America's First Struggle with Vaccination: The Boston Smallpox Epidemic of 1721 and the Fight Over Inoculation

 

It is April 22, 1721 and the small passenger ship HMS Seahorse arrives from London in Boston harbor.

Onboard is a sailor suffering from fever and uncontrollable vomiting.  He is hot to the touch and already his skin has begun to break out in a painful blistering rash.  This sailor is suffering from the dreaded disease of smallpox--the scourge of Colonial America--known to scientists as the virus Variola Major but simply called the Pox by everyone else.

Immediately, authorities in Boston ordered the sailor quarantined on Spectacle Island, a small 105 acre speck of land in the harbor that is located four miles from Boston’s city center.  On his deathbed, convulsing in and out of consciousness, this lone sailor is left on the island to die, but already it is too late.

The Pox has spread to others onboard the Seahorse, both to passengers from England and to local crew members who take the virus back with them to their residences in Boston.  

Before all is said and done ten months later in February of 1722 the Boston Smallpox Epidemic of 1721/22 will claim over 800 lives, mostly children and young people, and the virus will infect over 60% of Boston’s population.  More than 6000 Bostonians out of a total population of just over 10,000 will fall gravely ill from smallpox in less than a year, and most of those who do not die, will be left with disfiguring scars from the “Pox” that will mark them as survivors of the tragedy for the rest of their lives.

Spectacle Island

Boston was ravaged by smallpox epidemics seven times in the 1700’s.  The smallpox virus intermittently visited most major American cities several times during the 18th century but none were worse than the scourge that lasted from April of 1721 until February of 1722.

Out of the terror of this epidemic will come a new, as yet nearly unheard of treatment in western medicine--inoculation.  

Only the application of this controversial, mysterious and some would say Satanic new method of treatment will save Boston from utter depopulation by the spring of 1722

A war of words, and of violence, will be fought over the course of the winter of 1721/22 in Boston as hardline Puritans fight with unlikely (also Puritan) proponents over the benefits of inoculation.

Smallpox is a virus of the respiratory system that is transmitted, most commonly, from person to person by droplets in the air though it can be spread via contaminated items, particularly cloth, that has been saturated with the virus.

Prior to 1721 and the arrival of the HMS Seahorse in Boston Harbor, the last major smallpox outbreak in the city had occurred in 1703.  As Boston’s population continued to expand throughout the early 1700’s,  an entire generation grew up without having ever been exposed to the “Pox” and therefore had never developed any natural immunity to the virus.

In 1721, in the midst of the outbreak, with such a large and vulnerable population with no natural immunity to smallpox Bostonians were falling sick in droves and dying by the dozen each day.  Nearly a thousand people fled the city for the countryside of western Massachusetts with some simply camping rough out in the woods and others living in open fields just outside the city limits.

By summer Puritan ministers were preaching the doctrine of “Divine Punishment” and telling their congregations that smallpox was the wrath of God visited upon an unrepentant and sinful population.  

Many believed this preaching and countless days of Thanksgiving were declared in Boston during the summer and fall of 1721 in an effort to propitiate an angry God.  Rumors regarding the “Pox”, including prophecies of the impending end of the world, spread like wildfire throughout the city.

In an effort to stem the tide of refugees fleeing the city, and to combat misinformation regarding the spread of the virus, publisher James Franklin founded The New England Courant, one of America’s first daily newspapers in August of 1721 to report on the disease.  Realizing that the city, and its environs, needed to get a better grasp on the spread and deadliness of the virus local leaders in October of 1721 ordered Franklin to conduct a house by house report on the virus and publish his findings in The New England Courant.

The New England Courant from 1721

The report that Franklin published in his paper was grim.  By October 1, 1721 there had been 2,757 overall cases of smallpox in Boston and nearby Cambridge with 203 deaths reported, 1,499 complete recoveries and just over 1,100 cases that remained still active.  And it was about to get worse.

October and November 1721 were the peak months for the epidemic with the city of Boston recording 411 deaths from smallpox in that time alone.

Amidst the prayers of Thanksgiving, and fire and brimstone sermons preaching of divine retribution, one unlikely innovator stepped forward--Cotton Mather.

Cotton Mather was perhaps the most influential theological voice in all of Puritan New England at the time.  He was a prolific author, preacher and student of history.  Today he is often remembered for his role in the Salem Witch Trials of 1692, when as a young minister still under the age of 30, Mather published accounts of the Trials in which he championed the use of spectral evidence and reaffirmed the Puritan belief in witchcraft.

However, in Boston in 1721, this same man who three decades earlier had morally justified the trial and execution of over two dozen innocent women as accused witches, now was one of the few dissenting voices among all Puritan ministers who sought a medical remedy to the smallpox epidemic.

Cotton Mather

Earlier in the century, sometime around the year 1715, Mather had heard stories from one of his west African slaves, a man named Onesimus, of a procedure called  inoculation.  Mather wrote of Onesimus that, “[H]e told  me he had undergone an operation which had given him something of the smallpox, adding that it would forever preserve him from it.”

During the epidemic of 1721/22 Mather began to study written accounts of inoculation as performed in Turkey and he also began to interview members of Boston’s enslaved and free black community.  He noted that those individuals, who had been inoculated at an early age in Africa, were much less prone to even contract the virus in the first place let alone die from it than Boston’s white population.

Inoculation, as practised in certain parts of the world at the time, involved drying the pus from a person infected with smallpox and then rubbing that dried pus into an open wound on a healthy person.  This inoculation exposed the healthy person to the smallpox virus in a small, benign dose, thereby making them better able to fight off the disease.

Mather recognized the value of inoculation, practised the procedure on both himself and his own family, and he quickly realized that inoculation was an effective and safe means of saving lives and ridding the city of the deadly virus once and for all.

He wrote letters to all fourteen of Boston’s physicians in the summer of 1721 championing the benefits of inoculation and encouraging all men of medicine to launch a citywide inoculation effort against smallpox.

Only one physician, Zabdiel Boylston, answered Mather’s letter and launched an inoculation campaign of his own.  Boylston was a Harvard trained physician who is credited with having performed the first ever surgical removal of gallstones in 1710 and with the first ever removal of a breast tumor in 1718.  In an era when most Puritan physicians tended to trust God more than science, Boylston was the one outlier who pushed the envelope when it came to innovative medical procedures.

Zabdiel Boylston

In June of 1721 Boylston inoculated himself, his family members and volunteer students and staff at Harvard University.  Inoculation against smallpox proved to be both safe and effective.  Within weeks Mather and Boylston together begin a citywide inoculation campaign.  Mather preached the benefits of inoculation from the pulpit in local churches while Boylston continued to perfect the procedure and administer smallpox inoculations to all who were willing 

Boston’s hardline Puritans were outraged.  Mather preached that the practice of inoculation was a gift from God, but the city’s council believed that it was the work of Satan, a procedure of the devil, practised by heathens and Godless savages in the wilds of Africa.

Soon violence ensues between those Puritans loyal to Mather and his sermonizing on the benefits of inoculation and those who believe that the smallpox epidemic is Divine retribution.

In November 1721 a crude cast-iron bomb was thrown through the window of Cotton Mather’s home.  The fuse on the bomb is defective and it does not go off, but attached to the makeshift hand grenade was a note that read: COTTON MATHER, YOU DOG!  DAMN YOU!  I’LL INOCULATE YOU WITH THIS!

Inoculation against smallpox, as practised by Mather and Boylston, did pose some risk to those who received it at the time.  About 2% of individuals who received variolation (as the procedure was called at the time after the virus Variola Major) did die from smallpox, and around 10% did become seriously ill after purposefully exposing themselves to the virus.  However, these numbers pale in comparison to the 30% mortality rate that the virus had among that percentage of the population which had not become inoculated or variolated as Mather and Boylston called it.

Still, Puritan preachers and conservative Puritan pamphleteers took anecdotal stories of inoculations gone wrong and used them to stir up public fear and distrust.  Angry mobs attempted to attack both Mather and Boylston on several occasions, and many of those who had chosen to receive inoculation were chased out of the city and forced to quarantine in the harbor on Spectacle Island where the epidemic had originally begun in the first place.

Amidst growing tension and escalating violence, by the end of November 1721, Boston’s council of city selectmen ordered all inoculation efforts by Mather and Boylston to cease and desist immediately under penalty of arrest and imprisonment.

Inoculation during 1721 epidemic

By February of 1722, either through inoculation, or through herd immunity, it was announced that no new cases of smallpox had been reported in the city limits.  The epidemic had burned itself out, for the time being, though smallpox would return to Boston with all too alarming frequency throughout the 18th century.

The Boston Smallpox Epidemic of 1721 is unique in American history because it marked the first time that there was a concerted effort to inoculate members of the public against a life threatening disease.  And though the conservative minded Puritan public may not have been ready for such a new and innovative technology, the proof of the life saving effectiveness of the efforts of the unlikely duo of Mather and Boylston is in the numbers.

Out of 247 patients inoculated by Boylston and Mather only 2% died from smallpox as opposed to a 15% mortality rate among all other citizens of Boston who did not receive inoculation.

Today’s vaccines against viruses and infectious diseases may be safer and more effective than the inoculation, or variolation efforts, of the 1700’s, or perhaps not.  But no matter what, in the midst of the ongoing COVID-19 Pandemic we all owe a debt of gratitude to Cotton Mather, Zabdiel Boylston and the enslaved people of west Africa who brought the pioneering work of inoculation to our shores exactly 300 years ago.