Legends of lost islands and sunken lands abound on every continent and among many cultures across the globe. Atlantis, Mu, and Lyonesse are names that conjure up images of soaring towers, powerful magicians swooning maidens, often guarded by a terrifying beast. None of these, however, can hold a candle to the story of Gravelly Island, which used to lie between Tuckernuck and Muskeget islands but has long since disappeared. First of all, the existence of Gravelly Island is a well-attested fact; what's more, while all those semi- or wholly mythical islands are larded with castles galore, none bear the distinction, as Gravelly Island did, of once being home to a hospital. But as with the lost islands of lore a fearsome beast did once haunt the shores of Gravelly Island. It was known as the Speckled Monster: smallpox.

Smallpox is a highly contagious disease -- unique to humans -- that is caused by the Variola virus; the major (and more deadly) strain of the disease kills 20-40% of those infected. Once a person is exposed to the Variola virus (the scientific name for smallpox), incubation takes about 12 days. Then the victim suffers from a high fever, fatigue, head and backache, followed in two to three days by a prominent rash on the face, arms, and legs. The rash evolves into lesions, which fill with pus and begin to crust over; these scabs eventually fall off after a few weeks. Many of those who actually survive a bout of smallpox may be left blind in one or both eyes and almost certainly bear the pockmarked scarring that may cover most or all of their whole body.

Smallpox has been responsible for an estimated 300-500 million deaths in the 20th century alone. In 1979 the World Health Organization declared that smallpox had been eradicated completely, quite an accomplishment given that only a decade or so before two million people were dying of it each year. Today smallpox is only a distant memory, except for cultures of the virus being held by the U.S. and Russia in secure labs, where they sit waiting to be stolen by S.P.E.C.T.R.E. or their modern equivalent.

Young or old, wealthy or poor, no one was spared; even kings, queens and presidents were affected in varying degrees. Henry VIII's fourth wife, Anne of Cleves managed to survive the disease and also managed to avoid having her head chopped off, no mean feat as Henry's wife. Queen Elizabeth I of England (who, like many of her contemporaries, wore a ruff and heavy makeup to hide the ravages of the disease) and Abraham Lincoln both contracted it, although in Lincoln's case at least he contracted a less deadly strain. Shortly after delivering the Gettysburg Address on November 19, 1863 Lincoln became ill with red blotches all over his body. The President's physician diagnosed his condition as varioloid, a mild type of smallpox, and informed Lincoln that the disease was highly contagious. Upon hearing this Lincoln remarked: "There is one good thing about this. Now I have something I can give everybody."

When the English first arrived in North America they found ploughed fields, caches of food, and deserted villages. They assumed that it was God's will that had cleared their new land of the heathen Indian. While that assumption may be debatable, it was almost certainly smallpox that was the agent of the wrath of the Almighty. Between 1614 and 1617 three different plagues cut a swath through New England, wiping out roughly 3/4 of the original native population. It has been estimated that there were roughly 3,000 Massachuset Indians living in the greater Boston area; by the time that the first Puritans settled on the Shawmut peninsula in 1630 only 500 Massachuset were left, and smallpox killed many of these poor souls in 1633. Within a decade the Massachuset tribe had ceased to exist.

Periodic epidemics of smallpox continued to plague the New England colonies, especially Boston (crowded conditions being an easier place for infectious disease to spread); that city saw outbreaks in 1666, 1677, 1702 and 1721. In an effort to prevent the return of the disease from abroad Boston inspected all incoming ships; if one arrived with a suspected case of smallpox the vessel was required to fly a quarantine flag and remain isolated until the disease had passed. The 1721 outbreak was particularly bad, and nothing seemed to halt its progress: about 6000 people, out of a total population of 11,000, were infected, of whom 844 eventually died. In fact the epidemic was so bad, and the population so desperate, that some were led to a desperate measure that was considered sheer lunacy by the medical experts of the day: inoculation.

Inoculation is not exactly the same as vaccination. Vaccination was discovered by Edward Jenner in 1796, based upon his observations of milkmaids. They would oftentimes contract a relatively mild disease call cowpox, which is caused by the Vaccinia virus (the Latin word for cow is vacca, hence the name); remarkably, these milkmaids proved highly resistant to further infection by the Variola virus that causes smallpox. Jenner began vaccinating people with the cowpox virus shortly thereafter, and the tide began to turn against the dreaded pox.

Inoculation is a more dangerous procedure in that it consists of deliberately introducing a small amount of the live Variola virus into a healthy person; the idea was that, though the patient would indeed contract the disease, it would be relatively mild and they would thereafter be immune to further infection. Practiced in China and India since at least 1000 A.D., the method of inoculation consisted of inhaling powder from dried crusts of smallpox pustules, or rubbing it into a scratch on the skin. In the 1400s a new method of inoculation originated in the Middle East and spread from there. It consisted of administering the smallpox "crust powder" by inserting it with a pin into the skin, a process known as variolation. In 1717 Lady Mary Wortley Montagu, the wife of the British Ambassador to Turkey, heard of this procedure and had her son inoculated. When it proved successful she campaigned to bring inoculation to England but met major opposition from the medical establishment; it took fifty years before the effectiveness of variolation was confirmed by the College of Physicians in London.

Meanwhile, back in Boston in 1721 the smallpox epidemic that had begun in May raged unchecked; one man believed that inoculation was the answer. The Reverend Cotton Mather, member of the Royal Society and perhaps better known for his earlier role in the Salem witchcraft trials, had first heard of the practice of inoculation in 1706 from his slave Onesimus, who told him how he had been inoculated as a boy in Africa against the disease. Mather tirelessly badgered local physicians to try it but was met with scorn and ridicule for his troubles (ironically it was Boston's ministers who backed Mather in the face of the opposition of the medical establishment, and were accused of trying to subvert the will of God). Local newspapers, including one called the New England Courant, published writers who savaged inoculation and its advocates (the Courant, a recent scrappy upstart in the already cutthroat world of newspaper publishing, was put out by one James Franklin, whose fifteen-year-old brother Benjamin was a typesetter in the shop).

Finally, Cotton Mather managed to convince a local surgeon named Zabdiel Boylston to give inoculation a try. Not that Boylston's conversion would change the opinions of the local physicians -- surgeons generally had no formal medical training and were looked down upon by many physicians who saw them as mere "cutters" (the local barber, who often functioned as bloodletter, surgeon and dentist as well, would wrap bloody bandages around a pole to advertise his profession, which is where our modern day barber pole originated). Boylston used the variolation technique on his only son Thomas and two of his slaves. Although they contracted the illness the effects were relatively mild, and within two weeks they had recovered completely.

The citizenry of Boston was not impressed, at least not initially; outrage erupted the minute word got out. Although the Boston clergy lined up behind Mather and Boylston, most of the general public agreed with the town's physicians that the very idea of inoculation was insane -- and they didn't just stand idly by waiting for problems to occur. Cotton Mather's house was firebombed by an angry mob, and Zabdiel Boylston was confined to his farm out of fear that he would be assaulted. Following the public outcry, Boston's selectman passed an ordinance banning inoculation within the city limits.

However when word got out that Boylston's patients had survived people began to defy the ban; they were desperate for anything that might protect them from the ravages of the plague then sweeping the city. By the time the epidemic had petered out Boylston had inoculated 248 people, including Cotton Mather's son. Mather published the results, and people began to grudgingly accept the usefulness of inoculation -- which is not to say that everyone everywhere believed in it. New England in particular was slow in adopting inoculation; most towns continued to rely on quarantines and banned inoculations except in emergencies. The practice was also expensive and unpleasant for the patient.

During the smallpox epidemic of 1764 (which was even worse than that of 1721) John Adams decided to be inoculated. He was required to follow a strict preparatory regimen laid out by his physician: it began with a "vomit," followed by a strong cathartic and a restricted diet of bread, milk, pudding, and rice. He was also dosed with medications made of mercury and antimony, two poisons that were often proscribed as medicines at the time. After surviving both the preparation and inoculation Adams was confined to his sickbed for about a month, during which time he suffered from headaches, backaches, joint pain, fever, and the eruption of pock marks around the inoculation site. The practice was not to be taken lightly, and many would not or could not subject themselves and their loved ones to the practice.

One such Bostonian was a silversmith named Paul Revere. When one of Revere's three children fell ill, Revere appeared before the selectmen of Boston to inform them of the outbreak (in accordance with the law). Revere was ordered to send the ailing child to a pesthouse. Pesthouses were often established by municipalities on the outskirts of town to be used in times of plague. They were not hospitals, and no one received treatment there; pesthouses simply separated the sick from the healthy in order to stopping the disease from spreading (Nantucket had it's own pesthouse at one time -- the location was near what is still known as Pest House Pond). Rather than condemn his child to certain death Revere petitioned the selectmen to be sequestered in his own home. They agreed to his request but posted a guard to secure the quarantine; a white flag was also hung on the house to warn everyone that the Revere house was off-limits. It remained so for two months, with the family locked inside. Remarkably all of the Reveres survived.

Into the midst of the controversy over inoculation and the beginnings of yet another epidemic stepped Dr. Samuel Gelston. Born in the village of Southampton on Long Island on March 24th, 1727, Gelston apparently spent the first twenty-five years of his life quite close to home, returning there after receiving his doctorate to take up the life of a country doctor. What eventually prompted him to move away and take up the campaign for inoculation remains unclear, but perhaps it had something to do with what is inscribed on a tombstone in nearby Southold:

In Memory of Elizabeth Wife of Dr. Samuel GELSTON, who died 10 Jul 1760 Age 35 yrs, 4 mos

No mention is made of the cause of Elizabeth Gelston's death. It may have been smallpox, but then again it may simply be that the recurring pain of remaining in a once-happy place -- now marred by grief and premature loss -- was too much to bear.

Whatever Dr. Gelston's motivation, his arrival in Massachusetts was well-timed. In 1763 Gelston established a smallpox hospital in Holmes' Hole on Martha's Vineyard. The harbor there was bustling with trading vessels from ports all along the Atlantic seaboard and was a natural choice for such a facility. In August of that year the town gave Dr. Gelston permission to 'Cary on and Practice Inoculation of the Small Pox in Soume Suitable Place at Homeses hole', but it was made clear that he was totally on his own. Not only was he required to treat all comers, with no assistance from the town, he also had to pay six shillings for every person inoculated. How these fees were paid is not indicated, but since the arrangement was renewed the following year it must not have been onerous to do so.

Dr. Gelston next turns up on Noddle's Island in Boston Harbor during the 1764 smallpox outbreak. According to Samuel Drake's History of Boston, "when the smallpox raged in Boston, the physicians removed their inoculating hospital from Castle William [present-day Castle Island in Dorchester near the JFK Library] to Noddle's Island, at the mansion-house where Robert Temple, Esq. had lately resided, 'which contained elegant rooms, suitable for the reception of persons of the first condition' One of the physicians, Dr. Gelston, to remain constantly on the Island, and the others were to attend when desired." Prior to the establishment of the hospitals at Castle William and on Noddle's Island smallpox victims were left on the shore of nearby Spectacle Island to meet their ghastly fate all alone.

Apparently Dr. Gelston never stayed in one place for long (or was never allowed to do so) because he next surfaces in Nantucket in 1769, again looking for a place to establish another smallpox hospital. Nantucket had been flirting with establishing some kind of facility for some time; Edouard Stackpole notes in his monograph "Dr. Samuel Gelston -- Medical Pioneer" (Historic Nantucket, Vol. 31, No. 3, 1984):

"...there had been efforts to establish houses where inoculation could be practiced, the first area being on Coatue Point in October, 1763. But this vote of the Town was rescinded the following month, and a new area designated, this being at Shimmo."

The following summer the town voted to reconsider the vote of the previous year, and banned the practice of inoculation altogether. Clearly, the residents of the island had mixed feelings about the whole thing.

When Dr. Gelston arrived on the island the initial hostility to his plan melted swiftly in the face of the good doctor's enthusiasm and charisma. He managed to convince the selectmen of the Town that he could safely establish a smallpox hospital in a remote location, and set about finding one. The place Gelston chose was little more than a pebble-strewn hump that rose a few feet about the pounding surf, and was called Gravelly Island by the locals (located between Tuckernuck and Muskeget, Gravelly Island endured until the late nineteenth century before succumbing to the sea's relentless pull). Accordingly Dr. Gelston arranged for the construction of a sturdy little building and began inoculating patients as soon as it was completed.

The harmony between the doctor and the Town did not last long. Apparently some of the patients of Gravelly Island decided that they did not want to spend the mandatory three weeks of recuperatory time on their little shoal of respite, and left early. The local townsfolk, understandably alarmed at the thought of smallpox-infected visitors roaming Nantucket at will, shifted once again in their opinion of the whole affair and sought to shut down the hospital -- the problem was that there was no legal way to do it. Apparently Gravelly Island, along with Muskeget, lay outside of the jurisdiction of Nantucket; "apparently" because the Town had to resort to a petition originating from a June 6, 1771 Town Meeting, at which it was voted that Abishai Folger, Esq., Zaccheus Macy, Frederick Folger, Josiah Barker, and Timothy Folger draw up and forward said petition to the General Court in Boston asking that the two islands be annexed to Nantucket.

At yet another Town Meeting held in September of that year it was voted "...that a remonstrance be sent to the Governor to lay the state of inoculation before him in a true light, and to desire him to sign a bill to annex Muskeket and Gravelly Islands to this County...." Meanwhile the wheels of government continued to grind slowly along: a bill passed both branches of the Legislature approving the annexation, but the governor refused to sign it, leaving the Town without legal recourse.

Their last hope in Boston fading away, the Town decided to simply offer to buy out Dr. Gelston's investment in the hospital, lock, stock and variolation needle, and appropriated the money at a June 1772 Town Meeting. The letter from Dr. Gelston laying out the terms of purchase still exists, and is on record at the Town Clerk's office. Written in Dr. Gelston's on firm, clear hand, he notes that "as this Town seems amicably disposed to put an end to the Long prevailing controversy, Respecting my inoculating at Gravel Island" the good doctor was willing to consider terms but felt that "...such a compensation (at least) aught to be made me as will be adequate to the Real & Intrinsic cost of my Buildings." The page following his letter totals up all of his expenses (including grog for the workmen) and arrives at a figure of £1072 and change, which is roughly $175,000 in 2005 dollars (a bargain by Nantucket standards). The bill was paid, and Dr. Gelston ceased his inoculations.

This is not quite the end of the story, however. Dr. Gelston had built up quite a reputation as a general physician on Nantucket (in spite of his mad scientist leanings), and decided to settle here. When the Revolution broke out a few years later Dr. Gelston stood out as a vociferous Tory on a island known to be rather less than enthusiastic about the Continental cause; in fact Gelston's views were so well known that his arrest was ordered by the mainland authorities, and men were dispatched to haul him off to the jail in Plymouth. Gelston escaped from confinement with outside help and returned to the island; the following notice appeared in local newspapers:

"Advertisement. Watertown. January 26, 1776. Ran away from the custody of the messenger of the General Court, a certain Dr. Samuel Gelston, belonging to Nantucket; a short well fed man; had on when he went away a reddish sheepskin coat, dress'd with the wool inside, and a scarlet waistcoat; he was apprehended as an enemy to this country, 'tis suppos'd he will attempt escaping to the enemy, by the way of Nantucket, Rhode-Island, or New York ----- Whoever will take up said Gelston and deliver him to the messenger of the House of representatives, shall be well rewarded for his time and expence [Signed] William Story, Nathaniel Freeman, Ebenezer White. Committee of the House of representatives."

Gelston was recaptured and jailed again. This time he and his supporters resorted to petitioning the Legislature for his release, a request that was eventually granted. Dr. Gelston returned home to Nantucket and continued to serve the island, primarily as a doctor but also, on one notable occasion, as a negotiator: a fleet of Tory privateers was threatening to raid Nantucket for supplies, and Gelston managed to persuade them to spare the island, presumably using some of that old charisma of his. Dr. Gelston died on July 6, 1782 at the age of only fifty-eight. Although he and his son Roland were long-remembered as respected physicians on Nantucket, it is in his role as scientific pioneer that Dr. Gelston's true gift to humanity lay. In the end he was brought to earth by those who feared that the good doctor's attempts to tame the Speckled Monster would instead release its fury upon the people of Nantucket.