Gleanings from 1760’s 'Great Small Pox Epidemic' in Charleston

In 1760, Charleston, in what is now South Carolina, faced what was to become known as the Great Small Pox Epidemic.  In a city of 8,000 people, most of whom had no immunity, smallpox spread during the early months of 1760.  The Charlestonians' response was superior to the modern world's response to COVID.

Most importantly, Charlestonians did not overreact, although smallpox posed a more serious threat than COVID.  While COVID, on average, kills 2% of those who are infected, with the elderly and people with comorbidities at the greatest risk, smallpox killed 33% of those infected, regardless of age or underlying health.

Like modern society, Charleston resorted to quarantine as a primary response to the epidemic.  However, Charleston quarantined only the sick and those living in the same house as those with smallpox.  The government did not impose any restrictions on anyone else, even though smallpox was highly contagious.

In 1760, Charleston's government did not shut down any business; order any special precautions among the healthy; or force the end of commerce, including port traffic in one of the busiest ports in the colonies.  Healthy people were left to limit their activities as they saw fit without government oversight.  Wholly unlike modern society, Big Brother did not intervene.

Seventeen sixty was 38 years before the first true vaccine was introduced to medicine — which, ironically, was Edward Jenner's smallpox vaccine, derived from cowpox.  Modern vaccinations do not introduce the active disease into the body; instead, the material administered tricks our body into producing antibodies without the direct risk of the disease itself.  In 1760, though, the only known way to gain antibodies against smallpox was to catch the disease.

To that end, physicians had developed a process called "variolation," a primitive precursor to smallpox inoculation.  The doctor took a small amount of live smallpox virus and inserted it into a small incision in the patient.  A variolated person still contracted smallpox, but usually a mild case.

Still, variolation was dangerous.  Some variolated people would still catch full-blown smallpox, and 2% of variolated people died.  Moreover, all variolated people were fully contagious while they were sick.  The benefit was that they were later immune to smallpox.

Today's COVID vaccines are also somewhat dangerous.  All the vaccines produce some side-effects, though only a handful seem to have been deadly or life-threatening.  Still, that risk sees many people rejecting the COVID vaccine.  The Johnson & Johnson vaccine was stopped because of seven deaths out of a million vaccinations.

The contrary was true in Charleston in 1760.  People became "variolation mad," as Elizabeth Lucas Pinckney wrote at the time.  Within a one- to two-month period, over half of the town got variolated despite the risks.  Seemingly few, if any, of those who were not already immune to smallpox refused variolation.

As with COVID, there was a racial aspect to smallpox.  Smallpox was primarily a European disease.  All things being equal, non-European people, such as American Indians and Blacks from Africa, would experience somewhat worse outcomes when afflicted with smallpox.

Interestingly, the one time that was turned on its head was during a 1738 smallpox epidemic in Charleston.  That was because Blacks escaped the intensive medical care doctors visited on Whites.  The physicians, to "sweat out" the disease, kept Whites in enclosed rooms with fires running.  The same physicians left the Blacks mostly alone, so their bodies were able to heal.  As a result, Black Charlestonians had a higher survival rate in 1738 than did Whites.

While there is some debate about when in 1760 the Great Charleston Small Pox Epidemic began, there is no debate as to its end — it was over by June 1760.  By then, physicians had variolated three quarters of Charleston's population.  By March and April, almost every townsperson either had smallpox or was caring for someone with smallpox.  Yet with variolation, the city's final smallpox death toll was merely 650 people.  By June, there was only one reported smallpox case.  Life was wholly back to normal.

Charleston's experience contrasts starkly with the COVID epidemic.  Our governments tried to quarantine everyone to prevent the disease's spread, rather than letting COVID run its course, especially among those not endangered by the disease.  Instead of being done with COVID in a matter of months, we are still wrestling with it more than a year later, at tremendous cost to our nation, both economic and otherwise.

In 1760, the people of Charleston faced a deadly epidemic that they handled with grace and a minimal societal cost.  In 2020–2021, Americans have faced a mild epidemic that we have handled with fear-mongering and devastating government mandates.  Unlike the Great Charleston Small Pox Epidemic that was over in approximately four months, our modern society is still dragging on — at great social and economic expense — our response to COVID-19.  Will someone please explain to me how we have advanced in intelligence and common sense relative to our colonial forebears some 260 years ago?

Wolf Howling is a pseudonym for a long-time blogger at Bookworm Room.

Image: Smallpox: The Nature of the Disease and How it May Be Controlled. City of Boston Health Department (1900?), showing a vaccinated child with his unvaccinated father.  Public Domain.  Held in the Wellcome Collection.

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