Cotton Mather, Onesimus, George Washington, and Variolation

Here are a couple of vignettes that may be particularly interesting to American history buffs. They concern the introduction of variolation to New England during the Colonial Period in North America. A major smallpox outbreak occurred in Boston in 1620, and again in 1702 and 1721. These happened before the advent of Jenner’s smallpox vaccine, in the late 1790’s. Note that Native Americans suffered especially severely from smallpox.

The colonialists initially dealt with smallpox by quarantining individuals who might transmit the disease. However, bear in mind that variolation had been used successfully in China and India since the 11th century to block the spread of smallpox. Variolation is the practice whereby uninfected individuals are inoculated with material from the dried out scabs of individuals who survived a smallpox infection. [Variolation worked because the dried-out scabs on the skin of a smallpox survivor contained virus that had been partially inactivated by that individual’s immune response, as well as by the drying itself. And, the inactivated virus might yet induce immunity in the inoculated recipient.] The practice was inspired by the yet earlier recognition by the Chinese, well before the advent of the germ theory of disease in the West, that individuals experience some illnesses only once in a lifetime. [Remarkably, Thucydides came to the same realization 24 centuries ago in Greece. The reason Thucydides’ observation had no lasting effect on Western medicine is the subject of another tale.]

A transmission electron micrograph of smallpox viruses.  Source: CDC/ Fred Murphy
A transmission electron micrograph of smallpox viruses. Source: CDC/ Fred Murphy

By 1700, variolation had spread from China to India, the Ottoman Empire, and Africa. Lady Mary Wortly Montague, the wife of the British ambassador to Turkey, learned of the practice while in Constantinople, and brought it home to England in 1721. Before that, while still in Turkey, she had her 5-year-old son, Edward, undergo the procedure. Subsequently, in 1721, in England, she also had her 4-year old daughter variolated. Physicians of the royal court were present on that occasion to witness the procedure. English doctors then insisted that the relatively simple process of variolation be preceded by severe bloodletting to “purify” the blood, thereby excluding non-physicians from carrying out, and profiting from the practice.

The story of Lady Montague’s role in introducing variolation to England is rather well known. In contrast, the story of the introduction of variolation into North America is less well known, even though it has several intriguing aspects. So, the earliest known use of variolation in North America occurred during the 1721 smallpox outbreak in Boston. Its use resulted from the efforts of the prominent Puritan minister Cotton Mather, who persuaded a Dr. Zabdiel Boylston to try variolation in order to control the outbreak.

Most interestingly, Mather learned of variolation from his African slave, Onesimus, who had been inoculated as child in Africa, and who was a “gift” to Mather in 1706, from his Boston congregation. Variolation was then being practiced in western Africa, perhaps brought there by caravans from Arabia. So, an enslaved African man played a key role in bringing variolation to North America.

Mather tried to convert Onesimus to Christianity, but, finding him increasingly rebellious, Mather gave Onesimus the opportunity to purchase his freedom in 1721. Onesimus did so by helping Mather purchase another African slave to take his place. However, once freed, Onesimus continued to do chores for Mather and his family. Little else is known of Onesimus’ life.

The most bizarre aspect of this story may be that Mather is best known for his role in promoting the Salem Witchcraft trials. In 1688, he argued that the peculiar behavior of four Boston sisters was the result of witchcraft practiced on them by a washerwoman named Mary Glover. What is more, he argued that the behavior of these sisters should be taken as evidence against the accused during the trials. Yet Mather was also a prolific writer and, incongruously, he wrote extensively on science, as well as religion. Moreover, he acknowledged that his scientific writing was strongly influenced by Robert Boyle’s The Usefulness of Experimental Natural Philosophy. Furthermore, in 1716, following up his observation of differences among various strains of corn, he carried out one of the first recorded experiments with plant hybridization. And, for his scientific accomplishments, in 1713 he was elected as an honorary member of London’s Royal Society. Thus, this man who supported and witnessed the execution of “witches,” was in at least some ways a man of the Enlightenment. And, while Mather had no reservations regarding the morality of slavery, he believed that blacks had souls; actually a liberal view that was contrary to the prevailing views of the day. But, while he was enthusiastically committed to converting black slaves to Christianity, he also strongly held that conversion of slaves to Christianity was not incompatible with their remaining in bondage.

At any rate, Mather urged Boston’s doctors to try variolation, finally succeeding with Boylston. Boylston first tried the procedure on his only son and two slaves; one a child and the other grown. [Interestingly, although history credits young James Phipps as the first subject of Edward Jenner’s smallpox vaccination experiments in the 1790’s, the first vaccine recipient was actually Jenner’s 10-month-old son Edward Jr. Jenner also inoculated several other young children, including his second son Robert, when he was 11-months-old. More on this in another tale.]

Considering the risks associated with variolation (2 to 3% of variolated individuals died from variolation-transmitted smallpox), this practice generated considerable controversy among physicians of the day, with some asserting that it helped to spread, rather than contain the epidemic. In the end, critics of variolation, after observing its overall positive results, came to accept its use. [During the 1721 Boston epidemic, some 6,000 of Boston’s slightly more than 10,000 residents contracted smallpox, and some 14% of the infected individuals succumbed to the disease. In contrast, less than 3% of the variolated individuals died.]

Oddly enough, Mather went against his own Puritan ethic in promoting variolation. The Puritans viewed all afflictions, including smallpox, as part and parcel of God’s plan. What’s more, the debate over variolation between medical professionals and the clergy caused the latter to lose influence over secular matters in eighteenth-century New England.

A related vignette concerns George Washington, whose experiences during the French and Indian War (1754-1763) made him aware of how seriously smallpox might impair the fighting effectiveness of his soldiers. Later, in 1777, during the American War for Independence, and after the loss two major battles against British soldiers, who all had been variolated, Washington required the entire Continental Army to undergo variolation. Moreover, all new recruits had to be variolated immediately upon joining. [These were the days before informed consent.] Also, a political cartoon of the day implies that before Washington ordered the entire Continental Army to be variolated, he first tested the safety of the procedure on his Hessian mercenaries. One in 500 variolated soldiers died as a result of the procedure, but the odds still strongly favored variolation over taking one’s chances with an actual smallpox infection. There is speculation that at least some of Canada (Quebec) would have ended up as part of the United States if Washington had variolated his troops earlier in the Revolutionary War.

And, when did Jenner’s cowpox-based smallpox vaccine first come to be used in the New World? It first came to the attention of New England, and the rest of America, in 1799, thanks to Benjamin Waterhouse, a European educated Boston physician. Waterhouse wrote letters to newspapers throughout New England chronicling the new smallpox control method. Waterhouse not only wrote letters, but also introduced the Jenner vaccine in Boston, using cowpox that Jenner shipped to him by request (on threads dipped in cowpox exudates, sandwiched between glass plates that were sealed in lead). The vaccine could then be transferred from one individual to another by means of a lancet; a practice acceptable at the time because of the much greater danger of smallpox and the limited scientific knowledge of the day. Incidentally, Waterhouse also co-founded Harvard Medical School.

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