Library of Congress, Prints & Photographs Division, WPA Poster Collection, LC-DIG-ppmsca-23926ALTON - In the summer of 1924, Madison County faced an epidemic. On June 17, 1924, Madison County reported 34 new cases of smallpox to the State Department of Public Health in Illinois. The number of total new cases for the state was 70 that week, so almost half of those were in Madison County alone.

Illinois has 102 counties. The week before, Madison County had reported 15 new cases out of the state’s 60 total, which was still more than any other county. Smallpox was extremely contagious, and was fatal in approximately 30% of cases. Survivors often suffered blindness and skin scarring for the rest of their lives.

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On June 6, Dr. C.H. Diehl, district health superintendent, shared plans on for fighting the spread: “All persons not vaccinated, who have been exposed to a case of smallpox must be vaccinated or show a certificate that they have had smallpox. Cooperation of the public is needed urgently and I feel that the people of Alton will give us the greatest help. So far we have found all persons concerned willing to cooperate and if this is kept up we can prevent spread of the disease.” To prevent a vaccine shortage, Alton drug stores ordered calf lymph vaccine made under license granted by the United States Public Health Service’s Hygienic Laboratory.

Dr. Diehl’s June 6 statement sounded positive, but apparently not everyone cooperated. Some Altonians failed to report possible cases or reported them as chicken pox. At one point, half of the students at Irving School were kept home because they were in quarantine, were ill from the vaccine (which often produced uncomfortable but not fatal symptoms), or their parents refused to vaccinate. Next door in Jersey County, some Jersey Township High School students proclaimed that they would “quit school rather than submit to vaccination.”

Something had to be done, so a June 24 Alton Evening Telegraph article included a strongly worded proclamation from the Alton Board of Health warning that citizens should obey state and city laws to prevent an epidemic. Officials urged those who had not been vaccinated in the last five years or had not had small pox to get vaccinated immediately. All cases or suspect cases of small pox were to be immediately reported to the local health officer, and failure to do so would result in a penalty of $200 (the equivalent of over $3,500 in 2024 money) or six months in jail or both for each offense. Anyone unvaccinated and exposed was to quarantine for 20 days and quarantine was to be kept rigidly or offenders would be prosecuted.

The World Health Organization launched a vigorous plan to eradicate smallpox in 1967. For the next decade, immunization and surveillance efforts were conducted worldwide. The last known natural case of smallpox was in Somalia in 1977 and the WHO declared it eradicated in 1980, an incredible triumph for modern medicine.


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County Leads in New Smallpox Cases in State.” Alton Evening Telegraph (Alton, IL), June 17, 1924.

Jerseyville – Final Exams to be Rushed at J.T.H.S. to Beat Possible Vaccination Order.” Alton Evening Telegraph (Alton, IL), May 27, 1924.

Milk Truckers Do Not! (ca. 1936-40). WPA poster. Library of Congress, Prints & Photographs Division, repro. no. LC-DIG-ppmsca-23926.

Small Pox Proclamation to be Issued.” Alton Evening Telegraph (Alton, IL), June 24, 1924.

Smallpox.” World Health Organization. WHO, 2024.

State Helps in Fight Against Smallpox Here.” Alton Evening Telegraph (Alton, IL), June 6, 1924.

Vaccination Order Cuts Low Attendance.” Alton Evening Telegraph (Alton, IL), June 3, 1924.

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