Medical History, 1978, 22: 7142. THE SUflONS AND THE BUSINESS OF INOCULATION by DAVID VAN ZWANENBERG* SUMMARY THE SurroNs, an eighteenth-century family of Suffolk surgeons consisting of Robert Sutton and six of his sons, were largely responsible for promoting the practice of inoculation for smallpox from an occasional medical procedure to a widespread business venture. Their fame and fortune increased in the second half of that century as inoculation became more popular. Jenner's publication of his method of vaccina- tion in 17981 led to a decline in the use of inoculation and it was finally made illegal in 1840.' Possibly because their method of trying to prevent smallpox was superseded by vaccination, the reputation of the Suttons declined to such an extent that some commentators have regarded them as quacks, and their method of inoculation as both valueless and dangerous. Although there have been a number of short accounts about the Suttons, it is believed that this is the first attempt to trace their progress from contemporary sources and to evaluate their methods. Some of the previous accounts are based on that published in the book Lettsom,3 and were apparently derived from family tradi- tions which contemporary sources have shown to be inaccurate. EARLY HISTORY OF INOCULATION IN ENGLAND4 The inoculation of smallpox had been practised in Turkey and elsewhere "in the East" before the eighteenth century. Several reports of its use reached the Royal Society of London during the early 1700s. The method became more widely known after it had been described in a letter to Mrs. Chiswell from Lady Mary Wortley Montagu, who was in Turkey in 1717. After her return to London, Lady Mary had her small daughter inoculated by Mr. Charles Maitland in April 1721. In May 1721 Maitland also inoculated Dr. Keith's son, and went on to inoculate six condemned criminals in Newgate in 1722. In April ofthat year the king's surgeon, ClaudeAmyand, inoculated Princess Amelia aged eleven and Princess Caroline aged nine. Following these events, the procedure gained some degree of acceptance both by the medical *David Van Zwanenberg, D.M., MA., D.C.H., D.P.H., Consultant Physician, The Ipswich Hospital, St. Hele's Wing, Foxhall Road, Ipswich IP3 8LY. 1Edward Jenner, An inquiry into the causes and effects of variolae vaccinae, a diease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of cowpox, London, Sampson Low, 1798. sVaccination Act, 1840. ' J. J. Abraham, Lettsom. His life, times, friends and descendants, London, Heinemann, 1933. ' Early history in England, taken from C. W. Dixon, Smallpox, London, J. & A. C'hurchill, 1962. 71 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 24 Sep 2021 at 21:50:35, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300031756 David Van Zwanenberg profession and the general public, but in the next few years it was not often used. Nettleton inoculated sixty-one persons in Yorkshire in 1722, which was the largest series achieved for many years.5 By 1728 only 897 inoculations had been recorded in England and Scotland with seventeen deaths.6 Map showing the situation of the townsland villages of Norfolk and Suffolk which are referred to in the text. EARLY HISTORY OF INOCULATION IN SUFFOLK The earliest reference to inoculation in Suffolk is found in a letter by Dr. William Beeston from Ipswich in 1724:7 "The practice of inoculation in this town has so enflamed the angry passions and stirred up the bitter zeale of the bigotted High Churchmen and Dissenters to such a degree that they sentence to damnation all that are in anyway connected with it . .". The next reference occurs when Dr. Beeston himself inoculated Robert Warner, a student of Pembroke Hall, at Wood- bridge in 1729.8 This inoculation, which was successful, was presumably reported r T. Nettleton, An account of the success of inoculating the smallpox, London, 1722. ' C. P. Monty, 'Smallpox, scourge of mankind', Hist. ofMed., winter 1971, p. 25. 7Quoted by Dixon, op. cit., note 4 above-oriinal reference not traced. Ipswich Journal, 25 October 1724. 72 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 24 Sep 2021 at 21:50:35, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300031756 The Suttons and the business ofinoculation because it was an unusual event. In 1733 Dr. D. Hartley, a physician in Bury St. Edmunds, wrote a pamphlet9 advocating that inoculation should be introduced as it could be spread through the town much faster than natural smallpox. Basing his argument on Nettleton's ex- perience, he assessed the hazard from inoculated smallpox as one chance in fifty whereas the mortality in natural smallpox was four times greater. There is, however, no evidence that inoculation was used extensively in Bury St. Edmunds at that time. In 1742 John Rodbard, a surgical apprentice in Woodbridge, inoculated himself and used the same technique on his patients thereafter."' It is not known where he learned the technique since his master, James Lynn, was not inoculated until ten years later.11 No references to inoculation in or around Woodbridge have been found between Dr. Beeston's case in 1729 and John Rodbard's self-inoculation in 1742. Dr. Beeston had died in 1732, and therefore could not have instructed Rod- bard.'2 On completing his apprenticeship in 1745, John Rodbard moved to Debenham where he practised as a surgeon. ROBERT SUTrON Robert Sutton, the first member of the family to practise inoculation, was the son of a gentleman.13The family lived at Kenton, a small village in central Suffolk about three miles from Debenham, and Robert was baptized there on 12 February 1707.14 In 1726 he was apprenticed to John Turner, a surgeon in Debenham;15 in due course he completed his training and practised in and around Kenton.16 The exact date when he started to practise on his own is not known. He was still living in Debenham at the time of his marriage in 1731,17 but was registered as having a licence to practise surgery at Kenton in 1735.18* Robert Sutton must have known John Rodbard well: not only were they near neighbours but they were both involved in a local controversy in 1751 when Rodbard accused another local surgeon, Thomas Debenham, of mismanaging a case of extra- uterine pregnancy; Robert Sutton supported Debenham.19 Nevertheless, in 1756 Robert Sutton invited John Rodbard to inoculate his eldest son Robert (jr.) (baptized in 1732).20 Young Robert suffered a severe attack of smallpox. Possibly it was this ' D. Hartley, Some reasons why the practice of inoculation ought to be introduced into the town of Bury at present, Bury St. Edmuds, 1733. 10 Ipswich Journal, 14 February 1767. Account written by Rodbard. 1 Ibid., 30 May 1752. 1 Monumental inscription, Bentley Church, Suffolk. Dr. Beeston died on 4 December 1732. IIpswich Journal, 15 and 22 March 1755. 4Kenton Parish Register, East Suffolk Record Office, Ipswich. :sApprenticeship Book, Board of Inland Revenue, IR.17.36. Public Record Office. I' Ipswich Journal, 16 and 23 September 1749. 17 AMdeburgh Parish Register. East Suffolk Record Office, Ipswich. 1 Norwich Diocesan Register of Surgeons, Midwives, and Schoolmasters. Microfilm in East Suffolk Record Office, Ipswich. 19 Ipswich Journal, 22 June 1752. 'I Kenton Parish Register, op. cit., note 14 above. *This does not necessarily mean that he began practising at this date, as surgeons seem to have been registered in groups according to the area where they lived. Sutton's master, John Turner, was also registered in 1735. 73 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 24 Sep 2021 at 21:50:35, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300031756 David Van Zwanenberg experience which persuaded his father to improve the technique of inoculation. In April 1757 Robert Sutton (sr.) advertised that he had "hired a large house for the reception of persons who are disposed to be inoculated by him for the smallpox, terms for inoculation,.boarded, nursed, tea, wine, Fish and Fowl £7/7/- per month, £5151- for farmers, 10/6 for non boarders ... "21 This was the first advertisement for inoculation in the Ipswich Journal. It was repeated in several issues and followed by a series of similar advertisements but with added information. By October, Sutton had "two commodious houses for persons to be inoculated" and claimed "remarkable success with this method in the spring.""2 In April 1758 it was described as "The Art of the Inoculation that was carried on by. Robert Sutton .... with the greatest suc- cess".A Later in that year he had built an entirely new house for this purpose, and also attended for inoculation at Diss, Framlingham, Harleston, and Halesworth on market days." He announced in February 1759 that he was continuing "the practice of inoculation with the greatest success, never having lost one patient or had one so bad as to be blind with it"." By September he had three houses, one for reception, one for nursing, and one for the airing of patients. He now claimed "never having had one bad symptom".26 A year later the business had become. too large for him to manage alone, so he made arrangements with surgeons in Woodbridge, Ipswich, Diss, Yoxford, and Saxmundham to inoculate patients using the Suttonian method.