Smallpox was the most feared disease on the peninsula because epidemics were extensive and mortality rates were high. Before the practice of vaccination was established, few people avoided an encounter with smallpox.

Most references to the epidemiology of smallpox during this era are found in the Yijo Sillok, historical records of the Yi Dynasty. Thus, the records are biased toward epidemics that occurred near the capital and affected the royal family. For example, in 1418 the Prince died of the "disease with bean-sized eruptions." In 1424, King Sejong's son died of an eruptive disease. In 1675, King Sukchong contracted smallpox. In 1680, an epidemic broke out in the capital city, and the Queen contracted the disease (the King had previously moved to another palace). During the seventeenth and eighteenth centuries, Western science and technology were coming into Korea and stimulating progress in science and medicine. An example of this trend was the Makwa hoefong (Comprehensive Treatise on Smallpox), a specialized medical treatise published in 1798 (Lee 1984).

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