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Defeating the “Speckled Monster”: The Fight against Smallpox from Inoculation to Vaccination

Dr. Fansher’s Rules, To be observed during Vaccination Broadside

Dr. Fansher’s Rules, To be observed during Vaccination

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This broadside outlining the rules to be followed after receiving a vaccine was probably issued in 1810 in Providence, Rhode Island, where Sylvanus Fansher was vaccinating residents against smallpox. The work done by nineteenth century physicians and amateurs like “Doctor” Fansher was crucial in the battle against smallpox, although it would be more than 150 years before the disease was eradicated worldwide.

Bostonians Pave the Way

Smallpox is an age old scourge, known in the Old World and brought to the New by European explorers and settlers. It was deadly, but tended to be cyclical—ravaging communities, then abating for several years before roaring back. So it was that in 1721, with Boston’s last major smallpox outbreak 19 years in the past, an entire generation had come of age without personal knowledge of the horrors of the disease. Readers of the 17-24 April 1721 issue of the Boston Gazette likely saw the announcement that “on Saturday last arrived here, His Majesty’s ship, Seahorse, and several other ships ... ” Little could they imagine that stowing away aboard the Seahorse was smallpox, which would ultimately infect almost 5800 Bostonians and take the lives of 844 that year.

Not all were unprepared for the reappearance of the disease in Boston. Cotton Mather (1663-1728), the (in)famous Boston minister and an enthusiastic citizen scientist, had been reading, too, and when the epidemic began to gain a foothold in 1721, he was ready to champion a new plan of action. In 1716, Mather had been taken by an account of a successful inoculation of smallpox in the Royal Society’s Philosophical Transactions. This, combined with the testimony of his enslaved person Onesimus, who told Mather of his own inoculation in West Africa, spurred Mather to publicly call for a program of smallpox inoculation in Boston—a suggestion that received positive attention from exactly one Boston doctor—Zabdiel Boylston (1679-1766).

Boylston, like Mather, had been afflicted by smallpox during an earlier epidemic and agreed to experiment with inoculation of live smallpox—starting with his 6 year old son, his 36 year old enslaved person Jack, and Jack’s son. Nine days later, with none of the three developing full-blown smallpox, Boylston vowed to continue with other patients. Soon, however, he was ordered to appear before town authorities who reprimanded Boylston and “with high menaces warned him against proceeding with his Practice any farther.” Mather, too, received much harsh public criticism, culminating in a bomb being thrown through the window of his house.

Resistance to the efforts of Boylston and Mather was swift and fierce. A trained physician named William Douglass led the charge among Boston’s physicians, while the public was influenced by James Franklin, the firebrand publisher of the New England Courant. In her article on the smallpox epidemic in Boston, Amalie Kass set the scene, which sounds like it could have been ripped from today’s headlines: “Unfounded rumors, ad hominem attacks, and public disrespect for traditional leaders of the community made the controversy extremely distasteful.” Despite the controversy, during the 1721 outbreak, approximately 287 people were inoculated, only six of whom died, contrasted with a 14 percent mortality rate among the general population. With each succeeding outbreak, more people chose to be inoculated and physicians continued to refine the process. The next major breakthrough arrived at the end of the eighteenth century.

Inoculation or Vaccination?

Although the two terms are used interchangeably today, at the dawn of the nineteenth-century, they had different meanings. Inoculation or variolation (such as that used by Zabdiel Boylston) meant transferring active smallpox virus from an infected person to a healthy person. Vaccination (from the Latin vacca, or cow) referred to the process of transferring cowpox virus, a much milder but related virus, to cause immunity to the more deadly smallpox. The process of vaccination was the brainchild of Dr. Edward Jenner (1749-1823) of Berkeley, Gloucestershire, England. Jenner, who had been inoculated with smallpox at age 8, had a lifelong interest in science and nature and was apprenticed to a local physician, surgeon Daniel Ludlow, at age 14. Following this apprenticeship, he moved to London where he apprenticed in surgery and anatomy under famed British physician John Hunter. He returned to Gloucestershire by 1773 and became a successful family physician. As he worked among the rural community, he likely heard the lore that dairymaids were immune to smallpox because of their exposure to the related cowpox virus common in their bovine companions. Intrigued by the possibilities, by 1796, he was ready to experiment with this hypothesis, injecting an 8 year old boy with matter from a dairymaid’s fresh cowpox lesion. The boy recovered and Jenner then inoculated him with smallpox, which failed to develop. Jenner continued his experiments with other patients and in 1798, published his An Inquiry Into the Causes and Effects of the Variolae Vaccinae, which was to prove influential to a daring physician in Cambridge, Mass.

A New Century, a New Method

As the smallpox virus had arrived in Boston by sea, so too did its remedy. Dr. Benjamin Waterhouse of Harvard University had received a copy of Edward Jenner’s 1798 An Inquiry Into the Causes and Effects of the Variolae Vaccinae and having read other contemporary pro-vaccination tracts, he resolved to experiment as soon as a way of transporting cowpox virus to Massachusetts could be arranged (the cow-borne disease being unknown in New England). Although the cowpox virus was virulent, it was also susceptible to damage through handling. Waterhouse’s English compatriots decided that the best method of getting the virus to Boston in a viable state was to soak threads in the virus, tightly seal the threads in a glass vial, and get them on the next ship from Bristol to Boston.

On 4 July 1800, the ship Foxcroft from Bristol arrived in Boston Harbor, believed to be the ship that brought Dr. Waterhouse his vial of cowpox-infused threads. Like Zabdiel Boylston before him, Waterhouse started by vaccinating a member of his own family—his son Daniel Oliver Waterhouse, 5 years old. The disease progressed exactly as Jenner had predicted and within days, Waterhouse inoculated his younger son and namesake, as well as his infant daughter, her nursery maid, and other servants. All took to the vaccination well. Waterhouse, though, needed assurance that the cowpox had stimulated immunity to actual smallpox and so sent his son Daniel to the smallpox hospital in Brookline to be exposed to smallpox both through inoculation and close contact with ill patients. Twelve days later, Daniel was released from the hospital free of the dreaded disease. Dr. Aspinwall, who operated the smallpox hospital, exclaimed, “This is no deception. I rejoice at the discovery as a friend of humanity although it must deprive me of a very handsome annual income.”

Soon Waterhouse was being assailed from all over the area to provide cowpox samples for vaccination—by physicians and quacks alike. Mistakes in using degraded cowpox matter (or actual smallpox instead of cowpox) resulted in outbreaks such as that in Marblehead, Massachusetts, in the fall of 1800, threatening the progress of vaccine acceptance. In that case, residents vaccinated by Waterhouse remained healthy, while those vaccinated by other practitioners fell ill. Correspondence and viral samples traversed the Atlantic between Doctors Waterhouse and Jenner as the success of the vaccine became more and more evident (despite the often antagonistic attitude of Waterhouse’s Massachusetts medical colleagues, reminiscent of the establishment’s treatment of Mather and Boylston decades earlier).

Who was Sylvanus Fansher Anyway?

One of the New England practitioners spurred to action by Waterhouse’s success with vaccination was “Doctor” Sylvanus Fansher [or Fancher] (1770-1846), a native of Plymouth, Connecticut, whose circa 1810 broadside is featured above. Fansher was not a degreed physician, but an 1828 letter from Waterhouse to “a friend in the city,” attested to Fansher’s experience in vaccination, asserting that he had “vaccinated a greater number, by far, than any man in America, if in the world.” He continued that he esteemed Fansher for “the surest method of preserving the virus or matter, in its purest and most efficacious state … together with a spirit of disinterestedness, inducing him to vaccinate whole towns, for what, most frequently, could not be called a reward.”

Indeed, one can find Dr. Fansher’s advertisements for vaccination services in New England newspapers from Northampton, Mass., to Newport, R.I., throughout the eighteen-teens and later, often citing Fansher’s connection to Waterhouse. And as Waterhouse noted, Fansher was not always rewarded for his labors. An example of his challenges in receiving payment for his services is engagingly documented in the diary of Salem, Mass., clergyman William Bentley in the spring and summer of 1815. In 1816, Fansher was contracted by the town of Plymouth, Mass., to vaccinate some 2800 residents. Despite the many lives Fansher no doubt saved, he died in poverty at Hartford, Conn., on 6 June 1846. Dr. William Woodruff somewhat dismissively recalled his career for The Town and City of Waterbury, Connecticut, from the Aboriginal Period to the Year Eighteen Hundred and Ninety-Five.

[Fansher] was descended from one of those improvident families … which after a generation or two are swept away by the beneficent law that involves the “survival of the fittest.” … Singular as it may appear under the circumstances, the idea of vaccination was embraced by Dr. Fancher soon after its introduction … as a pioneer and specialist [he] soon became widely known … and the Royal Jennerean Society of London made him an honorary member. His remuneration was for that day ample, and might have insured to him an independence, had it not been frittered away in useless and foolish inventions. … His appearance, as I remember him, was singular in the extreme. Velvet small clothes, a parti-colored waistcoat from which dangled a half dozen watch-chains and trinkets for the amusement of the little folks, a faded blue cloak—all these surmounted by a slouched hat overhanging green goggles—made up the figure. No wonder he produced a sensation among the juvenile subjects of his craft when they were brought into his presence …


For further reading

Barber, John Warner. Connecticut Historical Collections: containing a general collection of interesting facts, traditions, biographical sketches, anecdotes, etc., relating to the history and antiquities of every town in Connecticut, with geographical descriptions New Haven: Durrie & Peck, 1849.

Bentley, William. The Diary of William Bentley: Pastor of the East Church, Salem, Massachusetts, vol. 4 Salem: Essex Institute, 1914.

Coss, Stephen. The Fever of 1721: The Epidemic That Revolutionized Medicine and American Politics New York: Simon & Schuster, 2016.

Fitz, Reginald Heber, “Something Curious in the Medical Line,” Bulletin of the History of Medicine, vol. 11, no. 3 (March 1942), p. 239-264.

Housman, Dr. Talya. “Pockey Companions”: Getting Inoculated in the 18th Century | Beehive (masshist.org)

----. Race and Infectious Disease in the 18th Century | Beehive (masshist.org)

----. Variolation vs. Vaccination: 18th Century Developments in Smallpox Inoculation | Beehive (masshist.org)

Kass, Amalie M. “Boston’s Historic Smallpox Epidemic,” Massachusetts Historical Review, vol. 14 (2012), p. 1-52.

Lawson, Brenda M. “Manuscripts on the History of Medicine at the Massachusetts Historical Society,” Proceedings of the Massachusetts Historical Society, vol. 103 (1991), p. 157-190.

A brief list of the Society’s sources, manuscript and printed, on smallpox inoculation can be found on p. 159-162.

Reidel, Stefan. “Edward Jenner and the History of Smallpox and Vaccination,” Baylor University Medical Center Proceedings, vol. 18, no. 1 (January 2005), p. 21-25.

Snow, Edwin M. “Early History of Vaccination in Providence,” Transactions of the Rhode Island Medical Society, vol. 3 (1883-1888), p. 53-63.

The Town and City of Waterbury, Connecticut, from the Aboriginal Period to the Year Eighteen Hundred and NInety-Five, vol. 3, ed. Joseph Anderson New Haven: Price & Lee, 1896.

Winslow, Ola Elizabeth. A Destroying Angel: the Conquest of Smallpox in Colonial Boston Boston: Houghton MIfflin, 1974.