Dr. James Smith's Dream of Eradicating Smallpox and the National Vaccine Institution.

This article re-examines from a new perspective the efforts of James Smith (1771-1841), a Maryland doctor, to eradicate smallpox in the United States. As one of the few successful cowpox inoculators at the turn of the nineteenth century, Smith recognized the necessity for a public vaccine institution that could ensure the safe production and continuous preservation and circulation of vaccine matter. Thus, he devoted himself to creating statewide and national vaccine institutions funded by the state and federal governments. He established the National Vaccine Institution (NVI), but despite his efforts, the NVI existed only a short time from 1813 to 1822. Previous studies on Smith have focused on the 1813 Vaccination Act (An Act to Encourage Vaccination) and the NVI, and have evaluated them as failed projects or historically missed opportunities. However, this kind of approach does not justly place the act and institutions within Smith's larger plan and do not fully discuss the role of the NVI in his system of promoting vaccination in the United States. This article analyzes how he responded to the problems hindering cowpox vaccination, including spurious vaccine, failed vaccination, and low public acceptance of cowpox vaccine. In doing so, this study shows that Smith attempted to establish a universal and systematic vaccination system connecting citizens, government, and medical personnel through the NVI, as well as ensuring a safe and regular supply of vaccine.