“Smallpox is dead!”
—Peter Davies, World Health, May 1980
T he World Health Organization made this triumphant declaration in May 1980 on the cover of its monthly magazine. Global cheers erupted at the eradication of a disease that had terrified people for centuries. Smallpox was so contagious, visibly disturbing, and lethal that long before people understood its transmission, they began intentionally infecting themselves with the disease, a practice called inoculation. Doctors and other inoculators took active disease matter from a smallpox sufferer’s pustule and then lanced the recipient’s arm, placing the matter into the open wound. Those who underwent inoculation (also called variolation) would inevitably develop smallpox, but with lower risks of complications and mortality compared with those who caught the disease in the “natural way.” From a contemporary perspective, the practice seems drastic or even suicidal. However, this willingness to submit to such a risky endeavor demonstrates the desperate fear and prevalence of the smallpox virus in the eighteenth century.
While this practice of inoculation was common in parts of the Old World, it did not come to colonial America until the epidemic in Boston in 1721. Pamphlets, newspapers, and books from this time captured the rise and fall of the outbreak, public response, and the fierce inoculation controversy that ensued. This chapter centers on this smallpox epidemic and the rise of inoculation. At the same time, it is also about the origins of American journalism and using print media as an outlet for public discussion. These eighteenth-century inoculation conversations set the stage for centuries of discord between the medical profession and vocal minorities opposed to immunization. Moreover, a look at contemporary messages about smallpox sheds light on how we remember this devastating disease and forget about the true roots of vaccine controversies.
The Dreaded Pox
Smallpox was horrifying. Caused by the variola virus, it was transmitted through air droplets or through shared crusty scab material. Approximately 60 percent of people with close contact with the infected developed the disease.1 After a nine-day incubation period, sufferers typically experienced fever, severe headache, vomiting, and back pain before developing unmistakable pustules that covered the diseased bodies, transforming victims into “grossly swollen, groaning monsters barely recognizable as human, bubbling with pus and reeking with the sickly-sweet smell of rotting flesh.” 2 Below the surface, the virus damaged the internal organs and intestines.3 After three to four weeks of this misery, survivors were often left with permanent scars and sometimes blindness.4 Approximately 15 to 30 percent did not make it, with fatality rates higher for infants, pregnant women, and the elderly.5 Moreover, the unfortunate few that developed hemorrhagic (or black) smallpox faced a most certain death.6
Evidence of smallpox has been identified in mummified remains tracing back to the ancient world, with the first epidemic in 1350 BCE, and thus has been feared for centuries.7 Its horror and contagious potential are much better understood than other diseases of the time. Unlike tuberculosis, there has never been a question about the infectious nature of smallpox. Its ability to wipe out families, tribes, and communities and to permanently disfigure and blind survivors has been nearly unmatched by any other known contagion. The smallpox virus was considered “the most voracious killer ever to stalk the human species,” causing hundreds of millions of deaths before its eradication.8 Across race and geographic boundaries, smallpox ravaged royalty and peasants alike; among its victims were England’s Queen Mary II, King Louis XV of France, Russian Tsar Peter II, Holy Roman Emperor Joseph I, and Chinese Emperor Fu-lin.9 During the seventeenth and eighteenth centuries, approximately four hundred thousand Europeans died each year from smallpox, accounting for 10 to 15 percent of the total deaths at this time.10 For indigenous people the devastation was much greater, with mortality reaching as high as 55 to 90 percent during epidemics, wiping out entire tribes.11 Smallpox caused the tragic decimation of the Incas, Aztecs, and many Native American populations, profoundly aiding in the European conquest and colonization of the New World.12
Inoculation: Intentional Infection
Smallpox was nearly impossible to prevent and had no effective treatment. When the disease came to town, only survivors of previous outbreaks had certain protection. Elders recalled the devastating effects of earlier epidemics, as people left town or prayed while attempting to isolate the sick or themselves. People were desperate for some means of control over this dreaded disease, with its lethality and transmission rate. Inoculation offered one such means of control, though the practice was much riskier than vaccination. With inoculation, a person developed a mild case of smallpox eight to ten days after the procedure and was less likely to die. In the epidemic of 1721, 2 percent of those who were inoculated died, compared with 15 percent of those who contracted natural smallpox.13 Since inoculated people did have smallpox, they were contagious and could spread the disease. As the historian John Duffy explained, “The healthy individual inoculated with smallpox usually only suffered a mild case, but the germs he passed on were virile and potent.” 14 Inoculation advocate Benjamin Franklin described the typical procedure in 1730: “Two small incisions are made, one in the muscular part of the arm, about the place where an issue is usually cut, and the other in the leg of the opposite side: Then being provided of a small quantity, as a drop of less of well-concocted variolous matter . . . are immediately put into the incisions, whilst the matter remains warm, and are kept on by a proper bandage.” 15
Forms of inoculation had existed for centuries in China, Africa, and parts of Western Asia.16 The rise of inoculation in England in the eighteenth century paralleled its diffusion in the New World. In 1713, Dr. Emanuel Timoni reported to the Royal Society of London his observations of inoculation in Constantinople, which he published in Philosophical Transactions the next year.17 After reading Timoni’s work, the Reverend Cotton Mather became determined to bring inoculation to his fellow colonists in Boston. Writing to Dr. John Woodward on July 12, 1716, Mather laid out his discovery of inoculation: “I accidentally lit on a hint in the Philosophical Transactions, that the famous Dr. Sydenham had saved more lives than the wars of Ireland had destroyed by teaching the true method of managing the smallpox.” 18
The Puritan minister described how he also learned anecdotally of inoculation’s success. Mather related that his slave, Onesimus, “told me that he had undergone an operation which had given him something of the smallpox and would forever preserve him from it.” He then promised in his letter to Woodward, “If I should live to see the smallpox again enter into our city, I would immediately procure a consult of our physicians to introduce a practice which may be of so very happy a tendency.” 19 Five years later, Mather got his opportunity. It should be noted that Mather neither invented nor discovered inoculation, but did succeed in bringing the practice to colonial America, persuading doctors to perform the procedure, and, just as importantly, convincing people to undergo it. His supporters included fellow members of the clergy and the field-trained physician Dr. Zabdiel Boylston, the first inoculator. Opponents of inoculation included Dr. William Douglass, who had a European medical degree, and the printer James Franklin, older brother to Benjamin (his teenaged apprentice), who fought arduously against it.
Smallpox in Colonial America
Although smallpox was somewhat endemic in London and other urban parts of Europe, it appeared in destructive waves in the New World. It was, as Duffy wrote, a “perpetual threat to public health.” 20 People had enough exposure to smallpox to be terrified but not immune. The first cases were likely brought over from England in 1630 on governor John Winthrop’s ship, the Arabella, which was carrying several ill and deceased passengers.21 Subsequent epidemics in 1634 and 1638 prompted early legislative acts. In 1647, the Massachusetts Bay Colony settlers established quarantine restrictions to protect against disease transmission in arriving ships.22 Rhode Island, South Carolina, and other colonies, as well as some Native American tribes, also implemented quarantine practices in the hope of warding off smallpox.23 Despite these restrictions, the transmission rate and incubation period made the disease hard to contain, as it was not possible to predict who was silently harboring the infection before pustules appeared.
In 1721, Boston was a bustling city of more than ten thousand residents. The town had two regular weekly newspapers, which published supplements as needed. The Boston News-Letter had emerged in 1704, becoming the first regular newspaper in colonial America. Edited by John Campbell, the weekly publication primarily reprinted news and essays from England, alongside blurbs of local news.24 Similarly, the Boston Gazette, started in 1719, also largely relayed British news and opinions.25 Like other newspapers of this time, these expensive papers were sold by subscription, with only a small portion being subsidized by advertisements.26 Systematic reporting did not exist. Instead printers either reprinted material from other papers, gathered editorials from those wishing to contribute, or wrote content themselves. In addition to newspapers, pamphlets offered writers a much cheaper and faster way to disseminate their messages. These short, cheaply bound, coverless books covered an array of topics, serving as a “ready-made paper platform or missile for heated disputation.” 27 Unlike newspapers, as pamphlets were privately printed, they bypassed the English government’s censorship.
Smallpox Comes to Boston
With its flourishing shipping industry, Boston was a hub for disease transmission. The city faced an epidemic approximately every twelve years, harboring more than seven outbreaks of smallpox before the 1721 epidemic, with the last occurring in 1702–3.28 In 1721, Boston residents had not seen smallpox in eighteen years. The April 13–17 issue of the News-Letter marked the first sign of trouble, briefly mentioning smallpox deaths in England two months earlier.29 The news was foretelling, as Boston was about to have its own epidemic, trumping the updates of the London outbreaks.
The disease arrived on HMS Seahorse, a British vessel traveling from Salt Tortugas to the Boston harbor on April 22.30 As the ship was anchored, several crew members became ill and then died of smallpox, while others, unknowingly infected, went ashore to venture around the city.31 On May 8, the selectmen (assembly of leaders) ...
