The Epidemic


For the colonists of Boston, smallpox was nothing new. The disease was endemic to Britain, and new outbreaks occurred in America nearly every year, affecting children and new settlers that had not been previously exposed. Colonists knew that smallpox was often carried by infected merchant ships, and in 1717 a “pest house” was set up on a nearby island to inspect cargo for infection. However, merchants seeking to maintain their profits often found ways around these precautions.

In April 22, 1721 a British ship  arrived in Boston from the West Indies with an infected passenger aboard. By May, reports of several cases of smallpox became public and the city immediately took measures to prevent it from spreading. Patients were put under formal quarantine with the house guarded by two men and marked with a red flag reading, “God have mercy on this house”. The streets were cleaned and the ship was isolated to the nearby Bird Island. Despite these precautions, the smallpox continued to spread and by mid-June, there were too many cases to maintain a formal quarantine. In response, the Governor of the colony ordered a day of fasting and prayer to ask God for forgiveness and mercy.


Cotton Mather, a Puritan minister, was prepared for this epidemic with knowledge of a new medical procedure: inoculation. The process of inoculation was relatively simple. A doctor would make a small cut in the arm of a healthy patient. Then they would rub the pus from an infected individual into that that cut with either a needle or soaked piece of thread. This would induce a mild case of smallpox within a few days, making the person immune to a later, more serious infection. The practice began in the far East, and Mather first heard of it back in 1707 from his African slave Onesimus. Then in 1716, Mather read about inoculation practiced in Constantinople in an article in a publication of the Royal Society of London.

When the epidemic started in 1721, Mather sent letters to local physicians suggesting that they attempt this procedure. None responded until he sent a second, personal letter to Zabdiel Boylston, a local physician and apothecary. Boylston had a reputation for being willing to perform risky procedures, and on June 26, Boylston inoculated his six year old son, 36 year old African slave, and his slave’s son. They came down with a fever and mild rash, but recovered within a week. Encouraged by his success, Boylston continued to inoculate individuals for the next several months, improving his procedures as he went.


severalargumentsagainstWhen colonists learned of this new practice, they were outraged. In their eyes, Boylston was intentionally spreading the infection disease, and further, the Puritans saw inoculation as rebellion against God’s will. Another physician, William Douglass, only intensified these protests. Douglass was trained in the medical schools of Europe and disdainful of Boylston’s lack of formal education. He published a series of protests against inoculation belittling the knowledge of a Mather and Boylston and playing to the fears of the public with reports of horrible side effects from inoculation in Europe. Mather and Boylston responded with their own articles and letters, and a paper war ensued.  On November 14, 1721 someone even threw a homemade bomb through Mather’s window with a note reading “Cotton Mather, You Dog, Dam you; I’ll inoculate you with this, with a pox to you” The bomb never went off, but Mather was actually pleased with the prospect of martyrdom. He firmly believed inoculation was a gift from God and continued to defend its merits even after the epidemic died down.


By February 24, 1722 the leaders of the town announced that no new cases of smallpox were present. By the end of the epidemic 6000 people were infected with smallpox and 844 died (about one in six, or 15 percent). Boylston had inoculated 286 individuals, and, in contrast, only 6 died (about 1 in 50, or 2.5 percent).1 Empirical evidence clearly pointed to the success of inoculation. Boylston was welcomed and supported by the Royal Society of London for his efforts, and he later published as scientific record of his work. However, when more smallpox epidemics arose in America, the same practice and debate occurred. Inoculation did eventually grow in popularity. An institution for inoculation was set up on an island in Boston Harbor, instructions were printed in newspapers, and George Washington had his whole army inoculated in 1777. Finally in 1799, Edward Jenner developed the first vaccine using cowpox. Still, new fears came with each new development, and the anti-inoculation movement that began in Boston remains strong today.

1. Amalie M. Kass “Boston’s Historic Smallpox Epidemic.” Massachusetts Historical Review 14 (January 2012): 1–52.

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