In the Cut: Smallpox, Slavery, and the Question of Consent

The 1804 introduction of the smallpox vaccine raised unprecedented questions in the Spanish Empire about patient rights and medical consent. Recent scholarship has shown how patients resisted vaccination, often for reasons more to do with community politics, personal grievances, or doubts about individual practioners than outright resistance to the vaccine. This work makes manifest the contingencies that organized immunizing campaigns and challenges outdated interpretations of vaccine opposition. Left largely unexamined, however, is the role that slavery played in facilitating these early vaccination campaigns—and the rights to medical consent that they helped to establish. This paper analyzes this arrangement, explaining how doctors relied on enslaved bodies to reproduce and incubate the vaccine between port cities like Havana, Veracruz, Campeche, and New Orleans. Foregrounding these patients, the paper traces events that led to a law, secured by doctors in 1808, that mandated vaccination for all slaves upon arrival to Cuba. Sanitation reports and municipal records reveal that they accomplished this through a humanitarian language of care, critiquing the conditions of slave ships and port barracks. Instead of reworking the economic system—predicated on the conditions that produced these health inequalities—they harnessed abolitionist calls for reform to justify the continued regime of enslaved labor. Challenging the ethics of this iteration of medical philanthropy, the paper considers the work of consent, as physicians, patients, and authorities, together, negotiated questions about trust, autonomy, and expertise—concerns that animated patient-doctor relations in the past and persist in contemporary debates like the anti-vaxxer movement. By exploring specific historical circumstances—linked, in my research to colonial attitudes about gender, race, and autonomy—the paper offers a nuanced reflection on the limits of consent and its promise of ethical care, asking us to consider how this concept helped to uphold rather than contest structures of colonial power.