The Archaeology of Vaccination (18th- 20th Centuries): An Examination of Four Diseases

With the recent development of Covid-19 vaccines by Moderna, Oxford University and Pfizer, there seems to be little else on everyone’s mind. Vaccination against deadly diseases has a history that can been illustrated in archaeological examples left behind. Death rates from crude attempts at ‘variolation’ (the practice of grounding up smallpox scabs for inhalation or scratching onto the skin) had a death rate as high as 30% in China during the 16th century. Refining of such techniques using inoculation and vaccination has led to a revolution in global health, with some diseases such as smallpox eradicated completely.
This blog post will examine the history of vaccines in the last 300 years, associated with four deadly diseases, by examining archaeological examples in museums. There are many more vaccinations for an array of diseases, but I have narrowed it down to four for this blog post. Although proven to be safe and effective, vaccines are becoming more and more controversial in today’s society- something that can be traced back to past societies as well.

Disease: Smallpox
Symptoms: Fever, aches, vomiting, rash, sores, and pustules that eventually scab and fall off.
Objects: Civil War Era Vaccine (Mutter Museum) and Lancets of Edward Jenner 19th century (Science Museum)

When one thinks of vaccination, Edward Jenner and smallpox usually springs to mind. Inoculation was being practiced in China as far back as 1000 years ago. This inoculation was being carried out using pus or scabs from smallpox to boost immunity against the disease. It was around the 18th century this concept began to develop in Europe. Lady Wortley Montagu seen the ‘scratch method’ of inoculation in 1721 in Turkey and used this method to inoculate her own children against smallpox. She is credited with introducing this method to London high society.
Edward Jenner (1749-1823) noticed a similar practice on English farms and in the surrounding communities. Milkmaids in the countryside were renowned for having a clear complexion. This was because they were often infected with cowpox, meaning they were often left immune to smallpox (thus not having any facial scarring). Locals began to inoculate themselves with cowpox to immunize against the deadlier smallpox. Jenner adapted this method in his own practice, applying pus from a milkmaid’s cowpox pustule (these were usually on the hand) to that of a young boy in 1796. You can still see the lancets Jenner used to apply the pus to the boy’s arm, he would have used the scratching technique. He later exposed the boy to smallpox, after which no disease developed. In 1798, Jenner published his findings in a book 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 The Cow Pox’ (Vacca is the Latin word for cow).

George Washington insisted on quarantining regulations within the Continental army in the 1770’s when smallpox outbreaks occurred, eventually crudely inoculating the army in 1777. A higher percentage of British troops had already suffered from smallpox, unlike the Americans who were more susceptible to catching the disease. Unlike Jenner, Washington was inoculating the army with the live smallpox virus- a very risky procedure instead of using a milder related orthopoxvirus. Vaccination was also being carried out in the army during the American Civil war (c.1860’s), an example of a lancet vaccination kit can be seen at the Mutter Museum in Philadelphia. Like Jenner’s kit, it consisted of lancets for scratching. DNA testing of the blades revealed a virus used for vaccination was present, there were no signs of the smallpox virus itself.

Six lancets of Edward Jenner used for vaccination
Civil War era lancet kit for vaccination

Disease: Cholera
Symptoms: Diarrhoea, vomiting, thirst, cramps.
Objects: Glass Amboules of Cholera Vaccine 1924 and 1892 (Wellcome Collection)

Cholera is most associated with the physician John Snow, who mapped the cases of cholera in Soho, London in the 1850’s – Asiatic cholera reached Britain in 1831. This allowed him to conclude that the water supply was the source of the disease, debunking claims concerning miasma theory. Prior to this there had been numerous outbreaks of cholera in Britain, with 1854 becoming the worst year of the disease to take hold. Snow realised sewerage contamination was the cause of the disease, suggesting the removal of the pump handle in the affected area.
However, it was not until 1885 that the vaccine was developed by Spanish physician Jaime Ferrán (1852-1929). The cholera vaccine was the first vaccine to protect humans against a bacterial disease. The vaccine was developed when Ferrán cultivated bacteria from an ill person and then administered injections into the arm (not the scratch technique). He went on to develop vaccines for plague, rabies, and tetanus. Louis Pasteur is also credited with developing a cholera vaccine using chickens. He used a weakened culture to inoculate the chickens, after survival they were immune to the disease. The Wellcome collection houses a 1892 example of the vaccine that had been developed from inoculating guinea-pigs.
In the Wellcome Collection, there is an example of the cholera vaccine dating to 1924. The amboules are French (from Paris), and have the name of a laboratory that developed vaccines for the army. Because of the water-borne nature of the disease, cholera, as well as typhoid, were considered serious threats to soldiers. Vaccination was a part of an initiative to keep the army healthy. This strongly echoes the times of the smallpox outbreaks amongst American soldiers in the previous centuries – however we see the move away from the previously crude ‘scratch’ technique with a lancet.

1892 cholera vaccine example
1924 French cholera vaccine

Disease: Influenza
Symptoms: Fatigue, aches, chills, cough, sore throat, fever, headache.
Object: 1919 Influenza Vaccine (Pharmaceutical Society Museum)

Since the outbreak of Covid-19 in 2020, there has been many comparisons drawn between today’s pandemic and the Spanish Flu H1N1 pandemic of 1918. The spread of the disease was exacerbated by movement of troops at the end of World War 1. Half a billion people all over the world were infected, eventually killing somewhere between 50-100 million people- the most severe pandemic in recent history. Mortality rates were high in children under 5, the elderly and those aged between 20-40 years old (the healthy being susceptible was unique in this pandemic). Prior to the vaccine, interventions such as quarantine, hand hygiene, social distancing, and disinfecting were used to control the illness.

Vaccines had been developed for other diseases at the time of the outbreak, so it was hopeful a vaccine could be developed for influenza. A few vaccines developed around this time are now thought to have been ineffective. As the disease was viral influenza, it would not have been treated by these newly developed bacterial vaccines, but many may have prevented pneumonia from developing. It wasn’t until the 1930’s that researchers realised that influenza was caused by a virus (in the 1918 case it was influenza A strain) – it was successfully isolated in 1933. It can be said then that the 1919 vaccine example from the Pharmaceutical Society Museum was likely ineffective during the outbreak. This had been developed by the Royal Army Medical College using lung scrapings from infected patients.
The influenza A vaccine was developed in the 1930’s, followed shortly by the influenza B vaccine in 1942. In 1945 the vaccine (for both A and B) was approved for military use in the US and for public use in 1946. Both Dr Thomas Francis and Dr Jonas Salk were involved in flu vaccine research and development after Ernest William Goodpasture was able to grow viruses using chicken embryos in 1931.

1919 Influenza Vaccine

Disease: Tuberculosis
Symptoms: Cough with bloody phlegm, weight loss, sweats, fever, fatigue, neck swellings.
Object: Freeze dried BCG (bacillus Calmette-Guerin) Vaccine 1980 (Science Museum Group)

The BCG vaccine is made from a weakened strain of Mycobacterium bovis, close in nature to M. tuberculosis which causes TB. Bacteriologists Albert Calmette and Camille Guerin are credited with developing the vaccine between 1908 and 1921 at the Pasteur Institute, Lille, France – the oral dose was endorsed by the League of Nations in 1928. Calmette was a pupil of Louis Pasteur and had acquired Mycobacterium bovis from the milk of an infected cow. The vaccine was adopted in France and Scandinavia initially, with widespread distribution stalled due to a contamination that killed 75 babies vaccinated within 10 days of birth- known as the 1930 Lubeck Disaster. The vaccine eventually became widespread after the Second world war and is administered via needle into the arm today.
The Science Museum houses a set of freeze-dried intradermal BCG vaccine dating to 1980-85. Made by Evans Medical Ltd, freeze drying allowing for transportation over long distances. This would have been particularly significant at the time as in the 1980’s there was a rise in TB cases in developed countries due to healthcare complacency, movement of people from countries with a lot of TB cases, and the spread of the HIV (there is evidence of co-infection). According to the World Health Organisation, TB kills 1.8 million people every year, with one third of the global population infected but asymptomatic. Despite initial reluctance in uptake, over 4 billion people have now been vaccinated against TB, making it the most widely used vaccine in the world. Unlike the UK, the US has never introduced mass use of the vaccine as it is thought there are not many cases of TB in America- vaccines can be purchased privately for around $100-200.

Freeze dried BCG Vaccine dated between 1980-1985

Arnold, C., 2008. Necropolis: London and its dead. Simon and Schuster.

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