[La expedición Balmis en el Suplemento a la Gazeta de Madrid (14 de octubre de 1806), difusión hispana.]

The Madrid Gazette published a Supplement on October 14, 1806, regarding the arrival of the Director of the Royal Expedition Vaccine Philanthropy, Francisco Xavier Balmis, and the reception held by King Carlos IV. Balmis had completed his journey across the Spanish overseas territories, taking the vaccine against smallpox from arm to arm with the help of a human chain of children. During this journey, Balmis also established Vaccination Boards and endeavoured to identify cows with cowpox. The publication endorsed the policies of a declining Bourbon monarchy and marked the peak of Balmis' professional career. Both sides emerged victorious: the Crown showcased itself as the sponsor and organiser of this altruistic journey, in line with prior scientific expeditions; and Balmis secured his place in Public Health history as the director of the first international vaccination campaign. This did not mean the culmination of the expedition, as other members were still administering vaccinations in the Philippines and South America. The main objective of this study was to assess the importance of the newspaper Madrid Gazette, outline the contents of the publication, authenticate the origins of the documentary sources underpinning its composition, and confirm its impact and citations throughout 19th-century Spanish publications. The components of the publication, its origins, as well as Balmis' involvement in its creation, have been substantiated. The Supplement's importance is defined by its utility as a resource for commemorating and appreciating the expedition.

Poxes great and small: The stories behind their names

The word "pox" indicated, during the late 15th century, a disease characterized by eruptive sores. When an outbreak of syphilis began in Europe during that time, it was called by many names, including the French term "la grosse verole" ("the great pox"), to distinguish it from smallpox, which was termed "la petite verole" ("the small pox"). Chickenpox was initially confused with smallpox until 1767, when the English physician William Heberden (1710-1801) provided a detailed description of chickenpox, differentiating it from smallpox. The cowpox virus was used by Edward Jenner (1749-1823) to develop a successful vaccine against smallpox. He devised the term "variolae vaccinae" ("smallpox of the cow") to denote cowpox. Jenner's pioneering work on a smallpox vaccine has led to the eradication of this disease and opened the way to preventing other infectious diseases, such as monkeypox, a poxvirus that is closely related to smallpox and that is currently infecting persons around the world. This contribution tells the stories behind the names of the various "poxes" that have infected humans: the great pox (syphilis), smallpox, chickenpox, cowpox, and monkeypox. These infectious diseases not only share a common "pox" nomenclature, but are also closely interconnected in medical history.

Dr. James Smith's Dream of Eradicating Smallpox and the National Vaccine Institution

This article re-examines from a new perspective the efforts of James Smith (1771-1841), a Maryland doctor, to eradicate smallpox in the United States. As one of the few successful cowpox inoculators at the turn of the nineteenth century, Smith recognized the necessity for a public vaccine institution that could ensure the safe production and continuous preservation and circulation of vaccine matter. Thus, he devoted himself to creating statewide and national vaccine institutions funded by the state and federal governments. He established the National Vaccine Institution (NVI), but despite his efforts, the NVI existed only a short time from 1813 to 1822. Previous studies on Smith have focused on the 1813 Vaccination Act (An Act to Encourage Vaccination) and the NVI, and have evaluated them as failed projects or historically missed opportunities. However, this kind of approach does not justly place the act and institutions within Smith's larger plan and do not fully discuss the role of the NVI in his system of promoting vaccination in the United States. This article analyzes how he responded to the problems hindering cowpox vaccination, including spurious vaccine, failed vaccination, and low public acceptance of cowpox vaccine. In doing so, this study shows that Smith attempted to establish a universal and systematic vaccination system connecting citizens, government, and medical personnel through the NVI, as well as ensuring a safe and regular supply of vaccine.

Controversies and lessons from the history of smallpox: the case of massive vaccination in British Corfu (1852)

The study presents an anti-vaccination action in the 19th century involving both scientific and political motivation. The research is based on an unpublished archive, namely the registries of the British Executive Police during the massive vaccination campaign in Corfu, the capital of the British possession in the Ionian Islands-Greece (1815-1864), after the smallpox outbreak of 1852. The archival material provides information about the number of vaccinated people, namely their sex, age, nationality, the year of the previous vaccination, along with the last year when a citizen "had smallpox". The records indicated 40,858 citizens and of these, a total 21,845 (53.46%) were vaccinated. Despite the impressive organization, the vaccination project caused a great controversy at both the scientific and political level between the British authorities and the Greek Ionian Assembly. The archival material gives a diachronic message in the fields of public health, infectious disease control, and health crisis management. The lack of control by a State or local authority, combined with political instability and the public's ignorance or distrust of scientific matters, are the main factors behind the failure to prevent, restrict or eradicate infectious diseases even nowadays.

[Development and use of vaccines from the 18th century to the SARS-CoV 2 period]

This review is about the development and use of vaccines from the early smallpox vaccine in the 18th century to the forthcoming SARS-CoV 2 vaccines. Immunisations have been of paramount importance for childhood mortality and public health in general, but some obstacles have also been encountered such as vaccine failures and vaccine scepticism. This calls for continued emphasis on large phase three studies not only for demonstration of efficacy but also for safety and possible side effects. The rapid approval of SARS-CoV 2 vaccines requires special attention.

Rethinking the History of Smallpox in the Early Twentieth Century: The SS Korea and Uncertainty Surrounding the Diagnosis of Smallpox

This research explores the case of the 1903 smallpox outbreak on the SS Korea , a transpacific carrier making runs between Southeast Asia, East Asia, Hawaii, and the United States. These regions were connected to a degree that no one had ever imagined through the SS Korea . Honolulu, Hawaii, was one of the most important territories in US maritime history and served as a waypoint between Asia and San Francisco on the mainland. As increasing numbers of people traveled by sea, various microbes were communicated across the Pacific Ocean. International tourists traveling across the ocean to Hawaii and the United States were alerted to infectious diseases, smallpox being one of the most significant of such diseases. The story of the SS Korea serves as an important lens through which to explore the early twentieth century transpacific world connected through Honolulu. Focusing on the spread of smallpox via international travelers, this research studies aspects of the public health system that were developed to contain smallpox infection on international ships and the application of smallpox vaccination as a method for infectious disease control. More importantly, in bringing attention to the uncertainty surrounding the diagnosis of smallpox, this research argues for the necessity of historians to build a more comprehensive medical historical context for disease control systems that includes the limits of medical science in making diagnoses of infectious diseases, the uncertainties arising from a lack of this component, and the implementation of health policies and preventative medical technologies.

Smallpox Vaccine and Resident Responses in Modern Shanghai: Focusing on Regional and Cultural Comparison

In modern Shanghai, smallpox was one of the most threatening diseases with its mortality rate going up to 30 percent. In response to the disease, Dr. William Lockhart, a medical missionary of the London Missionary Society, introduced vaccination to the Chinese people in Shanghai. He built the first western style hospital in Shanghai, Renji Hospital, in 1843. At this time, native doctors also played a very important role. For example, Huang Chun-pu was in charge of the dispensary in the Chinese City in Shanghai, and he was the one who introduced vaccination under Dr. Lockhart's direction. In 1868, the Health Office of Shanghai Municipal Council began to implement a vaccination program. Around the turn of the 20th century, the Health Office of Shanghai Municipal Council managed several sub-district offices, hospitals, dispensaries, gaol, and even the traditional place like simiao for the free vaccinations. Urban residents benefited from a sanitary system, such as wide and free vaccination, compared to people who lived in rural areas. Moreover, Shanghai possessed the advantage of having the vaccine as a staple product of the Municipal Laboratory. The number of units of the vaccine issued from the Laboratory in sequence of years from 1898 to 1920 has been 115,351 on average. Unlike the International Settlement, where systematic inoculation was conducted under the leadership of the Municipal Council, the Chinese City was still reliant on charity organizations in the early 1900s. The foreign residence in the International Settlement had a strong influence from the foreign governments, and foreign doctors were well-aware of the need for the vaccination. However, the Chinese City was a Chinese enclave that was still under the traditional rule of the Qing Dynasty. In addition, the people of Shanghai had different perceptions of the smallpox vaccination, and this became an obstacle to the establishment of urban sanitation systems. Some Chinese people still relied on the traditional Chinese variolation and Chinese custom. For example, Chinese people still applied for inoculation in the spring and avoided summer and fall following traditional Chinese variolation, even though the best time to get vaccinated was in early winter before the spread of smallpox. In addition, foreigners were often more problematic than Chinese because they often overlooked the importance of vaccines and relied on drugs instead. The municipal authority, therefore, provided a wide range of free vaccinations for the poor and needy people regardless of their nationalities, and with such measures, sought to establish a stable urban sanitation system. This had been the key to the success of hygiene policies.

An Analysis of the United States and United Kingdom Smallpox Epidemics (1901-5) - The Special Relationship that Tested Public Health Strategies for Disease Control

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901-3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

Death of the King: The Introduction of Vaccination into Nepal in 1816

This article explores the introduction of smallpox vaccination into Nepal in 1816 at the request of the Nepalese government; the king, however, was not vaccinated, contracted the disease and died. British hopes that vaccination would be extended throughout the country did not eventuate. The article examines the significance of this early appearance of vaccination in Nepal for both Nepalese and British, and relates it to the longer history of smallpox control and eventual eradication. When the Nepalese requested World Health Organization (WHO) assistance with communicable disease control in the mid-twentieth century little had changed for most Nepalese. We know about the events in 1816 through the letters of the newly imposed British Resident after Nepal's military defeat in the Anglo-Nepal War (1814-16). By also drawing on other sources and foregrounding Nepal, it becomes possible to build up a more extensive picture of smallpox in Nepal that shows not only boundaries and limits to colonial authority and influence but also how governments may adopt and use technologies on their own terms and for their own purposes. Linking 1816 to the ultimately successful global eradication programme 150 years later reminds us of the need to think longer term as to why policies and programmes may or may not work as planned.

The Cowpox Controversy: Memory and the Politics of Public Health in Cuba

Vaccination played an important role in the formation of a national consciousness in Cuba, and vaccination's earliest promoters dominate nationalist narratives of medical achievement on the island. This article investigates the intense hostility exhibited by the creole medical elite toward a pivotal figure in the history of smallpox vaccination in Cuba, Spanish physician Dr. Vicente Ferrer (1823-83), the first in the Americas to mass produce smallpox vaccine using calf vaccinifiers. I argue that anger and mistrust of both Ferrer and his innovatory vaccine production technology originated in the relationship between medical politics and cultural identity in late nineteenth-century Cuba. By the late nineteenth century, smallpox vaccination was linked to glorified memories of a Cuban creole-led vaccination program and a disinterested medical profession. Both Ferrer and his private institution for the mass production of "cowpox" became associated with destructive changes in public health, challenging cultural narratives and regional power structures.

Theodore Tronchin (1709-1781) and his friend Louis de Jaucourt (1704-1779)

Tronchin's main importance lies in his contribution to personal hygiene, more than to pioneering research. He was an industrious promotor of the inoculations of smallpox against all opposition offered by conservative physicians politicians and theologists. As an inoculator he was most successful in France, the Netherlands and Switzerland. He always tried to suppress malpractice committed by his colleagues and never ran away from conflicts.

Early Developments in the Regulation of Biologics

This article is a history of the policy positions and legal interpretations adopted by the Public Health Service (PHS) under the 1902 Biologics Control Act. PHS generally interpreted the scope of the Act narrowly because it lacked authority to deny marketing licenses for ineffective biologics and wanted to minimize the number of worthless drugs with the imprimatur of a governmental license. In addition, PHS implemented important regulatory strategies not expressly authorized by the Act.

Frederick, Duke of York (1763-1827) - Medical Patron

Frederick, Duke of York, was the hardest working prince of his day. He was Commander-in-Chief of the British Army for almost the entire period of the French revolutionary and Napoleonic wars and he used his position to implement important reforms to benefit the health of troops. He encouraged hygiene initiatives and improved medical treatment, steadily seeking to enhance the quality of medical officers and facilities. Frederick was particularly involved in the spread of vaccination, authorising the very earliest clinical trials of the process and doing all he could to promote the practice. He also played an active role in the fight to prevent and treat the ophthalmia that was decimating the British Army. As the favourite son of George III and ultimately his carer, he developed an interest in mental health and he sponsored the pioneering work of Alexander Morison (1779-1866) to expand understanding of the subject. Although not a medical man himself, Frederick was one of the most important patrons of the day and his efforts were the key to enabling others to make important advances that saved thousands of lives.

[The journey of the vaccine against smallpox: one expedition, two oceans, three continents, and thousands of children]

Spain encouraged, during the Bourbon dynasty, the formation of scientific expeditions, among which was the Royal Philanthropic Vaccine Expedition, an example of biopolitics applied by the state in order to protect health. The expedition went all over the world, using children as a reservoir to transport the vaccine fluid. Francisco Xavier Balmis established a human chain that arm-to-arm materialized the success of the mission. The characteristics and difficulties which children had to pass through and their contribution to the spread of the smallpox vaccine are analyzed.

The evolution of poxvirus vaccines

After Edward Jenner established human vaccination over 200 years ago, attenuated poxviruses became key players to contain the deadliest virus of its own family: Variola virus (VARV), the causative agent of smallpox. Cowpox virus (CPXV) and horsepox virus (HSPV) were extensively used to this end, passaged in cattle and humans until the appearance of vaccinia virus (VACV), which was used in the final campaigns aimed to eradicate the disease, an endeavor that was accomplished by the World Health Organization (WHO) in 1980. Ever since, naturally evolved strains used for vaccination were introduced into research laboratories where VACV and other poxviruses with improved safety profiles were generated. Recombinant DNA technology along with the DNA genome features of this virus family allowed the generation of vaccines against heterologous diseases, and the specific insertion and deletion of poxvirus genes generated an even broader spectrum of modified viruses with new properties that increase their immunogenicity and safety profile as vaccine vectors. In this review, we highlight the evolution of poxvirus vaccines, from first generation to the current status, pointing out how different vaccines have emerged and approaches that are being followed up in the development of more rational vaccines against a wide range of diseases.

What you don't know about vaccines can hurt you

As physicians, we've all learned in detail about the science behind vaccinations, but I suspect few of us have been taught about the history of vaccinations. Sure, we all know that Dr. Jonas Salk developed the poliovirus vaccine, but I wasn't aware that he inoculated himself, his wife, and his three children with his then experimental vaccine. When our editorial committee decided to focus on vaccinations as our theme for this month's Greene County Medical Society's Journal, I perused the internet for interesting topics. I came across a fascinating website, historyofvaccines.org; this website is a project of the College of Physicians of Philadelphia, touted as being the oldest professional medical organization in the United States. I credit the majority of the information in this article to the above website and the rest to the National Institutes of Health (nih.gov) website; I trust that the information is valid and true, based on the agencies behind these websites. Below are some interesting tidbits about vaccine preventable diseases that I found noteworthy to pass on to our readers.

[Manuel Julián Grajales: propagator of smallpox vaccine in South America. Anatomist and surgeon]

Grajales came to Chile in December 1807, noting that since 1805 smallpox vaccination had been introduced by Fray Pedro Manuel Chaparro, supported by the Councilor Nicholas Matorras. He founded the Vaccination Boards of Valparaiso and Santiago in 1808 and became professor of anatomy and surgery in 1819. In 1823 he received his authorization to practice medicine. He wanted to finish his medical studies at the University of San Marcos in Lima, but the war of Independence made this impossible. He returned to Spain in 1825. In 1848, he became Member of Honor of the Faculty of Medicine, Universidad de Chile.

[History of Smallpox Vaccination and of the Vaccine Supply in Hungary, up to 1890]

One of the preconditions for the spread of vaccination against pox diseases was making vaccination available. The first vaccinations were carried out using original cowpox lymph sent by Jenner. For further vaccinations the vaccine was extracted from the blisters of those who had been successfully inoculated. In order to provide vaccine continuously six vaccine centres were set up in 1804 in the following cities: Pest, Buda, Kassa, Gyula, Pozsony and Zágráb (Croatia). Detailed information is available only about the centre in Pest which operated in Rókus Hospital under the leadership of the hospital director András Bossányi. Besides regular vaccination they also provided vaccine for the countryside. From 1824 the vaccine was relocated to the medical faculty of the university in Pest and Ferenc Gebhardt, an instructor of surgeons, became its head. The centre operated in the building of the medical faculty and vaccinations were given on Thursdays and Sundays. After the retirement of Gebhardt in 1860, the centre was taken over by the dermatologist Ferenc Poor for a short time, then by Ignác Semmelweis. From 1863 Gergely Patrubány was responsible for managing the centre. In 1874 the central vaccine institution moved to the Hospital for Poor Children in Pest where it was led first by Lázár Wittman, then by Géza Hainiss. In the 1880s private institutions appeared, the best known were Dani Pécsi's centre in Pest and Béla Intze's one in Tirgu Lapus (Romania). Between 1873 an 1889 András Kreichel ran a vaccine centre in Nálepkovo (Slovakia).

[A study on the 1946 smallpox epidemic in Japan and measures taken against it]

In early 1946, immediately after World War II, there was a smallpox epidemic in Japan. In this paper we investigated trends in the occurrence of smallpox by week and region using official documents of the General Headquarters, Supreme Commander for the Allied Powers (GHQ/SCAP), which are stored in the National Diet Library Modern Japanese Political History Materials Room, and summarized the measures taken against this epidemic. The following two points were clarified: 1) The 1946 smallpox epidemic peaked in Week 13 (March 24-30; 1,405 new patients), and the highest morbidity during this epidemic was seen in Hyogo Prefecture, followed by Osaka Prefecture, Aichi Prefecture, Tokyo Prefecture, and Hokkaido Prefecture. 2) Measures taken against this epidemic were classified into the following three stages: 1. "Vaccine shortage/Manufacture acceleration stage," 2. "Vaccine sufficiency/Smallpox vaccination program implementation stage," and 3. "Detection of defects in vaccination technique/Reimplementation of the smallpox vaccination program stage".

Benjamin Waterhouse (1754-1846) and the riddle of Amos Babcock

The late Dr Henry R Viets (1890-1969) suggested in 1940 that the author of A Journal of a Young Man of Massachusetts was Amos G Babcock. He also showed that Benjamin Waterhouse edited the manuscript. A similar journal, The Prisoner's Memoirs of Dartmoor Prison by Charles Andrews, is also described and contrasted. The career of Professor Waterhouse is narrated in relation to the medical politics at that time in New England: a possible explanation for Babcock's anonymous authorship is given.

Vaccination and the politics of medical knowledge in nineteenth-century Japan

The adoption of the cowpox vaccine in nineteenth-century Japan has often been seen as a more straightforward development than its introduction to other non-Western countries. However, the research leading to this conclusion has been based primarily on sources written by Japanese practitioners of Westernstylemedicine (ranpoˉ), while the perspectives of Chinese-style (kanpoˉ) practitioners,who were more numerous than ranpoˉ practitioners but less likely to have shown immediate enthusiasm for vaccination, have been largely neglected. Kanpoˉdoctors typically learned about vaccination from Chinese rather than European sources and often held an ambivalent attitude toward the vaccine’s foreign origins.This article develops an analysis of kanpoˉ writings on vaccination and suggests that skepticism about the vaccine remained widespread for at least a decade after its initial arrival in Japan, providing new insights into both the initial opposition and the subsequent acceptance of the technique.

[Treatment and remedies against smallpox outbreaks in Ferrara in the late nineteenth century]

Health interventions against smallpox during the two epidemics in the second half of the 19th century are outlined. The 1871 hospital health report and the medical report on smallpox patients treated at the hospital and poorhouse of Ferrara between January 1891 and January 1892, drawn up by Alessandro Bennati, provide both interesting data and insights into the treatments and remedies of the time. The treatment of this illness was - and indeed could be - nothing other than symptomatic, there being no real means to halt the spread of the disease. Rather, other remedies were found by alleviating pain and regaining energy during the various stages of the disease. A close relationship between vaccination and the incidence and gravity of the illness is underlined. When the practice of vaccination started to be widely employed at the end of the century, there were almost no cases of death due to smallpox. The pharmacopoeias of the time, Antonio Campana's Farmacopea ferrarese in particular, proved an essential guide in the analysis of each document.

Thomas Paytherus (1752-1828): Entrepreneurial surgeon-apothecary and ardent Jennerian

Thomas Paytherus was born in Fownhope and apprenticed in Gloucester. He practised there and in Ross-on-Wye where he and Edward Jenner undertook an autopsy on a patient with angina that they linked causally to coronary artery ossification. In 1794 Paytherus moved to London and opened a highly successful pharmacy that he later sold to his partners Savory and Moore. Paytherus was among those who advised Jenner on the publication of his work on vaccination. Then he acted as an intermediary in the dispute between Jenner and Ingen-Housz and also alerted Jenner to Pearson's claims as a pioneer of vaccination. In 1800 he published a detailed analysis of the dispute between Jenner and Woodville whose patients had developed variola-like lesions following vaccination. Their correspondence shows that Paytherus, Jenner and their families remained firm friends. Paytherus and his family moved to Abergavenny where he died in 1828.

A brief history of vaccines: smallpox to the present

Modern vaccine history began in the late 18th century with the discovery of smallpox immunization by Edward Jenner. This pivotal step led to substantial progress in prevention of infectious diseases with inactivated vaccines for multiple infectious diseases, including typhoid, plague and cholera. Each advance produced significant decreases in infection-associated morbidity and mortality, thus shaping our modem cultures. As knowledge of microbiology and immunology grew through the 20th century, techniques were developed for cell culture of viruses. This allowed for rapid advances in prevention of polio, varicella, influenza and others. Finally, recent research has led to development of alternative vaccine strategies through use of vectored antigens, pathogen subunits (purified proteins or polysaccharides) or genetically engineered antigens. As the science of vaccinology continues to rapidly evolve, knowledge of the past creates added emphasis on the importance of developing safe and effective strategies for infectious disease prevention in the 21st century.

[Development of current smallpox vaccines]

The review gives data on the history of smallpox vaccination and shows the high topicality of designing the current safe vaccines against orthopoxviruses. Four generations of live smallpox, protein subunit, and DNA vaccines are considered. Analysis of the data published leads to the conclusion that it is promising to use the up-to-date generations of safe smallpox subunit or DNA vaccines for mass primary immunization with possible further revaccination with classical live vaccine.

[Smallpox at the Hotel Dieu of Paris in 1900. An unpublished letter of Professor Brissaud]

On November 26, 1900, René Monod, resident in Professor E douard Brissaud's department, wrote at Brissaud's request a report on the cases of smallpox which had happened in his department at the Hôtel-Dieu since September. This unpublished document attests to Brissaud's interest in hygienism, Pasteurism and Jennerian vaccination.