Nathan Smith and Smallpox Inoculation

Nathan Smith was an important doctor in the Upper Valley in the late 1700’s, if not the only doctor.  He married Sally Chase, Jonathan Chase’s daughter, and they lived right across the road from Colonel Chase in Cornish.  Emily Smith wrote a biography of her grandfather-in-law, The Life and Letters of Nathan Smith. In her book, she said that Nathan’s practice encompassed an hour fifty miles in diameter..

            Nathan gained the credentials he needed to begin a medical practice by serving as an apprentice for a well-respected, established doctor in Southern Vermont. After he had been in practice for a few years, he decided he needed formal medical training and became the 5^th student to receive a Bachelor’s in Medicine degree from Harvard. 

            Nathan took medical education seriously, and often had a medical student or two living with him and helping with his practice as apprentices. We get an idea of how he ran his household from a comment in one of his student’s diaries regarding a visit to Nathan’s home prior to his apprenticeship.  The student says, “I am not likely to be burdened with compliments, for, all the time I was there, Smith had not introduced us to the ladies of the family, and three were sitting silently engaged in needlework.” The student seemed to assume that Nathan’s lack of courtesy toward the female members of his family would likely extend to the newest and perhaps lowliest newcomer.

            This interesting tidbit notwithstanding, we can assume that Sally was called upon to assist with some of her husband’s medical endeavors.  The 1790 Cornish town report documents that Dr Nathan Smith “shall have the liberty to erect a pesthouse and inoculate for the small-pox.  A pest house was a sort of hospital, a building where the town constables and doctors would quarantine people who were sick with a communicable disease, usually smallpox, but sometimes other diseases as well.  These people would be confined to the pesthouse until they either died or got well. One wonders whether Sally helped with these inoculations or whether the apprentices did. The fact that Nathan himself was given the liberty to erect the pesthouse seems to indicate that he also had responsibility for the patients within them.

            When Nathan was at Harvard, one of the three medical school professors there was Benjamin Waterhouse, the first doctor in America to practice inoculation for smallpox.  Smallpox inoculations at that time involved making a scratch in a person’s skin and introducing matter from cowpox pustules into the scratch.  Cowpox was a non-lethal illness similar to smallpox.  People who had gotten cowpox were immune to smallpox. Edwin Jenner had developed the smallpox vaccine in England.  Waterhouse introduced it to America by inoculating his own children.  Then he inoculated a servant boy and sent him to a pesthouse, where he did not contract the disease.  Nathan studied under Waterhouse and came home to Cornish believing in smallpox inoculation.  The fact that the Cornish town report mentions a pesthouse and inoculation in the same entry probably means that anyone who was inoculated had to be quarantined in the pesthouse for a period of time, just in case they came down with smallpox. Inoculation was a brand-new procedure, and many people thought that it was unsafe and probably wouldn’t work. 

            Smallpox and cowpox were originally European diseases.  Waterhouse made a lot of enemies by insisting that doctors throughout America doing inoculations buy the inoculant from him only, thus insuring that he had a monopoly on the vaccine.  Without a doubt any vaccine used in Cornish or anywhere in the Upper Valley came from Waterhouse. The vaccine consisted of some pus or serum scraped onto a piece of cotton string from a cowpox lesion on a patient in England and shipped to America.  Since there were no refrigerated compartments on ships, and the voyage was not quick, some of the cowpox samples were dried out and dead by the time they were used, so effectiveness was not guaranteed.  Still, the inoculations done in this primitive way were remarkably powerful in reducing smallpox cases.

            There is some confusion between the words inoculation and vaccination. They are almost interchangeable. Inoculation refers to the practice of giving people a disease, under controlled conditions, causing them to contract the disease in a less virulent form, thus developing immunity to the disease but not dying from it.  Vaccination refers to giving a person dead or weakened pathogens so that the person develops immunity to the disease without getting the disease itself, or by getting a very mild case.  Some inoculations done in America were done by taking the serum from actual smallpox pustules and infecting healthy people with it. For some reason, people who contracted smallpox in this way became much less sick than from natural smallpox. This was done if an area couldn’t get any of Waterhouse’s inoculant, or if there was an outbreak of smallpox nearby and people were scared enough to take the risk.  I believe Nathan’s method of inoculation used Waterhouse’s cowpox inoculant.  We do not  have any evidence of a smallpox outbreak near Cornish, and Nathan would have had personal ties to Waterhouse and thus would have had access to his inoculant.  That being said, the mention of a pesthouse confuses the matter.  Why would they need a pesthouse if there had not been some cases of smallpox, unless they thought they were about to have some?  I stand by my original thought that they wanted to isolate the people who were inoculated, but it is a question.