Jefferson and smallpox in late-18th century North America

A new post in the smallpox and American otherness series.

The interest that the expedition led by Lewis and Clark cultivated in medical knowledge and in the observation and treatment of contagious diseases such as smallpox and syphilis was largely due to Thomas Jefferson. The correspondences between the protagonists allow us to reconstruct in detail various aspects of cultural as well as logistic planning in the preparation of the expedition, with the extensive involvement of Jefferson, who gave Lewis, already his secretary, minute indications for the recording of information in the field and its preservation.[1] Promoter of the whole project, Jefferson was also a key figure in soliciting indications from scholars and colleagues from the American Philosophical Society in various disciplinary branches regarding the information that the expedition would hopefully have to collect on the populations encountered.

In the second half of the 18th century Jefferson was one of the main experimenters and promoters of smallpox inoculation in North America, also working to contain the opposition and widespread fears that the practice aroused.[2] At the age of 23, he travelled to Philadelphia to undergo inoculation, in a Virginia where the practice was widely opposed.[3] Years later he encouraged his wife Martha to undertake the procedure, and it is known that he had his daughters inoculated a few months after his wife’s death in 1782.[4] During the brief period in which he practised law (1767-1774), in 1768-69 he defended the victims of riots that had broken out in Norfolk County (Virginia) at the introduction of the practice, including the physician Archibald Campell, whose home had been set on fire.[5]

C. Williams, Vaccination, [London], F.L. Smyth Stuart Esq. ca1802. Satirical etching against the practice of vaccination based on cowpox. The monster in the centre, symbolising the vaccine, has bovine features, lion forelegs, and a body riddled with ‘Pestilence’, ‘Plague’, ‘Leprosy’, ‘Fetid Ulcers’, ‘Pandora’s Box’. The creature is fed with infants and defecates their horned bodies, the vaccinators who feed it and shovel out the bodies are themselves equipped with horns and tails. The man tipping a basket into the jaws of the monster in the foreground carries a rolled-up paper in his pocket indicating a large income in pounds. The man shoveling on the right is trampling botany lessons. The obelisk in the background bears the names of some well-known opponents of the practice, including Benjamin Moseley, a physician at the Royal Hospital in Chelsea. Next to the obelisk, men demonstrating against the vaccine come from the ‘Temple’ at the top of the hill in the background, holding ‘Truth’ as a weapon. The shields bear the initials of the names also inscribed on the obelisk, suggesting their identities. The satire feeds on the fears raised by the anti-intuitive concept of variolation and the introduction of animal material into a medical practice. Copy at the Wellcome Collection, reproduced under an Attribution-NonCommercial 4.0 International licence (CC BY-NC 4.0).

Jefferson favoured an empirical approach to science and health. This not only in the case of variolation led him to support opinions and practices that contradicted the medical knowledge prevailing among his contemporaries, even though among these contemporaries were doctors belonging to his circle of acquaintances and friendships. This was the case with his aversion to bloodletting, or his support for dissection as a means of advancing anatomical knowledge.[6] He played a crucial role in the dissemination of inoculation and the vaccine, which he promoted at institutional level in numerous ways over the years. In 1769 he was a member of the committee that proposed a reduction in restrictions to the Virginia General Assembly.[7] In 1776, he was part of the congressional committee of enquiry investigating suspicions of a biological offensive by the British in Canada, which was supposed to be taking place through deliberate smallpox contagion.[8] A similar suspicion would also develop during the British invasion of Virginia.[9]

During his presidential term he followed, in his readings, the experiments of Edward Jenner[10] and John Lettsom that led to the development of a vaccine based on a mild form of cowpox. The catalogue of his personal library is revealing of his up-to-dateness. It includes Benjamin Waterhouse’s writings published since 1800,[11] Lettsom’s Observations on the cow-pock printed in London in 1801,[12] Louis Valentin’s Résultats de l’inoculation de la vaccine of 1802,[13] and a copy of John Redman Coxe’s Practical observations on vaccination, or, Inoculation for the cow-pock, printed in 1802 and given to Jefferson by the author, after he had sent him a provisional advance copy.[14] For the latter work, Jefferson granted Coxe permission to use a letter he had written to John Vaughan on November 5, 1801, as an important form of public endorsement. To a similar request by Vaughan, Jefferson had refused for fear of exposing himself to criticism because of his lack of qualifications as a doctor. The concession in 1802 is evidently a sign of a prevailing desire to exploit his public position in favour of vaccination practice.[15]

With Waterhouse Jefferson worked closely to directly test and promote the spread of the cowpox-based form of vaccine. From Waterhouse Jefferson receives the material with which he personally carries out the vaccination, mostly of African American slaves, and some relatives and neighbours at his residence in Monticello in 1801. He then obtained pathogenic material from the first treatments, with which he continued until he had about two hundred inoculations, and sent samples to colleagues elsewhere in Virginia and Washington DC.[16] Coxe’s Practical observations include, in addition to the letter to Vaughan, the data recorded by Jefferson during the Monticello experiments.[17] The open conduct and publicity of these experiments have already been evaluated as “essential for vaccine’s success in the United States” from the point of view not so much of an advancement or deepening of scientific knowledge as in the construction of a critical mass of evidence in favour of the efficacy of the practice.[18]

Jefferson promoted medical knowledge in Lewis and Clark’s expedition westward both as a tool of diplomacy and in terms of gathering information on diseases and remedies used by native peoples. This has been interpreted with regard to a general connection between the health of the individual and the Republican social body in the political planning of his presidency.[19] The same westward expansion was linked to the belief that an abundance of open land was necessary for the vitality of the republic and that settlement in healthy areas, unaffected by the unhealthy characteristics of east coast cities, should be encouraged: ‘By the early nineteenth century the search for a “salubrious” locale was a significant factor in the decision of where one settled in America. The geography of health became a metaphor that extended beyond the human body and connected to political and economic “health” and the advancement of the nation’.[20]


[1] See appendices in Lewis and Clark, Original Journals, VII, 193-287, especially Jefferson instructions to Lewis, June 20, 1803, pp. 347-352; and Ethnological information desired, n.p., n.d., pp. 283-287; see also Thwaites, Introduction, xxxiii-xxxiv.

[2] E. A. Fenn, Pox Americana: The Great Smallpox Epidemic of 1775-82, New York, Hill and Wang 2001, 1-43.

[3] Inoculation, in Thomas Jefferson Encyclopedia, accessed via Monticello,; D. Malone, Jefferson the Virginian, Boston, Little, Brown and Company 1948, pp. 99-100; J. E. Abrams, Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health, New York, New York University Press, 2013, p. 165.

[4] Thomas Nelson to Jefferson, February 4, 1776, in The Papers of Thomas Jefferson, general editor B. O. Oberg, Princeton, Princeton University Press 1950, vol. I – 14 January 1760 to 25 December 1776, p. 286; Jefferson to James Madison, November 26, 1782, in The Papers of Thomas Jefferson, general editor B. O. Oberg, Princeton, Princeton University Press. O. Oberg, Princeton, Princeton University Press 1952, vol. VI – 21 May 1781 to 1 March 1784, p. 207.

[5] F. L. Dewey, Thomas Jefferson’s Law Practice: The Norfolk Anti-Inoculation Riots, ‘The Virginia Magazine of History and Biography’, 91, 1, 1983, pp. 39-53.

[6] Abrams, Revolutionary Medicine, chapter 4.

[7] R. H. Halsey, How the President, Thomas Jefferson, and Doctor Benjamin Waterhouse Established Vaccination as a Public Health Procedure, New York, Published by the Author, 1936, pp. 33-34; W. Waller Hening, The Statutes at Large: Being a Collection of all the Laws of Virginia, Richmond, Printed for the Editor, George Cochran 1822, VIII: 371-73, IX: 371-73.

[8] A. M. Becker, Smallpox in Washington’s Army: Strategic Implications of the Disease during the American Revolutionary War, ‘The Journal of Military History’, 68, 2, 2004, pp. 381-430, see pp. 409, 415.

[9] P. Ranlet, The British, Slaves, and Smallpox in Revolutionary Virginia, ‘The Journal of Negro History’, 84, 1999, pp. 217-226.

[10] M. Bennett, The War Against Smallpox: Edward Jenner and the Global Spread of Vaccination, Cambridge, Cambridge University Press 2020.

[11] B. Waterhouse, A prospect of exterminating the small-pox; being the history of the variolae vaccina, or kine-pox, [Cambridge], Printed for the author, at the Cambridge Press, by William Hilliard […] 1800; B. Waterhouse, A prospect of exterminating the small pox. Part II, being a continuation of a narrative of facts, Cambridge, MA, Printed for the author, at the University Press, by William Hilliard 1802. For these and subsequent titles in Jefferson’s library: personal library catalogue at the Library of Congress, digitized via Library Thing,, ad vocem.

[12] J. C. Lettsom, Observations on the cow-pock, [London] 1801.

[13] L. Valentin, Résultats de l’inoculation de la vaccine dans les départemens de la Meurthe, de la Meuse, des Vosges et Haut-Rhin, Nancy […], Haener et Delahaye […], Messidor An X (Juillet 1802).

[14] J. Redman Coxe, Practical observations on vaccination, or, Inoculation for the cow-pock, Philadelphia, Printed and sold by James Humphreys at the corner of Walnut and Dock-streets 1802.

[15] Jefferson to John Redman Coxe, April 30, 1802, in The Papers of Thomas Jefferson, general editor B. O. Oberg, Princeton, Princeton University Press 2010, vol. XXXVII – 4 March to 30 June 1802, pp. 364-365, “[…] if however the letter can be useful as a matter of testimony, or can attract the notice or confidence of those to whom my political source may have happened to make known, and thereby engage their belief in a discovery of so much value to themselves and mankind in general, I shall not oppose it’s being put to that use […]”. The letter appears in Coxe, Practical observations, 120-122; for a modern edition see infra.

[16] Jefferson to John Vaughan, November 5, 1801, in The Papers of Thomas Jefferson, general editor B. O. Oberg, Princeton, Princeton University Press 2008, vol. XXXV – 1 August to 30 November 1801, pp. 572-573, in this volume also Jefferson to Dr. John Shore, September 12, 1801, pp. 277-278 and Jefferson to Waterhouse, September 17, 1801, pp. 311-312; on the Monticello experiments also Bennett, The War Against Smallpox, pp. 276 et seq.

[17] Coxe, Practical observations, folded synoptic tables on pp. 135 and passim, p. 147.

[18] R. Fields Green, “Simple, Easy, and Intelligible”: Republican Political Ideology and the Implementation of Vaccination in the Early Republic, “Early American Studies”, 12, 2, 2014, pp. 301-337, cit. p. 313.

[19] Abrams, Revolutionary Medicine, chapter 5.

[20] Abrams, Revolutionary Medicine, p. 194.

This post is adapted from: Giulia Iannuzzi, “in the raging time of the small pox”: Il vaiolo e la documentazione dell’alterità americana tra fine Settecento e primo Ottocento, Diciottesimo Secolo, 6 (2021): 67-82, doi: 10.36253/ds-12544; ISSN: 2531-4165. This article is available in full green open access:

Cite this article as: Giulia Iannuzzi, "Jefferson and smallpox in late-18th century North America," in Geographies of Time, 01/07/2022,

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