A Little Ditty about Smallpox

I received this in my work inbox at Mass General Hospital. History matters. Black history matters, and not just in February. Black lives have and continue to save our white asses, and our white asses often just save our own white asses. But we can change that, one story at a time.

A Look Back at Vaccinations – And a Slave Whose Knowledge Saved Lives

When the Mass General opened in 1821, Bostonians had already been contending for two centuries with a fearsome, deadly infection: smallpox. It came in waves, with epidemics hitting this region every 10 to 20 years.

The story of smallpox features some of the same themes as those of COVID-19 today – one of them inequity. Smallpox was a significant factor in dramatic declines in the populations of Native groups, including the local Massachusett, Pawtucket, Wampanoag and Nipmuc peoples.

In 1721, Puritan minister Cotton Mather and physician Zabdiel Boylston popularized a technique to minimize the impact of smallpox through inoculation. But only in recent decades have accounts rightly featured the enslaved man who told Mather about the technique. Very little is known about the man whom Mather held in slavery and called Onesimus (his real name is lost to history). He may have been part of the Akan people of what is now Ghana. He was captured and enslaved, taken from Africa, and likely sold in the West Indies slave trade before being shipped to Boston. People in many parts of sub-Saharan Africa had been practicing inoculation, also called variolation, for many years. It involved deliberately giving a patient a mild case of smallpox by inserting material from a smallpox pustule into the skin. These artificially induced cases of smallpox tended to be milder and had better survival rates than smallpox transmitted through contact with an infected person, and they still gave the patient immunity.

Colonial Bostonians had mixed reactions to variolation. Some welcomed the opportunity to reduce the risks associated with smallpox, while others were wary. Some skeptics had racism-fueled doubts about a technology that originated in Africa, and some feared that enslaved people had concocted the practice as revenge on their enslavers. Others, however, simply felt the risks of deliberately inducing smallpox were too high. In the 1790s, variolation began to be replaced by a safer alternative that didn’t sicken patients: vaccination.

During a smallpox epidemic in 1851, MGH leaders assessed their policies about the containment of infectious disease and created new vaccination policies. In a letter, MGH physician Dr. Jacob Bigelow reasoned that it would be impossible to prevent patients from bringing smallpox into the hospital because they could be contagious before they showed symptoms. Dr. Bigelow also expressed his confidence in the smallpox vaccine’s effectiveness based on the studies that had been done. Then he recommended:

“That all persons on becoming inmates [inpatients or residential staff] of the Mass. General Hospital, shall be vaccinated as soon as practicable, except in cases where in the opinion of the attending physicians or surgeons, vaccination is inexpedient.”

The following week, hospital cofounder Dr. James Jackson recommended that the MGH find some way to care for patients who developed smallpox after arriving at the hospital, such as a ward that was far from other patients. At the time, the hospital did not admit patients with certain infectious diseases, smallpox included. This was common for hospitals in the era, a generation before germ theory was well understood. In 1854, the hospital opened its first infectious disease ward, called the Isolation Ward, or informally, “The Brick.”

In the midst of our vast campaign to vaccinate against COVID-19, it seems fitting to remember and salute those who helped banish smallpox.

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