“The Town is become almoft an Hell upon Earth, a City full of Lies, and Murders, and Blafphemies, as far as Wifhes and Speeches can render it fo: Satan feems to take a ftrange Pofsession of it, in the epidemic Rage, againft that notable and powerful and fuccefsful way of faving the Lives of People from the Dangers of the Small-Pox . What can I do on this Occafion, to gett the miferable Town difpofsefsed of the evil Spirit which has taken fuch an horrible Pofsefsion of it? What befides Prayer with Fading, for it?”

— F rom the diary of Cotton Mather, August 24, 1721.

In the spring of 1721, Boston was greatly alarmed by the news that there were cases of smallpox in town. The dreaded disease had apparently been brought in toward the end of April by a sailor from a ship recently arrived from the Caribbean, and although the authorities had quarantined the house in which he lay ill — the only measure then available to combat its spread — the contagion was soon out of hand.

During the next weeks and months it took on terrible dimensions. When it had finally run its course more than half of the small community’s ten thousand inhabitants had contracted the disease, more than eight hundred persons had succumbed to it. As if this were not enough, the town’s ordeal was heightened by a medical controversy which split the community wide open and shook it to its foundations. Bloodshed often appeared imminent. At one juncture it was avoided only by the misfiring of a grenade.

Smallpox, long endemic in Europe, had been introduced repeatedly to the New World from there. With its high mortality, with its often agonizing course, and with the hideous disfigurement it indicted on those who survived, it ranked as one of mankind’s most awful scourges. When Boston realized that smallpox had again appeared in its midst, the populace was terror-stricken. The older generation, in whose memory the epidemic of 1702 was still vividly alive, was especially filled with trepidation.

The medical profession was helpless. Its measures were of no avail. The disease had to take its course, with survival or death a matter of chance or divine intervention, according to one’s philosophical and religious points of view.

Early in the epidemic the Reverend Cotton Mather, long a pillar of the community, attempted to interest the town’s physicians in “the Practice of conveying and suffering the Small-pox by Inoculation,” a practice “never used … in our Nation.” Having casually heard about it some years earlier from some African slaves, his interest was fully awakened when, subsequently, he chanced upon a communication in the Philosophical Transactions of the Royal Society of London, reporting upon its apparently successful use in Turkey. Then and there he decided to advocate its introduction if smallpox should again occur in Boston. He would now lay the matter before the physicians. Accordingly, in a letter to one of the practitioners, he requested that the physicians meet for a consultation and deliberate upon his proposal.

Tactless and overbearing, Mather had not sent his letter to the one man who, for many reasons, should have been approached. This man, young Dr. William Douglass, Edinburgh-trained and the town’s only full-fledged medical graduate, was incensed. He was thoroughly convinced that the method was inherently dangerous; it consisted, after all, in inoculating pus from the blisters of a smallpox sufferer into the skin of a healthy person! (The procedure of vaccination with cowpox virus lay many years in the future.) He was also furious about Mather’s obviously intentional slight; finally he resented the fact that Mather, a clergyman, should presume to instruct the medical profession. In the early days when the colony was still in its infancy, the ministers, it was true, were often of necessity called upon to function as medical practitioners. But now, with an ample supply of qualified doctors, they should cease dabbling in medicine.

The physicians, probably upon Douglass’ advice, decided against the method. But Mather persisted in his efforts. One doctor, Zabdiel Boylston, in total opposition to his confreres, decided to accede to Mather’s proposal and on June 26 he inoculated his young son and two of his slaves. Several days later a small number of other persons underwent the treatment.

Douglass flew up in arms. He fiercely opposed Mather’s sponsoring of inoculation, based as it was only on the reports of two little-known Turkish doctors and on the testimony of some uneducated slaves. It was not only preposterous and unheard of to subject large numbers of people to so dangerous an operation without any preliminary trials, it was a vast gamble to transmit the dreaded disease to a healthy person by inoculation in the hope that its course would be less severe if acquired in this way.

There were absolutely no sound medical arguments upon which to base such expectation. Also there was the added hazard that the inoculated patient would become a source of further spread of the epidemic. Surely it would be irresponsible to permit inoculation on the say-so of a mere layman against the advice of the physicians. Mather was indignant. Hadn’t his interest in medical problems always been more than casual? Hadn’t he even at one time contemplated becoming a physician? Above all, was he not an instrument of the Lord burdened with the responsibility of watching over and protecting his flock?

The two men had much in common, and there was much that separated them. Well educated and literate, with wide and varied interests, they were both imbued with a sense of the importance of their callings. Mather, aging, deeply conservative, was well established; Douglass, young, liberal, if not radical, was a newcomer to the colony, an interloper. Mather was in the eyes of Douglass a bigoted, pompous, vain old man; Douglass was to Mather presumptuous. The bitterness with which they fought one another contributed greatly to the discomfiture of the stricken town.

The news of Boylston’s inoculations was received with such indignation that the doctor felt compelled to justify his actions in an advertisement in the Boston Gazette . The “new Practice,” Boylston averred, had come well recommended by “Gentlemen of Figure and Learning” and had been embarked on by him for the good of the public. And, “for Encouragement,” he assured the reader that if he were inoculated he need not fear having pockmarks and scars on the face or ever having smallpox again. Such worries had been “fully cleared up” by the aforementioned “Gentlemen,” Boylston noted uncritically.

On the twenty-first of July the selectmen and His Majesty’s justices of the peace called a meeting at the Town House at which Boylston was confronted by other physicians. The practitioners were overwhelmingly opposed to inoculations and in a strongly worded statement declared it to be fraught with peril for the patient and likely to prove of “most dangerous Consequence” to the welfare of the community since it tended to spread and perpetuate the infection. Boylston was ordered by the authorities to desist from further inoculations. Backed by Mather and other members of the clergy, he defied the interdiction. He inoculated still other persons, some openly, some clandestinely. That he should have dared to carry on in contempt of the magistrates seems to indicate that other influential members of the ruling clique had lent him their support. Inoculation was becoming a partisan issue, with the leaders of the Puritan oligarchy standing for Boylston and the new practice and the town’s liberal elements rallying around Douglass and the physicians in opposition to it.

The majority of the population feared and condemned inoculation. Even many of those who were in favor of it were torn by doubts and religious scruples. Was inoculation a “lawful” practice? Was smallpox not a “judgement of God,” sent to punish and humble the people for their sins? Was being inoculated not like “taking God’s Work out of His Hand”? Douglass played upon such popular scruples to the apparent discomfiture of his clerical opponents. Turning to the ministers he challenged them to determine, as a “Case of Conscience,” how placing more trust in human measures than in God was consistent with the devotion and subjection owed to the all-wise providence of the Lord. That he had not raised this issue in good faith becomes evident from a passage contained in a private letter suggesting jeeringly that his correspondent might perhaps admire how the clergy reconciled inoculation with their doctrine of predestination.

The opposing factions now carried their feud into the newspapers, in whose columns they ridiculed and abused one another. The opening blast came from Douglass. In a letter to the Boston News-Letter signed “W. Philanthropos,” he called Boylston ignorant and illiterate and accused him of rashness, negligence, and lack of consideration. Promptly Boylston’s clerical friends came to his defense. Cotton Mather, his father, Increase Mather, and four other ministers — the “Inoculation Ministers,” as they came to be known — repudiated the charges against their protégé and called upon the people of Boston to “treat one another with decency and charity, meekness and humility.” But not a word was said about Boylston’s, and their, persistence in the prohibited practice of inoculation.

At the beginning of August a new weekly newspaper, the New-England Courant , printed and published by James Franklin, Ben Franklin’s older brother, made its debut. Boston held its breath. It had never seen such a newspaper before. Lively, irreverent, and saucy, the new publication plunged headlong into the battle. An article attacking the “Inoculation Ministers,” whom it called “Six Gentlemen of Piety and Learning, profoundly ignorant of the Matter,” was quickly followed by a sarcastic “Project for reducing the Eastern Indians by Inoculation” and other pieces against inoculation and its proponents.

The Mather group fumed. In the Boston News-Letter over the signature “Your Friends and Well-Wishers to our Country and all Good-Men,” the Reverend Thomas Walter, Cotton Mather’s nephew, anonymously directed a torrent of abuse against the Courant , that “Notorious, Scandalous Paper … fullfreighted with Nonsense, Unmannerliness, Railery, Prophaneness, Immorality, Arrogancy, Calumnies, Lyes.” This was polemic in the accepted Eighteenth Century manner. But when the letter writer stooped to accuse the Boston physicians of having banded together and clandestinely formed a “Hell-Fire Club … like to that … scandalous Club … set up in London to insult the most sacred Principles of the Christian Religion,” he went beyond even then acceptable invective.

All the while the epidemic took on greater dimensions. Was this not, people asked themselves, in consequence of Boylston’s and Mather’s unholy doings? Were these men not a menace to the whole community? Should they not be stopped by force if necessary? Resentment against the two men grew apace. Boylston was molested and insulted on the streets by “the vulgar.” Even “sober, pious people” declared that he ought to be treated as a murderer if any of his inoculated patients died. Mather, too, as he noted in his diary, became an object of the populace’s fury. The people, he wrote, raved, railed, blasphemed, and behaved not only “like Ideots but also like Franticks.” Conveniently, he attributed their anger to their blinding by Satan: “The Destroyer … has taken a strange Possession of the People. …” That he himself could possibly have been in the wrong apparently never entered his mind.

Thousands of fear-stricken Bostonians fled to the country while hundreds lay suffering and dying in their homes. Commerce and business came to a standstill. The General Assembly took refuge in Cambridge, and, upon the death of one of its members, suspended its sessions until the following spring.

The epidemic continued to spread, the mortalities increasing. In August there had been 26 deaths, in September 101, in October over 400. Indignation against Boylston and Mather turned into rage. On the fourteenth of November a lighted bomb was thrown into Mather’s house, but the fuse came off and it failed to explode.

Although this assault was generally condemned, the controversy continued in what has been called the “War of Pamphlets.” Tracts from the pens of the Inoculation Ministers appeared at the booksellers. They attempted to prove that inoculation was a “lawful practice, blessed by God,” and that it was not only not dangerous, but a “happy practice,” leading infallibly to recovery. The Reverend Benjamin CoIman virtually waxed poetic in describing the “ease and sweetness” with which the inoculated patients “lay praising God in their Beds. …”

Now Douglass renewed his attack upon inoculation and its clerical sponsors by recalling the persecution of the Quakers and the hanging of the Salem “witches,” blemishes on the ministers’ escutcheons that time had not blotted out. The Mathers answered in kind.

Then, however, came news from London to warm the hearts of the inoculators. In England, too, there occurred in 1721 a severe outbreak of smallpox, and there, too, inoculation found an impetuous lay advocate. But the advocate, far from being another stern Puritan divine, was one of the most broad-minded, charming women of the age, an earl’s daughter, a poetess who quarreled in verse with Alexander Pope.

Ever since she had accompanied her husband on a diplomatic mission to Turkey, where she had become acquainted with inoculation and convinced of its merits, it had been Lady Mary Wortley Montagu’s ambition to bring “this useful invention into fashion in England.” That the country’s best medical minds had not sanctioned the practice did not deter Lady Mary. She bided her time. In the 1721 epidemic she asked Charles Maitland, the physician who four years earlier had inoculated her young son in Constantinople, to perform the operation now on her little daughter. She also enlisted the interest of the Princess of Wales, at whose request the King agreed to pardon a number of prisoners who were under sentence of death if they submitted to inoculation. Six convicts in Newgate Prison were ready to do so, and on August 9, about the time Boylston was injecting his patients, they were inoculated by Maitland. The results at first were good. The ice had been broken and during the next months further persons underwent inoculation at his hands. The culmination of Lady Mary’s crusade was the inoculation of the daughters of the Prince and Princess of Wales.

In Boston the epidemic gradually spent its force and tempers cooled. When a final evaluation of inoculation was made it appeared in a more favorable light. Of over 240 persons inoculated during the epidemic six had died, a ratio of one in forty. Among the rest of the population the mortality was about one in six. Smallpox acquired by inoculation was apparently often less severe and mortality from it less high than when acquired “in the common way.” That inoculation had its merits even Douglass acknowledged, and when several years later there was a new outbreak of smallpox in Boston he too availed himself of it. But he never gave up his contention that Mather and Boylston had acted injudiciously and irresponsibly.

With improvement in its techniques, inoculation gained increasing favor as a method for the prophylaxis of smallpox until it finally, nearly eighty years later, gave way to Jenner’s magnificent discovery of vaccination.

There can no longer be any doubt that inoculation with virus from infected persons, despite its inadequacies, was not without value in combating smallpox. Of course, it did not “prevent” the disease. In fact, it transmitted the contagion, although usually in a greatly mitigated form. Why this should have been the case remained a mystery to the Eighteenth-Century physician. In the light of modern medical knowledge we may assume that introducing the smallpox virus into the skin was one of the reasons for the milder course of the resulting infection. Under “natural” conditions smallpox virus enters the human body by way of the air passages. Changing an infecting agent’s portal of entry has been shown to modify the course of the ensuing disease. Another reason for the less severe smallpox infection may be that smaller quantities of virus were introduced by inoculation than by inhalation.

The most serious drawbacks of inoculation were its unpredictability and manifest dangerousness. All too often it resulted in severe, even fatal, infection of the inoculated person; all too often it helped spread the disease. By replacing smallpox virus with the virus of cowpox, a disease of cattle, little noxious to man, Jennerian vaccination did away with these hazards. It made smallpox prophylaxis safe and highly efficacious. Where it has become compulsory it has eradicated the dreadful disease almost completely.

Yet the old practice of inoculation died slowly. In some countries it had to be outlawed by decree before enthusiastic adherents were willing to abandon it. To its very end it remained an object of contention. Today, over two and one-quarter centuries after the turbulent days of the Boston controversy, it is nothing more than a memory.