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Home » Uncategorized » Early modern “anti-vaxxers” and public health debates: reflections on the 1721 Boston smallpox epidemic, RBE 36 – TD Jacobs

Early modern “anti-vaxxers” and public health debates: reflections on the 1721 Boston smallpox epidemic, RBE 36 – TD Jacobs

The outbreak of the COVID-19 pandemic has inspired numerous conspiracy theories, which have appeared in various forms on different social media platforms. From pathetically anti-Semitic memes on Facebook, to the equally predictable and utterly unsubstantiated claims in Reddit forums that the virus was lab grown, to sadly amusing Twitter threads about Bill Gates’s burning desire to track our trips to the Piggly Wiggly via injectable microchips.  However, one conspiracy theory found instant success: the YouTube video, “Plandemic,” which claims ‘Big Pharma’ is in cahoots with doctors to keep people sick. In part, the popularity of the fake documentary derived from how it plays off the views held by established conspiracy groups concerning the safety and effectiveness of vaccines. The danger to public health represented by the misinformation campaign caused Facebook and Twitter to remove the video from their respective platforms in May, but not before it had been viewed an estimated 1.8 million times. And fears are growing among scientists and public health experts that anti-vaxxers will prolong the pandemic. Indeed, governments such as Germany’s are already having to make assurances that any future vaccine to combat COVID-19 will only be administered voluntarily.

While the impact of the anti-vaxxer movement on the current pandemic remains to be seen, it has had a demonstrable effect on public health with regard to other illnesses. Studies have linked anti-vaxxers to a rise in outbreaks of other preventable, infectious diseases. Remarkably, impetus for the movement can largely be traced back to a single scam artist: Andrew Wakefield. In 1998, he published a study claiming a causal relationship between the MMR (measles, mumps and rubella) vaccine and autism. Wakefield’s paper was retracted by The Lancet after his results were unable to be substantiated. Moreover, it was revealed that he had mistreated patients and that he stood to gain financially from his fraudulent research. As a result, Wakefield was barred from practicing medicine in the United Kingdom. And even though studies have since disproven any causal link between the MMR vaccine and autism – including a notable Danish study of over half a million children – Wakefield’s claims continue to find adherents. Measles, which had been declared eradicated in the United States in 2000, began to reappear as parents refused to vaccinate their children.  In 2019, the Centers for Disease Control reported that there had been over 1,200 measles cases across 31 states, leading to at least sixty cases that resulted in serious complications.

And while they banned ‘Plandemic’, social media platforms have done little to combat anti-vaccination groups in general. For example, anti-vaxxers have been permitted to run rampant on Facebook, harassing vaccine advocates and even threatening them with death – actions the platform recognizes as violations of its community guidelines, but says it can do nothing about. Moreover, a recent study tracking discussions on vaccines on Facebook found that anti-vaxxer views are growing unchecked, and will dominate the platform within a decade. Results from the investigation found that anti-vaxxers discuss their views more frequently, and actively target groups and individuals, so despite being smaller in number than those that support vaccines, they are more effective in spreading their beliefs. But was this the case with a similar controversy in the eighteenth-century?

2577020R.nlm.nih.gov

In 1721, Boston was rocked by an outbreak of smallpox, and the debate over how best to stop the spread of the disease played out in the press. At the time, severe epidemics were simply a part of life. During a measles epidemic in 1713-15 that swept the North American coast line, a Boston minister, Cotton Mather chronicled the outbreak in his diary. It reached the city in mid-October, and five individuals in his own household began showing symptoms on the same day, November 4. His wife died just five days later, then his maidservant, and three of his children. On November 23, Mather wrote: “My poor family is now left without any infant in it, or any under seven years of age.” In his own house, measles had killed 5 of the 11 people infected, a fatality rate of 45%. While the lack of uniform colonial records regarding populations at the time makes it difficult to say how many people died in total during the outbreak, a recent study using data from New France estimated a fatality rate of between 20 and 30% among infants and young children – those considered most susceptible to the disease. And indeed, Mather’s own observations regarding what part of his household was most affected by the measles would appear to confirm those findings.

It seems only natural that anyone who had experienced at first hand the deadly toll  extracted by infectious diseases would seize upon any and all means to combat them. Nevertheless, when smallpox arrived in Boston in April of 1721, community leaders were strongly divided over whether to adopt inoculation. Looking back from our current climate, with all the reports of conservative Christian pastors unwittingly spreading COVID among their flocks, it may be tempting to ascribe their eighteenth-century predecessors’ reluctance to some kind of religious superstition. However, that is not at all an accurate reflection of the divisions at the time. For one thing, clergymen were among the most outspoken participants on both sides of the debate, and one group of Puritan ministers formed the core of the pro-inoculation party. Their intense involvement is understandable considering that there were few actual physicians in the English colonies, and ministers regularly dispensed medical advice and served on the frontlines in any epidemic. Moreover, professional doctors were also divided on the issue. Indeed, William Douglass, who actually held a medical degree, was the loudest opponent of inoculation. His position may strike us incongruous now, but two factors must be taken into consideration: first, inoculation was a relatively unknown practice in Europe and in the American colonies. Second, inoculation – unlike vaccination – could result in death from the very disease it was meant to combat.

Modern vaccination typically uses a dead or inactivated form of a microbe, and cannot cause the disease in question. Rather, it primes the immune system to recognize the live microbe if and when it appears. But vaccines as we now understand them did not begin to develop until the end of the eighteenth century through the innovations of Edward Jenner. Inoculation, on the other hand, involves taking live, infected material from a patient and introducing it by various means into a healthy person. In this way, a milder, survivable form of the disease would be induced. Sometimes, however, the inoculated subject developed severe symptoms and died. Moreover, the inoculated subject was contagious and could spread the illness unless placed in strict quarantine. The practice had been employed in China since the fifteenth century but it was not promoted in Western Europe until the early eighteenth century via the work of Emmanuel Timonius, Mary Wortley Montague, and a somewhat more unlikely figure: the aforementioned Cotton Mather, now better known for his involvement in the Salem Witch Trials.

By the time of the smallpox epidemic, Mather had learned of inoculation from one of his own slaves and by questioning others, and he had read Timonius’s accounts in the Philosophical Transactions. Convinced that inoculation was effective, he laid plans to implement the practice in case of an outbreak. When the disease appeared in 1721, he immediately began to marshal his forces and lobby the Boston medical community. However, inoculation was met with fierce resistance – primarily in the form of James Franklin’s New-England Courant.

In fact, it has been argued that the Courant‘s entire raison d’être was to capitalize on the inoculation controversy. It is certainly no coincidence that the paper was founded in August of 1721, months after the outbreak of both the disease and the debate, and its first issue focused on smallpox. But those involved in the venture had varying reasons for taking part. As David Copeland has argued, the printer and his backers were not just motived by concerns over public health. Rather, the paper – and the debate on inoculation – was used to try and discredit the Puritan community to the advantage of Massachusetts’s Anglican contingent, which wanted to see the Church of England established as the colony’s official state church. And Douglass, as James Schmotter has pointed out, had a further motivation: establishing medicine as an actual profession in the colonies. This entailed challenging theories and practices that originated outside of the medical community.  

The anti-inoculation pieces in the Courant made use of a wide variety of arguments and discursive strategies, some of which probably sound familiar to us now. For example, references were made to a conspiracy to take down the local government and strengthen the authority of the English crown in the colony. Then too there were the exhortations that inoculation thwarted the will of god. The medical arguments were numerous, and essentially summed up by Douglass’s editorial in the first edition of the Courant titled “At the request of several gentlemen in town: a continuation of the history of inoculation in Boston.The doctor, identified as “a Society of the Practitioners in Physick,” wrote that inoculation was:

“entirely new, not in the least vouched or recommended (being merely published, in the philosophick transactions by way of amusement) from Britain, tho’ it came to us via London from the Turk, and by a strong viva voce evidence, was proved to be of fatal & dangerous consequence.”

Douglass went on to deride Mather and his associates as “six gentlemen of piety and learning, profoundly ignorant of the matter” who were making the case for inoculation on the basis of naught but their character for they certainly had no credentials. Lastly, he reported on one case in which a person who had been inoculated nearly died.

When it came to swaying the Boston public to his point of view, Douglass employed a shotgun approach. He made active use of xenophobia and racism by summoning the boogeyman of “the Turk.” He argued from authority and went after the credentials of those promoting inoculation. He misrepresented Timonius’s publications concerning inoculation. He tried arguing from anecdote rather than data. In fact, Douglass’s only scientifically sound arguments – that inoculation indisputably caused illness, and could possibly help spread it – were rapidly passed over with the briefest of references to “strong” yet unspecified evidence obtained by word of mouth.

For their part, the pro-inoculation camp tended to focus on direct observations and the data, such as it was. By the time the Courant was established, Mather had convinced a locally trained physician, Zabdiel Boylston, to begin inoculation. Boylston initially inoculated ten people over several weeks and his results were reported in another local paper, the Boston Gazette, that July. According to John Blake, during the course of the city’s epidemic, Boylston and other physicians inoculated a total of 287 persons (not all voluntarily) six of whom died – 2.1%. Meanwhile, 5,889 people had caught the disease naturally from a total population of 10,567, 842 of whom died – 14.6%. These fatalities made up more than three quarters of the total deaths in Boston that year. I have found no information concerning the relative rates of smallpox’s long-term effects (severe scarring and blindness) among the survivors in either population, but inoculation was undoubtedly better when it came to survivability.

To return to the question asked at the start of this essay, it is difficult to say what effect the arguments of either camp had upon the attitudes and actions of Bostonians in general. As is typical for early modern publications, we have little insight into audience reception. However, the vitriolic coverage in the Courant led – at least according to Franklin – to his being accosted in the street. And whoever threw a bomb into Mather’s house in November of 1721, attached a note referencing the inoculation controversy. Mather had no doubt who was to blame for his troubles, writing in December that:

“Warnings are to be given unto the wicked printer, and his accomplices, who every week publish a vile paper to less and blacken the ministers of the town & render their ministry ineffectual. A wickedness never parallel’d anywhere upon the face of the earth.”

On the other side of the debate, it is harder to tell what impact pro-inoculation reports in the Gazette had. Boylston later published an account of his activities and patients, and while it isn’t immediately clear how he and his colleagues found the vast majority of their test subjects, one passage indicates that it was largely via personal testimonies, as opposed to the presentation of carefully framed scientific arguments in the press:    

“These gentlemen came from Roxbury into Boston to be inoculated […] and their recommendation of this practice, at their return prov’d to be of great service to that town, in carrying the inhabitants soon thro’ that distemper, and in saving many lives”

At the same time, however, Boylston indicated that the “idle, unjust, and ridiculous stories and misrepresentations” published by anti-inoculators had been effective in influencing people against the practice.

Naturally, the public discourses surrounding the smallpox outbreak of 1721 and the COVID-19 pandemic of 2020 are not entirely comparable. Apart from the differences in scale and the kind of media in which debates have taken place, there are massive societal changes that need to be taken into account. Not least of which is that the residents of the industrialised West generally have less direct experience of virulent, infectious diseases. As has been pointed out elsewhere, modern medicine has become the victim of its own success. The necessity of vaccination becomes less apparent when the communicable illnesses that drove the science to produce solutions are no longer as familiar. Smallpox was officially eradicated in 1977, and the last outbreak of polio in the United States occurred in 1979. Then too, COVID-19 – often conflated with the seasonal flu – does not inspire the same visceral response in comparison to smallpox, or two diseases still extant: measles and the bubonic plague. All of which graphically advertise their presence upon their victims’ bodies. The odd case of “COVID toes,” on the other foot, are easily hidden from sight. These basic differences may help to explain why people question the existence of COVID-19, while the historical record doesn’t seem to contain references to Bostonians denying that there was a smallpox epidemic.

Nevertheless, there do seem to be some common features: conspiracy theories; effective, multi-faceted discursive strategies used by ‘science deniers;’ and ineffectual scientific communication. To this must be added the issue of impartiality in the framing of the debate by the platform on which it was held. James Franklin asserted that his paper was neutral. For example, in the eighteenth issue, he wrote:

“The Courant was never design’d for a party paper. I have once and again given out, that both inoculators and anti-inoculators are welcome to speak their minds in it.”

However, upon closer examination this appears to be the wordier, eighteenth-century equivalent of Fox News’s ‘fair and balanced’ slogan. Yes, the pro-inoculation party was given some space in the paper, but from my own observations it was nowhere near the amount provided anti-inoculators. Moreover, the pro-inoculator viewpoints were rarely presented in their entirety. Rather, they often took the form of snippet references to articles published in other papers and advertisements for pamphlets like this one:

“Just publish’d the Second Edition of Several arguments, proving that inoculation of the small pox is not contained in the Law of Physick, either Natural or Divine, and therefore unlawful. Together with a reply to two short pieces, one by the Rev. Dr. Increase Mather, and another by an anonymous author, intituled, Sentiments on the small pox inoculated. And also, A short answer to a late letter in the New- England Courant. By John Williams”

What the advertisement fails to mention is that Franklin was both printer and seller of this booklet – and several others. He had a clear financial stake in the continuation of the controversy, not its resolution. Just like Facebook, the money the platform has made on ads that specifically target anti-vaxxers possibly explains why the company is unable to do anything about them.

Closer examination of such debates in the past, their framing, their outcomes, and what discursive strategies worked, could aid us in finding a way to combat modern misinformation campaigns. At least one aspect of the 1721 case seems to reflect the findings of the aforementioned study regarding the on-line competition between anti-vaxxer and pro-vaccination narratives, namely the effectiveness of multiple narratives vs. a largely monothematic, data driven argument that can seem too theoretical. Researchers are currently discussing ways scientists and doctors can improve this aspect of their communication to combat anti-vax misinformation over the long haul, such as taking the time to address the concerns of individual patients. But the height of a global pandemic possibly requires an approach that is both more concrete and more diffuse – such as the dissemination of testimonials by those directly impacted by both disease and treatment across the same social media networks anti-vaxxers make active use of. Such a personal, anecdotal form of science communication seems counter-intuitive, but the above – admittedly preliminary investigation – suggests that it was somewhat effective in the inoculation fight during the midst of the 1721 smallpox epidemic.

References:

New-England Courant, nos. 1 and 18, 7.8.1721 and 27.11.1721. 

CDC, “Measles Cases and Outbreaks,” consulted 1.7.2020. https://www.cdc.gov.

Travis M. Andrews, “Facebook and other companies are removing viral ‘Plandemic’ conspiracy video,” The Washington Post, 8.5.2020. https://www.washingtonpost.com.

Philip Ball, “Anti-vaccine movement could undermine efforts to end coronavirus pandemic, researchers warn,” Nature, 13.5.2020. https://www.nature.com.

John. B. Blake, “The inoculation controversy in Boston: 1721-1722,” The New England Quarterly 25, no. 4 (1952): 489-506.

John B. Blake, Public health in the town of Boston, 1630-1822 (Cambridge: Harvard University Press, 1858).

Zabdiel Boylston, An historical account of the small-pox inoculated in New-England (London: Printed for S. Chandler, 1726).

Shawn Buhr, “To inoculate or note to inoculate?: The debate and the smallpox epidemic of Boston in 1721,” Constructing the Past 1, no. 1 (2000). ttps://digitalcommons.iwu.edu.

Elizabeth Cohen, “Facebook vowed to investigate horrific abuse by anti-vaxxers. Nine months later, no one was penalized,” CNN, 21.6.2020. https://edition.cnn.com.

David A. Copeland, Debating the issues in colonial newspapers: primary documents on events of the period (Westport: Greenwood Press, 2000).

David A. Copeland, The media’s role in defining the nation: the active voice (New York: Peter Lang, 2010).

Stephen Coss, The fever of 1721: the epidemic that revolutionized medicine and American politics (New York: Simon and Schuster, 2016).

Joan Donovan, “Vaccines stop diseases safely – why all the suspicion?” Nature, 22.7.2020. https://www.nature.com.

Neil F. Johnson, et al., “The online competition between pro- and anti-vaccination views,” Nature, 13.5.2020. https://www.nature.com.

Ryan Mazan, et al., “The measles epidemic of 1714-1715 in New-France,” PSC Discussion Papers Series 21, no. 4 (2007). https://ir.lib.uwo.ca/pscpapers/vol21/iss4/1.

Kreesten Meldgaard Madsen, et al., “A population-based study of measles, mumps, and rubella vaccination and autism,” New England Journal of Medicine 347, no. 19 (2002): 1477-482.

David M. Morens, “The past is never dead – measles epidemic, Boston, Massachusetts, 1713,” Emerging Infectious Diseases 21, no. 7 (2015): 1257-260.

Loveday Morris and William Glucroft, “Prospect of a coronavirus vaccine unites anti-vaxxers, conspiracy theorists and hippie moms in Germany.” The Washington Post, 3.7.2020. https://www.washingtonpost.com.

James W. Schmotter, “William Douglass and the beginnings of medical professionalism: a reinterpretation of the 1721 Boston inoculation controversy,” Historical Journal of Western Massachusetts 6, no. 1 (1977).

Julia Carrie Wong, “Revealed: Facebook enables ads to target users interested in ‘vaccine controversies,” The Guardian, 15.2.2019. https://www.theguardian.com.


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