Vaccine Insights

Reverend Mather and the First Vaccination Experiment

By Gordon Dickinson, MD

The world of preventive health has been dramatically changed in recent months, especially in Florida, where the concept of mandatory vaccination for school enrollment may be rejected upon the recommendation of the Surgeon General of our state and our Governor. The turmoil surrounding immunization has been present since the beginning of modern vaccination. I have read the reports of Surgeon General Dr. Ladapo linking mandatory vaccination to slavery. I wonder if he is aware of the contribution of slaves to the initiation of vaccination in America. This is a story worth telling, not only because of its link to slavery, but also because of the role of an evangelical minister as chief advocate for the introduction of vaccination in the Americas.

Smallpox was a scourge in the world long before it was known to be caused by the variola virus—or even before infections were attributed to microbes. Smallpox tended to occur in epidemic waves, and it was often severe, causing death in up to 30% of those affected, involving young and old, healthy and infirm.

In early Puritan New England, ministers were important leaders. Among these were two men, father and son, Increase Mather and Cotton Mather, who were widely respected in the late 1600s and early 1700s. His congregation gave him a slave, Onesimus, a man from northern Africa. Onesimus told Cotton Mather that he received an injection against smallpox, a common practice throughout the Ottoman Empire that involved taking pus from a smallpox lesion, scratching it into the skin, and producing a mild smallpox that afterwards protected against re‑infection. This process, known as inoculation, had developed in the remote past, a practice adopted because of the observation that if one survived smallpox, it would never return. Inoculation was not benign, since it involved giving smallpox to the recipient, and although the smallpox after inoculation was often mild and only 1 or 2% would die, this was much better than the wild form acquired by breathing in the virus, with a mortality rate that ranged up to 30%.

Cotton Mather was interested in Onesimus’ story, and he confirmed the story by speaking with other slaves. Cotton Mather was not only a theologian but also a man with a scientific mind, and a member of the Royal Society of London. A few years later, he read a letter written to the Royal Society by Dr. Emmanuel Timoni, an English doctor in Istanbul who wrote a letter about the practice of inoculation in the Ottoman Empire and its benefits. The medical profession in England was skeptical and did not accept the practice. But the story did catch Mather’s attention.

Then, in 1721, a ship brought smallpox to Boston and an epidemic developed. Cotton Mather advised the use of inoculation to save people, but the leading doctors—and other clergymen—disagreed, and presumably most Bostonians were against the concept of actively injecting something into your body. But Reverend Mather persisted, and Dr. Zabdiel Boyleston inoculated his own son and approximately 280 persons. Only 2% of those inoculated died, whereas 15% of the Bostonians not inoculated died (precisely 6 deaths of 282 inoculated compared to 844 of 5,759 not inoculated).

At approximately the same time, Lady Montague, returning from Istanbul to London, publicized and introduced variolation. Based upon Mather’s observations and advocacy, variolation became an accepted practice throughout England and the colonies. This occurred 75 years before Jenner introduced the use of cowpox to prevent smallpox and was acclaimed the father of modern vaccination.

What does this story tell us? I suppose it confirms that doctors tend to be conservative and can be wrong. And it shows that a clergyman with an open mind can be a powerful advocate for science. Yes, science in the early 1700s was rudimentary by today’s standards, but the principles were the same: observe, test, and measure. And it also demonstrates how we humans have evolved, from the days when clergymen held slaves, believed in witchcraft, and attributed all to the will of God, to a time when slavery is out of fashion and people of faith can be faithful but also scientific.