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One of the most feared diseases in the 18th century was smallpox. A high percentage of those infected died; many who survived were blinded or badly disfigured. Inoculation [1] against the disease had been introduced into Europe from the Middle East early in the century and subsequently conveyed to the American colonies. Inoculation, however, was not without risk. There were deaths associated with the inoculation process, as it initiated the disease, though in a milder form. There was also the not-unfounded concern that smallpox could be spread through an inoculated person not properly quarantined. Consequently, inoculation often encountered fear and opposition.[2]

It may seem surprising, then, that Thomas Jefferson, who boldly opined in 1799 that the “state of medicine is worse than that of total ignorance,”[3] would be an early advocate of smallpox inoculation and later as president would openly support the introduction of the less virulent but still controversial cowpox vaccine into the United States.

Smallpox inoculation was discouraged in many of the colonies, including Virginia, when Jefferson traveled to Philadelphia at age 23 to undergo inoculation.[4] When the procedure was brought to Norfolk County, Virginia, in 1768 and again in 1769, it provoked riots on both occasions. Jefferson, then practicing law, became involved when he agreed to defend victims of the Norfolk riots, including Dr. Archibald Campbell, whose house had been burned as a result of the inoculations carried out there. Jefferson would give up his law practice before the case was resolved, but he later served on a committee that placed a bill before the Virginia General Assembly to reduce the 1769 restrictions on smallpox inoculation.[5]

The spread of smallpox became an issue in the American Revolution, as the British were accused of conducting biological warfare. During the French and Indian Wars, the Ottawa Indians threatening the British at Fort Pitt were deliberately given blankets used by smallpox victims.[6] It was feared a similar action had taken place during the failed American campaign in Canada. In 1776, Jefferson was appointed to a congressional investigating committee and, according to his notes, one witness before the panel claimed, “The small pox was sent out of Quebeck by Carleton, inoculating the poor people at government expense for the purpose of giving it to our army.”[7] This issue arose again during the British invasion of Virginia, as an indeterminate number of slaves who had fled to the British army had contracted smallpox. Virginians feared that the sick slaves were being deliberately used by the British to spread the disease.[8]

This increased presence of the disease in Virginia may have prompted Jefferson to encourage his wife, Martha, to accompany him to Philadelphia in 1776 with one objective being smallpox inoculation. His friend Thomas Nelson encouraged him, “You must certainly bring Mrs. Jefferson with you. Mrs. Nelson shall nurse her in the small pox and take all possible care of her.”[9] Mrs. Jefferson did not make the trip to Philadelphia, and it is uncertain whether she ever received inoculation before her death in September 1782. But it is a testimonial to Jefferson’s confidence in smallpox inoculation that just two months after the devastating loss of his wife, he had their daughters inoculated.[10]

After becoming president in 1801, Jefferson expanded his commitment to smallpox inoculation. His library catalog indicates that he followed the work of the British physicians Edward Jenner and John Lettsom in their experiments with the use of the milder cowpox as an effective immunization against smallpox.[11] He worked with American doctors, especially Benjamin Waterhouse, to establish this new vaccine, also known as kinepox, in the United States and allowed his name to be used as an endorsement.

Jefferson brought his involvement to a new level during the summer of 1801, when he directed the inoculation of Monticello slaves, his sons-in-law, and some of his neighbors – about 200 people in all, according to his estimate. He began with vaccine received from Dr. Waterhouse but then was able to collect his own vaccine from those inoculated, and from this was able to send vaccine to other parts of Virginia and to Washington.[12] Some of his notes and statistics were published in Dr. John Coxe’s “Practical Observations on Vaccination: or Inoculation for the Cow-Pock,” and Jefferson received a letter from the Royal Jennerian Society in London recognizing his promotion of the vaccine in the United States.[13]

Jefferson also espoused the value of inoculation in his June 1803 instructions to Meriwether Lewis, who was preparing for what would become the Lewis and Clark Expedition: “Carry with you some matter of the kine-pox; inform those of them with whom you may be, of it’s efficacy as a preservative from the smallpox; & encourage them in the use of it.”[14]

Primary Source References

1801 August 20. (A. Bainbridge to Jefferson). "Its at the request of my old intimate friend, Doctor Edward Garrett. The inclosed letter to him contains some of the Vaccine matter. He says the most certain conveyance will be to inclose it to you, and you would send it to him."[15]

1802 January 17. (Jefferson to Martha Jefferson Randolph). "Dr. Gannt has inoculated six of his Cow-pox patients with the small pox, not one of which took it. Many have been tried in Philadelphia, and with the same issue. As the matter here came from Monticello, and that at Philadelphia from this place, they establish the genuineness of our inoculations and may place our families and neighbors in perfect security."[16]

1809 January 1. (Martha Jefferson Randolph to Jefferson). "...We received the vaccine safe and will inoculate our children immediately as well as our neighbors. Jefferson was inoculated with the small pox in Richmond with Virginia and Anne..."[17]


  1. This article is based on Gaye Wilson, "Jefferson: Advocate of Inoculation." Monticello Newsletter, 15:(Spring 2004).
  2. For a discussion of smallpox inoculation and its introduction into Europe and America see Elizabeth A. Fenn,Pox Americana: The Great Smallpox Epidemic of 1775-82 (New York: Hill and Wang, 2001), 1-43 and Genevieve Miller, "Smallpox Inoculation in England and America: A Reappraisal," The William and Mary Quarterly, 3rd series, 13 (October 1956): 476-492.
  3. Thomas Jefferson to William Green Munford, 18 June 1799. Peterson, Writings, 1065.
  4. Thomas Jefferson to John Page, 25 May 1766. PTJ, 1:18-20. Discussed in Malone, 1:99-1000.
  5. Frank L. Dewey, "Thomas Jefferson's Law Practice: The Norfolk Anti-Inoculation Riots," VMBH, 91 (January 1983): 39-53; Robert H. Halsey, How the President, Thomas Jefferson and Doctor Benjamin Waterhouse Established Vaccination as a Public Health Procedure, (New York: Published by the author, 1936), 33-34, cites W.W. Henig, "The Statutes at Large of Virginia," v. VIII and IX.
  6. Fenn, 88-89.
  7. PTJ, 1:435.
  8. Philip Ranlet, "The British Slaves, and Smallpox in Revolutionary Virginia," The Journal of Negro History, 84(Summer 1999): 217-226; Fenn, 130-133.
  9. PTJ, 1:286.
  10. Ibid, 6:206-207.
  11. Sowerby, 1:429-432.
  12. Thomas Jefferson to John Vaughn, 5 November 1801. Reprinted in Vaughn, found at Massachusetts Historical Society. See also a letter from Thomas Jefferson to Doctor Sharp. 12 September 1801. Massachusetts Historical Society and Thomas Jefferson to Benjamin Waterhouse 17 September 1801, Reprinted in Halsey, 41, found at Massachusetts Historical Society.
  13. Sowerby, 1:429 and 432.
  14. Thomas Jefferson to Meriwether Lewis 20 June 1803. Library of Congress.
  15. Massachusetts Historical Society.
  16. Family Letters, 216.
  17. Ibid, 375.

Further Sources


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