Monday, January 11, 2021

A Shot in the Arm

 By Rachel Dworkin, Archivist

 The first mass inoculation in North America occurred in Boston during an outbreak of smallpox in 1721. The inoculation campaign was spearheaded by Cotton Mather and Zabdiel Boylston, using a technique known as variolation which had been taught to Mather by an enslaved man named Onesiumus. Variolation, as practiced in Onesiumus’s native West Africa, involved rubbing dried pus from smallpox scabs into shallow cuts in a patient’s arm. They would then develop a relatively mild case of the disease and henceforth be immune. Over the course of the epidemic, Boylston and Mather managed to inoculate 247 people before anti-inoculation mobs forced them to stop. Still, the success of their efforts lead to the widespread adoption of variolation throughout the Colonies, especially in urban areas. In 1777, George Washington ordered that the entire Continental Army be variolated to prevent outbreaks in military encampments.

Modern vaccines are a bit different from variolation, although the basic idea is the same: give the body a taste of the disease so it knows how to fight it when it encounters the real thing. With variolation, the idea is to give the patient the actual disease, just a mild form. Vaccines, on the other hand, confer immunity without actually infecting the patient. There are seven types of vaccines currently in use:

  1. Inactivated vaccine using dead cells from the virus or bacteria. Examples include the Salk polio vaccine, hepatitis A vaccine, and most flu vaccines.
  2.  Attenuated vaccine using live, but weakened, strains of the virus (similar to variolation). Examples include the mumps, measles, and rubella vaccines.
  3. Toxoid vaccines using inactivated versions of toxic compounds which cause illnesses. Examples include tetanus, diphtheria and rattlesnake venom. 
  4.  Subunit vaccines using a fragment of a virus or bacteria rather than the whole thing. Examples include vaccines for hepatitis B, human papillomavirus, and the plague.
  5. Conjugate vaccine using a virus or bacteria along with a toxoid to boost immune response. Examples include vaccines for meningitis and typhoid fever.
  6. Heterotypic vaccines using a virus or bacteria which cause diseases in animals, not people. Examples include the original smallpox vaccine and the current tuberculosis vaccine.
  7. RNA vaccine using a virus’s genetic material. Examples include the COVID vaccine. This is the most cutting-edge type of vaccine on the market.

The first Chemung County residents to be vaccinated were soldiers. Beginning in 1812, the United States Army began regularly vaccinating troops against smallpox. During the Spanish-American War of 1898, all mobilized volunteer and militia members received the smallpox vaccine too. In fact, members of the US military were vaccinated against smallpox as late as 1990, long after the disease had been eradicated in civilian populations. Typhoid vaccines have been mandatory for members of the armed services since 1911. Even today, military members receive a battery of vaccines not commonly in use by civilians.

The first wide-scale civilian vaccination drive in Chemung County occurred in the summer of 1925. The Elmira Health Department worked with the Elmira City School District to vaccinate children under the age of 11 with the new toxoid diphtheria vaccine. Diphtheria is a potentially life-threatening bacterial infection which causes fever, cough, sore throat, and swelling of the throat resulting in difficulty swallowing or breathing. Over the course of the summer, the health department managed to vaccinate 1,468 children. Over the coming years, they continued to vaccinate children at their free Child Welfare Clinics and with the assistance of school nurses. By 1937, approximately 41% of pre-school aged children and 70% of school-aged children throughout the city were vaccinated against diphtheria. 

Dr. George Murphy of Elmira Health Department vaccinates child, 1935

During the 1940s, the city health department stepped up their vaccination efforts, adding vaccines for tetanus and whooping cough. In 1942, they launched a smallpox vaccination campaign. Starting on May 5, they offered weekly vaccination clinics. By year’s end, they’d vaccinated 1,218 children. Today, New York school children are required to be vaccinated against diphtheria, tetanus, and whooping cough, but not smallpox. 

Certificate of vaccination, 1886

 In 1955, Dr. Jonas Salk developed the world’s first polio vaccine. Just two years earlier in 1953, the county had suffered a serious outbreak of the illness. Beginning in May 1955, the county launched a massive and unprecedented vaccination drive. Children were bused from the schools to the County Health Center for their shots. Civil Defense volunteers were called up to help control the young crowds and direct traffic. Between May and October, they vaccinated 12,472 first, second, third, and fourth graders using vaccines donated from the Polio Foundation and the federal government. When the Sabine oral polio vaccine was released in 1962, the health department did it all over again, this time vaccinating 100,000 people of all ages.  

Little girl takes Sabine oral polio vaccine, July 1962. Image courtesy Star-Gazette

The current push to vaccinate everyone against COVID-19 is unprecedented only in its scale. Approximately 70% of the nation’s population will need to be vaccinated in order to generate herd immunity. Already, local efforts are underway. Employees at the local hospitals are being vaccinated and the Chemung County Health Department just opened up the Arctic League Headquarters at 249 W. Clinton Street as a vaccination center. The process will take months but, together, we can get there.  


  1. So Jenner and the milk maids with cowpox is not the first use of variolation?

    1. Variolation began in China sometime in the 10th century and spread west along the Silk Road before reaching Europe and the Americas in the 1720s. Technically, by using cowpox to protect against smallpox, Jenner was the first to use heterotypic vaccination.