No Pox Party in John Adams

I thought I was done writing about H.B.O.’s John Adams miniseries for a while, but interesting comments on Dr. Samuel Gelston’s smallpox hospitals got me thinking about that part of the show. Many critics have singled out the sequence in which Abigail Adams and the children are inoculated against smallpox as a particularly gritty portrayal of history.

There were actually two significant epidemics during the siege of Boston:

• “The bloody flux,” a form of dysentery that Judy Cataldo wrote about back here. This disease reached Braintree in October 1775, making Abigail and her three-year-old Tommy sick. Her mother, Elizabeth Smith, and John’s younger brother Elihu Adams both died.
• Smallpox, an untreatable, contagious disease with a death rate of close to 30% and a really scary rash.

The screenplay apparently combined these two diseases into something called “the bloody pox.”

After the winter of 1775-76, smallpox was the bigger worry for both armies and the civilian populations. Indeed, the epidemic eventually affected the whole continent, as Elizabeth Anne Fenn described in Pox Americana.

John Adams’s great-uncle, Dr. Zabdiel Boylston (1676 or ’79-1766), was the first American physician to try inoculating people against smallpox, provoking a huge controversy in 1720s Boston. The Rev. Dr. Cotton Mather supported him, citing advice from his enslaved man Onesimus. James and Benjamin Franklin attacked the practice in their newspaper. Because inoculation involved deliberately giving people (what everyone hoped was) a mild case of the disease, and those people remained contagious for a while, at first it seemed like a step backward in public health.

In 1730 Dr. Boylston published his results in London (as shown above, courtesy of the New York Academy of Medicine). He reported that although some patients had died after inoculation, their death rate was significantly smaller than that of people who caught the disease naturally. And the more smallpox survivors there were in a population, the less easily the disease could spread. By the middle of the 1700s, it was clear that inoculation saved lives. But it was still risky.

John had himself inoculated shortly before marrying. As a lawyer, he expected to travel and meet a lot of people, so he needed to protect himself. Abigail and the children were still vulnerable to smallpox in the summer of 1776, however. She decided to make arrangements for inoculation as she described to John in a letter dated 13 July:

I now date from Boston where I yesterday arrived and was with all 4 of our Little ones innoculated for the small pox. My unkle and Aunt [probably James and Elizabeth Cunningham] were so kind as to send me an invitation with my family.

Mr. [Richard] Cranch and wife [Abigail’s older sister, Mary] and family, My Sister Betsy and her Little Neice, Cotton Tufts [a cousin and physician] and Mr. [John] Thaxter [another cousin and tutor to the boys], a maid who has had the Distemper and my old Nurse compose our family. A Boy too I should have added. 17 in all. My unkles maid with his Little daughter and a Negro Man are here.

We had our Bedding &c. to bring. A Cow we have driven down from B[raintre]e and some Hay I have had put into the Stable, wood &c. and we have really commenced housekeepers here. The House was furnished with almost every article (except Beds) which we have free use of, and think ourselves much obliged by the fine accommodations and kind offer of our Friends. All our necessary Stores we purchase jointly.

Our Little ones stood the opperation Manfully. Dr. [Thomas] Bulfinch is our Physician. Such a Spirit of innoculation never before took place; the Town and every House in it, as are as full as they can hold. I believe there are not less than 30 persons from Braintree. Mrs. Quincy, Mrs. Lincoln, Miss Betsy and Nancy [okay, I’m giving up on the identifications] are our near Neighbours. God Grant that we may all go comfortably thro the Distemper, the phisick part is bad enough I know.

I knew your mind so perfectly upon the subject that I thought nothing, but our recovery would give you eaquel pleasure, and as to safety there was none. The Soldiers innoculated privately, so did many of the inhabitants and the paper curency spread it everywhere. I immediately determined to set myself about it, and get ready with my children. I wish it was so you could have been with us, but I submit.

The last paragraph reveals that Abigail had decided to go through with the treatment without waiting for a decision from John. As the war went on and their separations increased, she grew more comfortable making such decisions on her own. The whole family survived, as did most of their friends.

In the miniseries, Abigail and the Adams children undergo the inoculation and recovery at their home in Braintree without any servants, relatives, or neighbors in sight. A physician comes to their home with a poxy teenager in a wagon; that was the least realistic aspect for me. As the story of Dr. Gelston shows, towns were extremely edgy about confining and isolating people who might be infectious.

The actual inoculation process shown on screen—scraping pus from an infected person’s sores and inserting it into a cut on the inoculatee—was one of the cruder medical protocols of the time. Physicians also used ground-up scabs and threads dipped in pus to transmit the disease. They looked for infected people who seemed to have mild cases. According to an anonymous commenter on this posting, the series showed pus too thick to be from the early stage of the disease, and thus not contagious. I must confess that I don’t know my pus that well. But I commend the miniseries for including this unattractive but common aspect of eighteenth-century life, even within the confines of its budget.