1721 Boston smallpox outbreak

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1721 Boston smallpox epidemic
A South-East View of the City of Boston in North America.jpg
Disease Smallpox
Virus strainVariola major
Location Boston, Massachusetts
Index case British sailor disembarking HMS Seahorse [1] [2]
Dates22 April 1721 - 22 February 1722
Confirmed cases5,759 [3]
Deaths
844 [4] [3]

In 1721, Boston experienced its worst outbreak of smallpox (also known as variola). 5,759 people out of around 10,600 [5] in Boston were infected and 844 were recorded to have died between April 1721 and February 1722. [4] [3] The outbreak motivated Puritan minister Cotton Mather and physician Zabdiel Boylston to variolate hundreds of Bostonians as part of the Thirteen Colonies' earliest experiment with public inoculation. Their efforts would inspire further research for immunizing people from smallpox, placing the Massachusetts Bay Colony at the epicenter of the Colonies' first inoculation debate and changing Western society's medical treatment of the disease. The outbreak also altered social and religious public discourse about disease, as Boston's newspapers published various pamphlets opposing and supporting the inoculation efforts.

Contents

Smallpox in Boston

Spectacle Island was used to quarantine sailors with smallpox. Spectacle Island in Boston Harbor.jpg
Spectacle Island was used to quarantine sailors with smallpox.

On 22 April 1721 the British passenger ship HMS Seahorse arrived at Boston from Barbados, [6] after one stop at Tortuga, [7] with a crew of sailors who had just survived smallpox. [2] Customs' quarantine hospital at Spectacle Island was tasked with containing individuals who had contagious diseases, with a case of smallpox contained successfully the previous fall. [2] But one of Seahorse's sailors fell ill in Boston Harbor a day after arrival, and exposed other sailors to variola. [8] Boston's water bailiff inspected Seahorse and discovered another two or three cases of smallpox in various stages before ordering the ship to leave the harbor. Despite the sailor being hurriedly quarantined in the lodging house where he fell ill, nine other sailors at Boston Harbor exposed to him came down with smallpox in early May. [8] The sailors were quarantined on Spectacle Island's very-rudimentary hospital but staff and customs were unable to contain the virus. [9] On 26 May Cotton Mather wrote in his diary: "The grievous calamity of the small pox has now entered the town." [6]

Boston's last smallpox outbreak had been in 1703, and a new generation of non-immune children and young adults was vulnerable. By June the town was faced with a major public health crisis and the religious public became increasingly worried that they were the subjects of divine punishment. [10] Around 900 people fled Boston into the countryside, [11] likely spreading the virus. The General Court, colonial Massachusetts' legislating body, moved from Boston to Cambridge at summer's end, but smallpox cases began appearing in Cambridge in August. [10] James Franklin's The New England Courant was founded in August amid the outbreak and the issue of smallpox and preservation from it became front page news. [5] The Courant was ordered in early October by the town council to publish a house-by-house count on those affected so far by smallpox: 2,757 cases, 1,499 recoveries and 203 deaths were counted. [12] The outbreak peaked in October when 411 people died in that month alone. [12] Judge Samuel Sewall recorded in his diary the deaths of his friends and neighbors like one Madam Checkly on 18 October. [9] Thanksgiving sermons were also affected by the outbreak, and on 26 October most congregations held a single sermon at 11 in the morning out of fear of smallpox spreading during gatherings. The next day Judge Sewell attended the funeral of local child Edward Rawson before attending the burial of one of Sewell's own tenants, while a local college student and "many others" were buried that Friday night. [9] 8% of Boston's population would die during the epidemic, [7] and hundreds of other Bostonians would recover with severe scarring or disabilities.

Public inoculation campaign

Cotton Mather promoted America's first public inoculation campaign. Cotton Mather.jpg
Cotton Mather promoted America's first public inoculation campaign.

Cotton Mather sent letters to Boston's 14 other physicians regarding the outbreak [1] imploring them to wage a medical campaign against smallpox by inoculating their own patients or volunteers. Mather had been interested in inoculation since 1715 when a slave named Onesimus informed Mather about a procedure in Africa which made him immune to smallpox for life. The scars were commonly found on enslaved people kidnapped from Africa, and valued by slave traders. [13] Mather read physician Emmanuel Timoni's description of a similar procedure witnessed while serving Great Britain's ambassador in Turkey. [14] [5] The procedure Timoni called inoculation involved drying pus from a smallpox patient and rubbing or scraping it into a healthy person's skin, giving them a mild case of pox that conferred lifetime immunity. [15] Mather wanted to prove variolation was a relatively safe and effective procedure to protect people against smallpox. Most physicians, however, feared the possibility of smallpox fatally spreading and the social implications of deliberately infecting others.[ citation needed ]

Zabdiel Boylston of Harvard University was the only doctor who positively responded to Mather, beginning America's first public campaign of inoculation. On 26 June 1721, Boylston first inoculated his six-year-old son Thomas, and then his 36-year-old slave and the slave's two-year-old son. [16] To the doctor's relief, all survived relatively mild cases of smallpox without disability or disfigurement. Boylston then felt confident enough about the procedure's safety, and over a period of five months during the outbreak [5] inoculated 247 people in and around Boston (with 6 fatalities). [8] Among them was Cotton Mather's son Samuel, whose chambermaid contracted smallpox at Harvard. On the 25 November 1721, Boylston inoculated 15 individuals at Harvard: thirteen students, professor Edward Wiglesworth, and tutor William Welsted. [10] They all survived, leaving the university's student body and faculty fascinated by the procedure. Cotton Mather writes in a letter detailing Dr. Boylston's work in Boston: "The experiment has now been made on several hundred persons, upon both male and female, upon both old and young, upon both strong and weak, upon both white and black." [16]

Boylston was unable to continue his inoculation campaign beyond November due to opposition from Boston's Selectmen restricting him, as well as occasional violence from the public. But a tutor at Harvard inspired by his research, Thomas Robie, continued vaccinating patients at Spectacle Island. One of his patients was another tutor, Nicholas Sevier, who returned to Harvard sixteen days after he was inoculated to report on the success of his procedure. Harvard's academic community became more accepting of inoculation after the successful experiments of Boylston and Nicholas Sevier. [10]

Inoculation controversy and violence

Coverage of inoculation was a front page issue in The Courant's first publication. NewEnglandCourant 00001.jpg
Coverage of inoculation was a front page issue in The Courant's first publication.

Cotton Mather believed inoculation was a divine gift to protect people from smallpox [16] [5] and Boylston felt duty-bound as a physician to protect his children and others from smallpox. [4] Many contemporary Bostonians, however, were terrified of smallpox spreading from inoculated patients [17] [3] and outraged at the idea of deliberately infecting people. Inoculation also evoked anger from dubious physicians. One such physician, William Douglass, was a vehement inoculation opponent who published anti-inoculation pamphlets in response to Mather's experiment. One pamphlet published in The New England Courant read "Some have been carrying about instruments of inoculation, and bottles of poisonous humor, to infect all who were willing to submit to it. Can any man infect a family in the morning, and pray to God in the evening that the distemper will not spread?" [3] Douglass believed only accredited medical professionals like himself should conduct such dangerous procedures, [5] while he personally opposed inoculation. Boylston was ridiculed and satirized in the newspapers, portrayed as a quack by Douglass and other physicians. [3]

Variolation still did present a risk of death for 2% of those having the procedure. This was fertile ground for criticism. Furious rumors swirled around inoculation as The New England Courant published Douglass and Dalhonde's sensationalist articles against inoculation. [3] One article by Douglass darkly joked about using inoculations against surrounding Native American communities. [5] Dr. Boylston became notorious and the colonial government remained deeply skeptical of his and Mather's experiment. The Boston City Council summoned him in early August to explain his procedures, and the Council condemned inoculation and ordered him to desist immediately. Despite the opposition, Boylston garnered support of local learned men like Cotton's father Increase Mather and four other "inoculation ministers" by the names of Benjamin Coleman, Thomas Prince, John Webb, and William Cooper. Inoculations resumed two days later. [2] Dr. Boylston was assaulted in the streets for this [5] and eventually threatened to the point he secretly hid in his house for two weeks.

Cotton Mather was also terrorized by an angry public as rumors spread wildly about inoculations. Mobs eventually began forcing the variolated into isolation at Spectacle Island's quarantine house. [10] Cotton Mather inoculated his nephew, Reverend Walter, and offered to let him stay at Mather's home while he recovered from smallpox, but a fearful mob became aware and attacked and threw a crude bomb directly into the room where Walter was staying. [4] The device failed to explode, but a note tied to it read "Cotton Mather, I was once of your meeting, but the cursed lye you told of - you know who, made me leave you, you dog, and damn you, I will inoculate you with this, with a pox on you!" [4]

A prominent member of Boston's clergy to oppose inoculation was John Williams. Williams criticized variolation as sinful and "not in the Rules of Natural Physick." Cotton Mather countered that to reject inoculation would be a violation of the Bible's 6th Commandment since many people would die. [5]

Social and scientific impact

Boylston wrote extensively about inoculation after his experiments. Boylston - An Historical Account of the Small-pox Inoculated in New England (title).png
Boylston wrote extensively about inoculation after his experiments.

The outbreak was the first time in American medicine where the press was used to inform (or alarm) the general public about a health crisis. [1] The New England Courant, under the leadership of its new editor 16 year-old Benjamin Franklin, continued to publish satirical articles about the Mather and inoculation in the months following the epidemic. [7] Boylston wrote an account of his experiences with inoculation in An Historical Account of the Small Pox Inoculated in New England. Most of Boston's clergy seemed to have supported inoculation, and some wrote an op-ed opposing Williams and Douglass's criticism: "tho [Dr. Boylston] has not had... an Academic Education, and congruently not the Letters of some Physicians in town, yet he ought by no means be called Illiterate, Ignorant, etc. Would the town bear that Dr. Cutter or Dr. Davis be so treated?" Minister Benjamin Coleman, believing in inoculation, collected inoculation stories from slaves similar to Onesimus's account and published "Some observations on the new method of receiving the small pox by ingrafting or inoculation" in opposition to Douglass. [5]

Young Benjamin Franklin satirized inoculation, but would become a supporter later in his life. Benjamin Franklin 02.jpg
Young Benjamin Franklin satirized inoculation, but would become a supporter later in his life.

Boston's smallpox outbreak of 1721 is unique for motivating America's first public inoculation campaign, and the controversy that surrounded it. On 22 February 1722, it was officially announced that no new cases of smallpox were appearing in Boston and the disease was in decline. [1] In the outbreak's aftermath, with over 800 Bostonians dead and many more disfigured from smallpox, Boylston's 247 inoculated patients had a 2% death rate versus the 15% [8] [5] of people who died if they got smallpox naturally. [2] Boylston's successful experiments on students and faculty at Harvard led to early acceptance in Boston's powerful academic community for the procedure. [10] After Mather and Boylston's highly-publicized experiments with inoculation, and Lady Mary Wortley Montagu's similar experiments during a simultaneous outbreak in London, variolation would become a widespread and well-researched technique in the West decades before Edward Jenner's discovery of vaccination with cowpox. In 1723, Boylston traveled to England and received honors by King George. In London he published an account of his work, An Historical Account of the Smallpox Inoculated in New England. [4]

Related Research Articles

<span class="mw-page-title-main">Cotton Mather</span> Puritan clergyman (1663–1728)

Cotton Mather was a Puritan clergyman and author in colonial New England, who wrote extensively on theological, historical, and scientific subjects. After being educated at Harvard College, he joined his father Increase as minister of the Congregationalist Old North Meeting House in Boston, Massachusetts, where he preached for the rest of his life. He has been referred to as the "first American Evangelical".

<span class="mw-page-title-main">1721</span> Calendar year

1721 (MDCCXXI) was a common year starting on Wednesday of the Gregorian calendar and a common year starting on Sunday of the Julian calendar, the 1721st year of the Common Era (CE) and Anno Domini (AD) designations, the 721st year of the 2nd millennium, the 21st year of the 18th century, and the 2nd year of the 1720s decade. As of the start of 1721, the Gregorian calendar was 11 days ahead of the Julian calendar, which remained in localized use until 1923.

<span class="mw-page-title-main">Cowpox</span> Disease of humans and animals

Cowpox is an infectious disease caused by the cowpox virus (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more often from infected cats. The hands and face are most frequently affected and the spots are generally very painful.

<span class="mw-page-title-main">Smallpox vaccine</span> Vaccine against Variola virus

The smallpox vaccine is the first vaccine to have been developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox virus. Cowpox served as a natural vaccine until the modern smallpox vaccine emerged in the 20th century. From 1958 to 1977, the World Health Organization (WHO) conducted a global vaccination campaign that eradicated smallpox, making it the only human disease to be eradicated. Although routine smallpox vaccination is no longer performed on the general public, the vaccine is still being produced to guard against bioterrorism, biological warfare, and mpox.

<span class="mw-page-title-main">1775–1782 North American smallpox epidemic</span> Disease outbreak in North America

The New World of the Western Hemisphere was devastated by the 1775–1782 North American smallpox epidemic. Estimates based on remnant settlements say at least 130,000 people were estimated to have died in the epidemic that started in 1775.

Zabdiel Boylston, FRS was a physician in the Boston area. As the first medical school in North America was not founded until 1765, Boylston apprenticed with his father, an English-born surgeon named Thomas Boylston, and studied under the Boston physician Dr. Cutler. Boylston is known for holding several "firsts" for an American-born physician: he performed the first surgical operation by an American physician, the first removal of gall bladder stones in 1710, and the first removal of a breast tumor in 1718. He was also the first physician to perform smallpox inoculations in North America.

Artificial induction of immunity is immunization achieved by human efforts in preventive healthcare, as opposed to natural immunity as produced by organisms' immune systems. It makes people immune to specific diseases by means other than waiting for them to catch the disease. The purpose is to reduce the risk of death and suffering, that is, the disease burden, even when eradication of the disease is not possible. Vaccination is the chief type of such immunization, greatly reducing the burden of vaccine-preventable diseases.

James Jurin FRS FRCP was an English scientist and physician, particularly remembered for his early work in capillary action and in the epidemiology of smallpox vaccination. He was a staunch proponent of the work of Sir Isaac Newton and often used his gift for satire in Newton's defence.

<i>The New-England Courant</i> Early American newspaper

The New-England Courant, one of the first American newspapers, was founded in Boston in 1721, by James Franklin. It was a weekly newspaper and the third to appear in Boston. Unlike other newspapers, it offered a more critical account about the British colonial government and other royal figures of authority. The newspaper published critical commentary about smallpox inoculation which fueled the controversy during the smallpox epidemic in Boston. Ultimately it was suppressed in 1726 by British colonial authorities for printing what they considered seditious articles. Franklin took on his brother, Benjamin Franklin, as an apprentice and at one point was compelled to sign over publication of the Courant to him to avert further prosecution. Benjamin submitted anonymous editorials to the Courant, which resulted in James' imprisonment after he began publishing them. This sort of Governmental censorship of early colonial newspapers is what largely fostered the American ideal of Freedom of Speech in the press. The New England Courant is widely noted among historians as being the first newspaper to publish Benjamin's writings.

Disease in colonial America that afflicted the early immigrant settlers was a dangerous threat to life. Some of the diseases were new and treatments were ineffective. Malaria was deadly to many new arrivals, especially in the Southern colonies. Of newly arrived able-bodied young men, over one-fourth of the Anglican missionaries died within five years of their arrival in the Carolinas. Mortality was high for infants and small children, especially for diphtheria, smallpox, yellow fever, and malaria. Most sick people turned to local healers, and used folk remedies. Others relied upon the minister-physicians, barber-surgeons, apothecaries, midwives, and ministers; a few used colonial physicians trained either in Britain, or an apprenticeship in the colonies. One common treatment was blood letting. The method was crude due to a lack of knowledge about infection and disease among medical practitioners. There was little government control, regulation of medical care, or attention to public health. By the 18th century, Colonial physicians, following the models in England and Scotland, introduced modern medicine to the cities in the 18th century, and made some advances in vaccination, pathology, anatomy and pharmacology.

The history of smallpox extends into pre-history. Genetic evidence suggests that the smallpox virus emerged 3,000 to 4,000 years ago. Prior to that, similar ancestral viruses circulated, but possibly only in other mammals, and possibly with different symptoms. Only a few written reports dating from about 500 AD to 1000 AD are considered reliable historical descriptions of smallpox, so understanding of the disease prior to that has relied on genetics and archaeology. However, during the 2nd millennium AD, especially starting in the 16th century, reliable written reports become more common. The earliest physical evidence of smallpox is found in the Egyptian mummies of people who died some 3,000 years ago. Smallpox has had a major impact on world history, not least because indigenous populations of regions where smallpox was non-native, such as the Americas and Australia, were rapidly and greatly reduced by smallpox during periods of initial foreign contact, which helped pave the way for conquest and colonization. During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness. Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.

<span class="mw-page-title-main">John Williams (New England minister)</span> New England Puritan minister

John Williams was a New England Puritan minister who was the noted pastor of Deerfield from 1688 to his death. He and most of his family were taken captive in the Raid on Deerfield in 1704 during Queen Anne's War. He was held by the French in Montreal for more than two years, who wanted a high-ranking French pirate in exchange. After being released in late 1706, Williams became even more notable for The Redeemed Captive (1707), his account of his captivity. It became a well-known work in the genre of captivity narratives.

William Douglass was a physician in 18th-century Boston, Massachusetts, who wrote pamphlets on medicine, economics and politics that were often polemical. He was a central figure, along with Cotton Mather during the controversy surrounding the 1721 smallpox epidemic in Boston.

Thomas Frewen, M.D. (1704–1791), was an English physician.

Variolation was the method of inoculation first used to immunize individuals against smallpox (Variola) with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result. Only 1–2% of those variolated died from the intentional infection compared to 30% who contracted smallpox naturally. Variolation is no longer used today. It was replaced by the smallpox vaccine, a safer alternative. This in turn led to the development of the many vaccines now available against other diseases.

<span class="mw-page-title-main">William Woodville</span>

William Woodville was an English physician and botanist. Convinced by the work of Edward Jenner, he was among the first to promote vaccination. His four volume book on medical botany published between 1790 and 1794 with 300 illustrations of medicinal plants by James Sowerby was an important reference work for physicians in the nineteenth century with a second edition in 1810 followed by a revision in 1832 by William Jackson Hooker and George Spratt.

The Massachusetts smallpox epidemic or colonial epidemic was a smallpox outbreak that hit Massachusetts in 1633. Smallpox outbreaks were not confined to 1633 however, and occurred nearly every ten years. Smallpox was caused by two different types of variola viruses: variola major and variola minor. The disease was hypothesized to be transmitted due to an increase in the immigration of European settlers to the region who brought Old World smallpox aboard their ships.

Inoculation is the act of implanting a pathogen or other microbe or virus into a person or other organism. It is a method of artificially inducing immunity against various infectious diseases. The term "inoculation" is also used more generally to refer to intentionally depositing microbes into any growth medium, as into a Petri dish used to culture the microbe, or into food ingredients for making cultured foods such as yoghurt and fermented beverages such as beer and wine. This article is primarily about the use of inoculation for producing immunity against infection. Inoculation has been used to eradicate smallpox and to markedly reduce other infectious diseases such as polio. Although the terms "inoculation", "vaccination", and "immunization" are often used interchangeably, there are important differences. Inoculation is the act of implanting a pathogen or microbe into a person or other recipient; vaccination is the act of implanting or giving someone a vaccine specifically; and immunization is the development of disease resistance that results from the immune system's response to a vaccine or natural infection.

Onesimus was an African man who was instrumental in the mitigation of the impact of a smallpox outbreak in Boston, Massachusetts. His birth name is unknown. He was enslaved and, in 1706, was given to the New England Puritan minister Cotton Mather, who renamed him. Onesimus introduced Mather to the principle and procedure of the variolation method of inoculation to prevent the disease, which laid the foundation for the development of vaccines. After a smallpox outbreak began in Boston in 1721, Mather used this knowledge to advocate for inoculation in the population. This practice eventually spread to other colonies. In a 2016 Boston magazine survey, Onesimus was declared one of the "Best Bostonians of All Time".

The Norfolk Anti-Inoculation Riot on June 27, 1768 was part of a series of riots across the English Colonies in the New World surrounding inoculation against smallpox. Many inhabitants of the colonies were against this relatively new approach to build immunity against smallpox. Inhabitants were afraid that inoculation would infect and kill uninfected communities, but they also objected for political reasons. The riot on June 27, 1768 in Norfolk, Virginia consisted of an anti-inoculation mob invading a plantation where inoculated families resided, ending in the mob driving the families into the local pest house.

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