Hektoen International

A Journal of Medical Humanities

How a small town kept smallpox small

Annabelle Slingerland
Leiden, the Netherlands


Smallpox patient
Fig. 1 Presentation of smallpox.

To make a mountain out of a molehill is a vice, but to keep the mole underground is a virtue. The little town of Tilburg in the south of the Netherlands was not accustomed to seeing mountains, but when a molehill first came into sight, it promptly flattened it into the ground.

The story begins in April 1951, a few days before the celebrations of the Queen’s birthday, when the health inspector feverishly raised a red flag announcing the arrival of a highly contagious and deadly disease, smallpox. The news filled the front pages of the national newspapers, and was followed by daily updates and statistics. Some people had been vaccinated in childhood, some had not, and for some vaccinated people immunity had expired.

Specialized ambulance for smallpox patients
Fig. 2 Smallpox ambulance and crew Tilburg 1951.

The physician of the Tilburg Public Health Service who had sounded the alarm bells was alert and proactive. Though seen as the expert, he had never seen smallpox himself but immediately quarantined in their own homes those affected and wrote on their windows “contagious disease.” He organized a special ambulance service and sent those in need of hospital care to a section of the hospital baptized for the occasion “Infection Pavilion Outside Care.” It was staffed by six nurses who would remain there all the time.

Individuals quarantined for smallpox
Fig. 3 Last Supper, smallpox quarantine station for contact persons, Tilburg 1951.

Those who had been in direct contact with smallpox patients were quarantined for two weeks at a house of retreat surrounded by a double fence. The chaplain served as a contact person since the pastor had smallpox, officiated mass, and corresponded by phone with the families of those who were hospitalized or quarantined.

Indirect contacts were expected to self-isolate at home and provide their address to be monitored for two weeks after the expiration of the expected incubation period. All travel in and out of Tilburg was forbidden, outside events were cancelled, no train would stop there, and no car (few at the time), bike, or passenger on foot was allowed to cross the town’s border. The city markets were open only for local residents. The entire population would be vaccinated or revaccinated. Two flights with vaccines arrived at the nearby airport, people queued up to be vaccinated, and within ten days the job was done.

The inhabitants of Tilburg obeyed. There was no interference in the lives of healthy, supposedly non-infectious citizens, and internal events such as commemoration ceremonies for World War II were continued. Cinemas, cafés, and stores complained, writing letters to the newspapers about their economic downfall, their employees’ plight, and sole family breadwinners being unemployed, leaving families without food.

Stained glass window commemorating the smallpox epidemic
Fig. 4 Stained glass windows of the town hall.

One month later, after a standstill of twelve days, Tilburg was officially declared free of smallpox. After two weeks the last patient left the hospital. Two patients had died: a twenty-seven-year-old man unsuccessfully vaccinated in his youth (purpura variola), and a seventy-two-year-old woman (bronchitis variola) who had been successfully vaccinated. Forty-seven patients had been admitted to the hospital, including five who developed encephalitis from the vaccination itself, of which one girl died. The home soccer match was resumed, admitting anyone who could show a valid smallpox vaccination note. Despite a lack of evidence that contaminated imported animal coffins had transmitted the virus, the human dead were buried in lead coffins.

So the molehill of Tilburg was flattened by the bravery of its citizens, preventing the spread of the epidemic to the rest of the country. It was a tiny prelude to the announcement in 1980 of the worldwide eradication of smallpox, and to the announcement of March 24, 2020 that a patient diagnosed on February 27 as the first having COVID-19 induced pneumonia had left the same hospital and returned to work. Perhaps if it can be done once, it can be done twice.5


Image Credit

  • Figure 1. Presentation of smallpox, Archives Health and Youth Care Inspectorate, Ministry of Health, Welfare and Sport.
  • Figure 2. Smallpox ambulance and crew Tilburg 1951, BHIC/ Tilburg Archives Photo 042001, photographer unknown, Collection Regional Archives Tilburg. A related photograph used in the regional newspaper. The same applies to the photograph in this link, whereas the link to ‘TimemachineTilburg per year’ gives an impression of the ambulance
  • Figure 3. Last Supper, smallpox quarantine station for contact persons, Tilburg 1951, Photo 041998, photographer unknown, Collection Regional Archives Tilburg.
  • Figure 4. Stained glass windows of the town hall paid for with donations from Tilburg citizens in 1952, depicting scenes of the vaccination, administration, love of neighbor, and nursing of the sick during the smallpox epidemic. Photo by Jan Van Eijndhoven. Currently a window for the current epidemic is in process to thank all those involved from frontline to backoffice.


Further reading, listening suggestions

  • National Statistics, 1951: https://www.cbs.nl/nl-nl/onze-diensten/overzicht-publicaties/het-licht-van-destatistiek/1892-1940/voorspellen-een-directieaffaire Official Report of the Health Ministry on the Outbreak in Tilburg: Ministerie van Sociale Zaken en Volksgezondheid, Staatstoezicht op de Volksgezondheid Geneeskundige Inspectie. Rapport omtrent de pokken-epidemie te Tilburg in 1951. Staatsdrukkerij- en Uitgeverijbedrijf. ‘s Gravenhage, 1953.
  • Thesis on the smallpox epidemic in Tilburg: GJ. Sas. Klinische en epidemiologische waarnemingen tijdens de pokkenepidemie te Tilburg in 1951. Proefschrift. Drukkerij Antoine, Geertruidenberg, 1954.
  • RIVM, National Institute for Public Health and the Environment, Infectieziekten Bulletin, Jaargang 14, nummer 3, p78-80, J.A.van Vliet, 2003. https://www.rivm.nl/sites/default/files/2018- 11/jaargang%2014%20nummer%203x.pdf Original Newspaper articles 1951: Numerous- Delpher.nl
  • TV documentary, 8 January 1995: https://www.vpro.nl/speel~POMS_VPRO_472752~de-laatste-pokkenepidemie-hetspoor-terug~.html
  • Today resurfacing history:
    https://www.ad.nl/tilburg/chinese-toestanden-in-nederland-in-1951-ging-tilburg-opslot-tijdens-een-pokkenepidemie~a05437f7/ 8 https://stadsmuseumtilburg.nl/activiteiten/bouw-mee-aan-het-dankraam-vantilburg-1/



ANNABELLE SLINGERLAND, MD, DSc, MPH, MScHSR, was asked while in Ndala, Tanzania to take up thoracic surgery at Leiden University, following which side tracked to monogenic diabetes. She is also working in medicine and history encompassing diabetes and cardiovascular disease with Oxford University/ UK, Joslin Diabetes Center, and with Harvard University/ MIT, Boston staff. In the latter she explores the history of bypass surgery in particularly the Holland Houston London and Geneva airlifts where the US filled in a capacity demand in the seventies. She swims and sails rivers and oceans for charity and includes medicine and history narrating on those encounters.


Spring 2020  |   Sections  |  Infectious Diseases

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