“THE SCOURGE OF THE WORLD”

Smallpox outbreaks ravaged the town of Boston throughout the eighteenth century. The disease was known as “the scourge of the world,” and nobody was immune. Even George Washington contracted this “speckled monster” (as it was often called) in 1751 when accompanying his brother Lawrence on a trip to Barbados. “Was strongly attacked with the small pox,” he wrote in his diary on November 17. It would be his last entry for more than three weeks as he battled the disease’s ravages. Yet Washington would again encounter the scourge decades later as it threatened to decimate his army. Ironically, during the Revolutionary War (1775-1783) smallpox produced more deaths than the battlefields.

The earliest description of smallpox dates back to 1350 BCE. The disease was spread from human contact and symptoms included fever, headache, nausea, and intense aches followed by painful sores and skin eruptions. If one survived a severe bout, they could emerge blind or even mentally impaired. While the ancient Romans referred to the smallpox as “variola”—the Latin word for spotted—throughout most of Europe it was called “the Pox.” By the end of the fifteenth century a horrendous syphilis epidemic raged across Europe earning the term “the great pox” and thus variola came to be called the “small pox.”

Disease has been woven into the very fabric of this nation even before the first settlers arrived on Native-American soil over four centuries ago. The first smallpox wave struck Boston colonists in 1677, with subsequent epidemics striking in 1690 and 1702. The next scourge, in 1721, proved particularly devastating, since almost twenty years had passed since the last outbreak and most young people had no immunity. That spring, when the pox arrived on Boston’s shores the legendary minister Cotton Mather wrote, “The grievous calamity of the small pox has now entered the town.” But Mather would help start America on the long path to eradication. He had learned that smallpox inoculations had been practiced for many centuries in other countries. His own slave, Onesimus, had informed Mather that he had received inoculation as a boy in Africa. Procedures ranged from integrating infected pus fluid into the bloodstream of healthy individuals, to inhaling dried and ground pus scabs.

Many Bostonians believed that the pox was God’s divine intervention, intended to punish sinners. But Mather, a man who studied Enlightenment science as deeply as his Bible, was a rare proponent of smallpox inoculation. He convinced Dr. Zabdiel Boylston, a town physician and acquaintance, that inoculation provided the best chance for survival. Boylston took the lead and inoculated his youngest son and two of his slaves to the outrage of many. Some inoculation opponents demanded no less than the death penalty for doctors who performed the procedure, and Mather even had his home firebombed for his troubles. Although it failed to ignite, the incendiary message attached read, “Cotton Mather, You Dog, Dam You, I’ll inoculate you with this, a Pox to you.” But when the inoculations proved successful, minds quickly changed. In the end, the 1721 epidemic proved to be one of the worst in eighteenth century Boston, killing more than 14 percent of the naturally infected populace. Yet the mortality rate for those who were intentionally inoculated stood at just over 2 percent.

"This epidemic would be a proving ground for a future Founding Father, Dr. Joseph Warren."

When the 1764 outbreak struck Boston, inoculations were performed by almost all of the town’s physicians. This epidemic would be a proving ground for a future Founding Father, Dr. Joseph Warren. A decade later, Warren would lead the colonial rebellion, but in 1764 at the age of 23, he was just a promising young doctor thrust onto the frontlines of the epidemic. Ten of the first twelve people infected in the 1764 outbreak died, an ominous portent. Corpses were bound by a tarred sheet and hauled away by the gravedigger at off hours. The situation quickly became so grave that floggings were imposed on those who would flagrantly defy the imposed smallpox ordinances.

A makeshift quarantine hospital was established at the island fortress of Castle William in Boston Harbor. (Here Warren first met his lifelong friend John Adams in the spring of 1764 when Adams and his brother came to Castle William to be inoculated.) The forty-eight rooms accommodated nearly five hundred patients and would become the main battleground against the smallpox scourge. Doctors were required to bring their own medical supplies, in addition to non-medical items such as feather beds, pillows, and blankets. Without modern technology or conveniences such as plumbing, heat, or air conditioning, the conditions within the hospital were nothing short of miserable. The waft of human waste, oozing pustules, and death became a familiar stink; when the pustules burst, a distinct and foul odor emanated once described as “so loathsome and evil-smelling that none could stand the great stench.”

Although anyone who had previously survived smallpox was immune to the disease, doctors understood that inoculation did not guarantee survival. The chances of surviving smallpox were much greater if one received inoculation intentionally, rather than contracting the disease naturally, but death was still a very real possibility that weighed heavily on the physicians. The average recovery time took several weeks, confined in the horrors of Castle William.

"Yet of the hundreds of patients Dr. Joseph Warren inoculated, not a single person died."

Ultimately, the fatality rate from approximately five thousand inoculated individuals stood at just one percent—numbers previously thought unimaginable. The doctors were heralded as heroes and many went on to become prominent figures and well-respected advocates. Perhaps, most important, they set an example for the fledgling medical profession with their bravery and selflessness.

After at least 3,000 years and hundreds of millions of deaths, smallpox was finally eradicated in 1980. Today many adults over the age of 40 still bear the smallpox vaccination scar on their upper arm—a physical reminder of how recent and how devastating a toll the pox had throughout the world.

The next chapters in our history are unfolding with uncertainty. We have made momentous strides, but continue to face many struggles that also plagued those distant British subjects on the verge of revolution—disease, political rancor, economic malaise, and social warfare. Like the aspirational principles that form this republic’s bedrock, disease will continue to shape our daily lives and the narratives of our history. But perhaps there is solace to be found in recognizing that our early American forebears lived through these crucibles, and emerged strong enough to win a longshot revolution for liberty. While flawed, they were in many "the first greatest generation.”