First, flu-like symptoms emerge -fever, aches, pains, nausea. Exhaustion soon follows. It’s not until a few days later when the telltale, flat, red spots appear about the face, hands, and arms. The spots evolve into pus-filled blisters that scab first and then fall off, to reveal deep, pitted scars. Smallpox was one of history’s most dreaded diseases, not only for its tendency to produce significant and deep scarring to victims’ faces, but also for its ability to cause blindness, or even worse, death.
Fear of smallpox never lurked far from the worries of 19th-century Bostonians. Older folks still spoke of an epidemic that had struck Boston during 1721 and 1722 and killed 844, which was then more than 7% of the population. The chart at right, from a February 1881 edition of the Boston Medical and Surgical Journal shows the level of smallpox contagion in Boston during most of the 19th century. During the century’s first decades, after the first smallpox vaccinations were introduced in 1800, smallpox all but disappeared from Boston. From 1839 forward, the presence of smallpox remained more or less constant in the city. The epidemic that everyone talked about, though, dwarfed all the others and even rivaled the earlier outbreak of 1721. The smallpox epidemic of 1872 claimed over 1,000 lives before it finally abated in the first weeks of 1874.
During the 1872 epidemic, smallpox victims, or even those suspected of having smallpox, were brought, sometimes against their will, to Gallop’s Island in Boston Harbor. During the epidemic, those who could not get to the island or afford care there, were re-directed to the city’s smallpox hospital on Albany Street. The hospital, overwhelmed by the sudden onslaught of smallpox infections, quickly found its 30-patient capacity stretched to 48. Charges soon emerged that those admitted to the Boston Smallpox Hospital on Albany Street did not receive proper care or food and that they were forced to endure substandard conditions. The testimony provided by patients and medical staff has been preserved and provides some interesting insights into the experiences of 19th-century hospital patients.
The main complaint emerging from the hearings seems to have been the casualness around the enforcement of the smallpox quarantine. Several hospital patients claimed seeing the hospital’s gates open at different times of the day. Others reported seeing smallpox patients come in very close contact with women who came into the hospital yard to collect rags or boys who had come to collect nails. Several saw sailors near the hospital’s gates. Nearly all could not recall ever seeing the red flag (indicating smallpox contagion) hung at the gates to warn passersby and visitors of the smallpox infection inside.
Another complaint involved the hospital’s water closet, or bathroom/restroom as we call it today. Nearly all patients complained that the water closets were filthy and that most did not work. Administrators did acknowledge that toilets did not always work and explained the difficulty in finding plumbers who were willing to enter the hospital, make the repairs, and risk infection. Nevertheless, the stench from some water closets was so oppressive that several patients took it upon themselves to clean the water closets.
Lastly, many patients complained of the food, claiming that there wasn’t enough, or that it was of poor quality. Several claimed that eggs or meat that had been served them had gone bad, and in the case of meat, contained maggots.
In the end, the Smallpox Hospital was closed in September 1872, and patients were once again cared for either in the facilities on Gallop’s Island or in their own homes. Claims charging inadequate food or insufficient care were never substantiated. However, the claims that the hospital was overcrowded and lacked enough help were found to be true. The committee investigating the claims did decide that more nurses were needed, but also considered that patients, when sufficiently healthy, were expected to patch in too. Regarding the broken toilets, the committee did find that it was indeed broken, but sympathized with the hospital, which claimed, probably quite truthfully, that no one would enter the hospital to fix them because they were afraid of being infected with smallpox themselves.
No effective treatment was ever discovered for smallpox, a disease that killed up to 30% of those who were infected, and pockmarked up to 80% of its survivors – most often on the face. In 1967, the World Health Organization (WHO) launched a successful global eradication program, which led to the world’s last case of naturally-occurring smallpox, in 1977.