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Inoculating for Smallpox


Individuals and communities have contended with the threat of smallpox throughout the ages. A devastating disease, it had the potential to bring death and destruction to any community that it invaded. Newspaper accounts, letters, and doctors' records provide evidence for the presence of smallpox in Williamsburg during the eighteenth century. Symptoms included a high fever, body aches, and blister-like pustules covering the entire body. Complications such as blindness and pneumonia were also a threat. The mortality rate for smallpox could be as high as 25 percent, and survivors often suffered from scarring caused by the pustules. As early as the 16th century, people endeavored to find the means for controlling this disease.

Inoculation—that is, introducing some of a virus into another person in a controlled environment, so they contract the disease in a lesser form and don't get it again—was practiced in Africa, India, and China in the 16th and 17th centuries, and was introduced to Europe in the 18th century. It was first practiced in America in 1721. A doctor would scrape some pus from a smallpox sore on an infected person onto the skin of a healthy person. That person would generally develop a more mild case of smallpox, and after they recovered would never get the disease again. But there was a risk. Some people contracted a severe case of smallpox from the inoculation, and there was a small chance of death. Even if the case was mild, the patient still got the painful pustules of smallpox, though usually reduced in number and intensity.

It was a new concept, and some found it difficult to understand and therefore frightening. A riot took place in Norfolk, Virginia in 1768 when several gentlemen brought in a doctor to inoculate their families. The gentlemen were possibly reacting to a smallpox epidemic that had recently occurred in nearby Williamsburg. A mob of townspeople felt inoculation made smallpox spread in towns, not prevent it, and threatened to harm the families if they went ahead with their inoculation plans. The families did, and the mob broke windows in the houses of the families and chased them to the hospital. The leaders of the mob escaped punishment.

Public opposition to inoculation rose and fell in subsequent decades. Despite some objections, George Washington made sure his troops were inoculated beginning in 1777, thus limiting the threat of smallpox John Adams called "ten times more terrible than Britons, Canadians and Indians, together."

In the final years of the eighteenth century, English physician Edward Jenner invented a new way of controlling smallpox. In 1796, Jenner observed that cows sometimes suffered from a disease that looked a lot like smallpox, and that dairymaids who worked with those infected cows contracted this "cow pox," but they did not contract smallpox. He conducted an experiment: he scratched some pus from a cow pox sore on a dairymaid onto the hand of a young boy, who contracted cow pox. The boy was sick for a few days, but then recovered. Jenner then exposed him to smallpox pus, but the boy did not contract smallpox. Jenner repeated his experiment on other people, making the final conclusion that by exposing people to cow pox, they became immune to smallpox. Thus vaccination—inoculation using a different or dead form of a disease—was born.

Vaccination is now available for hundreds of diseases, and most states require children in public school to receive certain vaccinations. The question of individual rights vs. public health now takes center stage in the debate. Since the beginning of vaccination, citizens have claimed that their rights were violated by being forced to undertake a practice that they didn't believe in. However, in a Supreme Court case in 1905, Jacobson v. Massachusetts, the decision of the court was that states had the right to require vaccinations.

In 1980, the World Health Organization declared that smallpox had been completely eradicated. (As late as 1967, it was estimated that there were approximately ten million cases of smallpox worldwide.)


As a result of this lesson, students will be able to:

  • Read and extract information from a primary source account
  • Explain the difference between inoculation and vaccination
  • Identify the risks of 18th century inoculation and the controversy surrounding it
  • Analyze a political cartoon



  1. Ask students what they know about smallpox. Is smallpox something you can still catch today? Why or why not? Was it a dangerous disease? Use information from the Introduction to inform the discussion.
  2. Explain that there was a way to prevent smallpox: you could be inoculated for it. Define inoculation for students: introducing some of a virus into another person in a controlled environment, so they contract the disease in a lesser form and don’t get it again. Then define vaccination: inoculation using a different or dead form of the disease. Using information from the Introduction, discuss with students the differences between inoculation and modern vaccination (example: scraping pus vs. injecting with a syringe; becoming sick for several days vs. having a sore arm for a few minutes).
  3. Indicate to the students that they are now going to read about an incident in Norfolk, Virginia where members of the community confronted each other over the issue of the administration of smallpox vaccinations.
  4. As a class, or in groups, read over the account of the smallpox riot in Norfolk, VA in 1768. After reading the article, return and read it again this time highlighting the issues and the actions of the opposing groups of individuals. Make sure that the students understand that the inoculation process engaged in in 1768 was appreciably different than the vaccination process practiced today. The risks and potential dangers were much greater for the recipients of the vaccine.
  5. Explain that in 1796, Edward Jenner found a new way to create immunity to smallpox by vaccinating instead of inoculating. Define vaccination for students: inoculation using a different or dead form of a disease. Use the Introduction to the lesson to provide some background information on cow pox.
  6. Project and hand out "The cow-pock..." cartoon and analyze the cartoon with the class. (Use the Cartoon Analysis Worksheet if desired). Have them identify the issue being depicted and the various elements utilized by the cartoonist. Ask students, "Is the cartoonist agreeing with people who are frightened of vaccination, or making fun of them? How do you know?" (There is no right or wrong answer.) If students are unfamiliar with cartoon analysis, use the following steps:
    1. Set the stage for the cartoon analysis by introducing the notion that editorial cartoons have been a form of commentary and criticism throughout history. Editorial cartoonists have used this art form to identify and take a position on issues that have been a source of controversy within the society. They are meant to be controversial and designed to engender debate.
    2. At this point introduce and describe the essential elements that are integral to the development of an editorial cartoon. These include symbolism, exaggeration and distortion, caricature, stereotyping, humor, and captions. It should be made clear that not all cartoons may necessarily contain all of the elements, but these are the basis around which cartoonists create their images. Hand out the Elements of Political Cartoons Summary Chart for student reference.

    Lesson Extensions

    • Review the scientific method with students. Explore how Edward Jenner used the scientific method to discover the process of vaccinating for smallpox using cowpox.
    • If appropriate, have the students seek to determine if there are any vaccination procedures that are at issue today. If so, what are the reasons for and against its administration?