In 1980, the World Health organization declared the eradication of one of the most deadly viruses that humans have faced: smallpox. To say that this was welcome news is an understatement as smallpox left a swathe of death and misery over many centuries throughout the entire globe.
Most Americans today have only a vague notion of this disease. Older individuals sport a small round indented scar usually on one of their arms, the reminder of vaccination against the smallpox. The US ceased routine vaccination in 1972, meaning that a good number of Americans have never been protected against the smallpox.
Smallpox in its day was a terrifying disease, very contagious and horrifying in its aspect. A patient did not die gracefully from smallpox: it changed the appearance of the sufferer into something out of a nightmare. Those who survived could often be permanently disfigured with facial scarring or blindness. Variola virus was nasty stuff indeed.
For today’s observers, it is very difficult to understand the impact of smallpox on people in the Early Modern Period. In recent decades the rise of HIV/AIDS and Ebola have shaken human complacency and caused a good level of fear and even panic. However, unlike people in the past, there is an unspoken confidence today that medical science will figure out what causes the disease and produce a “silver bullet” to counter it.
While “silver bullets” have eluded medical researchers for HIV/AIDS and Ebola, recognizing what causes the disease does help reduce the instinctive panic hard-wired into homo sapiens. The biggest difference between modern medicine and that of the 18th century: we know.
This is not to denigrate the work of 18th century healers or their patients. Faced with a myriad of diseases they fought back with the medicines and knowledge they had. Often it was not quite enough and against smallpox it was futile.
What caused the disease? In 1738 Peter Shaw’s A New Practice of Physic was remarkably candid: “The true cause of this distemper, is hitherto unknown….” Then the text goes on to “account for it” beginning with infancy wherein the child needs to adapt to a new environment where “air and nourishment …which are different from what they received in the womb….” Then through the process of adapting, sometimes resulted in “the texture of all the [body’s] fluids must needs be altered, and imperfect chyle be made, and so the blood be rendered foul…which foulness or corruption, in the circulating fluids, may it is supposed, arrive by degrees to a fitness for eruption….”
It’s rather obvious that 18th century people had no concept of what we call today a virus. Interestingly, the word virus has been around in English since the beginning of the 17th century. Taken from a Latin word meaning “slimy liquid, poisonous, offensive odour or taste” it was synonymous with venom and associated mostly with poisonous snakes.
Although the cause of the disease couldn’t be nailed down, that did not excuse the healer from trying to effect a cure. First item of business: cleanse the system with a powerful emetic, ipecac. Then various medicines meant to absorb any nastiness were administered, including powdered crabs claws and salt peter (potassium nitrate). Other medicines were brought in to deal with the various symptoms: cherry water, serpentine root, ground up kermes insects were among the many medicinal substances used.
Some might be amused by the barrage of ineffective treatments used but modern medicine could not have done better. The Center for Disease Control (CDC) flatly states: “There is no proven treatment for smallpox disease.”
The obvious question arises, if this disease is incurable, how could humans have survived?
As the CDC points out, although there is no real treatment for smallpox, prevention is the key. “How”, one asks, “Avoid every other human being?” That actually would not work as the virus can be transmitted through clothing, blankets and darned near anything used by infected people. Paradoxically, the real way to prevent smallpox is to actually contract it.
It had been noted that those poor, scarred persons who had survived smallpox would not contract it again. Some daring soul in Asia or Africa took some of the pus from the small pimple-like vesicles on a person who had smallpox and used it to infect another individual. The second person came down with a much milder case of smallpox and had the same immunity.
Europeans and Americans picked up on the procedure in the 1720’s. Lady Worley Montague learned of inoculation from the Turks when her husband served as a diplomat to the Ottoman Empire. When smallpox threatened her family she had her children inoculated, and brought word of the treatment back with her to Britain. In America the Reverend Cotton Mather learned about the procedure from his slave, Onesimus. Mather, in turn, worked with the physician Zabdiel Boylston to combat an outbreak in Boston.
There was some resistance to the use of “varioliation” from the medical establishment, and even from some who felt it was tampering with Divine Will. Some rightly feared that inoculation would spread smallpox. The incubation period of the virus was about 8- 10 days, so a person who was already infected would receive no benefit from inoculation, and their infection could easily be spread. Yet, despite certain risks, there was the knowledge that the life inoculation saved could be your own.
It was no bowl of cherries.
Were you about to be inoculated, your body had to be prepared for the “operation”. A Dr. Thomas Nettleton noted in 1722: “What was done by Preparation, was chiefly purging with Rhubarb, for Children, and sometimes [induced] Vomiting, very rarely [therapeutic] Bleeding…and many have had no Preparation at all…But I always found that those whose Bodies were prepared, especially by Vomiting, had more favourable Symptoms than others in the same Circumstances where that was omitted….” 
By the time John Adams submitted to inoculation in 1764 “Preparation” was considered mandatory, and if not done, the doctor might not be willing to perform the procedure: “We arrived at Captn. Cunninghams, about Twelve O’Clock and sent our Compliments to Dr. Perkins. The Courrier returned with Answer that the Dr. was determined to inoculate no more without a Preparation preevious to Inoculation. That We should have written to him and have received Directions from him, and Medicine, before We came into Town. I was surprized and chagrined. I wrote, instantly, a Letter to him, and informed him we had been under a Preparation of his prescribing…”
Infecting the patient was done by making an incision into the skin and a small amount of the “Variolous Matter” put in. John Adams noted: “[The doctors] took their Launcetts and with their Points divided the skin for about a Quarter of an Inch and just suffering the Blood to appear, buried a Thread about (half) a Quarter of an Inch long in the Channell. A little Lint was then laid over the scratch and a Piece of a Ragg pressed on, and then a Bandage bound over all — my Coat and waistcoat put on, and I was bid to go where and do what I pleased….”
Apparently Adams had a fairly easy time of it. But his noting what he did not experience tells us a great deal about what could happen to a patient when inoculated: “I believe, None of the Race of Adam, ever passed the small Pox, with fewer Pains, Achs, Qualms, or with less smart than I have done. I had no Pain in my Back, none in my side, none in my Head. None in my Bones or Limbs, no reching or vomiting or sickness. A short shivering Fit, and a succeeding hot glowing Fit, a Want of Appetite, and a general Languor, were all the symptoms that ushered into the World, all the small Pox, that I can boast of, which are about Eight or Ten…”
By contrast, Abigail Adams had a rougher time of it 1776. She and her children were inoculated in July, and apparently the first tries did not ‘take’ “As to myself I am comfortable. Johnny is cleverly. Nabby I hope has gone thro the distemper, the Eruption was so trifling that to be certain I have had innoculation repeated. Charles and Tommy have neither had Symptoms, nor Eruption. Charles was innoculated last Sabbeth evening a second time, Tommy to Day, the 3 time from some fresh matter taken from Becky Peck who has enough for all the House beside. This Suspence is painfull. I know not what to do with them. It lengthens out the Time which I can but ill afford, and if they can have it, I know not how to quit till I can get them through. Youth youth is the time, they have no pains but bodily, no anxiety of mind, no fears for themselves or others, and then the Disease is much lighter. The poor Doctor is as anxious as we are, but begs us to make it certain if repeated innoculations will do it….”
A few weeks later Abigail reported the difficult time her daughter had: “Nabby was the first person who had complaints of our number, hers came on about the 8th day attended with a voilent pain in a tooth which she had which was defective. She was cold and shivery, then a voilent Heat insued; the doctor supposed it the Symptoms of the disorder, a day or two after she had 3 Eruptions upon one of her Eyes. I thought it did not appear like what I had seen which they calld small pox, however I submitted my judgment to those who knew better. But when I found some who were innoculated at the same time failing, I requested the dr. to innoculate her again. Symptoms she has had very severely and very diffirent from what she had before and small pox in plenty, she can reckon 500 allready. She is cleverly only soar, I am much better satisfied now, and we rejoice when we can reckon a hundred….”
Adams summed up the pros and cons of the whole experience:
“Dont conclude from any Thing I have written that I think Inoculation a light matter. — A long and total Abstinence from every Thing in Nature that has any Taste, Two heavy Vomits, one heavy Cathartick, four and twenty Mercurial and Antimonial Pills, and Three Weeks close Confinement to an House, are, according to my Estimation of Things, no small matters. — However, who would not cheerfully submit to them rather than pass his whole Life in continual Fears, in subjection, under Bondage.” 
According to Dr. Nettleton there was a finale to the treatment: “After the Small-Pox is gone, they have always been purged twice or thrice, and sometimes let Blood, which is all that has been usually done.”
Without doubt, it was an experience that was at the very least uncomfortable with a definite air of menace about it. Then in the 1790’s a procedure was discovered that was far easier: vaccination.
In England, Edward Jennner noted that people working around cows, especially milkers contracted a disease called “cow-pox” didn’t contract small pox. By using the pus from cowpox vesicles in the same manner as smallpox inoculation, Jenner gave immunity without the discomfort and risks of variolation or its treatment (no purging or vomits!!).
While vaccination does not give life-time immunity against smallpox, being more comfortable and safer than inoculation made it more palatable for people. Widespread vaccination plus quarantining eventually lead to the elimination of one of the most feared maladies of the 18th century. An Account of the Success of Inoculating the Small-Pox in a Letter to Dr. William Whitaker, Dublin 1722  Letter from John Adams to Abigail Smith, 13 April 1764 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society.  Ibid.  Letter from John Adams to Abigail Smith, 26 April 1764 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society  Letter from Abigail Adams to John Adams, 30 – 31 July 1776 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society  Letter from Abigail Adams to John Adams, 12 August 1776 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society  Letter from John Adams to Abigail Smith, 26 April 1764 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society