“The further we extend our knowledge of nature, the more we become convinced of our ignorance and the more clearly we see how little we know of the wonderful works of the Almighty Creator of things.” It is the somewhat vague and broad conclusion with which the American doctoral student Benjamin Waterhouse concluded his dissertation in 1780.
Today, medical students would no longer be able to get away with just 38 pages of expositions by mostly Greek philosophers, such as Paracelsus, when it comes to the topic of this PhD: explaining and curing infectious diseases. It would also no longer be written in Latin, but in English.
The yellowed and vulnerable book, which can still be found in the Leiden University Library, is one of the few tangible traces that Waterhouse has left in the student city. There is an ANWB sign on the facade of the red brick house where he lived between 1778 and 1781, Langebrug 45. But that only mentions John Quincy Adams, the sixth president of the United States, who lived there briefly during his student years. The adult Waterhouse was both mentor and roommate to the thirteen-year-old here Wunderkind.
Waterhouse ended up in Leiden after a formative period of study in London. There the American immersed himself richly in the environment of the Royal Society, the British academy of sciences. In the Netherlands he had to put his profession into practice. Or to, as physician friend John Fothergill put it, “develop some Dutch slime” – professional coldness. Becoming a tough healer. In 1781, Waterhouse returned to his home country as one of the best trained American physicians, writes his biographer Philip Cash. And just in time.
130,000 dead
The fledgling republic, still involved in the War of Independence against British rulers, was crying out for new ideas about disease control and medical innovations. At the same time as the revolutionary and Enlightenment-inspired ideals of equality and freedom, something else spread. A deadly virus: Variola major. The smallpox.
It is estimated that at least 130,000 people succumbed to variola in North America in the period 1775-1782, more than 5 percent of the total population. A percentage comparable to the Spanish Flu (1918-1920) and many times higher than what the corona pandemic has caused. Most victims occurred in the big cities and among the extremely vulnerable indigenous population. For the latter, it was yet another devastating European plague that wiped entire tribes and cultures off the map. Explorers such as the famous Meriwether Lewis and William Clark found empty settlements all over the country years after the epidemic. native Americans. The Arikas tribe in the current state of South Dakota had only two or three villages in 1794, compared to dozens twenty years earlier, the Frenchman Jean-Baptiste Truteau noted in his diary.
Native Americans during a confrontation with British Colonel Henry Bouquet, who had deliberately distributed among them blankets contaminated with the smallpox virus.
Photo Getty Images
There was a weapon in the fight against smallpox: variolation or inoculation, or the transfer of fluid from the pustules of patients infected with smallpox into small wounds inflicted by a doctor in healthy people. In China it was known as early as the sixteenth century that anyone who was infected with variola was subsequently immune. This knowledge spread to Europe and North America in the eighteenth century.
But in the thirteen rebellious British colonies, as now, they were somewhat anti-vax. The procedure was controversial. Those who sought treatment were ill and contagious for weeks. In many cities, inoculation was prohibited by law because it could cause smallpox outbreaks if quarantines were not properly enforced. One of the Founding Fathers of the United States, scientist Benjamin Franklin, did not believe in inoculation for a long time. Until his four-year-old son died of smallpox in 1736. “I have long regretted, and still regret, that I did not give him smallpox by vaccination,” he wrote years later in his autobiography.
This medical procedure was also expensive and therefore only reserved for the very rich – such as Franklin. Farmers, craftsmen and servants could not simply suffer illness for weeks. Barely educated and deeply religious, they did not understand or trust science and therefore had no interest in it.
Thomas Jefferson had already been illegally inoculated against smallpox in 1766
The War of Independence and the great smallpox epidemic were a turning point for variolation. “We must fear this disease more than the sword of our enemy,” wrote General George Washington to the chief physician of his Continental Army on February 6, 1777. The struggle of the American rebels against the British rulers had not been a success until then. With mostly untrained and undisciplined militia members – farm boys and old men – the commander-in-chief and future president lost more battles than he won against the most powerful army in the world during the eight-year conflict. Washington’s greatest enemies were not the redcoats and their infamous Hessian mercenaries, but smallpox.
For this Founding Father, the epidemic meant that hundreds of men at the front became ill at the same time and had to be quarantined. These patients then had to be guarded – so that they did not escape and infect more people – by resistant soldiers, who in turn Washington had to miss at the front. The Americans’ first major military campaign, the invasion of British-dominated Canada, failed because of variola. Nearly half of the eleven hundred men succumbed to it.
After months of hesitation, Washington ordered his men to be inoculated against smallpox in the spring of 1775. Sickening his army on a large scale and locking them up in hospitals for weeks was for a long time too great a risk. Yet, Washington felt, his military success depended on containing smallpox infections. Even though it was a logistical nightmare to keep it secret from the British that thousands of men were being taken from the front. “I need not tell you how important the need for secrecy is,” Washington wrote to a doctor. “There is no doubt that the enemy will use this information.” Thus, in 1777, the first state immunization campaign in American history began secretly. One that, according to historian Ron Chernow, was one of the decisive factors in winning the war against the British.
Prestigious faculty
This was the climate into which Waterhouse returned in 1781. One that inspired American ideals life, liberty and the pursuit of happiness were inextricably linked to a belief in medical progress. Where revolutionary new personal freedoms could only exist if citizens collectively protected each other against pathogens. In this America, a year after arriving, Waterhouse helped found Harvard Medical School. Then a small branch of the university, today one of the most prestigious and well-known medical faculties in the world.
Here Waterhouse began experimenting with a smallpox vaccine. In 1799, a physician friend from London sent him the book by the British physician Edward Jenner. What Waterhouse would call ‘the golden treatise’ for the rest of his life forever changed his life and American medical science. In the book, Jenner describes how infecting healthy patients with mild cowpox, vaccinating (after the Latin word for cow, ‘vacca’), makes them immune to the much deadlier smallpox virus. “While reading this work I was struck by the countless benefits it can bring to this country and to the human race,” an impressed Waterhouse wrote to the generous donor.
Letters about the potential of vaccination to his old friend and president John Adams, father of his Leiden housemate John Quincy, went unanswered in 1799. But his vice president and successor Thomas Jefferson, perhaps the greatest ally of American science and medicine at that time, did respond. This author of the Declaration of Independence had already been illegally inoculated against smallpox in 1766. The two corresponded extensively about Waterhouse’s experiments with vaccinations. As president, Jefferson helped spread the physician’s public health narrative beginning in 1801. With his help and insight to vaccinate vulnerable native Americans making it a priority, this new life-saving medical procedure spread throughout North America. It earned Waterhouse the title ‘the American Jenner’.
The fight against smallpox in the United States in the eighteenth and nineteenth centuries ushered in an era of medical progress and confidence in science. Highlights include the polio vaccine, which was partly developed through the efforts of President Franklin Delano Roosevelt, and the more recent Covid vaccines.
Measles outbreak
Waterhouse would be shocked by America in 2025. Under the leadership of Minister Robert F. Kennedy, research into promising mRNA vaccines was stopped this year. Also, established vaccination schedules for children are currently being adjusted without clear scientific reasons, the largest measles outbreak since 2000 is underway, quacks are being given a place on medical advisory committees and there is chaos at the Centers of Disease Control (the American RIVM).
It’s a bizarre twist for a medical success story in a country that will celebrate its 250th anniversary next year.
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