A Taxonomy of Vaccination Scars

March 10, 2014 Karie Youngdahl

Denarp Decanteleu JEB. The Historical Medical Library of The College of Physicians of Philadelphia.

I’ve been corresponding with a reader who is interested in HA Martin’s On Animal Vaccination, an 1877 publication by the physician who is widely credited with introducing and producing non-humanized smallpox vaccine in the United States. Martin obtained vaccine from the famed Beaugency vaccine line, begun in the 1860s with naturally occurring cowpox in a French cow. The French Académie du Médicine cultivated the vaccine in serial transmission in cows and avoided harvesting any vaccine from humans.

Martin was rather obsessed with vaccination scars, and he thought (as did many) that there was a direct relationship between the quality of the vaccine material and the features of the resulting scar. He was not much pleased with vaccine available in the United States, claiming that it was too far from the cow, and much too humanized, to be of any use in preventing smallpox. He noted that the crusts of long-humanized vaccine vesicles fell off around day 14, whereas vaccine at less remove from the cow resulted in deeper vesicles whose scabs did not fall until 28 or more days.

In On Animal Vaccination, Martin pays homage to a French predecessor who was similarly attentive to variations in smallpox vaccine scars. This was J.E.B. Denarp Decanteleu (1790-1852), who had proposed to write an entire book on the subject of the vaccinal scar. According to Martin, Decanteleu could not interest a publisher, and so only a plate from the proposed book was published in 1851. (Some libraries seem to have copies of Martin’s On Animal Vaccination bound with what they say is a 32 page work by Decanteleu—I haven’t seen one of these in person. It could be that these publications include some of the manuscript that Martin salvaged from Decanteleu’s French publisher.)

We are lucky to have a copy of Decanteleu’s plate in our Historical Medical Library. It’s large – about 79 X 57 cm. The illustrations were copied from casts of vaccine marks made with stucco. Martin writes about the plate, “The few pages of the single number of text give evidence of the author’s genius, vast labor, and enthusiams, and of the great curiosity and value the work would have had if it had been completed.

Decanteleu presents a “Lamarckian” taxonomy of vaccine scars, attempting to show the variety of marks that result from vaccination and distinguishing them from other types of scars – from burns, from leeches, from smallpox itself, from acne, and so on.

Decanteleu’s introductory remarks are below—I’m not good with French and so used Google Translate to help –

Descriptive, analytic table of vaccine scars, in accordance with the principles of the descriptive, analytical method of Lamarck; providing a method to determine the generic and specific types of any vaccination scar observed, arranged in a graphic manner to show not only the type, but the main varieties… a second table showing scars from various causes following the order of their greater affinity with vaccination scars and designed to show the relationships and differences between one and the other. And therefore making it easier and safer to determine those that result from the vaccine.

Why would it be important to be able to classify and interpret a vaccine scar? Martin surely wanted to equate a “good” vaccine scar with animal vaccine so that he could argue that his methods and products were superior to humanized vaccine. In Decanteleu’s case, he probably wanted to interpret the scar as a predictor of protection from smallpox and indicator of the necessity for revaccination. A “good” scar was a “good take” of effective vaccine and indicated a person would have better protection. A “bad” scar might indicate ineffective vaccine and the need for revaccination.

Jennifer Keelan, however, in her chapter on the 1872 smallpox epidemic in Montreal in Crafting Immunity (2008), says that number of scars was a more reliable indication of vaccine “take” – these would be scars associated with “number of discrete colonies raised during primary vaccination,” rather than revaccination, which generally resulting in less obvious scarring. Those with four scars a had much, much lower chance of being admitted to the hospital for smallpox than those who had no or fewer scars. In order to do this kind of disease monitoring, one had to be able to recognize, and count, the vaccine scars.


Denarp Decanteleu JEB. Tableau analytique, descriptif et iconographique des cicatrices de la vaccine disposé dans sa partie descriptive ... Imprint J.B. Baillière, [1851?].

Keelan JE. Risk, efficacy and viral attenuation in debates over smallpox vaccination in Montreal, 1870-1877. In: Crafting immunity: working histories of clinical immunology. Kroker K, Mazumdar MH, Keelan JE, eds. Burlington, VT: Ashgate, 2008.

Martin HA. On animal vaccination. Boston: James Campbell, 1878. Reprinted from the Transactions of the American Medical Association, 1877.