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Pox and the City: A public health history game

Learn about the conquest of smallpox, once known as the “speckled monster," through role-playing. Wanna be a virus?

It has been my privilege to serve as one of the historical consultants to Pox and the City, a digital role-playing game for the history of medicine.The game lets players learn about the conquest of smallpox (once known as the "speckled monster"). It was developed with funding from the National Endowment for the Humanities.

Pox and the City just completed beta-testing and got some great reviews from high school students. I interviewed the creator of this project, medical historian Lisa Rosner, who is a professor of historical studies at Richard Stockton College.

What made you want to teach history of medicine through a digital role playing game?

Games have emerged as an exciting art form for presenting humanities content. Hollywood merged medical history with entertainment back in 1936, with The Story of Louis Pasteur, the first film to turn a vaccination experiment into a cliffhanger. We hope that our game will be as successful in combining real historical material with new media.

Why smallpox?  What can we learn by looking at the controversy over inoculation?  How does this speak to current debates over inoculations?

Smallpox is a medical success story: it's the first disease in human history to be prevented by inoculation. The earliest account comes from China around 1000 C.E. In the 1790s, Edward Jenner, an English scientist, developed a safer form of inoculation by using the much less virulent cowpox virus.

You might think that was all there was to it. But just because doctors said the vaccine was safe, doesn't mean that everyone jumped to use it. For our game, players have to figure out what to say and do to attract patients to this new process – just as doctors did in the early 1800s. One of the key purposes of the game is to show how controversial early inoculation could be. After all, the doctor took real, oozing pus from the teats of a cow and injected it into the arm of a healthy child. That child became a kind of incubator for the virus: after a few days, when the pox marks appeared, the doctor again took pus and injected it into other healthy children. No wonder many parents objected!

To convince them, doctors would sometimes stage very public demonstrations. One physician inoculated his own 3-month old baby, and then gave her to a dying smallpox patient to cuddle and kiss. As he reported, his daughter stayed perfectly healthy–but I can't think of too many modern parents who would hand him their own children!

The public health statistics, though, are very clear: as inoculation spread throughout the world, deaths from smallpox declined dramatically. In 1800, about 40% of newborns might die before their fifth birthday. Around the world, children nowadays live long enough to start preschool because of inoculations against killer diseases.

What changes are you planning for the next version of the game?

We started out in Great Britain, but the next version will be set in Philadelphia. Philadelphia doctors were early adopters of Jenner's vaccine, and the Pennsylvania Hospital was one of the first places in the United Stated where vaccination was provided free of charge. Many of the documents and images we've used for the game come from our project partner, the College of Physicians of Philadelphia.

One of the roles you can choose in this game is that of the smallpox virus.  Tell us more about why you made that an option.

Who wouldn't want to play a speckled monster, fighting to survive and multiply? The more scientists reveal about the world–or worlds–at the cellular level, the greater their hold on our imagination. And there's precedent for games that focus on the microscopic world. Philly's own Cipher Prime Studios gave us Splice, in which players can combine DNA-like strands and watch them grow and mutate.

More important, game play as the virus allows us to be historically accurate. The history of medicine isn't just about great discoveries: it's really the interplay between the disease entity, the patient, and the health care professional. In our game, players will be able to take on all three roles.

Where can we learn more about pox and the city and about the history of smallpox?

For updates on our game, you can visit our blog at

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

Read more about The Public's Health.