{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:34:55Z","timestamp":1777448095059,"version":"3.51.4"},"reference-count":9,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p>When Benjamin Franklin published the mortality rates from smallpox during the Boston smallpox epidemic of 1752, he revealed that Blacks not only had a higher mortality rate from smallpox (12.8%, 62\/485; 8.9% for whites, 452\/5,059), but once inoculated, had less protection from fatal disease (mortality rate 5.0%, 7\/139; 1.2% for whites, 23\/1,954). His report was thus the first publication to document racial disparities in a disease and its treatment. The differential outcomes came about in the context of slavery, poverty, and war, the predecessors of the social determinates of health that we observe today.<\/jats:p>\n                  <jats:p>During the 1752 outbreak only 28 percent of the Boston\u2019s occupants were inoculated, a level that failed to protect the community. When the contagion returned in 1764, the town selectmen decided to provide inoculations at no cost to all that needed them. That year inoculated smallpox reached 87 percent of the total caseload. \u201cThis lowered the death rate for smallpox so markedly,\u2019 wrote John Blake, historian at the National Library of Medicine, \u201dthat for the first time a smallpox year failed to stand out as one of unusual mortality.\u201d<\/jats:p>\n                  <jats:p>One final observation came from Franklin\u2019s data: the unexpectedly high prevalence of inoculations among Blacks (6.8% of those inoculated, 146\/2,143; 8.5% of all those contracting the disease, 693\/8,201). Boston\u2019s whites had made certain enslaved Blacks were inoculated, evidence the extent to which slavery was essential to the economy of colonial Boston.<\/jats:p>","DOI":"10.1177\/00031348221093633","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T19:01:29Z","timestamp":1652900489000},"page":"173-177","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Racial Disparity, Social Determinates of Health, and Slavery During the Boston Smallpox Epidemics of the Eighteenth Century"],"prefix":"10.1177","volume":"89","author":[{"given":"Don K.","family":"Nakayama","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Pediatric Surgery, University of North Carolina School of Medicine, Chapel Hill NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"bibr1-00031348221093633","doi-asserted-by":"publisher","DOI":"10.18574\/nyu\/9781479816149.001.0001"},{"key":"bibr2-00031348221093633","volume-title":"Disowning Slavery: Gradual Emancipation and \u201cRace\u201d in New England, 1780-1860","author":"Melish JP","year":"1998"},{"issue":"1","key":"bibr3-00031348221093633","first-page":"143","volume":"117","author":"Koo K","year":"2007","journal-title":"Proc Am Antiq Soc"},{"key":"bibr4-00031348221093633","doi-asserted-by":"publisher","DOI":"10.4159\/harvard.9780674182899"},{"key":"bibr5-00031348221093633","doi-asserted-by":"publisher","DOI":"10.1093\/jhmas\/VIII.July.284"},{"key":"bibr6-00031348221093633","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.2008.08k008"},{"key":"bibr7-00031348221093633","volume-title":"Pox Americana. The Great Smallpox Epidemic of 1775-82","author":"Fenn EA","year":"2001"},{"key":"bibr8-00031348221093633","volume-title":"Some Account of the Success of Inoculation for the Small-Pox in England and America","author":"Franklin B","year":"1759"},{"key":"bibr9-00031348221093633","volume-title":"The Fever of 1721: The Epidemic that Revolutionized Medicine and American Politics","author":"Coss S","year":"2016"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348221093633","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348221093633","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348221093633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:36:56Z","timestamp":1777379816000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348221093633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,12]]},"references-count":9,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1177\/00031348221093633"],"URL":"https:\/\/doi.org\/10.1177\/00031348221093633","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,12]]}}}