly, that it contained "variolous" matter, and put it away carefully; waiting a proper opportunity to make that good use of it for which he had procured it; and for which the public should feel themselves much indebted, rather than make it any cause of accusation against him.

The vaccine matter is put up for distribution by Dr. Smith, between small plates of glass; but in this case a paper full of perfect small pox scabs, just as they were taken from the person who had this disease, were sent to Dr. Ward.  These scabs differ as much in appearance from the vaccine matter, as any one thing can well differ from another to which it bears no resemblance:  and it is not yet satisfactorily accounted for, how Dr. Ward came to use these small pox cabs; no directions for their use, or the use of any other matter, were put up with them.  The waste paper which contained them was sent to Dr. Ward in a letter which related entirely to his appointment as an auxiliary agent of the Vaccine Institution.  The letter it seems which Dr. Smith sent, or supposed he had sent to Dr. Ward, with the vaccine matter, and directions for its use, has never been acknowledged to have been received by him.

There are many physicians who yet disapprove of vaccination; and they prefer using the small pox matter whenever they can get it; and no one views this conduct as criminal when they honestly and openly declare that which they openly do.  Dr. Ward, however, does not inform us that he used the variolous matter from choice; and it is but charitable to admit that he used it ignorantly.  But there is no physician, we believe, that understands his business as he should, who would not have known what the paper that was sent to him contained, as soon as he opened it; even although it might not have been labelled as it was.  The whole blame, therefore, if any person known in this business, is to be blamed, should attach to Dr. Ward.  He acted with his eyes open, and unadvisedly.  If he did not know what the paper contained, when he opened it, he ought not to have used it on any account.  But how he managed to use it so successfully as he did, not knowing what it was, and having no directions of any kind how it should be used, is really a matter of some astonishment.  The obsolete paper in which the matter was folded, might itself, if he had read it, been sufficient to have led him to suspect that some mistake might have been made.

We have regretted, therefore, to find Dr. Ward in his justification, exerting himself in the public prints in North Carolina, to excite prejudices against Dr. Smith, to destroy his invaluable institution; and when he builds his accusation against Dr. Smith on the paper that contained the small pox matter, as if sent to him intentionally to deceive, we do not know which to condemn most, his ignorance, or his duplicity.

But as consequences to the public of very serious import have already ensued, and as many further injurious effects are likely to follow from this unfortunate accident--all the papers which relate to it shall be published.--In laying these papers before the public we are sorry we shall be obliged to expose to their view, an asperity of prejudice, and spirit of persecution apparently generated by this accident, still prevailing, and aiming at the destruction of Dr. Smith, for no act of misconduct alledged against him, further than the mere accident itself, which he has so fully and satisfactorily accounted for.  No good can possibly arise to the public, or to any individual, out of a course of proceeding so unjustifiable among any christian or enlightened people.

(pp. 112-115)
Copy of a letter from Dr. John F. Ward, of North Carolina, to Dr. James Smith, of Baltimore, dated
BERTIE COUNTY, December 29th, 1821.


I am sorry to inform you that the vaccine matter you last sent me, had a very different effect upon those I vaccinated, than could have been expected.  Twelve out of fifteen on whom I used the matter, had a crop of pustules, and in one instance attended with the most alarming symptoms.  My observations were more particularly confined to four cases, all of whom I vaccinated on the same day.  Five days after, I saw them.-- From the slow progress the vaccina had made upon their arms I concluded the matter would prove ineffectual -- but to my surprise, on the ninth day the pustules commenced filling, with slight inflammation around them.  I saw my patients no more until the fourteenth after vaccination;  I called at the house, and found one of them (a girl of nine years old) labouring under a violent fever, with a quick pulse and occasional delirium, respiration much hurried upon the least motion, had no pain, her hearing was impaired; was taken with a fever on the twelfth day after vaccination, and had been nearly as I found her ever since, (so stated to me); I administered an emetic, it operated twice as such, but its action on the bowels was more considerable; the general plan of treatment was cooling.  Towards the latter part of the third day after the fever commenced, an eruption was discovered about the mouth, quite florid and small; at night the delirium continuing, I applied a blister to the back part of the neck, and directed a dose of rhubarb.  The fourth day the symptoms of fever, &c. were not quite so violent; a very large crop of pustules were now visible -- on the face there were not less than two thousand; it was quite impracticable to count them.  They increased in number for two or more days, when her fever remitted and delirium abated.  Her face and body is literally covered with pustules; on the seventh or eighth after the eruption commenced, the pustules were flat, with a dry dark looking centre, and depressed; she is now much inclined to sleep, and difficult to rouze from that state; no small degree of prostration of strength is manifest, the sense of hearing is more perfect....

[he goes on to describe three other cases]

Please give me what information you can obtain upon this subject, and if you have any genuine vaccine matter, send it me by the first mail.

It has been ten days since I saw or heard from my patients.  Nothing but the indisposition of a patient fifty miles from Tarborough, would have induced me to have left my patient.  I will communicate with you again upon this subject.

Please direct your letters containing matter, &c. to Dr. Benjamin Boyken, Tarborough, in my absence.-- I have sent you a scab taken from the arm of Etheldred Phillips upon whom I used the matter you sent me, but who had been a subject of vaccination some years before:  the progress of the pustule on his arm was slow, like the others, and consequently the scab was obtained on the fifteenth after vaccination from the arm -- fifteenth of December was the day that he detached it from the arm, &c.

I remain, yours respectfully,


(pp. 115-117)
Copy of a letter from Dr. James Smith, of Baltimore, to Dr. John F. Ward, of North Carolina, dated
BALTIMORE, 10th January, 1822.


I have this instant received your very interesting communication of the 29th; for which, please to accept of my thanks.  I wish you to continue to investigate the nature of the disease which has been produced by the vaccine matter I sent, and to communicate with me again on this subject.  You speak of having obtained some vaccine matter, which you suppose was genuine, from some other source, when you found your patients labouring under an eruptive disease.  Will you be so kind as to inform me from whence this matter was derived, and, particularly, whether it was derived from any parcel sent by me, lately, into North Carolina, and when and to whom?  I sent some vaccine matter to your neighbour, Dr. Hunter, at the same time, and of the same parcel as that I sent to you, viz., on the 1st November; but I have not heard from him, and would be glad to know whether he used it, and with what effect.  We have had the natural small pox prevailing here since August last, and find many anomalous symptoms arising, on which the faculty here have not yet come to any decision, further than their own various speculations on the subject.  Persons who have been vaccinated, and others who have had the small pox before, are suffering an attack of the same disease again:  but some say it differs from the small pox, and is a new disease, to which they have given the name of varioloid.  In Europe, also, they have suffered lately in the same way; and I am sorry to say that I perceive more confusion in all their details than any rational or satisfactory theory of these anomalies.  As I sent some of the same kind of matter to fifty or more physicians in North Carolina that I sent to you, it will not be long until I learn the result, and will make you fully acquainted with every fact that may come to my knowledge on this business.  In the mean time let me beg of you to keep a history of any facts that may present themselves to you; and be particular to send me all the crusts that are formed in the arms of those you have vaccinated; also, some of the crusts of the eruptions when dry, if they are not lost.  Say, also, whether any persons have taken the disease from those you have vaccinated, and give the dates of all the symptoms as they have occurred.  The crust you enclosed me has no one appearance of a vaccine crust; and I do not know what to make of it.

I enclose you some matter, the same as I am now using here; and also a vaccine crust, the product of my matter.  I shall be very uneasy until I hear from you again.  Excuse the inaccuracies of this hasty letter.

Yours, truly,


(pp. 117-119)

Copy of a letter to Dr. Benjamin B. Hunter, of Tarborough, from Dr. James Smith, of Baltimore, dated
BALTIMORE, 14th January, 1822.


I had a letter, a few days since, from Dr. Ward, your neighbour, detailing some unpleasant circumstances relative to vaccination with matter sent to him by me, and of the same kind as that I sent to you, as well as to other physicians in North Carolina, at the same time, viz. about 1st November.

Dr. Ward's history of such important events, is not sufficiently explicit; and he has forwarded no crust to me from any of the persons vaccinated, except from one person, E. Philips, who had previously been a subject of this operation.  The Doctor, I fear, may be absent from home, as his letter is dated from Bertie county; would you, therefore, be so good as to make an inquiry for me, or co-operate with Dr. Ward, if he is at home, in this investigation, and inform me of every particular as soon as possible?

1. Give me the name and age of every person vaccinated with the matter sent by me, and the date of each operation.

2. If any of the scabs produced by this matter (the matter sent by me) can be procured, whether from the arm at the place of insertion, or from eruptions on the surface, let them be carefully preserved, and let a part of the same be sent to me by the first mail convenient.  Let the names of each of the persons, and the histories of their cases, accompany their own crusts.

3. If any persons have been vaccinated with any matter taken from those who were infected with the matter sent by me, let me have a history of their cases also, accompanied by crusts from them, to enable me to determine, with more certainty, the nature of the disease which, it seems, has been propagated among you.

4. The time of inserting the matter; the appearance of the pock produced; and the time of the falling of the scabs, whether from the arm, or from eruptions on the body; are the chief facts which I want to know relative to any of the cases of disease among you.  These facts, with the crusts themselves, will be sufficient, without any detail of the medical treatment, for our present purpose.  Any attendant symptoms, if affixed to the case, with the time of their occurrence, would be satisfactory.

5. If the disease has been communicated by contagion to any person or persons, I would be glad to learn their names, with the time they became diseased, the time of the appearance of eruption, and the time of the falling off of the scabs, with some of the scabs themselves.

My present fears are, that the persons from whom I procured the vaccine matter (although genuine to every appearance) may have had their systems previously affected by the variolous contagion, which has been epidemic here, and which I have found affects many of those who are vaccinated with more or less pimples, or smaller eruptions. Until this present epidemic, we were always free from appearances of this kind, except in solitary or chance cases.  But if you will aid me in this investigation promptly, while the first cases may be fully examined into, I flatter myself we will be able to solve every difficulty, and soon relieve you from such perplexity as I am sorry to find in your vicinity.  Please to inform me whether you used the matter, and when, and with what effect.

I enclose you a letter which I have just received from one of my most zealous and scientific correspondents, with the crust from his own child, which is perfectly genuine.  I hope you will use it, and let me know the result.

Most respectfully,

Your obedient servant,


(pp. 119-120)
Copy of a letter from Dr. Benj. B. Hunter, of North Carolina, to Dr. James Smith, dated
TARBOROUGH, January 16th, 1822.

Doct. James Smith,


Although I have not the pleasure of a personal acquaintance with you, you will find by adverting to the signature, that I am a practising physician, and a subscriber to the U.S. Vaccine Institution.-- The object of this communication, is to inform you that the matter which you enclosed to Dr. Ward of this place, some time in the month of November last, in every instance in which it has been used, has produced the genuine variolous disease.

As a confirmation of this fact, several cases have occurred not only in town, but in the vicinity, where the variolous disease has unquestionably been taken in the natural way.

At the commencement of this disease, the symptoms were so equivocal as to make it a subject of much doubt as to the existence of the small pox, but at present there is no division of opinion.-- I have five cases of the variolous disease in my own family!!!

In your letter addressed to Dr. Ward, I find this marginal note, "Variol. [•] 4th Oct. 1821," and beneath it a word which I supposed to be "Whitford."  An explanation of this circumstance, I think is due to yourself and the community, and I hope you will not fail to attend to it by the earliest opportunity.

Yours, respectfully,


N.B.--Two cases of the disease have been fatal.

(pp. 120-122)
Copy of a letter, from the same, to the same, dated
TARBOROUGH, Jan. 19th, 1822.

Doct. James Smith,


I am sorry that I neglected in my letter by last mail, to inform you that the matter which you sent me in November last, was used by me in eight cases without any effect, and it would have escaped my recollection, altogether, but for your last communication to Dr. Ward, in which you mentioned the circumstance of having sent it to me.  I ascribed its failure, to the circumstance of its being sent on glass, and perhaps may have been decomposed; whereas Dr. Ward received his in several scabs.  If that which you sent me, was of the "same parcel," as you have expressed it, in your letter to Dr. Ward, which was forwarded to that gentleman, I feel much gratified in knowing that the matter, from whatever cause it may have happened, was entirely inert.

It gives me much pain to inform you that a disease which I suppose to be the genuine small pox, is extensively prevailing, not only in ours, but the adjacent counties; every case of which, is easily traced to those families where the disease was propagated from the matter sent to Dr. Ward.  But I have much pleasure in informing you that the matter which we are now using in a general and extensive vaccination (and such as I know to be genuine,) is that which I received from the gentleman who presented me with a subscription for the vaccine institution; informing me at the time, that he had received it from you, for the purpose of distributing it among his subscribers.

Since the date of my last letter, three fatal cases have occurred, and many more are apprehended!!!

I perceive in your letter to Dr. Ward, that an eruptive fever is prevailing in Baltimore, of such an ambiguous nature, as to excite disagreement even among physicians; but in those cases which have occurred here, taken in the natural way, there are no anomalous symptoms.

In my next, I will give you a more particular history of the disease which is prevailing here; and hope that you will not fail to inform me of the progress of that which is raging in Baltimore.

There has no case occurred, where any persons have taken it, who have ever been the subject of the vaccine or variolous disease.

I hope you will excuse my solicitude, when I inform you that I have six cases in my own family; and many of my friends suffering great anxiety.  Please to write me as soon as possible, and give me all the information in your power.

Having for twelve years been a practitioner of medicine, and in many instances attended patients suffering with small pox, I feel no anxiety on my own account, but am exceedingly desirous to quiet the alarm, which has thrown this section of the country into the utmost confusion.

Yours, respectfully,


(pp. 122-125)
Copy of a letter from Dr. John F. Ward, of North Carolina, to Dr. James Smith, of Baltimore, dated
28th of January, 1822.


I should have written you before this time, had I not have understood that Dr. Hunter had apprized you of the contagious nature of the disease produced by the matter you sent me.  It has also appeared in the public prints.  Not less than forty or fifty persons are now labouring under the disease taken in the natural way.  Five only, as yet, have fallen victims to this dreadful disease.  Many are recovering from it, but I have just visited two, who I think must die.  I have not time, at this moment, of stating to you the symptoms and dates thereof of those cases which I have attended.  I discover it is a disease which the vaccine arrests in its progress.  I, however, have known two persons, who have been vaccinated, take the disease.  What effect the vaccine had upon them I know not.  I shall make all the observations I can upon the cases that come under my notice, and keep a correct history of them.  The matter which I used after I suspected small pox, was the produce of matter you sent to Dr. Hunter before the 6th of November.  It had a very happy effect.  You will no doubt be surprised to learn that so many cases have occurred in the natural way, when I inform you that I vaccinated at such an early period, after suspecting the nature of the disease, and that it had the most happy effects.  But, sir, very few believed with me that it was small pox; and Dr. Hunter and Dancy, in my absence from Tarborough, while at my father's, issued certificates, stating that the report of small pox being in town and its vicinity, was false and unfounded, in open contradiction to an opinion which Dr. Boyken and myself had expressed in a note addressed to the Commissioners of Tarborough, before I visited my father.  I expressed my opinion freely to the citizens of Tarborough as soon as I suspected the nature of the disease.  I vaccinated in the families where the suspicious disease was, as soon as I could obtain matter.  I made application to three different places for matter, viz. to John Cameron of Fayetteville, Dr. Purrington, Scotland Neck, and Henry A. Donaldson, Falls of Tar river.  I obtained it from the last mentioned, who obtained it some time before from Dr. Hunter.  I received matter afterwards from Mr. Cameron and Purrington.  Every part of my conduct, after I suspected the nature of this disease, I now contemplate with the greatest pleasure.

In consequence of this disease I have been much abused; have been charged, by some, of introducing it from lucrative motives; and, in addition to which, and worst of all, am accused of having received matter marked with the Latin word for small pox; and this has been magnified until it has become a serious charge.  It originated in consequence of noticing the mark at the bottom of the printed sheet of established regulations of the general institution, &c. which is thus -- "Variol. [•] 4. Oct. 1821, Whitford."

In my first communication to the Commissioners, I sent all the papers I had received from you at the time I received the impure matter, requesting it as a favour that they would read them, in order that they might know in what manner this disease had been introduced.  Some of them noticed the mark, and requested to know what it meant, but was quite ignorant of it until I explained the meaning of variolous, supposing "variol" an abbreviation of the former word.  That I supposed it some private mark best known to yourself; that I recollected, if I was not mistaken, to have seen a similar mark on papers that you had before sent me.  Dr. Hunter was present, and thought as I did, or pretended to think so, but since that time has most basely used it as an instrument to injure my character.  Write me what you know about it, and state to me what other persons you have sent similar papers to with genuine vaccine matter, as I have no doubt you have not only recently, but formerly, sent the same papers with marks similar to many.  I should be glad you would inform me, as far as you are able, how this unfortunate mistake was made.

Several persons have been attacked here with small pox after being vaccinated from four to six days, and they (their crusts) have much the appearance of the vaccine.  I shall be careful to preserve them, as they may be of some service to you, &c.

I close this letter in haste.  No mail comes to Tarborough at this time, and I have to send this letter to a distant post office.  Please write me to Tarborough, by the way of Sycamore Alley, Halifax, or Washington, N.C.

Yours, respectfully,


[To] Dr. Jas. Smith.

(pp. 125-131)
Copy of a letter from Dr. James Smith, addressed to the Citizens of the United States, and published in the Baltimore American


The following facts and observations will, I hope, assist those who are most concerned to investigate and arrive at just conclusions on the subject of this notice.  But neither the personal abuse or illiberal execrations that have been heaped upon me, as the ostensible instrument of evil in this case, can answer any good purpose whatever.

Every fact that I can ascertain, having any bearing on the subject, shall be fully and freely made known to all concerned.  And if I have committed any mistake, either from ignorance or through carelessness, I shall not ask any indulgence.  I shall only add on this subject, that if I should find it to be out of my power to preserve the vaccine matter in a pure state, I will cease to furnish that which I may have any reason to fear has become adulterated.  I have derived my supply of matter, for the last six weeks, from places that are free from any epidemic disease; and I consider it to be as perfect and genuine as any I have ever used.

By steadily persevering in the practice of vaccination for many years, we had completely banished the small pox from this city, and many began to imagine we would never again be visited by it.  Our fancied security, however, served to create the same neglect of the kine pock as is common in other places, until we had many subjects fit to be preyed upon by variolous contagion--and in this situation we were found suddenly exposed to great danger by the arrival of the Pallas, captain Otis, on the 14th August, fifty-nine days from Liverpool, with a few passengers, having among them the small pox.

The following extract from our bills of mortality, will serve to shew the progress which this disease has since made among us:

Deaths by small pox in Baltimore.
  In October







1st week,



2d     "



3d     "



4th    "



1st week,



2d     "


   47 deaths.

But, from the beginning of these misfortunes, the current opinions, not only of the people here, but of many of our first physicians have been much distracted by certain new and unexpected modifications of disease, which seem to have been introduced here along with these calamitous events.

Many persons, who had been formerly subjects of the natural small pox, or who had been inoculated for it, as well as others who had been vaccinated with the greatest care, have again become sufferers from this apparently new contagion.  But the disease produced by it in persons who had been previously vaccinated or inoculated, has invariably appeared in a more mitigated form than when it has attacked those who had not used these precautions.  It has been called here, as well as in Europe, where it has lately excited considerable attention, the varioloid disease.-- It is not easily distinguished from the small pox; and, perhaps, it may be truly entitled to the appellation of this contagious plague.

Of those who have been previously vaccinated here, some have suffered very severely from the varioloid eruptions, but I have not perceived any good reason on this account to doubt the efficacy of vaccination as a sufficient and invaluable remedy against the small pox.

There are some physicians of great eminence here, nevertheless, who seem to have lost their confidence entirely in vaccination, and among these I am sorry to enumerate my distinguished friends, Drs. Davidge and Potter, professors of surgery and anatomy and the theory and practice of medicine in the University of Maryland.

The first mentioned of these professors, has not only declared the kine pock to be of no use, but he has again recommended, and is now practising the old inoculation for the small pox.  Dr. Potter acknowledges the prophylactic powers of vaccination, but he is of opinion that we have not yet attained any method of determining with certainty, whether those who are vaccinated do really obtain security thereby from the small pox, or not, until they are exposed to its contagion, by inoculation, or otherwise.

But Jenner himself, the illustrious discoverer of vaccination, has more seriou[s]ly defamed the kine pock, than any author I have read on this subject:-- He states that ["]a single serous blotch upon the body existing during the progress of the vaccine vesicle on the arms, may occasion such irregularity and deviation from correctness, that vaccination under such circumstances cannot be depended on.-- Slight abrasions of the skin behind the ears, and upon many other parts where the cuticle is thin, he adds, will produce the same effect."  Now if any such difficulties and nice distinctions as these, did really exist, we should certainly be obliged to abandon vaccination very soon, or the chief part of our population would ere long be found to be fit subjects for the small pox.  But it is more than fortunate for mankind that the efficacy of the kine pock as a preventative of the small pox, does not depend upon the skill or opinion of any man, or set of men.  It has come to us from the Giver of every good gift, sufficiently perfect for the end that is to be accomplished by it, viz:  TO SECURE US FROM THE SMALL POX.  But if we would obtain this security without having to regret any exceptions to the general rule, it is essentially necessary that not only a few individuals, here and there, should subject themselves to vaccination at a suitable age, and as universally as the nature of the case will admit of, without injury or inconvenience to society.

Whether the disease which has been introduced into the village of Tarborough, be really the true small pox or not, I am not prepared to declare with any positive degree of certainty.  The directions which I sent with the matter were, as is too frequently the case, entirely neglected.  If Dr. Ward had used the matter I sent to him in proper time, and attended to me the crusts which it produced, I would have been able to have answered all his queries, and would likewise have prevented all the mischief which I fear has happened.

I can only state to the public then, at this time, that the evidence which I have received from Tarborough, is neither full nor satisfactory to me, as to the nature of the disease produced by the vaccine matter which I sent to Dr. Ward.  I am inclined, however, to suspect that the small pox contagion did really accompany the vaccine virus put up here, and was transmitted to him, by me.  My reasons for supposing this to be the fact, apart from Dr. Ward's statements, are these:

1st.  I have been unavoidably engaged in attending to persons diseased of the small pox here.  I daily visit, handle, and administer medicine to them -- and although I have always taken every precaution that I knew was necessary to prevent this contagion adhering to my person -- Still such an accident may have occurred.

2d.  The genuine kine pock is in itself so nearly allied to the small pox, that when this plague becomes epidemic in any place, it intermixes with the vaccine matter by a natural process, and in a manner that may possibly have illuded my care and vigilance to prevent it.*

3d.  The same persons or subjects, from whom the vaccine matter must be taken, (for it cannot be otherwise procured than from persons who are fit subjects for it) may be the bearers of the genuine kine pock, and of the true small pox, at the same time.*

4th.  The same identical kine pock vesicle, under such circumstances as we are now unhappily involved in, and that will furnish the most pure and genuine vaccine matter, on one day is susceptible of a change in its natural properties; and within a few days afterwards may furnish a different matter, capable of generating the most destructive small pox.*

*Dr. Smith proposes to shew, in the future numbers of the Vaccine Enquirer, from facts which have fallen under his own observation, that these positions are really true, and that it becomes us to beware of the new difficulties that have arisen and will yet arise from this source, to mankind.

There are but few practitioners of vaccination who have any idea that in the selection of the vaccine matter they may be exposed to so much danger, from causes of this description--and no one has yet pretended to account for them.

As these causes of defection in the vaccine matter, however, (and others will be hereafter enumerated) are of serious import to the public, I have stated them plainly, that all concerned may be put fully upon their guard, not only against my own mistake, but against the mistake of others, who may possess even greater skill in this business than myself.  I do not state these difficulties to excite any foolish alarm about them -- but I hope they will have the effect, at least, to excite public attention to them.

But, to conclude, if there is any person who can account for the difficulties which have presented themselves, and the new combinations of disease which have taken place, and threaten to extend their influence so far around us, let him come forward to lend his aid, and settle these differences of opinion which now distract the learned, as well as the unlearned, on the subject of vaccination.  He who can accomplish this task, will merit a reward from mankind even greater than he received who first transferred the vaccine virus from the cow to the human species.

JAMES SMITH, U.S. Agent of Vac.

Vaccine Institution,
Baltimore, January 24, 1822.

(pp. 132-134)
Baltimore, 1st November, 1821.


Wishing to bring into effective operation, without delay, the plan which has been proposed to secure a free and general distribution of the vaccine remedy, I have taken the liberty to appoint you an auxiliary agent of the institution, for the county in which you reside; and hope you will find it convenient to aid the efforts we are now making, with your influence and ability, to protect our country from the natural small pox -- a disease, which you are well aware, has been for ages past, one of the greatest destroyers of the human race; and which, it is yet to be feared, will at some future day again visit our fellow citizens with a desolating arm, unless they will take heed in time, and use the means we now possess, to secure us from it.

The concurring testimony of every civilized country is in favour of the kine pock; and most clearly shows that general security from the small pox, if not the total extirpation of this contagion, may be obtained by a proper distribution of the genuine vaccine matter, under such regulations as will at all times afford a free and easy access to it, with plain directions for its use.

According to the plan, therefore, now proposed to attain these important objects, it will be the duty of the agent of vaccination for the United States, to keep up a constant supply of genuine matter; and to appoint a number of auxiliary agents, one at least in each county, wherein our plan may be adopted, to whom he shall forward fresh matter as often as may be found necessary; so that every citizen who may be accidentally exposed to the contagion of small pox, or who may at any time hereafter, wish to protect his family against it, shall have it in his power to procure the means of security immediately, free of any costs, and in any part of our widely extended country.

Much good has been already accomplished, under the act of congress, passed in 1813, "to encourage vaccination."  But, after all the experience we have gained, I am satisfied, it is only in some such way as now proposed, that we can guard our fellow citizens, effectually, for any length of time, against the fatal effects of the variolous contagion -- a plague which may very aptly be compared to those destructive fires, that so often destroy our dwellings, and lay in ashes our most populous towns.  When this disease is at first introduced into any place, it can easily be extinguished by an immediate resort to vaccination; but if we are unprovided with the kine pock matter, or delay its use for a short time, the small pox is certain to spread itself and soon carries terror or death into every family liable to take it.

Should you find it agreeable to accede to my wishes, you will please, by the return of the mail, to signify your consent to serve as one of the auxiliary agents of this institution.

Any communication from you, relative to vaccination, or any of the concerns of institution, will always be received with great respect, and punctually attended to, by your obedient and humble servant,


United States' Agent of Vaccination.

Dr. Ward has been appointed an auxiliary agent of this institution for Edgecomb county, in the State of N.C.


United States' Agent of Vaccination.

(pp. 134-137)
Regulations relating particularly to Auxiliary Agents.

1.  According to the plan of this institution, auxiliary agents are to be stationed in every county in the United States, wherein the sum of two hundred dollars or more may be subscribed and paid in donations for this purpose -- the genuine vaccine matter is to be sent to them occasionally, as often as it may be wanted for distribution.  One person, it has been estimated, may conveniently perform the whole duty of this agency in any one county; but two or more will be appointed in the same county, if it should be deemed necessary or expedient at any time, to give greater facilities in the distribution of this remedy.

2.  Physicians of the first respectability and extensive practice will always be preferred, if it may be found agreeable and convenient for them to act as auxiliary agents of this institution; and when appointed, they will be continued as long as they will perform the duties of their office carefully and with dispatch.

3.  Auxiliary agents shall not charge any fee for furnishing the vaccine matter to any citizen who may apply to them for it; but it is not to be presumed, that citizens who employ them to attend on their families, or to vaccinate any person, will, on this account, refuse to pay them the just compensation which these services must always entitle them to.

4.  It will be the duty of auxiliary agents to receive communications relative to vaccination; and to take charge of every supply of matter which will be sent to them from this Institution.  They may either apply this matter themselves, or give it, at their pleasure, to any other person who will make use of it.  On the eighth day after using it, if it succeeds, a fresh production of matter may always be obtained from it, in sufficient quantity to supply any demand which will be made for it.  If it should not be wanted, the packet containing it is to be returned at the end of thirty days after it is received.

5.  If the matter should be used and have the desired effect, one or more of the crusts, being the produce thereof, is to be returned to the agent of vaccination for his examination.  The crusts returned for this purpose must be put up in some fine lint or cotton and folded in a paper, whereon must be written the time when, and the name of the person from whom they were taken; they may be then enclosed and directed to this Institution.  It is hoped that no auxiliary agent will, on any account, neglect this easy, but essentially important part of his duty.  It is the chain by which alone their connection with this Institution can be permanently sustained, with convenience to themselves, or safety to the public.  Those agents who do not attend to it must be discontinued, and others will be appointed in their stead.

6.  A certificate of the examination of any crust returned to the agent of vaccination will always be given, if requested, free of expense.

7.  If any supply of matter forwarded form this Institution should fail to take effect, as will sometimes unavoidably happen, notice thereof is always to be given forthwith to the agent of vaccination, whose duty it will be to renew it.

8.  If any auxiliary agent is applied to for matter, when he may have none fit to be used, he may order it by post, and it will be sent immediately.  But the commands of any citizen, who has contributed, or who may hereafter contribute to the support of this Institution, will always be attended to with particular satisfaction.

9.  The great object of this Institution is, to guard the people of the United States against the small pox, by a free and regular distribution of the genuine vaccine matter; and thus to put an end, if practicable, to all the sufferings among us which have hitherto followed in the train of this formidable enemy of mankind.  The friends of humanity, therefore, are requested, should they be informed of the recent introduction of the small pox into any part of the United States, to give notice thereof immediately, either to the agent of vaccination or to the auxiliary agent, who may be nearest to them.  To receive notices of this kind, as well as to give the most early information thereof, to those whom it may concern; and especially to communicate these facts to this Institution, must always be considered as necessary contingent duties, which every auxiliary agent, who is anxious to give his assistance in this undertaking, will most cheerfully perform.

10.  Until the clear capital required, or funds sufficient to defray the expenses necessary to be incurred to give permanent duration to this Institution shall be raised, any donation given or legacy left for this purpose will be thankfully received from any citizen of the United States, if forwarded to the Agent of Vaccination, or presented to any Manager of this Institution.



*Appointed at a meeting, convened in the City of Washington, on the 22d December, 1819, in pursuance of a notice given in the National Intelligencer for this purpose.



NO. IV. (1823)

(pp. 151-152)
Extract of a letter from Dr. James Smith, to the Hon. John Sergeant.
Baltimore, 20th March, 1822.


I perceive, by this day's Intelligencer, that the law relative to Vaccination has been referred to "the Committee on the Judiciary," and therefore take the liberty to enclose you all the papers which I have in my possession, connected with the accident which has happened in North Carolina, and which I think it probable has given origin to the inquiry you have to make.  I beg the committee will give these papers an attentive perusal, and if any further explanations should be wanted I will attend with great pleasure to any request you may make.

If Congress should think proper to repeal the law of the United States "to encourage Vaccination," I shall regret it as a national evil; and if it was not through fear of intruding on the committee I would state such facts as would make it plain to you that such a course on the part of Congress would really prove to be a most serious public evil at this time.  On my own private account, I could have no regrets on the repeal of this law.  It never contained the provisions which I wished, and which I know are necessary to put it in the power of the agent to comply satisfactorily with the wishes of those with whom he must have intercourse by a constant correspondence.  I have always found the execution of this law to be one continued scene of labour without profit; and I have had much trouble in teaching ignorant practitioners of medicine how to conduct Vaccination in different parts of the United States, without any grateful return from them.  If it should be the wish of Congress however to prevent any further accidents happening under my hand, as has been intimated by an honorable member from North Carolina, I will most cheerfully resign my appointment, immediately, that some other person, in whom the public may have greater confidence, may be appointed in my stead; for already the small pox is spreading abroad in various directions from this city, and will, I have no doubt, traverse the whole of our country, before it can be extirpated again.

That there should be some pure source therefore kept up without interruption, from which the genuine Vaccine matter may be procured by those who will want it, is absolutely and indispensably necessary; unless, through some extraordinary caprice we would wish to deprive our fellow citizens, without benefit to any person, of the very means of existence.

I have the honor to be,

With great respect,

Your most obt. and hum. sevt.


[To] The hon. John Sergeant,
Chairman of the committee on the Judiciary.

(p. 153)
Copy of a letter from the honorable R. M. Sanders, to Dr. James Smith, dated Washington, 25th March, 1822.


I return the enclosed [No. 1 of the Vaccine Enquirer) received in due course of yours of the 14th instant.  I feel no disposition to give any countenance, much less support, to a man who has been the means of doing so much mischief to the citizens of my state.  Whether the mischief at Tarborough, N.C. arose from accident or design, though not equally criminal, is, with me, at least without excuse.

I have the honor to be, &c.


[To] Dr. James Smith.

(p. 153)
Copy of a letter from Dr. James Smith to the hon. R. M. Sanders, dated Baltimore, 26th March, 1822.


I received yours of yesterday, but cannot condescend to notice your insinuations.

Your letter is not such as I had a right to expect from a member of Congress, with whom justice should never be disturbed by wanton passion, and by whom the public interest will never, I hope, be sacrificed to local prejudices or any disingenuous policy.

I have the honor to be, yours,


(p. 162)
Copy of a letter from the Hon. Thomas H. Hall, to Dr. J. Smith.
H. Reps. 30th March, 1822.


Being a member of the committee to which the subject of vaccination has been referred, I ask of you the favour to say, if to do so meets your approbation, what you believe is the proportion of subscriptions and money received, by contributions to the vaccine institution, from the interior of the country and the towns and cities on the maritime frontier.  Also, if you please, to say, what amount of subscriptions and receipts has been obtained from North Carolina, within the last six months.

Your compliance will oblige,


(pp. 163-164)
Copy of a letter from Dr. James Smith, to the Hon. Thomas H. Hall.
Baltimore, 2d April, 1822.


The information you have solicited, as well as that which has been requested by the chairman of your committee, shall be furnished as fully as I can, and with as little delay as possible.

No erroneous impression should be made on the public mind by partial statements relating to this agency, I must therefore claim the privilege of submitting a full account of the whole of my proceedings relative to this institution.

If indulged in this fair course, I will be able I have no doubt to show to the satisfaction of every just and candid man, that I have not done as much mischief as has been intimated--and unless prejudged through intemperate passion, I will prove to you I hope that I am not capable of "slaughtering our fellow citizens by hundreds with indifference, under the authority of our laws," as you have heard stated on the floor of Congress.

I will thank you to lay this letter before the honorable committee appointed to inquire into the expediency of repealing the law passed in 1813, to encourage vaccination.

The expressions which I have quoted above, and which were intended to be applied to me personally by the chairman of your committee, forbid my holding any correspondence with him.  I have on this account returned his letter unanswered, believing that no citizen of honorable feelings or delicacy could wish me to act otherwise towards him on this occasion.

I have the honour to be, respectfully,

Your obedient servant,


[To] Hon. Thomas H. Hall,
House of Representatives.

(pp. 164-165)
Addressed to the Editors, and published in the National Intelligencer of Friday, 5th April, 1822.

GENTLEMEN-- Having discovered that my remarks the other day, on the subject of vaccination, were not correctly understood, I take the liberty of correcting what was erroneous in the report of them.  A motion was made by the Chairman of the Judiciary Committee, to be discharged from the further consideration of the subject.  I then stated, that it was a matter of much more importance than those not immediately interested believed it to be.  Ten of our fellow creatures, I said, had lost their lives -- and by whom?  By the act of a man who styled himself the agent of the United States, and a law of the United States had placed it in his power to do this irreparable injury.  If this subject was not to be inquired into, what would be the impression on the public mind?  Would not the boasted protection of life, liberty, and property, be considered a solemn farce, if the lives of our fellow citizens were to be taken, and passed over with the same indifference as if there had been so many cattle slaughtered?  My object was to repeal the law, or place the Institution on a more respectable footing, and make the agent in some way responsible, that the same accident might not again occur.  I further said, I believed I could prove, to the satisfaction of any impartial mind, that the present agency was not only a nuisance, but a nuisance of the most dangerous kind.


April 4.

(p. 173)
Department of State,
Washington, 10th April, 1822.
[To] Doctor James Smith, Baltimore,


I am directed by the President of the United States to inform you, that he has revoked your commission as agent for the purposes designated by the act of Congress, of 27th February, 1813, entitled "An act to encourage vaccination."  You will henceforward consider the said commission as revoked accordingly.

I am, sir, your obedient and hum. Svt.


(pp. 173-176)
Proceedings in the House of Representatives, on Saturday, April 13, 1822.

Mr. Burton, from the select committee appointed to inquire into the expediency of repealing the law for the encouragement of Vaccination, made the following report:

The committee appointed to inquire into the propriety of repealing the act of 1813, to encourage vaccination, and if, on inquiry, it shall seem proper, to report a bill to that effect, have attentively and deliberately examined the subject, and submit the following report:

The recent unfortunate occurrence in the state of North Carolina, having involved considerations of the utmost importance to society, and intimately connected with the dearest interests of humanity, your committee feel it to be due to the occasion to commence their remarks by a distinct and unequivocal declaration of their entire and unshaken confidence in the efficacy of the vaccine disease as a preventative of small pox.  In addition to the experience of the most intelligent medical men, in all parts of the world, the committee have the satisfaction to state, that even the late unhappy accident in North Carolina has been attended by the consoling circumstance of another and a triumphant evidence of the virtue of vaccination.  The inquiry, therefore, appears to be very properly limited to the mere expediency of the existing law, which authorizes the appointment of an agent, from and to whom letters may be transmitted free of postage.  While the committee would on no account offer a suggestion which could be construed to imply a doubt of the efficacy of vaccination, they conceive it may, nevertheless, be a question, whether the general government can beneficially interpose for the furtherance of an object which seems, in a peculiar manner, to appertain to the municipal authorities in the several states, and which must, of necessity, be finally committed to the management and discretion of professional men, possessing the confidence of the community.  All our regulations for the preservation of the public health are questions of police, wisely committed to those who are immediately interested, and therefore most likely to adopt efficient measures for their own safety.  And it is doubted whether Congress can, in any instance, devise a system which will not be ore liable to abuses in its operations, and less subject to a prompt and salutary control, than such as may be adopted by the local authorities.  The privilege of franking letters, conferred upon an individual, for the purpose of enabling him to distribute the vaccine virus, and thereby to accumulate wealth, by levying contributions from all parts of the Union, affords an instance of monopoly as repugnant to the spirit of our political institutions as it is to the character of the medical profession, which, for public spirited and active benevolence, is too well established to require auxiliaries of this description in the performance of its duties.  But another and more forcible objection presents itself.  An establishment of this kind, under the authority of the general government, naturally commands the attention of all portions of the country; and the numerous requisitions for the vaccine matter, from regions so extensive, must occasionally reduce any single agent to the necessity of either relinquishing the profered fee, or of transmitting matter of doubtful character.  Sub agents must necessarily be employed to furnish a supply equal to the demand.  Careless or incompetent assistants, guided more by cupidity than intelligence, may thus be instrumental in producing mischief, by the distribution of inert matter, or by the more fatal error of disseminating a pestilence instead of a prophylactic.  That such unhappy mistakes may occur, is but too well attested by the recent events in North Carolina.  The committee are, therefore, inclined to the belief, that any single agency, for the whole Union, must always be liable to similar objections; and from which they apprehend no institution, clothed with the character of a lucrative monopoly or privilege, can be entirely exempted.  If, however, it should be deemed advisable for Congress to continue to aid in facilitating the distribution of vaccine matter by the mode now in operation, the committee are of opinion that some of the evils to which they have adverted might be obviated by the appointment of two or more agents, judiciously located in our large cities, in different quarters of the Union.  But, after mature deliberation, they have come to the conclusion that it would be still better to commit the subject altogether to the local authorities, who, with the aid of the professional men, will be more competent to the successful management of it -- and to whom, they believe, it properly belongs.  They, therefore, report the accompanying bill.

The report was accompanied by a bill to repeal the existing law; which was twice read and ordered to be laid on the table.

(pp. 176-185)
Copy of an explanatory letter from Doctor James Smith, to the Honorable Mr. Lloyd, read in Senate of the United States, May 1, 1822.
WASHINGTON, April 25, 1822.


The bill to repeal the law relative to Vaccination, being under your consideration, I beg leave to give the honorable Senate, through you, some information on this subject, that will, I hope, be acceptable to them.  All the difficulties existing, in regard to the Vaccine agency, have arisen, I believe, from a conspiracy or combination of certain professional interests and individual prejudices, which, taking advantage of the unfortunate accident that lately occurred in North Carolina, has made the most erroneous and unjust impressions on the public mind.  Many persons have been induced to believe that the Vaccine agency has hitherto constitu[t]ed a monopoly in my hands, of the most odious kind.  But the very reverse of this is the fact.  My efforts have been always directed with all the zeal I possess, to render Vaccination universal, and to put it in the power of every family in the United States to have free access to this remedy at any time they might want it.  The most liberal and enlightened of the faculty of medicine, to whom my plans to obtain this end have been submitted, have approved of them; and lent me their aid that they might be carried into effect.  But there are others who prefer their own private interests to the public god, and these do not cease to cry down the Vaccine agency; and they endeavor, by every means in their power, to prevent the free distribution of the Vaccine matter, which I have been striving to effect.  Now if these last should succeed in their intentions, the people will soon be obliged to pay well for the Vaccin [sic] Remedy, when they can get it, and they will often have to do without it when they will most want it.

If I had never discovered the simple criterion by which the efficacy of every Vaccine process can be determined, without the necessity or expenses of any professional attendance on the persons who are vaccinated, no prejudices, I believe, would ever have been raised by medical men against my Vaccine agency.  By the examination of the vaccine crusts, (and they can be sent to me by letter from any part of the United States,) I can decide as correctly on any case of Vaccination, as if I had been called in person, or had attended myself upon the individual vaccinated.  This particular method of practice is founded upon a new discovery in Vaccination, which has not yet been fully developed, neither does it appear to be at all known in Europe.  But highly useful and important as this method of practice is found, it threatens to cut off a source of profit from many physicians, who regard Vaccination only as a business of professional gain.  It does not serve as any excuse with these practitioners, that I make no charges for examining the Vaccine crusts, or informing those of their safety from small pox, who have been perfectly vaccinated -- they have lost their fees by my interference, and that is sufficient reason to support their determined hostility to my Vaccine agency.  That physicians should be well paid for all those efforts of mind and body which they should make to relieve the sick, and to preserve the public health, I do not pretend to deny.  I am perfectly sensible of the value of their services, and well know that they have never been either duly appreciated or sufficiently well paid for; but this affords no justification tot he views of those who wish to prevent the free distribution of the vaccine matter.  The operation for the Kine Pock is so simple, that any discreet person is fully competent to perform it.  Nay, I have known children who have performed vaccination as effectually as any learned doctor could have performed it himself.  The only difficulty that exists in this practice is to determine whether the true vaccine process has been produced or not.  Now, whenever you come to this part of the business, it is not unusual to find the same disagreement of opinion existing among physicians as is common with them upon almost every other occasion.  The learned professor of the Theory and Practice of Medicine, in the University of Maryland, than whom no one, I believe, stands higher in the estimation of Medical men, yet denies that there is, or can be, any criterion by which the efficacy of the Vaccine process can be determined, except by repeating the operation until no local inflammation can be produced by it[.]  Now, according to this practice the citizens of the United States could not expect to obtain any positive information whether they were secure from the small pox or not, during their whole lives.  If the professor, therefore, with all his experience, in the use of the Kine Pock, cannot determine the simple fact, every individual who submits to vaccination is most anxious to learn how it can be expected that every Doctor of every degree can determine it always with perfect accuracy!  But it is impossible that Physicians generally should ever obtain a sufficient practice to enable them either to preserve or select the Vaccine matter for their own use, or to decide the fact with invariable correctness; whether their operations are always perfect or not, by any other than the criterion I have pointed out, and which can only be generally servicible to the public by the establishment of Vaccine agencies.

But we have now scarcely obtained this knowledge of the Kine Pock, and brought into active operation an agency to extend this blessing among our people, than prejudices and jealousies are cherished, falsehoods of every description are circulated, and headlong we rush, propelled by a mere accident, to repeal the only law we have existing to encourage Vaccination!  And shall we not thus evince to the world, that we are ready and willing to abandon all the ground we have gained?  Or, that we are determined heedlessly to throw open our whole country for the special benefit of physicians, who must all, now it is said, be brought at once, and without any guide, to preserve and select the Vaccine matter for their own use?  If we adopt this course of proceeding, will not the same evils soon revert upon us, that we experienced before the establishment of this agency; which was scarcely one year in operation, until it corrected the mistakes that were prevalent in every direction?

The prevalence of the Small Pox in Baltimore, the seat of the Vaccine Agency, has been urged, with great plausibility, as one of the chief arguments against it; and it has been stated, with how much justice you will see presently, "that my inability to extirpate this plague from the place of my residence, affords sufficient reason for you to break up by institution entirely."  I must, on this account, inform you, that the Small Pox, although within this period it has ravaged both of the cities of New York and Philadelphia, has never been suffered to become epidemic in Baltimore, since the enactment of the law of 1813, until the present time.  And on this occasion its prevalence with us is to be ascribed much rather to the opposition which has been made to the Vaccine agency than to the agency itself.  This hostility to the Vaccine Institution has not arisen from any danger that is attached to it, or upon any injury or wrong that I have done; but, if the truth was known, it has originated, as I have already stated, from the opposite of these causes.  The great excitement, therefore, that has been so unwisely produced of late, will terminate, I fear, in an evil of much greater extent to the public than the accident which has given rise to it could ever have effected.

In the month of June, 1816, the Small Pox was imported into Baltimore, from Norfolk, and the infected person was suffered to lay in the midst of a dense population, liable to take it, and unavoidably exposed to its influence.  I was made acquainted with the first case of this plague as soon as it occurred, and gave information of the fact immediately to the public.  All concerned were at once supplied with a sufficiency of the vaccine matter, free of any charges; and we succeeded to extirpate this contagion without any difficulty.  About 500 persons were vaccinated in the infected neighborhood in the course of a few days -- one negro man, only, the slave of a gentleman residing on the Eastern Shore of Maryland, lost his life on this occasion.

In May, 1817, the Small Pox was again introduced into Baltimore, from Philadelphia, but it was kept in subjection, in same way, until it was extirpated again, through the immediate operation of this agency.

In October 1818, this plague was introduced a third time into Baltimore, from this city, and several persons lost their lives by it.  The physician who had the first case under his care, denied that it was a case of Small Pox, and he took no proper precautions to prevent its infecting those who were exposed to the contagion; but genuine vaccine matter was furnished again, free of any cost, from this agency, and the prompt and decisive measures that were taken, at my suggestion, succeeded effectually, and the variolous plague was again banished from Baltimore, in the course of a few weeks.

Now, it is morally certain, that if the Vaccine agency had not been established in Baltimore, my place of residence, the Small Pox would have become epidemic there on each of these three occasions; and it would have proved no doubt as destructive then as it has been on this last occasion, when the necessary steps that should have been taken, were not taken in time to prevent it.

That the variolous pestilence, and its newly generated prototype, the va[r]ioloid plague have been suffered lately to become such severe scourges to the citizens of Baltimore is not my fault; neither can any blame justly attach to the Vaccine agency on this account.

If I had known, within any reasonable time, that the Small Pox had been imported into Baltimore on this last occasion, I would certainly have prevented any injury resulting from it, for I was on the spot, and perfectly well prepared, and nothing was more easy to be done, or more within the compass of common prudence and common honesty to accomplish.

It was on the 14th of August last, that the contagion of our present epidemic was imported into Baltimore from Liverpool, but its existence was not made  known to me, as it should have been.  I discovered it by mere accident from the story of an old woman, who told me that the Small Pox had been several weeks among us.  This was about the last of September, when it was too late for any individual to interfere with any chance of success.-- The persons who first propagated the contagion were in a narrow street, in a thickly inhabited part of the city, and they were under the special care of the consulting physician of the Board of Health; but he kept their cases carefully out of my view, as well as concealed from the public, to prevent alarm, or to serve, perhaps, the mercantile interests of the city; but certainly without either judgement, discretion, or good sense.  No blame therefore should be attached to me, any more on this account than for the accident in North Carolina, over which I had no control.  Before I heard of the existence of the Small Pox in Baltimore, its contagion had been propagated to a considerable extent, and its further progress could not be arrested without one general and simultaneous effort on the part of the Physicians of the city.  To obtain this effort, to be made without the loss of an hour, I had a Circular printed, and sent the Vaccine matter to every physician who I expected would use it -- But they very generally discouraged my interference, and a few of them only could be induced to lend any aid to accomplish that which was certainly within their power, if they had been inclined to extinguish the flame that had  been just kindled among us.  The late destructive prevalence of the Small Pox in Baltimore, therefore, should not be ascribed in any way whatever to the Vaccine Agency.  The blame should rather attach to those who are hostile to this Agency, and who have left no means untried to accomplish their determination to destroy it.

It has been further alledged against this agency, in the House of Representatives, by a gentleman who is a stranger to me, and I do not know on whose authority he has made the erroneous statement, that I have drawn from the public something like forty-five thousand dollars by the Vaccine Agency.  Now, the fact is, as you will perceive by the documents herewith submitted to you, fully proven and authenticated, that the whole sum of money I have received on the account to which he has alluded, amounts to no more than twenty-two thousand three hundred and thirty-seven dollars, in upwards of four years; out of which sum I have had to pay all the current expenses of this agency, during these four years, which, in printing and stationary [sic] alone, to furnish proper directions for the popular use of the Kine Pock, has amounted to more than all the fees I ever received for vaccine matter, since the enactment of your law of 1813; a law which induced the citizens of the United States, generally, to believe that I was paid by government for my services, when in fact it never made any such provision.

Out of the above sum, likewise, (a part of which has been paid to me in donations, and must be returned to the donors,) I have supported twenty different special agents, who were employed and paid by me to serve those from whom I received it.  These agents were furnished with horses, and they rendered six thousand seven hundred and fifty days services, vaccinating and distributing the Vaccine matter gratuitously, for the use of the rich as well as the poor -- and we have secured, I believe, more than one hundred thousand souls from the Small Pox.  It must be easy for you, therefore, to perceive, that it has not been "taxing the people at large for the benefit of the agent of Vaccination," as has been stated, that has occasioned all the clamor that has been raised against me.  If those who have raised this clamor had vaccinated half the number of persons we have, they would have drawn from the people, ten times the sum of money for their services, and when they had drawn it, they could not be said to have drawn too much for such services.

It is true that the law you are now about to repeal originated at my request, but it never contained the provisions I asked and always declared were essentially necessary to make it answer the purposes for which I wished it.  As the law itself therefore is defective, and we have no prospect under the excitement and misapprehensions that now prevail on this subject, to render it more perfect, I pray it may be repealed that an end may be put to the prejudices and jealousies it seems to have so unnecessarily and unjustly brought into existence.  But in taking  this step, I would wish the Senate to act on it understandingly, and I wish they would direct an examination to be made of the documents I had prepared at the request of the select committee of the House of Representatives, who reported the bill before you without allowing sufficient time to enable me to furnish them with the information they asked from me.  If these documents cannot serve any other purpose at this time, they would I have no doubt satisfy the honorable Senate that I have not been an useless or slothful servant or an unfaithful stewart [sic] over the trust that has been reposed in me.

But it is my determination, under all the disadvantages I must encounter, not to relinquish an institution which I established many years before the enactment of the law of 1813, and have conducted with so much benefit to those with whom I have had constant intercourse.

The genuine Vaccine Matter therefore shall be preserved and furnished as heretofore to all those who may apply to me, attending to such regulations as I have or may hereafter establish, to enable me to serve them faithfully and punctually.

I will attend in person to give you any further information in my power respecting the Vaccine Agency, if requested.

I have the honor to be, with great respect, your obedient and humble servant,


(pp. 187-198)


Mr. WOOD turned to the act of Congress of 1813, which is proposed by this bill to be repealed, which confers no power or authority on the person named by the President as vaccine agent, other than of transmitting and receiving letters free of postage, which, he said, appeared on the face of it so harmless if not beneficial a provision, he should like to hear some explanation of the objections to it.

Mr. BURTON assigned some of the reasons which had influenced the committee to report this bill.  They were of opinion, he said, in the first place, that this subject was one strictly of internal policy, not properly within the province of this government but of the several states, whose duty it was to regulate every thing relating to health and police generally.  He had no objection, if Congress should think proper, to extend the privilege of franking so far that it should be allowed to an agent for vaccination for each and every state and territory; but he was opposed to Congress itself establishing the agencies.  In what manner, he asked, had this agency been conducted?  In the city of Baltimore, the very seat of it, the small pox, that scourge of the human family, had prevailed to an extent greater than in any part of the United States.  Was this not sufficient to convince any man that the institution had not been properly regulated?  No man at this day doubted the efficacy of vaccination to prevent the small pox.  Why had it not been prevented in that very spot which was the seat of the Vaccine Institution?  It was because it was rightfully a subject of state regulation, and could not be properly regulated by the government of the United States.  This very agent, too, had sent the small pox into the interior of the country, where in all probability it would not have found its way for forty years, but for this agency.  The British army, when it marched through that part of the country forty years ago, last communicated the small pox, and he thought it fair to presume that another foreign army was not likely to march through that country for forty years to come, to introduce it again.  We had no wish for the small pox, said Mr. B. but it was sent to us in disguise; and this mistake alone was a sufficient reason for the repeal of the law.  And, after having done this, the agent came out with an address to the public about some new disease, varioloid he believed he called it, which was calculated to destroy all confidence in the institution, and in vaccination itself.  Afterwards, finding that this address was not satisfactory, he had come forward and acknowledge that he had sent the small pox matter to North Carolina, and that it was an accident which had never happened before, and in all probability would never happen again.  That, Mr. B. said, might readily be.  The people who had been killed by it were not killed before, and could not be killed again.  The government of the United States, he added, did not possess the powers which enabled other governments to legislate efficiently on this subject.  In Denmark, for example, the people are compelled to be vaccinated before they can be married, and before their children can be christened they must be vaccinated.  But this government could exercise no such despotic power; all that it could do, constitutionally, in regard to it, and the best thing it could do, was to let the people, who are both able and willing, take care of themselves.

Mr. TAYLOR, of New York, said that the act establishing the agency had been in operation for nine years, and he thought ought not to be hastily repealed.  It was true, an unfortunate incident had occurred under the agency, which it was difficult to conceive could have arisen but from some negligence on the part of the agent.  But would Congress repeal the law because of this one instance of wrong?  If the agent has done wrong, said Mr. T. let him be removed.  He had always heard this agent, however, spoken of as a man of great attention to his charge, who never failed to procure and keep on hand vaccine matter of the greatest purity.  The most careful man may, from accident oar momentary inadvertence, commit a mistake.  If that be sufficient cause for his removal, let him be discharged.  But, let there remain some institution, at which there is a reasonable probability of obtaining vaccine matter in its purity.  Mr. T. said he had no acquaintance with the vaccine agent:  he knew nothing of him but from his letters for several, and public report, which had produced an impression on his mind favorable to the Doctor.  The gentlemen who lived nearer to him were better able to judge of his qualifications than he (Mr. T.) could.  But never, on this or any other occasion, would he repeal a law to get rid of any individual whatever, unless it was an extreme case--....

With regard to the policy of the law, he said there surely might be found in the United States some individual in whom the necessary confidence might be reposed, to discharge the duties of vaccine agent.  It did appear to him to be derogatory to the character of the medical profession to suppose, because Congress could not apply municipal regulations to punish the individual for misconduct, the, therefore, could not properly exercise the power of establishing an agency for vaccination.  This subject had been often before Congress since the year 1813, when the law first passed, and much had been said of it; but, as no considerations had heretofore procured its repeal, he hoped it would not now be repealed without due deliberation, &c.....

[The bill was passed 102 to 57 and sent to the Senate.  On May 1, 1822, the bill was passed in the Senate 29 to 6]

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).
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