Eradicating Smallpox

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A viral infection, smallpox spread along trade routes in Africa, Asia, and Europe, reaching the Americas in the 16th century. Because smallpox requires a human host to survive, it smoldered in densely populated areas, erupting in a full-blown epidemic every ten years or so. Wherever it appeared, smallpox caused blindness, sterility, scarring, and death.

In Africa and Asia, smallpox was traditionally contained through variolation—deliberately infecting an individual with a controllable case of smallpox to confer lifelong immunity. Variolation spread from Asia and Africa into Europe and the Americas during the 18th century. This practice had its dangers, as recipients of variolation could develop a full-blown case of smallpox.

In 1798, the English physician Edward Jenner developed a safer technique: vaccination with cowpox (vacca is the Latin word for cow). He based his “discovery” on existing folk knowledge but provided scientific proof of its veracity by testing the vaccine on a young child.

In 1809, following Jenner’s published account of his success in using vaccination to prevent smallpox, the town of Milton, Massachusetts, offered free vaccination to all its inhabitants. Over three hundred persons were inoculated during a three-day campaign in July. The town leaders then took the daring step of holding a public demonstration to prove without a doubt that cowpox vaccine offered protection from smallpox. In October, twelve children, selected from those vaccinated in July, were inoculated with fresh, virulent smallpox matter. Fifteen days later, they were discharged with no sign of smallpox infection. The experiment’s success led Miltonians to declare “He is Slain,” presaging the idea of “slaying” smallpox permanently.

 

Smallpox Card
Smallpox Card

Card commemorating a test of the effectiveness of vaccination on twelve children in Milton, Massachusetts, 1809.

During the mid-19th century, states began to mandate vaccination for schoolchildren. In response, instrument makers developed and patented a variety of ingenious vaccinators. Many of these instruments used a trigger mechanism; health care providers squeezed the trigger, releasing the needle and vaccine. Physicians, who earned a small fee for vaccinating, also performed arm-to-arm vaccination, scraping pus from a vaccinated arm to use on another patient.

Smallox Vaccinators
Smallox Vaccinators

John Zirbes' Vaccinator Patent Model, 1872. W. Gordon Automatic Vaccinating Instrument Patent Model, ca 1857.

After the Civil War, arm-to-arm vaccination became less common. Instead, cowpox was often harvested directly from cows and dried on ivory points such as these. Physicians used ivory points and might carry vaccine in a scab carrier like this one that belonged to a physician in Baltimore.

Ivory Points
Scab Carrier

Wooden box of ivory points, used for largescale smallpox vaccination. Vaccination scab carrier, Dr. F. E. Chatard, ca 1826-1888. Dr. F. E. Chatard of Baltimore used this small gold case to carry the scabs used to vaccinate his patients against smallpox. The interior contains wax to keep the scab moist. The scab provided the virus material that was used during the inoculation.

As the threat of smallpox receded, people sometimes became complacent and vaccination rates declined. When this occurred, smallpox epidemics often emerged, with the result that entire communities then rushed to be vaccinated. The last smallpox outbreak in the United States occurred in New York City in 1947. Public health experts arrested the outbreak in a matter of a few weeks with only two deaths, thanks to their moving quickly to vaccinate nearly 6 million New Yorkers.

Although smallpox had not yet been “slain,” as the citizens of Milton had so confidently proclaimed in 1809, the disease was on its deathbed by the mid-20th century. In 1958, the World Health Organization committed to eradicating the disease worldwide.

D. A. Henderson, a lead epidemiologist associated with the WHO smallpox eradication campaign, donated many of the objects he collected during the campaign to the National Museum of American History.

Among these objects are smallpox deities from the Indian subcontinent and the Yoruba people of Nigeria. Shapona, the Yoruba god, nurtured humans, giving them the grains that sustained life, but he also used smallpox (which caused granular pustules) to punish people. Henderson and other public health experts received these statues at a WHO conference. Sheetala (Śītalā), the smallpox goddess from the Indian subcontinent, used smallpox to chastise humans when they refused to worship her. When humans agreed to acknowledge her, she healed smallpox sufferers and even resuscitated those who had died.

Image of Shapona Deity
Image of Sheetala

Left, Sopona, God of Smallpox. Right, Shitala Mata, Goddess of Smallpox.

Ethiopian Poster
Smallpox ID Card

World Health Organization vaccination campaign poster, 1966 - 1977. World Health Organization smallpox identification field card, 1966 - 1977. Epidemiologists used cards such as these to help identify cases of smallpox

Bi-furcated needles were incredibly easy to use and required less vaccine than other methods of vaccination. Best of all, these needles could be sterilized and re-used. Wyeth Laboratories, which had developed the bi-furcated needle, waived their royalties.

Bifurcated needles

Bifurcated needles, 1965–1977

In 1967, WHO workers vaccinated 25 million people but many people in susceptible areas remained unvaccinated. Eradication Escalation (E2) now focused on containing smallpox outbreaks during October, the natural seasonal low point of smallpox transmission. Prevention of just one case during this period could permanently destroy a smallpox chain. E2’s success in breaking smallpox chains made eradication possible.

In 1980, the WHO proclaimed, “Smallpox is dead!” During the early 2000s, fears that terrorists might seize samples of the smallpox virus from a controlled laboratory and release it led the United States to reinvest in smallpox vaccine. These fears proved unfounded, and the replenished stocks of smallpox vaccine languished unused.

Smallpox vaccine, ca 1983

Smallpox vaccine, ca 1983, and bifurcated needles in sterile dispenser, ca 1983

Today, not only these vaccines but smallpox itself has been relegated to history.

This small gold case has ornate chasing upon its hinged lid. The bottom half of the case is filled with wax.
Description (Brief)
This small gold case has ornate chasing upon its hinged lid. The bottom half of the case is filled with wax. It is a decorative scab carrier - a scab containing vaccinia virus would have been set upon or within the wax, which, along with the tightly closed case, would have kept the scab moist and fresh. The fresh scab could then be easily carried by a doctor who used it when performing vaccination against smallpox.
The engraved inscription on the lid of the case on reads "Dr. F. E. Chatard." Ferdinand Edme Chatard was born August 3,1805 and died October 18, 1888. He had a general practice in Baltimore and specialized in obstetrics. Chatard received a degree in medicine in 1826 from the University of Maryland. He later studied in France for three years. F.E. Chatard's father had been a physician, as well.
Location
Currently not on view
date made
1826-1888
ID Number
MG.302606.414
accession number
302606
catalog number
302606.414
Thirty-five years have passed since the 33rd World Health Assembly declared the world free of smallpox, an infectious disease that had plagued humankind for most of written history.
Description
Thirty-five years have passed since the 33rd World Health Assembly declared the world free of smallpox, an infectious disease that had plagued humankind for most of written history. This momentous achievement was the result of a massive global eradication campaign begun in the late 1960s, but its real beginnings can be traced back much further—to a medical discovery made in the English countryside, which spread across the Atlantic and to the small towns of the new republic. This commemorative vaccination card is a small piece of evidence of this long and rich history.
This unassuming 3 x 5 inch card in the collections at the National Museum of American History attests to a remarkable event that took place over two hundred years ago in a small town outside Boston. On October 25, 1809, in Milton, Massachusetts, twelve children were released from quarantine after fifteen days of close observation for any sign of smallpox infection. This may not sound unusual for a time when smallpox epidemics were a part of life, but these children had been purposefully inoculated with virulent smallpox matter in order to make a public test of a new medical discovery—vaccination.
The discovery had been made over a decade earlier by Edward Jenner, a country doctor in Gloucester, England. In 1798 he published a pamphlet entitled An Inquiry into the Causes and Effects of the Variolae vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox. The booklet described his successful experiments using inoculation with cowpox to provide protection from the more serious disease smallpox. Jenner's method was named "vaccination," referring to the medical term for cowpox, Variolae vaccinae, and the Latin vacca, meaning "cow." Vaccination provided a potentially much safer alternative to the older practice of variolation, in which immunity was conferred by deliberately infecting a person with a small dose of smallpox.
As word of the vaccine's effectiveness spread, Jenner supplied cowpox vaccine matter to doctors throughout England. In 1800 vaccine material reached the United States through Benjamin Waterhouse, a professor at Harvard Medical School. Acceptance of vaccination did not come easily, and many members of the medical profession and the church opposed a method that introduced an animal disease into humans. In 1802 Waterhouse felt obliged to extol the virtues of the cow in an attempt to persuade the Boston Board of Health to set aside its objections to the "contemptible origin" of the vaccine. "The earth maintains not a more clean, placid, healthy, and useful animal than the Cow," he appealed. "She is peculiarly the poor man's riches and support. From her is drawn, night and morning, the food for his ruddy children; […] every part of her has its particular uses in commerce and medicine. On these accounts she is an [sic] useful, though invisible wheel in the great machine of state."
Whatever their attitudes toward cows may have been, in 1809 the citizens of the town of Milton, Massachusetts, became part of the first municipal effort in the United States to offer free vaccination to all inhabitants. Over three hundred persons were inoculated during a three-day campaign in July. Following this program, the town leaders took an unusual step—they decided to hold a public demonstration to prove without a doubt that cowpox vaccine offered protection from smallpox. On October 9, 1809, twelve children, selected from those vaccinated in July, were inoculated with fresh, virulent smallpox matter by Dr. Amos Holbrook and witnessed by eighteen town members. The children were confined to a single home for fifteen days and on October 25 were discharged with no sign of smallpox infection.
Each child received a personalized certificate pronouncing them a living testament to the "never failing power of the mild preventative the Cow Pox," "a blessing great as it is singular in its kind." Several other small certificates were produced to commemorate this remarkable demonstration, including the one now in the museum's collection. The names of the twelve children subjected to the vaccine test are inscribed on the back of the card:
"Joshua Briggs, Samuel Alden, Thomas Street Briggs, Benjamin Church Briggs, Martin Briggs, George Briggs, Charles Briggs, John Smith, Catharine Bent, Suzanna Bent, Ruth Porter Horton, Mary Ann Belcher"
Milton's councilmen published a detailed account of the vaccination experiment and sent a copy to the officers of every town in the state, as well as to Governor Christopher Gore, a proponent of vaccination. In 1810 the State of Massachusetts passed the Cow Pox Act directing every town, district, or plantation, within the Commonwealth, to provide for the vaccination of their inhabitants.
The world is now free of small pox—a remarkable global achievement that owes a small debt to the citizens in a little town in New England in the early years of our republic.
Front of card: He is slain. Milton 25th October 1809. The twelve children whose names are written on the back of this card were vaccinated by Doctr. Amos Holbrook at the town innoculation in July last. They were tested by smallpox inoculation on the 10th Inst. and discharged this day from the Hospital after offering to the world in the presence of most respectable witnesses who honored Milton with their attendance on that occassion, an additional proof of the never failing power of that mild preventative the Cowpock, against Smallpox infection. A blessing as great as it is singular in its kind, whereby the hearts of man ought to be eleveated in praise to the Allmighty Giver. (Signed) Oliver Houghton, Chairman of the Committee for Vaccination.
Back of card: Joshua Briggs, Samuel Alden, Thomas Street Briggs, Benjamin Church Briggs, Martin Briggs, George Briggs, Charles Briggs, John Smith, Catharine Bent, Susanna Bent, Ruth Porter Horton, Mary Ann Belcher
Location
Currently not on view
date made
1809
ID Number
2003.0176.01
accession number
2003.0176
catalog number
2003.0176.01
Currently not on view
Location
Currently not on view
date made
ca 1890 - 1920
ID Number
1997.0050.01
accession number
1997.0050
catalog number
1997.0050.01
Currently not on view (donkey figure)Currently not on view
Location
Currently not on view (donkey figure)
Currently not on view
ID Number
1985.0768.06
catalog number
1985.0768.06
accession number
1985.0768
Currently not on view
Location
Currently not on view
date made
ca 1899
expiration date
1899-08-01
maker
H. K. Mulford Company
ID Number
1978.0882.21
accession number
1978.0882
catalog number
1978.0882.21
An inscription on the cardboard package reads in part “DR.
Description
An inscription on the cardboard package reads in part “DR. WOOD’S / VACCINATION SHIELD” and “Manufactured by Johnson & Johnson / NEW BRUNSWICK, N.J., U.S.A.” Johnson & Johnson was established in 1886, and offering vaccination of shields of this sort by 1902
.
Ref: Fuller & Fuller Co., Drugs, Chemicals, Oils (Chicago, 1906-1907), p. 376.
Location
Currently not on view
date made
ca 1902 - 1911
maker
Johnson and Johnson
ID Number
MG.M-06942.02
catalog number
M-06942.02
accession number
214851
Currently not on view
Location
Currently not on view
maker
Eli Lilly & Company
ID Number
1985.0481.185
catalog number
1985.0481.185
accession number
1985.0481
1985.0481
Wooden box of ivory points used for smallpox vaccination.
Description
Wooden box of ivory points used for smallpox vaccination. These resemble the points used by Edward Jenner (1749-1823), the British physician who, in the 1790s, successfully tested the idea that an attack of cowpox, a milder form of smallpox, gave immunity to smallpox.
Location
Currently not on view
date made
ca 1870 - 1905
maker
unknown
ID Number
2017.0184.073
accession number
2017.0184
catalog number
2017.0184.073
Throughout the 19th century, vaccination became increasingly common and by the mid-20th century, smallpox was on the decline across the world. Yet even as it declined, smallpox lingered in less developed areas of the world.
Description
Throughout the 19th century, vaccination became increasingly common and by the mid-20th century, smallpox was on the decline across the world. Yet even as it declined, smallpox lingered in less developed areas of the world. Increased travel in the 1950s meant that the presence of smallpox even in remote areas presented a hazard to unvaccinated Americans and others who lived in countries which had successfully eradicated the disease.
Early estimates of the number of people who would need to be vaccinated to break the global chain of infection were in the range of 1.5 billion, with many of these people living in some of the most remote and inaccessible areas of the world. Mass vaccination would also require finding and training people to vaccinate others.
During the eight years of planning which preceded the launch of the smallpox eradication campaign, WHO leaders looked for an easy and cost-effective way to administer the vaccine. By the official start of the smallpox eradication campaign in 1967, the WHO had found the answer: the jet injector. Nicknamed "la pistola de la paz" in Nicaragua and "shanti ki handuk" in India, the jet injector was widely hailed as "the peace gun." A gun-like device that administered painless injections without needles, the injector was the brainchild of Robert Hingson, an American physician.
Hingson's device used a piston to propel the vaccine at a rapid speed into and under the skin—the vaccine moved so quickly and under such pressure that no needles were needed. Public health practitioners gleefully noted that this method of vaccination was so painless that it could be used on a sleeping baby. But best of all, the jet injector could hold 500 or more doses of vaccine, meaning that hundreds of doses could be delivered within an hour.
By the late 1950s, WHO officials had begun eyeing the jet injector, seeing it as the perfect mechanism for a mass vaccination campaign. But two problems remained before the jet injector could be used in the smallpox eradication campaign. First, the vaccines that had been administered with the jet injector were injected subcutaneously, that is under the skin. Smallpox vaccine, however, needed to be inserted intradermally, that is between the layers of skin. Second, developing a jet injector that could deliver the dose intradermally would only resolve part of the problem—jet injectors were powered by electricity, which made using them in remote areas impossible.
Aaron Ismach solved both of these problems, first by creating a special nozzle that delivered the vaccine intradermally and then by developing a pedal-operated and hydraulically powered model of the jet injector. Early in 1965, a pilot vaccine project was conducted in Brazil. Widely hailed as a success, this project proved not only that the jet injector could easily be used in the field but also that widespread use of the jet injector would require less manpower and cost significantly less than a campaign using conventional vaccination methods.
The "peace gun" played a crucial role in the early stages of the smallpox eradication program. Unfortunately, because wear and tear often damaged jet injectors, their use required WHO to maintain a staff that could care for these devices. As a result, jet injectors were used only in places like Brazil where the campaign was highly organized. In other areas, a bifurcated needle, which could be easily used and sterilized, delivered the vaccine.
As vaccinators crisscrossed the world using both the jet injector and the bifurcated needle, the WHO carefully tracked smallpox outbreaks and cases. In 1980, two years after the last case of smallpox had been documented, WHO officials proudly announced "Smallpox is Dead!" But smallpox was not truly dead. It was simply serving a life sentence, confined to a handful of government laboratories.
Location
Currently not on view
ID Number
2011.0130.01
accession number
2011.0130
catalog number
2011.0130.01
Harry K. Mulford, a Philadelphia pharmacist, opened a laboratory to produce diptheria antitoxin in 1894. This celluloid button advertises his patented “aseptic shield” that protected the open sore caused by a small pox vaccination.
Description
Harry K. Mulford, a Philadelphia pharmacist, opened a laboratory to produce diptheria antitoxin in 1894. This celluloid button advertises his patented “aseptic shield” that protected the open sore caused by a small pox vaccination. The text on the front reads "I AM VACCINATED WITH MULFORD’S VACCINE, ARE YOU?" A paper on the back reads “MULFORD’S / VACCINE / ALWAYS / TAKES. / MULFORD’S / ASEPTIC SHIELD / PREVENTS SORE ARMS / W. & H. Co. Patent...'94, April 14... / …"
Ref: Harry K. Mulford, “Vaccination Shield,” U.S. Patent 703,290 (June 24, 1902).
Location
Currently not on view
date made
ca 1902
maker
Whitehead & Hoag Company
H. K. Mulford Company
ID Number
2007.0201.01
catalog number
2007.0201.01
accession number
2007.0201
Currently not on view
Location
Currently not on view
date made
ca 1904 - 1917
maker
National Vaccine and Antitoxin Institute
ID Number
1978.0882.17
accession number
1978.0882
catalog number
1978.0882.17
Currently not on view
Location
Currently not on view
date made
ca 1962
expiration date
1936-05-03
maker
Wyeth Laboratories
ID Number
MG.M-10264
catalog number
M-10264
accession number
241519
The vaccinating lancet in this set, designed for giving smallpox vaccines by scarification, was devised by the Scottish physician, Thomas Graham Weir (1812-1896).
Description
The vaccinating lancet in this set, designed for giving smallpox vaccines by scarification, was devised by the Scottish physician, Thomas Graham Weir (1812-1896). According to a notice published in 1860, this instrument “has the merits of simplicity and convenience in a marked degree.” This was owned by Enoch T. Winter (d. 1871), a Yale graduate (class of 1845), and a physician in Harlem, N.Y.
Ref: Viator, Letter from Edinburgh, in The Boston Medical and Surgical Journal 62 (1860): 337-340, on 340.
Location
Currently not on view
date made
mid-1800s
used date
1845-1870
maker
George Tiemann and Company
ID Number
MG.M-02225
accession number
95819
catalog number
M-02225
Currently not on view
Location
Currently not on view
ID Number
1981.0786.05
accession number
1981.0786
catalog number
1981.0786.05
An inscription on this item reads “ALEXANDER’S ASEPTIC VACCINATOR / MARIETTA, PENN. / NEW YORK, CHICAGO, OMAHA.” H. M.
Description
An inscription on this item reads “ALEXANDER’S ASEPTIC VACCINATOR / MARIETTA, PENN. / NEW YORK, CHICAGO, OMAHA.” H. M. Alexander (1851-1903) was a graduate of Bucknell University and the University of Pennsylvania Medical School who, having become interested in smallpox, established the Lancaster County Vaccine Farm in Marietta, PA in 1882, and a second facility in Omaha in 1886.
Ref: William F. Burr, “The Marietta Vaccine Farms,” Medical and Surgical Reporter 75 (Oct. 17, 1896): 488-491.
“Dr. H. M. Alexander,” American Journal of Pharmacy 76 (Jan. 1904): 37-38.
Location
Currently not on view
maker
H. M. Alexander & Co.
ID Number
MG.M-07336
catalog number
M-07336
accession number
217731
Currently not on view
Location
Currently not on view
date made
1965 -1977
maker
Wyeth Laboratories
ID Number
1985.3109.100.2
catalog number
1985.3109.100.2
nonaccession number
1985.3109
Currently not on view
Location
Currently not on view
date made
1965-1978
patent date (for leakproof bottled liquid mailable container)
1965-08-03
ID Number
1985.0768.05
catalog number
1985.0768.05
accession number
1985.0768
patent number
3,198,374
Currently not on view
Location
Currently not on view
date made
ca 1920
maker
H. K. Mulford Company
ID Number
MG.M-00549
catalog number
M-00549
accession number
65614
Currently not on view
Location
Currently not on view
ID Number
2012.0165.380
accession number
2012.0165
catalog number
2012.0165.380
Steel vaccinator with “WHITTEMORE’S / PATENT / FEB. 20, 1866” and “MADE BY / CODMAN & SHURTLEFF / BOSTON” inscriptions. Amos Whittemore was an inventive machinist in Cambridge, Mass.Ref: Amos Whittemore, “Improvement in Vaccinators,” U.S. Patent 52,921 (Feb.
Description
Steel vaccinator with “WHITTEMORE’S / PATENT / FEB. 20, 1866” and “MADE BY / CODMAN & SHURTLEFF / BOSTON” inscriptions. Amos Whittemore was an inventive machinist in Cambridge, Mass.
Ref: Amos Whittemore, “Improvement in Vaccinators,” U.S. Patent 52,921 (Feb. 20, 1866).
Codman & Shurtleff, Illustrated Catalogue of Surgical Instruments (Boston, 1875), p. 84.
Location
Currently not on view
patent date
1866-02-21
maker
Codman & Shurtleff
ID Number
2012.0165.348
catalog number
2012.0165.348
accession number
2012.0165
An inscription on the cardboard package reads in part “DR.
Description
An inscription on the cardboard package reads in part “DR. WOOD’S / VACCINATION SHIELD” and “Manufactured by Johnson & Johnson / NEW BRUNSWICK, N.J., U.S.A.” Johnson & Johnson was established in 1886, and offering vaccination of shields of this sort by 1902.
Ref: Fuller & Fuller Co., Drugs, Chemicals, Oils (Chicago, 1906-1907), p. 376.
Location
Currently not on view
date made
ca 1902 - 1911
maker
Johnson and Johnson
ID Number
MG.M-06942.03
catalog number
M-06942.03
accession number
214851
catalog number
214851.50 DUP 1
Currently not on view
Location
Currently not on view
printer
Franklin Printing
ID Number
1981.0786.03
accession number
1981.0786
catalog number
1981.0786.03
Currently not on view
Location
Currently not on view
ID Number
1981.0170.112
catalog number
1981.0170.112
accession number
1981.0170
Yellow cardboard sign with black print. "SMALL POX / Isolation of patient until all scabs and crusts have disappeared. / Contacts released after successful vaccination. / McPherson County Health Department"Currently not on view
Description (Brief)
Yellow cardboard sign with black print. "SMALL POX / Isolation of patient until all scabs and crusts have disappeared. / Contacts released after successful vaccination. / McPherson County Health Department"
Location
Currently not on view
date made
ca 1950
user
Pierson, Weir
ID Number
2013.3021.06
nonaccession number
2013.3021
catalog number
2013.3021.06

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