05 Smallpox and the First Vaccine 4

8/11/2019 05 Smallpox and the First Vaccine 4

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Dissolving Illusions Disease, Vaccines, and a History You Dont Know

Smallpox and the First Vaccine [Draft 1.17]

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Smallpox and the First Vaccine

... they lye on their hard matts, the poxe breaking and mattering, and running one into another,their skin cleaving to the matts they lye on; they turne them, a whole side will flea off at once.

William Bradford, 1634

Fresh vesicles subsequently formed around the vaccination pocks coalescing with them and

causing them to spread. hey developed also on the face, head, body, and in the mouth, the later

prevented the child from suckling, and it died exhausted on the !"thday after vaccination.

Case of a healthy child after vaccination, March 13, 1891

ry re#vaccination $ %t never will hurt you,

For re#vaccination has this one great virtue&

'hould it in(ure or kill you whenever you receive it,

)e all stand prepared to refuse to believe it.

From a circular sined !"he #octors$, 18%6

&f all the devastatin infectious diseases of the 'ast, small'o( stands out as a 'articularly

dreadful )iller* +ts infamous re'utation is in 'art ecause it -ould cover its victims -ith oo.in

sores that disfiured and )illed many, and in 'art ecause it -as a disease that 'eo'le tried to usevarious medical interventions to hel' 'revent*

"he first attem't in the Western World in controllin small'o( ean -ith /ady Mary Wortley

Montau in 1%1%* 0he had returned from the &ttoman m'ire -ith )no-lede of a 'ractice of

inoculation aainst small'o( -hich -as a 'rocedure )no-n as variolation* "he 'rocedure

entailed ta)in a small amount of material from a small'o( lesion and scratchin the s)in of the

'erson* +f all -ent -ell the 'erson -ould suffer throuh a mild attac) of small'o( and then

-ould e immune to the disease for life* +noculation -as sim'ly ivin small'o( to a 'erson in

a time and settin of their choosin* "he idea ehind inoculation -as that in a controlled settin

a 'erson -ould do etter aainst small'o( than contractin it at some 'ossily less desirale timeand 'lace in the future*

*they generally use a small scratch, or scarification in one arm, and lodge therein a

small bit of variolated thread. his is no proportion or dose of variolous matter requisite

12 oman Bystriany) 0u.anne 5um'hries M# 71


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for inoculation; +ylarini writes, that by pricking the skin with needles dipt in variolous

matter or pus, people have been inoculated*1

"he 'rolem -ith variolation is that the treatment could in fact result in the 'erson dyin of

small'o(* "he other maor 'rolem -as that 'rocedure could s'read small'o(*

he ensuing and protecting attack of smallpox was by no means always a mild one; it

has been reckoned that two or three persons died out of every hundred inoculated.

Further, many people rightly suspected that inoculation, even though it might protect the

individual by a mild attack, spread the disease more widely by multiplying the foci of

infection. For these reasons inoculation fell into general disrepute in urope after

-/0.

+n 1%43, ames :ir)'atric) arrived in /ondon from Charleston 0outh Carolina -ritin of an

account of the 1%38 e'idemic stressin that inoculation has een outstandinly successful*

Because of his enthusiasm, inoculation reained favor throuhout uro'e in the latter half of theeihteenth century*

%n 1ondon, after the revival of 2irkpatrick3s influences in -!4, inoculation became a

lucrative branch of surgical practice* almost exclusively among the well#to#do. he

operation was by no means so simple as it looked. %t required the combined wits of a

physician, surgeon, and an apothecary; while the preparation of the patient to receive the

matter was an affair of weeks and much physicking and regimen. he inoculation was

for a long time the privilege of those who could afford to pay for it.3

Because of the com'le(ity and daner involved, inoculation remained an o'eration that could

only e afforded y the -ealthy*

here is no doubt that in urope, and especially in 5ritain, inoculation could be an

actual danger to the community because smallpox was more common in the cities, where

the density of population made isolation of inoculated cases difficult. For this reason,

inoculation was almost entirely confined to the wealthier classes who could be isolated in

the home or in a special hospital.4

#urin a 1%; e'idemic of small'o( in Boston, fiures sho-ed that more 'eo'le died -hen

e('osed to natural small'o( than they did -hen they contracted small'o( throuh inoculation*

"his sho-ed that inoculation did freolitical, of the First >lantin, >roressive +m'rovements and

>resent 0tate of the British 0ettlements of ?orth@=merica, /ondon, 1%67, '* 47%Frederic) F* Cart-riht,6isease and 7istory, u'ert@5art@#avis, /ondon, 19%, '* 143Aictor C* Aauhan M#,pidemiology and +ublic 7ealth, 0t* /ouis, C*A* Mosy Com'any, 19, '* 1894Frederic) F* Cart-riht,6isease and 7istory, u'ert@5art@#avis, /ondon, 19%, ''* 1;@16



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li)ely to die of natural small'o( than dyin of inoculation* +n contrast, lac)s -ereonly aout

times more li)ely to die of natural small'o( than of inoculation*

he small#pox in cold countries is more fatal to blacks than whites. %n 5oston small#

pox of -"/, there died whites in the natural way about one in eleven, by inoculation one

in eighty; blacks in the natural way one in eight, by inoculation one in twenty.;

#es'ite inoculation ein -idely used, there -ere those that sus'ected the 'rocedure -as in fact

s'readin small'o(* =1%64 article details statistical information that the author elieved sho-ed

the unintended result of inoculation -as increasin deaths from small'o(*

%t is said that a certain number who have the small pox by %noculation a much smaller

proportion dies than of the same number that take in naturally, but admit this to be true,

it does not follow %noculation is a practice favourable to life* %t is incontestably like the

plague a contagious disease, what tends to stop the progress of the infection tends to

lessen the danger that attends it; what tends to spread the contagion, tends to increasethat danger; the practice of %noculation manifestly tends to spread the contagion, for a

contagious disease is produced by %noculation where it would not otherwise have been

produced; the place where it is thus produced becomes a center of contagion, whence it

spreads not less fatally or widely than it would spread from a center where the disease

should happen in a natural way; these centers of contagion are manifestly multiplied

very greatly by %noculation*6

"he author of the article sho-ed that inoculation ean in /ondon in the year 1%1* +n the 38

years 'recedin the start of inoculation, the deaths from small'o( to the numer orn -as 97 'er

1,777 and to the numer of urials, 64 'er 1,777* +n the 38 years after inoculation ean, thedeaths from small'o( to the numer orn increased to 1% 'er 1,777 and to the numer of urials

increased to 81 'er 1,777* While inoculation -as celerated as hel'ful in decreasin the

li)elihood of an individual dyin from small'o(, the 'ractitioners of inoculation -ere creatin

vectors for s'readin the disease that they -ere tryin to 'revent* "his medically sanctioned

o'eration had the unintended conseolitical, of the First >lantin, >roressive +m'rovements and

>resent 0tate of the British 0ettlements of ?orth@=merica, /ondon, 1%67, '* 3986!"he >ractice of +noculation "ruly 0tated,$ "he entlemanDs Maa.ine and 5istorical Chronicle, Aol* 34, 1%64, '*333%li.aeth =* Fenn, !"he reat 0mall'o( 'idemic of 1%%;@8,$ 5istory "oday, uly 7, 773, '* 1



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= farmer named Benamin etsy -as a-are of the 'o'ular elief that co-'o( -ould 'rotect

aainst small'o(* +n 1%%4, he too) material from an infected co- and rued it into scratches

made -ith darnin needles usin his -ife and t-o sons as e('erimental suects* 5e -as met

-ith a reat deal of criticism for ma)in inhuman e('eriments on his family, althouh alleedly

-hen etsyEs sons -ere later delierately e('osed to small'o( they did not come do-n -ith thedisease*

+t -as rumored amon mil) maids that infection -ith co-'o( -ould 'rotect one from small'o(*

Believin these stories, in 1%96, d-ard enner 'erformed an e('eriment on a youn 8@year@old

oy named ames >hi''s* 5e too) disease matter that he elieved to e co-'o(, from lesions on

a dairymaid, 0arah ?elms, and inoculated ames >hi''s* 5e -ould later delierately e('ose

ames >hi''s to small'o( to test if he -as 'rotected y his co-'o( inoculation* Because the oy

a''arently did not contract small'o(, it'rovided the evidence that enner elieved -as sufficient

to claim that the techni


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small'o( sho-in that the techni


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'eo'le in the to-n* "he result -as an outrea) of small'o(, and y the end of the vaccine@

induced e'idemica re'orted 1,777 -ere sic)ened and 68 'eo'le died*

he town of Carblehead, we are glad to hear, is relieved from the distress occasioned

by the 'mall pox. 'ixty eight have died of the infection...13

"he medical community emraced ennerEs ideas only a fe- years after his discovery* arly

re'orts sho-ed there -ere cases of 'eo'le -ho had co-'o( or -ere vaccinated that -ere still

dyin of small'o(* 0'ecific cases of co-'o( and vaccine failure -ere re'orted in the 1879

Cedical Dbserver*

-. E ?hild was vaccinated by Cr. obinson, surgeon and apothecary, at otherham,

towards the end of the year -GG. E month later it was inoculated with small#pox matter

without effect, and a few months subsequently took confluent small#pox and died.

/. E woman#servant to Cr. Hamble, of 5ungay, in 'uffolk, had cow#pox in the casual way

from milking. 'even years afterwards she became nurse to Iarmouth 7ospital, where shecaught small#pox, and died.

4 and !. liarliament,$ Westminster evie-, Aol* 131, 1889, '* 171



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:ariola, above all, continues and spreads a devastating contagion. 7owever painful,

yet it is a duty we owe to the public and the profession, to apprirevailin #iseases,$ "he /ondon Medical e'ository Monthly ournal and evie-, Aol* A+++,

uly to #ecemer, 181%, '* 9;1%5enry #e-ar, !=ccount of an 'idemic 0mall >o(, -hich occurred in Cu'ar in Fife in the 0'rin of 181%, and the

#eree of >rotectin +nfluence -hich Aaccination affordedH accom'anied -ith >ractical +nferences and&servation,$"he /ondon Medical e'ository Monthly ournal and evie-, Aol* A+++, uly to #ecemer, 181%, '*

44



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xperience has also shewn =shown>, that the natural small#pox have made their

appearance, when the vaccine puncture had previously existed, surrounded with the

areola of the most perfect appearance for more than two days, and not in the least

modified, but in the highest degree confluent, and followed by death. 'mall#pox pustules,

too, existed within the very areola of the vaccine puncture*he accounts from allquarters of the world, wherever vaccination has been introduced... the cases of failures

are now increased to an alarming proportion; and from a fair and impartial examination

appears, where the small#pox contagion has access to operate upon vaccinated cases of

upwards of six years standing, and the contagion applied in a concentrated and lasting

form, nearly the whole of such cases will yield to the influence of the small#pox

contagion.18

"here -ere those that sa- that vaccination -as not fully 'rotective aain small'o(* "hey arued

that even thouh inoculation -ith small'o( -as more ris)y, it 'rovided for etter immunity*

Aaccination miht 'rovide a tem'orary 'rotection, ut -ould only delay catchin the diseaseuntil later*

he most unfavorable conclusion therefore that can be admitted is, there may be the

same risk of deaths from small#pox after vaccination, as of deaths in the early stage of

the inoculated small#pox. hus the risk is not only deferred to a later period, but is

ultimately far inferior to what it was under the use of the best inoculation previously to

the discovery of the cow#pox, and is in fact reduced almost to nothing. 19

&ther oservations sho-ed that small'o( could still infect those -ho 'reviously had small'o(,

and those that -ere vaccinated could also e infected* +mmunity -as not ranted to those -ho

had small'o( efore or had een vaccinated*

* during the years -0/B, -, and, / there was a great hubbub about the small#pox. %t

broke out with the great epidemic to the north* %t pressed close home to 6r. 9enner

himself* %t attacked many who had had small#pox before, and often severely; almost to

death; and of those who had been vaccinated, it left some alone, but fell upon great

numbers.7

William Coett -as a farmer, ournalist, and nlish 'am'hleteer* +n 189, he -rote aout the

failure of vaccination to 'rotect 'eo'le from small'o(* #es'ite ein vaccinated even y the

inventor and 'romoter of vaccination, d-ard enner, hundreds still contracted small'o( and18Mr* "homas Bro-n, 0ureonMusselurh, I&n the >resent 0tate of Aaccination,I "he dinurh Medical and0urical ournal, Aolume Fifteenth, 1819, '* 6%195enry #e-ar, !=ccount of an 'idemic 0mall >o(, -hich occurred in Cu'ar in Fife in the 0'rin of 181%, and the

#eree of >rotectin +nfluence -hich Aaccination affordedH accom'anied -ith >ractical +nferences and

&servation$, "he /ondon Medical e'ository Monthly ournal and evie-, Aol* A+++, uly to #ecemer, 181%, '*4;7!&servations y Mr* Fosro)e,$ "he /ancet, Aol* ++, 189, '* ;83



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many died* Coett considered vaccination to e an un'roven and fraudulent medical 'ractice*

CoettEs reference to 7,777 'ounds no dout refers to the amount the British overnment had

recently advanced to d-ard enner in 18 for further small'o( vaccine e('erimentation*

%n the midst of all this mad work, to which the doctors, after having found it in vain to

resist, had yielded, the real small#pox, in its worst form, broke out in the town of

ingwood, in 7ampshire, and carried off, % believe, more than a hundred persons, young

and old, every one of whom had had the cow#pox so nicelyK3 End what was now saidL

)as the quackery exploded, and the granters of the twenty thousand pounds ashamed of

what they had doneL Jot at all& the failure was imputed to unskillful operators; to the

staleness of the matter; to its not being of genuine quality* what do we know nowL

)hy, that in hundreds of instances, persons cow#poxed by 9JJ 7%C'1F =author3s

emphasis>, have taken the real small#pox afterwards, and have either died from the

disorder, or narrowly escaped with their livesK1

d-ard enner elieved the co-'o( disease had oriinated from a disease of the horse called the

!grease*$ 5e elieved that enuine co-'o( came from this horse@rease and 'roceeded in

vaccinatin 'eo'le from this source* 0ome 'ractitioners used other animals, such as oats, as

sources of vaccine material*

he lymph which 6r. 9enner then used, and which he had kept in circulation three or

four years about 5erkeley, had been taken by him, not from the cow, but the horse, and

never subsequently passed through the constitution. %n fact, the disease is an equine, not

a vaccine =cow> pox, as he decisively ascertained before he died, obtained from the

vesicles which arise upon the skin of the horse3s legs, in consequence of an erysipelatous

affection excited by the matter of grease... % have extracted an account from some country

of a goat pox, which so resembled the vaccine, that the doctors inoculated with it, and

found it an equal preservative. 7owever, this equine lymph of 6r. 9enner produced a

vesicle, which, he declared precisely resembled the natural cow#pox vesicle on the teat of

the cow*

For years !humani


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victims of that frightful malady. %n vain have some physicians denied the degeneracy of

the vaccine. hat fluid, evidently, is no more what it was*%t has evidently degenerated

through the continuity of its employment, and to restore its efficacy, % think it will be

necessary to return to its origin, and henceforth, derive it only from the teats of the

cow.3

Because vaccination -as ein done arm to arm, the vaccine fell out of favor -ith many havin

!disgust towards it*$ #r* #elarane determined that it -as needed to e ta)en from the !nipple$

of the co- only, and not from the arms of others*

*very few seek it, in spite all our government has done to propagate it. he vaccine,

then, is fallen into general discredit; and it may be said, at least in France, that it is upon

the point of being absolutely abandoned, unless steps are soon taken to put an end to the

cause of this re(ection.4

+n an attem't to ma)e ne- sources of vaccine, co-s -ere infected -ith horse rease as -ell ashumani.ed co-'o(* 5o-ever, these attem'ts failed to create ne- sources of vaccine*

*the old vaccination committee had repeatedly attempted to produce vaccinia, by

inoculating cows both the matter of the grease and with that of human cowpox

vesicles, but always unsuccessfully.;

=n 1834 article detailed the deate of the oriin of vaccine virus* =t this 'oint in history the

material used for vaccination -ould sometimes e referred to as !vaccine virus*$

hree opinions exist as to the origin of the vaccine virus. -st. hat of 9enner, who

supposed that it proceeded from a malady of the horse, called the Hrease, which was

contagious, and gave to cows that form of complaint denominated cow#pox. /nd. hat of

6r. obert of Carseilles, who thought that the vaccine virus was nothing less than the

small#pox poison communicated to cows, and modified by transition. 4rd. he opinion

that this complaint is as natural to cows as rot to sheep, the small#pox, measles, or

scarlatina to man* 6r. Fiard expresses, as his opinion, that the cow#pox is a malady

peculiar to cows; that it is very rare in ngland, in these animals; and that, in France,

there is no evidence to prove that it has ever been produced.6

=n 183% 'a'er sho-ed that it -as thouht that vaccination -ould not fully 'rotect an individual

as first elieved, ut concluded that it -ould result in a more mild disease*

3#r* #elarane of >aris, !&n the >resent 0tate of Aaccination in France,$ "he /ancet, Aol* ++, 189, '* ;84#r* #elarane of >aris, !&n the >resent 0tate of Aaccination in France,$ "he /ancet, Aol* ++, 189, '* ;83;!Co-'o( &riin of,$ "he Medico@chirurical revie- and ournal of 'ractical medicine, Aol* 7, 1834, '* ;746#r* Fiard, !('eriments u'on the Communication and &riin of Aaccine Airus,$ /ondon medical and surical

ournal, Ao* 4, 1834, '* %96



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5ut during this unhealthy season the whole of the vaccinated did not escape; many,

indeed, were affected with modified small#pox* there were a few of the vaccinated who

had the small#pox in the severest form, but those were so few in comparison with those

who had it in its mild form* it cannot but be concluded, that although vaccination does

not at all times completely protect the human frame from the infection of small#pox, itdoes so in many instances, and those who systems it does not entirely shield, it so far

prepares, that, instead of being afflicted with a long#continued, dangerous, and

loathsome disease, they are only affected with a mild disorder*%

+n 1836, in =ttenorouh, Massachusetts, #r* ohn C* Martin too) fluid from a 'oc) of a man

-ho died from small'o( and inoculated on a co-Es udder* 5e then too) matter from that co-and

used it to vaccinate 'eo'le* &ne of the vaccinated came do-n -ith une('ected sym'toms and

he -as later declared to have small'o(* = small'o( e'idemic ensued causin a 'anic*

hen those who had been vaccinated from the same source inquired anxiously what was

to be their fate* others soon began to be affected* xcitement and consternation

prevailed, sustained by the consecutive occurrence of new cases. 5usiness was

suspended; the panic of fear magnified the danger, and no man could see where it would

end* wo hospitals were established, to which many of those attacked were removed.

Four months elapsed before the last patient was discharged.8

=n 186; e('erimental inrotective >o-er of Aaccination,$ "he /ancet, Aol* ++, 0e'temer 3,

183% , '* 988'hraim Cutter M#, !>artial e'ort on the >roduction of Aaccine Airus in the nited 0tates,$ "ransactions of the=merican Medical =ssociationG Aolume LL+++, 18%, '* 779"he ncyclo'aedia Britannica, Aol* 4, >hiladel'hia, 1897, '* ;



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he character of the disease was very severe. he deaths amounted to -"-, being at the

rate of twenty#three and a half per cent. %n -0-, when the same number of patients was

admitted, the deaths were /", being at the rate of forty per cent. Df the total admitted,

4-/ were reported to have been vaccinated, and had congni


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quarter of that year, -0!!& --0 =-0-L> deaths from small#pox were recorded, MB, or

nearly one#third, of which had been vaccinated.3

#urin the 1877s there -ere 'eriodic re'orts made in the ne-s'a'ers of 'eo'le -ho died from

small'o( des'ite ein vaccinated 'ro'erly* "here -ere also re'orts of 'eo'le that died after

vaccination* #eath from a s)in condition called erysi'elas -as a 'articularly 'roloned and

'ainful -ay to die*

* a boy from 'omers#town, aged " years, small#pox confluent, unmodified @G daysA.3

7e had been vaccinated at the age of ! months; one cicatrix* the wife of a labourer,

from 1ambeth, aged // years, small#pox confluent, unmodified @0 daysA.3 :accinated in

infancy in 'uffolk; two good cicatrices* the son of a mariner, aged -B weeks, and the

son of a sugar baker, aged -4 weeks, died of general erysipelas after vaccination,

effusion of the brain.3 33

E girl, aged ! months, died from erysipelas after vaccination.34

0 deaths were tabulated under small#pox, of which two attributed to erysipelas after

vaccination,3 and one to effects of vaccination.3 3;

wo children, both of the age of six months, died from erysipelas after vaccination. %n

one case the erysipelas commenced a fortnight after the operation. 36

Claims -ere made that deaths from vaccination -ere often not re'orted ecause of an alleiance

to the 'ractice of vaccination* +f a 'erson had een vaccinated, their death -as less li)ely to e

recorded as a death from small'o(* 0ometimes a 'erson -ould have een indicated to have died

from another condition such as chic)en'o(, or it miht e indicated that they had not een

vaccinated* 5o- often this ha''ened is difficult to determine, ut it must have had some

im'act on the statistics of the day*

* deaths from vaccination and re#vaccination are hushed up* Cr. 7enry Cay, writing

to the 5irmingham Cedical eview, 9anuary, -0!, on ?ertificates of 6eath,3 says Es

instances of cases which may tell against the medical man himself, % will mention

erysipelas from vaccination and puerperal fever. E death from the first cause occurred

not long ago in my practice, and although % had not vaccinated the child, yet in my desire

to preserve vaccination from reproach % omitted all mention of it from my certificate of

death.3 3%

3!0mall >o( and Aaccination,$ 5am'shire "elera'h and 0usse( Chronicle, 0aturday March , 18;733"he Mornin Chronicle, Wednesday, ='ril 1, 18;434/loydEs Wee)ly ?e-s'a'er, 0unday une 17, 18673;laso- 5erald, #ecemer 14, 18%736"he Mornin Chronicle, Wednesday, &ctoer 3, 18613%"he +'s-ich ournal, ?ovemer %, 18%6



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Dne child, li


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#ata from Boston that eins in 1811sho-s that startin from around 183% there -ere 'eriodic

small'o( e'idemics that culminated in a reat 18% e'idemic J ;*1G Boston 0mall'o( 1811@

196K* =fter 18;; there -ere further small'o( e'idemics in 18;9@67, 1864@6;, 186%, and the

lare e'idemic in 18%@%3* "hese re'eat small'o( e'idemics sho-ed the strict vaccination la-s

instituted y Massachusetts in 18;; had no effect J ;*G Boston 0mall'o( 1841@1887K* +n fact,more 'eo'le had died in the 7 years after the strict Massachusetts vaccination com'ulsory la-s

than in the 7 years efore*



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;*1G Boston small'o( and scarlet fever death rates from 1811 to 196*


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Jever, however, did the faith in vaccination receive so rude a shock as in the Hreat

'mall#+ox pidemic of -0- and -0/. very country in urope was invaded with a

severity greater than had ever been witnessed during the three preceding centuries. %n

ngland, the number of deaths from the disease was increased from /,M/B in -0B to

/4,-/M in -0- and -G,BM! in -0/, falling again to /,M4! in -04. 8pon the ?ontinent,particularly in France and Hermany, the visitation was even more severe. %n 5avaria,

for example, with a population vaccinated more than any other country of Jorthern

urope, except 'weden, which experienced the greatest that had ever been known. )hat

was even more significant, many vaccinated persons in almost every place were attacked

by small#pox before any unvaccinated persons took the disease.44

+n 1888, des'ite a hihly vaccinated and revaccinated 'o'ulation, small'o( devastated a lare

numer of to-ns in +taly* +n many to-ns, 'eo'le had een 'ro'erly vaccinated t-ice a year for

many years* +n 1899, #r* uata re'orted on the failure to 'rotect the very -ell vaccinated 'eo'le

in +taly J=''endi(G Aaccination in +talyK*

Emong the great number of little epidemics which produced the -0,--B deaths

mentioned, % will only note the following& 5adolato, with a population of 4,0BB, had

-,/BB cases of small#pox; Huardavalle had /,4BB cases with a population of 4,"BB; 't.

?aterina del 9onio had -,/BB cases @population /,BBA; ?apistrano had !"B cases

@population /,"BBA. Ell these villages are in ?alabria. %n 'ardinia the little village of

1aerru had -"B cases of small#pox in one month @population, 0BBA; +erfugas, too, in one

month had "!- cases @population, -,!BBA;Dttana had G deaths from small#pox

@population, -,BBBA, and the deaths were "- at 1ei @population, !-!A. %n 'icily !!B

deaths were registered at Joto @population, -0,-BBA, /BB at Ferla @population, !,"BBA,"B at 'ortino @population, G,BBBA, -4" at 'an ?ono @population, -,MBBA, and /,-BB

deaths at :ittoria @population, /,MBBAK ?an you cite anything worse before the invention

of vaccinationL End, the population of these villages is perfectly vaccinated, as % have

proved already, not only, but % obtained from the local authorities a declaration that

vaccination has been performed twice a year in the most satisfactory manner for many

years past.4;

+n 1888, #r* Charles Creihton -rote a critical revie- of vaccination in thencyclopedia

5ritannica* 5e noted that in >russia -here vaccination -as -ell 'racticed, there -as a hih

mortality durin the 18%7@18%3 'andemic* +n 18%1 a''ro(imately 67,777 'eo'le died fromsmall'o( in >russia des'ite their strict adherence to vaccination*

44=le(ander Wilder, M#, !"he Fallacy of Aaccination,$ "he Meta'hysical Maa.ine, Aol* +++, ?o* , May 1898, '*

884;Charles uata, M* #*, >rofessor of 5yiene and of MateriaMedica in the niversity of >eruia, !Aaccination in

+taly,$ "he ?e- Nor) Medical ournal, uly 1899, ''* 188@189



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he practice of re#vaccination was first recommended in ngland by H. Hregory, and in

Hermany for the army by 7eim @-0/GA. %t has been more or less the law in +russia since

-04"; re#vaccination of school pupils at the age of twelve is an integral part of the

vaccination law.3Jot withstanding the fact that +russia was the best revaccinated country

in urope, its mortality from smallpox in the epidemic of -0- was higher @"G,04GA thanin any other northern state.46

By the end of 1868, over 9; of the inhaitants of Chicao had een vaccinated* =fter the reat

fire of 18%1 that leveled the city, vaccination -as made a condition of receivin relief su''lies*

5y the end of -0M0, /4B,BBB of the city3s /!-,BBB inhabitants had been vaccinated

against smallpox*vaccination against smallpox was made a condition upon which relief

supplies were issued to the needy.4%

5o-ever, des'ite strict vaccination la-s 'ut in 'lace, Chicao -as hit -ith a devastatin

small'o( e'idemic in 18%* "he small'o( fatality rate -as ; -ith the hihest ever recordedfatality in children under five* "he idea of vaccinatin most of the 'o'ulation, -hich -ould later

e termed !herd immunity$, did not 'rotect the 'o'ulation from ein devastated -ith small'o(*

5ut despite these measures, the death rate rose ominously in the aftermath of the fire.

Dver two thousand persons contracted smallpox in -0/, and more than a forth of these

died. he fatality among children under five was the highest ever recorded.48

ven thouh many 'eo'le throuhout the Western -orld had een vaccinated, they -ere still

ein afflicted -ith small'o(*

*5avaria =Hermany> in -0- of 4B,!/ cases /G,!/G were in vaccinated persons, or

G". per cent., and -4-4 in the un#vaccinated, or !.4 per cent. %n some of the small local

outbreaks of recent years the victims have been nearly all vaccinated @e.g., at 5romley

=ngland> in -00-, a total of !4 cases, including sixteen confluent, all vaccinated.49

Com'ulsory vaccination ean in a'an in 18%* +n 188; a'an 'assed more strict la-s -ith

com'ulsory revaccination every five to seven years* From 188; to 189 there -ere over

;,777,777 recorded vaccinations and revaccinations* #es'ite this, small'o( e'idemics still

struc) a'an*

*the official records show that during the seven years mentioned =-00"#-0G/> they had-"M,-" cases of smallpox and 4G,GG deaths. 5y a compulsory law, every infant in

46ncyclo'edia Britannica, 18884%"homas ?eville Bonner,Cedicine in ?hicago -0"B#-G"B E ?hapter in the 'ocial and 'cientific 6evelopment of a

?ity, "he =merican 5istory esearch Center, Madison, Wisconsin, 19;%, ''* 181@1848"homas ?eville Bonner,Cedicine in ?hicago -0"B#-G"B E ?hapter in the 'ocial and 'cientific 6evelopment of a?ity, "he =merican 5istory esearch Center, Madison, Wisconsin, 19;%, '* 1849"he ncyclo'aedia Britannica, Aol* 4, >hiladel'hia, 1897, '* 9



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9apan had to be vaccinated within the first year of its birth and in case it did not take the

first time, three additional vaccinations had to follow within the year, and every year to

seven years after. %n the event of an outbreak of smallpox the 9apanese authorities

rigidly enforced general vaccination. Jow in spite of these precautions the official

records show that from -0G/ to -0G, 9apan had -!/,B4/ cases of smallpox and 4G,"4Mdeaths.Enother act passed in -0GM made repetition of vaccination every five years

compulsory on every sub(ect regardless of station; yet in the very next year, -0G, they

had !-,G!M cases of smallpox and -/, /M deaths # a mortality rate of 4/ per cent, nearly

twice that from smallpox previous to the vaccination period.;7

5o- lon did some deree of immunity from small'o( -ith vaccination lastO &riinal claims of

lifelon immunity -ere re'laced -ith varyin claims from 17 years to as little as 1 year* Most

claims settled in to aout ; to % years efore re@vaccination -ould e necessary*"o this day, there

is no scientifically@ased consensus on ho- lon !immunity$ after small'o( vaccine lasts*

>eo'le -ere considered vaccinated and immune sim'ly y revealin the scar of vaccination*

%f all went well, the patient would then en(oy immunity from smallpox for five to seven

years, sometimes longer. End, of course, as long as a person is immune, she could not

pass along smallpox to others.;1

5o-ever, in a 1978 article entitled !For 7ow 1ong 6oes :accination ?onfer %mmunity from

'mall#+oxL$ y >rof "* 0mith #*A*0* a su''orter of vaccination concluded some limited

immunity lasted only around three years*

*it is observed that all un#revaccinated children over one and a#half years of age, or

thereabouts, and all re#vaccinated persons whose re#vaccinations are more than threeyears old, i.e., the vast ma(ority of the entire population $ are unprotected.;

&thers such as #r* &lesen claimed that revaccination should e done on a yearly asis*

ecent successful vaccination is an absolute protection against smallpox. +rotection

lasts from six months to twelve months and often much longer. evaccination is

advisable once a year.;3

=fter 18% the death rate for small'o( ean to decline* +n the early 1977s, death from small'o(

all ut vanished from nland J ;*3G :0mall'o(1838@19K* =fter 18%, vaccination

coverae rates also slo-ly declined from a hih of nearly 97* Coverae rates slihtly increased

;7#r* 0imon /* :at.off,!"he Com'ulsory Aaccination Crime,$ MachinistsD Monthly ournal, March 197, Aol* 3,

?o* 3, '* 61;1Michael Willrich,+DN. En Emerican 7istory, >enuin >ress, ?e- Nor), 711, '* 4;*W* 5ode, M#, !0tate@+nflicted #isease in our >ulic 0chools,$ Medical Century, &ctoer 1978, Aol* LA+, ?o*17, ''* 378@314;3#r* &lesen, !Aaccination in the >hilli''ine+slands,$Medical 0entinel, ='ril 1911, Aol* 19, ?o* 4, '* ;;



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in the late 1877s, ut then reatly decreased to only 47 y 1979 J ;*4G : 0mall'o(

Coverae 18%@19K* #es'ite declinin vaccination rates, small'o( deaths remained lo-,

vanishin to near .ero after 1976*

"he medical community often heralded vaccination as a very safe 'rocedure* 5o-ever, deaths

noted as !6eaths from ?owpox and Dther ffects of :accination$ did occur and usually from the

deadly s)in condition called erysi'elas*

%t is quite certain that in foundling hospitals, such as that of 't. +etersburg, the

erysipelas of vaccination has been the starting point of disastrous epidemics of erysipelas

affecting the inmates generally.;4

From 18;9 to 19, official deaths related to vaccination -ere over 1,677 in nland J ;*;G :

Aaccination #eaths 18;9@19K* +n fact, from 1976 to 19 the numer of deaths recorded from

vaccination and from small'o( -as nearly the same J ;*6G : Aaccination #eaths 1976@19K*

;4"he ncyclo'aedia Britannica, Aol* 4, >hiladel'hia, 1897, '* 6



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;*3G nland and Wales small'o( and scarlet fever death rates from 1838 to 19*


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;*4G nland and Wales small'o( death rate vs* vaccine coverae rates from 18% to 19*


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;*;G nland and Wales total deaths from co-'o( and other effects of vaccination from 18;9 to 19*


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;*6G nland and Wales small'o( deaths vs* vaccination deaths from 1976 to 19*


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Heorge 5anford had a child born in -0M0. %t was vaccinated and after the operation the

child was covered with sores, and it was some considerable time before it was able to

leave the house. Egain Cr. 5anford complied with the law in -0B. he child was

vaccinated by 6r. 'loanne in the belief that by going to him they would get pure matter.

%n that case erysipelas set in, and the child was on a bed of sickness for some time. %n the

third case the child was born in -0/, and soon after vaccination erysipelas set in and it

took such a bad course that at the expiration of -! days the child died.;;

aundice is the yello-ish stainin of the s)in and the -hites of the eye usually related to liver

'rolems* +t -as found to e sometimes related to vaccination* &ne noted e'idemic occurred

amon revaccinated adults at a lare naval shi'yard in Bremen ermany from &ctoer 1883 to

='ril 1884*

Dwing to an alarm of smallpox, -/0G workmen were re#vaccinated between the -4thEugust and -st 'eptember with the same humaniaris*

First % re(ected the idea that syphilis could be transplanted by vaccination. 5ut facts

accumulated more and more, and now % must concede the possibility of the transfer of

syphilis by means of the vaccine. % do this very reluctantly. Et present % do not hesitate

longer to acknowledge and proclaim the reality of the fact.;%

+n 1889, #r* Charles Creihton 'ulished a oo) hihly critical of d-ard enner and

vaccination* 5e oserved that 'eo'le -ho had een e('osed to co-'o( had also fre


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submitted to inoculation along with others, whenever a general inoculation was afoot;

and 9ennerOs cases were only a few, favourable to his contention... he himself stands for

the man who peremptorily decides on the truth or falsehood of a theory, on the supposed

authority of a few solitary instances.3 ;8

=t the end of the 1877s

small'o( chaned its

character* =fter the

summer of 189%, the

severe ty'e of small'o(

-ith its hih death rate,

-ith fe- e(ce'tions,

had entirely disa''eared

from the nited 0tates*

0mall'o( had turnedfrom a disease that

)illed 1 in ; of its

victims to any-here

from 1 in ;7 to as lo- as 1 in 387* "his disease could still )ill, ut havin ecome so much

milder it -as mista)en for various other diseases*

6uring -0GM a very mild type of smallpox began to

prevail in the 'outh and later gradually spread over

the country. he mortality was very low and it was

usually at first mistaken for chicken pox or somenew disease called ?uban itch,3 elephant itch,3

'panish measles,3 9apanese measles,3 bumps,3

impetigo,3 +orto ico scratches,3 Canila scab,3

+orto ico itch,3 army itch,3 Efrican itch,3 cedar

itch,3 Canila itch,3 5ean itch,3 6hobie itch,3

Filipino itch,3 nigger itch,3 2angaroo itch,3

7ungarian itch,3 %talian itch,3 bold hives,3

eruptive grip,3 beanpox,3 waterpox,3 or

swinepox.;9

"he author of a 1913 article in he 9ournal of %nfectious

6iseases'resented a tale sho-in that in 189; and 1896

;8Charles Creihton,9enner and :accination, 1889, '* ;9;9Charles A* Cha'in, !Aariation in "y'e of +nfectious #isease as 0ho-n y the 5istory of 0mall'o( in the nited

0tates,$"he ournal of +nfectious #iseases, Aol* 13, ?o* , 0e'temer 1913, '* 1%3


> ;*G(tremely mild case of small'o(, earin some resemlance to chic)en'o(*

J1971K

> ;*3G +m'etio contaion in anadult* J1971K


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the small'o(death rate -as around 7, as it had een historically* "he tale then sho-edthat

after 1896 the death rate ra'idly fell off startin -ith 6 in 189%to as lo- as 7*6 y 1978*

Dn the whole the disease seems to have shown a tendency to diminish, somewhat in

severity. his tendency is not marked and the somewhat lower case fatality noted in later

years may be due to the better recognition of cases, now that the type has become more

widely known. Et first fatalitiesof - to / per cent and even more were commonly

reported, while later fatalities have often been much less. hus in Jorth ?arolina in

-G-B there were 4,0" cases with 0 deaths, a fatality of B./ per cent, and in -G-- there

were 4,/G! cases in that state without a single death.67

0omethin had chaned to ma)e small'o( a much less danerous disease*"his ne- mild form of

the disease had no secondary fever -ith 'atientshavin little discomfort if any* "he eru'tions as

in classic small'o( -ere often only a do.en and sometimes even less* +n the asence of any

e'idemic a case of mild small'o( -as very li)ely to e overloo)ed* "he redness left y these

eru'tions often disa''eared in three or four -ee)s and usually left no 'ermanent mar)s*

)herever this mild type of smallpox has appeared there has usually developed a

controversy as to its nature. he public and the general practitioner consider smallpox a

serious disease and they are loath to believe that an affliction so mild as is usually

observed in this type can be real smallpox. he prodromal =early> symptoms are usually

not severe, and when the eruption appears, they disappear entirely. Efter that, in the

great ma(ority of cases, the patient remains practically well.61

"he articleEs author hy'othesi.ed that this ne- milder form of small'o( could e a mutation of

the oriinal* Was that the case, or had somethin else chaned to ma)e this and all otherinfectious diseases less fatalO

he evidence points to the existence in Jorth Emerica during the last -" years of two

distinct strains of smallpox, one the long recogni


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*chickenpox, is a minor

communicable disease of

childhood, and is chiefly

important because it

frequently gives rise todifficulty in diagnosis in

cases of mild smallpox.

'mallpox and chickenpox

are sometimes very difficult

to differentiate clinically63

By the 197s it -as reconi.ed that

the ne- form of small'o( 'roduced

little in the -ay of sym'toms, even

thouh fe- had een vaccinated*

%ndividual cases, or even epidemics, occur in which, although there has been no

protection by vaccination, the course of the disease is extremely mild. he lesions are

few in number or entirely absent, and the constitutional symptoms mild or insignificant64

=s the mild form of small'o( re'laced the classic and deadly variety, the rate of vaccination

declined* "his in turnincreased the an(iety of some in the medical community* "he fear -as that

themilder ty'e of small'o( could at some 'oint revert ac) to its oriinal and more deadly form*

)e must prepare for a pandemic of smallpoxK * %t has been two decades since

epidemics of any proportions swept over the country and while the war =)orld )ar %>resulted in the vaccination of large numbers of young adults the very young are almost

unvaccinated, while those of middle life and older have not been revaccinated for many

years.6;

By the 197Es and 1937Es mild small'o( had almost com'letely re'laced the severe form in the

nited 0tates* "here -ere e(ce'tions ho-ever -ith outrea)s in sea'orts and near the Me(ican

order* &nce the mild ty'e of small'o( ecame 'revalent, there -as no evidence that it ever

reverted to the older more virulent ty'e*

63ohn erald Fit.erald, >eter illes'ie, 5arry Mill /ancaster,En introduction to the practice of preventive

medicine, C*A* Mosy Com'any, 19, '* 19%64ohn >rice Cro.er riffith, he diseases of infants and children, :olume -, W*B* 0aunders Com'any, 191, '* 3%76;* :oehler,+harmacology and therapeutics, preventive medicine, "he Near Boo) >ulishers, 191, '* 3


> ;*4G Well mar)ed eru'tion of chic)en'o(, sho-in lesions in

varyin staes of develo'ment* J1971K


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Elthough mild cases of smallpox were known before, they have come practically to

replace the severe forms in many extensive areas, such as the whole 8nited 'tates, 5ra


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natural cycle of disease like plague, and that smallpox is no longer a natural disease for

this country.68

Aaccination rates declined from the late 1877s and remained lo- u' until the time com'ulsory

vaccination -as ended in nland in 1948*

:accination rates* fell to "B percent in -G-! and -0 percent in -G!0.69

#es'ite this e(tremely lo- vaccine coverae rate and 'ronouncements of doom from those that

favored vaccination, there -as never a resurence of small'o(* #eaths from small'o( remained

lo-* Net, from the time of the last small'o( death in the nited 0tates in 1948 until 1963,

small'o( vaccination continued, resultin in an estimated ;,777 hos'itali.ations from

enerali.ed rash, secondary infections, and ence'halitis* "here -ere also an estimated 77 to

377 deaths as result of small'o( vaccination*

he last smallpox death in the 8nited 'tates following an importation occurred in -G!0,but since that time there have been probably /BB to 4BB deaths from smallpox

vaccination.%7

"he authors of a 19%7 study thouht due to 'oor surveillance and vaccine reaction

underre'ortin that the numer of small'o( vaccine related deaths could actually e hiher* "his

study only e(amined deaths from 19;9 to 1968 in the nited 0tates* +f the deaths -ere this hih

in a country -ith a modern health care system, -hat -as the total numer of deaths from

small'o( vaccination from 1877 to the 'resent across the entire -orldO

he data presented here as well as findings from other studies indicate that the risks of

smallpox vaccination as currently practiced in the 8nited 'tates are considerable.

'urveillance of the complications of smallpox vaccination is poor, and the extent of

underreporting is unknown. he observation that several deaths from diseases other than

vaccinial complications were misclassified or erroneously reported as deaths from

vaccinia raises the possibility that vaccinial complications may also be misdiagnosed or

misclassified with other disease entities. 'ome patients die of residual effects of central

nervous system damage caused by postvaccinial encephalitis. heir death certificates

may mention only the immediate causes which developed during institutional care and

not the underlying cause of death. %n our studies of vaccination complications occurring

in -GM4, three of seven deaths definitely related to vaccination did not appear in our

search of death certificates. he actual number of deaths caused by smallpox vaccination

complications may be higher than the seven per year indicated by this review.%1

68ournal of the oyal 0anitary +nstitute, Aol* 66, 1946, '* 1%669=rthur =llen, :accine. he ?ontroversial 'tory of Cedicine3s Hreatest 1ifesaver, 77%, '* 69%7"he Nale ournal of ioloy and medicine, 1968, Aol* 41, '* 17



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"his rief ourney into the history of small'o( could only touch on information that -ould easily

fill multi'le oo)s* 0ome of the )ey 'oints uncovered -ereG

0mall'o( inoculation decreased the chance of death from small'o( for the individual, ut

-as a vector for s'readin small'o(*

Aaccination -as oriinally claimed to 'rovide com'lete immunity for life from small'o(,

ut later do-nraded to tem'orarily im'roved tolerance of small'o(*

Aaccine failure -as detected early on even -hen vaccinated y the inventor of

vaccination, d-ard enner* >eo'le still cauht small'o( and even died*

Aaccinated 'eo'le also died of small'o( althouh at times it -as elieved at less of a rate

than -hen small'o( -as ac5, Frederic) /* uen, M#, lias =rutyn, M#, and * #onald Millar, M#, #">5,!#eaths =ttriutale to 0mall'o( Aaccination,

19;9 to 1966, and 1968,$"he ournal of the =merican Medical =ssociation, ='ril 7, Aol* 1, ?o* , 19%7, '* 444



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deadly disease* "hese facts clearly sho-that vaccination -as not -hat caused the defeat of

small'o( at the end of the 1877s into the 1977s as is enerally elieved*

5o-ever, the stron faith in vaccination caused the overnments of the time to institute strict

com'ulsory la-s to ensure a hih com'liance rate in the 'o'ulation* =fter the 18%

'andemic,more 'eo'le lost confidence in vaccination, and they ean elievin in the ideas of

sanitation, hyiene, etter livin, and isolation as the -ay to deal -ith small'o(* "heir elief

-ould clash -ith the medical 'rofession and overnmental la-s, culminatin in a lare

demonstration in 188; aainst com'ulsory vaccination in the small manufacturin to-n of

/eicester nland*



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NOTES:

HISTORY:

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05 Smallpox and the First Vaccine 4

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