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The Lancet and Licensed Medicine, 1804-1821

Semirosas Consulting

Semirosas Consulting

Semirosas Consulting

Educational Consulting


UNC Press


Academic Publishing


Technical Writing

Excerpt from National Immunities: Vaccination and Identity in Modern Cuba. (under contract with UNC Press)



Secretary Tomás Romay’s summary of the activities of the Central Vaccine Board for the members of colonial Cuba’s prestigious Economic Society in December of 1835 was bittersweet.  Since the introduction of smallpox vaccination in 1804, officials boasted a total of 311,342 vaccinated persons over the last 31 years. Yet overall tallies obscured more troubling fluctuations over time; the fact that since the early 1820s, the number of persons vaccinated had dwindled to a mere thousand or so per year was probably a most glaring omission for those few vaccinators present.

These alarming downturns in activity on the part of the vaccination board and the high percentage of the population subsequently left vulnerable to smallpox were only tangentially addressed. Instead, the secretary emphasized the positive.

Early Vaccination.jpg

Romay insisted that in the long term, vaccination had not only “preserved the inhabitants of this island from the most deadly and generalized of diseases [smallpox]”; it had also “augmented the population, fomented agriculture, increased commerce, industry and the arts, and in this land privileged by nature, the level of prosperity and opulence that is its destiny.” The faculty present was to be especially praised for their professional contribution to this achievement in public health. Even if “[our] hopes have not been fulfilled, if the number of vaccinated persons progressively diminishes when it should increase, this has not been a result of any defect of zeal or constancy on the part of vaccinators.” In fact, after 31 years of hard work “the Central Junta abound[ed] with faculty members distinguished by their experience, understanding and practice”, more than capable of taking charge of the organization upon his departure.  

Romay’s closing address to his medical colleagues in December of 1835 is testimony to both the opportunity and daunting challenge that the introduction of smallpox vaccination offered to a growing medical elite in colonial Cuba. Acquired through a chance visit to Havana by vaccinated children from Puerto Rico in February of 1804, the vaccine arrived at a propitious time in the island’s history. During the late 18th and early 19th centuries, a core group of creole and peninsular intellectuals witnessed an economic and social transformation of unprecedented proportions. From the fairly diversified agricultural economy and low population characteristic of colonial peripheries, the island’s economy and social structure was converted into a brutal and cosmopolitan slave society. In densely packed port cities such as Havana, the resulting population growth from immigration, natural increase and the slave trade facilitated the spread of disease.

It was the danger that disease posed to the island’s economy and the rise of a trend in preventive medicine based on scientific precepts in Europe that allowed a growing number of elite creole physicians new professional and public functions in colonial Cuba. As “one of the first milestones in the advancement of preventative medicine,” vaccination inspired some of the first attempts to combat disease at the national level in many countries. It also opened doors to the early exercise of expert medical authority for revalued concepts of popular health. Using the Spanish colony of Cuba as a case study, this chapter uncovers the processes by which an interest group emerged in the wake of the vaccine’s introduction to engage the state in a struggle for privilege and status as bearers of the public good. Elite Cuban creoles and Spanish colonial reformers collaborated closely in their joint project to domesticate the technology of smallpox vaccination on the island after its introduction in 1804. Spearheaded by creole medical ‘high priest’ Dr. Tomás Romay y Chacón, the Central Vaccine Board of Havana became a center for licensed, medical practitioners to access new medical, professional platforms. Institutionalization of the service and the medical professionalization it fostered helped support claims of socio-political and economic relevance with direct intervention upon a significant percentage of the colonial population. Framed as a sacred obligation with humanitarian objectives, their medical mission was adapted to meet the needs of creole socioeconomic elites and dovetailed with imperial objectives to augment productivity for empire. 

Smallpox in Colonial Cuba

On the advent of the introduction of smallpox vaccination to the Spanish Americas in the early nineteenth-century, smallpox was a well-known and little controlled scourge of the Caribbean. Arriving to the Americas with the ships of Spanish conquest in the early 16th century, the disease decimated native populations. As trade and communications increased and more importantly, as African slaves were imported to meet labor needs, the re-introduction of smallpox to ports across the Caribbean became intimately associated with the slave trade that sustained commodity production on the plantation model. Though variola inoculation was widely practiced throughout Western and Central Africa, the social displacement, malnutrition, and overcrowding which accompanied the trade facilitated the spread of disease. Intensification of the trade was felt in the frequency of epidemics, particularly after the mid-seventeenth century development of slave-based plantation systems in the new British and French Caribbean. In Cuba, where the disease had not been seen for decades, smallpox caused great mortality amongst the African slave population in a flurry of epidemics from 1677 to 1684 and again in 1693. 

The advent of Cuba’s own export revolution almost a century afterwards added urgency for solutions to the increasingly frequent epidemics ravaging the major port cities of Cuba.  Precipitated by enlightened Bourbon trade policies and the fall of Saint-Domingue as a competitor in the sugar market, Cuban exports in primary goods boomed during the last three decades of the eighteenth century. Meeting the demand for sugar, coffee and tobacco production, as well as the growing urban industries thriving on the trade, required labor. In 1763, a brief occupation of the city by the English prompted Spanish authorities to reverse previous restrictions on large-scale importation of enslaved Africans. Between 1774 and 1792 the slave population increased from 44, 000 to 85,000 persons, representing a jump from 26 to 31 percent of the total population. Over the next forty years, particularly as the labor-intensive sugar economy expanded, hundreds of thousands more were imported so that by 1827, the island’s 287,000 slaves constituted an unprecedented 41 percent of the total population. On the eve of the introduction of smallpox vaccination in February of 1804, Cuba (particularly its western region) was incorporated into a global network as an importer of slaves to produce commodity agricultural goods for export.

These transformations had a profound impact on the major port city of Havana.  Dramatic demographic growth linked to the export sector was augmented by subsequent militarization of the colony, which brought tens of thousands of Spanish soldiers and administrators to Havana’s shores in order to maintain order and defend colonial claims in the new economy. The city expanded beyond the old walls and its center pulsed with the movement of people, animals and goods of all kinds, including massive quantities of bulky exports. As Prussian scientist Alexander von Humbolt noted during his travels to the island at the turn of the nineteenth century, the circulatory systems of increasingly congested streets and thoroughfares were generally muddy..


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