University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 1990 Pox Britannica: Smallpox Inoculation in Britain, 1721-1830 Deborah Christian Brunton University of Pennsylvania Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the European History Commons, History of Science, Technology, and Medicine Commons, and the Virus Diseases Commons Recommended Citation Brunton, Deborah Christian, "Pox Britannica: Smallpox Inoculation in Britain, 1721-1830" (1990). Publicly Accessible Penn Dissertations. 999. https://repository.upenn.edu/edissertations/999 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/999 For more information, please contact [email protected]. Pox Britannica: Smallpox Inoculation in Britain, 1721-1830 Abstract Inoculation has an important place in the history of medicine: not only was it the first form of preventive medicine but its history spans the so-called eighteenth century 'medical revolution'. A study of the myriad of pamphlets, books and articles on the controversial practice casts new light on these fundamental changes in the medical profession and medical practice. Whereas historians have associated the abandonment of old humoural theories and individualised therapy in favour of standardised techniques with the emergence of new institutions in the second half of the century, inoculation suggests that changes began as early as the 1720s. Though inoculation was initially accompanied by a highly individualised preparation of diet and drugs, more routinised sequences of therapy appeared the 1740s and by the late 1760s all inoculated patients followed exactly the same preparative regimen. This in turn made possible the institutionalised provision of inoculation, first through the system of poor relief, later by dispensaries and charitable societies. In addition, debates over inoculation reveal the disintegration of the old professional order and the struggles of the physicians--whose authority was based in individualised practice--to retain their monopoly of inoculation and their status as authorities on the practice. By the 1770s, the intellectual and professional leadership of the profession passed to a new generation of practitioners. The thesis ends with an assessment of the impact of inoculation on population growth and finds that it was not widely practiced and had, at best, a marginal effect on mortality. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) First Advisor Charles E. Rosenberg Subject Categories European History | History of Science, Technology, and Medicine | Virus Diseases This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/999 POX BRITANNICA: SMALLPOX INOCULATION IN BRITAIN, 1??1 - 1830 DEBORAH BRUNTON A DISSERTATION in the Faculty of Arts and Science.’? Presented to the Faculties of the University of Pennsylvania i Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy. 1990 ervisor of Di tation raduate Group Chairperson Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Acknowledgements First and foremost, I would like to thank my supervisors. Professor Charles E. Rosenberg first recommended the topic and oversaw the whole process. Dr. John Henry supervised the project from June 1989 to September 1989,, and went far beyond the call of duty by proof reading all the chapters. Professor Rosalind Mitchison kept me straight on the Scottish demography. Professor Alex Cheyne and Dr. Michael Barfoot also provided references and invaluable advice. The thesis was made possible by the University of Pennsylvania who gave me a one year fellowship. The Wellcome Trust then stepped into the breach with a further sixteen months funding. The librarians of the Royal College of Physicians and the Royal College of Surgeons in Edinburgh, the Hunterian Collections in Glasgow University, the Royal Society were unfailingly helpful. My heartfelt thanks to the librarians of the Science Studies Unit, particularly Eileen Dickson, and Special Collections in Edinburgh University library, who have transported literally hundreds of books during the last three years. I would also like to thank Special Collections, Edinburgh University Library for permission to reproduce the table of inoculation from Alexander Monro's Account of Inoculation in Scotland, the Keeper of Records at the Scottish Record Office for permission to quote from the Forfeited Estates Papers, the Registar General for permission to cite the Old Parochial Records, the Honorary Secretary of the Royal College of Surgeons, Edinburgh, for permission to quote from the College manuscripts, and the Coutv;l of the with permission of the copyright owner. Further reproduction prohibited without permission. i i i / Royal College of Physicians/ Edinburgh for permission to quote from manuscript sources. It gives me great pleasure to thank my family for years of moral support and for the cake which sustained the final days of this thesis. I would like to thank many friends - Daniel Sumsion, who lent me his flat in Glasgow, David Lott for help with chapter seven, all flatmates past and present, the members of Offshoot Dance Company, Seamus for interrupting, Carole for all the tea - without whom I would have gone completely mad. Thanks. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv ABSTRACT POX BRITANNICA: SMALLPOX INOCULATION IN BRITAIN, 1721-1830 DEBORAH BRUNTON CHARLES E. ROSENBERG Inoculation has an important place in the history of medicine: not only was it the first form of preventive medicine but its history spans the so-called eighteenth century 'medical revolution'. A study of the myriad of pamphlets, books and articles on the controversial practice casts new light on these fundamental changes in the medical profession and medical practice. Whereas historians have associated the abandonment of old humoural theories and individualised therapy in favour of standardised techniques with the emergence of new institutions in the second half of the century, inoculation suggests that changes began as early as the 1720s. Though inoculation was initially accompanied by a highly individualised preparation of diet and drugs, more routinised sequences of therapy appeared the 1740s and by the late 1760s all inoculated patients followed exactly the same preparative regimen. This in turn made possible the institutionalised provision of inoculation, first through the system of poor relief, later by dispensaries and charitable societies. In addition, debates over inoculation reveal the disintegration of the old professional order and the struggles of the physicians - Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. whose authority was based in individualised practice - to retain their monopoly of inoculation and their status as authorities on the practice. By the 1770s, the intellectual and professional leadership of the profession passed to a new generation of practitioners. The thesis ends with an assessment of the impact of inoculation on population growth and finds that it was not widely practiced and had, at best, a marginal effect on mortality. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vi Table of Contents Preface: The Problem of Inoculation................................................1 Chapter Cue: The Introduction of Inoculation 1721-1729...........8 Chapter Two: A Medical Reformation 1680-1730........................42 Chapter Three: Inoculation Established 1740-1765 ......................66 Chapter Four: The Triumph of Inoculation................................. 98 Chapter Five: Private Virtue and Public Vice: the Institutionalisation of Inoculation................... 135 Chapter Six: The End of Inoculation............................................ 183 Chapter Seven: Pox Caledonia - The Impact of Inoculation in Scotland....................................................215 Conclusion......................................................................................... 249 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vii List o( Appendices Appendix I: London Bills of Mortality.............................................. 253 Appendix II: Edinburgh Bills of Mortality ........................................ 257 Appendix HI: Table of Inoculation, 1765 ........................................... 259 Appendix IV: Inoculation in Scotland, 1765 .................................... 260 Appendix V: Distribution of Inoculation in Scotland, 1765 ....... 262 Appendix VI: General Inoculations in England to 1799................263 Appendix VII: Distribution of General Inoculations in England ............................................................. .........................265 Appendix VIII: General Inoculation around Crieff......................... 266 Appendix IX: Distribution of Inoculation in Scotland, 1790s..... 267 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 Preface : The Problem of Inoculation Inoculation - the practice of deliberately infecting patients with smallpox, in the hope of producing a mild form of the disease - is often regarded as something of an oddity within eighteenth century medicine. It was the first - and for