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Originally published in the Historic Nantucket Vol. 48, No. 4, Fall 1999, p. 14-16

Sally Takes the Smallpox
By Leslie W. Ottinger

Last year an antiques dealer in Eastport, Long Island, approached the NHA about a Nantucket manuscript. It had been found in the drawer of a chest acquired from an "antiques picker," and the actual origin of the chest was unknown. The price seemed reasonable and the association purchased the manuscript.

The acquisition proved to be a loosely bound journal with several missing pages. It is thought to have been the workbook of a Sarah Folger and includes a number of miscellaneous items copied from various sources and the drafts of several of her letters, dated between 1799 and 1802. It has not been possible to identify Sarah, who sometimes signed herself as Sally, with certainty, as there was more than one Sarah Folger on Nantucket at that time. Most likely she was the one who married Borden Chase in 1802. If so, they had one child, also Sarah, and Sally appears to have died during or just after childbirth. Her father would have been the George Folger who had married Rebecca Slocum, and the Sally of the manuscript does refer to Slocum relatives.

One of the letter drafts is of special interest since it concerns the hospitalization of Sally and her sister for inoculation against smallpox. The letter was to be for her friend Mary Rodman, and the conclusion is missing. Sally wrote: [Original spelling has been retained but punctuation added, for clarity. —Ed.]

Nantucket 1800

With pleasure I retire and take my pen to acknowledge the reception of thy favor that came safe to hand when I needed all the consolation that could flow from the streams of friendship, for at that time I was confined within the gloomy walls of a hospital. Altho tedious yet never had cause to complain and trusting it will not be tiresome to the ear of my dear Mary, I will give the short account how time past with thy favored friend—-as my sister inform'd you we for some time past had it in consideration to take the small pox. At length we thought the right time had come for us to go-—accordingly we pursu'd it and if I recollect right my sister gave an account until jallop day [See explanation below. Ed.] which my dear was a tedious day. Our next was spent more pleasant as our new acquaintance began to be more famillier and we found a number that was affible, conversant, and agreeable. Some were employ'd in telling their storys whilst others walk'd and immersid themselves in different recreations. I was very still in observing the different immusements which I thought was necessary in present situation often retired to that lock't room which my sister mentions. In the afternoon our worthy Doctr visited us and talk'd very comfortable which cheer'd our drooping spirits until the unwery'd sun had reclined his beams below the western horizon. We then retired to our strawy couch and I laid me down. I enjoyed none there downy pillow but the next rising sun alter'd the scene for my mouth began to be very sore which proved tedious for 10 days therefore will pass them silently by as nothing can flow from my pen that will be entertaining in that time for I willing itshoud be arrais'd from my own memory, although at the period I had 20 pocks cleverly turn'd and by degrees each gloomy scene vanish'd and the day once more shown in its wanted brilliancy and my bowl of milk porrage had the comfortable addition of a little fine biscuit which my craving appitite gladly receiv'd. The 13th was a memoriable day. I pro-pos'd a walk to my nurses daughter; she readily join'd me . . . much could I say on every day whilst there but long and tirsome would be my letter, therefore for Brevity's sake must leave till in a week was ready to come out but not being willing to leave my sister. Staid another week but finally wash day came and after sheding tears with my dear nurse and daughter for indeed my dear they seemed very near to me prepared to ...

Although by the end of the eighteenth century many residents of New England had survived smallpox and became immune to a second infection, there was still a large segment of susceptible people, especially children. Smallpox is caused by a virus and humans are the only host. Highly infectious, it is spread by breathing in particles from an infected person. It was endemic in the population and burst into epidemics in populous areas about every fifteen years. After an incubation period of perhaps ten days, a case began with fever and chills, and then produced characteristic lesions in the mouth and throat and finally on the skin. These skin "pocks" were the sign that established the diagnosis. Most patients recovered, though some had severe and disfiguring scars, and the mortality rate was still ten to twenty percent at the end of the century.

Inoculation was a means for bringing about a mild form of the disease with the consequent immunity. Practiced in the Middle East for centuries, it was introduced in New England by Dr. Zabdiel Boylston of Boston in 1721. Inoculation consisted of conveying the disease by scarifying the skin and implanting material obtained from the pock of a patient with naturally acquired smallpox. The resultant infection was relatively mild, although there were still occasional fatal cases, and the resultant pocks usually were followed by only imperceptible scars. Inoculation was not universally supported, in part because a person with this mild form of smallpox was nevertheless highly infectious, and the resulting cases were of the virulent form. For this reason, persons undergoing inoculation were isolated for three to five weeks. Failure to carefully observe this precaution put the general population at risk, and inoculation hospitals were at times the subject of intense regulation and also a degree of public opposition. These small hospitals, along with others established for the isolation of cases during epidemics, sporadically appeared during the last half of the century, and we do know of an inoculation hospital on Gravelly Island, west of Madaket, that was run by Dr. Samuel Gelston of Nantucket during the 1770s.

Perhaps there were other, later hospital sites on the island or Sally and her sister may have gone to the mainland for their inoculations. The decision to do so could not have been an easy one, since it involved immediate risk, expense, and inconvenience with only the possibility of future benefit. They did proceed though, and the letter provides details of her experiences and how she was able to cope with the hospitalization.

The medical routine of the time included, before inoculation, a short period of dieting with avoidance of foods from animal sources, and the use of a program of purging. "Jallop day" would have been part of the second, utilizing a common purgative in the medical practices of the eighteenth century (Jalap is a resin prepared from the root of a Mexican plant). These measures and a limited diet, which for Sally consisted of milk porridge, were thought to avoid the more serious complications of the disease. Bedding, which was provided by the hospital, appears to have consisted of a straw mattress and no pillow. The lesions began with a sore mouth and she developed twenty pocks, with an active infection that lasted for about ten days. She then began to feel better. Her diet was supplemented with biscuits, and she was allowed to walk about outside, although still no doubt isolated from anyone other than the other patients and the staff of the hospital. Then wash day came. The practice was to burn the bedding and clothing of each patient, supervise a careful bath, and then provide clean clothing, followed by their discharge from the hospital. By now Sally had clearly become quite attached to her nurse and the nurse's daughter, who had helped her through what must have been a tedious and sometimes frightening month-long experience.

A final point relates to the date of the letter, 1800. Two years before, in 1798, Edward Jenner, an English physician, had provided convincing evidence that an infection with cowpox, which is caused by a different but similar virus, could convey at least a degree of immunity to smallpox. Vaccination, using material from cowpox cases, was, compared to inoculation, quite safe and did not require isolation. It had been introduced in Boston by Dr. Benjamin Warehouse when he vaccinated his own four children in 1800. Inoculation fell into disrepute and the practice gradually disappeared over the next decade. Coincidentally, also in the NHA's manuscript collection, is an interesting related document. An item in the Charles Congdon Collection, dated December 16, 1802, is a broadside issued by the Board of Health of Boston. In it are described experiments, conducted by several Boston physicians, showing that children previously infected with cowpox by vaccination were not subsequently vulnerable to infection by inoculation or exposure to active cases of smallpox. The conclusion was that the board was "confident in affirming that cowpox is a complete preventive against all the effects of the smallpox upon the human system." Hence, Sally and her sister were likely among the last Nantucket citizens to undergo inoculation. And we know that over the next century with vaccination and the more rigid isolation of active cases, smallpox became an infrequent cause of death in New England.

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Leslie W. Ottinger, a physician, retired to Nantucket in 1996. He has been a volunteer in the NHA Research Center since February 1999.