Episode 1.

Smallpox Part 1: Edmund Massey

Hello, and welcome to the Poison Room Podcast. The idea behind this podcast is to indulge the interest I have had for as long as I can remember in dangerous books and texts more broadly. Now, throughout my research career I have never had the chance to study this directly, but… whatever I’ve looked at, I’ve always found that these books and texts are there at the edges of my research. Just… kind of mocking me by being one rabbit hole too far to actually make it into my work. So I finally decided that enough is enough, I’m just going to make those dangerous books and texts the actual focus of my research for once. So that’s what this podcast is, and I hope you find these topics as interesting as I do.

There are certain key genres where dangerous texts frequency crop up. Religion. Magic. The Occult. Medicine. And for this first episode, or episodes, medicine is where we’re headed. So let’s just get started.

I’m sure you’re all aware of the problems caused by the modern anti-vaccination movement, and of the role played by the thoroughly debunked and discredited paper by the infamous former doctor Andrew Wakefield and his nonsense claim of a link between vaccines and autism. Well, this is not the episode about him. Today we’re going to be talking about a far older case of anti-vaccine sentiment.

But before we can actually get to the texts of this episode, we need some historical context. So buckle in, guys, and let’s talk history and disease.

In the West the anti-vaccination movement has been around for as long as vaccines have been used. And the first vaccines used in the West were against smallpox. Yup. We’re talking about smallpox, today.

Over its long life the smallpox virus killed a lot more people than World War I & II combined. In the 20th century alone it was estimated that smallpox killed 300-500 million people (Saint Louis University: 2008). That’s at least three times more than the combined wars’ totals.

I’m gonna to take a moment here to describe the symptoms of smallpox, just so we’re all familiar with what people were facing. Smallpox isn’t pretty, so if you don’t want to hear the deets, skip forward thirty seconds or so.

For somewhere around the first 10-14 days, you won’t know you have it. The first symptoms will be a fever, some aches and pains, tiredness, fatigue – nothing too worrying. You might throw up. You’ll probably feel a bit sorry for yourself.

After 2-4 days of that, the rash appears. First it appears as small spots in the mouth and on the tongue. Over the next four days or so a rash of red bumps that develop into sores spreads over the rest of the body, starting with the face and spreading from there. Your fever might fade a bit at this point, so despite looking worse, you might actually feel a bit better.

Next the sores become pustules: raised, round bumps under the skin that can feel hard to the touch. These will be filled with clear fluid to start with, and then pus. Just so you know, I really, really hate the word ‘pus’, so from here on out I’m gonna’ use the much more technical term ‘gunk’.

Now after this the pustules begin to form a crust, and then scab. That makes it sound almost clean. They’re cracking and leaking too. David Martin compares the visuals to that of a burn victim (2002: 551). This phase lasts for about ten days. Over the next six days, the scabs will fall off and you’re free to assess the long-term damage you now have to live with.

This, of course, assumes that you survive. If you do, corneal scarring might leave you with impaired vision, or blind. And you will have some level of scarring on your face and on the rest of your body. It might well be very severe. Good news though, if you survived, you can’t catch it again.

How exactly smallpox kills you is apparently something we’re not altogether certain of. Guess one problem with eradicating a disease is that you don’t have patients to study anymore. In the past it was thought that death was probably caused by bacterial sepsis, but looking at the accounts and data available, David Martin rules out any major bacterial role and suggests that otherwise healthy patients ‘most likely succumbed to renal failure, shock secondary to volume depletion, and difficulty with oxygenation and ventilation as a result of viral pneumonia and airway compromise, respectively’. (Martin 2002: 551)

So, very, very basically (with profound apologies to any medical professionals listening, because that is not the type of doctor I am): the virus breaking down cells inside your body blocks up your kidneys and lungs. And smallpox might tag-team in viral pneumonia to help finish a victim off. The amount of liquid leaving your body through all the delightful pustules cracking, as well as liquid being in the wrong place because cells are breaking down basically reduced blood volume, and that lead to shock. Or… could lead to shock, if the renal failure and difficulty breathing didn’t get you first.

Now, the popular story of the discovery of vaccines attributes the idea to the English doctor, Edward Jenner. According to tradition, he realised that milkmaids who had previously caught cowpox due to their interactions with cows were immune to the much more serious disease, smallpox, and thus deliberately infecting someone with cowpox could be used to protect them from smallpox.

He shared his findings with the Royal Society of London in 1797, but they didn’t publish them. According to the Oxford Dictionary of National Biography, his paper wasn’t rejected, they just informally told him that it would damage his reputation if he published it without more proof, so he went away and got it. He self-published his findings in 1798.

Jenner, however, did not discover the concept of vaccination. He certainly formalised the practice in England, and greatly improved it, and named it too – ‘vaccine’ comes from the Latin word vacca, meaning ‘cow’ – but Jenner did not discover it. According to Richard Horton, Jenner was, quote ‘a political opportunist who obtained priority in the discovery of the vaccination… through his reputation … and aristocratic social standing.’ End quote. (Horton, R. 1995: 62).

22 years before Jenner, someone had already figured it out, and vaccinated their family using cowpox.

Benjamin Jesty, a farmer in north Dorset had had cowpox as a child, and noticed that he and his milkmaids who’d had cowpox never caught smallpox. In 1774 he persuaded his wife and kids to deliberately get infected with cowpox material. He did this by poking a needle into a pustule on a cow to get it nice and gunky, and then wiping that on scratches made on the arms of his family. We can’t say for certain that Jesty was the first to notice that cowpox provided immunity to smallpox, and frankly I find that idea highly unlikely, but he does seem to have been the first to decide to wipe cowpox gunk into scratches to prevent someone from getting smallpox. He’s certainly the first recorded instance we can find. Jesty’s inoculations didn’t go entirely smoothly. His wife’s cut got a septic infection and he had to call in a doctor to treat her. Apparently his neighbours didn’t think much of what Jesty had done and threw mud and stones at him, hooting and jeering.

Even though most of you have, in all probability, never heard of Benjamin Jesty, you’ll be pleased to know that eventually he did get some recognition. In 1805 he was presented with two lancets mounted in gold and a document acknowledging his discovery of the vaccination.

Congrats, Jesty. Today, however, we’re going back even before Jenner versus Jesty. You see, part of the reason that Jenner was looking for a way prevent smallpox was that there already was a method in use, and he didn’t like it. The method was basically the same, but with gunk from actual smallpox pustules. Jenner himself had been inoculated this way, and had had a pretty bad reaction to it. So he wanted to find something safer.

In other parts of the world, inoculation had been around for decades, or even centuries. But getting the Royal Society of London to take notice took a while. The first time – actually the first two times – the Royal Society had heard about the practice of smallpox inoculation was early 1700.

On the 5th of January 1700 Joseph Lister, who worked for the delightful East Indian Company and who was stationed in China, wrote to Dr. Martin Lister, then Secretary of the Royal Society. Trader-Lister reported that he had watched physicians extract gunk from smallpox pustules, dry it up with some cotton, and then preserve it in a box until they needed it, when they’d turn it into powder and blow it up someone’s nose. (Janetta 2007: 14). I don’t know if these two Listers are related, just in case you’re wondering. I poked around a little bit, but couldn’t find a connection.

Just over a month later, another letter was received, dated 14th February, from one Dr. Clopton Havers, reporting the same practice. Neither of these letters got published.

Unfortunately for Joseph Lister, Dr Clopton Havers, and people with a general interest in not dying of smallpox, the Royal Society didn’t seem particularly interested in 1700. Also unfortunately, for Dr Clopton Havers, he died in 1702, of ‘malignant fever’ (Martensen 2004). I have no idea when Joseph Lister died, or what he died of.

Over a decade later, in late 1712 to early 1713 one of the then secretaries of the Royal Society, Richard Waller, made a call for papers on the topic, hoping to raise awareness. His call was answered.

On May 27th 1714 Dr John Woodward shared with the Royal Society some extracts from a letter sent to him by Dr Emanuele Timoni, dated December 1713. According to Dr Timoni, inoculation had already been practiced commonly in Turkey for around 40 years. The first mention in Turkish literature is from 1679, where a man from Anatolia inoculated some children (Behebani 1983: 458). But don’t quote me on that because I did not go and find the original source because I am a hack and a fraud.

This time the Royal Society did actually publish Timoni’s account, but they wanted more information, which they got, two years later, when Dr Jacobo Pylarini produced a more detailed description of the procedure, which he had seen demonstrated by an old Greek woman. It was published by the Royal Society in 1716. The practice reported involved inducing a mild case of smallpox by wiping smallpox gunk, or crusts, into a small cut. And this is the method England got stuck with.

I won’t go into all of them, but between 1700 and 1723, the Royal Society got reports about the practice in China, ‘other parts of Asia’, the Middle East, Africa, Denmark, Switzerland, and Poland. (Silverstein 2009: 12). Oh, and there were a couple of reports of it in Wales, too.

Yeah. In Wales.

Two doctors reported that people in Pembrokeshire had been practicing this type of inoculation since ‘time out of mind. (Williams 1723: 262), and that it was a ‘very ancient Custom’ (Wright 1723: 267). How ancient? Well, Dr Richard Wright, one of the doctors who reported the practice, said that a 90 year old man had told him that the practice had been common in his time, and according to his mother, had been common in her time, too. That puts the practice as being well known in some Pembrokeshire villages as far back as the early 1600s. But despite people in Wales actually already practicing inoculation for over a century, and despite the Royal Society knowing about it for a decade or so, it’s only after the accounts of Timoni and Pylarini in 1714 and 1716 that the ball starts to get rolling.

And even then, it took some doing. Members of the Royal Society might have finally been interested in the idea, but English and colonial medical professionals at the time were still reluctant to try it out. It took two more people to finally get things started. The first was Cotton Mather, a colonial Bostonian who had independently ‘discovered’ the pre-existing practice of inoculation by African peoples when, in 1716, he asked his slave, who he had renamed Onesimus, if he’d ever had smallpox. Onesimus replied with an ambiguous ‘yes and no’, and then explained to Mather how he’d been inoculated.

If Cotton Mather’s name sounds familiar, it’s probably because of his involvement in the Salem Witch Trials, but that’s a story for another time. Mather described Onesimus (we do not know his real name) as being ‘Guramantese’. According to Peter Manseau, it’s possible that Mather was ‘using an archaic name to refer to the Sahara tribe occupying present-day Libya and Sudan. [But] given the trends in the enslaved population at the time… it is more likely that Onesimus was a member of the Coramantee, residents of the Gold Coast.’

In 1716, Mather wrote a letter to Dr John Woodward – the man who had brought Timoni’s account to the attention of the Royal Society. Mather had read Timoni’s account and wanted to know why inoculation had not been tried in England. Good question, Mather, good question.

As a side note, when Timoni’s account was published in 1714, Cotton Mather also had some letters published by the Royal Society, in the very same volume. In fact, his letters came directly before Timoni’s account, which is probably why Mather saw it. Mather’s contribution to that issue was notably less… uh. Well. In one of his letters he suggested that the migration of pigeons might involve them flying to an as of yet undiscovered moon (Mather: 1714: 64). This type of letter, Gareth Williams suggests, might help account for why it took so long for people to take notice of inoculations: the Royal Society published a lot of stuff, and a lot of it was rubbish (Williams 2010: 68-9). But it was also, y’know, because racism. These reports were about the practice of heathens and uncivilized people. Why would educated white men in Europe trust them?

Mather was key in getting inoculation to take off in America, and convinced Dr Zabdiel Boylston to perform inoculations during the Boston smallpox epidemic. Exactly what happened in Boston during this time is possibly something to be covered in more detail in its own episodes because one of the anti-inoculators over there apparently founded his own newspaper just to give himself a bigger platform to shout his views from. Also, someone firebombed Cotton Mather’s house. Safe to say, just as we’re about to see in England, inoculation caused a pamphlet war there, too.

But Cotton Mather was an international player, and in April 1722 there was a pamphlet published in England, of a letter Mather had sent in September of the previous year. There’s a couple of details worth noting.

The pamphlet was essentially a print of a forwarded letter from Jeremiah Dummer, a friend of Mather’s, to Doctor Hans Sloane, of the Royal Society. Much of Mather’s letter is a description of what the state of affairs has been in Boston thus far. Boylston is trying inoculation, and seems to be having success, but it’s causing a lot of public outcry. There were both religious and “scientific” arguments being made against inoculation, but Cotton Mather seems to have a genuinely held belief that opposition to inoculation is actually driven by the devil (Mather 1722: 16-18). In fact, he thinks this opposition is the most devilish thing he’s ever seen, and this guy was at Salem. He also pulls out the sixth commandment – ‘thou shall not kill’ to justify inoculation. He doesn’t provide any further explanation that this, but presumably his logic is something like ‘if we have the means to prevent a death, and we do not, then we have killed them through our refusal to save them’.

Mather also notes that there are a lot of rumours flying around – claims that the practice had been outlawed in England, or that they’d known of it for decades, and had shunned it as evil. Neither of which were true, of course, but they didn’t let that stop them.

He also notes that his pro-inoculation friend Boylston is concerned that they might not always be able to tell if someone has already caught smallpox just prior to inoculation, especially when you’re in the grip of an epidemic. It takes a few days for the symptoms of smallpox to appear, so people might well go to get inoculated not knowing that they’ve already picked the virus up in the last couple of days. We’ll come back to Cotton Mather and Zabdiel Boylston later, but for now, that’s all we need to know.

The second person to help finally push physicians in Britain into action was Lady Mary Wortley Montagu. She was the wife of the British Ambassador to Constantinople and was thus also aware of the practice happening there. In 1718 she had Charles Maitland, the surgeon of the Embassy, inoculate her six year old son. She did this despite the objections of the Embassy’s chaplain, who for some reason apparently thought that inoculation would only work on those infidel Turks. Oh, and she did it without her husband’s knowledge, too. They didn’t have a great relationship. She returned to London in 1719, and in 1721 she summoned Maitland, who had also returned to England, to inoculate her three-year old daughter. I know there have been a lot of names so far, but Charles Maitland is one you’re going to want to remember. Lady Montague also had a theory of why uptake might have been slow on this inoculation idea. In a letter written to her friend Sarah Chiswell, in 1717 when Montague was still in Turkey, she says:

I should not fail to write to some of our Doctors very particularly about it if I knew any one of 'em that I thought had Virtue enough to destroy such a considerable branch of their Revenue for the good of Mankind, but that Distemper is too beneficial to them not to expose to all their Resentment the hardy wight that should undertake to put an end to it. Perhaps if I live to return I may, however, have courrage to war with 'em. (Halsband 1965: 339)

Turns out Lady Montagu doesn’t trust doctors to do what’s in the best interests of their patients if it doesn’t also line their pockets.

As a side note, Sarah Chiswell did not try out this inoculation thing herself, and died of smallpox in 1726.

After Maitland inoculated Montagu’s children, the Princess of Wales convinced a group of physicians and her husband to let Maitland conduct a trial of inoculation. It was known as the Royal Experiment, and was the thing we might identify as a clinical trial. It involved offering 6 condemned prisoners in Newgate prison a pardon in exchange for being guinea pigs. Perfectly acceptable medical ethics, I know. They all survived the inoculation, and just to prove it actually worked, they sent one of their subjects, 19 year old Elizabeth Harrison, to look after first a maid, and then a kid with smallpox to see if she caught it from them. She did not. After this the Prince and Princess got their kids inoculated and everything was right with the world. Psych. People immediately started objecting to Maitland and this outlandish idea.

On the 14th February 1722, exactly 22 years after Clopton Havers’s letter, Maitland published a pamphlet. Apparently, he’s heard people spreading rumors and lies about his experiments, so he’s here to provide a full account (1722: 1). But before he does that, he’s heard that there are some objections to the practice. Congratulations, humanity. It’s 1722, and we already have anti-vaxxers. Or anti-innoculers.

Maitland starts his pre-emptive counter-offensive by describing his inoculation of Lady Montagu’s sprogs, and then of the kid of one of the doctors who’d been witness to the inoculation of the daughter back in England (7-11). He could give a bunch more examples of it from Turkey, but he wont. What he will note, is that he’s only seen it go wrong once, but that was because of the Surgeon’s ‘Rashness’ and ‘Inadvertence’ (12). And he sounds a note of caution here: just as with any other medical practice, you have to be careful. Despite that, the procedure is so easy (he even knows an old Greek woman whose been doing it her whole life [12]), and so blatantly useful that they should all embrace it for the good of mankind (13). Now, he’s had some questions about inoculation from some people already, some of which he hopes he’s now addressed with his testimony and accounts, others about the Lawfulness of it, and others about the facts. Maitland’s comments that:

They that scruple the Lawfulness of this Practice, are apt to call it, a Presumption, a forcing of Nature, a tempting of Providence and the like. (14)

When he says ‘Lawfulness’ he’s not talking about legality, about human law – those arguments come later. He’s talking about natural law. Briefly, natural law holds that there’s an essence of morality intrinsic to human nature; that we all intrinsically have an idea of what is right or wrong. Tack on to that the idea that humans are fundamentally rational beings (highly disputable, I know), and you have the idea that what is rational is natural and good, and what is irrational, unnatural, and bad. For England in the 1700s, you can also add in the idea that natural law was tied to divine law – i.e. what happened naturally is the will of God. Now this isn’t just about whether we do something natural or unnatural, but also about Divine Providence – whether something goes against the will of God or not. If something we do interrupts the divine plan for what should happen, it goes against nature, and is bad.

So the argument Maitland is explaining is that inoculation goes against the will of God by disrupting his divine plan, his blueprint of nature, and of when something should happen.

Hence, the first part of Maitland’s rebuttal is that there is nothing in the practice of inoculation that would offend delicate sensibilities, and that the idea is rational. He’s not causing something to happen before it’s time i.e., he’s not ‘forcing nature’. Instead, he’s ‘cleansing’ nature of some latent possibility for the future. It might be irrational to make things happen before their appointed time, but it’s totally rational to try and prevent something happening in future (15).

Secondly he points to the fact that they would all have been perfectly happy with it had they discovered a way of preventing the plague, and that they’re all very happy to engage with some form of medicine (15). I.e., why aren’t y’all trusting to the providence and the will of God with every minor illness, hmm?

Maitland’s argument is perfectly rational, but he failed to address the real reason opponents considered inoculation as ‘forcing nature’. He views it as a form of prevention; his opponents see it as deliberately giving someone a disease.

The final objection he’s going to debunk is the claim that it’s not actually smallpox being conveyed. It might be chickenpox. It could just be some… generic infection that doesn’t help anyone avoid smallpox (16). So he describes for those people what the difference are between chickenpox, smallpox, and smallpox via inoculation (16-17). But why are there differences between normal smallpox and inoculated smallpox? Well, he could easily explain that, but he’s 17 pages in and still hasn’t got to describing the Newgate experiment, so he’s not gonna.

But he will provide one final example to prove inoculation is really producing smallpox in the inoculant: they’re contagious. Other people who haven’t had smallpox can catch it from someone who’s just undergone inoculation (17-18). Maitland is a studious academic, and he attaches those accounts after the Newgate experiment results.

Okay, so we’re finally going to get to the Newgate prisoners now, right? No. Nonononono. There’s one more thing he needs to address. Some doctor approached Maitland and asked him whether he was sure this process would always convey smallpox, and that it really would prevent them getting smallpox again (18). His response is that it hasn’t let him down yet, and he doesn’t think it ever will, as long as it’s done properly. But he also gets a bit salty in his reply:

In the mean time, I had a Mind, with great Submission, to have ask’d the Doctor a plain question in Answer to his; and that it, Whether, when he prescribes a Purge or a Vomit, he is always sure, it will answer his intention? For I have often heard, that Vomits have sometimes prov’d Purges; and Purges Vomits, too; and, which is worse, that People have had the Misfortune to die under both Operations; which has never yet happen’d in the Case of Ingrafting. (18-19)

Yes, he’s sure it will work, but, uh, just out of interest, when this doctor is prescribing vomiting or purging as a cure, is he always sure that will work? ‘Cause Maitland has heard, often, even, that sometimes those don’t always work. And he’s even heard that those procedures have gone so wrong in the past that people have died. Is this doctor just perhaps demanding a higher success rate for inoculation than he does for any other medical procedure? Just a question. Just a thought.

As to the question of whether it will always prevent smallpox: there have been some experiments in Turkey, and it’s always worked, and he’s tried it himself with one of the Newgate prisoners (19).

Elizabeth Harrison, aged 19, was selected for this purpose. First he got her to care for a servant of Mrs Moss in the Christ’s Hospital Building, and she didn’t get smallpox. Then, immediately afterwards, he got her to care for a boy in the hospital who’d developed smallpox, too. He made her lie in the same bed with the boy every night, and she still didn’t get smallpox. Though she probably did get rather uncomfortable. Lots of people saw this, so there’s no denying it (19-20).

Finally after this we get to the Newgate experiment. He starts by listing the names of the prisoners, along with their ages. Interestingly, he’s got a 50/50 split of men and women. After this he gives a nearly day-by-day account of the experiment, noting what he does and documenting any changes in any of the prisoners (20-25).

There are a couple of details from his account that are worth noting. The first attempt to inoculate them was, in fact, not successful. After two days, Maitland decides that the material they had used, being 15 or 16 hours old, was already neutralized. Smallpox can actually survive for years outside the body, in the right conditions, so it’s unlikely this was true, but whatever the reason, he documents that it didn’t take, and that he tried again, successfully, two days later, with fresher gunk. He’s even so honest as to note that he didn’t have enough gunk to cover all six of them, so we’re down to five dubiously-consenting participants (21-22).

He documents a few days of the development and then, in his entry for the third day after the second inoculation, he notes that the prisoner he didn’t re-inoculate, Richard Evans, had apparently already had the smallpox in prison last year, and that there was no sign of him having it now. It seems pretty weird that he didn’t mention that earlier, but I suspect that’s because he didn’t know at the start that this was the case. Certainly, that’s what James Thatcher thinks (1828: 44), but he’s writing just over a century later, in 1828, and doesn’t say why he thinks this, or what his source is. On the other hand, Evans certainly had a good reason to have hidden this fact. Given that he knew he couldn’t get smallpox again, this was a get out of jail free card for him.

The next detail that’s worth noting is that one of the patients, John Alcock, during the night of the fifth day after inoculation 2.0, had a febricula and ‘disturb’d waters’. I.e. He had a short, unspecified fever, and his pee was, uh, disturbed, somehow. And on the night of the sixth day after the second inoculation, he, picked all his pustules with a pin to drain them, which caused them to crust sooner. Maitland was not amused, but I can’t say I blame the guy, I couldn’t have coped with that, either. He also notes that when he did the second inoculation, he actually only had enough gunk for one of this guy’s arms, whereas everyone else got gunk wiped into cuts on both arms, but it still worked on this guy, and he’s actually got more pustules than anyone else (23) He had at least 60, apparently, so maybe the second incision is unnecessary.

After that, it’s all fairly standard until the twelfth day after the second attempt, when he says he purg’d the two remaining men for the first time. He was going to do the women, too, but:

Was prevented by their monthly Purgations, which, I was not a little surprised to hear, feiz’d them all about the same Time; tho’ some of them had been obstructed several months before. (24)

He didn’t give the women diarrhea because they were on their period. Maitland was surprised to hear this, but perhaps he wouldn’t have been if doctors at the time had been paying more attention to what women said about their own bodies. Synchronisation is a thing, and being ill can dick with your menstrual cycle. It might delay it, or it might trigger it. It’s always fun when you’re already ill and your uterus decides it needs to join the party.

A few days later, ‘before she was quite free’ Mary North apparently took it upon herself to wash in cold water, which gave her a ‘violent Colic’ that lasted two days (24). Colic is abdominal cramping or pain. She got bad cramps, and Maitland thinks it’s because she washed in cold water. Could have been that her period was just that crappy, but hey, let’s find a way to make it her fault.

Unfortunately for the women, when their periods finished, Maitland purged them, too, and that also cured Mary’s cramps, supposedly. Can,t think of another reason why her cramps might have gone away. A few days later they all get purged again, and are sent off home, successfully recovered (25). Job done.

Maitland states that they didn’t do anything to try and help or hinder the course of the inoculation, and even though the conditions weren’t entirely favourable, nothing bad happened (25).

That’s the account of the Newgate prisoners over, but Maitland’s not done. He’s got a bunch more accounts of his inoculation attempts to document. This includes the ones where other people got smallpox after contact with the inoculant. The first case is when he inoculated a two-and-a-half year old. After he did so, something happened which he had hitherto not seen before. Six of the servants in the house, who had interacted with, and hugged the child:

were all seiz’d at once with the right natural Small Pox, of several and very different kinds; for some had the round and distinct Sort, some the small continued, and others the confluent; all of them had a great many, but especially the last, with the usual bad Symptoms, and very narrowly escap’d: But they all (God be thanked) did well, (except one Maid, that would not be govern’d under the Distemper, who dy’d of it) and now enjoy a perfect State of Health. (27)

Six servants got smallpox. Maitland says he’s not seen anything like this happen before, that neither he nor anyone else suspected that the pustules on the child were contagious. Some got good cases, others got bad cases, and they all survived and are doing totally fine now. Oh, except the one who died. Which is just no big deal, apparently. It’s her fault for not doing as she was told.

The second case is the sons of William Heath of Hertford. And wow, did Maitland not like one of these kids:

Joseph, being a fat, foul, gluttenous Boy, who would not be confined to the Rules and Directions I had strictly charged his Mother withal, as to Diet and keeping warm; was taken very ill before Eruption, and after it had a great Load of the continued small kind, but at last recovered and did well. (27-28)

Gosh, how different these two boys were! One is clean and obedient and did what he was told, and the other was:

of a gross, foul Constitution, but likewise had a voracious Appetite, always eating and filling his Belly with the coarsest Food; as Cheese, fat Country Pudding, cold boil’d Beef, and the like; which I saw my self as I came in by chance, the third Day after the Operation; nor was there any Care taken to restrain or keep him within in cold, windy, frosty Weather; he once wet his Feet in the Water. (28)

He ate too much, ate the wrong food, played outside in frosty weather and even got his feet wet, people. Honestly, thank god the kid didn’t catch smallpox the natural way, he definitely would have died. After dissing the kid, Maitland adds that Mr. Heath’s other kid, an infant, caught smallpox from them. She recovered just fine. And apparently Mrs. Heath, because she spent so much time with the kids, also broke out in a few pimples and pustules, even though she’d already had smallpox (29).

His next case isn’t one where someone caught smallpox from an inoculant. He goes to the house of Mr Hughes, Judge Advocate General for his Majesties Forces to inoculate his two kids, but when he gets there he discovers the boy is already coming down with smallpox. He alerts the parents, they isolate him, and he later uses the gunk from the boy to successfully inoculate his sister. The girl had around 2,000 smallpox pustules, the poor kid. But apparently that didn’t bother her much. She didn’t have any other symptoms, and didn’t even need to stay in bed or need a nurse’s attention (30).

So why is this case being included? Well. Apparently, a malicious account of the incident had been published in The Post Man on December 2nd. He’s including it here so he can set the record straight, though he notes that the father, Mr Hughes, already contradicted that account in the St. James Evening Post on December 7th.

Maitland includes one more case of inoculation, which again succeeds in all three kids, though one of the poor sods did also get around 2,000 pustules (31-32).

Tl;dr: Maitland concludes that:

that this Whole Practice, prudently manag’d, is always Safe and Useful, and the Issue ever Certain and Salutary.’ (33)

The final few pages of his pamphlet are the ‘Certificates’, which are basically sworn testimony from the people involved in many of the cases, attesting to the truth of the account. Signed by themselves, with witnesses to their signatures. Don’t worry, we don’t need to discuss the contents of them, but it really is worth taking a moment to marvel at the amount of evidence here. Maitland’s accounts are detailed, organized, seemingly honest, (since they report negative details), and are backed up with sworn testimony.

Now we finally reach the eponymous villain of this week’s episode: one Edmund Massey. On July 8th 1722 – just under sixth months since Maitland’s pamphlet was published – he delivered A Sermon Against the Dangerous and Sinful Practice of Innoculation. It was then printed as a pamphlet in London, and later in Boston which, I remind you, was in the grips of a smallpox epidemic.

Massey’s sermon contained several arguments against inoculation, but he has a big long intro before he even mentions smallpox. He starts by giving an interpretation of the story of Job. Now, I know we’re all intimately familiar with the Book of Job, but just in case, here’s the tl;dr of Job’s story:

The rest of the book is a discussion about what happened, why, and the nature of divine justice.

Massey stresses the interpretation of this story as one of practicing the virtue of patience, and happily accepting the will of God, and understanding that misfortune is divine and natural providence. God giveth, and God taketh away (4-7).

Now, Massey has an opinion about what those boils Job got really were:

The Silence of Scripture hath given Interpreters Occasion of guessing at the Distemper which the Devil here inflicted upon Job: But among them all, it appears not certain what it was. I will therefore desire to give an Opinion, equally I think true, with any that hath yet been taken Notice of: It is this, That the Devil by some venemous Infusion into the Body of Job, might raise his Blood to such a Ferment, as threw out a Confluence of inflammatory Pustules all over him from Head to Foot: That is, his Distemper might be what is now incident to most Men, and perhaps conveyed to him by some such Way as that of Inoculation. (Massey 1722: 8)

I.e., it was smallpox. Now, as far as I can see, none of his arguments actually depend upon Job’s boils being a case of smallpox, but this sure was a dramatic reveal, and is going to make it super easy for his congregation to sympathise with Job, and for him to make it super obvious that he thinks they should follow Job’s example. Oh, and also he seems to suggest that… the devil gave him smallpox by inoculating him against smallpox?

As an interesting aside, there is actually a condition now known as ‘Job’s Syndrome’. It’s very rare, and is nothing to do will smallpox; it’s an immune disorder.

But back to Massey, and his opinion: Satan’s goal was to make Job stop depending on God, to stop accepting his divine Providence: to question the justice of God and his actions. Remember what Maitland said – that people had objected to inoculation on the basis that it went against providence and natural law? Yeah, this is that argument.

Massey claims that diseases appear amongst mankind either as a test of faith, or as divine punishment. Either God wants it to happen, or… God wants it to happen (9). So if God is testing us, we should be grateful if we catch smallpox, because until we’ve been tested we can’t truly know whether we’d remain pious or not (10-11). Smallpox: totally doing you a favour.

If it’s option two and you’ve got smallpox because God is punishing you, then… well, better start considering what you did to deserve this, pray for forgiveness, and stop sinning (12).

But, thinks Massey, it’s not just that God might punish you for a past transgression. Might not God also use disease as a way to discourage future offences?:

This also gives us to consider, that Diseases are not only judicially inflicted for past Offences, but graciously also designed to prevent future: And a little Recollection will tell a Man, whether he has not often been kept Virtuous through fear of the Consequences, even when Inclination has gotten the better of his Duty. Hence some are made Honest for fear of a Prison; others continue Chaste for fear of Infection; a great many are Just for fear of losing their Character; and no doubt several are Religious more out of fear of going to Hell, than any thing else. So that we see the worst of evils have their Use, and in this Sense, and by proper Reflections, we may make a Moral of the Devil himself. (13-14)

i.e. Humans can’t be trusted and if they weren’t worried about getting an STI, they’d totally be banging everyone they could. Which is, uh. Still an argument used today. Condoms are bad because preventing pregnancy and STIs encourages adultery. Not one of religion’s best contributions to society.

But, for Massey, the world would be so much worse if we didn’t think we’d be punished for sinning. So we should be very grateful about this.

So far, then: either God is testing you, punishing you, or warning you. But whichever way, God wants it to happen.

Okay, there were two things Massey thinks we have to consider. Why there’s disease, and who has the power to cause disease. We’ve answered the first one, and now we’re getting to the second one: who has the authority to inflict disease?

Obviously, in the story of Job, the devil does. But, Massey points out, God grants the devil the power do inflict smallpox (though not the power to kill Job with smallpox). And whilst it’s true that God has given some of his sovereignty to men, no Christian should give someone a disease (15).

The Holy Scriptures give us frequent Instances of God's giving Power unto Men to heal Diseases; and by his Blessing a Power is still continued: But that one was ever granted to inflict Diseases, will I think hardly appear; unless in the Case of Moses with the Egyptians, and Elisha with his Servant Gehazi. But both these Cases were miraculous, and of God's own immediate Appointment, to vindicate the Honour of his Servants the Prophets, and for the Punishment of Sacrilege and Idolatry, and cannot be drawn into Precedent by any not invested with the same Character and Authority. Men may, and have invented Wracks and Tortures for each other, but no Man, let his Crimes be what they will, was ever yet condemned to an immediate Sickness.

(16-17)

Remember when I said Maitland had missed the argument made by his objectors? That they see inoculation as giving someone the disease rather than preventing someone getting it in future? That’s this. Now, to us this might sound absurd, but when your method of inoculation is to take pus from someone with actual smallpox and deliberately infect someone with it with the intention that they’ll get a very mild form of smallpox and thus not be able to catch it again? You can see why it might be a blurry distinction between the two.

So, according to Massey, men just don’t have the authority to inflict diseases! Except those few times they did. Ignore those. They don’t count. Given that disease is there either to test your faith or to punish you, it has to come from God. It’s intrinsically immoral for a mere mortal to give someone a disease – it goes against Nature, Providence, and against God. You’ll promote vice and immorality in others (17). And just because we can do something, doesn’t mean we should. Not every power we wield is moral, and even if you’ve got good intentions, you can’t justify doing an immoral thing to get a good outcome (17-18). So the fact that you’re trying to save someone’s life doesn’t make inoculation acceptable and, in fact, because inoculation is intrinsically immoral, it makes the outcomes of inoculation immoral, too. People being immune to smallpox and not dying of it is just not ethical.

Next up, Massey addresses the argument that those in favour of inoculation might make: that it is for the good of mankind, and seeking the good for mankind is one of the fundamental laws of nature (19).

Massey thinks this idea is just baffling. If ‘good’ means ‘preservation of life’ then we must first ask whether life is a good or not. If it is, then this inoculation thing is as useless as any other method of treating smallpox because… inoculation is actually more fatal than smallpox itself? This is a bold claim to make, so of course he doesn’t provide any evidence for it (19-20).

He also just doesn’t believe what those ‘Physicians of no value’, claim – that this inoculation actually does prevent future infections. These ‘forgers of lies’ just can’t know that for sure, so damn all their testimonial evidence. Of course, if this practice were moral, and did work, then what a boon it would be (20). But it’s not and it doesn’t. So he hopes that these ‘Spreaders of Infection’ will soon be disavowed by real physicians,

Lest like the Disease-Giving Practitioner, the Harlot whom Solomon describes, they entice us, till a Dart strike through our Liver, and we haste to their Snare, not knowing that it is for our Life. (21)

And after adding that sick burn? He’s still got another ten pages of sermon to go. His next argument takes quite a different approach: you might not even get smallpox! And if you do, it will proooobably only be minor (21). This part is, shall we say, of questionable veracity. It may, perhaps, be said to be the work of a ‘forger of lies’. There are different strains of the smallpox virus, which differ in severity. Different outbreaks had different fatality rates. But as an overall average, it killed one in five people who caught it. And if it didn’t kill you, it was probably going to leave you heavily scarred for life, and maybe even blind. But sure. Not that bad.

After this brief foray into lying about what smallpox is like, Massey returns to his more familiar territory: religious objections. Inoculation, he thinks, breaks the Sixth Commandment (21). That one about not killing people. If you remember, this is the same commandment Cotton Mather used in defence of inoculation.

There’s a very interesting theological question here, about what is actually encompassed by the word ‘kill’ (the Hebrew is רָצַח, rtsḥ). Is it specifically murder, or a more general ‘causing the death of’? Can it reasonably encompass ‘neglecting to prevent the death of’? Theologians are still debating these ideas, but for Massey, it seems, it definitely includes accidental death. Which means, as far as he’s concerned, that the Sixth Commandment doesn’t just prohibit killing, it prohibits actions that will probably lead to someone dying. Which is why Chapter 21 in Exodus, the very next chapter after the listing of the Ten Commandments, forbids ‘all voluntary and causeless Wounding, Mutilation, &c.’ (22).

‘Causeless’, you say? But Massey, inoculation isn’t causeless! It has a very good cause! Unfortunately, since Exodus 21 is a list of laws, Massey is probably referring to a legal cause. If someone kills a family member, you have legal cause to kill them back. If someone harms you, you have legal cause to punish them. Harmfully. But there is no legal cause for giving someone a very minor form of a disease.

Now, God might allow the devil to put a man’s faith to the test, but man is not allowed to put God’s law to the test. Which is what you’d be doing if you gave in to the devil, and got inoculated. Just like when Jesus was tempted by the devil in the desert to jump off the highest point of the temple because he knows God would send angels to save him. (Matthew 4: 5-7).

Getting inoculated against smallpox is testing God’s power by demanding that he prevent you from dying after you expose yourself to unnecessary danger. Jesus would never have got inoculated, and neither should you (23). If troubles overwhelm you, you can pray to God for help getting out of trouble, but if you jump into harm’s way, and deliberately get a disease, then you cannot rationally depend on God’s help. It’s hard enough to carry a burden inflicted upon us by outside forces, if we inflict them upon ourselves then we do so without the blessing and protection of God (23).

And getting inoculated tempts the Lord in another way too: in relying on an authority other than God, and putting yourself in the hands of mere men to keep you safe, you open yourself to the possibility of God punishing you for your rashness (24).

Massey makes a more subtle point next. It’s the answer to Maitland’s question of ‘why take any medicine at all, if you should be trusting to God?’

He argues that the bible tells us that we should honour physicians to the extent to which they are people who heal and prolong life. The knowledge that physicians have is a gift from God, and we should make use of God’s gift. But it should only be used in certain ways: to heal, and to prolong life (25). Okay, fair enough, you can’t exactly class inoculation as ‘healing’. But many of us might happily classify inoculation under ‘prolonging life’, given that not dying of smallpox generally prolongs someone’s life. But Massey doesn’t. Inoculation is not a correct application of God’s gift of knowledge.

In the good old days, physicians were more successful because they actually also prayed to God for the health of their patients. They should get back to doing that (26).

Massey seems to think that one of his strongest arguments is that old chestnut ‘smallpox is there to discourage you from sinning, and being able to prevent people getting the smallpox will just make you more sinful’, because he comes back to that next and really labours it. Even if inoculation really worked, and physicians could protect us from it, they wouldn’t actually be doing humans any good, because without smallpox to function as a deterrent, people would fall into sins they otherwise would have avoided (28-29).

And if you die of smallpox? Well, it’s providence, God’s will, that you should do so, even if humans might consider such death untimely. And if you’re good and you die, then you get to go to heaven, and if you’re bad and you die, well… then at least God has prevented you from making your fate even worse by sinning more.

In conclusion, we must accept the will of God (30), we must not try to appropriate God’s power for ourselves (30), and we must trust that God knows what’s best for us (31). Leave this inoculation nonsense to heathens (31), trust in God, be thankful if you get smallpox, whether it’s to test you or to punish you, pray to God and trust him (32).

Amen.

So, to summarise:

Congratulations, you’ve just made it through one of the first European anti-vaxx pamphlets.

Across all the parishes that provided records in 1722, there were 25,750 burials that year. 2,167 people were recorded to have died of smallpox. That’s just over 8% of the deaths. In St Andrew’s Holborn that year, 1219 people died. Statistically speaking, roughly around 102 people would have died of smallpox in Massey’s congregation. It was the 5th most common cause of death (Postlethwayt et al. 1759).

This is the end of today’s episode, but it’s not the end of this story. It was going to be, but then, y’know, research happened. Y’see, it wasn’t just religious types publishing pamphlets about how much they didn’t like inoculation; doctors were doing it too. Massey briefly alludes to this, and in the published version of his sermon, gives a footnote referencing it, directing us to look there for the medical arguments. So there we shall go, next episode.

Now, when I first started planning this podcast, I was intending to do mostly standalone episodes, and maybe aim for one episode a week, though I knew there were a lot of subjects that would require multiple episodes to cover. I figured I’d start where I did, because this would be an easy one to cover in a single episode. But then research happened, and I realised that was going to be a two-parter. And then research continued to happen, and it grew to three episodes. It might get even longer. If this keeps happening, then the show might end up being predominantly multi-part topics, and that might throw a spanner in the works for one episode per week being sustainable, but we’ll see how it goes. For now, the aim is one episode per week.

Thanks for listening. If you like the show, please subscribe on whatever podcatcher you use. Rate and review the show, especially on iTunes. If you have questions, comments, feedback, want to suggest a topic, etc. You can find the podcast on twitter @poisonroompod, or send an email to: poisonroompodcast@gmail.com

Alternatively, send a letter to the Royal Society and hope they publish it.

Transcripts of this episode, along with full citations and bibliography, are available at poisonroom.com.

You have been listening to The Poison Room, a podcast clinically proven to not cause smallpox.




Bibliography