The Devastating Smallpox Plague in Boston
Bloodletting treatment was worse than the disease
In November 1721, a small bomb crashed through a window and lay on the floor in Reverend Cotton Mather’s house in Boston. A message attached to the explosive, which didn’t detonate said, “Cotton Mather, you dog, dam you! I’ll inoculate you with this; with a pox to you.”
Mather was the son of the Reverend Increase Mather, President of Harvard College, minister of the South Chruch of Boston, and political leader. Cotton was a brilliant high-achiever as well. He began schooling at Harvard at age 12 and had earned an M.A. at 18.
Mather, who had a terrible stutter, became ordained as a Puritan minister, practiced preaching and worked in science as well. He found particular interests in Satan and witchcraft and became deeply involved in the Salem witch trials. He was a prolific writer and throughout his life was the author of over 400 titles and had done early work hybridizing plants. Mather learned about the practice of inoculation from his slave, Onesimus. Africans and Asians had administered smallpox inoculations by blowing dried smallpox scabs up the nose, while Europeans and their American cousins tended to innoculate through a puncture in the skin.
Mather publicized the puncture technique and the procedure was first tried during a smallpox epidemic in Boston in 1721. The smallpox epidemic that struck Boston that year was one of the most deadly in colonial America but even so, prevention of disease was still not a popular idea.
The epidemic took over the city of Boston from the spring of 1721 until the winter of 1722, with over 6000 cases reported in a population of 11,000. There were 850 fatalities from the disease. Even though smallpox was common in the 1700s it would take 80 years before the medical community would formally innoculate against it. Unlike a lot of maladies of the time it was very easy to diagnose.
Smallpox During the Revolution
Jedediah Johnson and Caleb White sat down after eating some pork and rice on the USS Liberty on Lake Champlain in the northeastern colonies. The year was 1776. After working all day on rigging and maintenance chores they were bone tired. Some of their ship-mates were on the shore, and others were having food on the boat or blowing off steam. The lake was calm but the air was misty in the damp chill in the August twilight. Like most of their crew, the two men hadn’t seen soap or even warm water on their bodies and hair for weeks. They were at one with their clothing, dirt, body lice, and other organisms.
“I might have the pox but I ain’t going to that damn hospital. Half the guys who go in never come out,” Johnson said. White looked over at him, “Yeah, that’s what happened to Crockett. He never came back.” White side-glanced at Johnson warily. “You got some nasty red bumps and pus in your mouth brother.” “I got some on my neck and I feel hot too,” Johnson complained. White noticed that Johnson was sweating profusely.
Johnson pulled out a flask of rum and poured three fingers of it into his tin cup. He had saved his ration for a few days. Getting only a third of a cup a day he hoped to see if the whiskey would heal the sores in his mouth. He tipped his head back, swished, and gulped the rum down like medicine. “Did you get variolated?” He asked White. White shook his head.
“Rub this into that cut on your arm,” Johnson said as he squeezed a pustule on the side of his neck. He held out his finger glistening with pus. White extended his arm and Johnson rubbed the pus on the open wound. “Here’s hoping you don’t get the pox,” Johnson said, laughing. By the late 1700s, soldiers were vaccinating themselves. Doctors were using a wood splinter and a quill to scoop up clear fluid from a smallpox sore, sometimes against their officer’s orders. (Wilbur)
A few minutes later, Ensign White left for his sentry duty post that would last late into the night. Smallpox was a devastating airborne disease that came from the variola virus that left victims with a robust fever, mouth and body rash, sores, head and body aches, fatigue, weakness, and sometimes vomiting. They were often unable to work. On average, during the 1700s three out of every 10 people who got it died.
The victims would progress with rashes and sores and pustules on the face, arms, legs, hands, and feet. The sores would eventually scab over after a few weeks. At that point, the victim would no longer be contagious. Those who survived were sometimes left blind and usually left with scars, which were sometimes severe.
The viruses in the patient’s sores spread to others through bedding or clothing or even through the air from sneezing, coughing, sneezing or spitting. People who cared for smallpox patients and washed their bedding or clothing had to wear gloves and take care to not get infected. Lord Jeffrey Amherst, then commander-in-chief of British forces in North America in 1763 during the French and Indian War, suggested handing out smallpox-infected blankets to his Native American foes. And narratives exist intentional infections occurred in the colonies.
During the 17th and 18th centuries, the pox killed 400,000 European commoners a year, and several reigning European monarchs, including Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France, as well as an Ethiopian king, a Chinese emperor and two Japanese emperors. Queen Elizabeth I of England, Andrew Jackson, and U.S. President Abraham Lincoln both contracted smallpox but survived. Ben Franklin lost an otherwise healthy four-year-old son to the disease.
By the late 1700s, following the advice of doctors and folk medicine, soldiers were inoculating each other using the fluid from active pustules on their skin. Doctors had noticed that those who were “variolated” as they called it, might contract some low-grade symptoms, but seldom became ill and incapacitated.
By 1796 an English doctor named Edward Jenner had observed that milkmaids who had contracted cowpox from milking cows did not show any symptoms of smallpox after variolation.
Doctor Jenner tested this on milkmaid Sarah Nelmes and James Phipps, the 9-year-old son of Jenner’s gardener. Jenner took material from a cowpox sore on Nelmes’ hand and inoculated it into Phipps’ arm. Months later, Jenner exposed Phipps a number of times to variola virus, but Phipps never developed smallpox.
More experiments followed, Harvard Medical School Professor Benjamin Waterhouse was following Jenner’s work. “So confident was Waterhouse of the efficacy and safety of the vaccination procedure that, on July 8, 1800, he used the matter from Jenner to vaccinate his young son, Daniel Oliver, and a household servant, Samuel Carter. Vaccinations of three more Waterhouse children and another servant, Kesiah Flag, soon followed.”
Later, cowpox material was used to develop the smallpox vaccine, and after that, the vaccina vaccine, which eventually eradicated smallpox around the world. At a time when six out of seven deaths were due to camp distempers during the revolutionary war era, the control of smallpox improved the health of the America. (Wilbur, 13)
As for our heroes, Johnson and White, they continued to eat, work and sleep elbow-to-elbow in close quarters along with the rest of the 70 men on the 117-foot-long ship. Johnson was soon dispatched to a military hospital in nearby Burlington, Vermont where he was fortunate to convalesce in a few week’s time and he returned to active duty on the ship. White did his best to take care of himself and although he had a mild fever from the inoculation, he avoided getting sick with smallpox.
Copious Bleeding For What Ails You
Because smallpox was such a devastating plague, healers were aggressive with their remedies. In the 1600s, treatments included copious bloodletting from the tongue or other body locations, purges to stimulate vomiting, and frequent ingestion of beer awaited well-to-do smallpox victims. A noted English doctor by the name of Thomas Sydenham had observed that the wealthy seemed to have a higher mortality rate from smallpox than the poor. He concluded that the medical treatments, which were usually inaccessible to the poor, might do more harm than good in mild smallpox cases.
Bloodletting persisted as a best practice in the colonies for a number of ailments, including smallpox. Many diseases were thought to be the result of excitability from external or internal factors. It was a common belief that draining blood would remove the excesses from the body by depletion. In fact, preeminent physician Dr. Benjamin Rush of Philadelphia advocated removing a quart of blood every 48 hours. It was thought the body contained 12 quarts, when in fact, the average adult only contains six quarts. (Wilbur)
Rush outlined the procedure used for the common practice of bloodletting, which included having the patient place his hand in hot water, tightly taping the wrist near the pulse, and having the patient squeeze and release his hand three times to further swell the veins.
Next, using a sharp lancet or fleam, the wrist vein would be pierced longitudinally, the hand placed back in hot water, and the wrist tape removed. The impure blood would now flow freely into a pewter bleeding bowl or another vessel. Leeches were sometimes employed to cut into veins or on the wound as they secreted an anticoagulant that helped stop the bleeding. Plenty of sites for venesection had been established throughout the body through history and the wrist was a common site in America.
The bloodletting process was a bit different than our experience of going to a phlebotomist to have blood work done today. Before the 1800s physicians were not concerned with using sterile materials to avoid microbes. And today’s phlebotomist uses needles and extracts much smaller quantities of blood for analysis. The benefits of bloodletting became more controversial as time went on and by the 1900s the practice faded out of practice.
Other parts of the smallpox treatment regimen included exposure to cold air, cold water or beer, and administering mercury calomel or other medicines as a purgative. Prevention proved to be the best cure and inoculation proved to be the most effective preventative measure.
By 1776 when the redcoats evacuated the city of Boston, citizens lined up to be inoculated. During the following year, General Washington saw to it that all of his troops were inoculated. And he ensured that his wife, Martha, was also inoculated, in Philadelphia. Sadly, During his last few days in 1899 General Washington suffered a sore throat and fever. He succumbed after nine pints of blood were taken by his physician in 24 hours. (Wilbur)
Wilbur, C.K., Revolutionary Medicine: 1700–1800, 1980, Globe Pequot Press.
