Prior to achieving independence in 1783, the original Thirteen Colonies generally followed standards of medical training that had been established in England. As there were no medical schools in the English Colonies until 1765 (when the first one was begun at the University of Pennsylvania), aspiring doctors learned their profession by being apprenticed to other physicians.
Zabdiel Boylston and Colonial Surgery
The first true American surgeon was probably Zabdiel Boylston (1679–1766). Zabdiel grew up in Massachusetts and was educated by his father, Thomas, in the rudiments of medicine. Although Thomas Boylston (1644–1695) was rumored to have attained a medical degree through Oxford University, contemporary records suggest that he was largely self-taught, as was common at the time. After his father's death, Zabdiel studied under a prominent Boston physician who is known variously in historical records either as John Cutter or John Cutler.
Zabdiel started his own medical practice in 1705. Records suggest that he was one of only 15 doctors practicing in the Boston area at that time. Unlike other doctors who visited patients in expensive carriages, Zabdiel made his rounds on a horse named Prince. In 1710, he performed the earliest known recorded surgical procedure by removing a bladder stone without the use of anesthetic. Some eight years later, Zabdiel treated a cancerous breast tumor by performing a mastectomy in about five minutes. Even more remarkable than the speed of the surgery was the fact that it was performed under strict antiseptic conditions that predated the work of Joseph Lister (1827–1912).
Variolation is Introduced in the Colonies
In May 1721, a virulent smallpox epidemic struck Boston. Approximately 5,800 people were infected with the variola virus, and 844 (or 15% of the afflicted population) died.
Some three years earlier, Zabdiel had visited London and become acquainted with the technique of variolation. On June 26, 1721, Zabdiel decided to inoculate his son as well as two slaves by applying small amounts of smallpox virus to incisions made in their arms. All three subjects survived the experiment and the epidemic.
Zabdiel believed that the benefits of variolation exceeded the risks. From 1721–1722, Zabdiel personally inoculated 244 people in the Boston area, of which only 6 (or 2%) died. According to Zabdiel's own records (published in 1726), deaths in the inoculated population occurred mainly in people older than 50 years of age. Of the 65 subjects aged 15 years or younger, not a single one died from the innovative technique.
Opposition to Innovation
Despite the apparent success of variolation, Zabdiel encountered stiff resistance to the procedure from other Boston physicians. The fiercest opponent was a Scottish doctor by the name of William Douglas. Of the 15 practicing doctors in Boston, Douglas was the only one educated at a European university and thus the only local physician not taught through an apprentice system.
It is not entirely clear why Douglas opposed a procedure that had such remarkable success. According to Boylston (2008), one possible reason for Douglas' conduct may have been money. As Lady Mary Wortley Montagu observed ruefully, English physicians opposed inoculation because it reduced the fees they charged for treating smallpox symptoms. Thus, a similar reason may have motivated the only true European physician in Boston.
Support from Cotton Mather
Zabdiel also found support from an unlikely source. The noted Puritan Minister, Cotton Mather (1663–1728), had heard about variolation from a slave named Onesimus, who claimed to have been inoculated as a boy in Africa. Mather did further research and found that the technique had ancient origins in China as well as in Turkey.
Mather's support was not enough to overcome prejudice, or fears that variolation itself spread the smallpox virus. Boston's elite rulers eventually forced Mather to stop advocating variolation and forbid Zabdiel from inoculating any further subjects. By the time this ruling went into effect, however, the smallpox epidemic in Boston had ended.
Zabdiel eventually went to England, where he was honored by the Royal Society. By the time the next smallpox epidemic broke out in Boston in 1730, fears of variolation had subsided. Ironically, one of the doctors who began inoculating during that epidemic was William Douglas.
References
Boylston AW. 2008. Zabdiel Boylston (1679/80–1766). The James Lind Library (www.jameslindlibrary.org).
Boylston Z. 1726. An Historical Account of the Small-pox Inoculated in New England, upon all Sorts of Persons, Whites, Blacks, and of all Ages and Constitutions. With some Account of the Nature of the Infection in the Natural and Inoculated Way, and their different Effects on Human Bodies. With some short Directions to the Unexperienced in this Method of Practice. London: S. Chandler.
Toledo-Pereyra LH. 2006. Zabdiel Boylston. First American surgeon of the English Colonies in North America. Journal of Investigative Surgery. 19:5–10.
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