America’s smallpox eradication has its roots in 18th-century Boston.
Harmony Hunter: Hi, welcome to the podcast. I’m Harmony Hunter. My guest today is author Tony Williams, whose new book is titled, “The Pox and the Covenant, Franklin, Mather, and the Epidemic That Changed America’s Destiny.” Thanks for being with us today.
Tony Williams: Thanks very much, Harmony, it’s good to be here.
Harmony: So I read your manuscript, and the way I want to kind of unpack this story: we’ve got a virus, a town, a reverend, and a doctor. Can you start by telling us about the virus?
Tony: Well, smallpox came onboard a ship from Barbados, because of course, Boston was part of the whole trans-Atlantic trade network, this global British empire. It came aboard the ship, some sailors had it. Of course they went ashore on leave and transmitted it to the population. The disease then started spreading, became an epidemic rather quickly.
Harmony: So that’s the virus. We’ve got the smallpox virus, which is extremely virulent, very contagious. So it lands in Boston in 1721, we almost instantly have an epidemic. Tell me about Boston in 1721.
Tony: Boston is America’s biggest city at the time, with a population of almost 11,000. It’s a trade hub, a very important trade hub of the British empire. It has a large seafaring population, so it was a center point for diseases like this because there was so much interaction with the Caribbean, with Great Britain, with Europe. It was always a powder keg waiting to explode, in terms of diseases.
Harmony: Now Boston was a Puritan town. How did that make the way for the virus?
Tony: It’s rather interesting, because the Puritans, in general, the population and even many of the doctors saw the disease as God’s punishment, as God’s will. So they said, “We cannot intervene against God’s will and try to stop it, we just have to try to let it run its course.”
Harmony: So we have a virus ripping through Boston, which is a very populous trade hub, and at the time, the prevalent thinking is that you should just let the virus run its course, infect who it will, because this is a test of faith, this is a punishment from God. So then comes the new idea: a guy named Cotton Mather, he’s a minister. Tell us about how his perspective changed the way that this virus was approached.
Tony: Right, well, Mather is of course one of the most important Puritan ministers. He had a long lineage stretching back to the founding of Massachusetts, and he’s one of the leaders of the town. He’s very well-respected. He’s also, besides a man of the cloth, besides being a man of God, he’s also a man of science. He was perhaps the preeminent scientist of his day. A lot of people don’t realize that.
He had read how inoculation was being done, primarily in Greece and Turkey and that part of the world, and he resolved based on all the suffering that he saw in Boston, not only among his own family, but he had had smallpox as a young man and also seeing the suffering among his congregation and among the population, he decided that he was going to call a meeting of the doctors next time smallpox appeared in Boston and was going to test out this hypothesis. That’s really all it was: it was a hypothesis that it worked.
Harmony: So inoculation, this is the big idea. This is the idea that hasn’t been tried out before in the Americas. So it’s innovative, but it’s also ancient. You mentioned some other countries where inoculation had already been an established treatment. Where else were they using inoculation?
Tony: Right, it had been done, as I said, in Africa and also in China. I believe there are some reports of it being done in China. Also they said in Greece and Turkey. It was seen as a radical innovation. Cotton Mather said, “Well, let’s give it a try.” People are already dying of smallpox, so why not give it a try?
It was a procedure in which they made a small incision in the arm, they placed live smallpox virus from a victim who was suffering from smallpox, they put it right into the arm. A person would, of course, get smallpox, but symptoms were usually a bit milder, and the death rate was much lower. It was only about one or two percent, as opposed to getting it in the common way of person-to-person contact in which about 15 percent to 20 percent would normally die in an epidemic.
Harmony: So, back on the ground in Boston in 1721, you’ve got a minister who’s read his whole life about medicine, he’s read about this idea of inoculation, and so here comes smallpox, and Cotton Mather knows it’s time. What does he do, how does he start?
Tony: Well, he writes a letter to all of the doctors, asking them to convene and consider this innovation that he’s read about and talked about with others. They all refuse him, of course. Finally, after about a week or two, he tries again. Finally one brave doctor decides to try it. His name is Dr. Boylston.
He actually tried it out on his own son as well as two of his slaves. Trying it out on his son, of course, showed the confidence that he had in trying it. A small boy, about six years old, he could have died. So very daring and courageous of him to try it on his own son. He does, on the three people, it works, and so more people hear about this and come to him and he tries it out on more willing patients.
After about 12 or 13 attempts, they all survive and he’s convinced that it works. Unfortunately, this also sets off a complete firestorm of opposition to him and Mather as they become the object of all sorts of invective and even threats of violence.
Harmony: So that sounds like a pretty good demonstration. Why are they getting such strong opposition from the town leaders?
Tony: I think the doctors were opposed to it for a couple of reasons. One is, they couldn’t understand why in the world you would give people smallpox when they’re already getting smallpox. They couldn’t think outside their paradigm, their way of thinking, they couldn’t think outside the box and try something new.
They also, as I said before, made very fundamentalist and Calvinistic arguments against it. The doctors – these supposed men of science – were saying, “You have to follow the will of God.” So they made religious arguments against it. Finally, I think they just hated Cotton Mather. He was a minister, they thought he had no business telling them how to do their physician duties and how to be a doctor. The population followed along with those ideas.
I think they were particularly worried that smallpox was going to spread. In many ways, they were right. Their fears were justified. The one failure that Boylston and Mather can be blamed for is the fact that during inoculation, sometimes they would let people go abroad. They would let people leave the home. One guy even went to fight a fire as his symptoms were starting. Some patients were allowed to go out and even have visitors and so forth. This may have contributed to the spread, but on the other hand it showed the success of a very great medical innovation.
Harmony: So what does it mean that this minister and the one doctor he’s able to convince – they’re working steadily, they’re trying to inoculate the population, but it doesn’t gain wide acceptance. What did it mean for the future?
Tony: Well for the future I think that it leads to a couple different things. I think short-term, they showed that it worked. Dr. Boylston came up with really one of the first compendium of statistics and sort of a case study of each patient and later transmitted that to the Royal Society, where it was accepted.
Inoculation was of course also being simultaneously, although independently, tried by Lady Montague in Great Britain. She showed that it worked, too, and of course there was opposition there, as well. I think for the longer term, it certainly is later accepted by the medical establishment, by the population, although not uncritically. There is still opposition even here in Virginia as late as the 1760s and 1770s.
For the most part, it gains acceptance and leads by almost in 1799 or so, to Edward Jenner’s famous experiments with cowpox and vaccination. That, of course, would lead to the eventual eradication of the disease in about 1978. You can trace the lineage of that eradication to Cotton Mather’s and Dr. Boylston’s very courageous experiments all the way back in 1721.
Harmony: All right, Tony, thanks for being with us today, we look forward to the publication of your new book. Where can people find that?
Tony: The book will be published by Source Books, probably in early 2010. But they can read an excerpt, which is in the paperback version of my book, “The Hurricane of Independence.” Which will be published July 1, 2009.
Harmony: Tony, thanks so much for being with us.
Tony: Thank you very much.