1721 Boston smallpox outbreak

1721 Boston smallpox epidemic
Disease	Smallpox
Virus strain	Variola major
Location	Boston, Massachusetts
Index case	British sailor disembarking HMS Seahorse
Dates	22 April 1721 - 22 February 1722
Confirmed cases	5759
Deaths	844

In 1721 Boston experienced its sixth and worst outbreak of smallpox. From April 1721 to February 1722, 5759 people out of around 10,600 in Boston were infected by the virus and over 844 died. The outbreak would motivate Puritan minister Cotton Mather and Harvard physician Zabdiel Boylston to variolate hundreds of Bostonians in America's earliest experiment with public inoculation. Their efforts would inspire further use and research of variolation for immunizing people from smallpox, placing the Massachusetts Bay Colony at the epicenter of America's first inoculation debate and profoundly impacting Western society's medical treatment of the disease. The outbreak would also permanently changed the medical and religious community's public discourse about disease as Boston's newspapers published various pamphlets opposing and supporting the inoculation efforts.

Smallpox in Boston

City of Boston's harbor and skyline ca. 1723-30

On 22 April 1721 the HMS Seahorse arrived at Boston from Barbados, after one stop at Tortuga, with a crew of British sailors who had just survived an onboard outbreak of smallpox. Customs' quarantine hospital at Spectacle Island was tasked with containing individuals who had contagious diseases like smallpox, with a case contained successfully the previous fall. But one of the Seahorse's sailors only began showing smallpox symptoms a day after the ship's arrival. Boston's water bailiff inspected the 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, 9 other sailors at Boston Harbor exposed to him came down with smallpox in early May. The sailors were quarantined on Spectacle Island's very-rudimentary hospital but staff and customs were unable to contain the virus. On May 26 Cotton Mather recorded in his diary: "The grievous calamity of the small pox has now entered the town."

It had been nearly 2 decades since Boston's last smallpox outbreak, and there would have been a new generation of non immune children and young adults. By June the town was coping with a major public health crisis. The religious public became increasingly worried that they were the subjects of divine punishment and around 900 people fled Boston into the countryside, which likely spread the virus. The General Court, colonial Massachusetts' legislative branch, moved from Boston to Cambridge at the end of summer but smallpox cases began appearing in Cambridge in August. James Franklin's The New England Courant, founded in August amid the outbreak, began immediately publishing angry criticisms by local physicians about an inoculation technique being promoted in town by Cotton Mather. The Courant was ordered in early October by the town council to publish a house-by-house count on those affected by smallpox: 2,757 cases, 1,499 recoveries and 203 deaths were counted. The outbreak peaked in October when 411 people died in that month alone. Judge Samuel Sewall recorded in his diary the deaths of his friends and neighbors like one Madam Checkly on October 18th. 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 Sewall's own tenants, and a local college student and "many others" were buried that Friday night. 8% of Boston's population would die during the epidemic, and hundreds of other Bostonians would recover with severe scarring or profound disabilities.

Public Inoculation Campaign

Cotton Mather promoted America's first public inoculation campaign.

Cotton Mather sent letters to Boston's 14 other physicians in response to the outbreak imploring them to wage a medical campaign against "the most terrible of all the ministers of death" by inoculating their own patients or volunteers against smallpox. Mather had been interested in inoculation since 1715 when his slave, Onesimus, informed Mather that he'd undergone a procedure in Africa which made him immune to smallpox for life. A year later, Mather read physician Emmanuel Timoni's description of a similar procedure witnessed while serving Great Britain's ambassador in Turkey. The procedure Timoni called inoculation involved 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. Mather wanted to prove variolation was a relatively very 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.

Dr. Zabdiel Boylston of Harvard University was the only doctor who positively responded to Mather's call to action, beginning America's first public campaign of inoculation. On 26 June 1721, Dr. Boylston first inoculated his six year-old son Thomas, and then his 36 year-old slave and the slave's two year old son. To the doctor's relief, all survived relatively mild cases of smallpox without disability or disfigurement. Dr. Boylston then felt confident enough about the procedure's safety, and over a period of 5 months during the outbreak he inoculated 247 people in and around Boston (with 6 fatalities). On the 25 November 1721, he inoculated 15 individuals at Harvard: thirteen Harvard students, professor Edward Wiglesworth, and tutor William Welsted. They, too, survived and the university's student body and faculty were both fascinated by the novel procedure. Cotton Mather writes in a letter detailing Dr. Boylston's work in Boston: "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."

Boylston was unable to continue his inoculation campaign beyond November due to opposition from the public and occasional violence. 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 inoculation after the successful experiments of Dr. Boylston and Nicholas Sevier.

Inoculation Controversy and Violence

Cotton Mather believed inoculation was a divine gift to protect people from smallpox and Dr. Boylston felt duty bound to protect his children and others from smallpox with inoculation. But many contemporaries, especially regular Bostonians with no knowledge or interest for inoculation, were terrified of smallpox spreading from inoculated patients and outraged at the idea of deliberately infecting people. Inoculation also evoked anger from dubious physicians. Dr. 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?" Dr. Douglass believed only accredited medical professionals like himself should conduct such dangerous procedures, while he personally opposed inoculation. Dr. Boylston was ridiculed and satirized in the newspapers, portrayed as a quack by Dr. Douglass and a French local physician named Dr. Dalhonde.

Furious rumors swirled around inoculation as The New England Courant published Dr. Douglass and Dalhonde's sensationalist articles against inoculation. One article by Douglass even joked (albeit disturbingly) about using smallpox in inoculations to kill off surrounding indian communities. Inoculation made Dr. Boylston notorious, and a colonial government that rejected the notion of inoculation was deeply skeptical of his and Mather's experiment. The Boston City Council summoned Dr. Boylston in early August to explain, and the Council condemned inoculation and ordered him to desist immediately . Despite the opposition, Dr. Boylston garnered support of local learned men like Costton's father Increase Mather and four other "inoculation ministers" (Benjamin Coleman, Thomas Prince, John Webb, and William Cooper) and defiantly resumed inoculating patients two day later. Dr. Boylston was assaulted in the streets for this. Eventually his life was threatened to the point where Dr. Boylston secretly hid in his house for two weeks.

Cotton Mather was also terrorized by an angry public as rumors spread wildly about inoculations. Angry mobs eventually began forcing the variolated to isolate themselves in Spectacle Island's quarantine house. Cotton Mather had his nephew Reverend Walter inoculated and offered to let him stay at Mather's home while he recovered from smallpox. A fearful mob attacked the house and threw a crude bomb directly into the room where Walter was staying. The device failed to explode, but a note tide tightly to the device was found that 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!"

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

Social and Scientific Impact

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. The New England Courant, under the leadership of its new editor 16 year-old Benjamin Franklin, continued to publish satirical articles about the Mathers and inoculation in the months following the epidemic. Most of Boston's clergy seemed to have supported inoculation, and some wrote an op-ed opposing Reverend Williams and Dr. 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 [sic] that Dr. Cutter or Dr. Davis be so treated?" Minister Benjamin Coleman, believing in inoculation, collected collected stories from slaves similar to Onesimus's about inoculation and published "Some observations on the new method of receiving the small pox by ingrafting or inoculation" in opposition to Dr. Douglass.

Boston's smallpox outbreak of 1721 is unique for motivating America's first public inoculation campaign, and the controversy that surrounded it. On the 22 February 1722 it was officially announced that no new cases of smallpox were appearing in Boston and the disease was in decline. In the outbreak's aftermath, with over 800 Bostonians dead and many more disfigured from smallpox, Dr. Boylston's 247 inoculated patients had a 2% death rate versus the 15% of people who died if they got smallpox naturally. As smallpox outbreaks continued to plague the colonies' small cities, New Englanders became more accepting of inoculation. Dr. Boylston's successful experiments on students and faculty at Harvard lead to early acceptance in Boston's powerful academic community for the procedure. After Mather and Dr. Boylston's famous experiments with incoluation, along with Lady Mary Wortley Montagu's similar experiments during a simultaneous outbreak in London, variolation would become a widespread and well-researched technique in the decades before Edward Jenner 's discovery of vaccination with cowpox.