Colonial Williamsburg Foundation - 0201
Williamsburg, Virginia
1990
In the early eighteenth century, Lady Mary Wortley Montague accompanied her husband, Edward, the British ambassador to Turkey, to Constantinople. She was instantly intrigued with all of the new and bustling sites and activities around her. One of the most interesting events that she and her husband encountered was a Turkish custom to guard against smallpox; this procedure was called "ingrafting". Ingrafting was usually for the wealthy and privileged people, those who would be attending a "smallpox party". The Wortley Montagues attended such a party and were amazed at what they saw. An old, poorly dressed woman was ushered into the room full of guests. She approached one of the guests, inquired about which vein he wanted opened, and scratched it with a needle til the blood came. She then brought out a nutshell from beneath her skirts inside which was pus from an open smallpox pustule. The old woman dipped the needle into the pus and then pressed it into the scratches, she bound this with a piece of hollow nutshell. Lady Mary was incredulous at this strange event. It looked as if the procedure would give the people the disease instead of guarding them against it. She kept in close contact with the Turks who had been ingrafted; shortly thereafter they all came down with mostly mild cases of smallpox. All recovered. Lady Mary then talked to Turks who had been ingrafted and then survived the severest smallpox epidemics without contracting the disease. Lady Mary was convinced she'd witnessed a miracle. Being an avid letter writer, she quickly spread the word of this Oriental practice to friends. She was so convinced of the value of her new-found discovery that she "[intended] to try it on my dear little Son"; which she did in March of 1718.1
When the inoculation procedure came to America in 1721 it revolutionized the way smallpox was dealt with; and it was a godsend to a weary people for whom smallpox was a dreaded nightmare. Throughout most of the 18th century 2 "…smallpox reportedly disfigured, crippled, or killed every tenth person"2. Few diseases at this time were as universal or fatal.3 Smallpox was first introduced into the New World as early as 1520 when the Spaniards invaded Mexico and it killed "over one half of the native population". Repeated outbreaks occurred in North and South America among the Indians, so, it was no new disease to the Indians when the permanent settlement at Jamestown began in 1607.4 The original place of origin of the disease is unknown, but either Central Africa or India is probable. It is usually classed as a filter virus, but sometimes seemed to be spontaneously generated. As a contact disease, overcrowding and unsanitary conditions favored it spread.5 The technical name is variola and it is characterized by fever and eruptions and is acutely infectious. The eruptions leave distinct scars, hence the common name.6 A temperature of 103° or higher, quick pulse and intense headache are symptoms along with vomiting and pains in the loins and back lasting about three days. On the third or fourth day the typical eruptions begin on the forehead and in the hairline, gradually spreading over all the body.7
In 1768, Dr. John Dagleish of Norfolk, Virginia set forth in the April 14 issue of the Virginia Gazette an essay on smallpox, explaining the different types and their characteristics: 1) distinct: pustules few and far separated. When eruption is completed, no more ailing. 2) coherent: pustules distinct, crowded onto the face. Sore throat and second fever occur. Some death in unfavorable times. 3) confluent: pustules erupt small and close, running into each other, very bad dangerous second fever. Many deaths, a very frequent type. 4) purple: no pustules, or very few, some purple spots appear; about the fourth day pain and anguish abate so much that the unskillful are deceived. All die, very rare type. The four stages of smallpox are: 1) dormant: the period from first receiving the infection to the time the fever begins. The constitution of the patient has a lot to do with which type is 3 contracted—this is established in the first fever. 2) eruptive: from the beginning of the first fever until eruption is completed and pustules ripen. The worst time for the body to throw off the disease. 3) turn of the pox: pustules dry and blacken, patient is extremely bad in appearance. Second fever comes. Most tragic events take place at this stage. Treatment is what is recommended by the physician. 4) convalescent: patient is judged to be out of danger, though further care is still necessary.8 These pustules left pockmarks on the faces of those who had had the disease, though the prevalence of the disfigurement has been greatly exaggerated to coincide with that of Europe.9
The fear of smallpox brought about the first medical publication in America by a man named Thatcher: A Brief Rule to Guide the Common people of New England, How to Order Themselves and Theirs in the Smallpox or Measles. It was a great success and was published repeatedly. Smallpox also sparked the beginning of the concept of preventative medicine with the inoculation and later vaccination against the disease.10
Virginia was hit relatively late and only periodically with smallpox during the colonial era; and also rather mildly compared to other colonies further south and further north. In 1696, the Assembly at Jamestown had to recess to escape infection.11 William Byrd reported two mild outbreaks in 1711 and illustrated the fear of the disease before the advent of inoculation: "No one would go near one of the victims, and the other died…for want of attention".12 Another outbreak in 1715 was devastating as it always is when a disease returns after a long absence with no one having been exposed to it so as to have acquired a natural immunity.13 Indians served as an intermediary in epidemics between Atlantic seaboard settlers and French Canadian settlers. They helped distribute the disease far and wide.14 Because destruction among the Indians was so great, the disease was a facilitator in furthering colonial expansion.15
4Before 1721, smallpox was virtually a deadly disease with no real cure, and very highly feared. During the late seventeen-teens, Cotton Mather, the fundamentalist Puritan minister heard of an old African procedure as a preventative for smallpox from one of his slaves who described to him a crude method of Lady Mary's ingrafting which had been performed in Africa for many years.16 Mather had been born in Boston in 1663, educated at Harvard and studied medicine for a time but then turned to the ministry. Two hundred years before Pasteur, Mather had published an early germ theory in Angel of Bethesda.17 He was greatly interested in the proper training of children and in an organized school for the education of blacks.18 In 1721, having now heard of inoculation in the Far East as a civilized practice, Mather wrote in his diary on May 26: "The Practice of conveying and suffering the Small Pox by Inoculation has never been used in America nor indeed in our Nation, but how many lives might be saved by it if it were practiced? I will procure a Council of our Physicians, and lay the matter before them."19 Unfortunately, out of the ten Boston physicians, only one—Zabdiel Boylston—did not condemn inoculation as both dangerous and irreligious. In answer to a letter concerning the inoculation, Boylston was only too happy to try experiments, and on June 26, 1721, he inoculated his six-year-old son, Thomas, for smallpox—the first person to be inoculated in the New World. During the next five months, during an epidemic, Boylston inoculated 247 persons; the first experiment with active immunization carried out in the New World.20 Boylston wrote a first-hand account of the 1721 outbreak in An Historical Account of the Small-Pox Inoculated in New England in 1726. The book contained the first clinical statistics in tabular form in American literature. When inoculation was employed as a preventative measure, Boylston was able to calculate that mortality from smallpox dropped from 15% of all cases contracted "the natural way" to 1-2% after inoculation.21 5 The reports of these figures were contested in London as well as Boston, but gradually they became the evidence supporting the procedure which spread to the Continent.22
Boylston's inoculation method was very similar to what Lady Mary witnessed in Constantinople. Infected matter, nine to fourteen days after eruption, was taken from a person with a mild case of smallpox (who was otherwise healthy). Boylston then made two incisions through the "true skin" with a lancet on the side of the arm or inside the leg. The pus was inserted into the incisions and covered with a simple dressing—usually a cabbage leaf. The rest was left to nature.
The pros and cons of inoculation as well as ill will toward the inoculationist raged in many cities, not only in the northern colonies.23 The port of Norfolk, Virginia saw many outbreaks and the ill feeling there over the inoculation procedure sparked riots and spread inland to include the capital city of Williamsburg in its skepticism.
During an outbreak in 1768 in Norfolk, strong anti-inoculation sentiments combined with the controversial politics of the time erupted into full scale rioting which issued reverberations for the next few years. Printed in the February 4, 1768 issue of Purdie and Dixon's Virginia Gazette, a resident with initials K. O. offered this suggestion to those returning from inoculations giving some idea as to why the practice was not well thought of:
The spreading of the smallpox amongst us might perhaps be prevented if the patient returning from the hospitals, as well from inoculation as from having them in the natural way were careful never to bring back any of their clothes, either wearing apparel or bedding that they carried thither with them; and before they put on clean clothes to come away in, to have their body well washed with warm water and vinegar. Such of them as wear their hair should be advised to part with it and no airing nor washing of clothes should be depended on.246
A group of Norfolk gentlemen led by Dr. Archibald Campbell decided to become inoculated against smallpox during an outbreak in 1768, and employed Dr. John Dagleish, an experienced inoculator to immunize them and their families. Other members of this group were Cornelius Calvert, James Archdeacon, James Parker, Lewis Hartford, and Neil Jamieson.25 Dr. Dagleish was well-known for his pro-inoculation sentiments, as he had urged the process in an April 14, 1768 article in the Virginia Gazette. The subject of the benefits of inoculation was touchy to begin with because a separate epidemic raging in Williamsburg was being blamed on the inoculation process (this problem involved students at William and Mary who had returned too early from their inoculation and were still able to transmit the disease). Despite the public sentiment, the gentlemen made arrangements to have their families inoculated three miles outside of Norfolk at Dr. Campbell's plantation on Tanner Creek. Before this occurred, the mobs opposing the practice rose up and asked the magistrate to refrain the Campbell party. He refused.
Sulking, the mob, including Samuel Bausch, Dr. John Ramsey, and Dr. James Taylor turned to the bottle as consolation, but a very dangerous mood prevailed.26 A meeting was arranged between the two warring factions; but nothing was resolved except to postpone the inoculation until after the Court of Oyer and Terminer met in Williamsburg on June 14.27 On June 25, in spite of the fact that nothing had been heard from the court session, the pro-inoculationists were taken out to Campbell's plantation and inoculated. A plan was devised to restrict those who submitted to inoculation to the pest house, but before a plan for the transfer could be implemented, a mob was formed to drive the unfortunates through a thunder storm to the pest house.28 Full scale rioting broke out on the evening of June 27, the magistrate making no effort to restrain the mob this time, many of whom were intoxicated. Windows were smashed, and rocks thrown at the houses of the inoculants.29 7 Throughout the summer court battles raged back and forth between the two factions. The printers of the two Virginia Gazettes, Purdie & Dixon and Rind both issued articles on a pro-inoculist view.30
While the controversy cooled for the remainder of 1768, a second riot heated up the next year involving basically the same people. Intense fear of the smallpox and the opposition to inoculation had become a latent issue now, while the political issue and the tenseness between England and the colonies was moving ahead.31 The pro-inoculation leaders and Dr. Dagleish himself were brought to trial and cleared, but not until the end of 1768. Still, no one had committed a real crime, since inoculation was not an outlawed practice. Fear was at such a high level, however; that Virginia inhabitants put forth the "destructive Tendency of Inoculation" and in June 1770 an act to "regulate the Smallpox with in the Colony" was passed to severely penalize "anyone wilfully importing variolous matter with the intention of inoculating".32 During the Revolution this act was amended to permit inoculation if families within a two-mile radius consented.33
By this time, everyone involved in the Norfolk riots was thoroughly tired of them and the success of the inoculation was becoming evident despite the protests. "Due to the success of inoculation, smallpox in the American colonies as compared to Europe and the mother country, was so well-controlled that some English parents sent their children to America for their education and safety from smallpox".34 Therefore, smallpox affected much in Virginia besides the obvious health debilitation and loss of manpower; though statistics were still below those of England. It affected education not only as previously mentioned, but the disease became the impetus for the founding of such higher educational institutions as the College of William and Mary. A student commencement speaker at the college on May 1, 1699 emphasized the needless risks in undertaking 8 to attend school in England. He pointed out that students doing so exposed themselves to the dangers of climate and smallpox in England and then had to readjust themselves to the "seasoning" in Virginia upon their return.35
During the years of the American Revolution, smallpox prevalence was higher everywhere, including Virginia. In spite of the increased risk, many Virginia troops were relatively free from infection until the time of the Yorktown campaign. Lafayette wrote Washington that through the utmost possible care the soldiers were avoiding disease.36 A crude form of germ warfare using smallpox was employed during the Revolution:
A Pennsylvania soldier who was with the army in Virginia in 1781 related that the British left one Negro man with the smallpox lying on the roadside in order to prevent the Virginia militia from pursuing them, which the enemy frequently did; left numbers in that condition starving and helpless, begging of us as we passed them for God's sake to kill them, as they were in great pain and misery. 37Benjamin Franklin noted that the "British tried to facilitate the spread of smallpox by inoculating black prisoners and then let them escape or sent them covered with the pock to spread the distempers among other blacks and also among the black country folk".38
The capital of the Virginia colony—the city of Williamsburg—was not primarily affected much by the disease itself, but much more by the impending threat of it. When Norfolk was being ravaged by the disease and when the small-pox riots were going full swing, Williamsburg was taking her stand as well. Because of all the problems concerning inoculation in Norfolk, most of Williamsburg was rather skeptical of the procedure, though some were in favor of it. Williamsburg, though generally bypassed by smallpox or affected only mildly, was thus affected in March of 1737 in an outbreak in which only a few families were taken sick. William Byrd, in writing to his friend, Sir Hans Sloane, in August of that year related a "certain" cure for smallpox consisting of large draughts 9 of water "that had stood two days upon tar. This remedy was so effective against smallpox that one could not take smallpox even by inoculation."39 In the June 3, 1737 issue of the Gazette a note from Exeter, England on a recent smallpox problem was printed. The patients in Exeter—five children—were given only water to drink and toast. The children recovered extremely well and without much problem.40 Williamsburg was hit again with the disease early in 1747 when the Governor was unable to call an Assembly meeting. On January 16, 1747, the Court of Common Council "decreed that every inhabitant and freeholder of Williamsburg must pay a fine of £2 sterling if he received an infected person into his home, and an extra £1 for each day he stayed in the house.41 A publication at the time of the 1748 outbreak, "A True State of the Smallpox" is the best source for historians studying population figures of Williamsburg and the predominance of tradesmen, but unfortunately provides no data about the ratio of blacks to whites.42
Again the smallpox struck Williamsburg early in 1768. In March, the president and masters of the College of William and Mary voted £50 to a local doctor for his attendance upon those at the college with smallpox. The blame, however; for bringing the disease rested on a Mr. Smith whose patients returned too early (again) from their inoculations.43 This epidemic apparently remained in Virginia throughout the winter. Its virulence may have been the result of unrestricted inoculation as evidenced in a petition of May 1768 addressed to the House of Burgesses. The petition set forth the destructive tendency of inoculation, and therefore begged that no such practice be allowed in Virginia. In November, the anti-inoculation petitions were rejected, and the only one offering a favorable reaction was accepted, and thus, Virginia conformed.44
The most important concern involving this epidemic was to curtail the 10 spread of the disease. In the February 4, 1768 edition of the Virginia Gazette, Mayor James Cocke placed an announcement stating that "further spread of the smallpox will entirely be prevented as the Common Council continues to take every necessary precaution and no expense is spared to reach this goal".45 In the Gazette's next issue, magistrates carried out the required duties of cleansing the house and securing the clothes and other items in which any infection might possibly remain.46 The anti-inoculation ordinance of early 1747 was brought back. In an effort to actually pin blame on an individual or as an incentive to try and control the smallpox an individual known only as T. O. M. submitted to the Gazette and had printed the following request:
I understand the reason of the late order of our Corporation, to deliver a list of tithables is to fix how much per pall is to be paid to defray the expense of the smallpox patients… I would propose that £20 should be paid by each of the persons who were instrumental in bringing the said disorder among us…47There was no pest house in Williamsburg in which to send our patients suffering from the smallpox, but an announcement in the March 5, 1779 issue of Dixon's Gazette advertised that on March 10 of that year, Doctor Gardiner's Hospital for the Smallpox would be opened in King and Queen County, Stratton Major Parish.48
"Much of what happened in Williamsburg before the time of the vaccination was synonymous with what happened elsewhere [in Virginia]. Ten percent of the population usually died during epidemic, but in Williamsburg the mortality rate was low— 0.71%. Like most outbreaks, the one in 1747 occurred during the winter with a high fatality rate among children (15) and the elderly (7)".49
With Edward Jenner's experiments on cowpox, a non-fatal, non-contagious disease, as a possible substitute for the smallpox virus in the inoculation, the 11 subsequent vaccination proved to be much more of a success in the prevention of smallpox. With the publishing of his book An Inquiry into the Causes and Effects of the Variolae Vaccinae in 1798, Jenner ushered in the science of preventative medicine.51
Jenner was a country doctor in Gloucestershire with a great love for its people and nature. After his medical apprenticeship and further studies, he returned to the country to practice.52 While he was still an apprentice, he was impressed with a remark from a country milkmaid who had come to see him about numerous pustular sores on her hands. "It can't be smallpox," she exclaimed, "for I've had the cowpox and everybody knows you can't have the smallpox after that." At the time, Jenner forgot the remark, but it would return to his memory.53 He had been taught by his master doctor again and again that to "experiment was the best way to learn. Observation, patience and accuracy were the paths to knowledge."54 This advice helped spark his desire to not only cure the patient, but to advance medical knowledge as we11.55
It was during an outbreak of the smallpox in 1770 that the milkmaid's statement was brought back to mind. Many people were seeking inoculation, but it had no effect on some of the people. If these people had had cowpox at one time it was not remembered nor recorded. There was no clear cut answer for Jenner, so he began experimenting.56 By chance he was present at a blacksmith shop when the owner was treating a horse for "grease" a disease of the heels. Later this same man milked a cow and both man and beast developed cow-pox. When inoculated with smallpox virus in the usual way the patient resisted infection. Did the diseased heels of the horse have something to do with the resistance? Jenner thought it might, but was later proven wrong.57 He did study cowpox, however; discovering several kinds and also that its protection was not absolute—sometimes it guarded against smallpox, sometimes it didn't. 12 Jenner's conclusion: like smallpox, cowpox changed at some point, thereby losing its protective power. More study was needed and Jenner became a permanent fixture in the dairy barns observing.58
He worked diligently and steadily through disappointments including disinterest among colleagues and a lull in smallpox outbreaks, forcing him to propagate the disease one person at a time in order to study it. After subsequent inoculations with smallpox resulted in no illness, Jenner was encouraged. It was not until 1796 hat he could inoculate a series of people from the same origin of infection. His eleven-month-old son, Robert, among them. No effect was noted when inoculated with smallpox. Jenner submitted his results to the Royal Society—he was now a member—at the advice of the Committee of Physicians. The paper was rejected as being "too revolutionary". With the Committee's support, Jenner published his Inquiry selling it for 7s. 6d. It was slightly over the heads of most people who read it, but mainly Jenner was stating that "The mild disease of cowpox protects the person who has suffered it forever afterward from infection from the smallpox". His positive and unqualified statement was followed by a list of cases in which this protection "has lasted for twenty-seven, forty-three, thirty-eight, two years, and one year without exception.59
By 1780, it was becoming evident in the colonies that inoculation was no longer adequate in controlling the incidence of smallpox.60 In fact, probably due to infractions of inoculation regulations, New England completely turned against it, and by 1790 the use of inoculation was strictly forbidden. In the middle and southern colonies, the disease had become more prevalent as the 18th century advanced, and inoculation was permitted at all times.61 An alternative method was still badly needed. Jenner's work, published in 1798, caused "inoculation, as a preventative measure against smallpox" to die almost 13 over night.62
London's reaction to Jenner's vaccine was slow, though with support and usage of the vaccine by Dr. Cline at St. Thomas' and Dr. Lister, the vaccination process became more widely known and Jenner was famous. The vaccine was soon travelling everywhere. Jenner became a letter writer, answering inquiries, criticisms, protests, etc., while maintaining his sanity and love for Gloucestershire.63
Thomas Jefferson was largely responsible for Virginians having a better attitude toward Jenner's vaccination. Jefferson introduced and popularized the procedure by experimenting on his own slaves at Monticello and by furnishing physicians in several parts of the country with the virus for future vaccinations.64 Benjamin Waterhouse, a professor of physic at Harvard Medical School made the first vaccination in America using his own children as subjects.65 He obtained dried vaccine on a silk thread or "quill" from Jenner, and on July 8, 1800, vaccinated his 5-year-old son who became America's first vaccinated person. Two years later, Boston conducted a controlled experiment on eleven boys, none of whom contracted smallpox. In 1803, a free vaccination clinic for the indigent was set up.66
Through the efforts of Cotton Mather, Zabdiel Boylston, Edward Jenner, Lady Mary Montague, Thomas Jefferson, and Benjamin Waterhouse, the scourge of the smallpox was expelled from young America early in its independence.
| 1520 - | smallpox first brought to the New World by Spaniards invading Mexico. |
| 1717 - | Lady Mary Wortley Montagu witnesses smallpox "ingrafting" for the first time in Constantinople and writes letters home about the miracle treatment. |
| 1721 - | Zabdiel Boylston, Boston physician, at the urging of Cotton Mather, experiments with smallpox inoculation, and on June 26, inoculates the first person in America—his 6-year-old son, Thomas. Boylston writes his first-hand account of his experimentation in An Historical Account of the Smallpox Inoculated in New England. Contains the first clinical statistics in tabular form. |
| 1737 - | mild smallpox outbreak in Williamsburg. |
| 1748 - | "A True State of the Smallpox" issued during another outbreak in Williamsburg. |
| 1768-69 - | rioting occurs in Norfolk, Virginia stemming from anti-inoculation and political sentiment. |
| 1780 - | it is becoming evident that inoculation is no longer adequate as a preventative against smallpox. |
| 1790 - | inoculation is strictly forbidden in New England. |
| 1800 - | July 8, Benjamin Waterhouse vaccinates the first person in America—his 5-year-old son. |
| 1803 - | a free vaccination clinic for the indigent is set up in Boston. |
Books
Periodicals
Newspapers