Smallpox, Vaccination, and the Founding Fathers

Please welcome Dr. Leni Sorensen as our latest guest writer.  She is a food historian and has also been the African American Research Historian at the International Center for Jefferson Studies (ICJS) at Monticello.

In this article Leni explores the long tradition of vaccination/inoculation in the United States. That tradition stretches back to colonial times.

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Throughout the 19^th century measles, diphtheria, typhus, tetanus, and mumps were everyday illnesses with no cure except chance recovery. Despite the limited understanding of vectors, viruses, or bacterial causes of infection or contagion by the mid-18^th century it was beginning to be clear to perceptive observers that hospital, jail or camp fever, and bloody flux (a form of dysentery), and typhoid, all diminished in clean environments, with fresh privies, and clean bedding. But it was very difficult to persuade others of that opinion; those who held to the common-sense observation that surely disease was caused by ‘bad or corrupted air’ or mists or ‘miasma’ or night chill or imbalance in the hot/cold/wet/dry of the bodily humors. The germ theory did not even begin to be articulated until the mid-19^th century.

Yellow fever raged off and on along the Atlantic seaboard for much of the 18^th century – and while the description of the disease was accurate doctors had no idea of its mode of spread or its treatment. It was to be more than 100 years before mosquitoes were shown to be the vector in causing yellow fever. [i] It is the understanding of these vectors and germ theory that would ultimately lead to more effective prevention of certain diseases through vaccination.

And if that initial horrific list of ailments weren’t enough, small pox erupted in epidemic after epidemic throughout the 18^th century. “From 1775 to 1782 Variola ravaged the greater part of North America, from Mexico to Massachusetts, from Pensacola to Puget Sound.”[ii] It was a constant reminder of the dangers of large groups pressed into unsanitary surroundings.

Inoculation itself was an ancient practice, spread, and then neglected, and rediscovered again in areas as far flung as Ciraffia along the Caspian Sea, in Constantinople, Bengal in India, in China, and on the coast and in the interior of Africa, from where the practice spread to Algiers, Tunis, and Tripoli.

However most living persons in our early 21st century have no idea of how terrifying smallpox was.

Smallpox-Wikipedia

In Europe the technique of inoculation was not introduced until the very early eighteenth century when Lady Worley Montague, the wife of the English ambassador to the Ottoman Empire, had her only son inoculated while she and her family were stationed there. Upon her return to England she had her infant daughter inoculated as well. Her example prompted physicians all across Western Europe to begin experimenting with inoculation in an effort to give the patient a limited case of the pox in the hopes of reducing the impact of the disease. The doctors noted that only one in ninety-five died of the inoculation whereas one in five-to-seven infected persons died of a naturally acquired small pox infection. Initially the evidence was not clear whether the inoculation could completely prevent the disease itself.

By 1721 New England’s most famous minister, Cotton Mather, was promoting the use of inoculation. He may have already learned of inoculation from his “negro man, Onesimus, who is a pretty intelligent fellow,” who when asked, “whether he had the Small Pox; he answered both Yes and No: then told me that he had undergone an operation which had given him something of the Small Pox and would forever preserve him from it; adding that it was often used among the Guramantese.”[iii]

In promoting inoculation Mather was bucking a very determined religious tide of resistance to the idea. Inoculation was seen as willfully going against the wishes of God – inoculation would bring down his wrath. In Europe smallpox was a leading cause of death in the 18th century, killing an estimated 400,000 Europeans each year.[iv]  Sixty years after Cotton Mather learned of a traditional African preventative method, and in the face of continuing protest, during the Revolutionary War General George Washington insisted on inoculating his troops.

Our third president Thomas Jefferson had a lifelong intellectual interest in medical knowledge. He scorned mere 4-humors theorizing; instead encouraging the development of a thorough understanding of botany and anatomy, topics he thought should be taught to all students. Following that leaning along with others of his peers, such as Washington, he became very involved as one of the leading voices and practitioners advocating small pox inoculation and later vaccination.  In the opinion of Monticello researcher Gaye Wilson, “. . . it is a testimonial to Jefferson’s confidence in smallpox inoculation that just two months after the devastating loss of his wife [1782], he had their two daughters inoculated. Jefferson brought his involvement to a new level during the summer of 1801, when he directed the inoculation of Monticello slaves, his sons-in-law, and some of his neighbors – about 200 people in all.”[v] He certainly would have remembered the events of 1781 when 30 of his own slaves escaped from Richmond to run to Cornwallis at Yorktown. They died of the pox along with several thousands of others within the British camp. [vi]

Dr. Benjamin Waterhouse, co-founder of the Harvard Medical School, proved that a vaccine made from cow-pox could inoculate a person against smallpox by using his own family as the test patients.[vii] The American physician Benjamin Rush declared vaccination “the most useful discovery of the 18^th century” and Waterhouse received letters of congratulation from two presidents; John Adams as he left office, and Thomas Jefferson as he entered his first term; “Every friend of humanity must look with pleasure on this discovery by which one evil more is withdrawn from the condition of man….; and I pray you to accept my portion of the tribute due to you, and assurances of high consideration and respect, with which I am, sir, Your most obedient humble servant. . . . ”[viii]

Despite the promotion of vaccination there continued to be an ongoing tragic global record of smallpox. War has too often brought with it smallpox; killing not only soldiers but civilians. The 19^th century Franco-Prussian War is a sad example; the Prussian soldiers were vaccinated; not so the French leading to the deaths of more than half a million Europeans. “There has never been a more dramatic demonstration of a vaccine’s power to alter the course of history,”[ix] says science writer Michael Spector.

The staggering fact is that “Before the virus was eradicated, in 1977, it killed three hundred million people in the twentieth century alone.”[x] (Emphasis mine; yes, that is correct, throughout the first seventy-five years of the 20^th century). Eradicated is a word that does not express how national and international governments struggled to vaccinate everyone that could possibly be reached so as to supply the deadly virus no more unprotected victims. Jefferson and his peers led the way. For that brave effort Washington, Jefferson, Rush, Waterhouse, the Lady Montague, the Guramantese slave Onesimus, and the Reverend Mather and all the unnamed others deserve our deepest and continuing national thanks. The very idea that their efforts at introducing the concept and practice of vaccination, efforts that contributed to the continuing elimination of other diseases that commonly killed their children, would, I believe, have thrilled those Early Federal thinkers.

Today the same issues, fears, and quasi-Biblical disputes seen in the 18^th / 19^th  centuries have been revived about vaccination; this time centered on chicken pox, tetanus, measles, mumps, Rubella, and diphtheria for our children here in the US. Who on earth would want their children to suffer from any of those contagious illnesses or, equally bad, to be a carrier and give one of them to another child or vulnerable adult? Tetanus is a danger in situations of natural disaster as well as from the more run of the mill childhood puncture wounds. Who would not want to be protected from lockjaw?[xi] Vaccines even for non-contagious diseases are under attack. Already anti-vaccine supporters have put impediments in the way of a vaccine for Lyme’s Disease.[xii]

We have a historical record of vaccination and its successes against epidemic disease. Let’s share that history with those who fear.

Bibliography

• Elizabeth A. Fenn. Pox Americana: The Great Smallpox Epidemic of 1775-82. Hill and Wang 2002

• Sharla M. Fett.  Working Cures: Healing, Health, and Power on Southern Slave Plantations. Chapel Hill: University of North Carolina Press, 2002.

• Zachary B. Friedenberg, M.D.  The Doctor in Colonial America.  Danbury, CTP: Rutledge Books, 1998.

• Kenneth F. Kiple, Virginia Himmelsteib King. Another Dimension to the Black Diaspora: Diet, Disease and Racism. Cambridge University Press, 1981.
  Oscar Reiss. Medicine in Colonial America.  University Press of America, 2000.

• Todd L. Savitt.  Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia.  University of Illinois Press, 1978.

References

[i]       Friedenberg, The Doctor in Colonial America

[ii]      Fen, Pox Americana: The Great Smallpox Epidemic of 1775-82

[iii]      Friedenberg. The Garamantes were a people who developed an advanced civilization in ancient southwestern Libya. They used an elaborate underground irrigation system, and founded prosperous Berber kingdoms or city-states in the Fezzan area of modern-day Libya, in the Sahara desert. They were a local power in the Sahara between 500 BC and 700 AD. https://en.wikipedia.org/wiki/Garamantes

[iv]     Smallpox-Wikipedia. https://en.wikipedia.org/wiki/Smallpox

[v]      Via Dr. Gaye Wilson of the International Center for Jefferson Studies, Monticello.  While he was abroad, and in Philadelphia, and at Monticello Jefferson had his slaves and his family either inoculated or vaccinated:  Inoculation: Robert Hemings (1775 in Phila.); Martin and James Hemings (1778 in Goochland County); daughters Martha and Mary (1782); Sally Hemings (1787 in Paris); Vaccination: 70-80 slaves (Aug./Sep. 1801)

[vi]     Cornwallis and the Siege of Yorktown. http://www.blackloyalist.info/cornwallis-and-the-siege-of-yorktown/

[vii]     Benjamin Waterhous-Wikipedia. https://en.wikipedia.org/wiki/Benjamin_Waterhouse

[viii]    Friedenberg. The Doctor in Colonial America

[ix]     Michael Spector. The New Yorker, May 30, 2011 “Resistant: why a century-old battle over vaccination continues to rage.”  http://www.newyorker.com/magazine/2011/05/30/resistant

[x]      Michael Spector. The New Yorker, May 30, 2011 “Resistant: why a century-old battle over vaccination continues to rage.”  http://www.newyorker.com/magazine/2011/05/30/resistant

[xi]      Tetanus. http://www.emedicinehealth.com/tetanus/page3_em.htm

[xii]     New Lyme Disease Vaccine Shows Promise Preventing Bacterial Sources Infection. http://www.medicaldaily.com/new-lyme-disease-vaccine-shows-promise-preventing-bacterial-sources-infection-312910

Image Credit: The Vaccine by Louis-Leopold Boilly