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Battling Smallpox

If you lived in Keokuk in 1881, Christmas day was unforgettable. Smallpox broke out in this southern Iowa city on that day. One of the most contagious diseases of this period in history, smallpox was a killer. It was passed from one person to another—quickly. It was a disease spread only through human contact. The disease did not affect animals or insects, nor could they transmit the virus. Sometimes a person could catch the disease by touching the skin lesions or wounds of an infected person. The virus could also be transferred through droplets of moisture from coughing or sneezing or by touching clothing, bedding or other objects used by someone with the disease.

Smallpox affected people of all ages. Those who survived could be left blind or disfigured by ugly scars called pockmarks. Few diseases were so destructive to humans. It was a disease with no cure. The word “smallpox” brought fear to Iowans as the disease could easily spread through whole communities!

The Keokuk epidemic had its start at a local medical college. The state’s oldest and largest medical school was located in Keokuk. A medical student nicked himself with a scalpel. The scalpel had come from a dead body infested with smallpox. The smallpox outbreak resulted in 71 cases being reported to the State Department of Health. There were nine confirmed deaths.

Local Control Fights Disease

Who worked to control the spread of contagious diseases and the prevention of illness around the state? In 1882 Keokuk had no local health board to deal with the epidemic. A State Board of Health had been established in 1880. But for the first few years its main concern was collecting statistics on births, death and marriages from Iowa’s 99 counties. Methods of communication were slow for collecting all this information. The state could provide little help to community leaders in Keokuk at the time. Whatever response was to be made to the epidemic had to come from local sources.

Keokuk in 1882 was better prepared than some Iowa cities to wage war against smallpox and other diseases. The city was located along a low-lying area of the Mississippi and Des Moines rivers. It had previously experienced malaria, cholera and yellow fever epidemics. A pest-house was located in Keokuk. This was a small wooden shack on the outskirts of town. Sometimes when people suffered from contagious diseases like smallpox, they needed to be isolated from others. Those individuals were quarantined in the pest-house. Keokuk had better medical facilities than many other cities at the time too. It had a ready supply of doctors and medical students.

A local board of health was quickly formed in Keokuk. Its first action was to close the medical school. The board quarantined all those suspected of exposure to the disease. During this time some area newspapers wrote articles that criticized the Keokuk health board for not being able to control the epidemic. The board began to vaccinate school children against the illness. By the end of February 1882 most of the city’s population had been vaccinated or revaccinated.

Headlines and Rumors

The smallpox epidemic in Keokuk made national headlines. The local newspaper, the Keokuk Constitution reported the effects on local businesses. Rural residents and river traffickers refused to enter the city. Hotels and other businesses had few customers. Within a week of the first smallpox deaths, the New York Times published a report on the “ravages of smallpox” affecting Keokuk. Other newspapers printed unconfirmed stories and wrongly condemned the local board’s efforts. The Constitution attempted to correct any misinformation. One rumor stated there were 40 cases of smallpox when in reality there were only about ten. Rumors and untruths were rampant.

Local and State Boards Work Together

Iowa was a young state in 1882. Its population was growing. During this time thousands of immigrants from European countries came to live in Iowa. Public transportation was increasing around the state too. Passenger rail travel brought many of the immigrants to Iowa communities. The immigrants aboard the trains carried the potential to spread disease including smallpox. The influx of new settlers helped spread health problems around the state. Some Iowans viewed these outbreaks of disease as an outside threat to their way of life.

By 1885 the State Board of Health was becoming more of a recognized resource in promoting public health. In various communities the local influence was not as important as it had been. Around the state local boards were allowing the state board to be the main authority in health matters. Both local and state boards were beginning to work together to fight disease. More counties required that the state board be notified and keep record of all epidemic diseases.

Worth County, located near the Minnesota border, was the site of two severe smallpox outbreaks. These occurred in July 1886 and December 1899. Many times over the years new immigrants and travelers brought smallpox epidemics into this rural county. At different times dozens of people fell ill from the disease and a few died. State and local boards worked together to fight the disease. Some citizens resisted the state board’s effort to reestablish order during the 1886 epidemic. Worth County officials supported the decision. Local officials arrested and prosecuted those people who refused to obey the quarantine.

During the 1899 epidemic the state board directed most of the actions of the local health boards. This epidemic was traced to a street carnival in Albert Lea, Minnesota. The state board put quarantines and preventive measures in place. The state board also encouraged county mayors and alderman to create local boards where there were none. A state law passed in 1897 enabled the Worth County boards to arrest infected people who used public transportation.

More Epidemics

At the turn of the 19th century the state board of health was still limited in what it could do. A smallpox epidemic broke out in southwestern Iowa and eastern Nebraska in 1989-1899. Iowa’s State Board of Health offered its encouragement and limited support. The epidemic threatened to cover the state. By the late 1890s the board was waging war against disease on a number of fronts. It was encouraging improvements in sanitary and water systems and the development of a new diphtheria vaccine. It was up to the local boards to have the ultimate responsibility for ending a smallpox outbreak. The state board provided education and support to prepare carefully for epidemics and be ready to act when they happened.

Other epidemics occurred elsewhere in the state. The Fremont County epidemic began in mid-November 1898. The Hamburg- Nebraska City epidemic probably arrived via a Missouri River steamboat. In June 1889 the Chicago & North Western Railway epidemic occurred. It was an example of smallpox spreading from trains carrying immigrant passengers. This epidemic spread from one end of the state to the other. Two individuals died.

Concern about smallpox weakened around 1900. The disease itself had changed and milder cases were being reported. The changing nature of smallpox changed the state board’s approach to the disease too. Instead of stressing how it could be deadly and kill people, the board issued posters and pamphlets. These were designed to portray people who refused vaccination as uneducated and those who suffered the disease as threats to society. The state board could not do much more to prevent the spread of the smallpox. But they used their authority to educate the public. The State Board of Health encouraged the use of cowpox vaccine and the quarantine of exposed persons.

No Longer a Threat

In 1949 the World Health Organization (WHO) identified smallpox as a disease that could be wiped out. In 1967 the WHO began a vaccination campaign to eliminate smallpox outbreaks throughout the world. The last recorded case of smallpox was reported in 1977 in Somalia. In May 1980 the WHO reported the world was free of smallpox.


  • Frana, Philip L. “Battling Smallpox State and Local Boards of Health.” Iowa Heritage Illustrated 86, No. 2 (Summer 2005). Iowa City: State Historical Society of Iowa. Excerpted from longer article, "Smallpox: Local Epidemics and the Iowa State Board of Health, 1880-1900,"published in the Annal of Iowa, 54:2 (Spring 1995), 87-118.
  • Morris, Stephen. Edward Jenner (Pioneers of Science). New York: Bookwright Press, 1992.
  • Sick! Diseases and Disorders, Injuries and Infections. Volume 4. Detroit: U.X.L Gale, 2000. p697-701.
Adapted from Frana, Philip L. “Battling Smallpox State and Local Boards of Health.” Iowa Heritage Illustrated 86, No. 2 (Summer 2005). Iowa City: State Historical Society of Iowa.



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