SMALLPOX

Smallpox is a highly infectious disease whose normal mode of transmission is through inhalation. Case mortality can be as high as 30 percent, and the disease is also feared for the permanent scarring it leaves. It was introduced to the Americas by Spanish explorers. Credited with the extinction of the indigenous Amerindian populations of the Caribbean islands by 1519, smallpox also contributed to the conquest of Mexico and Peru. In the 1760s Sir Jeffrey Amherst ordered the deliberate spread of the disease among Native Americans participating in Pontiac's War in western Pennsylvania.

The British also inadvertently brought smallpox to the territory of what would become the United States. As early as 1633, William Bradford noticed severe cases among Indians living near the Plymouth colony. The spread-out population of the English colonies—with regular replenishment of new smallpox cases disembarking from transatlantic voyages—meant that smallpox was sporadic but also more dangerous to nonimmune populations. Throughout the eighteenth century, natural outbreaks continued to afflict Indian populations. In 1763, for example, a group of Indian converts to Christianity who lived in Philadelphia lost one-third of their members to the disease.

Many Old-World cultures developed the practice of deliberately inoculating smallpox in order to confer lifetime immunity. Around the same time that this procedure was brought to England, the Puritan clergyman Cotton Mather independently learned of it from his slave, Onesimus. With the assistance of the physician Zabdiel Boylston, Mather began inoculating in Boston during an epidemic in 1721. During a 1731 epidemic in Philadelphia, Benjamin Franklin hailed inoculation, and over the course of the following decades, the practice became more popular in the Philadelphia region than elsewhere in the colonies.

Inoculation was a dangerous procedure since it bore the risk both of killing the inoculated person and of spreading the disease. As a consequence the procedure was generally restricted to more substantial members of the community, who could be more easily isolated and better cared for. In 1774 Philadelphians established a Society for the Inoculation of the Poor, whose work was soon suspended because nonimmune delegates to the Continental Congress (mainly from the South) were concerned about infection. During the War of Independence, George Washington had himself and his troops inoculated, in part because the British were rumored to be deliberately spreading smallpox. The fact that an eminent Virginian encouraged the practice may have led to inoculation becoming official policy of the Continental Congress.

In 1798 Edward Jenner published his Inquiries, detailing how inoculation with the relatively mild cowpox (or vaccinia) would immunize the patient against smallpox. Inoculation with smallpox now became known as "variolation" (variola being the Latin name for smallpox), and was gradually replaced by vaccination. Vaccination was introduced to the new Republic in 1800 by Benjamin Waterhouse of the Harvard Medical School, and President Thomas Jefferson immediately became an advocate of the new procedure. In 1802 Valentine Seaman of New York organized a system to provide free vaccination to the poor.

During his administration, James Madison encouraged the distribution of smallpox vaccine, and public health statutes from the colonial period into the early nineteenth century were concerned primarily with isolating smallpox patients among immigrants. In Pennsylvania, for example, it was only in 1824—when variolation was outlawed—that smallpox became a reportable disease and the isolation hospital within the city began receiving smallpox patients.

Although it had its opponents, vaccination gained general acceptance rapidly, and smallpox incidence in the United States declined significantly during the first three decades of the nineteenth century. Unfortunately this led to complacency, and after 1830 the United States experienced a number of devastating epidemics.

See alsoDeath and Dying; Epidemics; Health and Disease; Medicine .

bibliography

Fenn, Elizabeth Anne. Pox Americana: The Great Smallpox Epidemic of 1775–82. New York: Hill and Wang, 2001.

Stearn, E. Wagner, and Allen E. Stearn. The Effect of Smallpox on the Destiny of the Amerindian. Boston: Bruce Humphries, 1945.

Wolman, Roslyn Stone. "A Tale of Two Colonial Cities: Inoculation against Smallpox in Philadelphia and in Boston." Transactions and Studies of the College of Physicians of Philadelphia 45, no. 6 (1978): 338–347.

Edward T. Morman