The Jab: A True Story of Inoculation and Vaccine

• by
• Bart Casey

This year marks the 300th anniversary of the jab in Western civilization, a genuine turning point in humanity’s long-suffering war with infectious disease.
 
The story begins with smallpox, which by 1721 had been inflicting untold millions with disfiguration and death for thousands of years. In fact, the disease seemed unstoppable. More than 1,000 years before Christ, the pestilence was well known in ancient Egypt, China, and India. In the sixth century, historians credited it with destroying invading Ethiopian armies attacking Mecca in Arabia. Returning Crusaders introduced it into Europe around the year AD 1100. In 1562, the young Queen Elizabeth I of England survived a nasty case, emerg­ing with pock­marked skin. The same pattern of infection continued into the seventeenth and eighteenth centuries: typically the disease would arrive, terrify the population, and then subside, only to return again five or ten years later.
 
Smallpox entered its victims gently, with headaches, fevers, and chills. A few days later, a rash would appear, later changing into pimples and bumps. Several more days along, the skin would become covered with bulging pustules. There would be hemor­rhages at the nose, mouth and other orifices, followed by fits, convulsions, and delirium. The skin might turn black and swell so that the eyes could not see, nor the throat swallow. Then, two weeks later, the skin would blister and strip off to the raw layers underneath. The final stages varied. Some would recover to live on with disfigurement or blindness, but many others would die.
 
During the international outbreak in 1721, familiar responses played out yet again. Politicians tried to suppress knowledge of the new threat, hoping it might simply go away. Physicians resisted any newfangled treatments like inoculation. Clergymen proclaimed the disease should be accepted as God’s punishment for sin. And shrill voices in the media traded insults, stirring up riotous mobs to the point of murder. Looking back at it all in his 1796 History of Inoculation, Dr. William Woodville wrote “to the dishonour of the medical profession, it [inoculation] was for several ages under the management of old women, and ignorant persons, before it was patronized and adopted by the legitimate practitioners of medicine.”
 
Actually, not all of those persons were old or ignorant. Lady Mary Wortley Montagu, the woman who elbowed inoculation for smallpox into England and Europe in the spring of 1721, was 31 years old and absolutely brilliant.
 
It might have been easier for Lady Mary to be in her prime in 2021 instead of 1721, because she was an independent-minded woman who ignored any pressures to conform. Such behavior was not often appreciated in the male-dominated society of England and Europe at the time, but she was exceptional, confident, and would not be stopped.
 
The first signs of her independent spirit appeared early, after her mother and grandmother perished before she was nine. Her father, the Duke of Kingston, saw no need to continue her schooling and consigned her to her governess and the nursery with her younger siblings. Later, Lady Mary wrote that part of her education was “the worst—only superstitions and vile stories.” So she would slip away from 10 a.m. to 2 p.m. each day, and sometimes from 4 p.m. to 8 p.m. as well, to the library of her Nottinghamshire country home. With dictionary in hand, she taught herself Latin well enough to hold her own in classics conversations with the university-educated men in her circle and even impress her neighboring bishop with her translations of ancient texts. She also read widely in modern literature (as her surviving notebooks attest) and wrote clever poems and stories while awaiting her coming-of-age debut in London when she would join its lively dinners, balls, and salons.
 
When that transition happened, and her father noticed how Lady Mary enlivened every room, he was proud of her wit and learning. But he soon turned furious when she rejected the arranged marriage he had negotiated for her with the notably named Clotworthy Skeffington, heir to a wealthy Irish lord. By law, that match would ensure their firstborn son would inherit both the title and estate, continuing the aristocratic line and privileges so valued by Mary’s father.
 
But at age twenty-four, Mary wasn’t about to reduce herself into dull marital subjugation just to guarantee a tidy succession somewhere down the line. For a husband, if necessary, she preferred Edward Wortley Montagu, a thirty-four-year-old brother of her late childhood friend Anne Wortley. Some years before, Mary and Edward had an on-again off-again friendship and correspondence, with some talk of marriage. Edward shared her love of classics and also had excellent financial prospects. Born into a wealthy coal mine owning family, Edward was first in line to inherit a very substantial estate. He studied at the Westminster School and Cambridge, and had begun a promising career in the law. At age 27, he won election to Parliament for the Borough of Huntingdon, a seat controlled by his cousin, Lord Sandwich, and he became a rising star among the younger members. He even had a long-shot chance at inheriting his cousin’s title, but only if Lord Sandwich died without sons.
 
But to guarantee that his estate would pass to his eldest son, Edward would have to “entail” his estate (Downton Abbey style) in a legally binding marriage contract by fixing this yet-to-be conceived son as his heir—something he was reluctant to do, thus Mary’s father had turned him down. But now, when Mary needed to escape the Honorable Mr. Skeffington or be lost to him, the possibility for marriage had to be considered and dealt with by both Edward and Mary.
 
Mary made it clear to Edward she wasn’t sure of love. She wrote, “I can esteem, I can be a friend, but I don’t know whether I can love.” But “if you can like me on my own terms,” she was ready to end the uncertainty of her arrangements and marry Edward, as long as he knew they would have to elope, and there would be no dowry money coming with her from her father. “I shall come to you with only a night-gown and petticoat, and that is all you will get with me.” Edward wasn’t sure of love either, but it did seem right for him to have a wife and heirs, and Mary had always seemed intriguing to him. And so they went.
 
Things started well. Within a year, they had a son, Edward Junior, and were starting to reconcile with Mary’s father. Then, in 1714, the government threw out the popish Stuart Pretenders and ushered in the good Protestant King George I from Hanover, creating many new opportunities in the shuffle, especially for Edward’s Whig party, which had supported the new king. Edward won a new seat in Parliament, representing the City of Westminster. His relation, Charles Montagu, was created Baron Halifax and named First Lord of the Treasury in the new regime. He offered Edward a place as a Junior Treasury Commissioner, which Mary supported as a good steppingstone in his career. Thanks to Lady Mary’s winning personality, the couple was becoming very popular at court. Mary began a famous correspondence and friendship with the leading literary light, Alexander Pope, collaborating with him on amusing court poetry, jibes, and satires.
 
Lady Mary had already fought her first engagement with smallpox when the disease claimed her only brother in 1713. Now, two years later, Mary herself was infected and treated by London’s best physicians, Dr. Samuel Garth and Sir Hans Sloane. Even so, she barely escaped death and emerged with pockmarks on her face and the loss of her eyebrows. She soon regained her health and confidence just in time for what would become the great adventure of her life as Edward was appointed British Ambassador to the Court of the Sultan at Constantinople, usually a five-year posting. Then Turkey was imagined as an incredibly distant and exotic destination. Although the journey would be daunting, Mary had no doubt that she and baby Edward would be going along for the ride.
 
Preparing for the mission, Lady Mary took charge of all the non-diplomatic logistics. She recruited staff, including servants, nurses, chaplains, and doctors—all with the pioneer spirit. She selected and ordered all the clothing, liveries, books, medicines, and supplies that would later fill twenty wagons as they made what became a nine-month overland journey across Europe and the Balkans, meeting royalty and officials for briefings in key cities along the way. This was no humble caravan. For the last six weeks they were escorted by a guard of five hundred scimitar-swinging Janissary horsemen sent from Constantinople by the Sultan to protect them on the last leg of their journey through the recent battle zone between the forces of the Austrian and Ottoman empires. Indeed Edward’s first challenge for his diplomatic mission was to help mediate a treaty between those two and stabilize peace in the region. Lady Mary’s published record of her experiences entitled Turkish Embassy Letters is one of the true classics of travel literature. One hundred years later, Lord Byron studied it closely as a guidebook for his own Grand Tour to Turkey while composing Childe Harold’s Pilgrimage, the work that would make him famous. He told his publisher, John Murray, “I admire her so much, her beauty, her talent . . . She was an extraordinary woman.”
 
Mary made it her business to discover the true nature of Turkish culture by learning the language, engaging in friendships with its leading ladies, and creating her own unique new circle. And those are the activities she illuminated for her curious correspondents back in London, writing to Pope about the literature, to European churchmen about the Islamic religion, and to her lady friends about the unknown female worlds of Turkish love, matrimony, fashion, and domesticity—which had always been off-limits, on pain of death, to any male European travel writers who had been through Turkey before. She intended to get at the real Turkish culture, so “that the world should see to how much better purpose the LADIES travel than their LORDS.”
 
In early March 1717, Edward and Mary’s British delegation arrived in Adrianople (modern Edirne), where the personal household of the Sultan was in residence. Early one day, Mary “hired a Turkish coach,” alone and incognito, and drove to the “bagnio” or ladies’ bathhouse, to discover whatever goings-on were happening there. She sent her full report home in a letter dated April 1 to her friend Lady Rich, who was then a lady attending the Princess of Wales (later George II’s Queen Caroline) back in England. “I am now got into a new world, where everything I see appears to me a change of scene,” and that was certainly the case as she described her walk through the multi-domed and chambered bathing palace:

I was in my traveling habit, which is a riding dress, and certainly appeared very extraordinary to them. Yet there was not one of them that showed the least surprise or impertinent curiosity, but received me with all obliging civility possible. I know no European court where the ladies would have behaved themselves in so polite a manner to a stranger. I believe, in the whole, there were two hundred women, yet none of those disdainful smiles or satirical whispers that never fail in our assemblies when anybody appears that is not dressed exactly in fashion. They repeated over and over to me: “Guzelle, pek guzelle,” which is nothing but “charming, very charming.” The first sofas were covered with cushions and rich carpets, on which sat the ladies, and on the second their slaves behind them, but without any distinction of rank by their dress, all being in a state of nature, that is, in plain English, stark naked, without any beauty or defect concealed . . . some in conversation, some working, others drinking coffee or sherbet, and many lying negligently on their cushions while their slaves (generally pretty girls of seventeen or eighteen) were employed in braiding their hair on several pretty manners. In short, ’tis the women’s coffee house, where all the news of the town is told, scandal invented, etc.

Lady Mary settled into this new society. She wrote her friends back in London about the freedom felt by Turkish women when they donned their veiled costumes. Those outfits allowed them to wander about the cities in total safety, unidentifiable and incognito, even to members of their own family who might meet them. One wise Turkish pasha gentleman explained to her: “we have the advantage that when our wives cheat us nobody knows it.”
 
And discovering how to deal with smallpox would be part of Lady Mary’s revelations. She sent a more astounding letter about the same time to her childhood friend Sarah Chiswell. The topic was smallpox (which tragically would kill correspondent Sarah in ten years’ time):

The smallpox, so fatal and so general amongst us, is here entirely harmless by the invention of engrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation. Every autumn in the month of September when the great heat is abated, people send one another to know if any of the family has a mind to have the smallpox. They make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what veins you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much venom as can lie upon the head of her needle, and after binds up the little wound with a hollow bit of shell . . . The children or young patients play together all the rest of the day, and are in perfect health until the eighth. Then the fever begins to seize them and they keep their beds two days, very seldom three. They have very rarely twenty or thirty on faces, which never mark, and in eight days’ time they are as well as before the illness.

Lady Mary ends by declaring she has decided to have all this done to her own son Edward eventually, and that she might write to the English doctors at home about it, “if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind . . . Perhaps, if I live to return, I may however have courage to war with them.”
 
Approximately one year after these letters, in March 1718, Lady Mary updated her sister from Constantinople. She had just delivered a new baby daughter into the family. Her doctor brought from England, Dr. Maitland, attended her during the event, along with Dr. Emanuel Timoni, a distinguished Greek/Italian physician in Constantinople who had cared for the previous British embassy staff during their mission. Dr. Timoni had studied at Oxford and Padua and was a Fellow of the British Royal Society. At the same time, Mary also wrote to her husband, away in treaty negotiations, that she had their son “engrafted” with Dr. Maitland observing an old Turkish woman’s method and at the last minute jumping in with a sharper needle to help make it more comfortable for the boy. For reassurance, Mary had probably also spoken to Dr. Timoni about inoculation. He knew the custom well and in December 1713 had written a Latin description of the Turkish treatment published in the journal of the British Royal Society, Philosophical Transactions. Indeed the six-year-old soon made a complete recovery and was as handsome and healthy as before.
 
Meanwhile, Edward Senior’s diplomatic work was stalled. The Turks were demanding return of territory lost to the Austrians even though they had been fairly defeated in the battle to win it during the war. Edward was agreeing with their demands and insisting on this point with the Austrians. On the other side of the table, more experienced British diplomats working with the Austrians thought this was unreasonable and, privately, sent letters to London suggesting that Edward be recalled. Ultimately, his sponsors agreed, found him another position in London, and sent the new British warship HMS Preston to carry the Montagu family, their staff, and their four new horses home.
 
The Preston sailed with all of them for England on July 5, 1718. Edward was not too upset with being brought back so soon and not worried about his future. After all, he was wealthy from his coal mines at home, so they made the best of their Aegean and Mediterranean cruise with the Preston’s crew of 240 to take care of them. Just after passing the Hellespont, they stopped to explore the hillside where Achilles was said to be buried, and later visited both Troy and Carthage. Mary regaled her friends at home with her travel letters all along the way. Finally, they reached London in October. Since the treaty between the Ottomans and Austrians had been concluded while they were traveling back, Edward’s shortened mission did not seem much of a disappointment. An official announcement from the royal court proclaimed that Edward presented his report to the King a few days after returning, and that was that. He resumed his duties as MP for Westminster in Parliament, and from then on focused his energies on his business affairs and coal mines, never again holding a government appointment. Mary took her place at court again where her friends delighted in hearing more of her adventures.
 
The normalcy of their lives was interrupted, however, by a new and lethal outbreak of smallpox at the beginning of 1721. Lady Mary wrote to Dr. Maitland, her physician from the mission to Turkey, who had settled into retirement in the English countryside. She wanted her three-year-old daughter inoculated in the Turkish way immediately. He was hesitant at first, pointing out the Ottoman tradition was to wait for warmer weather, but he gave in to Mary’s insistence, on condition that doctors from the Royal College of Physicians would be witnesses. Dr. Maitland then inoculated the child on both arms, making her the first person ever inoculated in England. Soon after, watching the child play happily during a follow-up visit, witness Dr. James Keith had his own six-year-old son inoculated, too.
 
Sir Hans Sloane was probably another witness to these events. Besides being one of the doctors who treated Lady Mary’s own case of smallpox, he was at that time President of the Royal College of Physicians, Secretary of the Royal Society, and private physician to the royal family. Caroline, Princess of Wales, was also worried about her children. Sloane had already treated her eldest daughter, Princess Anne, for a dangerous case of smallpox, from which she recovered, but her younger daughters were still at risk. Noting how Lady Mary had managed to have her own son and daughter inoculated, Princess Caroline and the ever curious Sloane composed what can only be described as a draconian “clinical trial” for further validation of the treatment.
 
With the King’s agreement, six condemned criminals awaiting execution at Newgate Prison were offered a pardon if they would agree to be inoculated (and if they survived). A reluctant Dr. Maitland was again convinced to administer the venom, and the treatments produced the usual successful results. The convicts attained their freedom, and one female among them was even called back, for an additional reward, to confirm the efficacy of her jab by sleeping in the sickroom of smallpox patients in Hertford, which she did, without infection.
 
Princess Caroline then ordered one further test of the safety of inoculation for young children. Six orphans from the parish of St. James near the palace were scooped up and inoculated. All of the children ran the usual course after inoculation successfully. Without further delay, the royal princesses were inoculated on April 17 following, with the permission of the King.
 
As in many things, the royal seal of approval was a strong endorsement, and there was an immediate demand for the new treatment among the social set. As the disease threatened, Lady Mary was often asked to visit friends in person to convince doubters in the families. She would bring her small daughter into sickrooms with her, to show how the child was protected against the disease.
 
Inevitably, there was opposition to the new practice from some corners. Representing clerical disapproval, Dr. Edmund Massey delivered a sermon against inoculation at St. Andrew’s Holborn (and then published it). Some doctors were critical, such as Dr. William Wagstaffe, who warned some physicians had been caught up by the “fashion” of inoculation when they should be more cautious. After all, he wrote, the treatment was just “an Experiment practiced only by a few Ignorant Women, amongst an illiterate and unthinking people.”
 
That comment was too much for Lady Mary, who had actually lived among those very people. Since it was not only inappropriate for an aristocrat to engage in controversy in the press, but also unusual for a woman to enter into such an argument, Lady Mary assumed another identity to write “A Plain Account of the Inoculating of the Small Pox by a Turkey Merchant.” First, Lady Mary blasted the English physicians who had been ignoring the numbers proving the success of inoculation. Then, to set things straight, she repeated a precise description of how simply the operation is performed in Constantinople (because she is, after all, writing as a “Turkey Merchant”). She labeled the few recent deaths among the inoculated in London as murders done by those doctors who added unnecessary enhancements to increase their revenue, including blood-letting, purges, and cordials to be drunk during fever. All that only weakened the poor people.
 
But arguments pro and con soon became irrelevant because of the royal endorsements. Also, it became clear the recent outbreak was not simply a British affair. At exactly the same time, all hell was breaking loose on the other side of the pond in the colonies. In fact, the problem had spread across a large number of people, in a large number of countries, qualifying this to be labeled a true eighteenth-century pandemic.
 
It was on May 8, 1721 (just three weeks after Princess Caroline’s daughters were inoculated by Dr. Maitland) that the Selectmen of Boston met to consider the news. Two cases of smallpox had just broken out in their town of 11,000 loyal colonists. Politicians then, as now, decided to close up the houses where the infected were suffering, keep things quiet for a while, and pray that no more cases would appear. Perhaps it would just go away?
 
Many people in Boston had been through this before. On Captain John Bonner’s famous 1722 map of Boston, there are three lists: Important Buildings, the dates of Great Fires, and the dates of Small Pox—1721, 1702, 1689⁠–90, 1677⁠–80, 1660 and 1640. Since it had been almost twenty years since the last outbreak of 1702, the population knew trouble was overdue. And they knew what would happen when it came. At word of the first case, the 10 percent of the population with second houses, relatives, or friends in the countryside fled the city. Everyone else prepared for a lockdown.
 
One of the distinguished city fathers was Cotton Mather, its leading Puritan minister. Despite some unfortunate retro anti-Satan notoriety during the Salem witch trials, Mather was actually a student of modern science. He was an enthusiastic correspondent of the Royal Society in London, sending over what he called Curiosa Americana, a blizzard of reports on interesting natural phenomena in the New World. As fate would have it, a batch of about a dozen of these were collected and published in the journal of the Society, Philosophical Transactions, in the very same 1714 issue as Dr. Timoni’s letter in Latin about the Turkish practice of inoculation for smallpox, together with some English-language commentary.
 
Mather read the Timoni material with interest. Sending his feedback to the Society’s Secretary in London, he expressed the hope that England would make further tests of Turkish inoculation to give the members a verified new weapon for the next smallpox outbreak. He also reported on his own close conversation with his slave, Onesimus (a gift from his grateful parishioners), whom Mather described as “a pretty intelligent fellow.” Onesimus had been inoculated in Africa and showed Mather his scars to prove it. He explained how, back home, it was the customary treatment “for the brave,” and it had given him immunity from smallpox. Mather added he had heard similar stories from others in Boston’s one-thousand-strong African community. Unfortunately no one in England made any tests.
 
Now, five years later with eight smallpox cases reported by May 27, Mather wanted to re-read Dr. Timoni’s detailed description. The minister had a renowned library of his own, but only one man in town actually had the bound volumes of back issues of Philosophical Transactions—Dr. William Douglass, a prickly recent immigrant from Scotland. Dr. Douglass was the only practitioner in Boston with a degree from a real medical school back in Europe. He had a very high opinion of himself and only disdain for the other dozen “doctors” in Boston, most of who had come up through the apprentice and apothecary systems. However, Douglass didn’t hesitate to send Mather’s messenger back with the volume requested by the good minister as a courtesy.
 
After refreshing his memory of Dr. Timoni’s description and reading another inoculation report in Latin inside the same bound volume from a Dr. Pylarini in Smyrna, Mather composed his own letter to the Boston doctors, describing the Turkish treatment and urging them to inoculate. As support, he mentioned “several Africans among us” who had been so treated “in their own country.” However, he received no response. Perhaps the doctors did not value medical advice from a preacher?
 
Meanwhile the smallpox case count continued to rise. Harvard canceled its annual graduation festivities across the river. All that was usually a wide-open start-of-summer celebration for the whole community, with carriages of merrymakers arriving from far and wide. But now the college knew it was a super-spreader event waiting to happen. Gloom over town was darkening.
 
After waiting and praying for two weeks, Mather wrote a second time to the Boston doctors on June 24. This time one did reply. Dr. Zabdiel Boylston asked for all available information. Mather took the time to personalize the follow-up cover note, saying, “you are in many ways, sir, endeared to me” for the good God “honors you to do in a miserable world.” He pleaded with Dr. Boylston to consider the notes and Latin translations he was enclosing and “do as the Lord directs you.”
 
Boylston may not have gone to a medical school in Europe, but he was successful and well respected by his patients. He was trained by his father, Dr. Thomas Boylston, and, after his father’s death, by Dr. John Cutler, a noted surgeon. Months before, he had proved his skills and saved a woman’s life by performing one of the first mastectomies in America. He operated the largest apothecary medicine store in Boston in Dock Square near his home. By instinct, he had the same sort of enquiring and curious mind as Cotton Mather and Sir Hans Sloane. In particular, he was interested in natural sciences, horse breeding, and botany—and he collected “curiosities.” He was wide open to non-traditional sources of discoveries, having learned many Native American remedies while apprenticing with his father in the countryside.
 
Dr. Boylston narrowly escaped death by smallpox in the epidemic of 1702, and his wife suffered through a bad case before they were married. Now, his wife and daughters had already left town, and he was very worried about his six-year-old son Thomas who was still at home with him, as well as another son across the river at college. Like Lady Mary Wortley Montagu, in desperate times, when convinced a risk was worthwhile, he was quick to act. On June 26—just two days after receiving the added information from Mather—he went ahead and, in the Turkish style, inoculated young Thomas, as well as a family African slave named Jack, and Jack’s two-year-old son Jacky.
 
The good doctor did not keep secrets, and word of his willful experiment soon spread alarm around town. Cotton Mather described the reactions in his diary: “They rave, rail, they blaspheme; they talk not only like idiots but also like Franticks. And not only the physician who began the experiment, but I also am an object of their fury.”
 
Meanwhile Boylston kept a close watch on his first three patients. After three weeks, they were fully recovered. He published details of their safe passage through the side effects in the Boston Gazette on July 17, hoping the good news would help. He then went ahead with more inoculations, adding his thirteen-year-old son John and six other new patients. John had just come home from Harvard because his best friend and roommate (“chamber fellow”) was infected. That boy later died.
 
Instead of calming the city down, Boylston’s expanded jabbing and newspaper report only increased the panic. The historian and future colonial governor Thomas Hutchinson had been a boy at the time, and his older brother died during the outbreak. Writing about Boylston later, he remembered how “many sober pious people were struck with horror and were of the opinion that, if any patients should die, he ought to be treated as a murderer . . . His family were hardly safe in his house, and he often met with affronts and insults in the streets.”
 
Now Dr. Boylston was ordered to appear at a July 21 meeting of the Selectmen. A majority of the town’s doctors were there, with justices of the peace, provincial and regional officials. The inquisition fired a withering barrage of questions at him about the efficacy and dangers of the little understood treatment. Dr. Boylston answered as best he could based on his overall medical experience, his scant observations of his recent patients, and the summaries of the Turkish and African experiences he had received from Cotton Mather. The long session ended with some unexpected witness testimony (in French) from Dr. Dalhonde, a former French military surgeon. He told horror stories from Italy, Spain, and Flanders where he had seen soldiers inoculated. Afterwards, he claimed, many had plague-like symptoms and died. Dr. Douglass was very engaged in opposing inoculation during the proceedings, and even translated the gritty French testimony aloud for the assembly. Personally, he was incensed that Mather had distributed hearsay information from his own borrowed book and that one of the undereducated doctors had even acted on it. In fact, he had demanded the return of his book from Mather and afterwards refused to show it to anyone, including the Lieutenant Governor who asked for it.
 
After deliberating, the justices condemned inoculation based on Dr. Dalhonde’s stories. Thereafter, Douglass ramped up his anti-inoculation campaign. Three days later, the Boston Newsletter published a ghostwritten article of his (signed from “W. Philantropus”). He called Boylston “illiterate” for not being able to understand the Latin articles by Timoni and Pylarini, and “ignorant” for having acted on such meager experience with patients. He labeled Boylston’s brief report on his first successes published in the rival Boston Gazette a “dangerous quack advertisement” for his services. And he accused Boylston of “propagating the infection in the most public place in the town” near his shop and house in Dock Square.
 
Boylston was furious over Dalhonde’s improbable testimony and Douglass’ attacks, but he was more concerned about new disease reports. The Boston Newsletter on the same day tallied 168 people infected and 18 dead. The good doctor decided to let others fight out the media frenzy. He was going to ramp up his inoculating.
 
Watching from the sidelines, at least one person in town saw all the commotion as a wonderful business opportunity—in fact, it could mean salvation for his failing enterprise. Boston’s James Franklin had gone to London to learn the printing trade. He returned recently, bringing a used printing press and a single type font back with him. Then, he opened his own print shop. But now he was struggling to make ends meet competing against several established printers in town. His aged father was worried about payback on a substantial loan he had given him. Hedging his bets, his father vetoed his twelve-year-old younger son’s plans to go to sea and forced him to sign on as an apprentice to his older brother for nine years. This younger boy, named Benjamin, didn’t like that at all, but for the moment he was helping—and he was clever.
 
James Franklin’s new idea became the third newspaper in town, the New England Courant, printed by him and modeled on the popular and witty Tatler and Spectator publications he had seen in London. The first issue launched with spirited rants against inoculation contributed by Dr. William Douglass, who probably helped bankroll the venture as well. Although the two other papers in town took opposite sides on the issue, the Boston Newsletter and Boston Gazette were tame and respectful in compar­ison to the Courant. After a few issues from Franklin, which were being sold by young Benjamin pounding the pavement, the Boston Newsletter complained of “a Notorious, Scandalous Paper, called the Courant, full freighted with Nonsense, Unmannerliness, Railery, Prophaneness, Immorality, Arrogancy, Calumny, Lyes, Contradictions, and what not, all tending to Quarrels and Divisions, and to Debauch and Corrupt the Minds and Manners of New England.”
 
Publicly, Boylston and Mather then collaborated to publish the promised detailed inoculation report at the end of summer. They included descriptions of the “Turkish” methods from the European physicians, the treatments used in Boston, and a helpful section of Frequently Asked Questions. For anyone discounting the testimony of Africans, they said learning to fight smallpox from Africans was no different from learning to fight rattlesnake bites from the Indians. Then, in October, the Boston Gazette reported on the English experiments made on the condemned Newgate convicts back in the spring. If the royals were investigating all this, then maybe inoculation wasn’t so crazy after all?
 
Privately, however, Mather was in despair. He wrote in his diary “the town is become almost an Hell on Earth, a City full of lies, and murders, and blasphemies.” He did have good reason to worry. At three in the morning on November 14, someone threw a hand grenade through one of his front windows. Sleeping in the room were several patients visiting as houseguests while they ran the multi-day course of their recoveries from inoculation. Luckily, the device hit a piece of furniture hard, separating the fuse from the combustibles—otherwise many could have died. The grenade had a note attached: “COTTON MATHER, I was once one of your Meeting; But the cursed Lye you told of—You know who; made me leave You, You Dog. And Damn You. I will Enoculate you with this, with a Pox to You.” So the city’s rage had heated up to attempted murder.
 
Fortunately, after the New Year, the case count began to lessen. On February 24, the Selectmen announced there were no more smallpox cases in Boston. A few more popped up in March and April. Dr. Boylston was able to make his last inoculation in early May for patients fearing the future. The Selectmen ordered an official case count prepared. The town census number states 10,567 persons stayed in Boston after about 700 fled. As Dr. Boylston later reported, 5,759 caught smallpox (54.5%), and 844 died (15% of those infected). By comparison, of the 276 people exposed to smallpox by inoculation, only 6 died (2.2%), and some of those might already have caught the disease naturally before getting their jabs.
 
Dr. Boylston had several reasons for celebration. His instincts had been right when he made the decision to go ahead with the “Turkish” treatments. He protected a great many people from disfiguration and death. And he made approximately £1,000 for his services—equivalent to about £2,130,000 in today’s British pounds.
 
Interestingly, Dr. B. didn’t hold a grudge. In June, printer James Franklin was sent to jail for criticizing the government. Young Benjamin held the fort back at the office and kept writing and publishing the Courant for the next four weeks. Jail conditions were bad, and James became very ill. His family pleaded for his release with the town. And it was Dr. Boylston who went into the jail, examined James, and ordered his immediate release. It was not the last time he would help the Franklins.
 
Now the good doctor could slow down, resume his regular practice, enjoy his horses, and collect more “curiosities.” Except that’s when the letter from London arrived. The Royal Society and “a certain more exalted person” were inviting him to England. It was Sir Hans Sloane (and Caroline, Princess of Wales) making him an offer he couldn’t refuse.
 
Doctor Boylston took several months to close down his practice and rent his botanical garden used for his remedies. Then he chose several favorite horses he had bred to take with him on his December voyage across the Atlantic.
 
On January 26, London merchant Thomas Hollis, a benefactor of Harvard College, wrote back to Boston that “Doctor Boylston is well arrived here, and his fine horses.” There, Dr. Boylston was also welcomed by Sir Hans Sloane and introduced at a meeting of the Royal Society in February 1725. Then he went to work on a “deliverable” the members were eager to have. After the royal experiments with the convicts and orphans, demand for inoculation spread among the well-to-do set all over England. Sloane, now President of the Society, and Dr. James Jurin, its Secretary, were advertising for all inoculators to send in reports on their jabbing. One Dr. Thomas Nettleton from Yorkshire wrote in proposing a simple way to assess safety and efficacy by comparing the mortality numbers of natural smallpox and the inoculated kind, as the Selectmen had done in Boston. In England, this was a new idea. (The word “statistics” first appeared 62 years later.) Nettleton enclosed his own Yorkshire numbers showing 3,405 cases of natural smallpox with 636 dead. By contrast none of the sixty people he inoculated had died. The Boston case was vitally important because it involved a more diverse population (not just high society), with a larger sample of inoculated persons compared to the British reports. Dr. Jurin published annual summaries of these numbers from 1724 through 1727 and included all the info from the British colonies as well.
 
Dr. Boylston prepared all his data and wrote complete commentaries on the varieties of patient reactions in Boston. He presented the finished work to the Royal Society at their meeting May 19, 1726. The session was chaired by the past president Sir Isaac Newton and is said to have ended with a standing ovation for the doctor. Later that month the “sumptuous” London edition of his book was ready, entitled An Historical Account of the Small-Pox Inoculated in New England upon all Sorts of Persons, Whites, Blacks, and All Ages and Constitutions. On the title page it reads, “Humbly dedicated to her Royal Highness the Princess of Wales by Zabdiel Boylston, Physician.” At the July 7 meeting, he was then formally elected a Fellow of the Royal Society.
 
Now Dr. Boylston’s time in London was growing short. Probably he had met Lady Mary. We do know he delivered lectures at the Royal Society of Physicians and had a meeting or two with another American in town—young Benjamin Franklin, who had managed to break away from his confinement as an apprentice to his brother. Unfortunately Benjamin had come to London only to find he did not have the letters of introduction he had been promised to help secure a position, and he was in some financial distress. Dr. Boylston loaned him “twenty guineas” and gave him what Franklin later described as “fatherly advice and counsel.” Sir Hans Sloane also bought a “curiosity” from Franklin in the form of an asbestos purse, which went into Sloane’s collection, which, after Sloane’s death, became the foundation for the new British Museum.
 
In the autumn, Dr. Boylston sailed for home. A Boylston family story tells how he arrived back very rich from a royal reward for his services. It is certainly true the royals gave the long-suffering Dr. Maitland £1,000 for his work with the convicts, the orphans, one of the royal princesses, and for a trip to Hanover to inoculate Caroline’s son, Prince Frederick. Dr. Boylston probably received a similar amount. He also had sold some of his horses. At home, while he did continue serving some patients, he bought a large farm outside town in Brookline and spent more and more time there breeding horses. He was, however, back inoculating during the 1730 outbreak of smallpox in Boston, when even Dr. Douglass was jabbing his own patients as well. The acceptance of the treatment was becoming mainstream, both in Old and New England. The last reported sighting of Dr. Boylston was when he rode a colt he was training into Boston to see friends. That was when he was aged eighty-four. He died at eighty-seven.
 
What is certain is that Lady Mary, Cotton Mather, Dr. Boylston, and Sir Hans Sloane started the ball rolling in 1721 towards where we find ourselves battling our own infectious diseases today.
 
Of course, the other key step along the way was Edward Jenner’s work starting in 1796 to validate the English country wisdom that milkmaids were immune to smallpox because they had already had cowpox, a bovine disease passed onto them from sores on the udders of cows. When Jenner exhaustively researched, documented, and validated the fact that inoculations using cowpox “vaccine” worked as well as those using smallpox (but without exposing patients to smallpox at all), adoption of “vaccination” became virtually universal. Parliament gave Jenner a £10,000 reward in 1802, and then reconsidered five years later and gave him another £20,000. The good doctor built a hobbit-like one-room thatched hut in his back garden where he vaccinated anyone who visited for free. He called it “The Temple of Vaccinia.”
 
Almost eighty years later, Louis Pasteur was presenting his latest work at the 1881 International Congress of Medicine in London. He proposed using the term “vaccination” (meaning “jabbing with cowpox”) for all protective immunization treatments—as a way to honor Edward Jenner. Soon after modern science took over.
 
That brings us to last year and Özlem Türeci and Uğur Şahin, the wife-husband team of scientists who cracked the code for the first Pfizer vaccine against Covid-19. And they are Turkish citizens. Lady Mary would be pleased.