Editing Smallpox vaccine (section)

===Early vaccination===
[[File:Jenner phipps 01.jpg|thumbnail|Dr [[Edward Jenner]] performing his first vaccination on [[James Phipps]], a boy of age 8. 14 May 1796. Painting by Ernest Board (early 20th century).]]
In the early empirical days of vaccination, before [[Louis Pasteur]]'s work on establishing the [[germ theory]] and [[Joseph Lister]]'s on antisepsis and asepsis, there was considerable cross-infection. [[William Woodville]], one of the early vaccinators and director of the [[London Smallpox Hospital]] is thought to have contaminated the [[cowpox]] matter – the vaccine – with smallpox matter and this essentially produced variolation. Other vaccine material was not reliably derived from cowpox, but from other skin eruptions of cattle.<ref>{{cite web|url=http://lachlan.bluehaze.com.au/london2001/august2001/18aug2001c/|title=Statue of Dr Edward Jenner near the Italian Fountains, Kensington Gardens|website=lachlan.bluehaze.com.au|access-date=16 October 2019|archive-date=28 March 2006|archive-url=https://web.archive.org/web/20060328062647/http://lachlan.bluehaze.com.au/london2001/august2001/18aug2001c/|url-status=live}}</ref>

During the earlier days of empirical experimentation in 1758, American Calvinist [[Jonathan Edwards (theologian)|Jonathan Edwards]] died from a smallpox inoculation. Some of the earliest [[statistics|statistical]] and [[epidemiology|epidemiological]] studies were performed by [[James Jurin]] in 1727 and [[Daniel Bernoulli]] in 1766.<ref name="pmid15334536">{{cite journal | vauthors = Blower S, Bernoulli D | title = An attempt at a new analysis of the mortality caused by smallpox and of the advantages of inoculation to prevent it. 1766 | journal = Reviews in Medical Virology | volume = 14 | issue = 5 | pages = 275–288 | year = 2004 | pmid = 15334536 | doi = 10.1002/rmv.443 | url = http://www.semel.ucla.edu/biomedicalmodeling/pdf/Bernoulli&Blower.pdf | url-status = dead | s2cid = 8169180 | archive-url = https://web.archive.org/web/20070927032605/http://www.semel.ucla.edu/biomedicalmodeling/pdf/Bernoulli%26Blower.pdf | archive-date = 27 September 2007 }}</ref> In 1768, Dr [[John Fewster]] reported that variolation induced no reaction in persons who had had cowpox.<ref>{{cite book | veditors = Pearson G | title = An inquiry concerning the history of the cowpox, principally with a view to supersede and extinguish the smallpox | location = London, England | publisher = J. Johnson | date = 1798 | url = https://books.google.com/books?id=osdEAAAAcAAJ&pg=PA102 | pages = 102–104 | access-date = 31 December 2015 | archive-date = 25 January 2022 | archive-url = https://web.archive.org/web/20220125171737/https://books.google.com/books?id=osdEAAAAcAAJ&pg=PA102 | url-status = live }}</ref><ref>{{cite journal | vauthors = Thurston L, Williams G | title = An examination of John Fewster's role in the discovery of smallpox vaccination | journal = The Journal of the Royal College of Physicians of Edinburgh | volume = 45 | issue = 2 | pages = 173–179 | date = 2015 | pmid = 26181536 | doi = 10.4997/JRCPE.2015.217 | doi-access = free | title-link = doi }}</ref>
[[Image:The cow pock.jpg|thumb|right|An 1802 caricature by [[James Gillray]] depicting the early controversy surrounding Jenner's vaccination theory]]
[[Edward Jenner]] was born in [[Berkeley, Gloucestershire|Berkeley]], England. As a young child, Jenner was variolated with the other schoolboys through parish funds, but nearly died due to the seriousness of his infection. Fed purgative medicine and going through the bloodletting process, Jenner was put in one of the variolation stables until he recovered.<ref>Michael J. Bennett, War against Smallpox: Edward Jenner and the Global Spread of Vaccination (Cambridge, United Kingdom: Cambridge University Press, 2020), 32.</ref> At the age of 13, he was apprenticed to [[apothecary]] Daniel Ludlow and later surgeon George Hardwick in nearby [[Sodbury]]. He observed that people who caught cowpox while working with cattle were known not to catch smallpox. Jenner assumed a causal connection but the idea was not taken up at that time. From 1770 to 1772 Jenner received advanced training in London at St. George's Hospital and as the private pupil of [[John Hunter (surgeon)|John Hunter]], then returned to set up practice in Berkeley.<ref name=Bailey1996/>

Perhaps there was already an informal public understanding of some connection between disease resistance and working with cattle. The "beautiful [[milkmaid]]" seems to have been a frequent image in the art and literature of this period. But it is known for certain that in the years following 1770, at least six people in England and Germany (Sevel, Jensen, [[Benjamin Jesty|Jesty]] 1774, Rendall, Plett 1791) tested successfully the possibility of using the cowpox vaccine as an immunization for smallpox in humans.<ref>{{cite journal | vauthors = Hammarsten JF, Tattersall W, Hammarsten JE | title = Who discovered smallpox vaccination? Edward Jenner or Benjamin Jesty? | journal = Transactions of the American Clinical and Climatological Association | volume = 90 | pages = 44–55 | date = 1979 | pmid = 390826 | pmc = 2279376 }}</ref>

[[File:Smallpox vaccine.svg|thumb|Diagram A: Exposure to the cowpox virus builds immunity to the smallpox virus. 1a.&nbsp;Cowpox virus is injected into the bloodstream. 2a.&nbsp;The virus enters the cells and a mild fever develops. 3a.&nbsp;T-cells recognize the antigen as a threat. 4a.&nbsp;Activated T-cells replicate, and their offspring become memory T-cells. 5a.&nbsp;Antibodies are produced and destroy the virus. Diagram B: When exposed to the smallpox virus, the immune system is resistant. 1b.&nbsp;Smallpox virus is injected into the bloodstream. 2b.&nbsp;Memory T cells recognize the virus. 3b.&nbsp;Antibodies are produced and destroy the virus.]]

[[File:Edward Jenner- Smallpox.svg|thumb|upright=1.35|left| The process above shows the steps taken by Edward Jenner to create vaccination. Jenner did this by inoculating James Phipps with cowpox, a similar virus to smallpox, to create immunity, unlike variolation, which used smallpox to create an immunity to itself.]]

Jenner sent a paper reporting his observations to the Royal Society in April 1797. It was not submitted formally and there is no mention of it in the Society's records. Jenner had sent the paper informally to [[Sir Joseph Banks]], the Society's president, who asked [[Everard Home]] for his views. Reviews of his rejected report, published for the first time in 1999, were skeptical and called for further vaccinations.<ref>{{cite journal | vauthors = Baxby D | title = Edward Jenner's unpublished cowpox inquiry and the Royal Society: Everard Home's report to Sir Joseph Banks | journal = Medical History | volume = 43 | issue = 1 | pages = 108–110 | date = January 1999 | pmid = 10885136 | pmc = 1044113 | doi = 10.1017/S0025727300064747 }}</ref> Additional vaccinations were performed and in 1798 Jenner published his work entitled ''An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox.''<ref name="riedel2005"/><ref>{{cite journal | vauthors = Winkelstein W | title = Not just a country doctor: Edward Jenner, scientist | journal = Epidemiologic Reviews | volume = 14 | pages = 1–15 | year = 1992 | pmid = 1289108 | doi = 10.1093/oxfordjournals.epirev.a036081 }}/</ref><ref>{{cite journal | vauthors = Willis NJ | title = Edward Jenner and the eradication of smallpox | journal = Scottish Medical Journal | volume = 42 | issue = 4 | pages = 118–121 | date = August 1997 | pmid = 9507590 | doi = 10.1177/003693309704200407 | s2cid = 43179073 }}</ref> It was an analysis of 23 cases including several individuals who had resisted natural exposure after previous cowpox. It is not known how many Jenner vaccinated or challenged by inoculation with smallpox virus; e.g. Case 21 included 'several children and adults'. Crucially all of at least four whom Jenner deliberately inoculated with smallpox virus resisted it. These included the first and last patients in a series of arm-to-arm transfers. He concluded that cowpox inoculation was a safe alternative to smallpox inoculation, but rashly claimed that the protective effect was lifelong. This last proved to be incorrect.<ref name=Baxby1999/> Jenner also tried to distinguish between 'True' cowpox which produced the desired result and 'Spurious' cowpox which was ineffective and/or produced severe reaction. Modern research suggests Jenner was trying to distinguish between effects caused by what would be recognised as a non-infectious vaccine, a different virus (e.g. [[paravaccinia virus|paravaccinia]]/milker's nodes), or contaminating bacterial pathogens. This caused confusion at the time, but would become important criteria in vaccine development.<ref name=Baxby2001>{{cite book|title=Smallpox Vaccine, Ahead of Its Time – How the Late Development of Laboratory Methods and Other Vaccines Affected the Acceptance of Smallpox Vaccine | vauthors = Baxby D |year=2001|publisher=Jenner Museum|location=Berkeley, UK|isbn=978-0-9528695-1-1|pages=12–16}}</ref> A further source of confusion was Jenner's belief that fully effective vaccine obtained from cows originated in an equine disease, which he mistakenly referred to as ''grease''. This was criticised at the time but vaccines derived from horsepox were soon introduced and later contributed to the complicated problem of the origin of [[vaccinia virus]], the virus in present-day vaccine.<ref name=baxby1981>{{cite book| vauthors = Baxby D |title=Jenner's smallpox vaccine; the riddle of vaccinia virus and its origin|year=1981|publisher=Heinemann Educational Books|location=London|isbn=0-435-54057-2}}</ref>{{rp|165–78}}

The introduction of the vaccine to the New World took place in [[Trinity, Newfoundland and Labrador|Trinity, Newfoundland]], in 1798 by [[John Clinch|Dr. John Clinch]], boyhood friend and medical colleague of Jenner.<ref>{{cite web|url=http://ngb.chebucto.org/Articles/clinch1a.shtml|title=Plaque in Memory of Rev. John Clinch|vauthors=Piercey T|date=August 2002|access-date=28 May 2014|archive-url=https://web.archive.org/web/20180320171350/http://ngb.chebucto.org/Articles/clinch1a.shtml|archive-date=20 March 2018|url-status=live}}</ref><ref>{{cite book |vauthors=Handcock G |year=1996 |title=The Story of Trinity |location=Trinity |publisher=The Trinity Historical Society |page=1 |isbn=978-098100170-8}}</ref> The first smallpox vaccine in the United States was administered in 1799. The physician [[Valentine Seaman]] gave his children a smallpox vaccination using a serum acquired from Jenner.<ref>{{cite web |url=http://libweb5.princeton.edu/visual_materials/maps/websites/thematic-maps/quantitative/medicine/medicine.html |title=First X, Then Y, Now Z : Landmark Thematic Maps – Medicine |website=Princeton University Library|date=2012|access-date=22 May 2018|archive-url=https://web.archive.org/web/20180913015235/http://libweb5.princeton.edu/visual_materials/maps/websites/thematic-maps/quantitative/medicine/medicine.html|archive-date=13 September 2018|url-status=dead}}</ref><ref>{{cite book|title=Encyclopedia of the New American Nation| vauthors=Morman ET |publisher=Charles Scribner's Sons|year=2006| veditors=Finkelman P |pages=207–08|chapter=Smallpox}}</ref> By 1800, Jenner's work had been published in all the major European languages and had reached [[Benjamin Waterhouse]] in the United States – an indication of rapid spread and deep interest.<ref name = "Hopkins_2002">{{cite book | vauthors = Hopkins DR |title=The greatest killer : smallpox in history, with a new introduction |date=2002 |publisher=University of Chicago Press |location=Chicago |isbn=978-0-226-35168-1}}</ref>{{rp|262–67}} Despite some concern about the safety of vaccination the mortality using carefully selected vaccine was close to zero, and it was soon in use all over Europe and the United States.<ref name="Bazin_2000">{{cite book|vauthors=Bazin H|title=The Eradication of Smallpox|year=2000|publisher=Academic Press|location=London |isbn=978-0-12-083475-4|pages=94–102}}</ref><ref>{{cite journal |vauthors=Rusnock A |title=Catching cowpox: the early spread of smallpox vaccination, 1798-1810 |journal=Bulletin of the History of Medicine |volume=83 |issue=1 |pages=17–36 |year=2009 |pmid=19329840 |doi=10.1353/bhm.0.0160 |s2cid=24344691}}</ref>

[[File:Real Expedición Filantrópica de la Vacuna 01.svg|thumb|upright=1.35|right|The [[Balmis Expedition]] took the vaccine to Spanish America in 1804.]]
In 1804 the [[Balmis Expedition]], an official Spanish mission commanded by [[Francisco Javier de Balmis]], sailed to spread the vaccine throughout the Spanish Empire, first to the Canary Islands and on to Spanish Central America. While his deputy, José Salvany, took vaccine to the west and east coasts of Spanish South America, Balmis sailed to [[Manila]] in the Philippines and on to [[Guangzhou|Canton]] and [[Macau|Macao]] on the Chinese coast. He returned to Spain in 1806.<ref>{{cite journal| vauthors = Smith MM |title=The 'Real Expedición Marítima de la Vacuna' in New Spain and Guatemala|journal=Trans. Am. Philos. Soc. |series=New Series|year=1970|volume=64|issue=4|pages=1–74|doi=10.2307/1006158|jstor=1006158 }}</ref> The vaccine was not carried in the form of flasks, but in the form of 22 orphaned boys, who were 'carriers' of the live cowpox virus. After arrival, "other Spanish governors and doctors used enslaved girls to move the virus between islands, using lymph fluid harvested from them to inoculate their local populations".<ref name="lancet">{{cite journal |vauthors=Ranscombe P |date=July 2022 |title=Vaccine Voyages: where science meets slavery |url=https://doi.org/10.1016/S1473-3099(22)00270-5 |journal=The Lancet Infectious Diseases |volume=22 |issue=7 |pages=956 |doi=10.1016/s1473-3099(22)00270-5 |issn=1473-3099 |pmc=9023002 |access-date=26 June 2022 |archive-date=8 July 2022 |archive-url=https://web.archive.org/web/20220708045921/https://www.thelancet.com/retrieve/pii/S1473309922002705 |url-status=live }}</ref>

[[Napoleon]] was an early proponent of smallpox vaccination and ordered that army recruits be given the vaccine.<ref>{{cite journal | vauthors = | title = Nova et Vetera | journal = British Medical Journal | volume = 1 | issue = 2370 | pages = 1297–1298 | date = June 1906 | pmid = 20762710 | pmc = 2381502 | doi = 10.1136/bmj.1.2370.1297 }}</ref> Additionally a vaccination program was created for the French Army and his [[Imperial Guard (Napoleon I)|Imperial Guard]]. In 1811 he had his son, [[Napoleon II]], vaccinated after his birth. By 1815 about half of French children were vaccinated and by the end of the [[Napoleonic Empire]] smallpox deaths accounted for 1.8% of deaths, as opposed to the 4.8% of deaths it accounted for at the time of the [[French Revolution]].<ref>{{cite book | vauthors = Tizard IR |title=A History of Vaccines and Their Opponents |date=2023 |publisher=[[Elsevier]] |page=99}}</ref>

On March 26, 1806, the [[Cantons of Switzerland|Swiss canton]] [[Thurgau]] became the first state in the world to introduce compulsory smallpox vaccinations, by order of the cantonal councillor ''Jakob Christoph Scherb''.<ref>{{cite journal | vauthors = Habicht ME, Varotto E, Galassi FM | title = The Swiss Canton of Thurgau - not the Kingdom of Bavaria-was the first state to introduce compulsory vaccination against smallpox | journal = Public Health | volume = 205 | pages = e16–e17 | date = April 2022 | pmid = 35305819 | doi = 10.1016/j.puhe.2022.01.028 | pmc = 9768693 | hdl = 10447/621085 | hdl-access = free }}</ref><ref>{{cite web |url=https://archives-quickaccess.ch/statg/rechtserlasse/ref/3'69,+0.0/5,+21 |title=Verordnung des Sanitätsrates vom 26.03.1806 wegen jährlicher Impfung der Schutzblattern |access-date=11 January 2025 |website=Thurgauer Rechtserlasse ab 1803 |publisher=Staatsarchiv Thurgau |language=German |via=archives-quickaccesses.ch}}</ref> Half a year later, [[Elisa Bonaparte]] issued a corresponding order for her [[Principality of Lucca and Piombino]] on 25 December 1806.<ref>{{cite journal | vauthors = Pavli A, Maltezou HC | title = Travel vaccines throughout history | journal = Travel Medicine and Infectious Disease | volume = 46 | pages = 102278 | date = March 2022 | pmid = 35167951 | pmc = 8837496 | doi = 10.1016/j.tmaid.2022.102278 }}</ref> On 26 August 1807, Bavaria introduced a similar measure. Baden followed in 1809, Prussia in 1815, Württemberg in 1818, Sweden in 1816, England in 1867 and the German Empire in 1874 through the Reichs Vaccination Act.<ref name="MeyerReiter">{{cite journal | vauthors = Meyer C, Reiter S | title = [Vaccine opponents and sceptics. History, background, arguments, interaction] | language = German | journal = Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz | volume = 47 | issue = 12 | pages = 1182–1188 | date = December 2004 | pmid = 15583889 | doi = 10.1007/s00103-004-0953-x | s2cid = 23282373 }}</ref><ref name=":3">{{cite journal | vauthors = Klein S, Schöneberg I, Krause G | journal = Bundesgesundheitsblatt|title=Vom Zwang zur Pockenschutzimpfung zum Nationalen Impfplan|volume=55|at=pp.&nbsp;1512–1523|date=October 2012|language=German|doi=10.25646/1620 }}</ref> In Lutheran Sweden, the Protestant clergy played a pioneering role in voluntary smallpox vaccination as early as 1800.<ref>{{cite book | vauthors = Jarlert A | title = Sveriges Kyrkohistoria. | volume = 6 | location = Stockholm | date = 2001 | pages = 33–54 }}</ref> The first vaccination was carried out in Liechtenstein in 1801, and from 1812 it was mandatory to vaccinate.<ref>{{cite book | vauthors = Rheinberger R | chapter = Zum 200. Geburtstag von Landesphysikus Gebhard Schaedler. Ein Liechtensteinischer Artzt als Pionier der Pockenschutzimpfung. | title = Jahrbuch des Historischen Vereins fur das Furstentum Liechtenstein. Historischer Verein fur das Furstentum Liechtenstein | date = 1976 | volume = 76 | pages = 337–343 | chapter-url = http://www.eliechtensteinensia.li/viewer/image/000000453_76/333/ | access-date = 27 October 2021 | archive-date = 27 October 2021 | archive-url = https://web.archive.org/web/20211027101204/https://www.eliechtensteinensia.li/viewer/image/000000453_76/333/ | url-status = live }}</ref>

The question of who first tried cowpox inoculation/vaccination cannot be answered with certainty. Most, but still limited, information is available for [[Benjamin Jesty]], [[Peter Plett]] and [[John Fewster]]. In 1774 Jesty, a farmer of [[Yetminster]] in [[Dorset]], observing that the two milkmaids living with his family were immune to smallpox, inoculated his family with cowpox to protect them from smallpox. He attracted a certain amount of local criticism and ridicule at the time then interest waned. Attention was later drawn to Jesty, and he was brought to London in 1802 by critics jealous of Jenner's prominence at a time when he was applying to Parliament for financial reward.<ref>{{cite journal | vauthors = Pead PJ | title = Benjamin Jesty: new light in the dawn of vaccination | journal = Lancet | volume = 362 | issue = 9401 | pages = 2104–2109 | date = December 2003 | pmid = 14697816 | doi = 10.1016/S0140-6736(03)15111-2 | s2cid = 4254402 }}</ref> During 1790–92 Peter Plett, a teacher from [[Holstein]], reported limited results of cowpox inoculation to the Medical Faculty of the [[University of Kiel]]. However, the Faculty favoured variolation and took no action.<ref>{{cite journal | vauthors = Plett PC | title = [Peter Plett and other discoverers of cowpox vaccination before Edward Jenner] | language = de | journal = Sudhoffs Archiv | volume = 90 | issue = 2 | pages = 219–232 | year = 2006 | pmid = 17338405 | jstor = 20778029 }}</ref> John Fewster, a surgeon friend of Jenner's from nearby Thornbury, discussed the possibility of cowpox inoculation at meetings as early as 1765. He may have done some cowpox inoculations in 1796 at about the same time that Jenner vaccinated Phipps. However, Fewster, who had a flourishing variolation practice, may have considered this option but used smallpox instead. He thought vaccination offered no advantage over variolation, but maintained friendly contact with Jenner and certainly made no claim of priority for vaccination when critics attacked Jenner's reputation.<ref name = "Williams_2010">{{cite book| vauthors = Williams G |title=Angel of Death; the story of smallpox|url=https://archive.org/details/angeldeathstorys00will|url-access=limited|year=2010|publisher=Palgrave Macmillan|location=Basingstoke|isbn=978-0-230-27471-6|pages=[https://archive.org/details/angeldeathstorys00will/page/n182 162]–73}}</ref> It seems clear that the idea of using cowpox instead of smallpox for inoculation was considered, and actually tried in the late 18th century, and not just by the medical profession. Therefore, Jenner was not the first to try cowpox inoculation. However, he was the first to publish his evidence and distribute vaccine freely, provide information on selection of suitable material, and maintain it by arm-to-arm transfer. The authors of the official [[World Health Organization]] (WHO) account ''Smallpox and its Eradication'' assessing Jenner's role wrote:<ref name = "Fenner_1988" />{{rp|264}}

{{blockquote|Publication of the Inquiry and the subsequent energetic promulgation by Jenner of the idea of vaccination with a virus other than variola virus constituted a watershed in the control of smallpox for which he, more than anyone else deserves the credit.}}

As vaccination spread, some European countries made it compulsory. Concern about its safety led to opposition and then repeal of legislation in some instances.<ref name = "Williams_2010" />{{rp|236–40}}<ref name = "Williamson_2007">{{cite book| vauthors = Williamson S |title=The Vaccination Controversy; the rise, reign and decline of compulsory vaccination|year=2007|publisher=Liverpool University Press|location=Liverpool|isbn=9781846310867}}</ref> Compulsory infant vaccination was introduced in England by the [[Vaccination Act 1853]] ([[16 & 17 Vict.]] c. 100). By 1871, parents could be fined for non-compliance, and then imprisoned for non-payment.<ref name = "Williamson_2007" />{{rp|202–13}} This intensified opposition, and the [[Vaccination Act 1898]] ([[61 & 62 Vict.]] c. 49) introduced a conscience clause.<ref>{{Cite journal | vauthors = Durbach N |date=2002 |title=Class, Gender, and the Conscientious Objector to Vaccination, 1898-1907 |url=http://www.jstor.org/stable/3070762 |journal=Journal of British Studies |volume=41 |issue=1 |pages=58–83 |doi=10.1086/386254 |jstor=3070762 |url-access=subscription }}</ref> This allowed exemption on production of a certificate of conscientious objection signed by two magistrates. Such certificates were not always easily obtained and a further act in 1907 allowed exemption by a statutory declaration which could not be refused. Although theoretically still compulsory, the [[Vaccination Act 1907]] ([[7 Edw. 7]]. c. 31) effectively marked the end of compulsory infant vaccination in England.<ref name = "Williamson_2007" />{{rp|233–38}}

[[File:PO Notice 1919 re Small Pox Vaccination.jpg|thumb|upright|1919 Notice issued by the British [[General Post Office]] encouraging postal staff to apply for the free vaccination]]
In the United States vaccination was regulated by individual states, the first to impose compulsory vaccination being Massachusetts in 1809. There then followed sequences of compulsion, opposition and repeal in various states. By 1930 Arizona, Utah, North Dakota and Minnesota prohibited compulsory vaccination, 35 states allowed regulation by local authorities, or had no legislation affecting vaccination, whilst in ten states, including Washington, D.C. and Massachusetts, infant vaccination was compulsory.<ref name = "Hopkins_2002" />{{rp|292–93}} Compulsory infant vaccination was regulated by only allowing access to school for those who had been vaccinated.<ref>{{cite journal | vauthors = George NA | title = Compulsory smallpox vaccination; the University City, Missouri, case | journal = Public Health Reports | volume = 67 | issue = 11 | pages = 1135–1138 | date = November 1952 | pmid = 12993980 | pmc = 2030845 | doi = 10.2307/4588305 | jstor = 4588305 }}</ref> Those seeking to enforce compulsory vaccination argued that the public good overrode personal freedom, a view supported by the U.S. Supreme Court in ''[[Jacobson v. Massachusetts]]'' in 1905, a landmark ruling which set a precedent for cases dealing with personal freedom and the public good.<ref>{{cite journal |date=May 2008 |title=Toward a Twenty-First-Century ''Jacobson v. Massachusetts'' |url=http://cdn.harvardlawreview.org/wp-content/uploads/pdfs/a_twenty-first-century_jacobson_v_massachusetts.pdf |journal=[[Harvard Law Review]] |publisher=The Harvard Law Review Association |volume=121 |issue=7 |pages=1823–1824 |access-date=13 March 2014 |archive-date=26 October 2014 |archive-url=https://web.archive.org/web/20141026203112/http://cdn.harvardlawreview.org/wp-content/uploads/pdfs/a_twenty-first-century_jacobson_v_massachusetts.pdf |url-status=live }}</ref>

[[Louis T. Wright]],<ref name=North_by_South>{{cite web|title=A Brief Biography of Dr. Louis T. Wright|work=North by South: from Charleston to Harlem, the great migration|url=http://northbysouth.kenyon.edu/1998/health/wright.htm|access-date=23 September 2006|archive-date=20 October 2017|archive-url=https://web.archive.org/web/20171020103829/http://northbysouth.kenyon.edu/1998/health/wright.htm|url-status=live}}</ref> an African-American [[Harvard Medical School]] graduate (1915), introduced, while serving in the Army during [[World War I]], intradermal, smallpox vaccination for the soldiers.<ref name=MITRE_CDAC>{{cite web|title=Spotlight on Black Inventors, Scientists, and Engineers |work=Department of Computer Science of Georgetown University |url=http://www.cs.georgetown.edu/~blakeb/mm/BHM/Spotlight%20on%20Black%20Inventors,%20Scientists,%20and%20Engineers.htm |access-date=23 September 2006 |url-status=dead |archive-url=https://web.archive.org/web/20060907060826/http://www.cs.georgetown.edu/~blakeb/mm/BHM/Spotlight%20on%20Black%20Inventors,%20Scientists,%20and%20Engineers.htm |archive-date=7 September 2006 }}</ref>