What if smallpox was a mild disease?

(links to videos of the article appear at the bottom)

[“Extremely mild case of smallpox, bearing some resemblance to chickenpox,” American Medicine, vol. II, no. 23, December 7, 1901, p. 901.]

Smallpox. In the history books, smallpox is painted as a deadly menace, spreading fear wherever it went. It hung like a dark cloud over communities for centuries, leaving a trail of sorrow in its wake. Smallpox is reputed to have claimed the lives of up to 20% of its victims, leaving a legacy of pain and grief.

But what if smallpox wasn’t the formidable killer it’s reputed to be? What if it was mostly a mild disease?

On the surface, that sounds like a completely ridiculous idea. However, throughout history, some doctors documented that smallpox was a mild ailment when appropriately managed and not mishandled.

In 1688, Thomas Sydenham, MD, renowned as the English Hippocrates and regarded as the Father of English medicine, wrote about his observations on smallpox:

It would be too large for a letter, to give you an account of its history; only in general I find no variolis [smallpox], but do regret greatly, that I did not say, that, considering the practices that obtain, both amongst learned and ignorant physicians, it had been happy for mankind, that either the art of physic had never been exercised, or the notion of malignity never stumbled upon. As it is palpable to all the world, how fatal that disease proves to many of all ages, so it is most clear to me, from all the observations that I can possibly make, that if no mischief be done, either by physician or nurse, it [smallpox] is the most slight and safe of all other diseases.[1]

The gold-standard treatment of smallpox during Thomas Sydenham’s time involved keeping the patient in a hot environment and possibly covering them with blankets to induce sweating. It involved consuming spicy foods, alcoholic beverages, or other substances thought to increase internal heat. It was believed that heating the body could help to expel harmful substances and promote healing. Cordials were often made from various herbs, spices, and alcohol and were thought to increase internal heat or circulation. Dr. Sydenham found that these erroneous treatments turned smallpox from a mild disease to one that could be deadly.

…the Small-Pox being too much forced out, by giving Cordials, and by a hot Regimen run into one, a foul Spectacle, and one that threatens a sad event; and these and the like Symptoms are usually occasioned by these Errors; whereas I never observed any mischief from the other Method: For Nature, left to herself, does her Work in her own time, and separates, and the expels the Matter in the right way and manner...[2]

Dr. Sydenham shared his notions for curing smallpox, which did not use these widely used, faulty medical notions. In 1681, in a letter addressed to Dr. Thomas Sydenham, Dr. William Cole thanked Dr. Sydenham for his information that would easily cure smallpox. He also observed that the established medical approach involving the hot regimen and medicines led to the death of many who otherwise could easily have been cured.

I heartily thank you for your method of Cure in the Small-pox, whereby that dreadful Disease (unless some malignity, of some unusual thing happen, maybe be easily cured) if Nurses, a sort of People very injurious to the Health of Man, did not obstruct, who by the hot Regimen and Medicines, confound all things, and kill so many before their Time. You learned Sir, the Protector of Mankind, ought to be esteemed, who are a guide to the Sick in the greatest Danger of Life, that they may return to the way of Health, if they follow your Direction.[3]

Forty years later, in the early 1700s, Isaac Massey’s observations at Christ’s Hospital indicated that smallpox was rarely fatal when managed with appropriate treatment.[4]

A natural simple smallpox seldom kills, unless under very ill management, or when some lurking evil that was quiet before is roused in the fluids and confederated with the pocky ferment.[5]

Drawing from decades of experience at a children’s hospital, Isaac Massey noted that smallpox seemed to be a relatively mild illness, seldom resulting in fatalities. Having attended to the patients at Christ’s Hospital, which typically housed around 600 children, he observed that over 20 years, only 5 or 6 deaths were attributed to smallpox.[6] He believed that the newfangled notion of inoculating people with pus from a smallpox lesion was unnecessarily dangerous, mocking the procedure by calling it “incantation.”

In 1814, John Birch, a distinguished member of the Royal College of Surgeons, expressed his belief that a significant number of smallpox fatalities were, in fact, attributable to poor diet, unclean environment, and medical error.

I consider even the Natural Small-pox a mild disease, and only rendered malignant by mistakes in nursing, in diet, and in medicine, and by want of cleanliness… It would hardly be too bold to say, that the fatal treatment of this disease, for two centuries, by warming and confining the air of the Chamber, and by stimulating and heating cordials, was the cause of two-thirds of the mortality which ensued.[7]

Over the decades, other doctors also observed that smallpox was a mild disease.

…smallpox is generally a very mild disease…[8]—Dr. Montague R. Leverson, MD, PhD, 1898

It [smallpox] is a most harmless disease if properly treated. I have treated hundreds of cases without a single fatality.[9]—Dr. Smiley, 1907

Collectively, these statements suggest that smallpox was not simply a solitary killer claiming the lives of those unfortunate enough to be afflicted. Could these doctors have been right? Was smallpox primarily a mild disease made worse by not only the general health of the people and the environment in which people lived but also by the wrong-headed medical notions of the time?

Again, in this widely used “hot regimen,” individuals would be covered with numerous smothering blankets, encouraging copious sweating with the aim of eliminating excessive bodily fluids. Alternatively, patients might be immersed in a hot bath. This therapeutic fashion viewed light and fresh air as detrimental, leading to patients being kept in darkness whenever feasible, with minimal ventilation.

When any person afflicted with any species of fever, is confined in a close and heated apartment, in which the free circulation of air is prevented by closed doors and windows, curtains, &c. and is kept at the same time under a load of bed-clothes, and supplied with hot drinks, or even cordials of vinous and fermented liquors, with the view of inducing perspiration, the consequences are as follow. The whole train of symptoms is aggravated. The heat of the patient is raised considerably above the natural standard, notwithstanding the profuse perspirations that are constantly bathing him; the pulse is excited to the highest febrile standard; the thirst becomes incessant to supply the unnatural waste of fluids; the mouth and lips become parched…

the head is in constant pain, with confusion of ideas, preventing all sound sleep, and occasioning distressing dreams, and at length delirium; the whole powers of the frame become prostate, with disposition to fainting, on being moved, or on passing an evacuation by stool; and from this situation the recovery is extremely precarious. In cases of contagious fever, such as small-pox, measles, scarlet-fever, &c, the eruption is always greatly multiplied by this hot regimen, and all the symptoms changed to what has been called a putrid type; the tongue, teeth, and lips, become coated with black, clammy, and immovable fur; purple spots appear on the skin; and the whole disease assumes the character of malignancy. – The Cyclopaedia; Or, Universal Dictionary of Arts, Sciences, and Literature, vol. 29, 1819.[10]

This treatment was used on those inoculated with smallpox as well as those who acquired the disease naturally. In 1864, Dr. John Mason Good noted that this medical treatment often made smallpox severe and frequently deadly.

Unfortunately, the practice of treating the disease [smallpox] with cordials and a hot regimen at this time prevailed, and was too generally applied to the inoculated as well as to the natural process, by means of which the former was often tendered a severe, and, in many cases, a fatal disease.[11]

Standard and commonly accepted medical procedures of that time included bleeding patients to the point of fainting, withholding even a single drop of cold water, depriving patients of light and fresh air, and promoting catharsis, which involved inducing forceful and abundant bowel movements through the use of cathartics. In 1747, Charles Perry, MD, noted some of these medical notions widely used in treating smallpox.

Bleeding (which is now very generally practised amongst us, where Small Pox is expected, and even when it has just made its Appearance) is the first Thing necessary to be done; and ought to precede every Thing else... I advise Bleeding copiously... And this I advise to every one indiscriminately, without Regard to Age, Sex, or Temperament… The next Thing I advise, is to give a Vomit... This Medicine is evidently calculated to cleanse and empty the whole alimentary Tube, for it will purge as well as vomit…[12]

Calomel, a mercury-based compound, was a widely used treatment for many illnesses—constipation, syphilis, smallpox, influenza, and more. It was also a very powerful cathartic, which is “a sophisticated way of saying it will violently empty out your guts into the toilet. Constipation had long been associated with sickness, so opening the rectal gates of hell was a sign of righting the wrongs.”[13] As noted by Dr. H. G. Cox at New York Medical College in the mid-1800s:

There is much truth in the statement of Dr. Hughes Bennett, that blood-letting is always injurious, and never necessary, and I am inclined to think it entirely correct. Bleeding in pneumonia doubles the mortality. Calomel does no good in pneumonia. The fewer remedies you employ in any disease, the better for your patient. Mercury is a sheet-anchor in fevers; but it is an anchor that moors your patient to the grave.[14]

Samuel Dickson, MD, highlighted these disastrous medical ideas that had been in use for centuries in his observations in 1855:

For upwards of twenty-three centuries to starve, bleed, purge, and torture, had been the all but exclusive business of the man of medicine. From the days of Hippocrates till within the last few years, this was the undoubted practice in almost all diseases. In truth, what from the gloom of the sick room, and what from the obscurity that enveloped the science, no question was ever asked by the public at large about medical matters. The possession of a diploma or degree from a school or university of reputation was the only requisite for practice. The practice itself, no matter how destructive, signified little so long as it was the ‘established practice.’[15]

In 1889, Dr.  Henry G. Hanchett succinctly stated why diseases were so fatal – it was the medical treatments of bleeding and toxic medications. If the patients had been simply left alone, they would have recovered. As the use of these harmful medical treatments was reduced, so were their fatal consequences.

We can recognize the mistakes of our predecessors and those of some of our contemporaries. We wonder that the old-time doctor did not suspect that his lancet, his calomel and tartar emetic, put many a patient underground, whose disease would have ended in recovery if it had been let alone. We are ready to admit frankly that in the past many patients have unquestionably “died of the doctor;” in fact this very disease, variola [smallpox], is a case in point, for the change in the death rate… as compared with earlier records, leaves no possible doubt that mistaken treatment had more than anything else to do with the great mortality of the scourge. Some of us can see very plainly that our colleagues, who are to-day puzzling their brains to explain the terribly increased mortality of pneumonia, need only to leave their hypodermic syringes and morphine at home to find the solution of their problem.[16]

At the end of the 1800s, smallpox became a mild disease. After the summer of 1897, the severe type of smallpox with its high death rate, with rare exceptions, had entirely disappeared from the United States. Smallpox turned from a disease that killed 1 in 5 of its victims to one that only killed anywhere from 1 in 50 and later to as low as 1 in 380. This disease, having become so much milder,  could still kill, but it was often mistaken for various other pox infections or skin eruptions.

During 1896 a very mild type of smallpox began to prevail in the South and later gradually spread over the country. The mortality was very low and it [smallpox] was usually at first mistaken for chicken pox...[17]

By the early 1900s, there were those who recognized that sanitation had done what vaccination had failed to do—conquer smallpox. Smallpox vaccination was on the decline, and yet smallpox, like other diseases, was disappearing as a major threat. In 1914, Dr. C. Killick Millard wrote in his book The Vaccination Question in the Light of Modern Experience: An Appeal for Reconsideration:

For forty years, corresponding roughly with the advent of the “sanitary era,” smallpox has gradually but steadily been leaving this country (England). For the past ten years the disease has ceased to have any appreciable effect upon our mortality statistics. For most of that period it has been entirely absent except for a few isolated outbreaks here and there. It is reasonable to believe that with the perfecting and more general adoption of modern methods of control and with improved sanitation (using the term in the widest sense) smallpox will be completely banished from this country as has been the case with plague, cholera, and typhus fever. Accompanying this decline in smallpox there has been a notable diminution during the past decade in the amount of infantile vaccination. This falling off in vaccination is steadily increasing and is becoming very widespread.[18]

In 1914, Dr. Millard’s book clearly indicated that vaccination was not what the vast majority of the medical profession had and continued to believe. In his book, Dr. Millard provided a chart of deaths in England and Wales that clearly showed that death from diseases of scarlet fever, enteric fever, and smallpox declined at about the same time, beginning approximately in the 1870s. Of critical note is that vaccination rates also began to drop by about 1885 and reached a 40 percent lower rate by about 1910 with no resurgence of smallpox.

Moreover, it will be noticed that the drop in the mortality from “other zymotics” was almost as striking. So much is this the case, that, without being informed, it is difficult to tell which line represents small-pox, and which “other zymotics.” Obviously, causes other than vaccination must have been at work to have produced this fall in “other zymotics,” and we cannot say that the same cause did not also influence the mortality from smallpox.[19]

The author of a 1913 article in the Journal of Infectious Diseases presented a table showing that, in 1895 and 1896, the smallpox death rate was where it had been historically recorded for decades, around 20%. The table also showed that after 1896, the death rate fell rapidly, down from 6% in 1897 to as low as 0.26% by 1908. One factor that may have played a part in this decline is arm-to-arm vaccination, which had been performed for 100 years, fell out of favor, and was outlawed in 1898.

Smallpox had become a mild illness, with a significant decrease in its fatality rate. The fatality rate of 20.84% in 1895 had dropped to an astonishing 0.26% [98.7% decrease].[20]

On the whole the disease seems to have shown a tendency to diminish, somewhat in severity. This tendency is not marked and the somewhat lower case fatality noted in later years may be due to the better recognition of cases, now that the type has become more widely known. At first fatalities of 1 to 2 per cent and even more were commonly reported, while later fatalities have often been much less. Thus in North Carolina in 1910 there were 3,875 cases with 8 deaths, a fatal­ity of 0.2 per cent, and in 1911 there were 3,294 cases in that state without a single death.[21]

Something changed to make smallpox a much less lethal and morbid disease with no secondary fever and little if any, discomfort. The classic smallpox eruptions were often only a dozen or fewer. The redness usually disappeared in three or four weeks, leaving no permanent marks.[22] In the absence of an epidemic, a case of mild smallpox was likely to be overlooked or mistaken for chicken pox.

...chickenpox, is a minor communicable disease of childhood, and is chiefly important because it frequently gives rise to difficulty in diagnosis in cases of mild smallpox. Smallpox and chickenpox are sometimes very difficult to differentiate clinically.[23]

[Jay Frank Schamberg MD, “Small-pox – mild type observed within recent years in many sections of the United States.” Diseases of the skin and eruptive fevers, 1908, p. 408.]

By the 1920s, it was recognized that the new mild form of smallpox produced minimal symptoms, even though few people had been vaccinated.

Individual cases, or even epidemics, occur in which, although there has been no protection by vaccination, the course of the disease is extremely mild. The lesions are few in number or entirely absent, and the constitutional symptoms mild or insignificant.[24]

By the 1920s and into the 1930s, mild smallpox had almost completely replaced the severe form in the United States. There were exceptions, however, with outbreaks in seaports and near the Mexican border. Once the mild type of smallpox became prevalent, there was no evidence that it ever reverted to the older, more deadly type.

Although mild cases of smallpox were known before, they have come practically to replace the severe forms in many extensive areas, such as the whole United States, Brazil, large parts of Africa.[25]

The mild form of smallpox commonly designated by its Portuguese name, alastrim, has prevailed over vast regions of the United States for over 30 years. It is estimated that the germ of this disease must have been transmitted from one human being to another more than 800 times and yet it is bred true. Throughout all these “generations” the organism maintains its early characteristics... Most American health officers and epidemiologists who have experience with the two types of smallpox do not believe that as yet there has been any reversion of the mild strain to the old classic strain.[26]

A 1940 article in Public Health Reports showed the ever-downward spiral of smallpox – cases, case/fatality rate, and deaths all plummeted.[27]

Smallpox collapsed while smallpox vaccination rates fell, as seen in the Leicester, England, and England & Wales data.

By the time the following report was written in 1946, smallpox had all but vanished from England and the Western world. The health of people had dramatically improved. The hot regimen, bleeding, and calomel were largely no longer in medical fashion and were quickly forgotten.

What has been the cause of the rise and fall of smallpox? Its decline in the later decades of the nineteenth century was at one time almost universally attributed to vaccination, but it is doubtful how true this is. Vaccination was never carried out with any degree of completeness, even among infants, and was maintained at a high level for a few decades only. There was therefore always a large proportion of the population unaffected by the vaccination laws. Revaccination affected only a fraction. At the present the population is largely entirely unvaccinated. Members of the public health service now flatter themselves that the cessation of such outbreaks as do occur is due to their efforts. But is this so?[28]

The year 1948 brought an end to compulsory vaccination in England. By that point, the experiment of significantly reducing vaccination in Leicester, which had been going on for more than 60 years, proved a great success. In 1948, Dr. Millard stated:

...in Leicester during the 62 years since infant vaccination was abandoned there have been only 53 deaths from smallpox, and in the past 40 years only two deaths. Moreover, the experience in Leicester is confirmed, and strongly confirmed, by that of the whole country. Vaccination has been steadily declining ever since the “conscience clause” was introduced, until now nearly two-thirds of the children born are not vaccinated. Yet smallpox mortality has also declined until now quite negligible. In the fourteen years 1933-1946 there were only 28 deaths in a population of some 40 million, and among those 28 there was not a single death of an infant under 1 year of age.[29]

Dr. Thomas Mack had been involved in smallpox for roughly 40 years. His credentials include probably spending more time working up population-based outbreaks of smallpox than virtually anybody ever has. In the 2000s, Dr. Mack noted that societal changes had tamed smallpox. It was not from universal vaccination.

Disappearance [of smallpox] was facilitated, not impeded, by economic development. Long before the World Health Organization’s Smallpox Eradication Program began, and despite low herd immunity, unsophisticated public health facilities, and repeated introductions, smallpox disappeared from many countries as they developed economically, among them Thailand, Egypt, Mexico, Bolivia, Sri Lanka, Turkey, and Iraq.[30]

If people are worried about endemic smallpox, it disappeared from this country not because of our mass herd immunity. It disappeared because of our economic development. And that’s why it disappeared from Europe and many other countries, and it will not be sustained here, even if there were several importations, I’m sure. It’s not from universal vaccination.[31]

The notion that smallpox was just about a microbe that single-handedly killed millions needs to be questioned. This simplistic idea ignores the feeble health of the people and society during those times, as well as the dangerous and deadly medical practices. Copious bleeding, the hot regimen, and toxic medicines that purged the entire digestive system caused great harm, turning this disease into a fatal menace. Yet a microbe was 100% blamed for the deaths. It’s analogous to spraying gasoline on a tiny candle inside a home, which could make the whole house burn down, and then blaming the candle for the fire.

By the close of the 1800s, the health of people in society had vastly improved, and many faulty medical notions had all but vanished. Vaccination rates rapidly declined over the decades, proving to be more of a problem than a solution. Once again, smallpox had become a mild disease and slowly faded from the world. However, the idea that smallpox needed to be extinguished by the medical intervention of vaccination became a legend, and the only solution was very deeply embedded in our medical and societal consciousness.

It was so embedded that people were knowingly and willingly sacrificed on the ideological altar. According to an article written in 1968 by C. Henry Kempe, Professor and Chairman of the Department of Pediatrics, there were at least 200 to 300 vaccination deaths just because of a blind belief in the necessity for routine vaccination. How many died over the decades because of this belief?

The mortality and morbidity from routine infant smallpox vaccination in this country is now truly appalling when compared to the risk of smallpox… Analysis of data obtained from a review of questionnaires received from 19,616 physicians surveyed by us suggested that the estimated number of complications in 1963 was approximately 3,000, with ten to eighteen deaths among a total of fourteen million persons vaccinated… The last smallpox death in the United States following an importation occurred in 1948, but since that time there have probably been 200 to 300 deaths from smallpox vaccination… The majority of workers in the field of public health sincerely feel that the current morbidity and mortality from routine vaccination is “the price we have to pay” for keeping our country free of smallpox.[32]

This notion of defeating the “out there” enemy was so deeply entrenched that the idea and practice of vaccination was extended to several other diseases. What was ignored is that every single infectious disease death rate had fallen by a massive amount before any vaccine was introduced or, with some diseases, before any vaccine was used at all. For example, in the United States, measles deaths had dropped by over 98% before the vaccine was introduced in 1963. In England, measles deaths dropped by almost 100% before the vaccine was introduced in 1968. By the mid-1900s, measles, like smallpox, had become mainly a mild disease.

Yet, with enough indoctrination and repetition, mythology becomes a collective illusion, but that doesn’t make it true. As Giordano Bruno said over 400 years ago, “It is proof of a base and low mind for one to wish to think with the masses or majority, merely because the majority is the majority. Truth does not change because it is, or is not, believed by a majority of the people.”

The nearly general declaration of my patients enables me to proclaim that vaccination is not only an illusion, but a curse to humanity. More than ridiculous—it is irrational—to say that any corrupt matter taken from boils and blisters of an organic creature could affect the human body otherwise than to injure it… I myself know the names of a hundred physicians who think like me.[33] — Dr. Stowell, London, England, thirty years a public vaccinator

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[1] R. G. Latham, MD, The Works of Thomas Sydenham, MD, vol. I, 1848, London, pp. lxxii–lxxiii.

[2] John Pechey, MD, The Whole Works of that Excellent Practical Physician Dr. Thomas Sydenham, MD, 1696, London, p. 100.

[3] John Pechey, MD, The Whole Works of that Excellent Practical Physician Dr. Thomas Sydenham, MD, 1696, London, p. 404.

[4] Isaac Massey, apothecary to Christ’s Hospital, A Short and Plain Account of Inoculation, 1722, London, pp. 20–21.

[5] Isaac Massey, Remarks on Dr. Jurin’s Last Yearly Account of the Success of Inoculation, 1727, London, p. 5.

[6] Isaac Massey, apothecary to Christ’s Hospital, A Short and Plain Account of Inoculation, 1722.

[7] The Gentleman’s Magazine, July 1814, p. 24.

[8] The Public, Chicago, Saturday, August 27, 1898, no. 21, p. 5.

[9] The Parliamentary Debates, 1907, vol. CLXIX, p. 408.

[10] Abraham Rees, The Cyclopaedia; Or, Universal Dictionary of Arts, Sciences, and Literature, vol. 29, 1819.

[11] John Mason Good, MD, The Study of medicine: Empyesis Variola Smallpox, vol 1, 1864, New York, Harper & Brothers, Publishers, pp. 639–640.

[12] Charles Perry, MD, An Essay on the Smallpox, 1747, London. pp. 17–20.

[13] Lydia Kang, Nate Pedersen, “The ‘Murderous’ Medical Practice of the 18th Century,” March 1, 2018.

[14] “Russell Thacher Trall, MD, Water-cure for the Million, 1860, New York, p. 7.

[15] Samuel Dickson, MD, Glasgow, The “Destructive Art of Healing;” or, Facts for Families, Second Edition, 1855, London, Geo. Routledge & Co., pp. 5–6.

[16] Henry G. Hanchett, M.D., “An Inquiry in Prophylaxis,” The New York Medical Times, vol. XVI, no. 10, January 1889, p. 306.

[17] Charles V. Chapin, “Variation in Type of Infectious Disease as Shown by the History of Smallpox in the United States,” The Journal of Infectious Diseases, vol. 13, no. 2, September 1913, p. 173.

[18] Harry Bernhardt Anderson, State Medicine a Menace to Democracy, 1920, p. 84.

[19] C. Killick Millard, The Vaccination Question in the Light of Modern Experience: An Appeal for Reconsideration, 1914, London, pp. 15–17.

[20] Charles V. Chapin, “Variation in Type of Infectious Disease as Shown by the History of Smallpox in the United States,” The Journal of Infectious Diseases, vol. 13, no. 2, September 1913, p. 172.

[21] Charles V. Chapin, “Variation in Type of Infectious Disease as Shown by the History of Smallpox in the United States,” The Journal of Infectious Diseases, vol. 13, no. 2, September 1913, p. 178.

[22] Ibid., p. 179.

[23] John Gerald Fitzgerald, Peter Gillespie, and Harry Mill Lancaster, An Introduction to the Practice of Preventive Medicine, 1922, C.V. Mosby Company, p. 197.

[24] John Price Crozer Griffith, The Diseases of Infants and Children, Volume 1, 1921, W.B. Saunders Company, p. 370.

[25] George Dock, MD, “Smallpox and Vaccination,” Journal of the Missouri State Medical Association, vol. 19, April 1922, p. 168.

[26] Charles V. Chapin and Joseph Smith, “Permanency of the Mild Type of Smallpox,” Journal of Preventive Medicine, 1932.

[27] “Smallpox in the United States: Its decline and geographic distribution,” Public Health Reports, vol. 55, no. 50, December 13, 1940, pp. 2303-2312.

[28] Journal of the Royal Sanitary Institute, vol. 66, 1946, p. 176.

[29] C. Killick Millard, MD, DSc, “The End of Compulsory Vaccination,” British Medical Journal, December 18, 1948, p. 1074.

[30] Thomas Mack, MD, “A Different View of Smallpox and Vaccination,” New England Journal of Medicine, January 30, 2003, pp. 460–463.

[31] Transcript of the Meeting of the Advisory Committee on Immunization Practices held at the Atlanta Marriott Century Center, Atlanta, Georgia, on June 19 and 20, 2002.

[32] C. Henry Kempe, “Smallpox vaccination of eczema patients with attenuated live vaccinia virus,” Yale journal of biology and medicine, August 1968, pp. 9–10.

[33] A New Year's Gift to the Lord Provost, Magistrates, and Town Council of the City of Glasgow, 1st January, 1874. p. 46.