ANTI-VAXXERs and the smallpox debate of 1721
Anti-vaxxers in every age: An artist’s satirical portrayal of Edward Jenner’s patients turning into cows after being administered a smallpox vaccine derived from cow-pox. 18th-century etching by J. Gillray. Image: Wellcome Collection.
Smallpox was one of the most frightening diseases of the colonial era. The mortality rate was high and survivors suffered long-term complications, including pocked skin, blindness, and sterility. In 1716, Cotton Mather, Puritan minister and scientist, learned about inoculation, also known as variolation, from an article in Philosophical Transactions, published by the Royal Society in England, and his enslaved African man, Onesimus.
The article in Philosophical Transactions described the observations of Emanuel Timonius, a physician in Constantinople, on the local practice of inoculation. He observed that pus was collected from the pustules of a previously healthy boy infected with smallpox and stored in a glass vessel. Then the pus was administered to a patient. As Timonius described the process,
the Operator is to make several little Wounds with a Needle, in one, two or more places of the Skin, till some drops of Blood follow, and immediately drop out some drops of the Matter in the Glass, and mix it well with the Blood issuing out; one drop of the Matter is sufficient for each place prick’d. These Punctures are made indifferently in any of the fleshy Parts, but succeeds best in the Muscles of the Arm or Radius. (1)
He reported that of the thousands of patients inoculated during the previous 40 years, none had died from smallpox. In contrast, he wrote, the mortality rate of those catching smallpox naturally was 50%.
Immune for life
Onesimus told Mather about his own inoculation in his native West Africa. Mather later described the conversation:
I had from a Servant of my own, an Account of its being practiced in Africa. Enquiring of my Negro-man Onesimus… [w]hether 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 preserve him from it…He described the Operation to me, and shewed me in his Arm the scar, which it had left upon him. (2)
According to Cotton Mather, the process described by Onesimus was similar to that described above by Timonius. Once the inoculation was performed and the person recovered, Onesimus said, they were immune for life.
Smallpox recurred regularly throughout New England, devastating families and, especially, Native American communities. Photo: Sarah Stewart
In 1721, five years later, smallpox broke out in Boston. Mather encouraged Boston’s physicians to attempt inoculation, but only one, Zabdiel Boylston, was willing to take the risk, perhaps because he had barely survived a smallpox infection several years earlier. On June 26, Boylston inoculated his youngest son, Thomas - his enslaved man, Jack, and Jack’s son, both to protect them and to set an example. Jack had a very mild case. The boys had more serious cases, but all completely recovered. (3)
Agreeing to reason
The outcry against inoculation was immediate. A few weeks later, Boylston defended himself against the “Clamour and Ralary” in an article in the July 17th Boston Gazette, pointing out that inoculation was “Recommended from Gentlemen of Figure and Learning, and which well agrees to Reason.” (4) Boston authorities did not agree and issued a cease-and-desist order in mid-July. A few days later, on July 21st, Boylston was ordered to report to Boston town hall for an inquiry. He was questioned at length about the risks and effectiveness of inoculation. Lawrence Dalhonde, a former French military surgeon, testified to complications from inoculation, some deadly, that he had observed during his military service. Despite this testimony, Boylston stood by his claims that inoculation was safe and efficacious. (5)
“Onesimus… told me, that he had undergone an Operation, which … would forever preserve him from [smallpox].”
Cotton Mather
There were, however, valid concerns. Inoculation is different from vaccination: it administers the live virus in the hopes of inducing a mild case (or, as we now know, of creating immunity.) Someone could therefore contract smallpox. And anyone who contracted it, either naturally or by inoculation, could infect others. Purposely infecting people with smallpox during an epidemic seemed counterintuitive to many.
There was also a question of whether inoculation accorded with God’s plan. Ironically, most doctors opposed inoculation while many ministers supported it. Many townspeople feared the smallpox was a punishment from God. After the inquiry on July 21, a group of doctors in Boston published a warning that inoculation “tends to spread and continue the infection in a place longer than it might otherwise be; and that continuing the operation among us is likely to prove of most dangerous consequence.” (6)
“Preach up the POX!”
The physician William Douglass claimed that inoculation was contrary to the will of God; only God could decide who contracted a disease. He argued that Boston and its people risked angering God if inoculation continued. Several ministers, including Cotton’s father, Increase Mather, also a man of science, argued that God gave humans the reason and knowledge to make scientific discoveries that would benefit them, including inoculation. (7)
James Franklin, writing in the New England Courant, criticized the Puritan ministers supporting inoculation: “Who like faithful Shepherds take care of their Flocks / By teaching and practicing what’s Orthodox / Pray hard against Sickness, yet preach up the POX!” (8)
Bostonians died at an increasing rate through the summer and into the fall. But the debate over inoculation continued. Boylston continued to inoculate his patients and others who came to him. By the time the epidemic ended in May 1722, over 800 people had died. The 280 people inoculated by Boylston suffered significantly reduced mortality rates compared to those who became infected via natural means - 2.4% vs. 14%, respectively. Many people who had previously opposed inoculation became supporters, or at least recognized its merit. Inoculation continued throughout the 18th century until the development of the smallpox vaccine by Edward Jenner in 1796. (9)
1. Emanuel Timonius, “An account, or history, of the procuring the smallpox by incision, or inoculation; as it has for some time been practiced at Constantinople,” Philosophical Transactions of the Royal Society, 1714, 29, 72-28.
2. Letter published in George Lyman Kittredge, “Some Lost Works of Cotton Mather,” in Proceedings of the Massachusetts Historical Society, vol. 45 (Cambridge: John Wilson & Son, 1912), 422.
3. Stephen Coss, The Fever of 1721: The Epidemic that Revolutionized Medicine and American Politics (New York: Simon and Schuster, 2016), 86-95.
4. Boston Gazette, July 17, 1721, 2.
5. Coss, The Fever of 1721, 95-96, 100-103. Tony Williams, The Pox and the Covenant: Mather, Franklin, and the Epidemic that Changed America’s Destiny (Naperville, Illinois: Sourcebooks, 2010), 83-84.
6. Williams, The Pox and the Covenant, 84.
7. Williams, The Pox and the Covenant, 69-96.
8. New England Courant, August 7, 1721.
9. Coss, The Fever of 1721, 193-194.
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Lori Lyn Price is a biostatistician and historian who explores the daily life of ordinary people in the colonial period and their use of botanical and other medical recipes.
Further reading
Massachusetts Historical Society, “Defeating the ‘Speckled Monster’: The Fight against Smallpox from Inoculation to Vaccination,” February 2021
“The Fight Over Inoculation During the 1721 Boston Smallpox Epidemic”
Stephen Coss, The Fever of 1721: The Epidemic that Revolutionized Medicine and American Politics, New York: Simon and Schuster, 2016.