Sunday, July 17, 2011

When Franklin blew it

kw: book reviews, nonfiction, medicine, vaccination, variolation, religion

Before the discovery of vaccination, there was variolation. The Variola virus causes smallpox, the most dreaded disease of antiquity. The Vaccinia virus causes the related zoonosis cowpox. Someone who survives infection by either virus is thereafter immune to both.

Centuries before Edward Jenner observed that milkmaids were immune to smallpox, it had been observed in Asia that people who caught smallpox by direct contact with someone who was mildly infected were much more likely to survive their infection. They also became immune to future infection. Asians developed the practice of infecting people with smallpox and caring for them during their illness. By 1700 the practice had spread to Africa and the Mideast. In 1716 in England and America, this became known to two people with the intelligence to understand its implications, and the influence to initiate the practice. In England, the proponent was Lady Mary Wortley Montagu, and in America, specifically Boston, it was Cotton Mather.

Lady Montagu's story is told elsewhere. The Pox and the Covenant: Mather, Franklin, and the Epidemic That Changed America's Destiny by Tony Williams tells of Cotton Mather and the "inoculation" controversy that sundered the Boston polity in 1721, created a turning point in the acceptance of the scientific method, and broke the power of the century-old Puritan Covenant.

Early in 1621, Cotton Mather had just turned 58 years old, and was at the peak of his powers as a Puritan preacher of great influence, both civil and religious, and also as a scientist—he was elected to the British Royal Society in 1713. He is often considered the finest mind of his generation in colonial America. He had been told by an African slave boy about the African method of preventing smallpox by making cuts in the skin and rubbing in pus from the pustules of a smallpox victim. The person thus inoculated would suffer a fever and break out with a relatively small number of pustules, and recover, now immune to smallpox infection.

Mather searched for earlier accounts of this practice, and soon found them. He might have saved himself a world of trouble by immediately discussing this with his British colleagues and the local physicians and scientists and fellow-ministers, but he kept the matter close for five years, expecting a smallpox epidemic to occur, as they did about once per generation; then he could reveal the matter and instigate a program to save the population from a severe plague.

There was a bit of vanity in this view, and he was blinded by simplistic thinking. When a smallpox epidemic began early in 1721, brought by the ship Seahorse from Barbados, Mather wrote a letter to all the local doctors explaining inoculation and referencing the literature (he knew better than to quote a slave). There was no reply. He waited, prayed, waited, and finally wrote again, and this time there was a response. One doctor, Zabdiel Boylston, responded favorably, by beginning to perform inoculations. He experimented with a small number and saw how they were only mildly affected, in contrast to longer fevers, greater pains, and a 30% death rate among those who acquired smallpox the ordinary way.

Shortly after this, the other doctors responded, with fierce opposition. They stirred the Selectmen to prohibit inoculation. Mather and Boylston took the fateful decision to quietly defy the authorities. Possibly due to the stature of Mather and Boylston, the authorities did not arrest them, but dithered. A withering flurry of publications ensued, primarily of the doctors of Boston against inoculation. Soon another pair of actors entered the fray. James Franklin and his young apprentice, his 16-year-old brother Benjamin, began to print the New England Courant, a weekly paper in which they pushed the limits of attacking convention, authority, and religion in particular. This paper quickly became the focus of anti-inoculation fervor.

The drama took months to play out, and in the main, the disease ran its course until it had infected nearly everyone who was not already immune. Among the immune were those who were inoculated. By the end of the epidemic, it was found that nearly 900 Bostonians had died of smallpox, of about 5,000 who were infected. This doesn't quite square with the 25% and 30% death rates quoted throughout the book, but 18% is still terrifying odds. By contrast, of 242 persons inoculated, only six died, a death rate of 2½%. This was enough for Mather and others to publish a tract showing statistically that inoculation was superior to letting nature run its course.

Curiously, within nine years, Benjamin Franklin became a proponent of inoculation. After the epidemic burned itself out, in 1722 Mather had extended an invitation to young Franklin, author of so many diatribes against him, to visit him at his home. It is not known what they discussed, but Franklin subsequently became, scientifically at least, a man much like Cotton Mather: very well-read, with wide scientific interests, and a keen desire not just to win an argument but to win over an opponent. Though Franklin as a youth was on the wrong side of history, as he matured he had the flexibility of mind to learn where he had been wrong and correct his course.

While science took a great step in the West at this time, the change in religious polity was equally profound. From 1630 to 1721 the Puritan Covenant in Boston and the Massachusetts Bay Colony had prevailed, and the people were generally in agreement with the spiritual rigors it entailed, and with the hegemony of religion in civil affairs. Dissension and heresy were censured, and in a few cases, dissidents were hanged. By the early 1700s this Covenant seemed to be weakening as "worldly" influences became stronger, but the intense opposition directed primarily at Mather in 1721 broke the back of the Covenant.

Some years earlier the Crown had mandated religious tolerance in the Colonies, in the wake of the Glorious Revolution in England in 1688. This hardly weakened the committed Puritans, and their ministers continued to be held in very high esteem, much the way Catholics today esteem Archbishops and Cardinals. This was shaken in 1721-1722, and came to an end by the time of the American Revolution. The powerful sermons of Jonathan Edwards in the 1740s were pretty much the last gasp of Puritan influence, although even in the mid-20th Century "banned in Boston" was a common joke.

There is something we can learn from Cotton Mather, however. He risked everything for a scientific principle, as all his life he had risked everything for the sake of his faith. He saw "natural philosophy" and "natural theology" as handmaidens to one another. He understood the scientific method as well as any of his day, and believed that understanding the glories of nature and the worship of God went hand-in-hand. In contrast to the modern view of science and faith, best expressed by Steven Jay Gould as "non-overlapping magisteria", the Puritans embraced both. Without this embrace of science by the chief Puritan of his day, among those 242 inoculated Bostonians, another forty might have died.

Cotton Mather had dreams of saving the whole of Boston from the epidemic. He could save only a handful, but to that handful, that made all the difference. And indirectly, he brought in a turn toward a better attitude toward the men and women of God among us; that they are after all human, and deserve common respect, but are much better served by that alone than by the inflated esteem the "clergy" are often accorded. We would do well today to learn this of the Puritans: science and faith can work together. For myself and many others who are both scientists and people of faith, the "magisteria" overlap quite a bit.

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