Wednesday, November 03, 2010

Smallpox and the Adams

I posted earlier on both Washington and Jefferson in relation to smallpox. In my current reading (First Family by Joseph Ellis as noted earlier), I was reminded that John Adams, as well as most of his family, underwent innoculation as well, which was a major decision at the time, so I decided to post on that.

John Adams was inoculated during a Boston outbreak of smallpox right before his marriage to Abigail:
At the time of the epidemic, John Adams was a young attorney living in Braintree, about 14 miles south of Boston. He traveled up from Braintree and crossed over to Castle William to take advantage of the variolation treatment. During his two-week stay on the island, he wrote letters to Miss Abigail Smith (soon to be Mrs. Abigail Adams). As an old man, he recollected the episode in his autobiography.

Adams shared a room with nine other men. In preparation for the inoculation, the men were given medicines to make them vomit. In his letters to Abigail, John made the experience seem jolly for a while. According to his April 7 letter (http://www.masshist.org/digitaladams/): “We took turns to be sick and to laugh. When my Companion was sick I laughed at him, and when I was sick he laughed at me. Once however and once only we were both sick together, and then all Laughter and good Humour deserted the Room.”

When we think of this, we think of a shot, but this was much more complex and more risky:
The usual process of variolation involved making a cut in the arm of a healthy person and then applying to it scabs collected from the sores of a person with smallpox, according to The Invisible Fire: The Story of Mankind’s Triumph over the Ancient Scourge of Smallpox, by Joel N. Shurkin. Adams’ description suggests a variation of this. He wrote on April 13: “They [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 I get and do what I pleased.”

After variolation, Adams and his companions were quarantined to await their sickness, normally a mild case of smallpox, which would provide lifetime immunity from the disease. Adams wrote to Abigail that the room was equipped with a card table, “Chequer Bord,” flute and violin to distract the men while they waited for the disease to take its course.

Variolation was risky. According to Public Health, Its Promise for the Future by Wilson George Smillie, 47 people out of 4,977 innoculated—about 1 out of every 100—died during that epidemic. Still, variolation was safer than getting the disease the natural way. Of 669 people who “naturally” contracted the disease during that epidemic, 124 did not survive—about 18 of every 100. Those who survived could be horribly scarred. In his April 17 letter, Adams described one man: “His face is torn to pieces, and is as rugged as Braintree Commons.”

Now during the Revolution, Adams was usually away, but Abigail and the kids were close to Boston, all that fighting, and the smallpox that ran through both camps and so this was her major concern in July of 1776:
Independence was just one of many things on her mind that month. Her main concern was smallpox. She wanted to undergo variolation, a risky procedure of that time, to give her immunity from the deadly disease. She also wanted to see to it that her four children—ages 11, 9, 6 and 4—received the treatment, which involved making an incision and placing on the wound scabs from someone who had the disease. Occasionally the person undergoing such treatment would get a full-blown case of the disease and die. But usually, the person suffered a weakened form of the disease and survived, emerging with a lifetime immunity.

Abigail's mother wouldn't let her get inoculated with John when he did (she wanted to join him) and now she had four children to worry about. So Abigail underwent treatment with the kids, while John was away:
The physician overseeing the treatment for Abigail and her children did not subscribe to the practices of earlier physicians, who demanded that patients endure ten days of self-induced vomiting and other torments as preparation. Still he did prescribe some unpleasant medicines. It was not easy for the children: "We have enough upon our hands in the morning," Abigail wrote. "The Little folks are very sick then and puke every morning but after that are very comfortable."

The treatment was not easy and there was major worry for Charles, who got it the "natural" way, which was more dangerous:
...the smallpox treatment was not going as well as hoped. Abigail was still waiting to come down with the mild sickness and only one of the four children had certain signs of infection. But she noted to John that she was starting to feel miserable, hoping that was an indication: "A most Excruciating pain in my head and every Limb and joint I hope portends a speedy Eruption . . ."

Eventually one of the children had to be inoculated three times before it took. Out of frustration, she fed one son a little wine hoping that would somehow stimulate inoculation. When six-year-old Charles finally got the disease, it was not through inoculation, but the "natural" way, which meant it could be especially bad, even deadly. The boy was delirious for two days.

Charles did recover and Abigail left Boston on September 2.

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