Chapter 8 discusses the arrival of vaccination in Portugal and Spain. An early recipient of cowpox, Portugal proved barren ground until the Prince Regent promoted the practice. Given its long rejection of smallpox inoculation, Spain moved surprisingly rapidly to embrace the new prophylaxis, with the first vaccination at the end of 1800, with vaccine sent from Paris. During 1801, vaccination was established in Madrid and other major centres and there was a flurry of publications on the procedure, some original, others customised translations. Grandees patronised vaccination in the provinces and local initiatives led to good coverage in Barcelona and Navarra. In 1803, the Royal and Philanthropic Vaccine Expedition was organised to extend the practice through the Spanish empire, beginning in the Canary Islands. War and political upheaval frustrated measures to consolidate vaccination in Spain and Portugal, but the authorities, political and medical, and some communities retained their commitment to the practice.

Chapter 12 discusses the severity of smallpox in the New World and the use of smallpox inoculation to control smallpox in the West Indies and suppress epidemics in Spanish America. Early attempts to introduce cowpox in Jamaica and elsewhere led to disappointment, but local initiatives began to bear fruit prior to the arrival of the Spanish Royal and Philanthropic Vaccine Expedition in 1804. This well documented expedition, in which children under vaccination were escorted to go arm-to-arm with others along the way, naturally commands centre stage. Projecting an image of professional expertise and imperial benevolence, Dr Balmis and his assistants brought vaccination to Venezuela and helped to set the practice on a firmer organisational footing in Cuba, Guatemala and Mexico. In the meantime, Salvany, his deputy, headed south through Colombia and Peru, vaccinating on an epic scale. Although Lima was already supplied with vaccine from Brazil by way of Buenos Aires, Salvany continued his work in the remote districts of Peru until his death in 1810. His assistant, Grajales, remained in harness in Chile until 1812.