The epidemic was not confined to Massachusetts; it spread up and down the coast through all the major port cities of Britain’s American colonies. In Philadelphia, Ben Franklin became an ardent supporter of inoculation, using his editorial control of the press to trumpet the procedure’s merits. Six years later, though, his four-year-old son Francis died from smallpox before he could be inoculated; Franklin blamed himself for that death for the rest of his life. After he became a wealthy man, he paid for large numbers of Philadelphia’s poor to undergo the expensive operation.
Both directly and indirectly, inoculation had a major impact on the American Revolution. It certainly protected a number of the fledgling country’s great statesmen. Boylston’s great-nephew John Adams (the grandson of Zabdiel’s older brother Peter) had himself inoculated in Boston in 1764. Meanwhile, his fiancée, Abigail Smith, was banished from his side, reduced to disinfecting his letters with smoke before she read them; she was so lonely she threatened to come to the hospital to wave at him through a window. Down in Virginia, Thomas Jefferson had himself inoculated after losing a beloved sister to the disease. When the Continental Congresses convened in Philadelphia in 1774 and 1776, members who had not yet had smallpox had to wrestle with the decision whether to inoculate themselves or stay away; most decided to inoculate themselves. The Declaration of Independence was written and signed in safety as smallpox stalked the streets outside.
After receiving good evidence that the British were using smallpox-infected blankets and refugees as an insidious weapon—and knowing the terrible vulnerability of most of his men—George Washington had the entire Continental Army inoculated in 1777. Washington’s own face was already famously scarred from an earlier bout with the disease, contracted on a visit to Barbados in 1751. But Martha had herself inoculated, so that she might visit her husband in the soldiers’ camps with impunity; smallpox parties became popular among Revolutionary women—including Abigail Adams and Mrs. John Hancock.
In London, inoculation’s popularity waxed and waned through the 1730s, with the force of the disease: in bad years, people flocked to be inoculated; in light years, the practice shrank. Inoculation was a security—the only security—to cling to within the terror of an epidemic; in times of good health, however, it looked like a foolish flirtation with danger. (This is not unlike the vaccination for smallpox at present: in case of an outbreak of the disease, the vaccination is all that may stand between humanity and a massive, speedy die-off the likes of which this planet has not seen since the Black Death. In the absence of a real and compelling threat of smallpox, the vaccination itself—which kills one to two in a million and can seriously harm many more—is a danger not to be messed with.)
In 1743, inoculation became mandatory for the orphans of London’s Foundling Hospital; after the disease ran amok in 1746, a dedicated Small-pox and Inoculation Hospital was established, originally for the “deserving” poor and for servants of its wealthy contributors (such establishments as the smallpox house in Swallow Street proving too small and unregulated). On the Continent, despite early support by such thinkers as Voltaire, it took decades for the practice to break through barriers of conservatism. Holland was the first country to experiment with it and adopt it widely.
In later years, a series of self-proclaimed innovators (particularly James Kirkpatrick and Robert Sutton) announced at different intervals that the practice had died out, but that they had invented a brand new “light” process that would make inoculation safe and easy. In effect, they were rein-venting the Turkish, Greek, and African wheels: reverting to scratches or very shallow cuts, and using tiny droplets of matter.
On the other hand, the physicians kept “improving” the process according to the best medical theories of the time. They preferred ever longer “preparations,” often involving bleeding, vomiting, and purging, as well as cordials containing antimony and mercury. Many of the scholars who have studied this history most carefully come away shaking their heads, with the conclusion that doctors unwittingly “took a (relatively) safe procedure and made it dangerous.”
Its danger and discomforts kept many people from risking it. In 1754, the uninoculated Prince of Wales fell ill with the smallpox, but survived to become King George III; the following year, the Royal College of Physicians formally endorsed the operation. In a terrible twist of fate, in 1783, this king’s four-year-old son Octavius died as a result of being inoculated; the young prince was, however, the last royal Briton to suffer the disease.
For all its shortcomings, as Genevieve Miller has written, “Inoculation was the chief medical contribution of the Enlightenment, at least in the opinion of the age itself.”
In one of the many quirks of medical history, it was the very discomfort and danger of this first “improved” shield against the smallpox that produced a better one: and the birth of modern immunology to boot. In 1757, in the town of Berkeley, in the western English county of Gloucestershire, an eight-year-old orphan named Edward Jenner endured the three months’ misery that inoculation had become. From his older sister’s perspective, she was saving his life. From his boy’s perspective, he was starved, purged, and bled, and then locked up in a stable with other boys undergoing the treatment until the disease had run its course through them all.
While apprenticed to a surgeon in Chipping Sodbury in the rich dairy country of the Cotswolds in the 1760s, Jenner heard dairymaids fearlessly dismiss their chances of contracting smallpox—then rife in the neighborhood—on the grounds that they had suffered the sores of cowpox on their hands. He put the legendarily creamy skin of these women together with their old wives’ tales, and something began spinning in his brain concerning the connections between smallpox and the poxes that infected barnyard animals—cows, horses, and pigs—with a far lighter disease.
In 1788, Jenner first came to the attention of the Royal Society for his work on cuckoos, describing the exact process of how the birds lay their eggs in other birds’ nests, and the voracious young chicks then eject their foster siblings to monopolize the attention of the unwitting parents. That year, he was already showing a drawing of cowpox-infected hands to medical men in London. In 1790, he inoculated his own son and the boy’s nurse with swine pox; later that year he started collecting stories of dairymaids who’d had cowpox and then had resisted smallpox inoculations—though they had never had smallpox. He was an inoculator; he was in a position to see such curiosities in the flesh.
In 1796, a woman named Sarah Nelmes came to him terrified about a rash on her hands; he calmed her down and discerned that her cow Blossom had the cowpox, and had communicated it to her. On May 14, he inoculated James Phipps, the eight-year-old son of his gardener, with matter from one of Sarah’s pocks. Young Phipps duly developed a mild case of cowpox. At the beginning of July, Jenner then inoculated the boy with smallpox matter—with no reaction. The boy appeared to be immune. I shall now pursue my Experiments with redoubled ardor, dashed Jenner.
In 1797, he submitted his conclusions to the Royal Society, which soon returned his paper with a note recommending that if he valued the solid reputation he had established by his work on the cuckoo, he had best not promulgate such harebrained ideas as using cowpox to prevent smallpox. The following year saw an outbreak of cowpox; not to be so easily discouraged, Jenner gathered matter from the infected cows, and tried again. In June 1798, he published the results himself.
It was, wrote one of his supporters, “as if an angel’s trumpet had sounded over the earth.” By 1801, over a hundred thousand people had been vaccinated in Britain; in 1802, Parliament voted Jenner a £10,000 reward, and in 1806 another £20,000. President Thomas Jefferson supported the new practice in the United States; at the height of the Napoleonic Wars between Britain and France, Napoleon returned prisoners of war to Britain at Jenner’s request—remarking, it is said, “Ah, Jenner. Him I can refuse nothing.”
In the press, however, vaccination went through the same baptism of fiery controversy that inoculation had ear
lier endured. By this time, though, the scientific method of study had become well developed, and the application of mathematics to epidemiology was a standard practice. It did not take long for vaccination to overcome inoculation (more properly “variolation”) as the preferred prevention of the smallpox: vaccination was safe enough to practice even outside the immediate threat of an epidemic.
So successful was Jenner’s practice that researchers began to fiddle with it in fighting other diseases. The once disease-specific name of “vaccination”—from vaccinia, the Latin term for the cowpox virus—has long since become a generic term for inoculation against any disease, in the same way that Kleenex, Xerox, and Levi’s have given their brand names to whole technologies and products.
Where smallpox was concerned, vaccinators began aiming at something higher than the protection of individuals, something never before imagined: they began to dream not just of taming smallpox, but of conquering it. First, they concerned themselves with towns and counties, and then with whole nations. In the mid-twentieth century, under the field marshal-ship of D.A. Henderson, the World Health Organization launched a serious long-term war to eradicate smallpox from the earth.
In one of the last ironies of this struggle, the disappearance of the disease from India—one of its last three hiding places (along with Bangladesh and Somalia)—was hindered by an echo of the same religious objections that high-church Anglicans and conservative Puritans wrestled with in 1721. In 1974, the spiritual leader of a single Indian village in the southern state of Bihar refused to have his family or his flock of followers vaccinated on the grounds that smallpox was the rightful scourge of God. Smallpox kept flaring up in this corner of the world; in the end, he and his family were inoculated by force.
Jenner himself predicted that “the annihilation of smallpox—the most dreadful scourge of the human race—will be the final result of this practice.” In 1977, he at long last proved right.
Until and unless human beings prove fool enough to reopen Pandora’s box.
Jenner was not the first to experiment with cowpox as a shield against smallpox, but he was the first man with the dogged curiosity to study it systematically, and to have the equally dogged courage to force Europe’s scientific world to take notice. He has been justly celebrated ever since as the founding father of immunology, but this father had his own mother and father in Lady Mary Wortley Montagu and Zabdiel Boylston—whether or not he knew them any better than he knew his own parents. In turn, Lady Mary and Boylston had parents from the Ottoman Empire and Africa.
From beginning to end, the conquest of smallpox proved a global endeavor.
3
THE PEOPLE
Lady Mary soon broke with Alexander Pope in a long, loud, and nasty quarrel that distressed those like Lord Bathurst and Dr. Arbuthnot who strove to remain friends with them both. If their rupture was rooted, as she claimed, in her laughing refusal of Pope’s love, Cupid had his revenge. Not long after, she fell in love again, disastrously, with the wealthy young Italian Francesco Algarotti—who also charmed Voltaire, Pope, and Lady Mary’s friend Lord Hervey (though only Hervey appears to have been her rival for Algarotti’s attention).
Understandably tired of Wortley, in 1739 Lady Mary followed her brilliant and probably bisexual Venetian beloved to the Continent. Disappointed in him, she fell in love with an even more disastrous Italian, Count Ugolino Palazzi, who was younger than Lady Mary’s son and a ruthless extortioner, thief, kidnapper, and possibly poisoner to boot. None of this deterred Lady Mary from reveling in life as an expat; she remained in France and Italy until just before her death, becoming a fixture on the British Grand Tour. Young men with any claim to polish strove to come home with an anecdote of meeting Lady Mary. One scurrilous but not unlikely story has her showing off her commode, painted inside to look like the backs of books by Pope, Swift, and Bolingbroke. She knew them well, she told one astounded young man: “They were the greatest rascals, but she had the pleasure of shitting on them every day.” She seems to have either charmed her visitors—as she did Joseph Spence—or utterly repulsed them—as she did Horace Walpole. Either way, they gossiped about her and her love affairs (long past and present) incessantly. Early in 1761, she was shocked to learn—apparently in casual conversation—of her husband’s death. Not until she was probably already quite ill with breast cancer did she return to London, where she died at age seventy-three on August 21, 1762.
Edward Wortley junior proved an adventurer like his mother—but lacked her moral courage and fiber: he was an inveterate liar, a rake, and a scoundrel. As a youth, he ran away from school as often as possible, once getting as far as Gibraltar after joining the crew of a naval ship; his inoculation scars are said to have been used to prove his identity. As an adult, he lived mostly abroad at his parents’ insistence. He nevertheless begged money as often as he could, even while spouting lies that outraged his family—such as announcing that he was a bastard son of Sultan Achmet III. He died in 1776.
Mary Wortley, on the other hand, was prim and proper. She married John Stuart, earl of Bute, thereby becoming a countess; her husband later became one of King George III’s early prime ministers, and remained one of his closest advisors even after being forced out in a political contre-temps. Lady Bute proved no more eager to have her mother come home to Britain than Lady Mary was to live there. Lucky for the rest of us: their correspondence is one of the treasures of eighteenth-century British literature. Unluckily for the rest of us, her children calmed Lady Bute on her deathbed in 1794 by burning Lady Mary’s diaries, which she had cherished up till that point.
Charles Maitland returned to Aberdeen in 1726; he died a much-respected bachelor there in 1748, at the age of eighty.
Sir Hans Sloane became president of the Royal Society following Newton’s death in 1727. Sloane himself died in 1753, age ninety-two, still poking his fingers into almost every corner of British science. Having collected knowledge all his life, upon his death he willed the material remains of it—nearly eighty thousand objects—to the nation, so long as his daughters were paid £20,000. Parliament agreed that it was a collection fit for a king and footed the bill—and thus was born the British Museum. It would be interesting to know whether a five-and-a-half-pound stone from a gelding’s belly formed part of that original collection.
King George I died en route to his beloved Hanover in June 1727.
The Prince and Princess of Wales became King George II and Queen Caroline. For a decade, Caroline is said to have ruled Britain in all but name, managing ministers with discretion and her cantankerous husband with commendable patience. She particularly interested herself in prison reform. Though her husband was famous for scolding her in public, he loved her in his way. Upon her death in 1737, he was heard to say, “I never yet saw a woman who was fit to buckle her shoe.” He died in 1760, just shy of seventy-seven.
Their heartily disliked elder son, Frederick, died while still Prince of Wales; his son—another George—became Prince of Wales and later King George III. Prince William pursued his military passions, making a name for himself as the duke of Cumberland. Far from earning the epithet “the Great,” however, after the Jacobite rebellion of 1745 he became known as “the Butcher of Culloden”—though many in England celebrated his ferocity against the Scottish Highlanders.
The princesses lived out their lives in the gilded cages of Hanoverian and continental palaces. Both Amelia and Caroline remained unmarried. Amelia had many affairs with dashing noblemen; she loved brisk exercise outdoors, and would shock congregations by arriving to church in a riding habit, with a dog under each arm. She became hostess and companion to her younger brother, the duke of Cumberland. Caroline served as devoted companion to her mother; after the queen’s death she withdrew from the world, spending her days as an invalid, her fragility increased by hypochondria that exasperated her sisters, especially Emily.
The three others made unhappy marriages. Anne was so desperate to escape that she insisted upon
accepting the suit of the “grossly deformed” William IV, Prince of Orange, against everyone’s wishes, including her father’s. When the king warned her of the prince’s ugliness, she said she would marry him if he were a baboon; the king shot back that she would “have baboon enough.” Mary married Prince Frederick of Hesse-Cassel, who abruptly abandoned her and their young children for a former mistress seven years later. Princess Louisa, the most like her mother, married the crown prince of Denmark, became that country’s queen, and died young as a result of complications from childbirth.
Elizabeth Harrison nursed at least twenty people through smallpox in Hertford in the winter of 1721-22. After that, she dives beneath history’s sights: but she looks to have stood a far better chance than most eighteenth-century women with felony records to have wound up on her feet with a reputable career that could support her.
Zabdiel Boylston lived a long, quiet life, apparently never again leaving New England. He practiced medicine into the 1750s, though in 1741 he bought the seventy-five-acre family farm in Brookline, enlarging the house to a fifteen-room, three-story mansion, and moving there from Boston to raise his horses in the country. The house still stands—though it is no longer a country mansion. He worked with rattlesnakes and with the balsam from the white cedar tree. His work with smallpox, he thought, had given him the convulsive asthma that haunted him in later life. It does not seem to have slowed him too much: he was seen in Boston at the age of eighty-four, riding a colt he was breaking.
He died eight days shy of eighty-six, murmuring “my work in this world is done.” His tombstone stated, “Dr. Zabdiel Boylston, Esq., physician and F.R.S. who first introduced the practice of inoculation into America. Through a life of extensive benevolence, he was always faithful to his word, just in his dealings, affable in his manners, and after a long sickness, in which he was exemplary for his patience and resignation to his Maker, he quitted this mortal life in a just expectation of a happy immortality, March 1, 1766.”