Some are terrified by the disease, and others are more frightened by the new vaccine introduced to produce immunity to the disease. While I could be talking about today’s reaction to COVID-19, I’m referring to the situation 300 years ago in Boston.

Kate Dolan writes about vaccine fears in 1721In the spring of 1721, Boston was hit by a smallpox epidemic that would eventually sicken over half the population and kill nearly 8% of city residents. What the period is most remembered for, however, is not the disease itself but the efforts to eradicate it through inoculation.

Inoculation involves implanting a microorganism into an environment. In medicine, it usually means introducing a vaccine into the human body to make the recipient immune to a specific disease. The vaccine often contains a weakened or harmless form of a bacteria or virus. The goal is for the body’s immune system to fight off an impotent version of the germ and thereby develop the ability to stave off a stronger form of that germ when it encounters it in future.

The fear, of course, is that it won’t. Many people then as now are worried that instead of making you immune to the disease, the process of introducing a noxious substance into your body will have a noxious effect and give you the illness you were trying to avoid. Or worse.

In 1721, angry residents hurled a bomb through the window of the Rev. Cotton Mather, a minister who strongly advocated the use of inoculation to protect people from smallpox. Inoculation techniques against smallpox may have been used in China as far back as 1000 B.C. While the Chinese often blew bits of pox scabs into the nostrils to introduce the germs into the body, medical practitioners in Africa, India and Turkey usually conducted inoculation by making an incision in the skin and exposing the cut to pus from a smallpox patient. The deliberate induction of infection through a small wound was easier for the body to fight off than an infection acquired naturally through the respiratory system.

Most of the time.

Usually, those who were inoculated developed a mild form of the illness and then became immune to smallpox. Some of them, however, were not as fortunate, and the introduction of the virus made them deadly ill. And then just dead.

Later in the 1790s, Edward Jenner developed a vaccine based on the less dangerous cowpox virus, and the principles developed then are still essentially in use today.

But in 1721, that safer vaccine was not even on the horizon. Even the crude forms of inoculation were unknown to most practitioners of medicine in Europe and America. Mather is said to have learned of the process from an enslaved member of his household, Onesimus, who had undergone the procedure in West Africa. Mather talked to others who had been inoculated in West Africa, and then read about procedures performed in Turkey. After that, he started lobbying for widespread inoculation in his home town.

One doctor, Zabdiel Boylston, agreed that the technique was promising, but the rest of the medical community found the procedure too risky and unproven. Debate raged, with some arguing that inoculation thwarted God’s will and others saying it was no more scientific than folk medicine. By the end of the epidemic in Boston, however, Boylston had some statistics to show the effectiveness of the procedure. Of the 287 patients he had inoculated, 2% had died, compared with a nearly 15% mortality rate in those infected with the disease naturally. The practice of inoculation remained risky and controversial throughout the rest of the century until the safer vaccine eventually eradicated smallpox by the 1900s. We can thank Onesimus, Jenner, and a host of brave volunteers for the fact that none of us have ever seen a smallpox victim.
However, vaccinations remain controversial even now. Workers administering drops to immunize children against polio in places like Pakistan and Afghanistan are routinely accompanied by armed guards, and three were shot dead just a few weeks ago.


Much of the information in this article came from Science in the News, Special Edition on Infectious Disease published by Harvard University in December 2014.

The image was created by James Gillray in 1802, “The Cow Pock — or the Wonderful New Inoculation” satirizing people’s fears about what the cow pox vaccine would do to them.

In my book Restitution, set in 1774, some of my characters try to escape notice by disguising themselves as dead smallpox victims. But I have yet to write a story about inoculations.