May 20, 1999
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The Beginning of the End of Smallpox

Medical School Professor Benjamin Waterhouse first to test vaccine in the U.S.

By Alvin Powell
Contributing Writer

In 1800, Benjamin Waterhouse (pictured here in an 1831 oil painting by James Frothingham) became the first to test the smallpox vaccine in the United States. He carried out the test on his own family, while serving as one of the first three professors on the faculty of the Harvard Medical School. Photo courtesy of the Harvard Portrait Collection.

First came the fever and the aching back and bones. Then the rashes and the pustules that gave the dread disease its name: smallpox.

For millennia, smallpox was one of the scourges of humankind, killing 25 to 30 of every hundred it struck. The survivors were often left blind or disfigured with its characteristic circular scars.

Smallpox paid no attention to rank and stature; it killed monarchs and emperors, toppled kingdoms, and affected the course of human history. In Europe, smallpox was a constant companion, raging like a brushfire, spreading rapidly among the population before jumping to another area, only to return to afflict those it missed in its first passage.

In colonial America, smallpox was every bit the scourge it was in Europe. It not only sickened European settlers, who brought it with them when they came to the new land, it nearly wiped out the Native American population, which had no natural resistance. In a 1721 Boston epidemic alone, 5,980 of the city's 11,000 residents caught the disease. Of those afflicted, 844 died. As recently as the 1960s, smallpox killed as many as 2 million people a year.

Today, smallpox is the only disease that mankind has eliminated from nature. A case has not been reported in two decades, and frozen specimens kept in the U.S. Centers for Disease Control Laboratories and at a high-security facility in Russia are the last known samples. The World Health Organization has recommended the stocks be eliminated by June 30.

It took an all-out public health offensive spanning two centuries to eliminate the scourge, an offensive in which Harvard Medical School's first professor of the theory and practice of physic, Benjamin Waterhouse, played a key role.

Nearly 200 years ago, in 1800, Waterhouse became the first to test the smallpox vaccine in the United States. He carried out the test on his own family, while serving as one of the first three professors on the faculty of the Harvard Medical School, which had been established in 1782.

"I don't think that anyone would contend that he wasn't the dynamo that got [the smallpox vaccination] going and kept it going here in America," said Philip Cash, a professor emeritus at Emmanuel College who is writing a biography of Waterhouse.

The vaccine had been developed in England by physician Edward Jenner, who noticed that cowpox, a disease that struck cattle, provided immunity against smallpox for the milkmaids who contracted cowpox while milking infected cows.

Jenner wrote about his findings in 1798. Waterhouse, who was educated in Europe, received a copy of Jenner's writings a year later and immediately recognized their significance.

"On perusing this work," Waterhouse wrote in 1800, in his A Prospect of Exterminating the Smallpox, Part 1, "I was struck with the unspeakable advantages that might accrue to this country, and indeed to the human race at large, from the discovery of a mild distemper that would ever after secure the constitution from that terrible scourge, the smallpox."

Waterhouse's first test subject was his 5-year-old son, Daniel, whom he infected with a sample of cowpox sent by Dr. John Haygarth, England's leading expert on contagious diseases. After vaccinating several other family members and servants, Waterhouse first tested the vaccine by sending a 12-year-old servant boy he had vaccinated to Dr. William Aspinwall's Smallpox Hospital in Brookline, where he would be exposed to smallpox. The boy came home after 12 days having experienced little more than a sore arm, according to Waterhouse's own account of the procedure.

Educated in Europe

Waterhouse was born into a Quaker family in Newport, R.I., in 1754. At age 16, he was apprenticed to a Newport doctor for several years. In early 1775, Waterhouse left America to study medicine with some of Europe's best minds, taking advantage of his relation to Dr. John Fothergill of England, a prominent doctor of the time.

While studying in Holland, Waterhouse lived with future U.S. President John Adams, who had been sent there by Congress to seek an alliance.

On his return, in 1782, Waterhouse briefly practiced in Newport before accepting a position as professor of the theory and practice of physic at the newly formed Harvard Medical School.

Though best known for his work with the smallpox vaccine, Waterhouse also studied and lectured on natural history, particularly mineralogy and botany.

After his initial experiments, Waterhouse went on to advocate smallpox vaccination throughout the country, but not without resistance. Like many new practices and procedures, some people met the idea of vaccination with skepticism, others with indifference, and still others with hostility.

The times didn't help things. Rapid transit and refrigeration were nonexistent, meaning cowpox samples -- transported on pieces of cotton thread and intended for use as vaccine -- sometimes arrived dead or ineffective.

Medical practices were also not as sanitary as they are today, meaning doctors sometimes inadvertently administered vaccine contaminated with smallpox, starting smallpox epidemics and creating public doubt about the vaccine.

Waterhouse forged ahead anyway, sending cowpox samples to doctors around the country and enlisting the help of President Thomas Jefferson in the vaccine's distribution. Jefferson became a great believer in the vaccine and, in 1802, began giving it to Native Americans.

"Every friend of humanity must look with pleasure on this discovery, by which one more evil is withdrawn from the condition of man; and must contemplate the possibility that future improvements and discoveries may still more and more lessen the catalogue of evils," Jefferson wrote to Waterhouse in 1800.

Some of the resistance to smallpox vaccination in this country, however, may have been due to its source, Waterhouse himself.

Waterhouse was embroiled in long-running feuds with the Boston medical establishment, including the Massachusetts Medical Society and powerful Boston doctors, including Harvard Professor of Anatomy and Surgery John Warren.

Some biographers attribute Waterhouse's problems to an innate Boston tribalism and to jealousy. Waterhouse was discriminated against because he was not Harvard-educated, they say, and he was hated out of jealousy over his European education, which made him one of the best-educated American doctors at the time.

Others say Waterhouse was the source of his own troubles, describing him as arrogant and condescending and unaccustomed to the rough life in early America.

One bone of contention is Waterhouse's refusal to share the vaccine with nearby physicians and his insistence on receiving a share of the profits from doctors to whom he did send it. Some have explained that practice as an effort to ensure the vaccine was administered properly by qualified doctors, while others say it was a clear effort to profit by creating a vaccine monopoly.

Whatever the source of his troubles, Waterhouse doesn't appear to have shrunk from them. On the contrary, Waterhouse met accusers head-on, sometimes in newspaper articles that, often as not, added fuel to the fire.

Finally, in 1812, Waterhouse's opponents took their objections to the Harvard Corporation, which led to his being forced out of his job as professor.

Waterhouse didn't vanish from the scene, however. President James Madison made him medical superintendent of New England's military bases. Waterhouse also continued his writing career, contributing many newspaper articles and writing several books, including a best-selling account of a ship's surgeon in the War of 1812, A Journal of a Young Man of Massachusetts.

Today, Waterhouse, who died in 1846, and his achievements have not been forgotten. Images of him hang in the Medical School and his house on Waterhouse Street near Cambridge Common is marked with a plaque memorializing him as the introducer of the smallpox vaccine in this country.

"He was the promoter and the defender [of the vaccine] and he did it brilliantly," Cash said.


Copyright 1999 President and Fellows of Harvard College