Smallpox, Contagion, and Community in Eighteenth-Century Boston

Layers of Protection: Smallpox, Contagion, and Community in Eighteenth-Century Boston

An honors thesis for the Department of History

Elise A. Weir

Tufts University, 2015

ACKNOWLEDGEMENTS

Thank you to the Tufts University Summer Scholars Program for providing funding that allowed me to complete this research. Thank you to the Massachusetts Historical Society for granting me permission to quote and cite unpublished manuscripts. Thank you to Connie Reik at

Tisch Library for her assistance, and finally, thank you to Professor Alisha Rankin, Professor

Benjamin Carp, and Professor David Ekbladh for serving on my committee, reading countless drafts, and providing invaluable guidance and support.

TABLE OF CONTENTS

Acknowledgements………………………………………………………………………………ii

Introduction………………………………………………………………………………………1

One: Official Public Health Measures and the Complex Threat of Smallpox……………. 19

Two: Smallpox, Inoculation, and the Community…………………………………………...47

Three: Smallpox and the Household: Protecting the Family and Reconfiguring Domestic Healing………………………………………………………………………78

Conclusion …………………………………………………………………………………….106

Bibliography…………………………………………………………………………………...112

iii

Introduction

In early January, 1764, John Scollay and Benjamin Austin, both selectmen, turned onto

Fish Street in Boston’s North End. Having received word that a member of one Mr. Adams’ family lay ill with smallpox, they proceeded to his home to investigate. The selectmen had every reason to believe the veracity of the report: several days before, they had overseen the burial of

Joseph Bulkley, also of Fish Street, after he died of smallpox. Upon arriving at Mr. Adams’ home, the selectmen’s fears were confirmed. Mrs. Adams had indeed contracted smallpox.

Perplexed, the selectmen reported that Mrs. Adams, having recently given birth, had “not been out of her Chamber for five Weeks past,” and had very few visitors besides her family. She therefore “could make no conjecture how she had taken the Infection.”1 The selectmen tried to induce Mrs. Adams to consent to being removed from her home and isolated in the town hospital at New Boston, but she refused. Thus in accordance with the law, the selectmen ordered Mr.

Adams “to shut up his House immediately” and hang a red flag from the edifice, a symbol to all that smallpox lived within those walls. Mr. Adams was to send away any members of his family who might contract the virus, and a guard was ordered to stand watch starting at dawn each day to ensure than none but the physician entered or exited the infected home.2

Four days later, on January 17th, Mrs. Adams died. She was the second victim of what would be a prolonged outbreak. The selectmen ordered that she be buried in a “tarr’d Sheet and

Coffin… in the dead of the Night” to reduce the risk of susceptible townspeople coming in

1 A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1764 through 1768, vol. 20, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1889; Internet Archive, 2007), 1- 4 ,https://archive.org/details/recordsrelatingt20bost. 2 Ibid.

contact with her body.3 Before this could be done, however, John Gray, himself a guard for the home of another smallpox victim on Fish Street, entered Mrs. Adams’s room and touched her corpse, a violation of the selectmen’s orders. After an investigation, the incensed selectmen concluded that Gray had acted with a “malicious design to spread the Infection of the Small

Pox,” and ordered him imprisoned in “the Stone Jayl.”4 Amidst the uproar of Gray’s offence, the selectmen procured a wet nurse to care for Mrs. Adams’s infant child, now without its mother.5

Two days later, both child and nurse were sent to the hospital at New Boston, presumably in an effort to halt the spread of the virus.6 Meanwhile, some Bostonians urged the selectmen to allow inoculation in the town, hoping the procedure would protect their families from what threatened to be a devastating outbreak.7 Despite the selectmen’s best efforts, the outbreak continued for several months after Mrs. Adams’s death; by the time it subsided, 170 of the town’s roughly

15,000 people had died and 4,977 people were inoculated.8 In total, over 35% of Boston’s population contracted smallpox, either naturally or via inoculation, in 1764.9

The experiences of the Adams family in 1764 underscore the fear and suffering that smallpox wrought, as well as the strong community response that outbreaks elicited in eighteenth-century Boston. When Mrs. Adams broke out in the telltale pocks that accompanied

3 Ibid.,12. 4 Ibid., 25. 5 Ibid., 13; See also John B. Blake, Public Health in the Town of Boston 1630-1822 (Cambridge, MA: Harvard University Press, 1959), 90-91. 6 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 17. The Selectmen’s records do not state explicitly that the nurse and baby were sent to the hospital because one or both had smallpox. Once the baby and nurse were sent to the hospital, Mr. Adams was ordered to “continue Smoking and cleansing the House,” suggesting that it could be cleansed since all those infected with smallpox were removed. 7 See for example, “To the Publishers of the Boston Evening-Post,” The Boston Evening-Post, January 30, 1764, accessed July 14, 2014, Readex: America’s Historical Newspapers (108B71A08DE16FB0). 8 Massachusetts Sanitary Commission, “Report of a general plan for the promotion of public and personal health, devised, prepared, and recommended by the Commissioners appointed under a resolve of the Legislature of Massachusetts, relating to a sanitary survey of the State” (New York: Arno Press, 1972, originally printed Boston, 1850), 70; Blake, Public Health, 94-95, 244 (Appendix I, Table I); on Boston’s total population see Cornelia H. Dayton and Sharon V. Salinger, Robert Love’s Warnings: Searching for Strangers in Colonial Boston (Philadelphia: University of Pennsylvania Press, 2014), 14. 9 MA Sanitary Commission, “Report of a general plan,” 70.

the virus, it triggered a series of official procedures that formed the core of Boston’s public health system. Mrs. Adams’s mandated isolation, the boarding up of her home, and her child’s eventual removal to an isolation hospital were all policies established by law and overseen by

Boston’s selectmen, to whom Bostonians were required to report cases of smallpox.10 The selectmen’s supervision of Mrs. Adams’s burial, as well as their efforts to provide for the care of her infant, point to the active role officials in Boston played in trying to halt the spread of smallpox and provide for townspeople affected by the disease. The Adams family tried to preserve the domestic sphere of healing by insisting Mrs. Adams endure the illness in her home.

Still, they navigated the town’s regulatory system that made health and sickness a broader political and social issue. Meanwhile, Bostonians were expected to adhere to public health policies for the good of the community. For his defiance of official orders and perceived threat to the community, John Gray faced a criminal hearing and incarceration. Mrs. Adams’s fellow townspeople could not legally inoculate, though many wanted to, until the requisite number of inhabitants fell ill. As this case highlights, smallpox outbreaks engaged the entire community of

Boston as inhabitants, from the selectmen to the single family, sought to protect their town from the ravages of smallpox.

This thesis studies how Bostonians conceptualized the threat of smallpox and the ways in which they sought to protect their community from this threat in the eighteenth century. Boston warrants particular attention given the prominent role it played in the introduction of inoculation and because its strict public health regulations managed to largely halt outbreaks, but at the same time allowed the controversies of inoculation to persist throughout the eighteenth century. As this thesis demonstrates, the entity of the town was central to how denizens of eighteenth-century

10 “An Act to Prevent Persons Concealing the Small-Pox,” in Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 2, Acts 1715-1741 (Boston: Wright and Potter, 1874; Internet Archive, 2009), 621-622, https://archive.org/stream/actsresolvespass1541mass#page/n5/mode/2up.

Massachusetts conceptualized their community and experienced outbreaks. Thus, a local frame is required to accurately reflect the nuances of community responses to smallpox.

This thesis examines protective efforts in Boston from three levels: the government, the broader community, and the household, including overlap among the three. In Taming

Democracy: “The People,” the Founders, and the Troubled Ending of the American Revolution,

Terry Bouton introduces the concept of “concentric rings of protection” when analyzing how rural communities in post-independence Pennsylvania mobilized to protect against state policies that they perceived to be economically ruinous and contrary to democratic ideals. Each ring,

Bouton explains, encompassed specific groups of people and performed a distinct protective function to shield the community.11 A similar frame can be applied to Boston during smallpox outbreaks, with the government, the community, and the household forming Boston’s protective system against smallpox. Here, however, the system of protection is better described as layers of protection, and state policies were themselves protective. Rather than being distinct rings, in

Boston these layers had fluid boundaries, and they overlapped, conflicted, and reinforced one another to provide a multifaceted but contentious system of protection for the town as it confronted the threat of smallpox.

The government provided the first layer by crafting overarching regulatory policies, such as quarantine, isolation, and inoculation bans. These policies stemmed from a desire to not only protect the lives of inhabitants, but also from concerns about the broader costs of smallpox on a town faltering economically and struggling to provide for its indigent population. The

11 See Terry Bouton, “Rings of Protection: Popular Resistance During the 1780s,” chap. 7 in Taming Democracy: “The People,” the Founders, and the Troubled Ending of the American Revolution (New York: Oxford University Press, 2007); Bouton also discusses the idea of “protective networks” and “concentric rings of protection” in agrarian revolts in post-independence Pennsylvania in “A Road Closed: Rural Insurgency in Post-Independence Pennsylvania,” The Journal of American History 87, no. 3 (Dec. 2000): 855-887, esp. p. 867, http://www.jstor.org/stable/2675275. Thank you to Professor Benjamin L. Carp for bringing this frame to my attention.

community as a whole formed the second layer of protection. Within the community itself, the inhabitants of Boston sought to protect their town by establishing expectations of conduct that emphasized protecting the larger community. Even where opinions diverged and shifted over time, most notably over the issue of inoculation, the rhetoric of town debates reveals a continual emphasis on the health of the whole, a theme that ran throughout Boston’s smallpox debates. The third layer of protection was the household, as people sought to protect their families from the dangers of smallpox while navigating a public health system that emphasized the health of the broader community rather than individual people or families.

Drawing upon sources such as official town records, including the minutes of the Boston selectmen, newspapers, contemporary books and pamphlets, and personal correspondence, this thesis examines how these layers of society interacted to provide a nuanced picture of how

Bostonians conceptualized protection against smallpox outbreaks. By considering the ways in which the government, the wider community, and the household interacted, the broader themes of protection, community membership, and commitment to the good of the many that coursed through complex debates come to the fore. Bostonians developed a governmental regulatory approach to protect against smallpox as well as a broader community expectation that Bostonians would act with the good of the community in mind; this emphasis challenged but never quashed traditional domestic healing and familial obligations.

Smallpox, Theories of Disease, and Public Health

Declared eradicated by the World Health Organization in 1980, smallpox is caused by the contagious variola virus. It was spread usually through direct contact with an infected person, but was also spread through infected materials, such as clothing; body fluids; and in some cases,

by breathing air containing the virus. Symptoms included fever, headache, body aches, and the infamous pocks that usually concentrated on the hands and arms, feet, back, neck, and face.12

After initial exposure, people experienced an incubation period of about twelve to fourteen days where they generally had no symptoms and were not contagious. People were most contagious at the onset of the distinctive rash, which began in the mouth and throat. The rash formed pustules which covered the body and eventually scabbed, leaving scars. People were contagious until they were free of every scab. Across history, smallpox killed approximately 30% of those who contracted the virus, though fatality rates varied by outbreak.13

In eighteenth-century Western medicine, theories of diseases and their spread were still emerging, and there was no germ theory. The idea of “epidemic constitution” reemerged in the seventeenth century, gaining ground through the writings of people such as Thomas Sydenham and John Huxham. This idea posited that conditions of the air and atmosphere caused diseases; while Sydenham argued that the reason for these conditions could not be known, Huxham pointed to temperature, moisture, wind, and pressure to explain how atmospheric conditions caused diseases.14 However, even in the absence of germ theory, the people of the eighteenth- century recognized the communicability of certain diseases, including smallpox.15 For example,

Huxham thought that smallpox, plague, and certain fevers were contagious. Dr. William

Douglass, a prominent Boston physician in the early eighteenth century, distinguished between diseases that were “endemial” (the product of atmosphere and climate) and those that were

12 Elizabeth A. Fenn, Pox Americana: The Great Smallpox Epidemic of 1775-82 (New York: Hill and Wang, a Division of Farrar, Straus and Giroux, 2001), 15-18; Centers for Disease Control and Prevention, Smallpox, 2007, Accessed June 22, 2014, http://www.bt.cdc.gov/agent/smallpox/. 13 Centers for Disease Control and Prevention, Smallpox, 2007, Accessed June 22, 2014, http://www.bt.cdc.gov/agent/smallpox/. 14 Blake, Public Health, 38-39. 15 Ibid., 20-21, 37-39

contagious, though some could be both.16 These theories of disease influenced how Bostonians responded to epidemic threats.17

When Bostonians developed town responses to smallpox outbreaks, they based them on the assumption that smallpox could spread from person to person.18 This is clear not only from preventative policies, but also from the language used in town debates and legislation.

Throughout such documents, Bostonians spoke of spreading the disease to neighbors and fellow townspeople, and provincial legislation clearly delineated communicable disease as a class of sickness. For example, a 1701 law, “An Act Providing in Case of Sickness,” stipulated that “for the better preventing the spreading of infection,” selectmen had the power to isolate those suffering from “the plague, small pox, pestilential or malignant feaver, or other contagious sickness, the infection whereof may probably be communicated to others.”19 Painful, disfiguring, and often deadly, smallpox haunted both the motherland and her colonies, becoming the disease around which colonial conceptions of contagion and public health revolved. In the absence of plague, smallpox became, John B. Blake argues in Public Health in the Town of Boston, the

“familiar and classic contagious disease” that Massachusetts selectmen had experience fighting, experience they would apply when confronting the spread of other diseases like diphtheria and scarlet fever. With public health methods oriented around smallpox, the eighteenth century was, according to Blake, the “smallpox century.”20

16 Ibid., 39. 17 Ibid., 39. 18 On eighteenth-century North American colonists recognizing smallpox as a contagious disease, see Fenn, Pox Americana, 29; Blake, Public Health, 20-21; Amalie M. Kass, “Boston’s Historic Smallpox Epidemic,” Massachusetts Historical Review 14 (2012): 4. doi: 10.5224/masshistrevi.14.1.0001. 19 The Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 1, Acts 1692-1714 (Boston: Wright and Potter, 1869; Internet Archive, 2009), 469, https://archive.org/details/actsresolvespass9214mass; Blake, Public Health, 33. 20 Blake, Public Health, 50-51.

Smallpox represented a threat to not only the infected but also to the community at large.

As Simon Finger argues in The Contagious City, public health raises the “problem of collective action,” as the community must determine how to protect against and counter threats that affect all of its members.21 The Massachusetts Bay Colony responded to this issue, in part, with legislation. Provincial public health law encompassed everything from regulating certain trades and enforcing refuse removal to quarantining ships and instituting mandated isolation of those sick with contagious diseases.22 As early at 1699, the colony established quarantine laws for ships that carried infectious disease.23 Further legislation empowered town selectmen to isolate those sick with contagious diseases, potentially removing them from their homes.24 Subsequent laws regarding smallpox required all cases to be reported to town selectmen and empowered town selectmen to prohibit the sick or those travelling from infected locations from entering the town.25 Thus, the selectmen of Boston had significant power to take action to prevent the spread of smallpox.

The introduction of inoculation in Boston in 1721 added a new, highly controversial method to combat smallpox that brought issues of regulation, community membership, and the common good to the fore. Inoculation, or more specifically, variolation, was a centuries-old practice but was new to Western Europe in the eighteenth century.26 During the procedure, a person was intentionally infected with smallpox, often by an incision in the arm. This usually

21 Simon Finger, The Contagious City: The Politics of Public Health in Early Philadelphia (Ithaca, NY: Cornell University Press, 2005), ix. 22 Blake, Public Health, 10-12, 27-31, 36. In strict epidemiological terms, isolation refers to separating the sick from the healthy, while quarantine refers to restrictions placed on the interactions and movements of people who were exposed to a disease and may become ill. Centers for Disease Control and Prevention, Quarantine and Isolation, August 28, 2007, accessed June 22, 2014, http://www.cdc.gov/quarantine/quarantineisolation.html. 23 Blake, Public Health, 32-33. 24 Acts and Resolves, 1:469-470; Blake, Public Health, 33-34. 25 Acts and Resolves, 2:621-622; The Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 3, Acts 1742-1756 (Boston: Wright, 1878; Internet Archive, 2009), 35-37, https://archive.org/details/actsresolvespass4256mass; Blake, Public Health, 77. 26 Blake, Public Health, 53; Fenn, Pox Americana, 31.

resulted in a less severe case of smallpox with a lower mortality rate, though it could still result in death. If the procedure was successful, the inoculated individual developed lifelong immunity.

Variolation (henceforth referred to as inoculation to reflect the language of the eighteenth century) differs from vaccination in that inoculation used live smallpox virus. The vaccination method developed by Edward Jenner in 1796 used live cowpox, a much milder disease, and the vaccinated individual never developed an actual case of smallpox. Inoculated individuals, on the other hand, were contagious and could infect vulnerable people with natural smallpox.27

Once introduced in Boston in 1721, inoculation caused severe controversy. Having learned of the procedure from an account in the Philosophical Transactions of the Royal Society of London, as well as from his African slave Onesimus, the Reverend Cotton Mather sought to introduce the procedure in Boston. He had the support of several prominent ministers.28

Responding to Mather’s inquiries, Dr. Zabdiel Boylston and two other physicians inoculated a total of 287 people in Boston and nearby towns during the outbreak.29 Opposing inoculation were the Boston selectmen, the majority of the town’s inhabitants, and many of Boston’s physicians, led by Dr. William Douglass. Bostonians questioned the safety of the procedure, both for recipients and those who came in contact with them, as well its religious acceptability.30

Meanwhile, debates over the procedure pitted various sources of authority against each other, with the town’s doctors, ministers, and selectmen vying for the final say over the safety of

27 On inoculation and vaccination, see Fenn, Pox Americana, 31-33. 28 Kass, “Boston’s Historic Smallpox Epidemic,” 9-11. 29 Blake, Public Health, 61, Appendix I Table I. 30 Blake, Public Health, 63; John B. Blake, “The Inoculation Controversy in Boston: 1721-1722," The New England Quarterly 25, no. 4 (Dec., 1952):489-506; “To the Printers,” Boston Gazette and Boston News-letter, March 8, 1764, accessed July 15, 2014, Readex: America’s Historical Newspapers (105B58842FB904FD). This was a reprint of Rev. William Cooper’s noted 1721 summary of and response to religious objections to inoculation.

inoculation and whether it would be allowed in Boston.31 By the close of the 1721 epidemic, the selectmen prohibited Boylston from performing any more inoculations, and some Bostonians petitioned the Massachusetts General Court to pass legislation banning the procedure in the colony. However this did not occur.32

Though never free of controversy, inoculation increasingly became part of smallpox prevention and public health responses to outbreaks in Massachusetts. In the years after 1721,

Bostonians observed inoculation’s success and comparatively low mortality rate as it was used in

Boston and in other locations such as New York, South Carolina, and most famously,

Philadelphia.33 In Boston itself, only six of the 287 people inoculated in 1721 died. In 1730, 400

Bostonians were inoculated, of whom 12 died.34 In 1752, 2,124 Bostonians inoculated, with only

14 deaths. While only about 1.2% of Boston’s population was inoculated in 1721, by 1764 roughly 29.5% of Bostonians were inoculated. In 1792, the year of the last smallpox epidemic in

Boston prior to the introduction of vaccination, about 42% of Bostonians were inoculated during the epidemic.35 Public debates demonstrated Bostonians’ increasing acceptance of inoculation, particularly following the 1764 epidemic and the Revolution.36 As Blake argues, inoculation remained controversial and popular acceptance of the procedure developed slowly. However, by

31 On ministers versus selectmen, see Blake, “Inoculation Controversy,” esp. p. 503-505; On ministers versus doctors, see especially Perry Miller, “The Judgment of the Smallpox,” chap. 21 in The New England Mind: From Colony to Province (Cambridge, MA: Harvard University Press, 1953). 32 Kass, “Boston’s Historic Smallpox Epidemic,” 30; Blake, Public Health, 62. 33 On publication of inoculation statistics proving its efficacy to the public, see Carl Bridenbaugh, Cities in Revolt: Urban Life in America, 1743-1776 (New York: Knopf, 1955), 129. For an overview of the changes in acceptance of inoculation over the eighteenth century, see John B. Blake, “Smallpox Inoculation in Colonial Boston,” Journal of the History of Medicine and Allied Sciences 8, no. 3 (1953): 284-300. 34 On 1730 and statistical evidence pointing to the safety of inoculation, see Blake, “Smallpox Inoculation in Colonial Boston,” 288-289. 35 All statistics from Blake, Public Health, Appendix I Table I, p. 243-246. Blake’s figures come from a variety of sources, including the writings of William Douglass, the Selectmen’s reports, the reports of Thomas Pemberton and Lemuel Shattuck, and censuses. Blake adjusted some inoculation figures to account for non-residents inoculated in Boston during outbreaks and for discrepancies in sources. 36 Based on contemporary newspapers and Blake, “Smallpox Inoculation in Colonial Boston,” 295-296; Blake, Public Health, 140.

the 1760s, Bostonians were more accepting of its merits, and by the years following the

Revolution, inoculation was viewed less as a “last resort,” as it once had been, and more as a procedure to be utilized when smallpox threatened the town.37

Even though inoculation increasingly became part of measures taken to combat smallpox, it remained highly controversial. While some saw inoculation as a way to shield the town from smallpox, others saw the procedure as a dangerous threat to the town that could spark a widespread outbreak. All sought to protect the town and the health of its inhabitants, but inoculation divided the community over how this could best be accomplished. Provincial and town officials passed legislation to regulate the use of inoculation. In the first half of the eighteenth century, in the absence of an outbreak that sickened more than twenty families,

Bostonians could not legally inoculate. This created unequal access to the procedure. Wealthier

Bostonians could travel to the Middle colonies, where inoculation rules were much less strict.38

Massachusetts allowed inoculation hospitals starting in 1764, but inoculation outside of the hospitals was forbidden unless more than twenty families were sick.39 For most Bostonians, inoculation hospitals were prohibitively expensive in terms of both time and money.40

Inoculation and its regulation proved highly contentious as officials, families, and the broader

37 Blake, “Smallpox Inoculation in Colonial Boston,” 295-296. 38 Fenn, Pox Americana, 38-42. 39 Blake, Public Health, 92-93, 128; “An Act Impowering The Justices Of The Court Of General Sessions Of The Peace In The Several Counties In This Colony to Permit One Or More Inoculating Hospitals To Be Erected In Each Of The Said Counties,” in The Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 5, Acts 1769-1780 (Boston: Wright and Potter, 1886; Internet Archive, 2009), 554-555, https://archive.org/details/actsresolvespass6980mass; An Act In Addition To And For Amendment Of An Act, Pass’d In July, A. D. 177C, Intitled “An Act for Impowering The Justices Of The Court Of General Sessions Of The Peace In The Several Counties In This State To Permit One Or More Inoculating Hospitals In Each Of The Said Counties,” in Acts and Resolves 5: 633-635. 40 See Fenn, Pox Americana, 39-43; Blake, Public Health, 114; Andrew M. Wehrman,“The Contagion of Liberty: Medicine, Class, and Popular Politics in the American Revolution” (Ph.D. diss., Northwestern University, 2011), 70, Proquest (3456623).

community sought to protect the town from smallpox and determine if and how inoculation could be used to protect the community as a whole.41

Historiography

Scholarship on eighteenth-century North American smallpox epidemics is generally oriented around two seminal events: the Boston inoculation controversy of 1721 and the

American Revolution. The inoculation controversy of 1721 has been highly studied.42 Earlier studies, such as those of John B. Blake and Perry Miller, underscore the conflict of authority between ministers, doctors, and officials. Blake argues that too much attention has been given to the religious aspect of the controversy and contends that the town’s primary concern was the safety of the procedure. The conflict, according to Blake, underscored physicians’ desire to secure authority over the town’s health. Meanwhile Cotton Mather sought to maintain the authority of the minister over all aspects of town life, an effort that angered many Bostonians.43

Miller argues that the conflict ultimately undermined the authority of the ministers as Mather’s pro-inoculation arguments were couched in ideas of sin that overturned traditional conceptions of the Puritan covenant doctrine.44 More recently, Margot Minardi analyzed the racial components

41 Blake, “Smallpox Inoculation in Colonial Boston,” 284. 42See for example: Blake, Public Health; Blake, "The Inoculation Controversy in Boston 1721-1722," 489-506; Kass, “Boston’s Historic Smallpox Epidemic,” 1-51; Miller, “The Judgment of the Smallpox,” in The New England Mind, 344-366; Ola Elizabeth Winslow, A Destroying Angel: The Conquest of Smallpox in Colonial Boston (Boston, MA: Houghton Mifflin Company, 1974); On the 1721 controversy and race, see for example Thomas H. Brown, “The African Connection: Cotton Mather and the Boston Smallpox Epidemic of 1721-1722,” Journal of American Medicine 260, no. 15 (Oct. 1988): 2247-2249; Margot Minardi, “The Boston Inoculation Controversy of 1721-1722: An Incident in the History of Race,” The William and Mary Quarterly 61, no. 1 (January 2004): 47-76, http://www.jstor.org/stable/3491675; Kelly Wisecup, “African Medical Knowledge, the Plain Style, and Satire in the 1721 Boston Inoculation Controversy,” Early American Literature 46, no. 1 (2011): 25-50; For the 1721 controversy in the larger historical and scientific context of smallpox and its eradication, see for example Donald R. Hopkins, The Greatest Killer: Smallpox in History, with a new introduction (Chicago: University of Chicago Press, 2002); Gareth Williams, Angel of Death: The Story of Smallpox (Basingstoke: Palgrave Macmillan, 2010). 43 Blake, “The Inoculation Controversy, 1721-1722,” chap. 4 in Public Health”; Blake, “The Inoculation Controversy in Boston 1721-1722,” see esp. p. 499-500, 503-505. 44 Miller, New England Mind, 363-366.

of the controversy, arguing that white colonists questioned inoculation in part because of its

African roots.45

Beyond 1721, existing literature primarily focuses on smallpox and the American

Revolution. Elizabeth Fenn and Ann M. Becker trace the impact of smallpox on the war effort.

Fenn’s Pox Americana examines the North American epidemic that raged from 1775-1782. She argues that this epidemic reveals continental connections far beyond the eastern seaboard. Noting the infrequency of smallpox outbreaks and unequal access to inoculation, Fenn concludes that by the Revolution, smallpox “had emerged as a distinctly American affliction” with the potential to cripple the Continental Army.46 Becker similarly highlights the troubles smallpox caused the

American forces, as it hindered their ability to attract and retain healthy troops, weakened

Continental forces, and pushed General George Washington to adopt the risky and controversial practice of inoculation for his troops.47

Other scholarship on smallpox and the Revolution has focused on the social impact of the war and disease. Blake, studying the development of Boston’s public health measures from

1630-1822, views the Revolution as a critical time in the development of popular sentiment towards inoculation, as the Revolutionary era saw more lower class Bostonians support inoculation despite their earlier opposition.48 Andrew Wehrman argues in his recent dissertation

“The Contagion of Liberty” that on the eve of the Revolution, Americans claimed inoculation as their own unique invention superior to British medicine. Everyday Americans, he posits, increasingly demanded equal access to inoculation and challenged the town’s elite residents as

45 Minardi, “An Incident in the History of Race,” 47-76. 46 Fenn, Pox Americana, 46. 47 Ann M. Becker, “Smallpox in Washington’s Army: Strategic Implications of the Disease During the American Revolutionary War,” The Journal of Military History 68, no.2 (April 2004): 381-430, DOI: 10.1353/jmh.2004.0012. 48 Blake, Public Health, 140.

ideas about health interacted with political currents and ideas.49 Jeffrey M. Weir argues that inoculation threatened the American Revolutionary cause not only because of the danger it posed to the health of soldiers, but also because it was a “flashpoint for contention, conflict, and the reordering of social boundaries.”50

This study seeks to examine the broader effects of smallpox on eighteenth-century

Boston beyond the 1721 epidemic and independent of the American Revolution. It focuses primarily on epidemics that occurred from 1730 (the first outbreak after 1721) to 1792 (the final outbreak before the introduction of vaccination). Though the 1721 controversy and the

Revolution undoubtedly influenced Boston’s experience with smallpox epidemics, the cumulative effects of smallpox and inoculation on Boston’s politics, economy, and society were felt throughout the eighteenth century and were significant in their own right. Studying not only the regulatory apparatus but also the conceptualization of smallpox in the broader community and the household provides a more complete picture of how Bostonians protected their town against smallpox. It reveals that, despite the myriad changes that occurred over the long eighteenth-century, there endured a commitment to protect the community from the dangers of smallpox, expressed through rhetoric and action emphasizing the health and wellbeing of the whole.

Chapter Outline

Chapter one provides an overview of the development of Boston’s smallpox response system, including its regulation of inoculation. Over the course of the seventeenth and eighteenth

49 See Wehrman, “Contagion of Liberty,” 3-4. 50 Jeffrey Michael Weir, "A Challenge to the Cause: Smallpox Inoculation in the Era of American Independence, 1764 to 1781" (Ph.D. diss., George Mason University, 2014), Abstract (unnumbered), Proquest (3624982). [No relation to author.]

centuries, officials developed a public health system codified in law.51 A hallmark of

Massachusetts provincial legislation was strict regulation of inoculation and inoculation hospitals. Despite the growing popularity of inoculation and evidence of its efficacy, these strict regulations endured throughout the eighteenth century. Boston officials were reluctant to allow inoculation during outbreaks, even when provincial law permitted it. To explain their hesitation, historians such as Andrew Wehrman and Carl Bridenbaugh frequently highlight the loss of trade the town would endure as well as the costs the town endured to pay for medical care, hospital costs, and by 1764, inoculating the poor.52

However, as chapter one argues, Boston officials’ determination to halt the spread of smallpox came from more than worry over the short-term economic impact of smallpox, though this certainly was a concern. As the eighteenth century progressed, Boston encountered growing economic woes and increasing poverty.53 Officials recognized that smallpox would exacerbate existing economic struggles and potentially result in permanently lost trade. The precedent of inoculating the poor for free set in 1764 only increased the costs the town bore. Existing scholarship, though acknowledging Boston’s provision of inoculation for the poor, underemphasizes the extent to which this issue contributed to officials’ conceptualization of the threat of smallpox. Chapter one highlights how alongside concerns about trade and business were consistent concerns over how the town would provide for its poorest members, particularly since epidemics weakened the town’s charitable system. Such an understanding is necessary to more fully comprehend both the selectmen’s regulatory efforts to protect the town and the wider

51 Blake, Public Health, esp. p. 36, 150. 52 Wehrman, “Contagion of Liberty,” 70-71; Bridenbaugh, Cities in Revolt, 327. 53 Gary B. Nash, “Poverty and Politics in Early American History,” in Down and Out in Early America, ed. Billy G. Smith (University Park, PA: Pennsylvania State University Press, 2004), 3, 10.

community’s perception of the common good during outbreaks. Additionally, chapter one highlights the often-overlooked tension between sources of authority over Boston’s regulatory policies. The literature, such as Blake’s Public Health in the Town of Boston, primarily focuses on the selectmen, blurring the distinction between provincial and town authority and largely understating the political power of the inhabitants themselves. As chapter one highlights, Boston officials were beholden to provincial law and the will of the town, which at times created conflict. This underscores how Boston operated as a distinct community with its own unique challenges, controversies, and conceptions of the threat of smallpox.

Chapter two examines the town’s perceptions of smallpox outbreaks and their overlap with official policy. Recent scholarship has sought to reorient smallpox within the social and political currents of the eighteenth century. Wehrman highlights the class conflict and growing demands for equality elicited by unequal access to inoculation.54 In his 2014 dissertation, Weir argues that inoculation became a method of “class preservation and class emulation,” while class conflict could be eased with free inoculation.55 He argues that doctors and hospital proprietors helped make inoculation an exclusive procedure, thereby contributing to social inequities.56

Chapter two looks beyond class to adopt a broader community perspective. Though communities could be defined in different ways, such as geographic borders, ethnicity, or kinship, during outbreaks the town became the dominant marker of community.57 In conceptualizing the threat of smallpox, Bostonians framed their discussion of policies and personal conduct based on the idea that the good of the town was of the utmost importance. Blake argues that Boston’s public

54 Wehrman, “The Siege of ‘Castle Pox,’” chap. 3 in “Contagion of Liberty” ; Andrew M. Wehrman, “The Siege of ‘Castle Pox’: A Medical Revolution in Marblehead, Massachusetts, 1764-1777,” The New England Quarterly 82, no. 3 (September 2009): 385–429. http://www.jstor.org/stable/25652028. 55 Weir, “Inoculation at the Intersections of Class,” chap. 2 in “Challenge to the Cause,” see especially pp. 99, 103, 109, 111, 127. 56 Weir, “Challenge to the Cause,” 90. See pages 69-99 for Weir’s discussion of the inoculation hospital industry. 57 On definitions of community, see Marsha L. Hamilton, Social and Economic Networks in Early Massachusetts: Atlantic Connections (University Park, PA: Pennsylvania State University Press, 2009), 15-17.

health policies underscore a societal idea of the individual’s responsibility to his or her community.58 In evaluating these policies, he concludes that “[t]o all these measures the people gave wholehearted support.”59 Chapter two reveals, however, the complex controversies that continuously surrounded smallpox and inoculation policies. Nevertheless, it demonstrates that conceptions of community and community responsibility endured despite the lack of unanimous support for official policies. In the eyes of some Bostonians, inoculation regulations did protect the common good, and thus had to be upheld. For others, these regulations harmed the least affluent sectors of society, and those citizens, like the wealthy or even the selectmen themselves, who ignored the plight of the less affluent were violating their responsibility to uphold the good of the whole. Inhabitants on both sides of the inoculation debate couched their arguments in appeals to the wellbeing of the entire town. By emphasizing the good of the whole community,

Bostonians provided another layer of protection to the town.

Chapter three explores the intersection between smallpox outbreaks, public health policy, and the household. This has been largely unexamined in existing scholarship. Sara Stidstone

Gromin argues that inoculation was incorporated into traditional structures of domestic healing in New York because of the commercialization of inoculation and the spread of literature detailing how to inoculate.60 Weir, studying the broader thirteen colonies, examines gender roles in what he terms the “inoculation industry.” He argues that mothers in particular were expected to inoculate their children or risk failing in their motherly duty. He contends that inoculation both challenged and reinforced existing gender roles, for women could participate in the industry but

58 Blake, Public Health, 115-116. 59 Ibid., 116. 60 Sara Stidstone Gronim, “Imagining Inoculation: Smallpox, the Body, and Social Relations of Healing in the Eighteenth Century.” Bulletin of the History of Medicine 80, no. 2 (Summer 2006): 263-268. doi:10.1353/bhm.2006.0057.

in a secondary role.61 Chapter three argues that in Boston, unlike in New York, smallpox and inoculation regulation brought healing into the political realm, challenging the traditional sphere of domestic healing. Bostonians railed against policies that forced the sick from their homes into a hospital, and they objected to town policies that prevented them from protecting their families.

By 1792, calls for inoculation focused largely on the need to protect the children of Boston.

Here, particular emphasis was placed on men’s role as protectors of their families, in contrast to the maternal emphasis Weir posits. Policy decisions about smallpox response measures were made in the political sphere and thus challenged women’s traditional role as overseers of their families’ health. However, women retained their decision-making power regarding their and their families’ health, and they often defied the wishes of their husbands and town officials in the process. When regulations prevented parents from taking action to preserve the health of their children, the town was expected to fulfill this duty, thus linking the household with the regulatory and community protective layers. By examining not only the regulatory but also the community and household response to smallpox, this thesis provides new depth to our understanding of a community in crisis.

61 Weir, “Challenge to the Cause,” 152, 159, 168.

Chapter One: Official Public Health Measures and the Complex Threat of Smallpox

Introduction

On March 12, 1764, the freeholders of Boston met at Faneuil Hall for their annual town meeting. On the meeting’s agenda was, among various topics of town business, the election of the town’s selectmen, Overseers of the Poor, and numerous other town officials.1 However, at this particular meeting, the town also needed to discuss an issue of particular concern: the use of inoculation to protect the town from a smallpox outbreak that began two months prior.2 For those two months, the selectmen had enforced strict isolation and quarantine measures to stem the outbreak, and the General Court banned a general inoculation in the town unless thirty families fell ill.3 Now, with the number of infected families climbing, the town voted that “ALL

Persons…[to] be allowed to be inoculated for the Small-Pox before the 20th of April next.”4

After April 20th, however, inoculation would cease and the selectmen would commence

“cleansing and freeing the Town from Infection.”5 Under the oversight of the selectmen and with legal permission from the province and town, nearly 5,000 Bostonians were inoculated for smallpox.6

Such a scene underscores several central characteristics of Boston’s eighteenth-century experience with smallpox outbreaks and, after 1721, inoculation. As historian John B. Blake

1 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 49-50. 2 Ibid., 50. 3 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 18; “An Act to Prevent, If Possible, the Further Spreading of the Small-Pox in the Town of Boston,” in The Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 4, Acts 1757-1768 (Boston: Wright and Potter, 1881; Internet Archive, 2009), 668, https://archive.org/details/actsresolvespass5768mass.On Selectmen isolation and quarantine, see Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 1-51. 4 On town vote: “By a Vote of the Town at the Above,” The Boston Evening-Post, March 19, 1764, accessed July 14, 2014, Readex: America’s Historical Newspapers (108B71ADE8C977A0). 5 Ibid. 6 Blake, Public Health, Appendix I, Table I, 244.

chronicles in Public Health in the Town of Boston, throughout the eighteenth century Boston developed a public health system to confront contagious diseases, both epidemic and endemic, as well as health and sanitation issues.7 In the case of smallpox, this was accomplished largely through provincial legislation that established overarching quarantine, isolation, and inoculation regulations while leaving substantial authority to Boston officials and voters to execute the laws.

Throughout the eighteenth century, considerable swaths of Boston society remained susceptible to smallpox. Smallpox, be it natural or inoculated, had the potential to spark a long-lasting, widespread outbreak.8 For officials in Boston, smallpox posed a serious threat to the wellbeing of the town not only in its potential to disfigure and kill, but also in the severe economic costs it imposed on the town, already struggling from economic difficulties and growing poverty. These costs stemmed not only from lost business, but also from efforts to aid the poor. Meanwhile, provincial law and the need to obtain town approval of smallpox prevention measures meant that

Boston officials had limited power to independently change smallpox policies, even when they thought such changes were a necessity. Over the course of the eighteenth century, Boston and

Massachusetts more generally refined smallpox regulations to protect the town from smallpox and manage the use of inoculation, which itself could be a threat to the town. Throughout this period and its myriad public health policy changes, smallpox and inoculation continued to present a complex threat to the town, endangering lives and the economy, particularly given its impact on Boston’s least fortunate inhabitants.

7 Blake, Public Health. 8 Fenn, Pox Americana, 27-28, 39; Blake, Public Health, 111-113; Roslyn Stone Wolman, “A Tale of Two Colonial Cities: Inoculation Against Smallpox in Philadelphia and in Boston.” Transactions & Studies of the College of Physicians of Philadelphia 45, no. 6 (October 1978): 344.

Public Health Measures Prior to Inoculation

Decades before the famous inoculation controversy of 1721-1722, the Massachusetts

General Court and town officials took action to prevent the spread of contagious disease and improve health. In seventeenth-century Massachusetts, conceptions of epidemics rested on a spiritual understanding of disease. God sent epidemics to punish the sinner or the entire impious community. Important methods of defense were fasting, prayer, and religious devotion, and the province’s doctors were often its ministers.9 As Blake argues, official action to contain disease was, to an extent, restrained by religious beliefs about sickness.10 However, as the late seventeenth century stretched into the early eighteenth, the provincial and Boston town government increasingly took action to combat disease and deadly epidemics. These efforts included provisions to improve overall sanitation through official oversight of sewer systems and public wells (though enforcement proved an enduring issue) and laws regulating trades deemed dangerous to the public health.11 Boston officials also attempted to improve street cleanliness through street refuse removal rules, though controversies over cost and who was responsible for cleaning the streets created challenges.12

In addition to these measures to improve overall sanitation, government officials crafted procedures, such as quarantine and isolation requirements, to confront contagious disease. Such efforts would not have been foreign to colonists, as many regulations originated in earlier

European methods to prevent the spread of illnesses such as plague and leprosy.13 Though epidemics came from God, Massachusetts officials recognized that infectious disease traveled on earthly sources, particularly ships. In a break with English methods of periodic quarantine during

9 Blake, Public Health, 21; Kass, “Boston’s Historic Smallpox Epidemic” 3. 10 Blake, Public Health, 5. 11 Ibid., 27-29. 12 Ibid., 30-31. 13 Ibid., 10-12.

outbreaks, the Massachusetts General Court passed “An Act for the Better Preventing of the

Spreading of Infectious Sicknesses” in 1699. This law required that the health status of all ships be determined at a designated fort. Those ships found to be harboring contagious disease were not allowed to proceed beyond this checkpoint unless they had special permission from the governor or two justices of the peace; any sick person aboard could not leave the ship without permission. Those violating the act faced stiff fines or forced isolation. When British officials rejected the law, Massachusetts officials revised the law in 1701 to continue to allow authorities to prevent infected ships from docking.14

Though quarantine measures applied to the entire province, Boston became the epicenter of Massachusetts’ preventative health measures. In 1717, the province constructed an isolation hospital on Spectacle Island in Boston Harbor. All infected ships were required to stop at

Spectacle, and those that instead sought another port could be ordered to Boston harbor for isolation. Though the province paid for the hospital and its expenses, the Boston selectmen oversaw its operation.15 Nor was official action limited to regulating disease brought through maritime trade. Further regulations allowed officials to isolate denizens of Massachusetts who had infectious diseases like smallpox, and officials could demand caretakers, supplies, and shelter for the sick.16 Thus, by the late seventeenth century, provincial and town officials had not only established their role in combating public health crises, but had also developed early quarantine and isolation systems to prevent the spread of diseases such as smallpox. These systems were codified in law and carried out through a developing infrastructure of hospitals and checkpoints.17

14 Blake, Public Health, 32-33. 15 Ibid., 35. 16 Ibid., 33-34. 17 Ibid., 36.

The 1721 Inoculation Controversy

The late seventeenth and early eighteenth centuries laid the foundation for provincial and town regulations to address the potential spread of infectious disease. The introduction of smallpox inoculation in Boston in 1721 radically changed the methods available to prevent smallpox outbreaks. It set the stage for the attitudes and policies that would influence Boston’s experiences with smallpox until the introduction of vaccination in 1800.18 The 1721 controversy encompassed concerns over the safety and medical soundness of inoculation, as well as charges that inoculation defied God’s will by sickening the healthy and placing faith in an earthly rather than divine source.19 Several town ministers, led by Cotton and Increase Mather, sought to counter such religious qualms. In November 1721, the Reverend William Cooper wrote a cogent response to religious objections to inoculation, which would be reprinted in future outbreaks. He argued that inoculation was acceptable because God provided inoculation as a way to escape the scourge of smallpox. Provided people still approached the procedure “with many Prayers to

God, and other suitable Expressions of Trust and Devotion,” they could inoculate with a clear

18 Throughout this work, I refer to variolation as inoculation in order to match the terminology used by eighteenth- century Bostonians. When they spoke of inoculation, they meant variolation, or inoculation with the variola virus. On inoculation and vaccination, see Fenn, Pox Americana, 31-33. On the 1721 outbreak, see for example: Blake, Public Health; Blake, "The Inoculation Controversy in Boston: 1721-1722," 489-506; Kass, “Boston’s Historic Smallpox Epidemic,” 1-51; Miller, “The Judgment of the Smallpox,” in The New England Mind, 344-366; Ola Elizabeth Winslow, A Destroying Angel: The Conquest of Smallpox in Colonial Boston (Boston, MA: Houghton Mifflin Company, 1974); On the 1721 controversy and race, see for example Thomas H. Brown, “The African Connection: Cotton Mather and the Boston Smallpox Epidemic of 1721-1722,” Journal of American Medicine 260, no. 15 (Oct. 1988): 2247-2249; Margot Minardi, “The Boston Inoculation Controversy of 1721-1722: An Incident in the History of Race,” The William and Mary Quarterly 61, no. 1 (January 2004): 47-76, http://www.jstor.org/stable/3491675; Kelly Wisecup, “African Medical Knowledge, the Plain Style, and Satire in the 1721 Boston Inoculation Controversy,” Early American Literature 46, no. 1 (2011): 25-50; For the 1721 controversy in the larger historical and scientific context of smallpox and its eradication see for example Donald R. Hopkins, The Greatest Killer: Smallpox in History, with a new introduction (Chicago: University of Chicago Press, 2002); Gareth Williams, Angel of Death: The Story of Smallpox (Basingstoke: Palgrave Macmillan, 2010). 19 Blake, Public Health, 63; and Blake, “The Inoculation Controversy in Boston: 1721-1722.”

conscience.20 Though religion continued to influence debates, it was not a prominent point of objection to inoculation in future epidemics.

While the religious controversies of inoculation in 1721 have garnered much attention in historical studies, at the heart of the debate was an overarching fear and mistrust of inoculation as a medical procedure, as Blake argues.21 This fear of the dangers of inoculation was particularly important for town officials, who were charged with protecting the town from the looming danger of smallpox. In response to town alarm, the selectmen oversaw a public meeting on July 21, 1721 where they heard testimony on the safety of inoculation. They demanded that

Dr. Zabdiel Boylston, the physician performing inoculations, appear at the meeting. After hearing accounts of the horrors accompanying inoculation, from ulcers to tumors and lost limbs to death, the selectmen held that Boylston had endangered the town and demanded he cease inoculating immediately.22 Boylston himself later reflected that the selectmen’s opposition played a significant part in solidifying popular anti-inoculation sentiment.23

As town ministers persistently advocated inoculation, Boylston defied official orders and continued to perform the procedure, inoculating over 100 people in November alone.24 As people from surrounding towns like Roxbury and Charlestown came to Boston to inoculate, Boston officials demanded their isolation or removal from the town, lest Boston become a smallpox haven.25 By April, the epidemic began to subside, but still Boylston inoculated at the request of a town merchant. The town again turned to its officials and a town meeting, where Boylston swore

20 “To the Printers,” Boston Gazette and Boston News-letter, March 8, 1764, accessed July 15, 2014, Readex: America’s Historical Newspapers (105B58842FB904FD). This was a reprint of Reverend William Cooper’s noted 1721 summary of and response to religious objections to inoculation. The printer notes that it was also reprinted in 1730. 21 Blake, Public Health, 64; Blake, “Inoculation Controversy,” 499. 22 Kass, “Boston’s Historic Smallpox Epidemic,” 16-17; Winslow, Destroying Angel, 50. 23 Kass, “Boston’s Historic Smallpox Epidemic,” 17. 24 Ibid. 29. 25 Blake, Public Health, 60.

to cease inoculating unless he received express permission from town authorities. Bostonians also called upon the Massachusetts General Court to pass a ban on inoculation in all towns in the province unless the town selectmen gave approval.26 The “Bill to prevent the Spreading of the

Infection of the Small-Pox by the practice of Inoculation” passed the House, but it failed to gain favor with the Governor and Council and never became law.27 Though this and later calls for legislation banning inoculation failed, a lively discourse arose over who should have authority over smallpox decisions. Notably, the town ministers were charged not only with promoting a dangerous procedure, but also with trying to usurp power that lay with the selectmen and General

Court.28 Thus, the 1721 epidemic not only introduced inoculation and a vigorous controversy over its use, but it also gave town and provincial officials authority over the conflict.29 Decisions about smallpox outbreaks and inoculation would not be left to individual choice or even ministers and doctors acquainted with the body and religious conceptions of disease. Rather, in

Boston smallpox was to be prevented and inoculation regulated through legislation and government oversight.

Post-1721 and the Evolution of Smallpox Policies and Legislation: An Overview

Though 1721 is often referred to as “the inoculation controversy,” its conclusion in no way heralded the end of smallpox outbreaks in Boston and inoculation debates. Over the next eighty years, Bostonians continued to grapple with the threat of smallpox and the controversies of inoculation. In earlier decades, the town remained divided over inoculation, but much attention was given to ascertaining its safety. In January 1730, an excerpt from a London

26 Kass, “Boston’s Historic Smallpox Epidemic,” 30; Blake, Public Health, 62. 27 Kass, “Boston’s Historic Smallpox Epidemic,” 30; Blake, Public Health, 62. 28 Blake, “Inoculation Controversy in Boston: 1721-1722,” 503-505. 29 Weir, “Challenge to the Cause,” 65.

publication by one Dr. Fuller appeared in Boston during its first outbreak of smallpox since

1721. Dr. Fuller attempted to explain not only why smallpox acquired via inoculation was less severe, but also why inoculation was preferable to contracting the virus naturally. Here,

Bostonians were promised that inoculation “never (except in cases of unfitness of bodies, or bad management) causeth much trouble or sickness,” all while allowing people to choose who would undergo the procedure and the most advantageous time to do so.30 Whereas in the 1721 epidemic

Bostonians had no direct experience to verify positive accounts of inoculation, as the decades passed there was epidemiological evidence to influence policy decisions.31 Boylston reported that in 1721, of the 287 people inoculated, only six died.32 In 1730, the town ordered that inoculating physicians report weekly to the town clerk or selectmen so as to keep record of who was inoculated and how they fared.33 Throughout the remainder of the eighteenth century, officials tracked outbreaks, differentiating between those who contracted and died of natural smallpox versus inoculated smallpox, thus providing evidence of inoculation’s efficacy.34

30 New England Weekly Journal, January 5, 1730. accessed July 17, 2014., Readex: America’s Historical Newspapers (108C9AB3917880F0). 31 On statistical evidence of inoculations’ success, see John Duffy, Epidemics in Colonial America (Port Washington, NY: Kennikat Press, 1972), 34-36; Philip Cash, “The Professionalization of Boston Medicine, 1760- 1830,” in Medicine in Colonial Massachusetts, 1620-1820, vol. 57 of Publications of The Colonial Society of Massachusetts (Boston: Colonial Society of Massachusetts, distributed by University of Virginia, 1980), 73. For epidemiological statistics, see Blake, Public Health, Appendix I, Table I. 32 Blake, Public Health, 242-245, Appendix I, Table I. 33 New England Weekly Journal, March 16, 1730, accessed July 12, 2014, Readex: America’s Historical Newspapers (108C9AC03B609790); Record Commissioners of the City of Boston, A Report of the Record Commissioners of the City of Boston Containing the Boston Records from 1729 to 1742 (Rockwell and Churchill, 1885; Internet Archive, 2010), http://www.archive.org/details/recordsrelating12bost; Blake, Public Health, 76.

34 See, for example, A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1742/43 through 1753, vol. 17, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1889; Internet Archive, 2007), 283, https://archive.org/details/recordsrelatingt17bost; Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 80; A Report of the Record Commissioners of the City of Boston, Containing the Boston Town Records from 1770 through 1777, vol. 18, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1887; Internet Archive, 2007), 240, https://archive.org/details/recordsrelatingt18bost; A Volume of Records Relating to the Early History of Boston, Containing the Boston Town Records from 1784 through 1796, vol. 31, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1887; Internet Archive, 2007), 306, https://archive.org/details/volumeofrecordsr31bost; For a summary of these statistics, see Blake, Public Health,

Reports also circulated of successful inoculation in other parts of the colonies.35 The

New-England Weekly Journal reported in February 1730 that on Long Island, 160 people were inoculated with no deaths, while half of those who contracted smallpox naturally died.

Meanwhile, the article continued, in New Brunswick, New Jersey, those who were inoculated survived and had “the Distemper very easy.”36 Whether these statistics were accurate, still they emphasized the safety of inoculation and its favorability over contracting natural smallpox. In

1738, James Kilpatrick famously inoculated people during a smallpox outbreak in South

Carolina, with considerable success, though still the procedure was not highly popular. First introduced in Philadelphia in 1730, inoculation was increasingly used in that city, as reported by inoculation’s famous champion, Benjamin Franklin.37 By 1759, Franklin deemed inoculation an

“uncontroverted success.”38

Despite evidence and accounts of the safety of inoculation, it remained controversial and the Massachusetts General Court took steps to limit its use, particularly in the first half of the eighteenth century. With no official ban on inoculation in place in 1730, Bostonians called for town action to adopt “proper Methods for preventing the Spreading [of the] Small Pox by

Inoculation.”39 As the number of people infected continued to rise, some Bostonians began to

Appendix I, Table I. Elaine G. Breslaw argues that statistical evidence was important but had limited ability to convince many in the medical community during the earliest uses of inoculation of its safety, for the profession did not yet rely as much on statistical evidence. Lotions, Potions, Pills, and Magic: Health Care in Early America (New York: New York University Press, 2012), 35. 35 See also Bridenbaugh, Cities in Revolt, 129; Blake, Public Health, 82. 36 New England Weekly Journal, February 7, 1732, accessed November 12, 2014, Readex: America’s Historical Newspapers (108C9B4387CB48F8). A 50% mortality rate for natural smallpox would be high—historically smallpox had a 30% mortality rate, though it could be higher or lower depending on the outbreak. 37 Blake, Public Health, 82. 38 Benjamin Franklin, “Preface to Dr. Heberden’s Pamphlet on Inoculation, 16 February 1759,” April 1, 1758, through December 31, 1759, Vol. 8 of The Papers of Benjamin Franklin, ed. Leonard W. Labaree (New Haven and London: Yale University Press, 1965), 281–286. Founders Online. National Archives. Accessed January 12, 2015. http://founders.archives.gov/documents/Franklin/01-08-02-0073 39 Record Commissioners Containing the Boston Records from 1729 to 1742, 14.

inoculate, leaving officials only the ability to regulate the actions of those already inoculated.40

Thus, they asked inoculated inhabitants to stay off the streets and warn their neighbors that they had undergone the procedure.41 After the outbreak, the General Court passed new legislation,

“An Act to Prevent Persons Concealing the Small-Pox.” The law dictated that the head of the family had to alert selectmen if anyone in the family fell ill with smallpox, and red flags were to hang outside infected homes. Those who violated the terms of the act faced a £50 fine or up to 30 lashes if they refused to pay. The law did not apply in towns with more than 20 families infected.42 This established not only legislation regarding public notification about smallpox infections, but also effectively established the “twenty families rule,” the accepted threshold at which legal inoculation could occur. At that point, the outbreak was considered beyond the control of traditional containment measures. Thus, before twenty families in a Massachusetts town were sick, inoculation would not be practiced.43

In 1742/43, the General Court passed “An Act To Prevent The Spreading Of The Small-

Pox And Other Infectious Sickness, And To Prevent The Concealing Of The Same.” This extended the 1730/31 Act and gave town governments increased authority to guard against smallpox being brought into their town from abroad. With this act, guards could be stationed to bar the entrance of people traveling from infected towns or showing signs of illness. Such persons could only enter with the permission of the selectmen or justices of the peace.44 Thus, by the 1740s, Massachusetts had established its basic policies surrounding smallpox and inoculation: inoculation, despite evidence of its merits, would only be acceptable when more

40 Blake, Public Health, 76. 41 New England Weekly Journal, March 16, 1730, accessed July 12, 2014, Readex: America’s Historical Newspapers (108C9AC03B609790); Report Record Commissioners Containing Boston Records from 1729 to 1742; Blake, Public Health, 76. 42 Acts and Resolves, 2: 621-622 43 Blake, Public Health, 77. 44 Acts and Resolves, 3: 35-37.

than 20 families fell ill, while town selectmen and justices of the peace received more power to enforce traditional methods of quarantine and isolation.

Though Bostonians had mounting evidence from their own experiences and reports from around the colonies that inoculation could be safe and beneficial, the potential to spread smallpox through inoculated individuals was a legitimate and lasting worry.45 Inoculation had been used successfully, though limitedly, in Boston’s 1752 epidemic.46 Compared especially to the middle colonies, Boston and New England in general experienced less frequent outbreaks and this, coupled with limited use of inoculation, meant fewer people had immunity. Thus, when smallpox appeared, it could result in a widespread epidemic.47 In contrast, Philadelphia placed fewer restrictions on inoculation, becoming, as Roslyn Stone Wolman argues, a “center of inoculation” by the 1760s. Even traditional methods of isolation and quarantine were seldom employed.48 Outbreaks occurred more frequently in Philadelphia, but generally they were less severe than outbreaks in Boston, perhaps, Wolman notes, because of their policy differences.49

Contemporaries recognized this contrast. In his 1759 preface to Dr. William Heberden’s pamphlet on inoculation, Benjamin Franklin, an outspoken proponent of the procedure, noted that “in Boston they always keep the distemper out as long as they can, so that when it comes, it finds a greater number of adult subjects” compared to Philadelphia.50 Though Boston experienced fewer outbreaks, when they did appear more people were susceptible. Inoculation could save lives, but it could also cause natural smallpox to tear through a largely vulnerable population.

45 Weir argues that the potential of spreading natural smallpox through inoculation was the “most fervent point of contention with the procedure.” See Weir, "Challenge to the Cause,” 43-44. 46 Over 2,000 Bostonians (out of an estimated population of 15,684) were inoculated in 1752, with a death rate of 14 deaths per 1,000 inoculated cases versus 97 deaths per 1,000 natural cases. Blake, Public Health, 244. 47 Fenn, Pox Americana, 27-28, 39; Blake, Public Health, 111-113; Wolman, “Tale of Two Colonial Cities,” 344. 48 Wolman, “Tale of Two Colonial Cities,” 342, 344. 49 Ibid., 344. 50 Franklin, “Preface to Dr. Heberden’s Pamphlet on Inoculation, 16 February 1759.”

Thus, in 1764, with an outbreak threatening to devastate Boston, the selectmen worried that “some of the inhabitants might go upon the practice of Inoculating their Familys [sic].”51

Because smallpox was spreading primarily around Fish Street, the selectmen were convinced they could stem the outbreak using quarantine and isolation. They requested Thomas Cushing, a representative of Boston in the Massachusetts General Court, to ask the General Court to prevent the use of inoculation in Boston even if the requisite twenty families fell ill. Inoculation, they argued, would “spread [smallpox] all over the Town.”52 Cushing responded that the representatives of Boston would not forward the selectmen’s request, as they thought it “not advisable to make any new Provisions relative to the Small Pox” at present.53 Alarmed, the selectmen expressed their disagreement, writing Cushing that “it [was] of the utmost importance that something should be done by the [General] Court” to prevent mass inoculation.54 The

General Court eventually obliged, passing a law to “prevent the immediate spread of the Small

Pox… by a too hasty Inoculation.”55 According to the law, unless the selectmen gave permission, thirty families were now required to be sick before inoculation could begin, though the law expired after two months.56

While the Selectmen continued to stall the open use of inoculation in Boston, the provincial government, in consultation with the selectmen of the town of Chelsea, allowed for

51 Statistics from Blake, Public, Appendix I; Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 14. 52 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 15. 53 Ibid., 15. 54 Ibid., 16. 55 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 18. “An Act to Prevent, If Possible, the Further Spreading of the Small-Pox in the Town of Boston,” Acts and Resolves, Public and Private, of the Province of Massachusetts Bay, vol. 4, Acts 1757-1768 (Boston: Wright and Potter, 1881; Internet Archive, 2009), 668, https://archive.org/details/actsresolvespass5768mass. 56 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 18. Acts and Resolves, 4: 668; The Boston Post-Boy & Advertiser, January 23, 1764, accessed July 13, 2014, Readex: America’s Historical Newspapers (1089CD129A470D00); Blake, Public Health, 91.

the establishment of an inoculation hospital at Point Shirley, outside of Boston.57 Additionally, the Boston selectmen allowed for inoculation to occur on select harbor islands, including at

Noddle’s Island and Castle William.58 In March, as the number of smallpox cases climbed ever higher, the town finally allowed a general inoculation until April 20.59 When the outbreak subsided, inoculation was once again forbidden. The hospital remained at Point Shirley, but no inoculation hospital existed in Boston itself.60 At the close of the outbreak, the General Court passed additional legislation that forbade anyone from establishing an unauthorized inoculation hospital in Massachusetts, provided for guards to watch over infected houses, and set penalties for anyone who spread smallpox through inattentive or malicious behavior.61

The 1764 outbreak particularly underscores the sources of authority in the creation and execution of smallpox and inoculation policies. Though Boston officials held significant authority over the implementation of smallpox and inoculation regulation, their ability to dictate or change policy was ultimately limited. For the threshold for allowing inoculation to be increased to thirty families, the selectmen needed to apply to the General Court and have provincial legislation passed, which was only done after several urgent requests by the selectmen. Their inoculation policies had to comply with provincial law, and they were powerless to institute new policies contrary to provincial law. Meanwhile, the selectmen were also beholden to town votes—provincial legislation left many inoculation policy decisions to a

57 The Boston Post-Boy and Advertiser, February 13, 1764, accessed July 16, 2014, Readex: America’s Historical Newspapers (1089CD165BC880C8); Blake, Public Health, 93. 58 Blake, Public Health, 93. 59 “By a Vote of the Town at the Above,” The Boston Evening-Post, March 19, 1764, accessed July 14, 2014, Readex: America’s Historical Newspapers (108B71ADE8C977A0). 60 A Report of the Record Commissioners of the City of Boston, Containing the Boston Town Records from 1758 to 1769, vol. 16, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1886; Internet Archive, 2007), 123, https://archive.org/details/recordsrelatingt16bost ; Blake, Public Health, 95-96. 61 “An Act In Addition to an Act, Intitled ‘An Act Providing in Case of Sickness,” Massachusetts Acts and Resolves, 1757-68, p.728-29. To establish an inoculation hospital, one needed town approval. See also Blake, Public Health, 95.

town vote.62 The town meeting was an integral part of life in New England and was the heart of the social-political contract.63 As early as the 1721 controversy, the selectmen held open town meetings to debate inoculation. In 1764, when Boston officials sought to extend the ban on inoculation, Boston’s representatives to the General Court cautioned that they thought no changes to inoculation policy should be made “unless the mind of the Town is known on this

Head.”64 Once prevention was deemed futile, a town vote decided for how long inoculation would be allowed.65

Town opinion was particularly important in decisions regarding inoculation hospitals in

1764. Previously, in 1761 voters rejected Dr. Sylvester Gardner’s bid to build an inoculation hospital in Boston, deciding that there was no location “within the limits of the Town, where such an Hospital can be Erected, consistent with the safety of the Inhabitants.”66 In 1764, voters once again played a decisive role in determining whether inoculation hospitals would be allowed in Boston. As discussed, voters approved a handful of inoculation hospitals on harbor islands.67

However, as the 1764 outbreak drew to a close, Bostonians petitioned to have “the sense of the

Town [may be] known respecting inoculation at Noddles Island.” The town voted to close the hospital, and reiterated that, moving forward, the town should “allow of no Inoculating Hospital” within town limits.68 Thus officials in Boston had to comply with provincial laws and,

62 Donald R. Hopkins argues that inoculation was more strictly regulated in Boston than in Philadelphia because Massachusetts was relatively democratic and the general population feared smallpox, prompting them to oppose the procedure and the government to follow their will. The Greatest Killer, 254. On politicians acting on popular fear of smallpox to establish and enforce regulations, see Blake, Public Health, 108-109. 63 Jacqueline Barbara Carr, After the Siege: A Social History of Boston 1775-1800 (Boston, MA: Northeastern University Press, 2005), 140; Richard D. Brown and Jack Tager, Massachusetts: A Concise History (Amherst, MA: University of Massachusetts Press, 2000), 58. 64 Record Commissioners containing Selectmen’s Minutes from 1764-1768, 15. 65Record Commissioners containing Selectmen’s Minutes from 1764-1768, 50; “By a Vote of the Town at the Above,” The Boston Evening-Post, March 19, 1764, accessed July 12, 2014, Readex: America’s Historical Newspapers (108B71ADE8C977A0). 66 Record Commissioners containing the Boston Town Records, 1758 to 1769, 51-52. 67Record Commissioners containing the Boston Town Records, 1758 to 1769, 102-103; Blake, Public Health, 93. 68 Record Commissioners containing the Boston Town Records, 1758 to 1769, 123; Blake, Public Health, 95.

particularly in the case of inoculation hospitals, also often needed the approval of the town before they could change inoculation policies.

Boston’s next smallpox outbreak occurred during the first two tumultuous years of the

American Revolution. With war comes disease, and smallpox plagued the fighting armies.

However, as historian Elizabeth Fenn argues, smallpox “had emerged as a distinctly American affliction.”69 With smallpox endemic in Britain, American troops and the civilian population, particularly in New England, were much more susceptible than their British adversaries.70

Governor Jonathan Trumbull of Connecticut, writing to General George Washington in July

1776, bemoaned the vulnerability of Connecticut’s Continental troops. “Probably not one in twenty of our men,” he lamented, “have ever had that distemper, when the New York, Jersey, and

Pennsylvania men have generally passed through it.”71 As a result of their susceptibility, he noted, “[t]his distemper strikes a greater dread in our men who have not had it, than the British troops.”72 Trumbull’s comments underscored the lower smallpox immunity rates in New

England compared to other parts of the colonies, as has been previously mentioned. Bostonians’ susceptibility proved particularly problematic in the opening years of the war.

In 1775, with Boston occupied by the British, smallpox began to break out in the town.

General William Howe allowed for the inoculation of British soldiers and those civilians who wished to undergo the procedure, but still the disease spread.73 For Washington, the susceptibility of soldiers and recruits was a strategic weakness, brought into sharp relief by smallpox fatalities endured by the Continental Army during the Canadian campaign of 1775-

69 Fenn, Pox Americana, 46. 70 Fenn, Pox Americana, 27-28, 46-47; Becker, “Smallpox in Washington’s Army,” 403. 71 Governor Jonathan Trumbull to General George Washington, 6 July 1776, in American Archives, ed. Peter Force, 5th series, 1: 45-46, https://archive.org/details/PeterForcesAmericanArchives-FifthSeriesVolume1vol.7Of9 72 Ibid. 73 Carr, After the Siege, 27-28; Fenn, Pox Americana, 49.

1776 and by the siege of Boston.74 With smallpox spreading in the town, Bostonians themselves became a danger to the Continental Army; some suspected them to be unwitting pawns in a

British biological war.75 Refugees from Boston were barred from the Continental camp, and

Washington forbade soldiers from “any sort of intercourse with the people who this day came out of Boston,” for “there [was] great reason to suspect that the smallpox [was] amongst them.”76

The end of the siege brought no relief for the beleaguered town. As refugees returned to the city in 1776, smallpox continued to spread, and eventually the town allowed open inoculation.77

In response to the threat of smallpox during the conflict, in 1776 the General Court allowed private inoculation hospitals to be established with the approval of the justices of the peace, who had the power to regulate the hospitals as they saw fit. Inoculation was not allowed outside of the hospitals unless more than twenty families were sick in the respective town.78

Inoculation hospitals were one of the most controversial aspects of inoculation. They often had prohibitively high prices, lax internal oversight, and they ensured that smallpox would always be present on the geographic fringe of the community. They drew the ire of inhabitants across

Massachusetts and became a feature in town debates, as will be discussed in chapter two. After public outcry over hospital mismanagement, the General Court amended the 1776 act less than one year after its passage. The amended law required the “consent and approbation of such town,

74 Fenn, Pox Americana, 47-54, 62-77; Becker, “Smallpox in Washington’s Army381-430. 75 Horatio Gates to Major General Artemus Ward at Roxbury, 6 December 1775, Miscellaneous Bound Collection, 1774-1775, Massachusetts Historical Society, Boston, MA. Becker, “Smallpox in Washington’s Army,” 399-400; Wehrman, “Contagion of Liberty”; On Boston during the siege, including smallpox outbreak, see Carr, After the Siege, 22-30. 76 Stephan Moylan to Colonel Loammi Baldwin, 4 December 1775, Miscellaneous Bound Collection, 1774-1775, Massachusetts Historical Society, Boston, MA. On refugees and Continental camp, Fenn, Pox Americana, 50. 77 Blake, Public Health, 127; The Continental Journal and Weekly Advertiser, July 18, 1776, accessed April 1, 2015, Readex: America’s Historical Newspapers (10897E98BB709938). Washington eventually instituted a systematic inoculation of all non-immune soldiers and incoming recruits, a process that took over a year to complete. On Washington’s decision to inoculate the Continental Army, see Fenn, Pox Americana, 93-100; Becker, “Smallpox in Washington’s Army,” 422-427; Wehrman, “Contagion of Liberty,” 237-248; On Washington’s decision and resistance of his orders, see Weir, “Challenge to the Cause,” 320-352. 78 Acts and Resolves, 5:554-555; Blake, Public Health, 128.

at a regular town meeting” for an inoculation hospital to be established.79 Additionally, it provided legal authority for the justices of the peace to shut down hospitals not adhering to regulations and established minimum standards of operation for all inoculation hospitals.80

The final major outbreak of smallpox in the eighteenth century occurred in 1792. As in

1764, the selectmen balanced provincial law and town approval when executing public health policies. The authority of provincial law was again highlighted when citizens requested a town meeting to discuss allowing preventative inoculation before twenty families were infected. The selectmen declined; such authority, they argued, did not “lay with the Town … until the number of Houses infected amounted to the number stated by Law.”81 On August 9, “[a] Lengthy Debate took place,” at the conclusion of which the town voted to continue to rely on traditional isolation and quarantine methods.82 Inoculation outside of established hospitals was only allowed two weeks later when, twenty families being sick, the town voted to allow inoculation until

September 15.83 Following the outbreak, the General Court repealed the 1777 hospital laws and replaced them with stricter regulations over hospital operations; inoculation outside of the hospitals continued to be banned if fewer than twenty families were ill.84 Eight years later, Dr.

Benjamin Waterhouse, European-trained professor of physic at Harvard, introduced vaccination in Massachusetts. The era of traditional inoculation with smallpox gradually drew to a close.

79 Acts and Resolves 5: 633-635; Weir argues that this is reflective of a broader move toward democratic process given the political currents of the American Revolution. Weir, “Challenge to the Cause,” 256-261. 80 Acts and Resolves 5: 633-635; Blake, Public Health, 128. 81 A Report of the Record Commissioners of the City of Boston, containing Selectmen’s Minutes, 1787 to 1798 (Boston, MA: Rockwell and Churchill, City Printers, 1896, Internet Archive, 2007), 170-171, http://www.archive.org/details/recordsrelatingt27bost. 82 Volume Records Containing the Boston Town Records from 1784 through 1796, 302. 83 Columbian Centinel, September 1, 1792, accessed July 14, 2014 (1064DA36F20AE885). 84 Acts and Laws of the Commonwealth of Massachusetts 1792-93 (Boston: Wright and Potter Printing Company, 1895; Internet Archive, 2009), 85-88, https://archive.org/details/actsresolvespass179293mass.

The Complex Threat of Smallpox and Inoculation

Thus, between 1721 and 1792, Bostonians weathered six major smallpox outbreaks, developed a public health response to smallpox, and increasingly, though always hesitantly, incorporated inoculation into their protective arsenal. The threats posed by smallpox and inoculation were multifaceted, and thus so too were the motivations behind public health measures and regulations. At their core, these measures were created in response to the danger of smallpox—a contagious, painful, disfiguring, and potentially fatal disease. In the early outbreaks of the eighteenth century, including in 1702, 1730, and 1752, the overall mortality rate in Boston almost doubled, according to Blake’s estimates.85 Though it had the potential to save lives, inoculation itself could be a threat to the community, for inoculated individuals risked infecting vulnerable people with natural smallpox. As the siege of Boston reveals, Bostonians faced potentially widespread outbreaks if smallpox broke out either naturally or through inoculation.86

In addition to the threat to health and safety that smallpox and inoculation posed, they also carried high economic costs. As Carl Bridenbaugh highlights, smallpox outbreaks stalled trade while concurrently requiring the town to spend considerable sums on public health measures and care.87 Gary Nash, tracing broader eighteenth-century economic trends in the

North American colonies, also notes how Boston’s 1752 epidemic resulted in population losses from deaths and people fleeing the town. This in turn decreased the tax base and further burdened Boston’s struggling economy. In 1764, he notes, expenditures on the poor increased as a result of the smallpox epidemic. 88 The particular impact of the outbreaks on business has been

85 Blake, Public Health Town Boston, 107. 86 Fenn, Pox Americana, 27-28, 39; Blake, Public Health, 112-113; Wolman, “Tale Two Colonial Cities,” 344. 87 Bridenbaugh, Cities in Revolt, 327. 88 Gary B. Nash, The Urban Crucible: Social Change, Political Consciousness, and the Origins of the American Revolution (Cambridge, MA and London: Harvard University Press, 1979), 183, 254.

widely noted.89 As both Blake and Andrew Wehrman underscore, these concerns seeped into town debates, particularly regarding inoculation. Merchants and businessmen were not the only townspeople concerned over these economic effects. Throughout the eighteenth century, the economic costs of smallpox and inoculation weighed on officials as they considered the financial troubles already plaguing Boston and the need to care for Boston’s poor during outbreaks.

The Seven Years’ War had left Boston facing inflation and a struggling economy.90 The

Revolution, too, disrupted Boston’s economic outlook.91 Smallpox exacerbated Boston’s economic woes. As historian John Duffy notes, the exact impact of smallpox outbreaks on

Boston’s economy is unclear.92 However, Bostonians themselves were very aware of the disease’s ability to increasingly cripple business, diminish the town’s tax base, and increase government expenses. The prospect of losing business due to lost labor and quarantine laws

(both within Massachusetts and at ports throughout the colonies) loomed large in officials’ minds. Petitioning the General Court for a grant of money or tax reprieve during the 1752 smallpox outbreak, the town noted that “with this Raging Sickness and Losses by Death and

Desertion, there is almost a total decay and Extirpation of Trade & Commerce, the only means of the Town’s Subsistance [sic].”93 The town beseeched the General Court to consider that troubles from smallpox only added to the “Great & Growing Difficulty’s” of the town due to, among other things, the decline in the distilling and ship-building industries and competition from nearby towns such as Nantucket, Salem, and Medford.94 Indeed, smallpox outbreaks in Boston had the potential to cause not only a temporary suspension of business, but also a permanent loss

89 See for example, Blake, Public Health, 86, 137-138; Bridenbaugh, Cities in Revolt, 327; Nash, Urban Crucible, 183; Wehrman, “Contagion of Liberty,” 70-71, 82, 88, 112-113; 90 Nash, “Poverty and Politics in Early American History,” in Down and Out in Early America, 10. 91 Carr, After the Siege, 89. 92 Duffy, Epidemics in Colonial America, 110. 93 Record Commissioners Containing Boston Town Records from 1758 to 1769, 221. 94 Record Commissioners Containing Boston Town Records from 1758 to 1769, 221.

of some business to nearby towns. As residents in Salem noted in 1792, the smallpox outbreak in

Boston could give Salem, then free of the virus, “a considerable accession of business…part of which might be retained for years, and be a permanent benefit.”95 Whether or not such shifts in business actually occurred, the potential for smallpox to permanently weaken business in Boston would have certainly weighed heavily on officials’ decisions. For Boston officials, smallpox dealt an additional, and potentially long-lasting, economic blow to an already struggling town.

By the 1764 epidemic, trade had become an important part of the inoculation debate, particularly when considering whether or not to establish inoculation hospitals. One writer to the

Boston Evening Post reflected on “the damage which the town in general [would] sustain in their trade by the town’s being shut up” due to an outbreak, and argued that inoculation could allow the outbreak to occur so as to be least disruptive to business.96 When inoculation hospitals opened at Point Shirley, officials similarly linked inoculation policies to trade, proclaiming that

“Trade [would] not be liable to such interruptions from it [smallpox]” with the establishment of the hospitals.97 While clearly doctors and hospital proprietors stood to benefit from commercial inoculation, some argued that towns could also benefit from the profits of inoculation.98 Prior to the legalization of smallpox hospitals in Massachusetts, wealthy denizens had traveled to inoculation hospitals in the middle colonies, where these hospitals became a rather booming business.99 Once inoculation hospitals became legal in Massachusetts, a similar connection was made between hospitals and business potential. In nearby Salem, proponents of building an

95 “Small Pox,” The Salem Gazette, September 4, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1084F175C54B3980). 96 “To the Publishers of the Boston Evening-Post,” The Boston Evening-Post, January 30, 1764, accessed July 13, 2014, Readex: America’s Historical Newspapers (108B71A08DE16FB0). 97 Boston Gazette, February 13, 1764, accessed July 13, 2014, Readex: America’s Historical Newspapers (1046ED1487F55037). 98 On doctors making inoculation a business, see Weir, “Challenge to the Cause,” 84-90, 126-127. On similar arguments in Newport, Rhode Island of the town benefitting economically from a hospital, see Bridenbaugh, Cities in Revolt, 329. 99 Fenn, Pox Americana, 40; Weir, “Challenge to the Cause,” 72, 76-78.

inoculation hospital in 1792 argued that “great sums of money [which] would probably be carried from the town” should Salem continue to ban inoculation hospitals while such establishments opened in nearby towns and drew paying customers.100 While this argument failed in Salem, it highlights the integral connection between not only smallpox, but also inoculation and local boosterism during the late eighteenth century.

The economic costs of smallpox extended beyond damage to business and trade.

Provincial regulatory policies, including guarding the homes of the sick, as well as efforts to aid poor and struggling inhabitants, contributed to the costs the town government shouldered during an outbreak.101 The costs of smallpox were compounded in earlier outbreaks by a diminished tax base as a result of people fleeing the town.102 In 1752, officials estimated that in addition to costs from lost population, the smallpox outbreak cost “a Hundred Thousand Pounds old tenor” given the expense of “Physicians Apothecarys [sic], Nurses, Watchers and other Attendants, extraordinary Fire, Candles and other unavoidable Charges.”103 While the accuracy of this estimate is unclear, it highlights some of the various sources of expense during outbreaks. For example, one Widow Gauge was paid 30 shillings a week to nurse the sick in 1752.104 In January

1764, when Isaac Massingham moved his family from their home on Black Horse Lane at the request of the selectmen in order to contain smallpox, the selectmen paid the rent on his home;

100 “Small Pox,” The Salem Gazette, September 4, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1084F175C54B3980). 101 Bridenbaugh, Cities in Revolt, 327. 102 Nash, Urban Crucible, 104, 183; The town recognized this reality in the 1751/52 outbreak, lamenting that many who left Boston during the outbreak may never come back, as this had happened in the previous outbreak of smallpox in Boston. This, they concluded, would result in “Loss to the Town.” A Report of the Record Commissioners of the City of Boston, Containing the Boston Town Records from 1742 to 1757, vol. 14, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1885; Internet Archive, 2007), 220-221, https://archive.org/details/recordsrelatingt14bost. 103 Record Commissioners Containing the Boston Town Records from 1742 to 1757, 220. Officials were particularly concerned that, with large numbers of inhabitants sick, fires were more likely to break out. For example, in the 1764 outbreak, officials cautioned inhabitants to be particularly careful cleaning chimneys and taking care of fires in their home. The Overseers of the Poor were instructed to ensure the safe cleaning of the poor’s chimneys. Record Commissioners Containing the Boston Town Records from 1758 to 1769, 106. 104 Record Commissioners Containing Selectmen’s Minutes from 1742/3 through 1753, 100.

the cost to quarantine his family; and doctor’s fees if they arose.105 Between March 10 and

March 21 alone, the selectmen paid twenty-three people for “services in the Small Pox,” with the payments ranging from a few shillings to up to eleven pounds.106 The town’s ability to absorb such costs was weakened when it voted for tax relief for inhabitants who had suffered from smallpox.107 In May 1764, the town voted to apply to the General Court for “relief under the present distress’d Circumstances of the Town by means of the Smallpox.”108 A year later, the town still struggled to recover from the costs of smallpox, and again applied to the General Court for aid.109

A particularly important expense the town assumed during smallpox outbreaks was the cost of caring for and inoculating the poor. The high costs of inoculation and caring for the sick during outbreaks were of particular importance in Boston, which faced increasing poverty rates.

As Gary B. Nash argues, “Boston confronted poverty earlier, more continuously, and with the most severity of any eighteenth-century seaport.”110 Across the colonies, there was increasing inequality, and the lower 80 percent of Boston society saw their assets shrinking.111 By 1790, about 10% of Bostonians were poor, while 37-47% were “near poor.”112 Town expenditures on poor relief increased by midcentury, rising from about 730 pounds prior to 1751, to 1,999 pounds

105 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 18-19. It appears that a neighbor of the Massingham’s had contracted smallpox, and the Selectmen requested that vulnerable families on the street leave if they could find another place to stay. 106 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 50-52. 107 Record Commissioners of the City of Boston, Containing the Boston Town Records from 1758 to 1769, 122. 108 Ibid., 122. 109 Ibid., 150. 110 Nash, “Poverty and Politics,” in Down and Out Early America, 3. 111 Gary B. Nash, “Urban Wealth and Poverty in Pre-Revolutionary America,” The Journal of Interdisciplinary History 6, no. 4 (Spring 1976), http://www.jstor.org/stable/202532, p. 552, 574; Allan Kulikoff, “The Progress of Inequality in Revolutionary Boston,” The William and Mary Quarterly 28, no. 3 (July 1971), http://www.jstor.org/stable/1918824, p. 376, 379-380. 112 Kulikoff, “Progress of Inequality,” 383-384. Kulikoff defines “near poor” as “widows, blacks, seamen, laborers, and poorer artisans who might dip below the minimum level of subsistence when unemployment increased,” p. 383- 384.

sterling by 1764.113 Modeled on English poor relief laws, the Massachusetts system of poor relief had several levels of aid based on town residency. If someone had legal settlement in Boston, then he or she was entitled to town poor relief if he or she became impoverished or sick. If one was not a legal inhabitant of Boston, he or she could be “warned out.” This in effect absolved

Boston of financial responsibility should the person become sick or indigent. Those warned out could get relief funds from either the town where they had legal settlement, or from the province account if they did not have legal settlement in Massachusetts.114 Nor was poor relief an insignificant part of provincial expenditures; before the Revolution, relief funds for the care of the indigent accounted for about “10 percent of all province appropriations,” as Cornelia Dayton and Sharon Salinger estimate.115

Charitable medical care for the sick poor, linked to conceptions of Christian charity and piety, was already a centuries-old tradition in Western medicine.116 However, smallpox epidemics weakened colonial systems of community charity by placing economic strain on the town. With inoculation generally banned in Massachusetts unless it was performed in an approved hospital or more than twenty families were sick, it was feasible only for those residents who could afford the initial monetary cost of inoculation and subsequent opportunity costs from a month of isolation.117 Because it could spread natural smallpox, inoculation could only benefit the town if it was widely available. As inoculation became more prevalent, the procedure was incorporated into the frame of charitable care. The provision of free inoculation for the poor met with less resistance than other inoculation policies. The question was less whether the town

113 Nash, The Urban Crucible, 253-254. 114 Dayton and Salinger, Robert Love’s Warnings, see chaps. 1 and 3. For an overview of warning out, see esp. pp. 1-5. 115Ibid., 50. 116 Vivian Nutton, “Medicine in Medieval Western Europe, 1000-1500,” in Lawrence I. Conrad, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear, The Western Medical Tradition: 800 BC to AD 1800 (Cambridge: Cambridge University Press, 1995), 153. 117 Fenn, Pox Americana, 41; Blake, Public Health, 114; Hopkins, Greatest Killer, 256.

should ensure the inoculation of the poor, but rather how it would go about doing so. That

Boston officials secured free inoculation for the poor is widely cited in the existing literature.118

However, this literature underemphasizes the role that poverty played in the selectmen’s conceptualization of the smallpox threat. As much as the selectmen worried about the threat of smallpox to trade and business, how smallpox would affect the poor of Boston was also a critical concern. Nor was this concern only expressed in reference to inoculation, as it is often portrayed in existing scholarship. The selectmen secured free inoculation for the poor, but they also expressed continual unease as to how the town could afford to aid the needy during outbreaks.

This issue came to the fore in 1764, the first outbreak in which officials arranged for the poor to be inoculated free of charge.119 At the opening of the outbreak, the selectmen worried as to how the town would care for the poor, for the overall economic troubles caused by smallpox would decrease private charitable donations.120 When the selectmen of Boston wrote to the

General Court in 1764 asking for aid for the “Poor and nedy Familys” of Boston, they noted that not only did the epidemic cause great suffering for the poor who could not afford medical care, but it also made it so “[t]heir Neighbors in better circumstances… [could not] afford that relief they were wont to at such Times.121 They thus turned to Boston’s physicians. In March, the

Overseers of the Poor informed the selectmen that “a number of Physicians were willing to

Inoculate such of the Poor Gratis, as were desirous of receiving the Small Pox in that way.”

118 See for example, Blake, Public Health, 94, 116, 138; Bridenbaugh, Cities in Revolt, 327; Hopkins, Greatest Killer, 256; Nash, Urban Crucible, 254; Weir, “Challenge to the Cause,” 117-118. 119 Boston was not alone in making strides to inoculate the poor for free. In Philadelphia, a private charity was established in 1774 to inoculate the poor. While both Boston and Philadelphia relied in part on the charity of physicians, Boston’s efforts to inoculate the poor were organized by public officials and preceded Philadelphia’s efforts by ten years, even though Philadelphia was arguably a “center of inoculation” since the early 1760s. Blake, Public Health, 110; On smallpox and inoculation in Philadelphia, see Wolman, “A Tale of Two Colonial Cities,” 338-347. For discussion of smallpox throughout the colonies, see Duffy, Epidemics in Colonial America; On Philadelphia as “center of inoculation,” Wolman, “Tale Two Colonial Cities,” 342. 120 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 23. 121 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 23.

Medicines and care would also be provided at no cost.122 Some justified inoculating the poor as the most economically prudent option.123 A writer to the Boston Evening-Post advocated free inoculation, reasoning that this was in the town’s best economic interest, for doing so “would greatly abate the charge, and expedite the passage of the distemper thro’ the town.”124 However, the potential economic benefits of mass inoculation were not the only considerations when determining treatment of the poor. Even when informed that physicians would inoculate the poor for free, the Overseers worried that a mass inoculation would hinder physicians from “attending the sick Poor who may thereby suffer.” The town approved of the free inoculations once the

Overseers identified doctors who would “be at the call of the Overseers” when the poor needed care during the outbreak.125 Additionally, the Almshouse accepted impoverished smallpox suffers.126 The town worked to ensure not only that the poor could inoculate if they desired, but also that they received adequate care as they endured the disease.

By the end of the 1764 outbreak, the Overseers reported that 1,025 of Boston’s poor had been inoculated and cared for free of charge by a number of physicians.127 Despite physicians treating the poor for free, Boston still struggled to shoulder the costs of aiding the poor during the outbreak. At the same town meeting where the selectmen secured the physicians’ agreement to inoculate the poor for free, the town debated whether to accept a three thousand pound grant

122 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 105-106. 123 Weir argues that governments were motivated to inoculate the poor for free because it “eliminated potential points of infection within a large segment of their populations and thus eliminated potential burdens on the public welfare system as well.” Inoculating the poor was a “matter of preventative welfare for colonial governments.” “Challenge to the Cause,” 128. While this may to an extent be true, Boston only inoculated the poor during outbreaks. Preventative measures would only work without causing substantial upheaval if large swaths of society already were immune. 124 “To the Publishers of the Boston Evening-Post,” The Boston Evening-Post, January 30, 1764, accessed July 13, 2014, Readex: America’s Historical Newspapers (108B71A08DE16FB0). 125 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 106. 126 Eric G. Nellis and Anne Decker Cecere, eds. The Eighteenth-Century Records of the Boston Overseers of the Poor. Vol. 69, Publications of the Colonial Society of Massachusetts. (Boston: The Colonial Society of Massachusetts, distributed by University of Virginia Press, 2007), 151-158. 127 Boston Gazette, May 28, 1764, accessed July 23, 2014, Readex: America’s Historical Newspapers (104F834260C303DB); Record Commissioners Containing the Boston Town Records from 1758 to 1769, 116-117.

from the General Court. “After many objections and difficultys [sic]”, the town voted to accept the money given the troubles created by smallpox and the “absolute Necessity of ready Money for the Poor and Needy.”128 Even after the outbreak subsided and the physicians who inoculated the poor received the official “Thanks of the Town,” the town applied to the General Court for additional aid to help the town recover.129 Though some of Boston’s poor were brought through the disease with the help of the town, other Bostonians suffered from the distemper and later applied for aid. For example, the selectmen granted £15 to John Vinal, the usher at the South

Writing School, to help him given the “Straits and Difficultys [sic] he [had] been reduced to by means of the Small Pox.”130 Thus the town did not consider its obligation to the less fortunate fulfilled by providing free inoculation, as they also attempted to help those impoverished by smallpox. As requests for help from the General Court underscore, this aid produced a substantial economic strain on the town.

From 1764 on, the selectmen worked to help the poor during outbreaks and secure free inoculation. In 1778, the selectmen again secured the agreement of Boston’s physicians to inoculate the poor gratis.131 In the 1792 outbreak, Boston officials continued to secure free inoculation for the poor. By this time it was only provided to those “who in the Opinion of the

Overseers [of the Poor], may be unable to provide for [themselves].”132 The Overseers of the

128 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 110. 129 Boston Gazette, May 28, 1764, accessed July 23, 2014, Readex: America’s Historical Newspapers (104F834260C303DB); Record Commissioners Containing the Boston Town Records from 1758 to 1769, p. 122. 130 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 118-119. 131 A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1776 through 1786, vol. 25, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1894; Internet Archive, 2007), 59, https://archive.org/details/recordsrelatingt25bost. 132 Volume of Records Containing the Boston Town Records from 1784 through 1796, 304. Those recommended were more likely to be children than adults. See “Smallpox inoculation: orders to physicians, 1792,” 1.Ku.14, Boston Medical Library in the Francis A. Countway Library of Medicine, Harvard University, Boston, MA., http://nrs.harvard.edu/urn-3:HMS.COUNT:1196087. The tendency to inoculate the children of the poor may have been the natural result of population immunity—older Bostonians to have immunity through previous exposure. Still, it allowed inoculation to fall neatly within societal notions of poverty. As Richard Olivas argues, seventeenth- century Puritan society understood poverty to be one’s divinely-determined fate. Thus, society should aid the poor,

Poor paid doctors nine shillings per patient to perform the procedure.133 So systemized was this relief system that the Overseers printed blank forms to inform doctors who to inoculate “on

Account of the Town of Boston.” On these forms, the Overseer wrote the name of the doctor, the number of people to be inoculated, the name of the head of the family, and the ward where the person or family lived [see Figure 1].134 Thus, from 1764 through the end of the eighteenth century, when an outbreak struck, the town ensured the inoculation of the poor either through charitable treatment or, by 1792, direct payment of doctors from town accounts. Unequal access to inoculation and strained charitable systems during outbreaks prompted Boston officials to see smallpox as a particular threat to its poorest inhabitants. How the town would care for the indigent during outbreaks proved to be a lasting worry when smallpox threatened.

and widows and orphans were particularly deserving of aid. However, as poverty rates grew in the eighteenth- century, poverty was increasingly explained as the result of sloth rather than divine will. J. Richard Olivas, “‘God Helps Those Who Help Themselves’: Religious Explanations of Poverty in Colonial Massachusetts, 1630-1776,” in Down and Out in Early America, ed. Billy G. Smith (University Park, PA: The Pennsylvania State University Press, 2004), 262-265, 267. Inoculating children, even if not all were orphans, during outbreaks would have been more acceptable within both older and newer conceptions of poverty, as society felt more of an obligation to protect children during outbreaks. 133 Volume of Records Relating to the Early History of Boston, Containing the Boston Town Records from 1784 through 1796, 303-304; Blake, Public Health, 138. Nine shillings would be lower than most inoculation fees. The most expensive inoculation fee had been at Cat Island, Marblehead at a rate of five pounds per person (see ex. Wehrman, “Siege Castle Pox”). Blake notes that Dr. John Warren charged on average 28 shillings per inoculation during the 1792 outbreak, still more than the nine shillings offered by the Overseers. Blake, Public Health, p. 139 n58. 134 “Smallpox inoculation: orders to physicians, 1792,” 1.Ku.14., Boston Medical Library in the Francis A. Countway Library of Medicine, Harvard University, Boston, MA, http://nrs.harvard.edu/urn- 3:HMS.COUNT:1196087.

Figure 1. Overseers of the Poor orders to physician for smallpox inoculation, 1792. Boston Medical Library in the Francis A. Countway Library of Medicine, Harvard University, Boston MA. http://nrs.harvard.edu/urn- 3:HMS.COUNT:1196087

Conclusion

From the late seventeenth century onward, officials in Boston and the wider

Commonwealth of Massachusetts sought to prevent the outbreak and spread of infectious disease, particularly smallpox. For officials in Boston, smallpox posed a serious threat to the wellbeing of the town not only in its potential to disfigure and kill, but also in the severe costs it imposed on the town through lost business, the expense of enforcing public health regulations, and caring for a growing indigent population. However, the legal structure of public health regulations limited the selectmen’s ability to independently alter policies established to protect the town. As regulations shifted to adapt to public health needs and safely incorporate inoculation into protective policies, smallpox and inoculation continued to pose a complicated threat to Boston’s economy and the lives of its citizens. While these regulations formed an important piece of Boston’s protective measures, as chapter two will discuss, a broader community ethos emphasizing the common good and vilifying defiance added an additional layer of protection against the threat of smallpox.

Chapter Two: Smallpox, Inoculation, and the Community

Introduction

“COTTON MATHER, You Dog, Dam you; I’l inoculate you with this, with a pox to you.”1 So read the note attached to the bomb hurled through the bedroom window of Cotton

Mather, inoculation’s most ardent proponent, in the middle of the night on November 14, 1721.

As an unfamiliar procedure of unknown safety and questionable moral standing, inoculation added a thorny dimension to the already strong community reactions elicited by the dangers of contagious smallpox. Early legislation made clear that the safety of the town trumped individual freedoms, and the town would not tolerate an infected person spreading the disease by roaming the streets.2 Thus when Dr. Boylston, encouraged by Mather, defied if not the letter then the intent of the law by spreading smallpox via inoculation, the town reacted with contentious town meetings, incensed demands for legal action, and on November 14, violence.3 The inhabitants of

Boston had spoken: to endanger the community by spreading smallpox, be it naturally or via inoculation, was reprehensible, and anyone who did so would answer to the entire community.

The controversy of 1721 was only the first of many that surrounded inoculation and conduct during smallpox outbreaks. Fear of contagion haunted eighteenth-century townspeople and presented, as it continues to today, a conflict between individual and community rights and responsibilities.4 On one hand, Bostonians feared for their individual safety and the well being of their families. On the other hand, epidemics could tear through the entire town, and thus were by

1 Diary of Cotton Mather 1709-1724, vol. 2, Collections of the Massachusetts Historical Society, 7th ser. vols. 7-8 (Boston, 1911-1912), 657-658; Kass, “Boston’s Historic Smallpox Epidemic,” 28. 2 See Blake, Public Health, 33-34, on early legislation allowing for the forced isolation of people infected with smallpox. Blake also discusses how regulations reveal how government assumed powers over the public health, how community safety trumped individual rights, and how community members were responsible for one another’s health. See p. 115-116. 3 On 1721, see for example, Blake, Public Health and “The Inoculation Controversy in Boston 1721-1722”; Kass, “Boston’s Historic Smallpox Epidemic.” 4 See also Blake, Public Health, 116.

their very nature an issue for the community as a whole.5 Wrapped in this conception of community was an expectation that one was responsible to the community and should not endanger the public health.6 John Blake argues in Public Health in the Town of Boston that public health legislation indicated an expectation that the individual was accountable for fellow inhabitants’ health. Recent scholarship has moved away from regulatory analysis to place smallpox within a broader social context, and issues of class have come to the fore. Elizabeth

Fenn argues that the opposition of the poor and working classes to inoculation stemmed not from blind mistrust, but rather from prudent evaluation of risk—because the lower classes could not afford the high costs of inoculation (in both money and time), inoculation could spread the disease to them in the natural way. Unequal access to the procedure, Fenn argues, allowed more immunity (via inoculation) to develop in the upper classes than the lower.7 Jeffrey Weir also stresses the class distinctions made visible by inoculation. He argues that by the Revolution, inoculation became a method of “class preservation and class emulation” while free inoculation was a way to ease class conflict.8 Andrew Wehrman connects smallpox to the Revolutionary political movement, arguing that the crowd action that resulted in the destruction of the Essex

Hospital represented “radically egalitarian justice,” by which people in the lower classes demanded equal access to medical care in defiance of upper class authority.9

While these works provide cogent analyses of class conflict, particularly in the context of

Revolutionary sentiment, eighteenth-century Boston’s conceptions of community membership

5 Simon Finger refers to this as a “problem of collective action: How do communities respond to shared dangers?” Contagious City, ix. 6 On this being evidenced by legislation, see Blake, Public Health, 116. 7 Fenn, Pox Americana, 40-43. 8 Weir, “Inoculation at the Intersections of Class,” chap. 2 in “Challenge to the Cause,” see especially pp. 99, 103, 109, 111, 127. Weir argues that fear of the procedure and distrust of professional medical practitioners, as well as varied cultural traditions of healing, were the driving factors for low inoculation rates among the poor. 9 Wehrman, “The ‘Siege of Castle Pox,’” chap. 3 in “Contagion of Liberty,” esp. p. 66; Wehrman, “Siege of Castle Pox,” 428-429.

and responsibility were also central to these disputes.10 Smallpox epidemics pushed inhabitants to define their communities, and provincial legislation coupled with social sentiment of belonging and town membership ensured that in the case of epidemics, the primary community to which one was beholden was the town.11 The townspeople directed their ire at any defiance of town regulations or a perceived disregard for the wellbeing of the broader community, particularly one’s poorer neighbors. Though opinions diverged over whether or not inoculation should be allowed, at the core of these debates was the expectation that any measures taken to protect against smallpox should be for the benefit of the wider community. For some, this meant outlawing inoculation so that it would not spark an outbreak of natural smallpox. For others, inoculation should be allowed because it would protect the town from the devastation of smallpox. This created dueling images of community members, whose conduct was judged based on whether or not it was in the best interest of the town as a whole. Ultimately, at the foundation of smallpox and inoculation debates was the expectation to protect the town of Boston from smallpox by adopting those policies and behaviors that benefited the whole of the community.

“This suffering Town”: Defining the Community During Smallpox Epidemics

In July 1776, with the dramatic prose of the Declaration of Independence still echoing in the streets, the Selectmen of Boston dreamed that their “suffering Town may not continue a

Hospital.”12 A smallpox epidemic was threatening civilians and soldiers alike, forcing the town to almost completely close its borders. No one was to enter or leave Boston without a thorough

10 Simon Finger employs a broader community lens in The Contagious City, which studies public health in early Philadelphia through a population perspective. Finger argues that public health measures pushed early Philadelphians to define their community, particularly given an influx of immigrants, and to reevaluate charity. Contagious City, 4-5, 67. 11 On people defining their communities during public health crises in Philadelphia, see Finger, Contagious City, 4- 5. 12 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 5.

cleansing, and if they had contracted smallpox within the last month they could not leave at all.13

The Boston smallpox outbreak of 1776 had, as the selectmen lamented, isolated Boston from the wider province, turning it into a veritable smallpox hospital—a community of contagion.

While the selectmen defined their community as the town itself, this was not the only parameter by which to define community. As historian Marsha Hamilton discusses, the idea of community in the colonial era can refer to geographic distinctions, such as a town or region.

However, it can also refer to “communities of interest,” which Hamilton defines as “the bonds between people based on shared ideology, experiences, or goals.”14 Networks, whether based on kinship, economic interests, religion, nationality, etc., connected the people of Massachusetts as early as the seventeenth century, contrary to the popular image of the insular New England town.15 Contagious diseases cast a morbid spotlight on the interconnectedness of eighteenth- century communities, since they travel through social and economic networks. Though never endemic in North America, still smallpox haunted colonial ports and highways.16 The North

American smallpox epidemic that raged from 1775-1782 revealed continental connections that reached far beyond the eastern seaboard and into what is today the American West, as Elizabeth

Fenn argues.17 The most populous cities of eighteenth-century British America—Boston,

Newport, New York City, Philadelphia, and Charleston—each had measures in place to stop disease from entering the city, be it by land or by sea, a testament to their connection to the

Atlantic world and the expansiveness of colonial networks.18

13 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 3-4. 14 Hamilton, Social and Economic Networks in Early Massachusetts, 15. 15 Ibid., 15-17. 16 Elizabeth Fenn argues that smallpox was not endemic in North America because of more limited “transportation networks” and less concentrated population compared to Europe. See Fenn, Pox Americana, 28. 17 Fenn, Pox Americana. 18 Bridenbaugh, Cities in Revolt, 129-131; on Boston, see Blake, Public Health; on Philadelphia, see Finger, Contagious City, 31-36.

The dangers of smallpox and threat of its spread underscored the interconnectedness of colonial communities, while at the same time smallpox and inoculation pushed inhabitants to define and distinguish their communities.19 The networks of family, trade, and social connection did not disappear during epidemics, but in Massachusetts the town became the primary marker of community. The town, and town residency, had long been important to social and political life in colonial Massachusetts. Though beholden to provincial laws and the General Court, towns enjoyed significant control over their own affairs and their dealings with other towns.20 The town meeting was crucial to the social-political contract and was an important vehicle for political participation, including during smallpox epidemics.21 As discussed in chapter one, the entire

Massachusetts system of poor relief rested on determining the poor person’s town of legal residence. In the realm of contagious disease, though the Massachusetts General Court passed provincial public health legislation, this legislation left a great deal of power to the town and its selectmen.22 Most notably, the selectmen could bar the sick from entering the town, and inoculation and inoculation hospitals were permitted on a town-by-town basis.23 A town had every incentive, beyond the devastating effects on life and health, to keep itself free of the distemper. Provincial legislation made smallpox legally a town issue, and the wellbeing of a town depended upon its freedom from disease. Thus during smallpox epidemics, diverse

19 On this being the case in Philadelphia, Finger, Contagious City, 4-5. 20 Brown and Tager, Massachusetts Concise History, 41-42. Governor Hutchinson wrote about the autonomy of Massachusetts towns, and was particularly critical of Boston and its defiance of provincial authority. See Robert E. Brown, “Democracy in Colonial Massachusetts” New England Quarterly 25, no. 3 (1952): 308. http://www.jstor.org/stable/362278 21 On town meeting, see Carr, After the Siege, 140. 22 See chapter one for more detailed summary of provincial laws. 23 Acts and Resolves, 3: 35-37; Acts and Resolves 5: 633-635; On legislation and inoculation rules, see also Blake, Public Health, 82, 128. The Boston selectmen had the added authority of overseeing the isolation hospital on Spectacle and later Rainsford Island in Boston harbor, where all infected ships were required to report. The General Court had to approve major expenditures on Rainsford Island, but it generally did as the Boston selectmen requested, including building another hospital on the island and securing a boat to transport the ill. See Blake, 35, 79-80.

networks of society were subsumed by the town, and the community was defined by the town’s borders.

The emphasis placed on the town and town residency is underscored in the interactions between Boston and surrounding towns during smallpox outbreaks. News of smallpox outbreaks traveled through the province and the fear it inspired often strained relations between towns. This was particularly pronounced during the American Revolution, when authorities feared smallpox would spread from Boston and infect the Continental Army during the siege. Nearby towns had striven to help beleaguered Boston in the opening days of the conflict with the mother country.

Marblehead, among other towns, sent aid to Boston after the passage of the Boston Port Act in

1774.24 Bostonians suffering during the siege could, for a time, find refuge in Salem or Chelsea, but this changed once a smallpox epidemic seemed likely.25 By November 1775, Boston became synonymous with occupation and, to the horror of American civil and military authorities, smallpox. Washington forbade refugees from Boston from entering the Continental camp and banned “any sort of intercourse with the people who this day came out of Boston,” for “there

[was] great reason to suspect that the smallpox [was] amongst them.”26 Many military leaders, including Washington, feared that Bostonians were being used by the British to infect the

Continental Army with smallpox.27 To be Bostonian during the siege was to inspire fear as a perceived source of contagion and a walking threat to the American cause.28

24 Wehrman, “Siege Castle Pox,” 425-26. 25 Fenn, Pox Americana, 48-49. 26 Stephan Moylan to Colonel Loammi Baldwin, 4 December 1775, Miscellaneous Bound Collection, 1774-1775, Massachusetts Historical Society, Boston, MA. On refugees and Continental camp, Fenn, Pox Americana, 50. 27 Becker, “Smallpox in Washington’s Army,” 399-401. 28 On the broader idea of smallpox and, in particular, inoculation, as a danger to the American cause, see Weir, “Challenge to the Cause,” esp. chaps. 5-6.

The end of the siege did not bring relief to Boston, and 1776 was another year of smallpox when refugees returned to the town.29 As civil authorities regained control of the town, they ran afoul of nearby towns for their perceived lax enforcement of smallpox regulations.30 On

July 18, Timothy Pickering of Salem wrote to Richard Derby complaining that Boston failed to halt or cleanse potentially ill travelers leaving the town, thus putting other towns at risk.31 Four days prior, the Massachusetts General Court had passed legislation allowing inoculation in

Boston. However, the law stipulated that inoculated individuals were required to “remain within the said town [Boston]” until entirely clear of smallpox as certified by the selectmen. The selectmen, meanwhile, were tasked with ensuring that none left the city unless they and their belongings were “thoroughly cleansed and free of infection.”32 Pickering lamented that Salem residents so feared smallpox from Boston that they wanted to build gates and hire guards to protect their borders. He charged Bostonians with “carelessness,” by which “the infection may be spread far and near, and a great many towns put to a very great expense.”33 Finally, Pickering demanded that Boston remove its poor presently residing in the Salem hospital.34 The selectmen moved to enforce the General Court’s requirements, stationing guards at the town’s exit at

29 Fenn, Pox Americana, 51-52. 30 The British had allowed inoculation in Boston during the siege. When American officials regained control of the town, they banned inoculation, only to allow it for a brief window of time beginning on July 3. See Fenn, Pox Americana, 49-50, 53. 31 Timothy Pickering to Richard Derby, Esq. 18 July 1776, in American Archives, ed. Peter Force, 5th series, vol. 1, 426-427, https://archive.org/details/PeterForcesAmericanArchives-FifthSeriesVolume1vol.7Of9 32 Acts and Resolves 5: 554-557. 33 Pickering to Derby, 18 July 1776, in American Archives, ed. Peter Force, 5th series vol. 1, 426-427. 34 Pickering to Derby, 18 July 1776, in American Archives, ed. Peter Force, 5th series vol. 1, 426. This likely refers to Salem’s inoculation hospital. It was built using subscriptions, which were then paid back using the money raised by inoculation fees, which were initially set at twelve dollars. Once the town paid back all the subscriptions, the price of inoculation at the hospital decreased, and the hospital became town property. See Wehrman, “Siege Castle Pox,” 405. The Salem hospital stands in contrast to other hospitals in Massachusetts, such as William Aspinwall’s hospital at Brookline, or the doomed Essex Hospital in Marblehead, which were privately owned and operated (though by 1776 provincial law dictated that all inoculation hospitals were subject to regulation by the town selectmen).

Roxbury Street. Shortly thereafter, the selectmen decided that “No Persons who ha[d] had the

Small Pox since the 1st of July Instant [could] be suffered to leave the Town” before August 3.35

Salem’s grievances, the General Court’s legislation, and the selectmen’s decision to prohibit movement out of the town underscore how communities were conceptualized along town lines during smallpox outbreaks. On the one hand, the shared experience of infection formed a kind of distinct community in its own right. However, in the public mind, smallpox and the entity of the town were virtually inseparable. In the eyes of the people of Salem, Bostonians were sick and endangering inhabitants of Salem. Other towns should not be jeopardized by

Bostonians’ negligence. Boston’s poor did not belong in Salem’s hospital. Meanwhile, provincial legislation and town regulations severely limited, if not prohibited, one’s ability to leave the town. Boston itself was essentially isolated, and its inhabitants were trapped within town limits not necessarily because they themselves were presently sick, but because they were members of an infected community.

The inter-town conflict of 1776 reappeared in 1792, when a protracted war of words between Boston and Salem again underscored the emphasis placed on the entity of the town during smallpox outbreaks. On August 21, the Salem Gazette warned that smallpox had broken out in Boston and that a general inoculation seemed imminent. Thus, it warned Salem residents susceptible to smallpox that it would “be very dangerous… to visit the metropolis.”36 The Boston selectmen declared this a “wrong and injurious report[s],” and assured those who would trade with Boston that every precaution was being taken to prevent smallpox’s spread.37 Though

Salem proclaimed they had “much tenderness” for their “brethren in the metropolis,” in Boston

35 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 3-5. 36 “Salem, August 21, 1792,” Salem Gazette, August 21, 1792, accessed July 17, 2014, Readex: America’s Historical Newspapers (1084F170EC0AC3D8). 37 Columbian Centinel, August 25, 1792, accessed July 17, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78).

inhabitants expressed suspicion of Salem’s motives.38 One writer to the Columbian Centinel argued that Salem sought to usurp Boston’s trade by asserting that Boston was diseased and thus unsafe. The author was critical of stories appearing in Boston newspapers reporting rampant smallpox in the town, stating that if the author of said reports was “hired by the people of Salem to drive people from trading with us, and to lead them eastward, he could not discover more zeal.”39 Salem was equally suspicious of Boston. On September 1, the Salem selectmen wrote to the Centinel to protest a recent article in the American Apollo that reported smallpox in Salem.

The Salem selectmen “charitably hoped” that the report did not stem from “a malicious intention” to halt trade in Salem.40 In these cases, the state of smallpox in the province was defined strictly by town; to assert that smallpox was present in a town was to ignite fear and suspicion, which propelled a town to defend itself not only for the sake of the health of its inhabitants but also for the overall economic well being of the town. While in reality the entire province was vulnerable to smallpox, the virus’s presence was largely associated with a specific town. It was the infected town, deemed dangerous by its neighbors, that became the symbol of smallpox.

The issue of inoculation further underscored the primacy of the town as the embodiment of community during smallpox outbreaks. Because inoculation was only permitted on a town-by- town basis, a town allowing open inoculation became a destination for outsiders seeking to inoculate. Bostonians were particularly incensed by non-Bostonians—commonly labeled

“strangers”—coming to Boston to inoculate. From the time Mather and Boylston introduced

38 “Small Pox,” Salem Gazette, September 4, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1084F175C54B3980). 39 “Miscellany. for the Centinel,” Columbian Centinel, August 26, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA339BE12723). 40 Columbian Centinel, September 5, 1792, accessed July 14, 2014, Readex: America’s Historical Newspapers (1064DA3AA7EF0DD5).

inoculation to Boston in 1721, people came from neighboring towns to receive the virus, much to the anger of Bostonians. The trend continued during the 1730 outbreak. The New England

Weekly Journal reported that inhabitants petitioned the selectmen to halt “Inhabitants of other

Towns” from coming to Boston to inoculate, arguing that such a practice was “highly unreasonable, and injurious to this Town.”41 Though inoculation was controversial in general, the idea of outsiders coming to Boston to receive the treatment was particularly alarming and repugnant to Bostonians who felt that strangers perpetuated outbreaks as the town sought to free itself from the virus.

By the 1760s, as discussed in chapter one, inoculation was increasingly being used throughout the colonies, though its use never came without controversy. Despite the strong opposition to strangers coming to inoculate in previous outbreaks, in 1764 the town decided to allow non-inhabitants to inoculate in Boston until mid April.42 However, the town kept close track of outsiders who came to inoculate. When the selectmen and Overseers of the Poor traveled through Boston’s wards to determine the state of the outbreak, in addition to asking each head of family how many in the family were sick, they inquired “What Strangers, they have in their

Families under Inoculation.”43 When in May non-inhabitants continued to stream into Boston, either already sick or planning to inoculate, Bostonians once again expressed anger that outsiders were threatening their community. “[T]he Town,” reported officials, “esteem[ed] it a great grievance that such Persons obtrude themselves to perpetuate a Distemper among us.”44

Inhabitants encouraged the selectmen to “take every legal measure” to banish such persons from

41 “Boston,” New-England Weekly Journal, March 23, 1730, accessed July 15, 2014, Readex: America’s Historical Newspapers (108C9AC17729CBB0). 42 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 109; “By a Vote of the Town at the Above,” The Boston Evening-Post, March 19, 1764, accessed July 15, 2014, Readex America’s Historical Newspapers (108B71ADE8C977A0). 43 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 62-63. 44 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 117.

the town, and recommended that the offenders’ names, town of origin, and the area of Boston in which they stayed be published in the local newspapers. Finally, Bostonians requested that the

General Court pass a law granting selectmen power to remove any non-inhabitant who came to inoculate or was sick with smallpox.45

Through the remainder of the eighteenth century, Bostonians continued to view strangers as a particular concern during smallpox outbreaks. In 1776, outsiders were again allowed to inoculate in Boston. Once again, the Selectmen tracked how many strangers came to Boston to undergo the procedure, levying a forty-pound fine on any Bostonians who housed strangers but failed to report their presence to the selectmen within three days of the strangers’ arrival.46

When Boston announced a general inoculation in 1792, over a thousand non-residents capitalized on this policy.47 However, as was the case in 1764, when the deadline for inoculation passed and still strangers filled the town, Bostonians considered this a “high Insult” and demanded that the selectmen do everything in their power to remove “all Such Persons as do not belong to This town.”48 For Bostonians, outsiders who came to Boston to inoculate in defiance of town decrees were a pernicious threat, a source of continued infection while the town tried to escape the clutches of the disease. While town residents who violated smallpox regulations faced the ire of the town, as will be discussed, outsiders faced particularly pointed criticism. The importance of the town went beyond legal jurisdiction; it signified community membership.

Strangers, ultimately, were not members of the community of Boston, and their violation of town regulations posed a threat to Boston as a whole.

45 Record Commissioners Containing the Boston Town Records from 1758 to 1769, 117-18; See also Blake, Public Health, 90-96. 46 Acts and Resolves 5: 556. 47 A Volume Containing the Boston Town Records from 1784 through 1796, 307. 48 Ibid., 307-308.

Communalism and the “Common Good” in 17th and 18th-Century Massachusetts

As Bostonians weathered the dangers and controversies wrought by smallpox outbreaks throughout the eighteenth century, their enforcement of regulations and expectations of behavior underscore a valuation of protecting the broader community and the common good.49 The importance of community loomed large throughout the history of Boston and Massachusetts beyond the realm of public health. From its founding, the Massachusetts Bay Colony rested in part on a concept of “Christian communalism” rooted in not only religious doctrine, but also in secular communitarian values common to agricultural towns in Britain and Continental Europe.

Though this ideal did not include conceptions of social equality, it championed the community above the individual and stressed commitment to the common good.50 This communitarian emphasis endured through the myriad changes that transformed the Bay Colony, particularly in coastal towns, from John Winthrop’s Puritan “city on the hill” to an Atlantic-oriented province increasingly connected to commerce and British culture.51 The colony experienced increasing conflict between its religious roots and its emerging social and economic life, particularly in

Boston and other port towns. As the decades passed, the Christian communalism of the colony’s founders shifted to what Richard D. Brown and Jack Tager describe as “social piety” rather than

“spiritual piety,” the focus now more on the earthly welfare of community members.52

Though the fabric of Massachusetts society changed through the continued development of a commercial economy and religious shifts, the communalism of the colony’s founding and its emphasis on the common good endured into the eighteenth century, if in an altered form.53 To

49 On regulations reflecting individual responsibility for the health of fellow community members, see Blake, Public Health, 116; Finger, Contagious City, 5. 50 Brown and Tager, Massachusetts Concise History, 34-35, 41-42. 51 On this shift, see Brown and Tager, Massachusetts Concise History, 51-57. 52 Ibid., 44. 53 Ibid., 56-57.

this the Revolution added political currents that challenged concentrated power of a political elite and emphasized the issues and concerns of sectors of society beyond the wealthy and powerful.54

“Patriotic politics,” as Barbara Clark Smith argues, rested on neighborly ties and accountability to one’s community.55 Even through the dramatic changes wrought by the American Revolution, the valuation of collective wellbeing over individualism remained in Boston following independence.56

“[A]n Enemy to the Welfare and Security of This Town”: Defiance of Town Regulations

As Bostonians conceptualized smallpox outbreaks, they championed behavior that they believed benefitted all, and they vilified behavior that threatened the health of the many, adding to the protective layer created by formal public health regulation.57 Though Bostonians were especially critical of non-inhabitants who they felt endangered the town during outbreaks, town residency afforded no protection from repercussions for behavior deemed dangerous to the town.

Disregard for isolation or quarantine regulations were not taken lightly, and the government assumed the duty to protect the community.58 When one Mrs. Glentworth, quarantined because her child had the virus, was suspected of leaving her home to attend a sermon, a selectman visited her home to determine if she had broken town orders. He left only after Mrs. Glentworth

54 Gary B. Nash, “Social Change and the Growth of Prerevolutionary Urban Radicalism,” in Gary B. Nash, Race, Class, and Politics: Essays on American Colonial and Revolutionary Society (Urbana and Chicago: University of Illinois Press, 1986), 233. 55 Barbara Clark Smith, The Freedoms We Lost: Consent and Resistance in Revolutionary America (New York: The New Press, 2010), 112-113, 132-133. 56 Carr, After the Siege, 96-97, 112, 140. Bouton also discusses the emphasis on the community over the individual in post-independence Pennsylvania. Taming Democracy, 52, 146. 57 Simon Finger argues that as Philadelphia recovered from the crisis of the 1793 fever epidemic, doctors and town officials purposefully emphasized community responsibility. This was part of their strategy to gain support for public health reforms. “Philadelphia’s public health strategy,” Finger writes, “depended on building unity and cooperation among its inhabitants.” Contagious City, 127-134. While similar sentiments existed in Boston, they were more an organic result of the dangers and controversies of smallpox and inoculation than they were a specific strategy. Indeed, Bostonians did not even always agree on what exactly was in the best interest of the common good. 58 Blake, Public Health, 116.

and the man guarding her home swore she never left.59 One Mr. Flagg also faced the ire of the selectmen when it was reported that, “contrary to Orders,” he continued to “go in and out” of his home, where his children lay ill with smallpox. Flagg informed the selectmen that he had found another home to live in for the time being, and promised that he “should not enter his own

Dwelling until he had first obtained Liberty there for.” 60 In both cases, suspected defiance of town law was reported to authorities, and the selectmen moved to enforce the law for the safety of the town.

The extent to which the community mobilized against those who defied protective regulations is made particularly clear in the curious case of John Gray. In January 1764, with the smallpox outbreak still in its nascent stage, Gray, a shoemaker tasked with guarding the infected home of Daniel Mon Warrens, drew the ire of the selectmen for what they perceived to be malevolent efforts to spread the virus.61 Called upon to help transport a sick patient to an isolation hospital, Gray commented that he had viewed the corpse of Mrs. Adams, recently deceased from smallpox, as discussed in the introduction. “[T]here was some resentment express’d against this behavior” by his companions, none other than the selectmen of Boston, who wondered “what could induce him to Go into an infected Chamber.” While Gray faced questioning and underwent the cleansing process, those who witnessed his behavior reported it to the selectmen. They reported that Gray went to the body of Mrs. Adams, whereupon he rubbed papers upon her arms. Following an investigation, the selectmen concluded that Gray “did in direct violation of our written Orders leave his Station” and go to the home of a woman who recently died of smallpox, where he “took hold of her Corps and…took his written Orders and

59 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 41. 60 Ibid., 40-41. 61 Ibid., 24-25.

rubbed them on the deceaseds Arm, and all as we apprehend with a malicious design to spread the Infection of the Small Pox.” The selectmen imprisoned Gray for his actions.62

This instance reveals both the fear surrounding smallpox and the anger that defiance of regulations and the selectmen’s authority provoked. The orders of the selectmen play a central role in the case. Witnesses reported that when Gray placed papers on the corpse, he explained that “these are the selectmens Orders.”63 Though perhaps he referred to the papers themselves, it seems likely, considering no one stopped him, that he meant that the selectmen had ordered him to touch the body. This excuse did not save Gray from being reported to the authorities by his fellow townspeople—indeed, the selectmen hypothesized that Gray thought it so likely that he would be reported that he brought his actions to the attention of the selectmen himself. Once brought before the selectmen, chief among the charges against Gray was his defiance of selectmen’s orders—not only did he leave the post he was commanded to guard, but he dragged his paper orders over the body, perhaps as a symbolic challenge to the selectmen’s authority.64

While earlier witness accounts were more ambiguous about the content of the papers, the selectmen were clear: the papers were Gray’s official orders, and he defied and defiled them.

The orders had been given to protect the community; in violating them, he became part of the threat of smallpox, and thus the community took action against him.

62 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 24-25. 63 Ibid., 24. 64 The Selectmen’s Minutes do not record what exactly John Gray’s written orders said. They report that on January 16, “Mr. John Gray [was] appointed a Watch for Mr. Warren’s House in Fish Street, and the Town Clerk is directed to give him his orders” (6-7). The orders given to other watches, however, were recorded. For example, the next day Peter Curtis was appointed watch over one Mr. Bradford’s home. His orders read: “The Small Pox being at Mr. Bradford’s House on Colmans Wharff, We hereby Appoint you a Watch for said House, and our Directions to you are, that you suffer no Persons to go in or out of said House except the Doctors; Any Necessarys that may be wanted for the Family, you are to get into them as well as you can.—You must not leave The Watch until 10 O’Clock at Night, nor fail attending again by Day break. We have Ordered a Flag to be put out as a Signal of Infection in ye House; and we depend on your behaving with great care and faithfulness in you Watch as the safety of the Inhabitants will much depend upon it, and on your doing so we shall make you a proper allowance for your services.” Future references to orders given “in the usual form” suggest that these orders were standard for all watchmen. Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 10, 13.

The enforcement of quarantine and isolation policies continued throughout the eighteenth century. In 1776, officials reminded the town that if any person did not report a case of smallpox, he or she would be “prosecuted for the penalty incurred by such neglect.”65 Two years later, the town voted to appoint a selectmen who had the specific task of prosecuting those who broke smallpox regulations, for the town was “greatly disturbed with the conduct of some Persons” during the outbreak.”66 As a result, two men, Mr. Knight and Mr. Ramsdel, were charged with

“bringing the Small Pox into the Town or concealing it,” while another man, one Captain

Stanton, was being investigated for allegedly concealing a case of smallpox in his home.67 As

Blake argues, the existence and content of the regulatory laws themselves highlight the idea of having a responsibility to others to not endanger their health.68 However, Bostonians’ implementation of these laws underscores the extent to which Bostonians accepted this idea.

Violations of town regulations were reported, and with the support of the town, the selectmen held the offenders responsible for their actions and the threat they posed to the community at large. The community would mobilize to protect the health of the town.

Inoculation: Threat and Protection

Inoculation complicated the regulatory and social response to smallpox. While isolation and inoculation were generally accepted protective measures, inoculation had sparked intense controversy since its introduction to Boston. In the earliest outbreaks, as discussed in chapter one, much of the debate centered on the safety of inoculation, and to a lesser extent the religious

65 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 10. 66 Ibid., 67. 67 Ibid., 67-68, 73. 68 Blake, Public Health, 115.

and authoritative ambiguities of the procedure.69 By the 1760s, the colonies had more extensive experience with the procedure through further outbreaks in Boston as well as notable successful uses of inoculation in South Carolina and Philadelphia. Boston’s selectmen—and, to an extent, doctors—tracked inoculation and fatalities, resulting in epidemiological evidence that one was less likely to die if inoculated than if one contracted smallpox naturally.70 Though the procedure was not without its risks, the question of the safety of the procedure for the individual receiving the virus was less of an issue than it was in 1721. However, the question of inoculation’s effect on the community remained.71 Opinions differed on whether inoculation, widely applied, would protect the town from smallpox or instead pose just as significant a threat as a natural smallpox epidemic. Inoculation could save lives, but it could also spark an outbreak of natural smallpox.

At the core of each argument, however, was the assertion that that particular inoculation policy was meant to protect the entire community.

For those who opposed inoculation, the potential for inoculation to spread natural smallpox represented a threat to those who either could not or did not want to inoculate.

According to the twenty families rule, not until twenty families were sick would open inoculation occur. As they did with quarantine and isolation policies, the selectmen took action against those who inoculated contrary to this policy. In February 1764, while the selectmen continued to fiercely oppose a general inoculation, they received word that Mr. Flagg and another man, Mr. Hitchburne, had their children inoculated. The selectmen demanded that the men appear before them, where both fathers “declared, that they had not Inoculated them [the

69 See Blake, Public Health, chapter 4; Blake, "The Inoculation Controversy in Boston: 1721-1722," 489-506. 70 See Blake, Public Health, Appendix I, Table I, for a summary of Boston smallpox/inoculation statistics. Blake uses the reports of Douglass, Boylston, Thomas Prince, and the Boston Selectmen to compile his figures. The Selectmen generally took surveys of the town to determine how people contracted smallpox and whether they survived. See for example, Record Commissioners Containing the Selectmen’s Minutes from 1742/43 through 1753, 283. 71 See also Weir, “Challenge to the Cause,” 43.

children].” To investigate, the selectmen sent Dr. Gardner to the suspected transgressors’ respective homes to inspect the children for signs of inoculation; none were found.72 Here, promises and oaths were insufficient to convince the selectmen that one was following the law, and the selectmen made clear that a father did not have to right to endanger the entire town in his efforts to protect his children.

The selectmen continued to enforce inoculation bans in subsequent decades. In 1774, the selectmen received word that the children of Captain Trigs and Dr. Hill had been inoculated. The selectmen investigated, noting that neither man “would own that they [the children] had received the Infection by Inoculation.” Nevertheless, the selectmen announced that “the Inhabitants may be assured that such measures will be pursued…for the present and future safety of the Town and

Country.”73 In May 1778, rumors circulated that people were secretly inoculating in the town, prompting the town to task Mr. Austin, a selectman, with investigating and prosecuting those who did.74 Still, in 1783 the selectmen again received reports of illegal inoculation, having been told that the child of a Mr. Seabring, in isolation at the hospital in New Boston, had been inoculated. The selectmen asked that the physician at the hospital, Dr. Appleton, “make thorough search” to determine whether this was the case.75 Though they do not record whether the transgression actually occurred, their investigation again highlights a commitment to protect the town from the dangers of unchecked inoculation. The selectmen saw defiance of inoculation policies as a threat, and enforcement of these policies as a way to protect the town as a whole.

72 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 40. 73 A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1769 through April 1775, vol. 23, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1894; Internet Archive, n.d.), 237, https://archive.org/details/recordsrelatingt23bost. 74 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 67. 75 Ibid., 228.

The selectmen had legal recourse to punish offenders. Provincial legislation passed in

1775 allowed the selectmen to levy a £50 fine for unauthorized inoculation; those who could not pay faced either thirty lashes or six months in jail.76 By 1792, when the selectmen published inoculation regulations in the town newspapers, they included a notice about the £50 penalty and the £100 fine for doctors performing illegal inoculations.77 However, if fines failed to deter would-be inoculators, the selectmen had another method, one that harnessed the fear and anger of the wider community: anyone who inoculated contrary to regulations would be “declared an

Enemy to the Welfare and Security” of Boston, and his or her name would be printed in town newspapers.78 Indeed, one writer to the Columbian Centinel expressed confidence that no one in

Boston secretly inoculated or failed to report smallpox cases. Even if Boston had no punishments for such behavior, he argued, “the torrent of indignation which would roll down upon a person so conducting, is sufficient to deter any man from acting so base and murderous a part.”79 In the author’s eyes, breaking smallpox laws was not only criminal, but was seen as a dangerous betrayal of the town that few would commit. The wider community’s vilification of those who inoculated was itself a method of protection.

The larger community’s resentment of unauthorized inoculation was further underscored by the currents of potential violence that ran underneath the debates that graced the pages of the town’s newspapers and filled its meeting halls. Bostonians experienced firsthand the violence that accompanied inoculation debates when an assailant attempted to bomb the home of Cotton

Mather, and violence remained a concern in Boston throughout the remainder of the eighteenth

76 Acts and Resolves, 5:554-555. 77 The Boston Gazette, February 27, 1792, accessed July 17, 2014, Readex: America’s Historical Newspapers (1044567AF636ECBA). 78 A Volume, Containing the Boston Town Records from 1784 through 1796, 309. 79 “Miscellany. for the Centinel,” Columbian Centinel, August 29, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA339BE12723).

century. When reports circulated in June of 1764 that patients were coming into Boston “from

Point Shirley [hospital] quite Green with the Small Pox and very infectious,” the selectmen urged the hospital physicians to put an end to such actions.80 They warned that “the Inhabitants

[of Boston] resented this conduct so much, that there was danger of their taking some extraordinary steps to prevent it.”81 Though in 1764 violence did not erupt over the spread of smallpox from inoculation hospitals, it did nine years later in Marblehead, where in 1773 a crowd burned Essex Hospital to the ground and twice tarred and feathered a group of men accused of potentially spreading the virus.82

For their role in endangering the public health, physicians also came under fire. When in

1764 the Boston selectmen received notice that patients from Point Shirley were endangering the community by leaving the hospital while still infectious, they expected the doctors to take appropriate action to protect the town from such behavior. Writing to Dr. Barnet, a physician at the hospital, the selectmen demanded that the physicians put a stop to this behavior, noting that they “do desire and must insist upon it.” Two days later, on June 4, Dr. Gardiner, also inoculating at Point Shirley, reported to the selectmen, per their request, where he promised to enforce stricter regulations at the hospital.83 Five days later, with legal inoculation in the town officially over, the selectmen published a piece in the town newspapers, assuring the town and indirectly warning physicians, that “the Gentlemen [town physicians] will not violate their obligations to us, or be so regardless of the Interest of this Community, as to Inoculate[d] a

80 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 69; Blake, Public Health, 96. 81 Ibid., 69-70 82 See Wehrman, “Contagion of Liberty” and “Siege of Castle Pox.” Marblehead also experienced inoculation riots in 1730, as did Norfolk in 1768. Wehrman, “Contagion of Liberty,” n135. On Norfolk, see Patrick Henderson, "Smallpox and Patriotism: The Norfolk Riots, 1768-1769," The Virginia Magazine of History and Biography 73, no. 4 (1965): 413-424, http://www.jstor.org/stable/4247156. 83 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 69-70; See also Blake, Public Health, 90-96.

single Person in the Town.”84 Thus the selectmen made clear that doctors inoculating in defiance of town orders or not enforcing hospital regulations failed to uphold their responsibility to protect the town. In these cases, doctors were expected to maintain health and safety of the wider community, and when the community was in fact threatened by their actions, physicians were expected to answer for their conduct.

The specter of violence found in inoculation debates in the 1760s-70s remained in 1792.

When “A Bostonian” wrote to the Columbian Centinel intimating that Bostonians had a right to inoculate in their own defense, another writer responded in the Boston Gazette with a tale from

Connecticut in 1776 to warn Bostonians of the violence that could result from illegal inoculation.

There, the writer related, a colonel inoculated his family in defiance of the law and the sentiment of the community. In response, his fellow inhabitants destroyed his property and the colonel

“Just escaped with the skin of his teeth.”85 Far from condemning this violence, the writer seemed to view it as just retribution for a criminal act. “The PEOPLE,” the author declared, “removed this pest [the colonel] of society… and he has remained almost ever since, a standing monument of the PEOPLE’S resentment.”86 Whether or not this actually occurred, the author’s message was clear: Bostonians must protect their community from those who would threaten it by inoculating, even if that meant taking violent action. Another writer to the Columbian Centinel in

1792 also criticized arguments that people had a right to inoculate in self-defense. The author declared, “If my neighbor has a right to innoculate [sic] his children in his own defence, without the intervention of authority, I have also a right to shoot them, in defence of my children, if I do not choose that they should be exposed to the distemper.” The author argued that the rights of a

84 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 72-73. 85 “Of the Small-Pox and About it Mess'rs Edes,” Boston Gazette, and the Country Journal, August 20, 1792, accessed July 14, 2015, Readex: America’s Historical Newspapers (1044569902ABE35D). 86 Ibid.

person as an individual and the rights of a person in society differ, for one can act to protect his or her wellbeing, but he or she has “no right to expose [a] neighbor.”87 These arguments underscore how the community would not stand for individual behavior that threatened the entire town. Massachusetts’s longstanding emphasis on prioritizing the community over the individual was evident in Bostonians’ conceptions of smallpox epidemics.

While many Bostonians virulently opposed inoculation and considered it a threat to the town, others supported the procedure and considered it an invaluable protective measure that could benefit the entire community. Writing to the Boston Evening-Post in 1764, one Bostonian noted that thanks to inoculation, the “severity and danger of it [smallpox] has undeniably been very much lessen’d.” Criticizing officials who continued to prohibit inoculation, the author warned that unless officials provided better reasoning for forbidding it, the “town [would]…take that method which they esteem[ed] most conducive to their security.”88 Whereas those who opposed inoculation viewed the inoculated as deviants who, in their selfishness, threated the community, here the entire town was depicted as being desirous of undergoing the procedure since it was in the community’s best interest. Inoculation might at first glance benefit only the individual, but in fact, according to this argument, it would protect the entire town. When an inoculation hospital was eventually erected nearby at Point Shirley, supporters heralded it for the

“great Advantage” that it could bring “to the Public.”89 Inoculation at Point Shirley, town clerk

William Cooper wrote, would ensure that the town would not “be thrown into such

87 “Miscellany. for the Centinel,” Columbian Centinel, August 29, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA339BE12723). 88 “To the Publishers of the Boston Evening-Post,” The Boston Evening-Post, January 30, 1764, accessed July 14, 2014, Readex: America’s Historical Newspapers (108B71A08DE16FB0). 89 The Boston Post-Boy and Advertiser, February 13, 1764, accessed July 12, 2014, Readex: America’s Historical Newspapers (1089CD165BC880C8).

Consternation and Distress from the Alarms of this Distemper.”90 Just as those opposed to inoculation believed their position promoted the health of the community, those who supported inoculation rested their stance on the belief that inoculation was for the good of the town.

Because they saw inoculation as a way to protect the entire community, Bostonians who supported inoculation objected to town regulations that limited its use.91 “Let me ask,” the writer to the Boston-Evening Post railed in 1764, “whether any civil law can set aside the law of self- preservation…when our lives are threatened by a pestilence, have we not the same liberty to save them as when they are endangered by the violent assault of an enemy?—Doubtless we have…what power on earth can deprive us of it?”92 A similar sentiment was present in 1792, when the Salem Gazette reported that some Bostonians “claim[ed] a right of inoculating in their own defence [sic].”93 By this time, inoculation was permitted only in costly hospitals if less than twenty families were sick, limiting many people’s access to the procedure.94 Critics charged that inoculation restrictions cruelly disregarded the lives of susceptible children and condemned vulnerable citizens to potential death. One critic, writing as “BENEVOLUS,” argued that continued inoculation bans “favour[ed] of cruelty in the extreme” and indicated “ the absence of the best feelings of the heart, to expose our little ones to such complicated evils [natural smallpox].”95 Writing to the Columbian Centinel, “NO PHYSICIAN” was critical of the role official policy played in keeping large swaths of society liable to contract the virus. He cried that,

90 The Boston-Gazette, and Country Journal, February 13, 1764, accessed July 12, 2014, Readex: America’s Historical Newspapers (1046ED1487F55037). William Cooper was the son of the Reverend Cooper who had published his religious defense of inoculation in 1721. 91 For an analysis of the connection between smallpox inoculation debates and Enlightenment ideas such as that of self-preservation, see Wehrman, “Preserving the Body Politic,” chap. 1 in “Contagion of Liberty,” esp. pp. 15-20. 92 “To the Publishers of the Boston Evening-Post,” The Boston Evening-Post, January 30, 1764, accessed July 14, 2014, Readex: America’s Historical Newspapers (108B71A08DE16FB0). 93 “Salem, August 21, 1792,” Salem Gazette, August 21, 1792, accessed July 14, 2014, Readex: America’s Historical Newspapers (1084F170EC0AC3D8). 94 See Fenn, Pox Americana, 39-43; Blake, Public Health, 114; Wehrman, “Contagion of Liberty,” 70. 95 “Mr. Russell,” The Columbian Centinel, August 11, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA20CF2D14F0).

“[b]y the present mode of procedure [banning general inoculation] we and our children must unavoidably be assassinated thereby as it comes to our turn.”96 While some saw inoculation bans as protective and thus praised officials in their efforts to enforce them, those who sought the protective benefits of inoculation opposed bans, and by extension, the officials who imposed them.

Proponents of inoculation had long touted its benefit to the town as a whole. In the years following the American Revolution, this argument increasingly highlighted disparities in access to the procedure. Recent scholarship on inoculation has emphasized the class dimensions of inoculation, particularly in the context of the American Revolution.97 Indeed, Blake sees the

Revolution as a turning point in the class dynamics of inoculation. He argues that prior to the

Revolution and the concurrent rise of inoculation hospitals in Massachusetts, the rich favored looser inoculation policies. After the Revolution, with inoculation hospitals more prevalent, the lower classes were more likely to support a general inoculation in order to gain access to a procedure that was increasingly available only to those who could afford hospital fees.98 While

Blake’s argument rests more on the increased availability of inoculation hospitals, which happened to coincide with the war period, Andrew Wehrman and Jeffrey Weir more explicitly link inoculation debates to Revolutionary sentiment. Wehrman argues that the destruction of

Essex Hospital in Marblehead reflected growing demands for increased equality, as townspeople opposed the hospital that benefitted only a small portion of society rather than the entire town.99

Weir posits that inoculation was “at times, yet another challenge to the patriot cause,” for its

96 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78). 97 See for example, Fenn, Pox Americana; Wehrman, “Contagion of Liberty” and “Siege of Castle Pox,” and Weir, “Challenge to the Cause.” 98 Blake, Public Health, 140. 99 Wehrman, “‘Siege of Castle Pox,’” 397-398, 428-429.

commercialization conflicted with Revolutionary sentiment emphasizing equality.100 In Boston, supporters of inoculation objected to unequal access, and they were particularly critical of those people, including the rich and enterprising physicians, who contributed to this reality.

The inoculation debates of 1792 offer a window into how the inhabitants perceived their responsibility to one another in the wake of the Revolution and the changes it brought. In these cases, the argument was as much about anger over one’s own lack of access to inoculation as it was about a perceived lack of caring on the part of those who inoculated when their neighbors could not. Prior to the announcement of a general inoculation on August 20, serious debate arose over whether inoculation should be allowed openly in the town.101 Some argued against it on the grounds that it would be too hurtful to trade and the daily functioning of the town.102 Supporters of inoculation attacked this stance as selfishly placing monetary gain over the health of the town.

A writer to the Columbian Centinel railed that Bostonians suffered because of “sordid principles of gain,” and were forced to endure the disease without inoculation “least the fall business should be hurt.”103 In the eyes of those favoring open inoculation, the opponents of a general inoculation were usually those who could afford to send their families to inoculation hospitals. One writer to the Columbian Centinel complained that one of the most outspoken opponents of inoculation at a town debate sent his family to be inoculated at a hospital “the very next day.” Such behavior, according to the author, was “generally the case with all those that are able to pay.” “As for those who have not the money [to inoculate in a hospital],” he continued, “they must have it

100 Weir, “Challenge to the Cause,” 66. 101 On the general inoculation policy, see Columbian Centinel, September 1, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA36F20AE885). 102 “Miscellany. for the Centinel,” Columbian Centinel, August 29, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA339BE12723). 103 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78). On 1792 outbreak and inoculation debate, see also Blake, Public Health, 137-140.

[smallpox] the natural way…be sent to the Pest-House—and there die.”104 In painting this dichotomy, the author portrayed the affluent as unaffected by the plight of poorer Bostonians and actively opposed to policies that saved many people from what was depicted as certain death.105

At issue was not only lack of access, but also the upper class’s unwillingness to support policies that would, in the eyes of the author, benefit the entire community.

Subsequent articles in the Boston papers further highlighted anger over the perceived indifference of the upper class in violation of the social valuation of the common good. One writer, going by the name “NO PHYSICIAN,” criticized the upper classes for acting as though the smallpox issue disappeared once their own families were inoculated, which furthermore was usually done “without advertising to their poor neighbors who are unable to do that.” In their careless obliviousness, they left “the poor man, whose child has been exposed to, or perhaps… destroyed by the Small Pox” to bear all the burdens—physical, emotional, and economic—of a smallpox epidemic.106 Another writer, criticizing the Captain at New Boston,107 asked that those who protected their families from smallpox using methods that could not easily be “adopted by the common tradesmen and the poor of this town” refrain from engaging in debate over smallpox regulations for the entire community. In this Bostonian’s eyes, if one engaged in behavior not available or beneficial to the whole community, then one had no place making decisions for the community. The author further wondered whether the Captain made any effort to protect a poor family that lived near his home, sardonically noting that it “would be a pleasing task to inform the publick [sic] that some attention had been used to prevent the Small Pox spreading amongst

104 “For the Centinel. Small Pox,” Columbian Centinel, August 22, 1792, accessed July 12. 2014, Readex: America’s Historical Newspapers (1064DA2DB9B80D35). See also Blake, Public Health, 138. 105 Blake highlights how Bostonians found the hypocrisy of anti-inoculators appalling. Public Health, 138. 106 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78). 107 Possibly referring to the captain who oversaw the isolation hospital at New Boston.

them.”108 These arguments demonstrate the anger over the upper classes’ perceived indifference and failure to promote policies that benefitted the common good. The objection to unequal access to inoculation extended beyond opposing hospitals that could infect those unable to inoculate; equally abhorred was the upper classes’ apparent disregard for the plight of the entire community.

Bostonians’ perceptions of physicians provide a particularly cogent example of the emphasis they placed on the common good during smallpox outbreaks. Bostonians expressed often contradictory opinions regarding the physicians performing inoculations, who were depicted simultaneously as generous, learned caregivers and irresponsible swindlers. As seen in objections to inoculation hospitals and unauthorized inoculations, the town strongly resented when physicians inoculated contrary to law or failed to uphold hospital regulations designed to prevent the infection from spreading from the hospital to vulnerable populations in the town.

Additionally, the necessity of physicians’ skills and knowledge of inoculation were also repeatedly called into question in popular literature throughout the colonies. Benjamin Franklin famously helped distribute Dr. William Heberden’s pamphlet on inoculation, which reached

Boston in 1764. An at-home inoculation guide, the pamphlet, Franklin explained in his introduction, was written by a physician detailing how to properly inoculate and care for the inoculated. Franklin hoped that “by encouraging parents to inoculate their own children, [the guide would] be a means of removing that objection of the expence, render the practice much more general, and thereby save the lives of thousands.”109 The pamphlet indicates that people

108 “[Mr. Russel; New Boston; Captain; Small Pox; Town Meeting],” Columbian Centinel, August 22, 1792, accessed July 13, 2015, Readex: America’s Historical Newspapers (1064DA2DB9B80D35). 109 Franklin, “Preface to Dr. Heberden’s Pamphlet on Inoculation, 16 February 1759,” The Papers of Benjamin Franklin, ed. Leonard W. Labaree, vol. 8, April 1, 1758, through December 31, 1759 (New Haven and London: Yale University Press, 1965), 281–286. Founders Online. National Archives. Accessed January 12, 2015. http://founders.archives.gov/documents/Franklin/01-08-02-0073 .On the pamphlet’s spread to Boston, see note 6.

questioned whether a doctor was required to carry out every inoculation, and that particular objection was made to the cost created by physicians’ care.110

William Buchan’s Domestic Medicine, first published in North America in Philadelphia in 1772 and popular throughout the colonies (originally published in Edinburgh, 1769), promoted expansive inoculation and disregarded the need for doctors.111 Buchan recommended that the clergy perform inoculations, a recommendation likely more controversial in Boston than in other cities of publication. If the clergy could not inoculate, according to Buchan, then people should perform inoculation themselves.112 Criticizing the exclusivity of the procedure, Buchan wrote that “[w]hile it [inoculation] is confined to the few, it must prove hurtful to the whole.”113 In

Massachusetts, the Essex Journal published an article hailing an English man who went by the name Johnny Notions for his skills as an inoculator. A veritable jack-of-all-trades, Notions was

“unassisted by education, and unfettered by the rules of art,” and he managed to inoculate “many thousands, without losing a single patient.”114 Again, the need for a doctor to perform inoculations was called into question. Not only were doctors’ authority as inoculators challenged, but by extension their contribution to the exclusivity of inoculation was also suspect.

110 This eighteenth-century analysis of the role of doctors is echoed in modern scholarship. In his recent dissertation, “A Challenge to the Cause,” Weir emphasizes the commercialization of inoculation by physicians and hospital proprietors, writing that “not only did physicians and entrepreneurs turn a simple medical procedure into something complicated and expensive, but they also changed a medical procedure into a product to be marketed, sold, and a product to be procured.” Weir, “Challenge to the Cause,” 90. See pp. 69-99 for Weir’s discussion of the inoculation hospital industry. 111 For discussions of the importance of Buchan’s Domestic Medicine, see Wehrman, “Contagion of Liberty,” 23-37 and “Siege of ‘Castle Pox,’” 405; Lamar Riley Murphy, Enter the Physician: The Transformation of Domestic Medicine, 1760-1860 (Tuscaloosa: University of Alabama Press, 1991), 9, 42. 112 William Buchan, Domestic Medicine: or, a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines. With an appendix, containing a dispensatory for the use of private practitioners, 14th ed. (Boston: Printed by Joseph Bumstead for James White and Ebenezer Larkin, 1793), 161. Early American Imprints, Series 1, no. 25236, Evans 25236, accessed November 17, 2014, Readex: America’s Historical Imprints. 113 Buchan, Domestic Medicine, 159, 162. See also Wehrman, “Contagion of Liberty,” 23-37 for his extensive analysis of Domestic Medicine. 114 “Ingenuity in Trifles,” The Essex Journal and New-Hampshire Packet, June 6, 1792, accessed July 15, 2014, Readex: America’s Historical Newspapers (1089D40EE2093220).

In contrast to these negative views, the town expressed gratitude for physicians during outbreaks when they believed physicians acted charitably for the good of the community. In

March 1764, the Boston Evening-Post reported that “the Physicians of the town have generously offered to attend the poor gratis,” and the author argued that this, coupled with rising acceptance of inoculation, would allow Boston to more quickly halt the virus.115 That the physicians offered to inoculate for free, rather than being commanded by the selectmen, likely recommended them to the townspeople. In May 1764, the Overseers of the Poor published in The Boston Gazette the names of those doctors who had inoculated the poor; they related that the town “voted unanimously, that the thanks of the Town be and hereby are given those Gentleman, Physicians, who in this Season of Difficulty and Distress have generously inoculated and carried through the

Small-Pox so considerable a number of the inhabitants.”116

Though often a point of criticism, even inoculation hospitals could garner physicians praise if the hospital was perceived to be operating safely and to the benefit of the community.

When the hospital opened at Point Shirley in 1764, one writer to the Boston Post-Boy noted that the physicians, “at a considerable Expence [sic]” to themselves, helped open the hospital, where they practiced with “great and good success.” Reflecting on the doctors’ cooperation with the town of Chelsea and province officials, the author proclaimed that “such united Efforts of

Humanity cannot fail of being approved by him [God].”117 Physicians themselves framed their work as being for the good of their fellow townspeople, even when they charged for their services. For example, when James Latham, Thomas Bulfinch, Joseph Warren, and Samuel

115 “Boston, March 26, 1764,” Boston Evening-Post, March 26, 1764, accessed July 15, 2014, Readex: America’s Historical Newspapers (108B71AF76364BC0). 116 Boston Gazette, May 28, 1764, accessed July 15, 2014, Readex: America’s Historical Newspapers (104F834260C303DB). 117 “To the Printers,” Boston Post-Boy, March 12, 1764, accessed July 13, 2014, Readex: America’s Historical Newspapers (1089CD1CD3D30320).

Adams, “Practitioners in Physick and Surgery,” petitioned the town of Chelsea in 1774 for permission to open an inoculation hospital on Point Shirley, they wrote that the purpose of their hospital was “preventing the many distresses which always are occassioned [sic] by that malignant disease [smallpox].” They assured the selectmen that they would take the utmost care to prevent the spread of smallpox because of their “tender and conscientious regard to the health and lives of their fellow creatures.”118 In these cases, doctors were depicted as generous and skilled upstanding citizens who sacrificed their time and resources to help their community. A doctor who threatened the town through careless conduct was vilified, while a physician who cared for the poor and protected the wellbeing of the town was praised by the wider community.119 As was true in the broader inoculation debate, of primary concern was whether the health of the entire community was being protected.

Conclusion

The smallpox epidemics and accompanying inoculation controversies of eighteenth- century Boston underscore the importance of the town and community membership, as well as a commitment to protect the town as a whole. Though Bostonians disagreed over whether inoculation should be used, they based their arguments on a valuation of and commitment to protect the community at large, in line with Massachusetts’ longstanding valuation of the common good. Bostonians emphasized protecting the entire community from smallpox and condemned defiance of public health regulations, but they proved divided over how this could

118 James Latham, Thomas Bulfinch, Joseph Warren, and Samuel Adams petition to the Selectmen of Chelsea, July 18 [?], 1774, Box I, Folder 1770-1774, John Collins Warren Papers II, 1756-1857, Massachusetts Historical Society, Boston, MA. 119 Gianna Pomata presents the idea of physicians as protectors in her study of early modern Bologna. She argues that physicians were seen as protectors of their patient’s health. “The Medical System As Seen by the Sick,” chap. 5 in Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore: The Johns Hopkins University Press, 1998).

best be achieved. For some, inoculation threatened the town and thus policies restricting its use were warranted and supported. For others, inoculation would protect the entire town, and restrictive policies failed to secure the health of all Bostonians, particularly its poorest members.

The contradictory depictions of authority figures— town officials and physicians—at the center of these debates, highlight this divide and the town’s emphasis on protecting the whole. Thus, the protections conferred by the legislative apparatus designed to protect the town were bolstered by a community emphasis on protecting the town and all its inhabitants.

Chapter Three: Smallpox and the Household: Protecting the Family and Reconfiguring Domestic Healing

Introduction

In 1764, the child of one Mr. Nazaro of Fish Street fell ill with smallpox. When informed of this by the child’s doctor, the selectmen hoped to remove the child to an isolation hospital. Mr.

Nazaro however, “would not consent that it [the child] should be removed.” As a result, the selectmen ordered that “the House be shut up immediately” and a red flag hung from the doorway, as was required by law.1 Such a scene played out countless times throughout eighteenth-century smallpox outbreaks in Boston, pitting household authority against the authority of the selectmen and town regulation. Smallpox and inoculation led Bostonians to place particular emphasis on the town, regulation, and the common good. Where then stood the individual household, the traditional sphere of healing? Legally, officials in Massachusetts made the household an important concept in the realm of contagious disease. The home could become one’s prison during a mandated isolation, but one could also be removed from the home to endure the virus in a pesthouse or hospital, outside the traditional space of domestic healing.

These conflicts pushed Bostonians to reconsider domestic care during smallpox outbreaks as they sought to protect their families within the confines of the community’s public health system.

Scholarship on smallpox epidemics and public health in general during the colonial and revolutionary eras has focused largely on the political and military dimensions of smallpox.

Scholars have increasingly sought to place smallpox, and particularly inoculation, within a larger social frame to study issues of class and race.2 However, less attention has been given to

1 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 13. 2 On class, see for example Fenn, Pox Americana; Wehrman, “Contagion of Liberty” and “Siege of Castle Pox”; Weir, “Challenge to the Cause.” On race, see Weir, “Challenge to the Cause”; Thomas H. Brown, “The African Connection: Cotton Mather and the Boston Smallpox Epidemic of 1721-1722,” Journal of American

smallpox and inoculation in relation to gender and the household. Sara Stidstone Gromin discusses the relationship between inoculation and the household in colonial New York. She argues that as inoculation became more commercialized, the proliferation of pamphlets, books, and newspapers articles detailing how to inoculate allowed the procedure to be integrated into existing structures of domestic healing, while doctors and hospitals offered people options for treatment outside the home if they so chose.3 Jeffrey Weir, discussing the thirteen colonies, argues that inoculation both challenged and reinforced existing gender norms, for women could participate in the “inoculation industry,” but in a “subordinate role.”4 Meanwhile, he argues, mothers were seen as the guardians of their children’s health, and thus for them the decision to inoculate was particularly pressing.5

While these histories provide important insight into smallpox and gender norms, a narrower focus on the town of Boston makes particularly clear the challenges that public health regulation presented to traditional domestic healing. There, inoculation bans and strict regulations made sickness and healing a political issue for the wider community and created more varied spaces in which healing occurred. Concepts of family and space assumed critical importance in the implementation of the twenty families inoculation regulation. Hospitals became an important space where inhabitants experienced smallpox, challenging domestic medicine at least in the instance of contagious disease. However, Bostonians maintained elements of domestic care as they weathered epidemics. The family itself was important in

Medicine 260, no. 15 (Oct. 1988): 2247-2249; Margot Minardi, “The Boston Inoculation Controversy of 1721-1722: An Incident in the History of Race,” The William and Mary Quarterly 61, no. 1 (January 2004): 47-76, http://www.jstor.org/stable/3491675; Kelly Wisecup, “African Medical Knowledge, the Plain Style, and Satire in the 1721 Boston Inoculation Controversy,” Early American Literature 46, no. 1 (2011): 25-50. 3 Sara Stidstone Gronim, “Imagining Inoculation: Smallpox, the Body, and Social Relations of Healing in the Eighteenth Century.” Bulletin of the History of Medicine 80, no. 2 (Summer 2006): 263-268. doi:10.1353/bhm.2006.0057. 4 Weir, “Challenge to the Cause,” 168. 5 Ibid., 152, 159.

public debates, as the health and safety of children as well as the need for their parents, particularly their fathers, to protect the family became a frequent refrain of Bostonians. Public health regulation brought healing into the political sphere, yet women continued to act as caregivers and maintained a degree of authority over decision-making for their health and the health of their families. When town policies restricted the ability of parents to make health decisions for their families, Bostonians expected the town to assume responsibility for the health of the children of Boston, thus uniting the protective layers of regulation, community, and household. Bostonians sought to protect their household, particularly their children, from the horrors of smallpox, but did so within a reconfigured realm of domestic healing both constrained and bolstered by law and community expectations.

The Spaces of Sickness and Recovery

As a contagious virus, smallpox by its very nature made space assume critical importance in eighteenth-century Massachusetts. Public health policies relied upon isolating the sick or potentially infected within a particular space: a home, hospital, or even an entire town.

Traditionally, the domestic realm played an important role in healing in seventeenth and eighteenth-century America.6 Most medical care, if a family could afford it, was provided at home by mothers, kin, and sometimes outside practitioners.7 For those who could not afford to receive care at home, almshouses provided medical care for the sick poor, and therefore were sometimes referred to as hospitals.8

6 Murphy, Enter the Physician, xiii; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 32; John Duffy, The Healers: A History of American Medicine (Chicago: University of Illinois Press, 1979), 57. 7 Duffy, Healers, 57; Rebecca J. Tannenbaum, The Healer's Calling: Women and Medicine in Early New England (Ithaca, N.Y: Cornell University Press, 2002), 22-23; Starr, Social Transformation American Medicine, 32. 8 Duffy, Healers, 56-57. The first voluntary hospital established in what would be the United States was the Pennsylvania Hospital, founded in Philadelphia in 1751. The hospital did not admit patients with contagious

To contain contagious disease, over the course of the eighteenth century, Boston established several hospitals, or pesthouses, to isolate the sick and quarantine those who might contract the disease. These could be permanent establishments, such as those established at

Spectacle and later Rainsford Island, as well as facilities in Boston’s West End.9 However, they also could be temporary facilities established during outbreaks. For example, in 1738 the selectmen leased a home in Boston’s West End to serve as a temporary isolation hospital.10 In

1792, though by then Boston had a permanent isolation hospital infrastructure, the selectmen

“hired Houses for an Hospital for People with the Small Pox.”11 Finally, from midcentury on, inoculation hospitals were allowed in Massachusetts, though Bostonians generally opposed their presence within town limits. Here, patients paid to receive the infection from physicians and remained in the hospital until they were no longer contagious (though as discussed in chapter two, these requirements were often ignored).12 The desire to isolate the sick and provide a safe space for inoculation prompted Bostonians to establish more varied spaces of healing where one could experience smallpox during the eighteenth century.

The tension that quarantine and isolation policies created was evident throughout the eighteenth century. Bostonians lamented when smallpox, inoculation, and the quarantine policies they triggered turned Boston into “a Hospital,” the entire town becoming a space for sickness and healing.13 The issue became particularly thorny when it involved removing the sick from

diseases like smallpox. See Finger, Contagious City, 59-66. Boston did not establish a voluntary hospital in the eighteenth century. 9 Blake, Public Health, 35, 79-80, 82, 88. 10 Ibid., 81. 11 A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1787 through 1798, vol. 27, Records Relating to the Early History of Boston (Boston: Rockwell and Churchill, 1896; Internet Archive, 2007), 185, https://archive.org/details/recordsrelatingt27bost. 12 The General Court had established overarching hospital regulations in 1776. Acts and Resolves, 5:554-555. 13 When smallpox struck Boston, the town was often referred to as a “hospital.” See for example, A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1776 through 1786, 5; See also, Moses Morse to Commanding Officer at Crown Point, 9 July 1776, in American Archives, ed. Peter Force, 5th

their homes. A 1701 act empowered the selectmen to take over dwellings to isolate the sick and also allowed them to remove the sick from their homes to be isolated elsewhere. It is unclear in the language of the law whether this power meant the selectmen could force someone who refused to leave to move to another location. In some interactions, this seems to be the case. In

1702, the selectmen, by power of a warrant, moved the smallpox-afflicted Paige family to an isolation hospital at Apple Island.14 Another case recorded in 1744 noted that the selectmen removed a black man and the child of one Nathaniel Vials to a different home in order to isolate smallpox cases; when the patients left without the selectmen’s permission, the selectmen obtained a warrant to force their return.15

However, in countless other cases, Bostonians refused to be removed from their homes, prompting the selectmen to isolate the home and post guards at its entrance. The Selectmen’s

Minutes make frequent references to the selectmen requesting people move to isolation hospitals, if it could be done without endangering their health. This was a request that was often refused.

For example, in 1764, over a four-day period in January 1764, eight people refused to allow a member of their household to be removed from their home despite the selectmen’s request.16 The selectmen themselves were unsure of the extent of their authority, noting in 1774 “the doubtfulness of the Law as to impowering [sic] the selectmen to remove any Person contrary to their consent.”17 The issue of removal without consent remained a gray area of the law, and

Bostonians’ refusal to leave their homes highlights their valuation of the domestic sphere for healing and their wariness of the isolation hospital.

series 1:145, https://archive.org/details/PeterForcesAmericanArchives-FifthSeriesVolume1vol.7Of9. Writing while Boston officials briefly allowed inoculation within the town, Morse commented “Boston is become a hospital with the small-pox.” See also Fenn, Pox Americana, 53. 14 Acts and Resolves, 1:469-470. On law and Paige family, see Blake, Public Health, 33-34. 15 Record Commissioners Containing the Selectmen’s Minutes from 1742/43 through 1753, 102. 16 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 5-13. 17 Record Commissioners Containing the Selectmen’s Minutes from 1769 through April 1775, 238.

Despite this ambiguity, removal of the sick to hospitals appears to have occurred more frequently after the Revolution. Indeed, a 1776 law instructed the selectmen to “remove every person who shall be visited with the Small Pox within the said town [Boston], unto some place where they will not endanger the inhabitants thereof.”18 This push to isolate the sick included an increased tendency to quarantine in a hospital those liable to contract smallpox. Officials had employed this practice as early as 1744, when they quarantined in a hospital two widows who lived in the same home with their two children; when one child fell ill, the entire household was sent to the hospital.19 Hospital quarantine appears in the record of future outbreaks, such as cases in 1764 and 1769, but by the 1780s quarantine of household members in a hospital appears more frequently.20 For example, on December 13, 1781, Jane Sanford contracted smallpox.

Elizabeth Sanford and Betty Peters, both of whom lived in Jane’s home, were “liable to the

Distemper,” and thus “they were all three ordered to Rainsford Island.”21 In 1788, one Mrs.

Baker was suspected of having smallpox. Had it been 1764, she would likely have been moved to a hospital or allowed to remain isolated in her home. Her family members would probably be expected to either remain quarantined in their home or find alternate lodging, as was the case for

Mr. Flagg (discussed in chapter two) who was made to promise that he would not go to his home until his children had recovered from the virus.22 In this case, however, Mrs. Baker, her husband, and their six children were all removed to the hospital at New Boston.23 One Captain Potter’s family faced a similar action in 1788; when Captain Potter fell ill, his entire household, including

18 The Boston Gazette, and the Country Journal, July 9, 1792, accessed July 14, 2014, Readex: America’s Historical Newspapers (1044569207EC8E5B). 19 Record Commissioners Containing the Selectmen’s Minutes from 1742/43 through 1753, 100. 20 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 12; A Report of the Record Commissioners of the City of Boston, Containing the Selectmen’s Minutes from 1769 through April 1775, 20, 32. 21 Record Commissioners Containing the Selectmen’s Minutes from 1776 through 1786, 163. 22 On Mr. Flagg, see Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 40-41. 23 Record Commissioners Containing the Selectmen’s Minutes from 1787 through 1798, 60.

a young servant girl, was moved from their home into quarantine at West Boston.24 When one

Mr. Francis’s sister, with whom he lived, fell ill with smallpox, his four susceptible children were also sent to the hospital to be quarantined.25 Boston officials thus increasingly made efforts to isolate the sick and to quarantine members of their household who might fall ill and spread the virus when they traveled through town.

By 1792, officials’ willingness to isolate the sick and quarantine their families met with public backlash. Bostonians had long resisted removal from their homes when afflicted with smallpox. However, during the 1792 outbreak public discourse over the issue became particularly contentious, especially in the Columbian Centinel, a newspaper published by active commentator on issues of public health, Benjamin Russell. Russell publically promoted sanitation efforts to combat yellow fever, including the proposed building of an aqueduct to bring clean water to Boston. He also supported vaccination when Benjamin Waterhouse introduced the procedure to Boston in 1800, and Russell participated in the politics of the Boston

Board of Health, established in 1799. He was an active Federalist during the years of the early

Republic, and his newspaper carried strong opinion pieces regarding smallpox during the 1792 outbreak.26

In 1792, Bostonians objected to removals to hospitals on the grounds that it allowed officials to evade the twenty families rule. The twenty families rule contributed to less equitable access to inoculation and thus, as discussed in chapter two, spurred debates about equal access and the common good. In 1792, critics objected to how the twenty families rule used ideas of the

24 Ibid., 65. 25 Ibid.,, 69. 26 The Columbian Centinel was originally published as the Massachusetts centinel: and the Republican journal (1784-1790) by Willian Warden and Benjamin Russell. It began being published as the Columbian Centinel on June 16, 1790, with Benjamin Russell as its sole publisher. See Blake, Public Health, 156-157, 181, 184-85, 198, 204- 205, 229-30, 234; Early American Newspapers in the Library of Congress, http://www.loc.gov/rr/news/18th/158.html.

family to prevent open inoculation. Much of the controversy rested on conceptions of space in relation to the family. Was the family defined as a group of people living in the same building, or was family defined as kinship? In eighteenth-century America, the idea of the family was fluid.

The family, synonymous with the “domestic unit” or “household,” could include a married couple and their children, as well as servants, relatives, and workmen.27 This composition could easily change not only through deaths or births, but also through travel and movement into or out of a home.28 This fluidity was also the case during smallpox epidemics, as the writings of Abigail

Adams reveal. In 1776, Adams and her four children underwent inoculation in her aunt’s home in Boston. While in her letter to John Adams she distinguished between different nuclear families, Adams considered the current residents of her aunt’s home to be another, broader family linked by space and the shared experience of smallpox inoculation. She wrote that “Mr.

Cranch and wife and family, My Sister Betsy and her Little Neice, Cotton Tufts and Mr. Thaxter, a maid who has had the Distemper and my old Nurse compose our family.”29 Adams defined her

“family” as all the current members of the household, regardless of blood relation or social class.

In 1792, officials utilized the equation of family with the household to stall a general inoculation, drawing the ire of inoculation advocates. In the opening weeks of the epidemic, officials reported the number of infected families, but they did not include the people sick in the hospital in this count. For example, in February, the selectmen reported in the Boston Gazette that excluding the hospital, “there are only two families infected [with smallpox].”30 Critics castigated officials for this method of reporting, arguing that it obscured the true state of the

27 Carr, After the Siege, 73; On family as “domestic unit,” Carr, After the Siege, 73. On the “household” as a more accurate depiction of how early Americans understood family, see Kate Fawver, “Neolocality and household structure in early America,” The History of the Family 17, no. 4 (2012): 407-408. 28 Carr, After the Siege, 73. 29 Letter from Abigail Adams to John Adams, 13 - 14 July 1776 [electronic edition], in Adams Family Papers: An Electronic Archive, Massachusetts Historical Society, Boston, MA, http://www.masshist.org/digitaladams/. 30 The Boston Gazette, and the Country Journal, February 27, 1792, accessed July 10, 2014, Readex, America’s Historical Newspapers (1044567AF636ECBA).

town’s health and allowed them to evade the twenty families rule by counting all of the people in the hospital as one family. One writer to the Centinel, writing as “NO PHYSICIAN,” sardonically asked to know “of how many members this SINGLE family [referring to the people in the isolation hospital] consists.” Advocating for a general inoculation, “NO PHYSICIAN” implied that to count the people in the hospital as a single family was dishonest and allowed the town to continue to prohibit inoculation in violation of the twenty families rule.31 Another commentator in the Centinel, writing as “A Citizen,” argued that “twenty families infected, although moved into one hospital, is sufficient authority [to meet the 20 families rule and have a general inoculation] without seeking any other—they are no less different families because they are moved into one house.” “A Citizen” rejected the idea that a group of people living in the same space necessarily constituted a family, writing that “we frequently hear of two or more families living under one roof.”32 In these cases, Bostonians opposed the selectmen’s use of physical space as a marker of family in order to avoid allowing open inoculation. Thus, the family unit as well as space assumed critical importance in the town’s protective policies to guard against smallpox.

Parents and Children: The Household and Protection Against Smallpox

Throughout the eighteenth century, Boston’s protective policies against smallpox rested on macro conceptions of community and the common good, with officials and townspeople supporting those policies and standards of behavior that they believed would benefit the town as a whole. The final dimension of Boston’s protective schema, however, rested on conceptions of

31 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78). Blake, Public Health, 137-138. 32 “Miscellany. For the Centinel,” Columbian Centinel, September 8, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA3E049AA287).

household healing and, in particular, the parent-child relationship. Spaces for sickness and healing caused controversy not only because of their influence on inoculation policies, but also because hospitals, whether they were for isolation or inoculation, challenged traditional domestic medicine. Bostonians described isolation hospitals as places to be hated and avoided.

Commentators in the Columbian Centinel spoke of isolation hospitals, frequently referred to as pesthouses, with open disdain. One writer railed that Bostonians were being “dragged into loathsome hospitals” where they were forced to endure the virus with “all the fashionable equette

[etiquette?] of the Pest House.”33 The author’s comments underscore the undesirable conditions in the pesthouses as well as some Bostonians objection to the hospital as a space for healing, particularly when one’s stay was compulsory. Another writer to the Columbian Centinel criticized forcible containment in an isolation hospital. This author, however, went further to equate the pesthouse with death, lamenting that those who could not afford inoculation would be

“taken from their houses, sent to the Pest-House—and there die.”34 These comments underscore not only the anger over removal policies, but also the trauma that such policies wrought by being removed from one’s home, especially when ill, to a space seen as dangerous to one’s life.

Inoculation hospitals also came under fire for their conditions. Even William Aspinwall, whose successful hospital in Brookline offered scenic surroundings and pleasant company, had to ward off reports in 1792 that the hospital was overcrowded.35 When Mercy Otis Warren had her sons inoculated at a hospital in Plymouth, she complained that ““[t]heir accomodations [sic]

33 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78). See also Blake, Public Health, 137-138. 34 “For the Centinel. Small Pox,” Columbian Centinel, August 22, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA2DB9B80D35). 35 The Independent Chronicle and the Universal Advertiser, March 5, 1789, accessed July 14, 2014, Readex: America’s Historical Newspapers (10B3C40FF65FEFE8); Columbian Centinel, June 13, 1792. Accessed July 14, 2014. Readex: America’s Historical Newspapers (1064D9E3172A796E). Blake discusses Aspinwall’s hospital as a place of “games and amusements,” Public Health, 134.

are not altogether to my Liking nor are their Nurses sufficient.”36 Warren, worrying that her sons’ inoculations might prove fatal, confessed that “if my family should then be Retrieved in safety to my own Roof I shall be thankful.”37 A writer to the Independent Chronicle asked rhetorically, “how many are there who… [would be] content to be separated from their bosom friends and dearest connections for man[y] weeks and months, and deliver them into the hands of

Doctors and Nurses, who perhaps they never saw or heard of before.”38 The hospitals, however necessary they had become to contain or receive the virus, still were regarded warily as people questioned their safety and wanted their relations within the protective embrace of domestic care.

The desire to preserve domestic medicine is underscored by parents’ efforts to care for their children within the space of the hospital. In many cases, parents refused to be separated from their children, opting to have their houses shut off from the world rather than send a child alone to an isolation hospital.39 However, in several instances parents went to the isolation hospitals with their children in order to care for them. For example, in 1769 Mr. Bills, a soldier, spent “a fortnight” at the Rainsford Island hospital, “where he had attended his Child.”40

Similarly, Mrs. Sanders, a “Soldiers wife,” spent fourteen days at Rainsford Island “where she had been attending a Child.”41 In November, 1774, five children sick with smallpox were sent to the hospital at New Boston. The selectmen decided that “[t]he Mother of three of the Small Pox

Children, and the Father of two of them, were permitted to go into the hospital, to attend their

36 Mercy Otis to James Warren, 24 November 1776, in Mercy Otis Warren: Selected Letters, ed. Jeffrey H. Richards and Sharon M. Harris (Athens and London: University of Georgia Press, 2009), 79. See also, Weir, “Challenge to the Cause,” 93. 37 Mercy Otis to James Warren, 24 November 1776, in Mercy Otis Warren: Selected Letters, 79. 38 “Small-Pox. to the Inhabitants of the Town of Boston,” The Independent Chronicle, August 30, 1792, accessed July 6, 2014, Readex: America’s Historical Newspapers (10B3C5F5B30B3ED8). 39 For myriad examples, see Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768. 40 Record Commissioners Containing the Selectmen’s Minutes from 1769 through April 1775, 41. 41 Ibid., 43.

children.”42 Indeed, even in an inoculation hospital staffed with medical practitioners and aids, parents wanted to care for their children, as Mercy Otis Warren’s writings attest. Worried about conditions in the inoculation hospital, she resolved that, “if my dear Children should be very Ill I must go & take charge of them myself.”43 The expectation that parents should care for their children and protect them from suffering survived in the smallpox hospitals of the eighteenth century. If parents could not protect their children from contracting smallpox, they could still nurse them during their sickness and try to protect them from further distress.

Children were a feature in smallpox debates throughout the eighteenth century. Jeffrey

Weir argues that eighteenth-century Americans conceived that inoculation was a duty—people owed it to their families, particularly their children, to have them inoculated.44 Indeed, the idea of inoculation as a duty one owed one’s children was seen in many pro-inoculation arguments. In

Britain, James Buchan argued in his influential Domestic Medicine for an increased focus on parents’ responsibility to protect their children’s health.45 Buchan was unequivocal about what he believed was parents’ duty to inoculate their children, asserting that “[s]urely such parents as wilfully [sic] neglect the means of saving their children’s lives [through inoculation], are as guilty as those who put them to death.”46 He advocated regular inoculation of children as a way to eradicate smallpox.47

Buchan’s emphasis on children likely lay in part on the nature of immunity in England, where endemic smallpox meant children were more susceptible to the virus than adults.48

However, the emphasis on the need for parents to protect their children using inoculation

42 Record Commissioners Containing the Selectmen’s Minutes from 1769 through April 1775, 232. 43 Mercy Otis to James Warren, 24 November 1776, in Mercy Otis Warren: Selected Letters, 80. 44 Weir, “Challenge to the Cause,” 157-162. 45 Murphy, Enter the Physician, 41. 46 Buchan, Domestic Medicine, 157, 159. For further analysis of Domestic Medicine, see Wehrman, “Contagion of Liberty,” 23-27 and Murphy, Enter the Physician, 9-10, 15. 47 Buchan, Domestic Medicine, 159. 48 On immunity in Britain, see Fenn, Pox Americana, 27-28.

endured across the Atlantic, though there smallpox was not always a childhood illness. As early as 1764, a commentator in the Boston Evening-Post echoed the sentiments of Benjamin Franklin, imploring parents to not let misguided “tenderness and scrupulosity” keep them from inoculating their children.49 In 1788 and into 1789, smallpox once again threatened to devastate Boston. Pro- inoculation advocates argued that inoculation should be allowed for the sake of the town’s children, though ultimately open inoculation was not allowed during this outbreak. “A

Bostonian” wrote to the Herald of Freedom in September 1788 arguing that there were “several thousands of children” who were liable to contract smallpox and had “an unanswerable claim, upon their parents, their guardians and fellow-citizens, for the privilege of inoculation.”50 Several months later, “A Ship Carpenter” wrote to the Massachusetts Centinel lamenting that he could not afford to inoculate his “large family of children,” and thus he desired open inoculation outside of the hospitals.51 Of course, those parents opposed to the procedure felt just as strong an obligation to protect their children, often from inoculation itself. A commentator in the

Columbian Centinel underscored this viewpoint when he claimed a right to shoot inoculated children “in defence of [his] children” who had never had smallpox.52 Whether the protective method used was inoculation or avoiding smallpox in all its forms, parents were expected to shield their children from the dangers of smallpox, forming another layer of protection for the town.

While public discourse emphasized parental responsibility to protect their children, it also more specifically underscored the emphasis placed on masculinity and paternal protection. The

49 Boston Evening-Post, April 2, 1764, accessed July 10, 2014, Readex, America’s Historical Newspapers (108B71C635EF30A0). 50 “For the Herald of Freedom,” Herald of Freedom, September 25, 1788, accessed July 9, 2014, Readex, America’s Historical Newspapers (10BCF30A53750888). 51 “[Mr. Russels; Citizen; Townsmen; State; Small Pox],” Massachusetts Centinel, March 7, 1789, accessed July 9, 2014, Readex: America’s Historical Newspapers (1107BF09805E19D8). 52 “Miscellany. For the Centinel,” Columbian Centinel, August 29, 1792, accessed July 12, 2014, Readex: America’s Historical Newspapers (1064DA339BE12723).

ship carpenter’s plea for open inoculation highlights the particular angst felt by men who wanted to protect their children but could not given the town’s restrictions on inoculation. Nor was this sentiment particular to this ship carpenter. In 1792, there was a similar conception of paternal obligation to protect the family. One writer to the Columbian Centinel underscored the inherent emotional investment fathers had in inoculation, asking if “any man who has a family of children

[could] be uninterested [in issues of smallpox].” The author concluded that if a father did not care about the outcome of inoculation debates, then he must “be either more or less than man.”53

The author made clear that a father engaged with public debate about smallpox because of his concern for his children; to not care about their health was a violation of his paternal role. A writer to the Independent Chronicle expanded the conception of the paternal role to include a man’s desire to protect his wife. The author implied that husbands and fathers were most qualified to vote on smallpox measures, since their concern for their family influenced their perception of smallpox policies. “Many who will have to vote on this question [inoculation], have wives and children to have it [smallpox],” while “those who have none cannot have the same feelings on this occasion [sic],” the author concluded.54

Demonstrations of fatherly concern in town meetings regarding smallpox were also applauded. When town clerk William Cooper participated in debates over smallpox policies at a town meeting in early August, a correspondent for the Argus hailed Cooper for his “benevolence, charity, and parental affection for a family.” The correspondent later praised Captain James

Prince for the “manly boldness” he displayed when engaging in the debate.55 Bostonians’

53 “For the Centinel. Small Pox,” Columbian Centinel, August 22, 1792, accessed July 10, 2014, Readex America’s Historical Newspapers (1064DA2DB9B80D35). 54 “Small-Pox. to the Inhabitants of the Town of Boston,” The Independent Chronicle, August 30, 1792, accessed July 6, 2014, Readex America’s Historical Newspapers (10B3C5F5B30B3ED8). 55 “Boston, Tuesday, August 14,” The Argus, August 14, 1792, accessed July 10, 2014, Readex America’s Historical Newspapers .

emphasis on masculinity and fathers’ particular concern for and role in protecting their children’s health is especially noteworthy given that women were usually responsible for familial health and healing in the eighteenth century.56 Indeed, Weir argues that “as protectors of their families’ health,” women were particularly invested in inoculation; to have their children die of smallpox that could have been prevented was “often considered a dereliction of their motherly duty.”57

However, Bostonians’ valuation of masculinity and paternal protection in smallpox debates is indicative of the structure of Boston’s public health system. With some exceptions, women were primarily responsible for domestic healing.58 Boston’s smallpox response policies, however, brought healing, in this particular case, into the political sphere. While most

Bostonians still preferred to suffer through the virus at home, they had to undergo inoculation in a hospital in the absence of an outbreak and they could be forced to heal in a pesthouse.

Decision-making about smallpox responses occurred outside of the home, as laws, public debates, and town votes dictated which policies would be adopted and which medical procedures would be allowed. Meanwhile, as Weir argues, male doctors became the accepted dominant medical authority on matters of smallpox and inoculation.59 Ultimately, as a public health threat, smallpox was a political issue. In eighteenth-century Massachusetts, politics was considered men’s sphere, while women were believed to belong in the private sphere; because married couples were considered to be of a “single will,” with men holding the authority, men were

56 See for example, Murphy, “The Maternal Physician,” chap. 2 in Enter the Physician; Tannenbaum, Healer’s Calling, 22-23; Starr, Social Transformation American Medicine, 32. 57 Weir, “Challenge to the Cause,” 152, 157-159. This idea of a mother’s role in her children’s health would become linked to the cultural movements of the early republic, Lamar Riley Murphy argues. During the opening years of the nineteenth century, he argues, ideals of republican motherhood emphasized women’s role in raising children healthy in body and civic spirit. See Murphy, Enter the Physician, 52-53, 68-69. 58 Murphy, Enter the Physician, 35. 59 Weir, “Challenge to the Cause,” 166-167.

supposed to act as intermediaries between women and politics.60 With smallpox placed in the political realm, it is unsurprising that men’s role in health gained more attention as men engaged in political debates about public health policies. Bostonians had entrusted the protection of the town’s health to public officials—the symbolic fathers of the town; it follows that Bostonians would emphasize a father’s role in defending the health of his family.

In the decades following the Revolution, inoculation gained in popularity, and increasingly the lower classes demanded access to the procedure which was still legally allowed only in costly inoculation hospitals until more than twenty families were sick.61 As discussed in chapter two, critics railed against these policies that, in their view, endangered the children of the town by denying them access to a potentially life-saving procedure; with inoculation so restricted, parents were unable to protect their children. They argued that if parents could not protect their children because of restrictive inoculation policies and the resultant high costs of the procedure, then it was the duty of the entire town to ensure that the children of Boston were inoculated. The ship carpenter writing in 1789 argued that because he could not inoculate his children, it was “the duty of the town” to protect children from smallpox by allowing open inoculation.62 Similar arguments appeared in 1792. In August, “A Bostonian” wondered if it was

“not the duty of the town to permit the children to have the disease by inoculation” since children had no previous exposure and meanwhile went to school and traveled, thereby risking

60 Linda K. Kerber, Women of the Republic: Intellect and Ideology in Revolutionary America (Chapel Hill, NC: University of North Carolina Press, 1980), 35-36, 120-121. On women’s roles in early New England, see Laurel Thatcher Ulrich, Good Wives: Image and Reality in the Lives of Women in Northern New England, 1650-1750, (New York: Alfred A. Knopf, 1982). On women’s roles during the Revolutionary period and early Republic, see Kerber, Women of the Republic; Carol Berkin, Revolutionary Mothers: Women in the Struggle for America’s Independence,” (New York: Alfred A. Knopf, 2005); and Mary Beth Norton, Liberty’s Daughters: The Revolutionary Experience of American Women, 1750-1800, with a new Preface (Ithaca, NY and London: Cornell University Press, first published 1980, 1996). 61 Blake, Public Health, 140. 62 “[Mr. Russels; Citizen; Townsmen; State; Small Pox],” Massachusetts Centinel, March 7, 1789, accessed July 9, 2014, Readex: America’s Historical Newspapers (1107BF09805E19D8).

contracting natural smallpox.63 Another writer to the Independent Chronicle emphasized the duty of the town to help children whose parents could not afford to inoculate them. The author implored readers to “consider the duty that we owe these children [whose parents cannot afford to inoculate them]… Let us my friends, act [?] from a regard for our children…” and allow inoculation in order to give them “every advantage.”64 In these cases, commentators first looked to parents to protect their children, but when town regulations prevented them from doing so, they expected the town to assume responsibility for the health and wellbeing of the children of

Boston. This could be accomplished by voting to allow inoculation when twenty families fell ill.

In this way, parents acknowledged the town’s ability to assume authority over health, but as a result expected the town to act in the best interest of inhabitants when their policies infringed on decision-making traditionally left to the individual household. Here, the protective layers of the household, the broader community, and official policy merged to protect the children of Boston.

The prioritization of protecting children is evidenced in the inoculation records available that record the age of recipients. Official town records do not note the age of those who inoculated.65 However, a sample of inoculation requests from the Overseers of the Poor to physicians in 1792 sheds some light on the matter. Sixteen of the seventeen requests were for the inoculation of children; only two also provided for the inoculation of adults, both of whom were the mothers of the children being inoculated.66 During the same outbreak, Jeremy Belknap, minister at what was then the Federal Street Church, recorded the gender and age of parishioners

63 “For the Columbian Centinel,” The Columbian Centinel, August 18, 1792, accessed July 6, 2014, Readex: America’s Historical Newspapers (1064DA2A5C73673D). 64 “Small-Pox. to the Inhabitants of the Town of Boston,” The Independent Chronicle, August 30, 1792, accessed July 6, 2014. Readex America’s Historical Newspapers (10B3C5F5B30B3ED8). 65 They typically recorded the race of the inoculated individual and whether or not he or she survived. See for example, Boston Town Records 1784-1796, 307. 66 “Smallpox inoculation: orders to physicians, 1792,” 1.Ku.14, Boston Medical Library in the Francis A. Countway Library of Medicine, Harvard University, Boston MA. http://nrs.harvard.edu/urn-3:HMS.COUNT:1196087.

inoculated for smallpox.67 Though this is only a small sample of the Boston population, the number of children inoculated was more than double the number of adults; 177 parishioners inoculated were under sixteen, while 79 were over sixteen. The tendency to inoculate more children than adults was likely the result of the realities of population immunity—older

Bostonians were more likely than children to have already developed immunity to smallpox through previous exposure, as contemporary commentators were quick to point out.68 These records underscore that the emphasis on protecting the town’s children was more than rhetoric employed during inoculation debates. Bostonians indeed moved to inoculate children during outbreaks, and the town, as evidenced by the Overseer of the Poor’s inoculation requests, did take action to provide inoculation to those children whose parents could not provide this protection themselves.

Women, Smallpox, and Inoculation

As public inoculation debates emphasized children and paternal protection, noticeably absent from these debates were references to women, despite their historically prominent role in domestic healing. Traditionally, women provided much of their families’ domestic care, from nursing the sick to diagnosing sicknesses and concocting and administering remedies.69 If the

1792 debates are significant for their emphasis on paternal care, they are equally noteworthy for

67 Jeremy Belknap, “Jeremy Belknap’s List of Families in the Parish, with Information about ‘Inoculation’ of Members, and Records of Deaths from Smallpox in Boston, 1702-1792,” Arlington Street Church (Boston, Mass.) Records, 1730-1979, Andover-Harvard Theological Library, Harvard Divinity School, Cambridge, MA. http://nrs.harvard.edu/urn-3:DIV.LIB:1144117?n=2. The congregation relocated from Federal Street to Arlington Street in 1862, changing its name from the Federal Street Church to the Arlington Street Church. 68 See for example, “For the Columbian Centinel,” The Columbian Centinel, August 18, 1792, accessed July 6, 2014, Readex: America’s Historical Newspapers (1064DA2A5C73673D). The commentator noted that there had not been an outbreak in Boston in fourteen years, meaning that an entire generation of children had never been exposed to smallpox. 69 Tannenbaum, The Healer’s Calling, 22; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 32; Murphy, Enter the Physician, 35.

their limited discussion of women. Commentators in public newspapers alluded to mothers by speaking of the parental unit, but specific discussions of women were sparse. A writer to the

Independent Chronicle discussed women susceptible to smallpox, but only in reference to husbands’ desire to protect their wives.70 Another brief comment in the Columbian Centinel noted that a man inoculated his family without regard for “the life of his wife.”71 Only one other newspaper specifically discussed women and inoculation policies’ impact on them. Writing to the Columbian Centinel to advocate continuous inoculation of children, “A Citizen” criticized the town’s decision to allow open inoculation until September 15. The author contended that the limited time frame prevented many from inoculating, “particularly women, and others, whose health would make it imprudent.”72

Arguments for inoculation tended to rest on assertions that people needed access to the procedure because they would be out in society and thus liable to contract the disease. Women were not referenced in such arguments. Rather, commentators frequently focused on children who would go to school and travel as they approached adulthood, as well as on men who traversed the town on business. For example, “NO PHYSICIAN” argued that without inoculation smallpox would spread because “the children associate at the schools, and the men continue in the usual intercourse of business.”73 Some arguments emphasized the particular necessity of inoculating male children. The ship carpenter anxious to inoculate his children worried

70 “Small-Pox. to the Inhabitants of the Town of Boston,” The Independent Chronicle, August 30, 1792. Accessed July 6, 2014. NewsBank/Readex America’s Historical Newspapers (10B3C5F5B30B3ED8). 71 “For the Centinel. Small Pox,” Columbian Centinel, August 22, 1792, accessed July 10, 2014, Readex: America’s Historical Newspapers (1064DA2DB9B80D35). It is unclear why the author felt the man disregarded his wife’s life by inoculating his family. Not everyone was considered suited for inoculation, including those who were sickly (see for example “Miscellany. For the Centinel,” Columbian Centinel, September 8, 1792. Accessed July 13, 2014. NewsBank/Readex, America’s Historical Newspapers (1064DA3E049AA287) Pregnant women were also considered particularly at risk of death if they contracted smallpox (see Buchan, Domestic Medicine, 158). Perhaps this man’s wife was ill or pregnant, and thus his inoculation of their children was viewed as a danger to her life. 72 “Miscellany. For the Centinel,” Columbian Centinel, September 8, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA3E049AA287). Again, this perhaps referred to pregnancy. 73 “For the Centinel. Attention! My Fellow Citizens!,” Columbian Centinel, August 25, 1792, accessed July 13, 2014, Readex: America’s Historical Newspapers (1064DA30B7D85F78).

particularly about his sons, arguing that “[his] boys will soon want to go to sea” and were thus in greater danger of contracting natural smallpox.74 Two years later in 1792, a commentator in the

Independent Chronicle implored his “Fellow Citizens” to adopt a general inoculation and urged them to “consider that [the situation] of the male-children,” whose worldly travels would put them at risk.75 Though officials would record the names of women ill with smallpox, in public discourse women could become invisible victims of the disease. When one commentator wrote to the Columbian Centinel, he noted that there were “men and children, in all parts of the town, taken with that disorder.”76 Women were subsumed into broader categories of “parent” and

“smallpox victim” in public discourse.

If women’s role in smallpox epidemics is obscured in the historical record, it is similarly underemphasized in existing scholarship on eighteenth-century North America. Women feature prominently in scholarly discussions of smallpox in Europe, as it was a woman, Lady Mary

Wortley Montagu, who first introduced the procedure in England. Shortly thereafter, the Princess of Wales, Caroline of Ansbach, championed the procedure.77 However, the role of women in

North American smallpox outbreaks has been little studied. In her study of women and medicine in seventeenth-century New England, Rebecca Tannenbaum highlights women’s role in the

74 “[Mr. Russels; Citizen; Townsmen; State; Small Pox],” Massachusetts Centinel, March 7, 1789. Accessed July 9, 2014. NewsBank/Readex, America’s Historical Newspapers (1107BF09805E19D8). 75 “Small-Pox. to the Inhabitants of the Town of Boston,” The Independent Chronicle, August 30, 1792. Accessed July 6, 2014. Readex: America’s Historical Newspapers (10B3C5F5B30B3ED8). 76 “For the Centinel. Small Pox,” Columbian Centinel, August 22, 1792. Accessed July 10, 2014. NewsBank/Readex America’s Historical Newspapers (1064DA2DB9B80D35). 77 On women and the introduction of inoculation in England, see for example, Fenn, Pox Americana, 32; Hopkins, Greatest Killer, 47-50; Williams, “The Ambassador’s Ingenious Lady”, chap. 4 in Angel of Death; Duffy, Epidemics in Colonial America, 25; Genevieve Miller, “Smallpox Inoculation in England and America: A Reappraisal,” The William and Mary Quarterly 13, no. 4 (Oct., 1956): 476- 492, http://www.jstor.org/stable/1917019.

community as healers. One such healer, a “doctoress” named Mary Hale, cared for smallpox patients in her home.78

Jeffrey Weir’s recent dissertation, “A Challenge to the Cause,” offers the most extensive analysis of women in smallpox outbreaks in eighteenth-century America. He argues that as the overseers of their families’ health, women gained knowledge of inoculation and some, such as

Eliza Pinckney of South Carolina and Margaret Morris of New Jersey, performed inoculations.

Others participated in what Weir describes as the “inoculation industry” by providing lodging, caring for the sick, and overseeing hospitals. Despite their knowledge of inoculation and participation in the “inoculation industry,” women, Weir contends, were still subordinate to male doctors; thus, inoculation both challenged and maintained prescribed gender roles. Finally, Weir posits that inoculation of women was a particular concern during the eighteenth century, as many contemporaries viewed it as a way to save feminine beauty from the disfiguring grip of smallpox.79 In Boston, though less visible in public discourse, women were part of the terror and controversies that smallpox inoculation launched. They navigated a public health system that required them to confront officials and legal hurdles as they made decisions for their own and their families’ health during smallpox outbreaks.

Though the 1792 debates obscured women’s place in inoculation and the threats they faced from smallpox, women were intimately connected to smallpox and inoculation, both within their own households and beyond throughout the eighteenth century. Some public discourse referred primarily to men and children as needing inoculation; however, others emphasized the particular need to protect women from smallpox, largely because of their role as mothers. As early as 1726, Zabdiel Boylston wrote about the particular issues to consider when inoculating

78 Tannenbaum, The Healer’s Calling: 119-121. 79 Weir, “Inoculation and Gender.” Chap. 3 in “Challenge to the Cause.”

women. In his Historical account of the small-pox inoculated in New-England, dedicated to the

Princess of Wales, he stressed that pregnant women should “avoid the Small-Pox every way

[natural and inoculated].” However, he argued that if they could not, then they should be inoculated to “save the fruit” and the mother.80

In his highly influential Domestic Medicine, Buchan also argued that women faced particular dangers from smallpox. He held that young women especially needed to be inoculated given the potentially tragic outcome if they contracted smallpox while pregnant or nursing.

Buchan noted that “a woman with child seldom survives” if she fell ill with smallpox.81 He argued that smallpox made susceptible mothers choose between their own lives and caring for their sick children, noting that disease led the “affectionate mother…to leave her house, and abandon her children, at the very time when her care is most necessary.” However, should mothers choose to stay, their risked their own lives—Buchan lamented that he had seen mother and child “laid in the same grave, both untimely victims to this dreadful malady.”82 Buchan’s description highlights the conflict between a mother’s health and the health of her children. By his account, women should inoculate to protect their own lives and in the future, be able to carry

80 Zabdiel Boylston, “Historical account of the small-pox inoculated in New-England, upon all sorts of persons, whites, blacks, and of all ages and constitutions. With some account of the nature of the infection in the natural and inoculated way, and their different effects on human bodies. With some short directions to the unexperienced in this method of practice. Humbly dedicated to Her Royal Highness the Princess of Wales, by Zabdiel Boylson, F.R.S.” (London: Printed for S. Chandler 1726. Re-printed at Boston for S. Gerrish in Cornhil, and T. Hancock, 1730), 41. Early American Imprints, Series 1, no. 3259 (filmed). NewsBank/Readex, Archive Americana. Accessed January 12, 2015. 81 Buchan, Domestic Medicine, 158. It is difficult to determine the impact of smallpox on pregnant women, particularly for outbreaks prior to the nineteenth century. It is generally believed, based on studies from the twentieth century, that smallpox was “more severe” in pregnant women than in “nonpregnant women or adult men.” A 2006 analysis of maternal outcomes in historic smallpox outbreaks studied fatality rates and rates of miscarriages or premature birth in outbreaks during the nineteenth and twentieth centuries. The study’s author found an overall fatality rate of 34.3%, though it varied by outbreak; the highest case fatality rate (81.5%) was recorded in the earliest outbreak studied (1830). The overall miscarriage or premature birth rate was 39.9%. The fatality rate was found to be highest among women in their third trimester, and there was a “high risk” of miscarriage or premature birth even during mild cases of smallpox. See Hiroshi Nishiura, “Smallpox during pregnancy and maternal outcomes,” Emerging Infectious Diseases 12, no. 7 [serial on the Internet, Centers for Disease Control and Prevention] (July 2006) http://dx.doi.org/10.3201/eid1207.051531. 82 Buchan, Domestic Medicine, 158.

out their motherly duties when their children fell ill. Nor was Buchan’s grim picture an unlikely extreme. As discussed in the introduction, Mrs. Adams contracted smallpox in 1764 shortly after

83 the birth of her child; she died several days later.

Supplications to inoculate women did not fall on deaf ears. Selectmen’s records of inoculation rates do not indicate the gender of those inoculated. However, Jeremy Belknap’s records of inoculations in the Federal Street Church, distinguish by both the gender and age of members of the congregation inoculated in the 1792 outbreaks. The records indicate that though more men were inoculated than women, still women inoculated in high numbers. By the close of the epidemic, 143 men and 113 women in the Federal Street congregation had been inoculated.84

Beyond such statistical records, personal records also indicate that women were regularly inoculated. Abigail Adams was inoculated in 1776 alongside at least four other female acquaintances.85 Nor did women only inoculate during outbreaks when inoculation could be performed at home. Women also underwent the procedure in inoculation hospitals. For example, in 1778 James Freeman, future minister of King’s Chapel, recorded in his diary that his sister arrived in Boston on July 9 and entered an unnamed inoculation hospital two days later to undergo the procedure. She remained in the hospital until August 20.86 As Andrew Wehrman describes, the infamous inoculation hospital at Cat Island off of Marblehead accepted both men and women for treatment, and it soon gained a reputation as a place of sexual promiscuity.87

Though not inoculated there herself, Mercy Otis Warren brought her children to be inoculated at

83 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 4, 12-13. 84 Jeremy Belknap, “Jeremy Belknap’s List of Families in the Parish, with Information about ‘Inoculation’ of Members, and Records of Deaths from Smallpox in Boston, 1702-1792,” Arlington Street Church (Boston, Mass.) Records, 1730-1979, Andover-Harvard Theological Library, Harvard Divinity School, Cambridge, MA. http://nrs.harvard.edu/urn-3:DIV.LIB:1144117?n=2. 85 Letter from Abigail Adams to John Adams, 13 - 14 July 1776 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society. http://www.masshist.org/digitaladams/. 86 James Freeman Diary, 1777-1779, Ms. S-271, Massachusetts Historical Society, Boston, MA. 87 Wehrman, “Siege of Castle Pox,” 402-403.

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a hospital in Plymouth, though she thought the space “too much crouded [sic].”88 In this sense, women participated in the public realm of healing as they had themselves and their families inoculated outside of their homes.

Bostonian women engaged in the public sphere of healing beyond their experiences with treatment in inoculation hospitals. As Weir and Gromin observed in several North American colonies, such as New York, women cared for the sick and oversaw hospitals during smallpox outbreaks.89 This was also the case in Boston. For example, in 1744 the Widow Gauge received

“Thirty Shillings old tenor” each week for nursing smallpox patients at Hospital Island.90 In

1788, the “keeper” of the hospital at West Boston was one Mrs. Richardson.91 As previously discussed, they continued to care for their children, even if this occurred within a hospital.

Though smallpox and inoculation increasingly made women patients in a developing medical realm outside the home, this did not eliminate their role as caregivers in the community.

In addition to highlighting women’s continued role as healers during smallpox epidemics, the payments to the Widow Gage and Mrs. Richardson’s work at the hospital at West Boston underscore how women engaged with the economy of smallpox. As Weir argues, payments to women for services rendered during smallpox outbreaks allowed women to earn money when they had limited options and become part of the “inoculation industry.”92 However, women did not only engage with the economic effects of smallpox by earning money for healing. Just as men’s businesses were hurt by smallpox, so too were women’s. For example, when smallpox struck Boston in 1792, Catherine Davis posted an advertisement in the Columbian Centinel assuring customers that her “Assortment of Goods, Wholesale and Retail,” were free from

88 Mercy Otis to James Warren, 24 November 1776, in Mercy Otis Warren: Selected Letters, 80. 89 Weir, “Challenge to the Cause,” 164-166; Stidstone Gromin, “Imagining Inoculation,” 265-266. 90 Record Commissioners Containing the Selectmen’s Minutes from 1742/43 through 1753, 100. 91 Record Commissioners Containing the Selectmen’s Minutes from 1787 through 1798, 65. 92 Weir, “Challenge to the Cause,” 167-168.

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infection since “she ha[d] no person in her House to have the Small Pox.”93 Thus, women were closely affected by the economics of smallpox and inoculation.

Though the provincial public health laws and town policies gave men more influence in smallpox debates and decision-making and brought health into the public sphere, Bostonian women nevertheless retained authority over their health and the health of their families, and in doing so they directly confronted town authorities. Women continued to act as caregivers, and as was seen in the cases of Abigail Adams and Mercy Otis Warren, women made the decision whether or not to inoculate their children.94 However, women also played an important role in removal policies in Boston. In many recorded cases, women refused to allow either themselves or their family members to be removed from their homes to be isolated elsewhere in the town.

When Mrs. Warren contracted smallpox in 1764, her husband alerted the selectmen, as was required by law. The selectmen tried to remove Mrs. Warren to “the Hospital at New Boston,” but she refused to leave. As a result, her home was “shut up” and a red flag hung from the edifice as a “signal of Infection.”95 Though the selectmen referred to it as “Mr. Warrens House,” it was

Mrs. Warren who decided where she would recuperate, and it was Mrs. Warren’s wishes that the selectmen respected. In the same year, though “[g]reat pains were taken by Mr. Johonnett, the selectmen and others” to convince Mrs. Johonnett of Orange Street to consent to removal, she repeatedly refused and ultimately was never moved from her home.96 Mrs. Johonnett retained power over her health and the space in which she would heal in direct opposition to the wishes and authority of her husband and the Boston selectmen.

93 Columbian Centinel, September 1, 1792, accessed July 13, 2014. Readex: America’s Historical Newspapers (1064DA36F20AE885). 94 See Weir, “Challenge to the Cause,” chapter 3. 95 Record Commissioners Containing Selectmen’s Minutes from 1764 through 1768, 6. 96 Ibid., 91-95.

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Women also retained decision-making power when their children fell ill. For example, in

1764 Mrs. Glentworth “could not be prevailed on” to allow the selectmen to take her sick child to a hospital. Her authority to make such a decision was confirmed when the selectmen, in deference to her wishes, allowed the child to stay, though they isolated the house.97 Similarly, one Mrs. Dommett’s two children and a young enslaved girl living in their home fell ill with smallpox. The selectmen tried to convince Mrs. Dommett to allow the sick children to be moved to a smallpox hospital, but Mrs. Dommett would not “suffer any one of the Family to be removed.”98 Fathers too could consent to the removal of family members, but women appear to have retained this power even when their husbands would have allowed their children to be moved. In January 1764, Mr. Roach of Cold Lane reported that his twenty-month old child had contracted smallpox. In response, “Mr. Lewis together with D. Whitworth went to the House and used many Arguments to persuade the Mother to consent to its [the child’s] being removed.” The child’s mother, however, did not agree, and as a result the child stayed isolated in the home on

Cold Lane.99 In this case, the approval of a mother was specifically sought before officials took any action affecting her children, and her wishes, though in conflict with those of town officials and medical authorities, were respected.

In at least one case, a woman was even able to negotiate with town officials over the conditions of her family’s removal to the hospital. In August 1788, one Captain Potter contracted smallpox. In past outbreaks, the sick were often consulted themselves about whether they would consent to be moved. In this case, perhaps because Captain Potter was too ill, the selectmen sought the approval of Mrs. Potter. They requested permission to remove not only her husband, but also “herself and four Children” to the West Boston hospital. Mrs. Potter countered that she

97 Ibid., 39. 98 Ibid., 5. 99 Ibid., 22. Mr. Lewis was perhaps Ezekiel Lewis, a selectman of Boston.

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would consent only if she could have “her own Doctor her own Nurse & a Girl that lives with her to go with her.” The selectmen apparently agreed, for the hospital made “the necessary preparations for their [the Potter family’s] reception.”100 This underscores the authority that women held over the fate of their family’s health, even when confronted by town officials.

Though law and policy brought smallpox into the political sphere, still women were closely connected to smallpox and inoculation for the sake of their own health and the health of their families. Men could advocate for their families’ health in the halls of the town meeting, but within the household women held power over health care decisions, even when their opinion clashed with those of their husbands and town officials. They were an influential part of the protective shield provided by the household and domestic care.

Conclusion

During eighteenth-century Boston’s smallpox outbreaks, public health regulations and community expectations collided with traditional domestic care, pushing Bostonians to reconceive domestic care and familial responsibility as they sought to protect their household during epidemics. Concepts of family and space were a critical component of regulatory policy, and the hospital became a particularly contentious space where Bostonians tried to preserve elements of domestic healing. In particular, parents sought to protect their children from the ravages of smallpox. While public debates emphasized men’s role as protectors of their families, women continued to act as caregivers and maintained authority within the domestic realm to make decisions about the health of the household. When regulations limited parental agency, parents expected the town to adopt regulatory policies that would protect the children of Boston.

Though the protective layers of official regulation and community expectations could conflict

100 Record Commissioners Containing the Selectmen’s Minutes from 1787 through 1798, 65.

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with the household, here the three protective realms merged to promote the health of Boston’s youngest inhabitants.

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Conclusion

Boston experienced myriad changes through the long eighteenth century, including in the realm of public health. While the town weathered political and economic woes, poverty, and war, inhabitants also witnessed the introduction of inoculation, the fallout wrought by its associated dangers, and eventually growing acceptance and use of the procedure. However, throughout these changes there endured a commitment to shield the community from smallpox. While officials crafted policies, the broader community added a layer of protection by expecting that

Bostonians would adhere to the law and aid their fellow townspeople; those who did neither were perceived as violators of these ideals, a part of the threat of smallpox rather than a member of the community that needed protecting. The final layer of Boston’s protective system was the household, as parents sought to protect their families despite the tensions this sometimes created with community-level protective measures. Hence, Bostonians developed not only an official regulatory approach to combat the perils of smallpox, but also a larger social response that required Bostonians to conduct themselves with the good of the community in mind; this emphasis challenged but never overturned longstanding valuation of domestic healing and familial obligations.

On September 20, 1800, Dr. Benjamin Waterhouse wrote to the Columbian Centinel proclaiming that he had proved that “THE COW, OR KINE-POX IS A PERFECT SECURITY

AGAINST THE SMALL-POX.”1 Four years earlier in England, Edward Jenner experimented with a new inoculation method, later known as vaccination, which utilized the cowpox virus to confer immunity to smallpox. In July 1800, Waterhouse tested this new method on several of his

1 “Kine-Pox-Confirmation,” The Columbian Centinel, September 20, 1800, accessed April 2, 2014, Readex: America’s Historical Newspapers (10644EAC73C91F10).

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children, making Boston the site of the first inoculations and vaccinations in the United States.2

When traditional inoculation failed to produce typical smallpox eruptions on his vaccinated children, Waterhouse declared vaccination a success.3 Though not without its own difficulties, the introduction of vaccination did not spark the intense controversies that inoculation provoked in Boston and its environs. By 1802, the Boston Board of Public Health issued a report supportive of vaccination and encouraged its use by the public.4 In 1810, the General Court instituted “An Act to diffuse the benefits of inoculation for the Cow Pox,” which allowed towns, under the purview of appointed town officials, to provide subsidized vaccinations. Though seldom enforced, the act signaled a quickly growing approval of vaccination, in stark contrast to the slow, labored increase in acceptance of inoculation.5 As a generally safer practice that did not risk starting a smallpox outbreak, vaccination replaced traditional inoculation and signaled a new era in smallpox prevention.6

For most of the eighteenth century, however, Bostonians faced the threat of smallpox without the benefit of vaccination. To protect their community from the scourge, they could rely only on quarantine, isolation, and traditional inoculation, itself a danger to the community if not properly managed. Smallpox threatened not only inhabitants’ health, but also Boston’s economy and daily functioning. This was particularly distressing given Boston’s existing economic troubles and growing indigent population. Town and provincial authorities were highly aware of the multifaceted threat that smallpox posed. To protect the town, officials established and

2 Blake, Public Health, 177-180. 3 “Kine-Pox-Confirmation,” The Columbian Centinel, September 20, 1800, accessed April 2, 2014, Readex: America’s Historical Newspapers (10644EAC73C91F10). 4 Blake, Public Health, 181. 5 Ibid., 187. 6 On the early years of vaccination, see for example Blake, Public Health, ch. 9 “The Conquest of Smallpox”; Winslow, Destroying Angel, ch. 13 “Benjamin Waterhouse’s Campaign in Boston”; Rebecca Fields Green, “‘Simple, Easy, and Intelligible’: Republican Political Ideology and the Implementation of Vaccination in the Early Republic,” Early American Studies: An Interdisciplinary Journal 12, no. 2 (Spring 2014): 301-337, doi: 10.1353/eam.2014.0008.

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enforced isolation and quarantine policies and regulated inoculation. These policies largely succeeded in preventing frequent outbreaks, but in doing so, reduced the community’s immunity and made Boston particularly vulnerable to a widespread, devastating outbreak when smallpox did appear.7

Beyond the limitations imposed by legal restrictions, the high costs of inoculation made it available primarily to the wealthiest Bostonians, leaving those without access vulnerable to infection through their interactions with inoculated citizens.8 A procedure designed to protect could in fact be a threat to the public health. While the risk to trade and business caused anxiety, officials also considered how best to care for Boston’s ever-growing indigent population during epidemics. Even as inoculation increased in popularity, town officials, beholden to provincial legislation and town votes, continued to restrict its use throughout the eighteenth century, fearing its potential to spark a massive outbreak with devastating results for Boston’s economy and the lives of its citizens, particularly the poor. Thus, guided by a genuine attempt to protect its peoples, Boston authorities developed a detailed public health response to the complex threat posed by smallpox and inoculation that endured throughout the eighteenth century.

While officials crafted regulatory policies to protect the town, the broader community of

Boston also reacted to the threat of smallpox and inoculation, conceptualizing policies and behaviors during outbreaks as either protective of or threatening to the town. During outbreaks,

Bostonians defined their community based on town borders and inhabitancy. Strangers, whether sailors bringing smallpox into Boston Harbor or residents of other towns perpetuating outbreaks through inoculation, were viewed as a potential danger from which Bostonians needed to defend their town. Within the town itself, Bostonians developed expectations of behavior that was

7 Wolman, “Tale of Two Colonial Cities,” 344. 8 See Fenn, Pox Americana, 39-43; Blake, Public Health, 114; Wehrman, “Contagion of Liberty,” 70. See also Winslow, Destroying Angel, 89-90.

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required of all inhabitants to protect the town. In many cases, this meant abiding the law; inoculating contrary to policy or breaking a quarantine or mandated isolation were unacceptable.

Community members, Bostonians reasoned, should protect, not endanger, their fellow inhabitants. However, this expectation went beyond upholding the law to include, particularly in the case of physicians, actively working to provide for Boston’s least fortunate. Enterprising physicians, the wealthy, and even in some cases the selectmen, were criticized for their irresponsible use of inoculation or perceived indifference to the plight of those who could not afford the procedure. Though they might not violate the law, they violated community expectations to protect one’s fellow Bostonians and provide for their wellbeing. In this way,

Bostonians added an additional layer to the protective measures set forth in official policy, as they established a broader community expectation to protect the town and the common good.

By the latter half of the eighteenth-century, the efforts of town officials and the broader community to protect against the ravages of smallpox increasingly conflicted with traditional notions of domestic healing. While isolation and quarantine in town hospitals protected the town at large, many inhabitants objected to removing healing from the home. In the process, they highlighted the town’s nebulous definition of “family” and its important implications for legal inoculation. Parents stressed their need to protect their children, and particular emphasis was placed on men’s protective role. While the politics of smallpox challenged women’s traditional authority over the health of their families, women still retained some decision-making power, even if it meant defying the wishes of their husbands and town officials who sought to remove from the home afflicted children or other household members. Though parents took action to protect their own children, when town policies limited their ability to do so they called upon the town to assume this responsibility.

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Studying smallpox in eighteenth-century Boston offers more depth to our understanding of the changes and continuities experienced by that town over the course of a century. Boston was at the epicenter of eighteenth-century Massachusetts’ preventative health measures and it had a strong regulatory regime, and so the town presents a particularly interesting and complex case study. While Boston did not embrace inoculation with the enthusiasm witnessed in some other eighteenth-century cities and towns such as Philadelphia, in many ways it successfully defended against frequent outbreaks. Nevertheless, the threat of smallpox and the controversies of inoculation remained throughout the eighteenth century, shaping law, the spaces of healing, and community ideas about the common good during public health crises.

Though the virus has since been eradicated, it would be folly to consider smallpox and the challenges it brought as simply features of the past, a completed chapter in the historical record. Boston’s smallpox epidemics highlight how a community responds to public health threats, health inequalities, challenges to cultural conceptions of healing, and promising yet problematic advances in medical science. Though no longer sparked by smallpox, these issues endure today, enflamed by infectious disease outbreaks, inequitable healthcare access, and the changing landscape of modern medicine and healing. Eighteenth-century Boston may not provide answers to today’s dilemmas, but studying these outbreaks encourages a nuanced approach to public health that considers not only scientific evidence and economic efficiency, but also community conceptions of healing and the ramifications of medical advancement and public health systems. Boston’s layers of protection underscore that public health is more than governmental regulation—it is a complex, and potentially contentious, interaction between different levels of the community. Applying this concept to other epidemics, these layers could become more numerous to include groups such as international organizations and national

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governments in addition to local regulation, broader society, and the individual household. In this way, Boston’s historic smallpox outbreaks are significant to our understanding of life in that town in the eighteenth century as well as our present-day conceptualization of the intersections of health, disease, and society.

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