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The history of smallpox prevention—"the one early striking instance of the conquest of disease"—is especially rich in folk tradition. As one eighteenth-century commentator observed, "this Wonderful Invention was, first . . . found out, not by the Learned Sons of Erudition, but by a Mean, Course, Rude Sort of People. . . . It was rarely, if ever, used among People of Quality, until after the Beginning of the present Century."

Healers in many parts of Africa and Asia had for centuries been practicing variolation or inoculation; that is, drawing pus from the sores of smallpox victims and introducing it into the bodies of healthy people. The recipients of the attenuated variola virus would typically contract a relatively mild, nonlethal case of smallpox and would thereby gain lifetime immunity from the disease. . . . The originators of smallpox prevention are anonymous, but the name of the African who introduced it into North America is known. The famous Puritan preacher Cotton Mather learned the technique of inoculation from a slave he owned named Onesimus. (A book entitled Cotton Mather: First Significant Figure in American Medicine certainly does an injustice to Onesimus.) In a letter of July 12, 1716, Mather wrote to friends in England:

I do assure you, that many months before I mett with any Intimations of treating the Small-Pox, with the Method of Inoculation, any where in Europe; I had from a Servant of my own, an Account of its being practised in Africa. Enquiring of my Negro-man Onesimus, who is a pretty Intelligent Fellow, Whether he ever had the Small-Pox, he answered, both, Yes, and, No; and then told me, that he had undergone an Operation, which had given him something of the Small-Pox, & would forever preserve him from it; adding, That it was often used among the Guramantese, & whoever had the Courage to use it, was forever free of the fear of the Contagion. He described the Operation to me, and shew'd me in his Arm the Scar, which it had left upon him.**

In a later account, Mather added (interspersing his narrative with his version of African dialect):

I have since mett with a Considerable Number of these Africans, who all agree in one Story; That in their Countrey grandy-many dy of the Small-Pox: But now they Learn This Way: People take Juice of Small-Pox; and cutty-skin, and putt in a Drop; then by'nd by a little sicky, sicky: then very few little things like Small-Pox; and no body dy of it; and no body have Small-Pox any more. Thus in Africa, where the poor Creatures dy of the Small-Pox like Rotten Sheep, a Merciful God has taught them an Infallible Praeservative. Tis a Common Practice, and is attended with a Constant Success.

Mather launched a public campaign to convince his fellow citizens of the virtues of inoculation, but his efforts were met with fierce opposition. The resistance was not entirely irrational, but Mather's most vocal opponents appealed to racism by ridiculing him for adopting an idea from Africans: "There is not a Race of Men on Earth more False Lyars, &c." Mather countered by reminding his critics of the proven value of indigenous medical knowledge: "I don't know why 'tis more unlawful to learn of Africans, how to help against the Poison of the Small Pox, than it is to learn of our Indians, how to help against the Poison of a Rattlesnake."

The debt owed to Africans for introducing inoculation in North America was soon forgotten, but it was rediscovered by a scientific gadfly named Cadwallader Colden in 1753. "It seems probable," he wrote, "that the practice . . . came from Africa originally." Colden, who was at that time unaware of Mather's earlier revelation, continued:

I have lately learned from my negroes, that it is a common practice in their country, so that seldom any old people have the disease. . . . It will be objected, how comes this not to have been sooner discovered, since so many negroes have been for near one hundred years past all over the colonies. But it is not to be wondered at, since we seldom converse with our negroes, especially those who are not born among us.

The knowledge that was thus gained from African slaves was soon turned against them. Small-scale experimental trials designed to test the safety of inoculation had been performed in England on condemned prisoners, but the slave trade provided a much larger pool of involuntary subjects. Then, when it was found to be effective, slave dealers began routinely inoculating their chattels as a means of maximizing profits. Because immunized slaves were considered a safer investment, they brought a higher price. . . .

The evidence that inoculation preserved the lives of slaves and condemned felons led to its general acceptance as a legitimate medical procedure. In the hands of the medical elite, however, it became an expensive treatment that only the well-to-do could afford. When only a few people undergo inoculation, it actually puts the larger population of unimmunized people at greater risk of contracting smallpox. (Inoculees contract contagious smallpox; although their own case is relatively mild, the disease they can spread to others is the usual virulent form.) It is no wonder, then, that in America it generated a class-based controversy: the wealthy tended to support inoculation while the less affluent opposed it. Benjamin Franklin was an advocate of inoculation on scientific grounds, but he recognized the social injustice it entailed. "The expence of having the operation perform'd by a Surgeon," he wrote, "has been pretty high in some parts of America." To immunize a typical workingman's family "amounts to more money than he can well spare." When smallpox claimed about three hundred lives in Philadelphia in 1774, Franklin was not surprised that "the chief of them were the children of poor people."

Immunization was extended to the working classes in 1777 to 1778 when George Washington had the soldiers of the Continental army inoculated in "the first large-scale, state-sponsored immunization campaign in American history." Historian Elizabeth Fenn argues persuasively that Washington's decision to protect his troops from smallpox was essential to the victory of the American Revolution. To the extent that is true, the United States owes its very existence to the medical knowledge transmitted by Onesimus and other Africans.


The way knowledge of the currents came into being is well illustrated by Benjamin Franklin's publication of the first chart of the Gulf Stream, the powerful current that explodes out of the narrow channel between Florida and the Bahamas, proceeds northward parallel to the coastline of the United States, and in the north Atlantic deposits waters whose warmth is carried by winds all the way to the shores of Ireland and England. Sailors had discovered no later than the early sixteenth century how to utilize the Gulf Stream to their advantage, but it remained their craft secret until Franklin published his chart more than two and a half centuries later. Franklin, one of the familiar Great Men of Science, had the good grace to report honestly how he came into possession of the knowledge embodied in his chart.

In 1769 a complaint was brought to Franklin's attention, in his capacity as head of the postal service for the American colonies, that it took mail boats ("packets") two weeks longer to make the trip from Falmouth to New York than it took merchant ships to travel from London to Rhode Island. Franklin was puzzled

That there should be such a difference between two places scarce a day's run asunder, especially when the merchant ships are generally deeper laden, and more weakly manned than the packets, and had from London the whole length of the river and channel to run before they left the land of England, while the packets had only to go from Falmouth.

Franklin said that he "could not but think the fact misunderstood or misrepresented," but he investigated and to his surprise found it to be true. It was Franklin's good fortune to have a cousin, Timothy Folger, who happened to be a Nantucket whaleboat captain. Folger explained the nature of the Gulf Stream to him:

"We are well acquainted with that stream," says he, "because in our pursuit of whales, which keep near the side of it, but are not to be met with in it, we run down along the sides, and frequently cross it to change our side; and in crossing it have sometimes met and spoke with those packets, who were in the middle of it, and stemming it. We have informed them that they were stemming a current, that was against them to the value of three miles an hour; and advised them to cross it and get out of it; but they were too wise to be counselled by simple American fishermen. When the winds are but light," he added, "they are carried back by the current more than they are forwarded by the wind; and, if the wind be good, the subtraction of seventy miles a day from their course is of some importance."

Franklin then remarked to Folger that it was too bad this current was not on any charts and "requested him to mark it out for me, which he readily complied with." Folger drew for Franklin "the dimensions, course and swiftness of the Stream from its first coming out of the Gulph when it is narrowest and strongest, until it turns away to go to the southward of the Western Islands, where it is broader and weaker," and added "written directions whereby ships bound from the Banks of Newfoundland to New York may avoid the said Stream." Franklin published this information "for the benefit of navigators," fully acknowledging his debt to "the Nantucket whale-men" who were "extremely well acquainted with the Gulf Stream, its course, strength and extent, by their constant practice of whaling on the edges of it, from their island quite down to the Bahamas."

The economic value of this natural knowledge was evident; it meant that "a vessel from Europe to North America may shorten her passage by avoiding to stem the stream . . . and a vessel from America to Europe may do the same by . . . keeping in it." This relatively recent (late-eighteenth-century) example of how the charting of an important ocean current depended upon the input of "simple fishermen" should not be minimized as anecdotal evidence, but rather should be recognized as a rare instance in which the source of the essential knowledge in question can be documented.


Slightly—but only slightly—less noxious than the notion that masses of poor people should be left to starve to death was the idea that the human race could hasten its evolution toward perfection by restricting the reproductive capacity of "inferior" types of people—which almost invariably meant the darker-skinned ones. That was the inspiration behind eugenics, a new science founded by a first cousin of Darwin, Sir Francis Galton. Galton urged the "gifted class" to produce more offspring of their own and to take measures to limit the procreation of "children inferior in moral, intellectual and physical qualities."

Among other things, Galton attempted to provide a biological justification for scientific elitism. The primary thesis of his books Hereditary Genius and English Men of Science was "that great men, including creative scientists, tend to be related and that therefore a series of elite families contributed perhaps the majority of distinguished statesmen, scientists, poets, judges, and military commanders, of his day and of the past."

Galton was a wealthy polymath who is traditionally awarded a place in the pantheon of Great Minds for pioneering methods of applying mathematics to the study of human behavior. He has been called the father of intelligence testing, he is frequently credited with the invention of fingerprinting as a means of identifying individuals, and modern statistical analysis owes an immense debt to his undeniably brilliant innovations. But his eugenics—as well as his other attempts to apply scientific methodology to the solution of social problems—was constructed on the false foundation of social prejudice.

He held "axiomatically" that "certain marked types of character" can be "justly associated" with the "different races of men." Galton maintained, for example, that "the typical West African Negro" has "strong impulsive passions, and neither patience, reticence, nor dignity. . . . He is eminently gregarious, for he is always jabbering, quarrelling, tom-tom-ing, or dancing . . . and he is endowed with such constitutional vigour, and is so prolific, that his race is irrepressible." Eugenics was, among other things, the supposedly scientific answer to the demographic threat posed by the sexually hyperactive Black race and its infernal drumming.

Because it seemed to offer a scientific explanation of why privileged social groups deserved their privileges, Galton's eugenics gained and maintained an influence far exceeding what it would have achieved if science really were a disinterested, objective quest for truth. That influence was strong and growing stronger at the end of the nineteenth century and persisted well into the twentieth. Unfortunately, it has not entirely disappeared even in the twenty-first.


Surgeons—especially those who aspired to elite status—also practiced heroic interventions other than blood-letting. In sixteenth-century France, orthodox surgical practice was dictated by the scholars of the Surgeons' College of Saint Cosme. The standard treatment for wounds was cauterization, which required application of a red-hot cautery iron to the flesh. For gunshot wounds, a no less painful variant was used: boiling oil. The theory justifying these severe measures was the mistaken belief that they were necessary to drive out "poisons" and prevent the flesh around the wound from putrefying. By happy accident, a French military surgeon, Ambroise Paré, was able to disprove the theory.

Paré, born in 1510, was the son of a barber-surgeon and had been trained by apprenticeship to barber-surgeons. But his prowess on the battlefield as a military surgeon won him royal favor and in 1552 he was appointed surgeon to Henri II. A few years later "the elite surgeons of the College of St. Cosme were obliged to accept in their ranks this barber who did not even know Latin."

The fortunate circumstance that led Paré to question the efficacy of cauterization occurred in 1536, well before his rise to prominence: on his first campaign with the French army, he ran out of oil to boil. Compelled to use a substitute, he treated some soldiers' wounds with "a digestive of yolkes of egges, oyle of Roses, and Turpentine." The next day he was astonished to find that those who had received the mild ointment were in much better shape than those he had subjected to the boiling oil. "And then," he said, "I resolved with my selfe never so cruelly to burne poore men wounded with gunshot."

Paré extended this insight to challenge the orthodox use of cauterization to stop bleeding after amputations. It is difficult enough for us to contemplate the pain of having a limb sawed off without benefit of anesthesia, but imagine having it compounded by application of a red-hot iron immediately afterward. Paré was able to show that the latter step could be avoided by skillfully tying the blood vessels (vascular ligation).

Paré, like Paracelsus, felt there was much to be learned from folk medicine. Asked by a nobleman to treat the burns of one of his "kitchin boyes" who had fallen into a cauldron of nearly-boiling oil, Paré went to an apothecary's shop, where he met "a certaine old countrey woman." The woman gave him a recipe for a dressing made from onions and salt, which Paré tried out on the boy and found remarkably effective in reducing the blistering.

Another noteworthy sixteenth-century surgical innovation was accomplished by a practitioner in Switzerland far lower on the social scale than Paré. Jakob Nufer, whose skill with the surgeon's knife derived from castrating farm animals for a living, performed the first recorded cesarean section on a live mother in about 1500. The operation had routinely been performed on dead pregnant women in ancient times because Roman law required separate burial of the deceased mother and her fetus. But the Swiss pig-gelder extracted a living baby from a woman who is said to have later borne more children and lived to the age of 77. Nufer's triumph could not have been replicated often, and then only with a great deal of luck, until antisepsis became standard in the twentieth century, but it was significant as a demonstration of what surgeons could hope to accomplish under ideal circumstances.

**The sources of all quotations in these excerpts are identified in footnotes in the book.


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