Garth Williams, author of the recent Polio Revisited, previously penned Angel of Death: The Story of Smallpox. Although first published by Palgrave Macmillan in 2010, the well-researched book is a great read for anyone who works with vaccinations or has an interest in the social and historical aspects of vaccine-preventable diseases.

While a recap of the topics covered in the more than 400-page book may be useful, this review will selfishly focus on one of the most fascinating aspects of the book to this reader; specifically, the parallels between arguments put forth today against vaccinations and those used in reference to the smallpox story. As someone who spends days working to address the misinformation and concerns surrounding vaccines, it was both interesting and, somewhat cathartic, to know that those who traveled before dealt with many of the same issues. Likewise, it was with great appreciation for today’s standards, that I finished the book pleased to be addressing these issues in the current tense.

Arguments against smallpox vaccination that may sound familiar:

  • “Set around the unfortunate Job and entitled The Dangerous and Sinful Practice of Inoculation, this railed against this ‘diabolical operation’ which ‘promotes the increase of vice and immorality.’” p. 132
  • “Compulsion often stirred up protests, mostly from those who saw it as a violation of their freedom and right to choose.” p.237
  • “The anti-vaccinationists were always on the prowl for propaganda coups and triumphantly paraded big names in medicine, science and society who were prepared to support the cause.” p.240
  • “The medical arguments against vaccination were that it was dangerous and useless – and superfluous because any falls in smallpox were due to general improvements in sanitation and living conditions.” p. 241
  • “A recurrent theme was the evidence that vaccination did not protect against smallpox. Various studies supported anecdotal reports of people who had been vaccinated but later caught smallpox.” p. 241
  • "Which brings us to the lunatic fringe. This was the age of the pamphleteer, and anyone could spread their views (no matter how crazy or outrageous) far and wide at low cost and without the inconvenience of peer review or editorial interference.” p. 250
  • “Natural healers sided with Boëns’ view that smallpox was mild and broadcast news of the horrible complications (real and imagined) of vaccination that they believed were being hushed up by the medical establishment.” p. 251
  • In reference to well-known activist, Lora C. Little, who believed her child had been killed by smallpox inoculation, “His mother wrote that ‘it was as though he had died the day his arm was punctured.’ Powerless, she watched the happy little boy turn into an invalid who fell victim to one illness after another.” p. 257

    Of note, Mrs. Little’s son, Kenneth, was vaccinated in September 1895 and died in April 1896. Between the time of inoculation and death, he suffered recurrent ear and throat infections, measles and diphtheria. The latter was the ultimate cause of his death. Mrs. Little pointed to ‘the artificial pollution of the blood,’ [that] had fatally weakened his constitution and left him at the mercy of the subsequent infections.” (p.281). His measles infection was described as typical.
  • “All diseases, including cancers as well as infections, were temporary disturbances that could be avoided altogether by a healthy diet and lifestyle.” p. 260
  • “It [vaccination] caused a long list of serious and sometimes fatal complications, thanks to the toxins introduced in the vaccine lymph.” p.261
  • “The anti-vaccinationists also claimed that vaccination caused many other diseases, for which there is no convincing evidence of any causative link.” p.275
  • “Vaccination was also held responsible for numerous other disorders, including diphtheria, bronchitis, whooping cough, cancers, heart disease, stroke and diabetes. It was often difficult to rebut the accusation that vaccination caused a particular disease, especially when this was backed up by official data (even if these had been massaged into absurdity) or by emotionally-charged case reports.” p. 276
  • “Various groups in ‘fringe’ medicine aligned themselves with the cause, including natural healers, homeopaths and chiropractors.” p. 294

To be fair, some concerns during the period of smallpox inoculation were valid. Of note, bacterial infections like syphilis and viral infections like hepatitis B were actually spread through smallpox inoculation procedures due to the lack of sterile procedures: “For example, nobody saw anything wrong with medical students going straight from dissecting fresh corpses to attend mothers giving birth; their professors were not much better, sometimes pocketing organs cut out of the recently deceased, to teach students in the delivery room.” (p. 269) Likewise, some doctors did work the system to profit from vaccinations. While there will always be more to learn, the state of science today and the checks and balances in place in the vaccine industry have made today’s vaccine programs extremely safe and effective.

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