Smallpox

Smallpox was among the most feared infectious diseases in human history. Caused by the variola virus, it killed roughly one in six people who contracted it naturally, left survivors scarred and sometimes blinded, and struck with particular severity in populations encountering it for the first time. The response to smallpox produced two of the most important developments in the history of preventive medicine: variolation (deliberate inoculation with smallpox matter to produce a mild case) and vaccination (inoculation with cowpox matter to confer immunity without the risks of smallpox itself). Both practices were rooted in empirical observation rather than scientific theory, and both were widely used long before any understanding of the biological mechanisms involved. The disease was declared eradicated by the World Health Organization in 1980 — the first and so far only infectious disease to be eliminated from human populations.

The Disease

Bazin places smallpox’s historical entry into the Mediterranean world in the 8th century, carried westward during the Moorish invasion of Spain from Arabia, where the disease had been recorded since AD 572.(Bazin, 2000) The Persian physician Rhazes provided the first clinical description around AD 900, and the first English mention appears in 1366 in a chronicle recording “also manie died of the Small Pocks, both men, women, and children.”(Bazin, 2000) The longevity of Rhazes’s treatise is remarkable: when an English translation appeared in 1747, Dr Mead wrote the preface and called Rhazes “the greatest physician of the age he lived in,” a judgement that shows the treatise was still considered important clinical reading more than eight centuries after its composition; Rhazes had classified measles, which he distinguished from smallpox, as arising from bilious blood and producing states of nausea and anxiety.(Stapley, 2024) Bazin estimated pre-Jennerian mortality at between one-quarter and one-third of those who contracted it during normal epidemics, with at least one person in ten dying overall when newborns were included.(Bazin, 2000)

Smallpox presented as a severe febrile illness with a characteristic pustular eruption. William Heberden, writing from decades of direct clinical observation in the late eighteenth century, noted that a person who had never had the disease could safely share a bed with a variolous patient during the first two or three days of the eruption without danger of infection — the disease became communicable only around the sixth day after its height.(Heberden, 1802) He identified an excruciating pain in the loins as an infallible prognostic sign that a severe case would follow, with the violence of the pain proportional to the danger; pain between the shoulders was safer, and no back pain safest of all.(Heberden, 1802)

The mortality varied considerably by era, population, and type of exposure. During the first eight years of inoculation practice in Britain (1721—1729), it was calculated that of all those who contracted smallpox naturally, about one in six died, while the mortality from deliberate inoculation was approximately one in fifty-three.(Crookshank, Edgar M., 1889)

Smallpox and the Conquest of the Americas

Smallpox played a role in the European conquest of the Americas that no army could have achieved alone. The case mortality of approximately 30 percent in unvaccinated populations (Alfred W. Crosby, 1972) tells only part of the story; in populations with no prior exposure whatsoever, the disease struck with far greater severity. In late 1518 or early 1519, smallpox arrived among the Indians of Santo Domingo from Castile. It killed one-third to one-half of the indigenous population; it touched few Spaniards, and none of them died (Alfred W. Crosby, 1972). The same differential mortality repeated across the hemisphere. Between 1520 and 1600, Mexico suffered some fourteen major epidemics and Peru perhaps seventeen, representing a sustained biological catastrophe without precedent in recorded history (Alfred W. Crosby, 1972). For the broader ecological context of this exchange, see The Columbian Exchange.

Global Inoculation Practices

The practice of deliberately inducing a mild case of smallpox to prevent a fatal one was of great antiquity and had no single identifiable origin.(Crookshank, Edgar M., 1889) It derived from non-European practices in West Africa and the Ottoman Empire, and despite government support for inoculation programmes around the Western world from the 1720s onwards, the execution of this prophylactic measure was resisted in many areas, so that inoculation sometimes had to be forcibly imposed.(Jackson (ed.), 2011) It was practiced across Circassia, the Ottoman Empire, India, China, Africa, and the Americas before being formally introduced to European medicine.

Circassia. In Circassia, inoculation was performed by elderly women who used three needles fastened together to scarify five sites on the body — the pit of the stomach, over the heart, the navel, the right wrist, and the left ankle. They applied variolous matter from a person with a mild case, covered the sites with dried angelica leaves, then wrapped them in lambskin. The patient was put on a regimen of cumin-flour pap mixed with sheep’s milk, and given a tisane of angelica, bugloss roots, and liquorice.(Crookshank, Edgar M., 1889)

The Ottoman Empire. Emanuel Timoni communicated a description of Turkish inoculation practice to the Royal Society in 1714, reporting that of fifty persons inoculated, none had died, whereas natural smallpox killed about half of those infected in that epidemic season.(Crookshank, Edgar M., 1889)

India. Inoculation was performed annually by specialized Brahmin castes who traveled circuits through the countryside. They used year-old variolous matter preserved on cotton pledgets — never fresh matter and never matter from naturally acquired disease. This was combined with a cold-water dousing regimen and open-air convalescence.(Crookshank, Edgar M., 1889)

China. The Chinese method differed fundamentally from the scarification techniques used elsewhere. Practitioners performed insufflation — they blew powdered dried pustule scales, wrapped in cotton with a small portion of musk, into the patient’s nostril. Woodville argued that this method probably produced natural smallpox via inhalation rather than the milder inoculated form, which may account for its reported higher failure rate.(Crookshank, Edgar M., 1889)

The Arab world. In Syria, Palestine, and Arabia, practitioners made needle punctures with variolous matter, employed no preparatory regimen, and called the practice “buying the smallpox” because the child to be inoculated brought sweets to exchange for the pustular matter.(Crookshank, Edgar M., 1889)

Africa and the Americas. Zabdiel Boylston, encouraged by Cotton Mather (who had learned of inoculation from an enslaved African man named Onesimus), inoculated 244 persons in Boston during the 1721 epidemic. Six died, though Boylston attributed the deaths to other causes.(Crookshank, Edgar M., 1889)

Folk practice in Britain. Before inoculation was formally introduced to England, it was already practiced informally. In Pembrokeshire, Wales, the inhabitants had carried on a custom of self-inoculation with variolous matter from time immemorial.(Crookshank, Edgar M., 1889) In the Scottish Highlands, parents tied worsted threads wet with variolous matter around their children’s wrists, or had them share beds with mildly infected children.(Crookshank, Edgar M., 1889)

The English Introduction

The formal introduction of inoculation to England came through Lady Mary Wortley Montagu, who observed the practice in Adrianople in 1717 while her husband served as ambassador to the Ottoman court. She had her son inoculated there, and her daughter was inoculated in England in April 1721 — the first openly performed British case.(Crookshank, Edgar M., 1889)

The practice faced immediate opposition. An anonymous pamphlet described it as the product of atheism, quackery, and avarice. The Reverend Mr. Massey condemned it in a sermon as sinful. Dr. Wagstaffe of St. Bartholomew’s Hospital declared that posterity would marvel at a practice employed by ignorant women among an illiterate people being adopted by one of the politest nations in the world.(Crookshank, Edgar M., 1889)

Maitland’s 1721 inoculation of Newgate prison volunteers under Royal Society observation was the first formally observed British trial.(Crookshank, Edgar M., 1889) James Jurin — an ardent Newtonian who served as secretary of the Royal Society — used statistical analysis to conclude that natural smallpox killed one in fourteen children, while inoculation with selected subjects killed only one in ninety-one.(Crookshank, Edgar M., 1889) Porter notes the significance of Jurin’s Newtonian affiliation: it was the Newtonian physician who “clinched the statistical case for smallpox inoculation,” linking the methodological commitments of the mechanical philosophy directly to preventive medicine.(Porter, 2000) This was not a coincidence but a philosophical alignment: the same quantitative approach that had produced Newton’s laws of motion was being applied to questions of population health.

A persistent problem was that inoculated persons could transmit natural smallpox to others. After inoculating the Batt child in 1721, Maitland recorded that six domestic servants who had hugged and caressed the child during the eruption all contracted natural smallpox.(Crookshank, Edgar M., 1889) Haygarth demonstrated that variolation itself had helped spread the disease, introducing smallpox into towns that had been free of it for years and creating new epidemics.(Crookshank, Edgar M., 1889)

France prohibited inoculation in Paris in 1763 when a fatal smallpox outbreak was blamed on the practice, then reinstated it in 1768 after the faculties of medicine and theology approved it.(Crookshank, Edgar M., 1889) Russia did not adopt inoculation until 1768, when John Dimsdale was summoned to St. Petersburg to inoculate the Empress Catherine II.(Crookshank, Edgar M., 1889)

The Suttonian system, developed by the Sutton family of inoculators in England, refined the practice considerably. It required a two-week preparatory regimen excluding animal food and fermented liquors, used fresh pre-eruptive matter rather than mature pustular fluid, and gave patients cold air and exercise during convalescence. About 17,000 persons were reportedly inoculated under this system with only five or six deaths.(Crookshank, Edgar M., 1889)

Haygarth argued in 1784 that smallpox was caused solely by infection and never by climate, soil, or season, anticipating the germ theory approach to infectious disease control by nearly a century.(Crookshank, Edgar M., 1889) He provided epidemiological evidence from Chester showing that smallpox spread by contact along streets and through social networks rather than uniformly through the air as miasmatic theory predicted.(Crookshank, Edgar M., 1889)

Jenner and Vaccination

The transition from variolation to vaccination rested on the observation that people who had contracted cowpox — a disease of cattle that occasionally infected milkers — appeared to be immune to smallpox. Crookshank argued that this folk tradition arose specifically from the failure of variolation to take in persons who had recently contracted cowpox, not from ancient knowledge predating inoculation. In parts of the country where inoculation was uncommon, the tradition was unknown even among people familiar with cowpox.(Crookshank, Edgar M., 1889)

Benjamin Jesty, a farmer of Yetminster in Dorset, deliberately inoculated his wife and two sons with fresh cowpox matter from infected cows in the spring of 1774 — twenty-two years before Jenner’s first experiment.(Crookshank, Edgar M., 1889) Crookshank documented Jesty’s case from a portrait at the Royal Jennerian Society, noting that he had first acted from his own knowledge that cowpox in his own person and in others conferred insusceptibility to smallpox, and that subsequent trials confirmed the same in his wife and sons.(Crookshank, Edgar M., 1889) Fifteen years later, in 1789, his sons were challenged by inoculation with variolous matter alongside unvaccinated children: the vaccinated sons showed only local inflammation and no fever, while the unvaccinated children went through the full course of inoculated smallpox.(Crookshank, Edgar M., 1889) Jenner dismissed Jesty’s prior vaccination as an invention of George Pearson designed to deprive him of credit, and Baron’s biography of Jenner virtually ignored Jesty’s documented vaccinations.(Crookshank, Edgar M., 1889)

Multiple other practitioners had independently tested cowpox inoculation before Jenner. Mr. Nash documented around 1781 that of approximately sixty persons who reported having had cowpox, about forty could not be infected with variolous matter — the earliest known statistical record of cowpox immunity.(Crookshank, Edgar M., 1889)

As early as 1780, Jenner had articulated to his friend Edward Gardner the hypothesis that cowpox derived from horsepox (“the grease”), along with his hope of disseminating the practice “all over the globe, to the total extinction of Small Pox” — but he kept these ideas private for years, fearing ridicule if his experiments failed.(Crookshank, Edgar M., 1889) Jenner’s own childhood experience of variolation — six weeks of preparatory bleeding, purging, and low diet followed by confinement in an inoculation stable in a terrible state of disease — may have motivated his later work.(Crookshank, Edgar M., 1889) On 14 May 1796, he inoculated the eight-year-old James Phipps with cowpox matter from a dairymaid’s sore. The boy was mildly ill on days seven through nine and well on day ten.(Crookshank, Edgar M., 1889) Less than seven weeks later, on 1 July 1796, Jenner challenged Phipps with variolous matter; no disease followed.(Crookshank, Edgar M., 1889)

Porter identifies Jenner’s vaccination as the one eighteenth-century improvement in practical medicine that decisively saved lives on a large scale.(Porter, 1997)

The Balmis-Salvany Expedition (1803)

The global distribution of the Jennerian vaccine required solving an urgent logistical problem: no means existed to preserve the vaccine material during long sea voyages. The solution was biological. In 1803, Charles IV, the Bourbon King of Spain — having lost a child to smallpox — sponsored an expedition throughout the Spanish Empire led by Francisco Xavier de Balmis. Because the vaccine could not be stored, it was administered live, carried arm-to-arm in the bodies of twenty-one Spanish orphans, each vaccinated in succession to maintain the material alive for the duration of the voyage.(Jackson (ed.), 2011) The expedition reached Spain’s American colonies, the Philippines, and China, distributing vaccine across the Spanish colonial world in one of the earliest organized global public health campaigns.

Crookshank’s Critique

Edgar Crookshank, Professor of Comparative Pathology and Bacteriology at King’s College London, published his History and Pathology of Vaccination in 1889 after conducting an independent investigation prompted by an 1887 cowpox outbreak in which he proved that the cows had not been infected by milkers suffering from smallpox, contradicting the commonly accepted doctrine.(Crookshank, Edgar M., 1889)

Crookshank made several findings that complicated the standard Jenner narrative. He discovered at the Royal College of Surgeons Library a manuscript that was Jenner’s original Communication to the Royal Society — the paper that had been rejected before Jenner published his Inquiry — which differed substantially from the published version.(Crookshank, Edgar M., 1889) (Crookshank, Edgar M., 1889) Jenner’s original manuscript had opened with the hypothesis that cowpox derived from horsepox (“the grease”), and presented only ten cowpox cases as evidence, all selected as instances where smallpox inoculation had failed to take.(Crookshank, Edgar M., 1889)(Crookshank, Edgar M., 1889) No cases of successful re-inoculation after cowpox were included, and no allowance was made for individual insusceptibility to smallpox.(Crookshank, Edgar M., 1889)

Jenner’s three horsepox (“grease”) cases showed contradictory results: one subject resisted smallpox inoculation, another had eruptions, and a third contracted natural smallpox.(Crookshank, Edgar M., 1889) William Smith’s case — cowpox contracted in 1780, 1791, and 1794 with equal severity each time — directly contradicted the theory that a single attack conferred lasting immunity, yet Jenner included the case without explanation.(Crookshank, Edgar M., 1889)

Crookshank also argued that Jenner classified vaccination failures as caused by “spurious” rather than “genuine” cowpox, creating a distinction that allowed him to explain away any contradictory result.(Crookshank, Edgar M., 1889) Woodville had been appointed physician to the Smallpox Hospital at St Pancras in 1791, where he established a botanical garden in two of the hospital’s four acres at his own expense and began publishing his four-volume Medical Botany in 1790, a work that became a standard reference for over fifty years.(Stapley, 2024) After Jenner’s initial publication, Woodville at the Smallpox Hospital vaccinated extensively but in a variolous atmosphere, producing cases where cowpox and smallpox occurred simultaneously. Jenner blamed the generalized eruptions on contamination with variolous matter.(Crookshank, Edgar M., 1889)

Crookshank found that practitioners at the National Vaccine Establishment in the 1880s had no precise knowledge of the history or pathology of the diseases from which their lymph stocks had been obtained, being entirely occupied with vaccination technique.(Crookshank, Edgar M., 1889)

The Nineteenth Century

Heberden observed that inoculation did not always secure patients from subsequently contracting smallpox, particularly when the initial eruption was imperfect. He described a case of full smallpox appearing ten years after inoculation.(Heberden, 1802) This problem of incomplete or waning immunity would persist as a concern throughout the history of vaccination.

Jenner’s Parliamentary grants — the first of 10,000 pounds — and the institutional establishment of vaccination stations across Britain and Europe marked the beginning of systematic state-supported preventive medicine.(Crookshank, Edgar M., 1889) Vaccination gradually replaced variolation as the standard preventive measure, and compulsory or obligatory vaccination was adopted across Europe and beyond with notable speed. Napoleon decreed in 1809 that vaccine depots be established in all large cities of the French Empire, and obligatory vaccination sessions were applied even to prisoners.(Bazin, 2000) Denmark enacted compulsory vaccination in 1810, Norway followed in 1811, and Sweden made vaccination obligatory in 1816.(Bazin, 2000) In England, Parliament passed the Vaccination Act in 1853, making vaccination compulsory — though John Simon, writing from inside the public health apparatus, observed bluntly that the legislation had been enacted without any requirement that public vaccinators should actually know how to vaccinate.(John Simon, 1890) A nationwide survey of all 3,500 vaccination districts, conducted by Simon’s department between 1860 and 1864, supplied the evidence base for the 1867 Vaccination Amendment Act, which tightened enforcement mechanisms.(John Simon, 1890) Japan made Jennerian vaccination obligatory in 1885, requiring revaccination at five- and seven-year intervals.(Bazin, 2000) The pattern across these jurisdictions was broadly consistent: compulsory vaccination followed quickly on the establishment of national supply and distribution systems, and the opposition it generated — on grounds of bodily autonomy, medical skepticism, and class resentment of state coercion — was proportionally intense.

Farr’s Epidemic Modeling and Competing-Risks Analysis

William Farr brought statistical precision to the analysis of smallpox epidemics and their relationship to other causes of death in ways that have not been fully appreciated. On the mathematical structure of epidemics, Farr proposed that smallpox increases at an accelerated and then a retarded rate, and that it declines first at a slightly accelerated rate, then at a rapidly accelerated rate, and lastly at a retarded rate, until the disease attains minimum intensity and remains stationary.(Farr, William (Humphreys, Noel A., ed.), 1885) He modeled this progression using calculated series based on quarterly mortality rates divided by mid-quarter population, providing one of the earliest mathematical frameworks for epidemic curves. The accelerating-then-decelerating pattern Farr described is now recognized as the basic shape of an epidemic wave.

Farr’s disease-classification statistics revealed the competitive relationship between smallpox and other zymotic diseases with unusual clarity. After diphtheria was first distinguished in English registration returns in 1855, Farr tracked the subsequent shifts in mortality: deaths from scarlatina and diphtheria together were 30,317 and 29,494 in 1858-59, rising to 36,982 and 35,164 in 1863-64, while smallpox mortality fell from 3.35 per 10,000 in 1858 to 2.93 in 1863.(Farr, William (Humphreys, Noel A., ed.), 1885) The scarlatina and diphtheria mortality of 15.72 and 15.13 per 10,000 in 1858-59 dwarfed the smallpox rate, providing quantitative context for the relative public health burden of the major childhood diseases in the vaccination era.

Duvillard had calculated that vaccination against smallpox would add 3.5 years to mean lifetime — an early quantitative estimate of the population-level demographic benefit of the intervention that Farr cited in his life table analysis, translating clinical prevention into the language of actuarial demography.(Farr, William (Humphreys, Noel A., ed.), 1885)

Farr also used smallpox as the central example for his theory of epidemic disease mechanism. He proposed that each zymotic disease is generated by species of living molecules, which he called “biads” (from the Greek bios), of a twofold nature analogous to the germ and sperm plasms of plants and animals. The biad theory drew explicitly on Darwin’s Pangenesis hypothesis and explained why a single attack of smallpox conferred lasting immunity: the proliferous coalescence that produced the disease simultaneously exhausted the substrate necessary for renewed attack.(Farr, William (Humphreys, Noel A., ed.), 1885)

George Pearson independently investigated cowpox immunity in 1798, producing a competing volume within six months of Jenner’s Inquiry and creating the first of many priority disputes that would surround vaccination.(Crookshank, Edgar M., 1889)

Global Eradication

The campaign to eradicate smallpox was formally authorised by the XIIth World Health Assembly in May 1959, with the Soviet Union’s Minister of Health Viktor Zhdanov among its most committed advocates; the USSR donated up to 140 million vaccine doses annually once the intensive phase began in 1967.(Bazin, 2000) The campaign introduced a critical technological innovation: the bifurcated needle, developed by Wyeth Laboratories in the 1960s, which retained a single dose of vaccine between its prongs and could be reused after sterilisation up to 200 times. Wyeth waived patent charges for the design.(Bazin, 2000)

India presented the most formidable challenge. In most years the country accounted for more than half of all smallpox cases worldwide; at the peak incidence in 1953 there were 253,332 recorded cases. The eradication effort mobilised up to 152,000 Indian health workers alongside 230 WHO personnel from 30 countries, systematically visiting every village and every house multiple times. Cases fell to 1,436 in 1975 and to zero in 1976.(Bazin, 2000)

Bazin identifies the biological features that made smallpox an eradicable disease: it was a single stable virus with no animal reservoir, produced a clinically distinctive presentation that could be diagnosed without laboratory equipment, had no healthy carriers or latent infections, conferred long immunity after natural infection, and could be prevented by an inexpensive vaccine that was straightforward to manufacture and distribute.(Bazin, 2000) Most pathogens lack several of these properties simultaneously, which is why smallpox eradication has not been replicated for other diseases.

The last naturally occurring case was Ali Maow Maalin, a 23-year-old hospital cook in Merca, Somalia, whose rash onset was confirmed on 26 October 1977; he had not been vaccinated.(Bazin, 2000) WHO solemnly declared global eradication on 9 December 1979, and the formal certification ceremony was held during the Eighth Plenary Meeting of the World Health Assembly on 8 May 1980.(Bazin, 2000) The total cost of the eradication campaign was 312 million dollars — compared to the 200 million dollars that traditional disease-control measures would have cost over the same period with far less effect.(Bazin, 2000)

The post-eradication period introduced a different set of dangers. On 27 August 1978, Janet Parker, a 40-year-old photographer at the University of Birmingham, was confirmed as having contracted smallpox from a virology laboratory one floor below her workplace. She died on 11 September 1978. Her department head, Professor Henry Bedson, attempted suicide on 2 September, leaving a note expressing his sense of responsibility, and died five days later.(Bazin, 2000) The incident accelerated the consolidation of all surviving smallpox virus stocks: by the time Bazin was writing, all approximately 600 known stocks from around the world had been deposited in two repositories — the CDC in Atlanta and the Research Institute for Viral Preparations in Moscow (later moved to the Russian State Research Centre of Virology and Biotechnology in Koltovo, Siberia). In May 1999 the Clinton administration decided not to proceed with the planned destruction of the US stockpile.(Bazin, 2000)

The Politics of Eradication

The dominant historiography of smallpox eradication privileges the voices of senior WHO officials and neglects the diverse local, regional, and national actors who shaped the programme; Sanjoy Bhattacharya has argued that narrowly heroic accounts obscure the complex political negotiations that made eradication possible.(Jackson (ed.), 2011) Most rich industrialized nations had already eradicated smallpox within their own territories through vaccination, isolation, and surveillance regimes, leading their leaders to question whether it was necessary or prudent to finance a worldwide programme.(Jackson (ed.), 2011) The WHO smallpox eradication unit struggled in 1967-68 to identify adequate producers and stocks of freeze-dried vaccine for the anticipated needs of a global campaign.(Jackson (ed.), 2011)

Incidents of smallpox importation into Europe proved strategically valuable for WHO negotiators, allowing them to argue that no part of the globe was safe from variola as long as the disease persisted anywhere.(Jackson (ed.), 2011) D. A. Henderson used the threat of such importations to persuade reluctant donor nations such as SIDA to fund the programme, explicitly linking financial arguments to security fears.(Jackson (ed.), 2011) The WHO’s World Health Day celebrations of 1966 were similarly mobilized to raise awareness about smallpox dangers and highlight the long-term financial benefits of global eradication.(Jackson (ed.), 2011) Indian federal authorities demanded that WHO meet 50 percent or more of campaign expenses as the price for retaining India in the programme during 1967-68.(Jackson (ed.), 2011) An unexpected outbreak of smallpox in Bihar in 1974 threatened to destroy all gains of past years and required emergency funding from SIDA to sustain the programme at a critical juncture.(Jackson (ed.), 2011)

An additional complication was the uncertain viral identity of the vaccine material itself. Bazin notes that the four vaccine strains most widely used during the WHO eradication campaign — the Lister Institute strain, the New York City Board of Health (Wyeth) strain, the Temple of Heaven strain used in China, and the Patwadanger strain used in India — could not be traced to their precise origins and were distinct from both the smallpox virus and cowpox.(Bazin, 2000) The “vaccine virus” had become a separate entity from either of its putative parent organisms through decades of passage through human arms and, later, animal hosts.

Nature Cure Opposition to Vaccination

The Nature Cure movement, represented most systematically by Henry Lindlahr, offered a sustained alternative theory of smallpox causation and prevention that stood in direct opposition to the germ-theory rationale for vaccination. Lindlahr’s central claim was that vaccination perpetuated rather than eliminated smallpox: by keeping the vaccine virus alive in an unbroken chain of transmission from one living being to another, mandatory inoculation programmes maintained a reservoir that sanitation alone would have allowed to die out (Lindlahr, Henry, 1918). He cited as supporting evidence the decline of other epidemic diseases — plague, black death, leprosy, typhoid fever, scarlet fever, diphtheria — that had never been vaccinated against, attributing their reduction entirely to improved sanitary conditions. He also invoked the authority of Prince Bismarck, who had stated in 1888 that “the hopes which were placed in vaccination have proved entirely deceptive” and that it had “completely failed” to banish smallpox from Germany (Lindlahr, Henry, 1918).

Lindlahr’s own clinical record entered the argument directly. He reported that his son contracted smallpox despite prior vaccination, that the attack was severe, and that treatment consisting of fasting and wet packs produced complete recovery without any scarring (Lindlahr, Henry, 1918). He cited multiple similar cases as evidence that natural treatment was superior to what he regarded as suppressive allopathic intervention. These accounts cannot be independently verified. The claims about Bismarck are a partial quotation from a contested speech; contemporary historians of vaccination note that Germany’s compulsory vaccination laws were associated with substantial reductions in smallpox mortality through the second half of the nineteenth century. Lindlahr’s anti-vaccination arguments belong to the historical record of the late-sanitarian critique that preceded the germ-theory consolidation of preventive medicine, and they are documented here as part of the intellectual context in which the case for vaccination was historically contested.

See Also

• edward-jenner
• vaccination
• variolation
• contagion
• public-health
• germ-theory
• preventive-medicine
• The Columbian Exchange
• epidemic-disease

Sources

• Bazin, H. (2000). The Eradication of Smallpox. Academic Press. (source_id: bazin-eradication-of-smallpox-2000)
• Crosby, A.W. (1972). The Columbian Exchange. Westport: Greenwood Press. (source_id: crosby-columbianexchange-1972)
• Simon, John. (1890). English Sanitary Institutions. London: Cassell. (source_id: simon-englishsanitaryinstitutions-1890)