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In early 1822 Dr. James Smith, the Baltimore-based United States vaccine agent, received a disturbing letter from Dr. John Ward of Tarboro, North Carolina. Ward had recently vaccinated some patients with vaccine from the National Vaccine Institute, and he was concerned about its violent effects on his patients. According to physicians like Smith, vaccine was preferable to smallpox because it was a gender virus that still conveyed immunity to that disease, the scourge of the eighteenth century. Yet many of Ward's patients were now covered in a "crop of pustules." Ward wrote frantically to Smith telling him in detail about the vaccine he had used-scabs wrapped in a small piece of paper. Smith sent back a puzzled reply, asking how Ward had come by this packet. Smith noted that he always sent out the institute's vaccine preserved on glass, not as loose scabs in paper, and suggested that perhaps the vaccine had become "inert" in transit. Meanwhile, Ward obtained more trustworthy vaccine from a nearby colleague and successfully vaccinated his neighbors to prevent smallpox from spreading. All together, twelve people contracted the dreaded disease, although no one died.1Though Ward's actions halted the spread of smallpox in Tarboro, the medical emergency quickly morphed into a political batde over federal government involvement in affairs "best left to the states."2 In further correspondence among Smith, Ward, and another North Carolina physician, Benjamin Hunter, it emerged that the packet of vaccine enclosed in the letter Ward received from Smith was marked with a square box with a dot in its middle and the word "variol"-the indication Smith used for himself to denote the packets of potential smallpox scabs he collected to examine. How this packet was included in the letter to Ward remains unclear, but upon learning of the mistake, Smith castigated Ward for being so obtuse as to use scabs marked "variol," a word any trained physician should know referred to smallpox. For his part, Ward demanded to know why Smith would even have kept such a packet, let alone allowed it to slip into an official institute letter. To this challenge Smith never had a satisfactory answer.3 When word of the Tarboro disaster and Smith's confused conduct reached Congress, representatives wasted litde time in investigating and disbanding the National Vaccine Institute. Their reasoning, however, was not that vaccine was dangerous. Instead, congressman after congressman rose to register objection to the danger of federal involvement in health concerns, which they viewed as a local problem. Smith's failure as vaccine agent, they opined, was the result of improper government action. Vaccine itself emerged unblemished from the political fray.* * * 4The political theater surrounding the death of the National Vaccine Institute was the last stage in more than two decades of ideological conflict over the implementation of vaccination in the young American republic. First publicized in Edward Jenner's 1798 pamphlet, An Inquiry in to the Causes and Effects of the Variolae Vaccinae, the cowpox virus generated a global sensation as a "wonderful Prophylactic" against smallpox in the early nineteenth century. Jenner had conducted experiments confirming a longstanding folk belief that the cowpox virus protected against smallpox when inserted into the human body, a discovery welcomed as a sign of progress in science and medicine. In the United States physicians and political visionaries were especially excited about vaccine, as the "simple, easy, and intelligible" preventive seemed uniquely suited to both the enlightened ideals and the practical needs of the American republic.5 Yet because Americans interpreted these ideals in two fundamentally different ways, vaccination became a significant batdeground in disagreement over the shape of America's political future. For twenty years, conflicting political ideologies-one egalitarian, one more hierarchical-sought to shape the way in which Americans implemented Jenner's medical innovation. …