Smallpox Inoculation in Charleston, South Carolina, Part Two: 1760

In January 1760 a major smallpox epidemic struck Charleston, the first one in twenty-two years. The long time between epidemics meant that a new generation had been born who had no immunity to the disease. The population had also grown by immigration of both Europeans and Africans -- in the latter case not by choice). The city was now home to about 10,000 people of all hues.

During the previous epidemic in 1738 local doctors had employed inoculation for the first time in the city, with considerable success. [See Smallpox Inoculation in Charleston, South Carolina, Part One]

In this case, the disease did not arrive by sea but by land, from the backcountry. A smallpox epidemic had been spreading through Eastern North America for several years. War once again aided the transmission of the disease, in this case, the French and Indian War. Both sides enlisted Native American allies, whose movements helped to spread smallpox. 

Late in 1759, a punitive expedition from Charleston against the Cherokees led by Royal Governor Lyttleton coincided with a virulent smallpox outbreak among that nation. Soldiers returning to the city from it carried the infection back to the city. Efforts to contain it failed. 

In 1760, the inhabitants were much less reluctant to undergo the procedure than in 1738. No one opposed it upon religious or medical grounds in this instance. The people were now more familiar with it, and some residents recalled its effectiveness in the earlier epidemic. (It seems they had better memories than 21st Century Americans facing the Covid Pandemic). 

For the same reasons, most of Charleston's doctors were prepared to inoculate in 1760, and the numbers inoculated were much higher than in 1738. Mass inoculations took place almost immediately after the outbreak of the disease. Eliza Pinckney commented that the doctors had no choice: "The people would not be said nay." 

The demand for inoculation overwhelmed the doctors, who worked constantly to meet it. (It was also quite profitable.) Dr. Alexander Garden, who was in high demand, wrote that "many more people were inoculated than could be attended by the practitioners of physic." He recorded that he had inoculated more than 500 people himself, and the effort had left him completely exhausted. [Image: Alexander Garden. Garden was also a highly competent naturalist for whom Linnaeus named the gardenia.  History and Other Stuff: How the Gardenia Got its Name (mycandles.blogspot.com)

Garden estimated that 2400 to 2800 people were inoculated in less than two weeks. Another doctor, Lionel Chalmers, later estimated that more 3500 had been inoculated during the entire epidemic, while about 2500 contracted smallpox naturally. 

Deaths from smallpox numbered 940, or about 16 percent of infections and close to 10 percent of the population.  Of those infected naturally, 848 died -- about 33 percent. Of those inoculated, deaths numbered 92 -- between 2 and 3 percent. 

Other sources claimed that deaths among the inoculated were higher -- 140 to 160 -- but Chalmers thought that an exaggeration. An exact count was extremely difficult due to the chaos the epidemic produced. Total deaths in South Carolina in 1759-1760 are unknown, but must have numbered in the thousands. Native Americans, the Cherokee and Catawba, had the greatest losses. [Image: Lionel Chalmers]

Among the dead were French Acadians (exiled from today's Nova Scotia at the start of the war with France) interned in South Carolina during the war. One third of the 300 who were still alive died during the epidemic. Poor whites and enslaved Africans also suffered disproportionately, due to lack of necessities and care.

It is impossible to know how many Africans were inoculated, though letters and other documents show that some certainly were. Household slaves were most likely to be inoculated, plantation workers less so. The expense plus the problem of having all the work force inoculated at one time held down the numbers inoculated. 

The lack of care for those inoculated was another problem. Eliza Lucas Pinckney, famed for introducing indigo cultivation into South Carolina, reported that "the poor blacks have died very fast even by inoculation." She attributed the outcome to a lack of proper nursing.

Some masters compromised by having a few of their slaves inoculated so they could travel to town to deliver goods and obtain supplies. In that way, they hoped that the disease would not spread to their workplace. 

Several months into the epidemic, in April, some prominent Charlestonians began to call for an end to inoculation within the city. They did not oppose the procedure itself, but they feared that it was prolonging the epidemic and hurting the economy through continued quarantine. Many rural people white and black were coming to town to be inoculated. 

The Assembly revived the act of 1738 restricting inoculation, with minor revisions. It banned inoculation within two miles of Charleston. The main innovation was the creation of a commission to enforce the law and report on cases of smallpox until the town and its environs were free from the disease. Despite the ban, the city was not declared smallpox free until December.  

Despite the chaos and uneven allocation of its benefits, in 1760 inoculation had once again proven its value.  

 

Sources: 

Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (New York and Cambridge: 2011, 2014)