To inoculate, or not to inoculate – that is the question

The settlement of Boston in 1720 was quite different from the sprawling metropolis of today.

The settlement had around 10,600 people (some sources say 12,000) making it the largest city in the colonies. On April 22, 1721, HMS Seahorse let down its anchor in Boston harbor. The ship sailed in from Barbados and Tortuga. Even at this early date, ships entering had to pass inspection at Spectacle Island, where anyone ill would be quarantined. One sailor fell ill the day after the ship passed Spectacle Island. Though he was removed to a quarantine house, others broke out with pox shortly after. It was variola or smallpox.

This virus exists in two main forms: Variola major, which historically has a mortality rate of around 30%, and the less severe Variola minor with a mortality rate around 1% .

Smallpox epidemics were not new. There had been a dozen at least in New England prior to this date, but none within the last generation. The current colonists had no immunity. Within a short time, 5,759 people in Boston had the disease. That’s fifty-four percent of the population, with 844 deaths, i.e. almost eight percent of the city’s population died of smallpox over a ten-month period. To put that in perspective, Boston now has 710,195 people with 28,053 cases of COVID, and 925 deaths – just under four percent of the population has had COVID, and 0.1 percent have died due to COVID (Boston Public Health Commission, bphc.org ). As with modern statistics, the figures from 1721 varied some according to the source.

The settlement flew into a panic, looking for someone to blame. Fear reigned, and the virus was front-page news (The New England Gazetteer started in August 1721, carrying the stories on the virus).

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Two decades earlier, a slave was purchased for Rev. Cotton Mather, of Salem Witch Trial fame. Mather named the slave Onesimus, after the slave in the biblical book of Philemon. In 1714, Onesimus described a process to Mather that he claimed would prevent smallpox – an inoculation. By 1716, a paper published in the Royal Medical Society journal described inoculation as it was practiced in Turkey. Mather wrote to John Woodward of the Society:

“I do assure you, that many months before I mett with any Intimations of treating the Small-Pox, with the Method of Inoculation, any where in Europe; I had from a Servant of my own, an Account of its being practised in Africa. Enquiring of my Negro-man Onesimus, who is a pretty Intelligent Fellow, Whether he ever had the Small-Pox; he answered, both, Yes, and, No; and then told me, that he had undergone an Operation, which had given him something of the Small-Pox, & would forever praeserve him from it; adding, That it was often used among the Guramantese. ” (spelling original)

Cotton Mather to John Woodward, July 12, 1716, transcribed in G. L. Kittredge, “Some Lost Works of Cotton Mather,” Proceedings of the Massachusetts Historical Society, 45 (1911–1912), 422.

Lady Mary Wortley Montagu, the wife of the English Ambassador to Turkey, described the practice in a letter to a friend in 1716, had her son inoculated soon afterward, and in 1718 returned to England determined to do what she could to bring what she calls “this useful convention” into fashion. She later protested that for four or five years after her return she scarcely passed a day without repenting her audacity. If she followed up what she wrote to her friend in 1716, she told all and sundry that smallpox so fatal in England was entirely harmless in Turkey, that old woman operated every autumn on parties of people who decided to have the disease together (these parties were common in New England later in the century), that patients were rarely in bed more than 2 or 3 days, never had more than 20 or 30 pocks on their faces and no scars, and that there was no example of one who had died of it, but it was not until April 1721, three years after her return to her home, that under the protection of the Princess of Wales, later Queen Charlotte, she arranged the first inoculation in England that of her own child, little Mary Alice. A clamor rose beyond belief. Much like today, the religious were aligned on one side, the with others just as vehemently protesting against – except that Mather was on the side of the inoculators. Other clergy thundered about the sin of taking matters out of God’s hands.

“inoculation had been practised in India from time immemorial and in China for hundreds of years where inoculation in the nostrils was the usual practise—the right side being used for males, the left for females—it does seem rather remarkable that it was unknown in England and indeed in Europe generally 40 years after it had been practised in Turkey and it comes to us with rather of a shock to read in the court records of 1710, but 11 years before Lady Mary’s experiment, that one, Thomas Hawkins, “was paid 8d. for whipping two people who had ye smallpox”, whether as a cure or a punishment does not appear.”

Massachusetts Medical Society, massmed.org

The inoculation process Onesimus described went like this: drying pus from a smallpox patient and rubbing or scraping it into the skin of a healthy person, giving them a mild case of pox that conferred lifetime immunity. Doctors scoffed, and only Zabdiel Boylston of Harvard was brave enough to try it, using his slave and his own son. Both contracted mild cases, and survived.

“The experiment has now been made on several hundreds of persons, upon both male and female, upon both old and young, upon both strong and weak, upon both white and black.”

Cotton Mather, Minardi, Margo (January 2004). “The Boston Inoculation Controversy of 1721-1722: An Incident in the History of Race”. The William and Mary Quarterly. Omohundro Institute of Early American History and Culture.

The storm broke; the other physicians would have no part in the matter; the mob, believing that inoculation was simply giving smallpox to those who might otherwise escape, were roused to fury.

The medical establishment was divided, with a few supporting Mather and Boylston, and others vehemently against him. The clergy almost unanimously supported Boylston. The physicians almost as unanimously derided his efforts. There were times when Boylston was truly in great peril. Thatcher declares that before the excitement subsided men patrolled the town with halters threatening to hang him to the nearest tree.

Boylston wrote in a newspaper article : ” “I take”, says he, “the case to be this. Almighty God in his great mercy to mankind has taught us a remedy to be used when the dangers of smallpox distress us; may not a Christian employ this medicine and humbly thank God for his good Providence in discovering it to a miserable world?”

Human trials were shut down by the Boston selectmen. At least, that was the order. Boylston bravely ignored them, and went right on inoculating.

Physicians in the town wrote that “after mature deliberation, that inoculation had moved the death of many persons and had brought distemper upon many others which in the end proved deadly to them and that the natural tendency of infusing such malignant filth into the mass of the blood is to corrupt and putrify it”.

By October, 60 persons had passed through his hands, and by November 18, when smallpox was present in every street and almost in every house, 110. The town was by this time in a panic. Work was generally suspended. Many families moved away.

But Mather, too, would not give up. He remembered well the epidemic of 1702 that endangered his own children. Mather was terribly overworked, writing, debating, preaching, continually visiting the sick, and called on to offer prayers for the dying. His work in the support of Boylston is now largely forgotten, while every graduate of a primer of history is taught, as Dr. Dexter well says, “to sneer at his memory as the cruel and credulous apostle of the witchcraft mania and murders”. He suffered a lighted hand grenade thrown through his window, with a note attached cursing him and wishing the disease upon him.

Despite the opposition, a survey of the almost six thousand people who contracted the disease between 1721 and 1723 showed that the inoculation method was effective in curbing the disease.

Only 2 per cent of the six hundred Bostonians inoculated against smallpox died.

Meanwhile, 14 percent of those who contracted the disease but were not inoculated died from the illness.

By 1728, Mather’s chief detractor, Scotch physician William Douglas was forced to recant, and even sponsor the process of inoculation. Boylston was honored in 1726 with election to the Royal Society of Medicine.

Inoculation became an accepted procedure and with each recurring epidemic more and more submitted to it until in 1792 but 232 of the 8,346 persons who had the smallpox acquired it in the so-called natural way.