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http://www.nytimes.com/2002/12/17/health/17SMAL.html?tntemail0

Boston's 'Grievous Calamity of the Small Pox'

By THE NEW YORK TIMES

hese excerpts are from an essay, "Smallpox in the Americas: 1492 to 1815, Contagion and Controversy," by Dr. Stanley M. Aronson and Dr. Lucile F. Newman, that accompanies an exhibit of colonial-era documents at the John Carter Brown Library at Brown University. Dr. Aronson is dean emeritus of medicine at Brown. Dr. Newman is professor emerita of community health.
(For complete essay: Click here.)

"Because of the destroying angel standing over the Town, a day of prayer is needed that we may prepare to meet our God."

Thus wrote Cotton Mather in 1721 as his Boston congregation faced the return of smallpox. It was not the first such epidemic in New England, but it would prove to be its most lethal.

Bostonians knew of few interventions to slow the spread of smallpox. Days of fasting, self-denial, prayer and strict quarantining were considered the sole means of arresting its remorseless advance. . . .

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The Boston of 1721 was a prosperous port city of some 11,000 residents with seven churches and, by some estimates, 11 practicing physicians. Most of its residents older than 19 years had lived through the 1690 and 1702 waves of smallpox, many having contracted the disease and thereby blessed with lifelong immunity.

But those younger than 19 years had never encountered smallpox; and as each smallpox-free day passed, some of the older people with immunity died of unrelated causes while newborns were continually added to the local population of susceptibles. Thus, as the interval between smallpox epidemics lengthened, the fraction of the population with immunity to smallpox diminished, the number of susceptibles increased, and the likelihood of a major epidemic was heightened.

On April 22, 1721, the British vessel Seahorse, recently from the Caribbean, arrived in Boston harbor. It passed the customary quarantine inspection and proceeded then to its dock.

Within a day, one of its crew was stricken with smallpox and forcibly confined to a house near the docks. A red flag was implanted in front of the dwelling with the emblazoned words, "God have mercy on this house."

Any naïve thoughts that smallpox had been effectively contained were dashed by early May when nine more seamen showed evidence of acute smallpox.

Despite frantic efforts to quarantine the latest victims, cases were now appearing among the residents of Boston. And on May 26, the Rev. Cotton Mather entered the following in his diary: "The grievous calamity of the small pox has now entered the town."

About 1,000 Bostonians immediately fled the community. Of those remaining, 5,980 were ultimately stricken with smallpox and 844 died of the disease before the epidemic finally abated by the following spring. The case fatality rate was 14.1 percent.
 

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