Portrait and signature of FRANCISCO XAVIER BALMIS (1753–1819). Born in Alicante, Spain, Balmis was a physician and army surgeon (physician to King Charles IV as of 1795) and a pioneer in international vaccination. In 1781, 1791, 1795, and 1798, Balmis travelled to America to collect plants; while there, he studied plant remedies for venereal diseases, having published the Tratado de las virtudes del agave y la begonia in 1794. Balmis first translated into Spanish the Traité historique et pratique de la vaccine (Tratado histórico y práctico de la vacuna) by French physician Jacques Louis Moreau de La Sarthe. The Spanish version included a foreword by Balmis himself that added and clarified information contained in the book. When it was decided that an expedition, the Real Expedición Filantrópica de la Vacuna (Royal Philanthropic Expedition of the Vaccine), would be set up to spread smallpox vaccination into all of the overseas Spanish territories, Balmis was appointed its commander. On November 30, 1803, the corvette Maria Pita left the Spanish harbor of La Coruña, with the expedition team: Balmis, Antonio Salvany (second in command), three surgeons, two first-aid practitioners, four male nurses, 22 children from the Casa de Expósitos (orphanage) of La Coruña, and Isabel Sendales y Gómez, the rectoress of the orphanage, who was charged with taking care of the children. These children were the initial carriers of the smallpox vaccine: sequentially vaccinated arm to arm every 9–10 days, they were a living chain of transmission. Other children in the countries where the expedition stopped became part of that chain. The journey around the world took almost four years and can be considered as the first global vaccination campaign. [See: García de los Ríos JE, Jiménez Gómez PA (2005) Bicentenario de la expedición Balmis de la vacuna (1803-06). Actualidad SEM 39:8-15]