Before Edward Jenner widely publicized his observations on vaccination, the only protection against smallpox was the practice of variolation (also known as inoculation). Variolation consisted of artificially exposing a person to smallpox (usually Variola minor since it caused less death than Variola major) under the care of a physician. Observations on this practice — along with observing those who survived full-blown smallpox — led physicians to conclude that some sort of immunity resulted from infection. However, they lacked the scientific instrumentation and understanding to truly know how the human immune system worked to protect against future disease.
The practice of variolation arrived at the American British colonies in several waves, the first of which was through the wisdom brought over by Onesimus, an enslaved man living in the Massachusetts colony in the late 1600s and early 1700s. Onesimus told his enslaver, Rev. Cotton Mather, that slaves in North Africa were given smallpox artificially to make them immune to the disease, and thus more productive and profitable. Mather consulted with Dr. Boyleston of Boston, and Dr. Boyleston confirmed that this practice was being promoted in parts of the Middle East and Northern Africa. At the same time, Lady Mary Wortley Montagu, a British aristocrat, and wife of the British Ambassador to the Ottoman Empire (modern day Turkey), saw the practice being used in Istanbul. She wrote back to England about her observations and even had her own child variolated.
When the American Revolutionary War started, British soldiers would bring smallpox with them. They would then infect the people they encountered, including American soldiers. In December 1775, the Continental Army lost the Battle of Quebec in part because smallpox went through the ranks. Starting in 1777, at the direction of General George Washington, the American troops were variolated as part of their recruitment and training. Even during the brutal winter in Valley Forge, the troops continued to be variolated.
Variolation did not come without any risks. In 1736, Benjamin Franklin lost a son to smallpox. He then became a champion for variolation, encouraging his contemporaries to consider variolation. In doing so, he wrote the introduction to a pamphlet by an English physician in 1759. In it, he noted that people acquiring smallpox naturally had about a 10% probability of dying. Those who were variolated had less than a 2% probability of dying. (The actual death rates during epidemics of smallpox could reach up to 50%, depending on the strain of the virus and the population it hit.) Back in Boston in 1721, an epidemic of smallpox killed up to about 15% of those who were not variolated. Of those who were, 2% died.
Before telling you the story of what happened in Norfolk, Virginia, you need to understand the following: Just like smallpox is contagious from person-to-person through droplets and aerosols, people who received variolation were also contagious. Thus, those who were variolated had to remain in quarantine. If they came in to contact with a non-immune person, they could pass on the infection. This was variolation and not vaccination.
In 1768 and 1769, a series of events in Norfolk, Virginia, became known as the anti-inoculation riots. The genesis of the disagreement over variolation started with news that some patients who had received the variolation in Yorktown, Virginia, left quarantine early, triggering a smallpox epidemic. As a result, people in other parts of Virginia became skeptical of the practice. At the very least, many of them wanted stricter rules for variolation. At the most, they wanted no part of it.
In June 1768, Dr. Archibald Campbell wanted several of his loved ones to be variolated by a Dr. John Dalgleish. To do this, Dr. Campbell offered his plantation outside of Norfolk as the site for the inoculation and for the quarantine of those receiving the procedure. But those who were opposed to anyone receiving the procedure were having none of it. Even though Dr. Campbell agreed to have those inoculated move to a “pesthouse” used for quarantining of people with smallpox — and a place more under control of the authorities than the plantation — a mob gathered and attacked Dr. Campbell’s plantation. Two days later, the house was burned down.
In May 1769, Cornelius Calvert — who was Mayor of Norfolk — feared that the people he enslaved had been exposed to smallpox. He asked Dr. John Dalgleish to inoculate the enslaved men at the pesthouse to avert an epidemic. (Remember that it had been 48 years since variolation saved lives in Boston.) When word of the variolation of the enslaved men got to Maximillian Calvert, the borough justice, had Dr. Dalgleish arrested. A couple of weeks later, another mob appeared at the homes of Cornelius Calvert (brother of Maximillian) and Dr. Archibald Campbell. The mob also intended to attack James Parker’s home, but they were forewarned that he was armed and willing to defend his home. (Cornelius Calvert’s account of the whole thing can be read in the Virginia Gazette edition published in January 1772, page 2.)
In the following months and years, civil and criminal cases were brought against the participants in the mobs and Dr. Dalgleish and his clients. Why against those performing the variolation? Because those against variolation occupied positions of power and had the ability to charge them with “nuisance” crimes. The cases went back and forth between courts, and some were not settled. Thomas Jefferson became involved in them until 1774, when he left his practice to begin his work in the American Revolution.
According to Dewey (citation below):
“The financial results to Jefferson of all the cases considered here were unusually good. The details are instructive. When he was first retained by Campbell and Parker in 1768 to bring civil suits, he charged each of them £2.10.0, his standard fee for common law actions. Nothing was paid by either at that time. Parker paid £2.11.6 in April 1769. When Campbell consulted Jefferson in December 1769 about the possibility of suing Boush for the destruction of his house, Jefferson charged him £1 for his opinion. Campbell paid him £2, of which Jefferson regarded 1s. 6d. as a gratuity for the opinion, crediting 18s. 6d. to Campbell’s civil suit. The balance of Campbell’s £2.10.0 fee was never paid. In preparing to turn his legal business over to Edmund Randolph in 1774, Jefferson realized that he had brought two civil suits for Campbell and had charged him for only one. The list of amounts due furnished to Randolph indicated that Campbell owed him £4.1.6.Dewey, F. (1983). Thomas Jefferson’s Law Practice: The Norfolk Anti-Inoculation Riots. The Virginia Magazine of History and Biography, 91(1), 39-53.
For his services in the two criminal cases arising out of the 1768 riot, Jefferson charged “Campbell et al.” £2.10.0 for each case when he was retained. “Campbell et al.” paid £10 at that time and another £10 when the case was over. Jefferson regarded the £15 difference between payments and charge as a gratuity. Such gratuities were few and far between in his legal career.
While the inoculation controversy was in the courts, it was also before the Virginia General Assembly. At the November 1769 session, the Committee on Propositions and Grievances presented two resolutions to the House of Burgesses. The first found reasonable “the Petition of the Inhabitants of the Borough of Norfolk and other Parts of this Colony” that the practice of inoculation be regulated. The second rejected petitions of “divers Inhabitants of this Colony” that the practice be prohibited. A law was accordingly enacted on 27 June 1770 which in effect made inoculation a matter of local option, permitting one who wanted it to apply to the local magistrates, who might either deny the application or grant it “under such restrictions and regulations as they shall judge necessary.” The effect was to stop the practice almost entirely in Virginia.”
Of course, Thomas Jefferson was not the first nor the last American President to have contact with and/or influence the history of vaccines. Before Jefferson, President John Adams received a copy of Edward Jenner’s manuscript on vaccination, but he did not do much with it. Thomas Jefferson did. He wrote to Dr. Jenner:
“Sir,Letter from Thomas Jefferson to Edward Jenner, May 14, 1806
I have received a copy of the evidence at large respecting the discovery of the vaccine inoculation which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts, in this part of the globe, to its efficiency, I took an early part in recommending it to my countrymen. I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey’s discovery of the circulation of the blood was a beautiful addition to our knowledge of the animal economy, but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated.
Accept my fervent wishes for your health and happiness and assurances of the greatest respect and consideration.”
By 1830, the vaccine against smallpox (Jenner’s vaccine) was gaining increased traction in the young United States, so much so that President Andrew Jackson used it as both a weapon and a reward in his dealings with Native Americans. In the early 1900s, Franklin Delano Roosvelt acquired polio as a young man, devoting his political career (which included three full terms as President and a fourth interrupted by his death) to finding a cure for the disease. Through FDR’s leadership, the March of Dimes organization eventually funded the efforts of Jonas Salk and his team toward developing the vaccine against polio.
Dewey, F. (1983). Thomas Jefferson’s Law Practice: The Norfolk Anti-Inoculation Riots. The Virginia Magazine of History and Biography, 91(1), 39-53. Retrieved June 19, 2021, from http://www.jstor.org/stable/4248609
Inoculation. Monticello.org: https://www.monticello.org/site/research-and-collections/inoculation