Smallpox Deaths Research Articles

Life and death of smallpox

Smallpox is an ancient scourge known since the Antiquity. It is caused by a highly contagious airborne poxvirus. This strictly human disease exists in two forms: variola major (Asian smallpox) with mortality of 20–45%, and an attenuated form called variola minor or alatrim with mortality of 1–2%, which only recently appeared in Europe and America towards the end of the 19th century. The first smallpox pandemic was the "Antonine plague", which swept through the Roman Empire in the 2nd century AD, after which smallpox became endemic in the Old World, causing seasonal and regional epidemics in Europe, affecting mostly young children until the 19th century. The discovery of the New World in 1492 and the opening of the African slave trade favored in 1518 the contamination by smallpox of the native Amerindian populations, who were massively decimated during the following centuries. In the absence of any effective treatment, preventive methods were developed from the 18th century. First, variolation was used, a dangerous procedure that consists in inoculating intradermally a small quantity of virus from convalescent patients. In the early 19th century, Edward Jenner popularized the practice of inoculating cowpox, a mild cow disease. This procedure proved to be very effective and relatively safe, leading to the decline of smallpox during the 19th century. In the 20th century, a ten-year WHO vaccination campaign led to the total eradication of smallpox in 1977. During that century, smallpox caused an estimated 300–500 million deaths worldwide. Using molecular approach, it has been discovered that the smallpox virus emerged 3000–4000 years ago in East Africa and is closely related to the taterapox virus from African gerbils and to the camelpox virus, which causes variola in camelids. Today, smallpox virus strains are stored in freezers at the CDC in Atlanta and at the Vector Center in Koltsovo, Siberia. That is why smallpox remains a potential threat to the highly susceptible human species, as a result of an accident or malicious use of the virus as a biological weapon.

Pandemics, economic freedom, and institutional trade-offs.

We argue that institutions are bundles that involve trade-offs in the government’s ability to provide public goods that affect public health. We hypothesize that the institutions underlying economic freedom affect the mix of diseases by reducing diseases of poverty relative to diseases of commerce (those associated with free movement of people, such as smallpox or COVID-19). We focus on smallpox and typhoid fever in the late nineteenth century and early twentieth century in order to build on recent work that make arguments similar to ours, especially the framework Werner Troesken sets forth in The Pox of Liberty. Our evidence shows that economic freedom, in multiple periods of time and settings prior to the eradication of smallpox in the second half of the twentieth century, reduced typhoid mortality but had no effect on smallpox deaths. The implication for COVID-19 is that the trade-off between fighting the pandemic and preserving economic freedom may not be too severe in the short run. However, in the long run, the wealth benefits from economic freedom are likely to be crucial in reducing vulnerability to diseases of commerce primarily from their impact on comorbidities (such as diabetes and heart disease). Thus, economic freedom is on balance good for public health, which suggests that it, while requiring trade-offs, might be the best institutional bundle for dealing with pandemics. Supplementary InformationThe online version contains supplementary material available at 10.1007/s10657-021-09704-7.

Assessing a syndemic: Gibraltar in the time of cholera

More than a decade ago Singer (2009) described Gibraltar's experience with cholera and smallpox in 1865 as a syndemic. In this study, we provide a reassessment of that event and, consequently, propose a methodology to identify a syndemic at the population level. We propose that the concept of the harvesting effect from demographic studies on crisis mortality provides a useful framework for evaluating the presence of a syndemic. Our research begins by establishing a normative baseline mortality (BM) through life table analysis, where changes in life expectancy (LE) around BM can be used to show a distinctive pattern of significant decline and increase. Such was the case with the presence of both cholera and smallpox in the fall of 1865, when LE fell significantly to 19.64 years from the background LE of 32.88 years. A year later, this decline was followed by a significant increase in LE to 41.34 years. Excessive mortality followed by a fallow (healthy) period represents a signature feature of a syndemic driven by a short-term infectious disease epidemic. The presence of both cholera and smallpox in 1860 did not produce similar results, evidence which suggests that the presence of two infectious epidemics in an impoverished population was not sufficient to produce a syndemic. The presence of a protracted state of quarantine, with its concomitant social and economic consequences, was a driving force responsible for amplifying the disease burden in 1865, and elevating to a syndemic status.Multivariate Poisson regression revealed patio level limiting factors (such as, presence of a cistern, a well, a live-in servant, and a Jewish co-resident), as well as risk factors (such as, a smallpox death in the building; the presence of a foreign-born individual). From the two-phase assessment of the syndemic in Gibraltar, we developed a conceptual framework for identifying, contributing, driving, and limiting factors.

“CHILDREN’S PLAGUE”: SMALLPOX IN EUROPE 16TH - 18TH CENTURIES AND THE FIRST ATTEMPTS TO PREVENT IT IN POLTAVA REGION

The article deals with the morbidity and mortality of smallpox in Western Europe and the Russian Empire from the 16th to the beginning of the 19th century. At that time smallpox was almost a childhood disease, because before the introduction of vaccination in the 18th century about 80% of its victims were children under the age of 10. Widespread was the theory that the pathogens are present in the human body from birth. Effective treatment for smallpox has never existed, but the main procedures were correspond to the general level of medicine (bloodletting, laxative, herbal treatment). The first thing that really could protect for the disease was variolation. It is an artificial infection of a healthy person with smallpox material from a sick person with the hope that it can cause a mild illness with a small rash. It spread in Europe in the first quarter of the 17th century, thanks to E. Timoni, J. Woodworth and Lady M. Montague. Vaccination was the inoculation of humans with cowpox material, which also gave immunity from smallpox. It was invented in 1796 by the English doctor E. Jenner. His experiment based on the common belief that milkmaids never get sick with smallpox, but only with the cowpox. Since 1800, this method has spread into the Europe, displacing variolation. In the Russian Empire in 1811 the decree about the spreading the cowpox vaccinations was officially issued. It include the point about origination of the provincial and county smallpox committees to promote vaccination. Imperial officials in the case of the introduction of mass vaccination were relied on a church organization. It allows us to track smallpox control measures in the local level. In particular, the documents about the fight against smallpox in Pyriatyn County are concentrated in the fund of the Pyriatyn Spiritual Board of the State Archives of Poltava region (F. 801). The first official appeal to the Pyriatyn Spiritual Board in the case of encourage the population to vaccinate cowpox took place in 1804. In 1806 in each church was send the book about the useful of cowpox vaccination and the practice of this procedure. In 1831 the Pyriatyn Spiritual Board, for appeal of the County doctor, was call for priests to practice the vaccination against smallpox himself in their parishes. Poltava spiritual consistory established a number of decrees that introduce the duty of parishes clire to sent the semi-annual reports. They‘s content was different in different decree, and include the number of birth, death and vaccine children. The first was issued in 1806, and the next were after the establishment of smallpox committee in 1812, 1824 and 1833. The last of them provided the fixation of the number of death of smallpox among the children for every 6 month, from the second half of 1832. There was preserved corresponding reports of parish priests for the period from the second half of 1832 to the end of 1841. The most completed they was in 1833. In this year the general number of smallpox victim in the whole county was about 985 person. The following reports show significantly smaller numbers of them - less than 20 deaths per year in 1835, 1837, 1840 and 1841. This issue needs further investigation. Key words: smallpox, vaccination, morbidity, mortality, children mortality.

Lenape Country: Delaware Valley Society Before William Penn by Jean R. Soderlund (review)

Reviewed by: Lenape Country: Delaware Valley Society Before William Penn by Jean R. Soderlund Sandra L. Dahlberg LENAPE COUNTRY: Delaware Valley Society Before William Penn. By Jean R. Soderlund. Philadelphia: University of Pennsylvania Press. 2014. A commonly held idea is that Quaker settlers led by William Penn established Delaware Valley society’s emphases on freedom, tolerance, and peaceful conflict. In Lenape Country: Delaware Valley Society Before William Penn, however, Jean R. Soderlund demonstrates that these Delaware Valley hallmarks originated with the Lenape Indians and were the bases of Lenape economic and political dominance through successive waves of European colonization in the region. Soderlund states that the Lenapes were “amicable in large part from their own self-interest,” but also points out that the Lenapes’ value system was predicated on “a long-term commitment to personal freedom, religious liberty, political sovereignty, and peaceful resolution of conflict” that allowed Lenape and European communities to flourish (92, 196). Soderlund focuses on the period between 1615 and 1681, from the initial Dutch and Swedish colonies to Penn’s Quaker settlement. Soderlund convincingly argues that, until the 1730s, Europeans adapted to conditions that the Lenapes established for trade and land use and respected Lenape autonomy. In the seventeenth century, to ensure political stability in the region, the Lenapes “protected the Swedes and Dutch from each other because the competition among Europeans allowed the Natives to set prices and define the terms of trade” (75). Soderlund shows that the Lenapes determined where Europeans erected forts for trade and how much agricultural land they cultivated. Rather than permanently ceding their lands to Europeans, the Lenapes granted Europeans land-use privileges for which the Lenape received annual gifts from the settlers. Only once did settlers, the Dutch at Swanendael in 1631, circumvent the Lenapes’ terms. The Lenapes destroyed Swanendael, forcefully demonstrating that they preferred peaceful relations but would resort to violence to protect their sovereignty and maintain political dominance in the region. Soderlund’s thorough examination of colonial documents yields evidence that the Lenapes, not the Europeans, dictated conflict resolution processes. An example Soder-lund provides is the Lenape mourning war tradition, whereby “family members of a murder victim either could accept compensation in wampum or other goods to ‘cover’ the death or could kill the perpetrator” (38). Significantly, Soderlund demonstrates that through mourning war the Lenapes redressed smallpox deaths that they attributed to Europeans, from whom the Lenapes expected and received appropriate compensation. Soderlund shows that the Lenapes sustained mutually beneficial, peaceful alliances with the Swedes, Finns, Dutch, and English while maintaining their autonomy and sovereignty in the region until the Quakers’ arrival in the 1680s. The Lenapes outnumbered the Europeans until roughly 8,000 Quakers settled in the Delaware Valley between 1680 and 1685. Even though, as Soderlund states, “the Friends’ belief in religious liberty and commitment to friendly relations with Native Americans complemented [Lenape] cultural practices already in place,” Quakers also [End Page 122] instituted a hierarchical political structure that privileged provincial investors who expected profits (149). The English and Quakers challenged the land usage of the Lenapes’ “Swedish” (Swedes, Finns, Dutch, and German) allies and levied taxes to generate proprietary income, actions that led Swedes to abandon the region. Soderlund painstakingly details the most devastating blow to Lenape sovereignty, the 1737 Walking Purchase. Soderlund argues that because Penn did not complete the treaty by paying the Lenapes in full or delineating the boundaries of his “purchase,” the resultant confusion enabled Penn’s heirs and Penn’s secretary of the province, James Logan, to defraud the Lenapes by seizing the vast majority of remaining Lenape land. Throughout her book, Soderlund asserts that the Lenapes identified themselves as “’a free people, subject to no one,’ and as a group had no interest in destroying the liberty of others” (198). Even in the midst of decline, Lenape commitment to liberty compelled the Pennsylvania assembly to ban the importation of Carolina Indian slaves to the Delaware Valley. Soderlund’s Lenape Country provides an important corrective to Eurocentric myths about the evolution of Delaware Valley society. Lenape Country is meticulously researched and cautiously analyzed, qualities that strengthen Soderlund’s assertions for the primacy of Lenape influence in the formation...

Smallpox and Native American mortality: The 1780s epidemic in the Hudson Bay region

The smallpox epidemic of 1781–82 in the Hudson Bay region is said to have devastated the native population, causing mortality of at least 50%. We reassess this claim using a four-pronged approach. First, we total smallpox deaths reported by two fur trading posts that were in the midst of the epidemic. Second, we review case fatality rates in other smallpox outbreaks, and discuss the likely incidence of the disease among Native Americans. Third, we analyse trade during the period of the epidemic. Fourth, we estimate the native population prior to the epidemic based on the carrying capacity of the region. All four approaches lead to a similar conclusion. Mortality from smallpox was likely under 20%, which is much less than previously asserted.

Mortality from Smallpox: The 1780s Epidemic in the Hudson Bay Region

The smallpox epidemic of 1781-82 in the Hudson Bay region reportedly devastated the native population, causing mortality of at least 50 percent. We reassess this claim. We total smallpox deaths reported by two trading posts in the path of the epidemic. Next we review mortality from smallpox in other outbreaks. Then the volume of trade is analysed. Finally, mortality is inferred from the pre-epidemic population, based on the region’s carrying capacity, and the post-epidemic population, from later estimates. Our approaches imply a similar conclusion. Mortality from smallpox was much less than has previously been asserted, likely under 20 percent.

Smallpox eradication in Bangladesh, 1972–1976

Rahima Banu, the world's last endemic case of severe smallpox, Variola Major, developed rash on October 16, 1975 on Bhola Island, Bangladesh. Achieving eradication in a country destroyed by war challenged the achievement of smallpox eradication. Between January 1, 1972 and December 31, 1975, 225,000 smallpox cases and 45,000 smallpox deaths occurred. Adapting the global smallpox eradication strategies of surveillance, the detection of smallpox cases, and containment, the interruption of smallpox transmission, utilized progress toward three objectives to monitor performance: (1) surveillance - the percent of smallpox infected villages detected within 14 days of the first case of rash, (2) knowledge of the reward - public knowledge of the current amount of the reward for reporting smallpox, and (3) containment - the percent of infected villages interrupting smallpox transmission within 14 days of detection. Failures to achieve these objectives led to the identification and implementation of improved strategies that eventually achieved eradication. Essential to this success was a tripartite partnership of the citizens of Bangladesh, the Bangladesh Ministry of Health, its field staff, and staff and resources mobilized by the World Health Organization.

The Life and Death of Smallpox (review)

Reviewed by: The Life and Death of Smallpox Jeffrey Koplan Ian Glynn and Jenifer Glynn. The Life and Death of Smallpox. Cambridge: Cambridge University Press, 2004. x + 278 pp. Ill. $25.00 (0-521-84542-4). Smallpox is a disease whose time has come and gone and then come back yet again. From the official declaration of eradication in 1979 to the mid-1990s, study of and reflection on the disease was largely limited to medical historians and a few virologists. With increasing concern about potential bioterrorist agents, smallpox included, and the recurrent rumors and anecdotes of potential unaccounted-for caches of the lethal virus, the press and the public, public health researchers and government officials, intelligence agencies and pharmaceutical manufacturers have all developed a renewed interest in this pathogen. The Life and Death of Smallpox provides a relatively pithy primer on the biology and history of both the disease and the vaccine. It is clearly written and contains considerable information. The general reader looking for an overview might turn here and gain some insights. However, the authors seem to have relied on a small number of oft-referenced sources; they only superficially address some key policy issues and recent events; and they offer no new insights about them. For the reader interested in the history of smallpox, it is best to seek Donald Hopkins's book The Greatest Killer.1 For the clinical aspects of smallpox, the disease, see C. W. Dixon's text, Smallpox.2 For details of the eradication effort, see the series of country-specific volumes produced by the World Health Organization. For consideration of more recent smallpox vaccination policy, see the report of an Institute of Medicine committee, The Smallpox Vaccination Program.3 The first several chapters cover the histories of first the disease and then the discovery and dissemination of vaccination. The chapters are organized chronologically, and within each era they address events and individuals in many parts of [End Page 385] the world. Thus, the reader is taken from England to Scotland to France to New Zealand to the Crimea to the U.S. Civil War within two pages in chapter 10. The resulting narrative is filled with information, and because there is no easy way to present such multinational, multimillennial material, the reader may occasionally feel a bit jet-lagged. One attribute of this book is its more extensive coverage of smallpox and vaccination in England. There are many interesting anecdotes and facts—from references to smallpox in the works of great British novelists, to learning that Josiah Wedgwood (of pottery fame) was the grandfather of Charles Darwin. But some interesting and relevant historical elements are not included. George Washington is mentioned as having "an acute awareness of the danger of inoculated smallpox" (p. 88), for example, but there is no mention that his face was pockmarked due to an infection acquired in Barbados in 1751. Chapters on the recent history of the eradication effort and on the issues of smallpox and bioterrorism suffer from a reliance on limited sources (the IOM report is not referenced) and a lack of critical analysis. Many individuals who played critical roles in smallpox eradication have been ignored or undervalued. In the late 1960s and early 1970s David Sencer, the director of the then Communicable Disease Center, made key decisions in resource allocation and prioritization that provided crucial support to the global effort. The role of the U.S. Agency for International Development is not discussed. The authors do not mention that the WHO during the smallpox eradication campaign used as a justification for the program their belief that this agent was very unlikely to be used for bioterrorism. In addition, the story of eradication could be considerably enhanced by including more of the perspectives of the local participants in programs for which most of the histories have been provided by a few international participants. Such a book has yet to be written. The discussion of recent smallpox-vaccination policy decisions also suffers from little political context. The IOM committee report questioned the scientific credibility of the promulgated policy. The role of the USSR in advocating early for the eradication of smallpox and then later stockpiling...

The Life and Death of Smallpox. By Ian and Jenifer Glynn. Cambridge and New York: Cambridge University Press. $25.00. x + 278 p; ill.; index. ISBN: 0‐521‐84542‐4. 2004.

Previous articleNext article No AccessHuman Biology & HealthThe Life and Death of Smallpox. By Ian and Jenifer Glynn. Cambridge and New York: Cambridge University Press. $25.00. x + 278 p; ill.; index. ISBN: 0‐521‐84542‐4. 2004.Jonathon ErlenJonathon ErlenGraduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania Search for more articles by this author Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by The Quarterly Review of Biology Volume 80, Number 2June 2005 Published in association with Stony Brook University Article DOIhttps://doi.org/10.1086/433143 Views: 5Total views on this site PDF download Crossref reports no articles citing this article.

Smallpox

In many ways, The Life and Death of Smallpox portrays the history of this devastating disease with more human interest than other recent volumes covering the same subject. Unfortunately, this is only true after chapter 7.

The life and death of smallpox

The life and death of smallpox

The life and death of smallpox

1. 'The most terrible of all the ministers of death' 2. From myths to mummies 3. Coming into focus: 0 - 1500 AD 4. Smallpox in the age of discoveries: 1500 AD to 1700 AD 5. News from the east 6. Kicking against the pricks 7. The heyday of inoculation 8. From cuckoos to cowpox 9. The world-wide spread 10. Confusion and compulsion 11. A hundred years on 12. 'Bring hither the fatted calf' 13. Sorting out the viruses 14. Eradication: the beginning of the end 15. 'Annihilation of the smallpox' 16. 'And out of good still to find means of evil'.

The life and death of smallpox

The life and death of smallpox

ESTIMATING THE DISEASE PARAMETERS FOR SMALLPOX IN LONDON OVER THE PERIOD 1708 TO 1748

When predicting the spread of a disease such as smallpox, knowledge of the transmission parameter, R0, is important. Previous studies have estimated R0 from outbreaks of the disease, but these estimates are prone to uncertainties because of the small population sizes and the short data runs. This study uses data from smallpox deaths in London over the period 1708 to 1748. Although smallpox was endemic in the population at this time, by using an estimator based upon a second order Gaussian filter to fit a nonlinear model to the dynamics of the disease, the disease parameters are obtained, leading to an estimate of R0. The model also reveals the importance of temperature and rainfall on the transmissibility of the disease.

The Prodigious Pustule

The Prodigious Pustule

Discovery of antivirals against smallpox.

Smallpox, a devastating infectious disease dreaded throughout much of recorded history, is caused by the variola virus, a member of the poxviridae family. In the 20th century alone, smallpox deaths worldwide numbered in the millions. In 1980, after an intensive program of immunization with vaccinia virus, a related but relatively nonpathogenic virus, the World Health Organization (WHO) declared the disease eradicated. By 1983, all known stocks of variola virus were in two WHO collaborating centers: the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta and (after a transfer in 1994) the Russian State Research Center of Virology and Biotechnology (the Vektor Institute) in Novosibirsk. The WHO Committee on Orthopoxvirus Infections voted on several occasions to recommend destruction of the stocks, but each time the decision was deferred to permit more research on live variola virus. A 1999 National Academies report summarized and assessed scientific needs for live variola virus (1). The concern that undeclared stocks of variola virus might exist and that they might be used as a bioterrorist weapon (2) was heightened in late 2001 by the deliberate release of Bacillus anthracis , the agent of anthrax, in the weeks after the September 11, 2001, attacks. That concern prompted a voluntary national-preparedness effort to vaccinate healthcare workers, first responders, and members of the military against smallpox. However, given the substantial side effects, the risks associated with the smallpox vaccine, and the absence of information about an imminent bioterrorist attack, vaccination was not accepted by all members of those groups, nor was it recommended for the general public by the government (3). Whatever the likelihood of covertly held variola virus stocks, an intentional release of the virus would pose a serious health threat and would probably provoke a …

The Two Faces of Smallpox: A Disease and Its Prevention in Eighteenth- and Nineteenth-Century Sweden

Reviewed by: The Two Faces of Smallpox: A Disease and Its Prevention in Eighteenth- and Nineteenth-Century Sweden Donald A. Henderson Peter Sköld. The Two Faces of Smallpox: A Disease and Its Prevention in Eighteenth- and Nineteenth-Century Sweden. Demographic Data Base, Umeå University, Report no. 12. Umeå, Sweden: Umeå University, 1996. 654 pp. Ill. $69.95 (paperbound). This book, as the author explains, is intended to portray the eighteenth-century face of smallpox, then the most feared of all diseases, and a second face typifying the nineteenth century, when smallpox mortality declined precipitously as vaccination came to be widely applied. Based on the all-too-limited data available, smallpox mortality rates began to decline in the mid-to-late 1700s in those parts of Europe where variolation began to be practiced, and then plummeted dramatically when, in the early 1800s, vaccination was introduced. However, there exists little detailed information about smallpox epidemiology, and few quantitative measurements of the impact of inoculation and vaccination, because of the incompleteness of national mortality and morbidity data before the mid-eighteenth century. Sweden is the exception in having reasonably complete data on smallpox deaths since 1747, as well as some information as to the numbers inoculated and vaccinated. Peter Sköld has clearly made a formidable effort to compile and analyze the available information from Sweden. In a book of more than 650 pages, he presents his findings in a veritable tidal wave of tables and maps, including some unusual parameters such as the relationships between smallpox immunity and fecundity and fertility, and the choice of marriage partner by immunity status. Despite the massive quantity of data presented, I found little here that was really new or particularly interesting. Unfortunately, Sköld has little to offer regarding the influence of inoculation on smallpox deaths because very few inoculations appear to have been performed in Sweden. Case-fatality rates over time would have been of the greatest interest, but information on cases and deaths is available only for the period 1862–74. Vaccine-efficacy data are similarly lacking because the data needed for such estimates were simply not collected. We are thus left with a formidably long book with more tables and maps than we can begin to digest. It is suggestive of a thesis at the end of a first draft. One would hope that the author might distill from this a more succinct version of perhaps 100–150 pages that would focus on the more important data, trends, and relationships. It is quite possible that buried under the massive data sets there are important insights that even this especially motivated reader may have missed. Donald A. Henderson Johns Hopkins University Copyright © 1999 The Johns Hopkins University Press

From inoculation to vaccination: smallpox in Sweden in the eighteenth and nineteenth centuries.

Smallpox was a dominating cause of death in eighteenth-century Sweden. Inoculation, introduced in 1756, was never widespread. The districts with the highest mortality at the end of the century were more prone to accept vaccination when it was introduced in 1801. However, within 15 years almost 80 per cent of all new-born children were vaccinated. The organization of vaccination was efficient, vaccinators were appointed in all 2,500 parishes in Sweden, and a report system gave all the necessary information. The last step was taken in 1816 when vaccination became compulsory. Before vaccination; 95 percent of smallpox deaths were those of children, but after 1801 it became as common among adults. Due to problems with re-vaccination, adults faced a much greater risk of infection during the last epidemic of 1873–75 than during the previous century. After the 1880s smallpox became an uncommon disease and smallpox deaths were rare.

Snippets from the Past: Seventy Years Ago in the Journal

What will epidemiologists in the year 2067 think as they leaf through the two volumes of the Journal published in 1997? Will they find any topics of current interest? As we look back to 1927, we note that the 54 papers in volume 7 included quite a few that are of little interest to most of today's epidemiologists. For example, nine dealt with parasitology (e.g., The Viability of Cysts of Giardia lamblia from Man in the Stomach of the Rat (1)), six with mosquito habits and taxonomy, and six with nasal infections of rabbits (e.g., Bacteria Occurring in Nasal Cultures from Rabbits and Their Relation to Snuffles and Pneumonia (2)). While a good case could be made for the value of all 54 articles in the development of public health science, there are several that seem more relevant to recent problems. Although smallpox has now been eradicated, it was still a serious concern in the United States when volume 7 was published. In 1920, 498 smallpox deaths occurred in the Death Registration Area, and in California alone, 4,486 cases were reported (3). Although most of the cases were mild in nature, virulent outbreaks occurred from time to time. Assurance was needed that vaccines were potent Back in 1902, Congress had made the regulation of viruses, serums, and toxins a responsibility of the US Public Health Service, then part of the US Treasury Department, Testing of these products was done in its Hygienic Laboratory (4). In 1927, John N. Force, along with James Leake, who was to become a leading authority on smallpox, developed an improved test of the potency of smallpox vaccine (5), a test based on the work of Calmette and Guerin (6), French scientists who later became famous for their tuberculosis vaccine. In this volume of the Journal, Force and Eddie (7) reported on the use of the new test to evaluate smallpox vaccines available commercially in San Francisco, California. Smallpox vaccine was supplied in small capillary tubes and had to be kept on ice to protect its potency. Vaccine from 16 different retail and wholeReceived for publication October 3, 1997, and accepted for publication October 7, 1997.