Sam's Shorts Episode 1: Get Vaccinated

Get Vaccinated, 1871

This episode examines a Christmas letter Sam Clemens sent to his wife Olivia in 1871, full of good wishes for the season—and urging her to get her smallpox vaccination. Erin’s guest on this episode is Kelly O’Donnell, lecturer in History at Yale University.

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Erin: Hello and welcome to Sam’s Shorts, a project of The Mark Twain House & Museum in Hartford CT. I’m Erin Bartram. Sam’s Shorts explores the unfamiliar, unconventional, and uncensored writings of Sam Clemens–better known as Mark Twain. Each month, we share a short excerpt from Sam’s writings and invite you to read, reflect, and respond. Then we share what we learned from your responses, answer some of your questions, and tell you a bit more about the background and context of the piece. In each episode of this podcast, we’ll talk about one of these selections with an interesting member of our community. You can share your thoughts on the current selection at or by visiting us at the museum. Each reader’s perspective adds something new to our conversation about Clemens.

Today, we’ll be exploring a letter Sam Clemens wrote to his wife Livy on Christmas Eve 1871. We’ll talk with Kelly O’Donnell, a historian of medicine and gender, to get her perspective on Sam’s words. Let’s start by listening to those words, read by Kit Webb, one of the museum’s historic interpreters.

Kit, as Sam Clemens: Chicago, Christmas, 2 AM

Joy, & peace & be with you & about you, & the benediction of God rest upon you this day!

It must have been about this hour, when a brooding stillness lies like a healing sleep upon all nature, & the passions intranced in human hearts & the good impulses take holiday & visit with the gentle strangers that come in dreams from some happy country beyond our ken, that marvelous vision, that diminishing milky-way of white wings, stretched its long course out of the firmament & from the heights of Bethlehem the angels sang Peace on Earth, good will to men!

There is something so beautiful about all that old hallowed Christmas legend! It mellows a body—it warms the torpid kindnesses & charities into life. And so I hail my darling with a great big, whole-hearted Christmas blessing—God be & abide with her evermore!—Amen. And God bless the boy, too—our boy.

And now to bed—for I have worked hard all day yesterday—& till late last night—& all day again & till now—on my lecture—& it is re-written—& is much more satisfactory. To-morrow I shall memorize it.

Get vaccinated—right away—no matter if you were vaccinated 6 months ago—the theory is, keep doing it—for if it takes it shows you needed it—& if it don’t take it is proof that you did not need it—but the only safety is to apply the test, once a year. Small pox is everywhere—doctors think it will become an epidemic. Here it is $25 fine if you are not vaccinated within the next 10 days. Mine takes splendidly—arm right sore. Attend to this, my child.2

With a whole world of love & kisses.


Erin: If you’re a Twain fan, you may have read the beginning portion of this letter elsewhere; the smallpox portion is often left off, because it can seem jarring after Sam’s dreamy musings on Christmas Eve. When we first shared the letter in December 2020, people were struck by these two different topics appearing in one letter, even remarking that nowadays, we’d probably send two different emails–or a series of texts! Letter-writing is a different form of communication, of course, but the composition of this letter also reflects the realities of Sam’s life on the lecture circuit. He often wrote these letters to Livy before or after his speaking engagements, when he had time, and they contained whatever was on his mind. 

You may be wondering if it was common for him to be away from his family at Christmas. It was, especially in his younger years, even before his marriage. But during this period of his life in particular, when he was an up-and-coming author, lecture tours were an important part of building his brand, so to speak. They brought in money, of course, but they also functioned as promotional tours for his writing. 

This letter was written in the middle of his longest tour to date: October 16, 1871 through February 27, 1872, with 77 speaking engagements throughout the Midwest and the Northeast. Livy was at home with their son Langdon. It’s no wonder Sam was missing his family, but spare a thought for Livy as well, home at Christmas with a 13 month old–and six months pregnant with the couple’s second child!

Given that we shared the letter with our readers in 2020 and are recording in 2021, that last section of the letter is particularly intriguing. Sam’s urgent message about getting vaccinated against smallpox wasn’t just born out of fear of the disease, though. Of all the deadly diseases humans faced in the 19th century, especially in the United States, smallpox was the only one you could vaccinate against. 

An earlier form of immune-system based protection known as variolation dates to 1000 BCE, and was widely practiced in China, India, and the Ottoman Empire before being adopted in Europe in the 18th century. Edward Jenner’s late 18th century innovation of using a related disease, cowpox, to prompt an effective immune response gave us vaccination, with the name drawn from the Latin word for cow. To vaccinate an individual, practitioners dipped a clean lancet into fluid taken from a human cowpox pustule and punctured the patient’s skin to introduce the material into their system. This safer practice swiftly spread through the United States, often at the urging of federal, state, and local officials and doctors. 

Chicago, where Sam was staying for this portion of his tour, had recently developed a series of public health measures to protect the population from epidemics in response to a completely different disease: cholera. 

A cholera outbreak in the 1840s had left one out of every thirty-six people in the city dead, and the health board tried to prevent similar outbreaks through a combination of improved sanitation, better record-keeping, and more strict isolation of sick people. But with smallpox, there was another weapon–vaccination. The records of the board of health show how they identified barriers to vaccination and attempted to remove them.

In 1848, they gathered a list of doctors willing to vaccinate people for free and posted those lists publicly with information about the vaccine in English and German, so that the city’s largest immigrant population could be informed.

The following year, the city council appropriated money to be used to vaccinate children in public schools. In 1851, the City Physician was ordered to provide the vaccination to all in the city who needed it, at the city’s expense. 

Beyond making the vaccine free, the city also took enforcement steps. In 1855, the council directed the mayor to enforce an existing law requiring physicians to report cases, and public health officials were directed to place signs saying “Small-pox here” on houses with infected people. 

But as vaccination rates increased and small-pox cases dwindled, city residents–and the board of health itself–got complacent. By the end of the 1860s, the danger of smallpox reemerged in the city because of this complacency. 

Sam’s Christmas letter came in the middle of a push for vaccination but also for revaccination–of those who’d been vaccinated in the city in previous years whose protection may have worn off, and of those who’d been vaccinated elsewhere–including other countries–because of concern about variant versions of the disease. Back home, a piece in the Hartford Courant from August 1871 titled “Forewarned, Forearmed” warned against complacency as well:

“. . . that common sense maxim ‘an ounce of prevention is better than a pound of cure” seems to have lost its influence in the matter of vaccination . . . Months ago the alarm was raised in London that while vaccination was going out of vogue, small-pox was steadily increasing, and it is stated by the physicians that the recent outbreak of this fearful scourge in the city of New York and its vicinage is the direct and necessary result of a neglect of vaccination for the last quarter of a century. 

Having sown to the wind it is to be hoped that the metropolis and its sister cities may not reap the whirlwind in the ensuing fall . . . We have hitherto, thanks to Jenner, been remarkably free, as a people, from this visitant that leaves such dreadful marks of its presence, but if we grow careless from our immunity, we may receive a reminder that will cause lamentation . . . it devolves upon every intelligent member of the community to use his influence in favor of so simple and complete a remedy as vaccination, that we may not suddenly be decimated by small pox, as many parts of the world have been.”

This urgency around taking personal responsibility to get vaccinated, and to encourage others to do the same, came from the fact that there were not compulsory vaccination requirements in most towns and states. 

Sam remarked that there was a fine for remaining unvaccinated in Chicago, but newspaper reports from the period show that even months later, city doctors were begging for some kind of law to compel people to be vaccinated. No such requirement existed when Sam was there, despite his certainty, a reminder of how easy it is for misinformation to spread in times of epidemic disease. 

To share her reactions to this letter, we’re joined by Kelly O’Donnell. Kelly is a historian of medicine and gender in the modern United States. She is a Lecturer in the History of Science and Medicine at Yale University, where she also received her PhD. She writes broadly on the history of women and health politics, and is currently completing a book titled, The Pill Hearings: Science, Politics, and Birth Control.

Erin: Well, welcome to the podcast. Kelly, we’re glad to have you here.

Kelly: Thanks so much for having me here. And I’m really excited to be here on the first episode, right?

Erin: Yes, this is our first episode we’re recording. It may not be the first episode you’re listening to. But this is the first one we’re recording. And so Kelly’s had a chance to read the letter. And I’m wondering, what did you think of it? What did it make you think about?

Kelly: Well, it being Christmas Eve letter, I just had Christmas carols stuck in my head, the whole time I was reading it. And for the rest of the day, I just love . . . it’s very evocative of this holiday cozy moment. In the beginning, at least, I want to be hanging out by the fire with the decorations. Just getting in the Christmas spirit with him. It just seems like a very pleasant holiday scene. And then rather abruptly it changes at the end there to talk about vaccination. So I was both very seduced by the Christmas ethos of it, but also really thrown by how it’s–not contradiction, but a very abrupt turn there as he’s writing and finishing up the letter.

Erin: Yeah, that reminder that it may be Christmas, but Smallpox is still there, and that these things don’t wait. I think a lot of readers were simply surprised to see that. In fact, many people have read the beginning of that letter. The Christmasy part is usually excerpted, and I think it draws on all of these cozy themes that you say, but also the fact that he is writing a lecture and preparing to do work on Christmas, and he’s separated from his family. But it’s often kind of reprinted and shared without that last bit about vaccination. And when we shared it with people in the fall of 2020, it got a lot of interesting reactions. People were sort of surprised, both by the abruptness that you pulled from it, and also, just that the way people were talking about vaccines in this moment,

Kelly: Yeah, I’m sure it hit very differently this year, this holiday season, than it would have in any Christmases past for sure, given the context of our current epidemic disease problems.

Erin: And I wondered if, since you have some sort of historical background, not just on vaccines and public health, specifically, but on gender, and health care, I wondered if that played into your reading at all. In particular, the husband writing back to his wife saying, make sure you get vaccinated.

Kelly: Honestly, that’s surprising to me. When you said that I was like, oh, right, there is gender here! I’m a historian of gender and medicine and I wasn’t–I didn’t even pick up on that at all. It’s just such a Christmas vibe. I was coming up with alternate lyrics to The Little Drummer Boy around vaccination when I was reading this. It didn’t even hit me at all, the gender dynamic there, but I definitely think there is a sort of paternalism thing going on with this. Okay, I’m imploring you: go get vaccinated. It’s a very much “protection of the family” kind of vibe as well going on.

Erin: I wonder if some of that comes from the fact that he isn’t there. He’s quite far. She’s in Hartford and he’s in Chicago.

Kelly: Yeah. So it’s fatherly-husbandly, kind of: this is what you should do, we need to keep our families safe, our boy, you need to keep the kids safe, keep you safe.

Erin: Would it change your reading in any way to know that . . . So Langdon, the son they’re talking about, he’s born November 1870. February 1871, Livy has typhoid fever. She’s very, very sick. And she has just barely recovered and she is pregnant again in July of 1871. So she is home with a boy who has never quite been very well, having recovered from typhoid fever that year, pregnant with the child that will be Susy Clemens, so . . .

Kelly: There’s that urgency of, you know, protecting especially little kids, right? If you’ve had that experience with typhoid or typhus, I couldn’t remember exactly what you said a moment ago.

Erin: It was typhoid fever.

Kelly: You don’t want to mess around with smallpox, right? If there’s an option to avoid one of the big epidemic diseases of your day, that’s definitely something you’re going to want to get with, for your family. When you see sick kids, when you see a sick family member, that’s not an experience that you want to repeat. That’s definitely something that you would like to avoid, if at all possible. So the option to have a vaccine is like a Christmas miracle, the idea that you can take proactive measures to prevent someone you love from getting really ill and potentially dying, right? This is still an era where little kids, especially if they get hit with one of the big epidemic diseases, are pretty vulnerable to it. That’s something that someone like him is definitely going to be a huge proponent of and you can absolutely pick that up in this letter, right? He’s public health advocate number one in this letter. You’ve got to go right away. Even if you already were vaccinated at some point in the past,you’ve got to keep doing it. Because here’s my explanation of why that works and so forth.

Erin: Well Langdon, their baby boy, actually does die the following spring. 

Kelly: Oh, no!

Erin: Yeah, he dies of diphtheria.

Kelly: Oh, no. See, you gotta protect those kids. 

Erin: So which of the common childhood illnesses that we now vaccinate against were there inoculations for at this point? Was there anything other than smallpox?

Kelly: I kind of feel like smallpox is unusual in that it has a much earlier history in terms of vaccination, right? It’s—I don’t even really talk about smallpox, when I teach it in this era. Because I talk about 18th century, the invention of inoculation, and Jenner and the controversies up in Boston. And then it kind of fast forwards to the very tail end of the 19th century, early 20th century, when you have all of these new vaccines, these antitoxins. To be in this moment, in what is this, 1871?  It’s kind of an odd moment, because it’s just before you get all these new vaccines that would take care of things like diphtheria and so forth.

Erin: So it would be effectively really the only thing—you know, there’s this kind of maelstrom of diseases, that smallpox might be one of the only ones you have something like this for. 

Kelly: Yeah, like, let’s at least take smallpox off the table, deal with that one. There’s a lot of other things that will endanger my child. But if I can, at least, you know, get him inoculated or vaccinated against smallpox, we avoided that, we dodged that one. This was a really interesting moment in terms of the history of vaccines because it’s just prior to a whole slew of new developments, right? This is 1871. And I guess, Louis Pasteur is over in France, tinkering with anthrax and that kind of stuff yet, but there’s not the anthrax vaccine yet, or that later, in the next decade or so, the rabies vaccine. They’re both huge concerns, right? You don’t want to catch smallpox. You don’t want a rabid dog to bite you. The difference between the two of them is that with one of them at this time, you can prevent it. So that’s why our boy Sam is all gung ho about this vaccine, right? Because it’s a tool that people have available to them to prevent at least one of these life threatening diseases. So it’s fascinating to see . . . with hindsight we know, in the coming decades, there’s going to be all these developments that allow people to fight other things, rabies or diphtheria, coming up in the future, when these people are still going to be alive, some of them. But it’s really smallpox, that is the thing where they’re like, yes, intervene, use these technologies. This is great that we have this.

Erin: And I did notice that when Clemens is writing for his brother’s newspaper, the Muscatine Tri-Weekly Journal, in Iowa in 1855, he notes there is some smallpox in the city. He’s reporting from St. Louis, there’s some smallpox in the city. “But the number of cases is unimportant. Persons afflicted with this disease are immediately conveyed to the past hospital. And it is best prevented from spreading, so they have that method in place”. You know, there’s quarantine. But as this is pointing out, this is, as you said, the one thing we have a tool to prevent against. And it’s not just a childhood disease, it seems to be an equal opportunity offender. And the discussion in the paper seems to be about what Clemens talks about. This is not about getting vaccinated— everyone needs to get vaccinated once. The concern is really about boosters. And the discussion of immigrants needing the smallpox vaccine, at least in the Tribune, is not “Oh, these people come from somewhere else that isn’t advanced, and they don’t have the smallpox vaccine.” It’s more a belief that the smallpox vaccine you would have gotten in Ireland or Germany might not protect you from the smallpox variant in the country you’re in now. So people say “no, but I did get vaccinated in Ireland two years ago.” And I don’t know, but given how the vaccine worked–given how the inoculation worked at that time—it doesn’t seem out of the realm of possibility.

Kelly: That’s true. I hadn’t even thought about that. But I was also taken by, you know, his own epidemiological theories about how the vaccine works, regarding himself as an individual, right? He’s like: keep doing it, if it takes it shows you needed it.

Erin: I wonder what it meant for it to take?

Kelly: So I’m not sure, but I’m assuming that he’s talking about showing some kind of immunological response. So, some sort of mild symptoms, or some reaction by the body showing that, you know, something is happening. It’s not clear to me if he’s got a firm grasp of how the immune system works, or if he’s relying on this notion, this older notion of seasoning. That would be something that people would think about, in terms of basically acclimatizing to a particular area, like yellow fever and so forth.

Erin: I think of it earlier in the 19th century, the idea of seasoning with malaria in movement into the South.

Kelly: I would like to also relate pretty hard to him working all day  yesterday and till late last night, and then all day again until now, which is 2am and needing to sleep. Right, as someone who writes lectures and has to deliver them. It’s like conferences or to students. I definitely, definitely appreciated that. This was such a great choice of letter for me, as someone who’s like, not necessarily a writer, but like an educator who’s just lived through a pandemic, you know, who had my sore arm? I was . . . okay. I got this.

Erin: It made me think of many similar . . . you might think, “Oh, well, at least as an educator, you’re not doing it on Christmas.” Well, Kelly and I are both in a field where one of our major conferences usually starts the Wednesday or Thursday after New Years, which can be the second of January: the American Historical Association. There are many times when Christmas Day has involved working on a paper.

Kelly: Sam Clemens prepping a job talk,

Erin: Basically. And a lot of his speaking tours he’s doing the same talk over and over again, which is another familiar thing. How do you . . .you think of bands that . . . like, how does Bono get hyped to do “Where The Streets Have No Name?” after 30-something years? There are lessons and lectures that we give over and over again, but it’s suggested in some way he’s trying to zhuzh it up a little for Christmas. The question of “Is he a workaholic?” Yes, in the sense that lecturing was such an enormous part of his life, we can think of it the same way contemporary authors have to go do a book tour, even if that’s a Zoom book tour. It was a significant part of his income, and I found myself honestly thinking of the Doctor Who–Ninth Doctor–Charles Dickens episode, which is about Dickens doing a reading on Christmas. Obviously he had a slightly Christmas-er thing to read. But this is pretty common, and he is out there on tour pretty constantly, which is why lots of people can say they’ve seen Twain speak. He starts touring that year, October 16, at the Moravian Day School Hall in Bethlehem, Pennsylvania. He then goes Allentown, DC, up to Great Barrington, which is where near where I grew up, Brattleboro, Milford, MA, Exeter, New Hampshire, comes back down through Connecticut, performs at Allen Hall, one of his regular stomping grounds here in Hartford, at Mechanics Hall in Worcester, all throughout Massachusetts in November. Then he goes back to Albany at the end of the month, and he’s in Newark the next day. Oswego, Geneva, Syracuse. He’s in Erie by the first week of December. Then he goes through Michigan, ends up in Chicago by December 18th. And then he’s still on tour January 1, he ends up in Indiana. Dayton, Columbus, Steubenville, Wheeling, West Virginia, Pittsburgh.

Kelly: So this guy you’re saying has been basically giving the same speech for like, several months, dude is still up at 2am on Christmas Eve, like frantically revising it as if it’s the most important thing in the world.

Erin: He gives two different speeches, essentially two different lectures: “Artemus Ward” or something drawn from Roughing It and he is on tour from then goes back through. Harrisburg, Lancaster, Carlisle, Baltimore, New York City, Scranton, Jersey City, Paterson, Troy and ends up in Danbury on February 21. But then–that’s the end of his official tour–two days later, he’s giving a different talk in the city and then a few days after that he’s up in Amherst giving a talk. So this is an enormous part of his life. And it’s what helps save him after they lose . . . after his business dealings caused them to really lose all of their money in the early 1890s. It’s going back out on a big worldwide tour, which then becomes Following The Equator, that helps him recoup those losses. It is not, however, a thing that he likes doing. And he does talk about how miserable it often is, especially when he is leaving, you know, he is away from his family at Christmas. He’s leaving his baby, his wife who has . . . who is pregnant, and has a baby and has really had a really terrible time of it in 1871 herself.

Kelly: Yeah, but you can totally see in this letter, this earlier letter, that he would be a really great Christmas dad if he weren’t separated from his family. And he’s all talking about the heights of Bethlehem and angels singing peace on Earth, goodwill to men, right? He’s definitely a Christmas guy.

Erin: So I think this is interesting and sort of an interesting inflection point in his life where he goes very quickly from being “Mark Twain,” Westerner, rough and tumble traveler, journalist, to husband, father—but still has to be out there treading the boards doing all of this and wondering, as so many of us have, when we’re separated from people during a pandemic, 

Kelly: “Are they safe? How can I help them be safe?”

Erin: I can’t do anything physically. I can’t take care of them. But I can provide at least what I think is sound public health advice. 

Kelly: Exactly.

Erin: Clemens would be separated from his family in Hartford for another month. He worried about his son, especially when he heard Langdon may have had pneumonia, and he worried about his wife, nursing one baby back to health while carrying another. He also grew increasingly frustrated with the separation, writing to his wife: “I would give the world (if I had another one like it,) to be out of this suffering lecture business & at home with you.

By the end of January, he was back in Hartford, though he continued to lecture through the end of the winter, refusing to accept an invitation that would take him out of New England during the last few months of Livy’s pregnancy. Their daughter Olivia Susan Clemens, known as Susy, was born in March. In mid May, just before Susy was baptized, her brother Langdon developed a cough. He got sicker as the month progressed, and died on June 2, 1872

After Langdon’s death, Clemens rarely mentioned him in writing. Thirty four years later, however, in an autobiographical writing, he confessed that he still believed himself responsible for his son’s illness and death. He had taken Langdon for a drive in an open coach on a “raw, cold morning.” Distracted with thoughts of his own writing, Clemens failed to notice that the child’s blankets had slipped off of his son, allowing him to catch a chill. But in the end, Langdon Clemens died of diptheria, a disease that killed millions of children around the world in this period. It would take another fifty years for scientists to develop a vaccine against this disease.

Sam’s Shorts is a production of The Mark Twain House & Museum in Hartford, Connecticut. The producer is Maxwell Norteman. Thank you to Kelly O’Donnell and Kit Webb for their contributions to this episode.  

Programs at The Mark Twain House & Museum are made possible in part by support from the Connecticut Department of Economic and Community Development, Office of the Arts, and the Greater Hartford Arts Council’s United Arts Campaign and its Travelers Arts Impact Grant program with major support from The Travelers Foundation.

Thanks for listening, and don’t forget to share your thoughts on the current Sam’s Shorts by following the link in the show notes or visiting us here at the museum.