Inoculation*
‘A Practice newly introduced into this Country …’[1]
Inoculation as a preventative medical procedure for the treatment of smallpox was a relatively new (and contentious) medical practice in early eighteenth-century Europe and America.[2] Worth’s small collection of tracts and books on the subject reflect this, as all date from the 1720s, and show the varying reactions (both within and without) the medical community to the new practice.
A collection of pamphlets: containing the way and manner of inoculating the small-pox both in Britain and New-England (Dublin, 1722), title page.
The procedure was first attempted in Britain and Boston in 1721. Worth’s A collection of pamphlets, printed in Dublin in 1722 by the enterprising Dublin printer George Grierson (c.1680–1753), includes an account of the challenges affecting proponents of the new procedure when attempting to introduce the practice in Boston: A Narrative of the Method and Success of Inoculating the Small-Pox in New England. By Mr. Benj. Colman. With a Reply to The Objections made against it from Principles of Conscience. In a Letter from a Minister at Boston. To which is now prefixed, An Historical Introduction. By Daniel Neal, M.A. (Dublin: Printed by George Grierson, at the Two Bibles in Essex-Street, 1722).
Crucially, in Boston, some physicians and clergymen came together to promote the new method. Worth’s tract outlining the advent of inoculation in Boston was written by Daniel Neal (1678–1743), an Independent minister and historian in Boston, whose text in support of the procedure was not only widely printed – it was also read by Caroline of Ansbach (1683–1737), Princess of Wales, who was impressed by Neal’s work.[3] The method also had the support of the influential clergyman Cotton Mather (1663–1728), who had, indeed, been advocating for the introduction of the procedure as early as 1716.[4] An outbreak of smallpox in 1721 drove Cotton to write to Boston physicians, suggesting they attempt the procedure.[5] While the inoculations proved successful, an outcry soon followed for the novelty of the new procedure did not inspire confidence in the general population. Many were afraid of the possibility of the new procedure actually spreading infection in a city that had already been ravaged by smallpox. Others, as Courgeau suggests, might have been wary of ‘a costly and complicated procedure whose outcome was uncertain’.[6] In addition, most Bostonian physicians questioned the procedure, not only because they feared that instead of curing the smallpox epidemic it might actually make it worse, but also because, as Van de Wetering notes, some physicians based in Boston were dismissive of what they viewed as ‘clerical meddling’.[7] In addition, as Meyer suggests, university-educated physicians might have been wary of a new development which lauded empiricism over theory, conscious as they were of competition in the medical marketplace from other non-university trained medical practitioners.[8]
Sir Richard Blackmore, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723), title page.
The debates in Boston were replicated in England. Worth, as a Fellow of the Royal Society, would have been familiar with the ongoing debate about the utility of inoculation as a treatment for smallpox, for the Society, and especially its Secretary, Dr James Jurin (bap. 1684, d. 1750), played an important role in promoting the new treatment.[9] The Royal Society had been alerted to the possibilities of inoculation as early as 1699 but it was in the second decade of the eighteenth century that more detailed reports on it were submitted at meetings. In 1714, a letter from Emmanuel Timoni (1669–1718), a physician based in Constantinople, who had previously studied at both Oxford and Padua, was read to the Society by John Woodward (1665/1668–1728).[10] Timoni (via Woodward), related the following exciting news:
‘That although at first the more prudent were very cautious in the use of this practice; yet the happy success it has found to have in thousands of subjects for their eight years past, has put it out of all suspicion and doubt; since the operation, having been performed on persons of all ages, sexes, and different temperaments … none have been found to die of the smallpox’.[11]
Two years later, another physician based in Constantinople, Jacob Pylarini (1659–1718), wrote again about the method, stating that it had been used in Constantinople since 1660.[12]
However, not all were as enthusiastic as the Fellows of the Royal Society about the new method. Unlike in Boston, where clergy and some physicians had joined forces in support of the process, in England sermons were being preached against it.[13] Prominent physicians such as William Wagstaffe (1683/4–1725) and Sir Richard Blackmore (1654–1729), attacked the innovative practice on a number of grounds. Worth did not own a copy of Wagstaffe’s A letter to Dr. Freind; shewing the danger and uncertainty of inoculating the small pox (London, 1722), but he did collect a number of texts by Blackmore (mainly his poetical offerings), but also his A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723).
Blackmore’s treatise was a product of his retirement. His main career had been as physician to Willliam III (1650–1702) and Queen Anne (1665–1714), but the advent of the Hanoverians had led to a relative eclipse, since they chose other physicians.[14] In 1687 he had become a Fellow of the Royal College of Physicians, but his relations with the College were fraught and, unlike Worth, he never became a member of the Royal Society. Blackmore, despite being a keen advocate of the role of experience in the education of a physician, and an enthusiastic follower of the influential English physician Thomas Sydenham (bap. 1624, d. 1689), had little good to say of inoculation, which he argued was a dangerous, untested novelty.[15] For Blackmore, there was insufficient evidence to recommend the new procedure, and many reasons to oppose it: it might not work, it might create an epidemic; it might bring infection from other diseases; there were other methods to attain the same goal.[16]
Blackmore accused advocates of inoculation of covering up failures and attacked their three key claims.[17] He noted that:
‘The Undertakers that imported from Turkey this extraordinary Invention, and intended by it the Service of their native Country, as it is charitable to believe, told the People first, that this Operation would produce the Small-Pox in the Persons that never had them before.
In the second Place, that it did not bring forth the true Small-Pox in its proper Forms, but Flushings and a Rash of a different Size and Figure, yet these spurious Eruptions together with a copious Serum, or thing Matter, that issues from the Wound, would so intirely eradicate and carry off the Seeds and Principles of the Small-Pox contained in the Blood, that the Person should never, during his Life, afterwards be attacked or seized by this Distemper, but that this irregular Discharge would be effectual to all Intents and Purposes as the true and genuine.
And Thirdly, they gave out with great Assurance, that the Small-Pox, propagated by Inoculation, should always be of the mild and distinct Kind, and that therefore all their Patients should recover’.[18]
He took each claim and argued that the practitioners of inoculation were either making a false claim or ignoring cases which did not fit in with their method.
Blackmore’s distrust of the practitioners of inoculation, be they physicians, surgeons or empirics, was also rooted in his distrust of the boldness of their claims – a boldness, which he confessed reminded him of the worst excesses of empirics:
‘And I must acknowledge that I was at first prejudiced against them, by their boastful and Quack-like Conduct, while they roundly and with intrepid Confidence affirmed, that their unerring Method would always propagate a safe and Distinct Kind, not guarding themselves by any saving Exceptions, or Limitations; this, I say, was such an arrogant and empirical Manner, that it made me suspect the Operators were either ignorant or unfaithful’.[19]
In reality, however, Blackmore was swimming against the tide of English public opinion – at least among the nobility, for the championing of the new procedure in Britain by Lady Mary Wortley Montagu (bap. 1689, d. 1762), who had her daughter inoculated in England in April 1721, led to its rapid acceptance by the nobility.[20] As Miller has noted, the acceptance of the practice by members of the royal family led to other members of the nobility following suit.[21] According to the annual reports collected by James Jurin, ‘in the period 1721–1728, there had been 897 inoculations reported in the British Isles, America and Hanover’.[22] 845 of these had proved to be successful inoculations (in that they had led to true smallpox), and only seventeen patients had died. By the 1730s there was widespread consensus among the medical community of the efficacy of inoculation.[23]
Philippe Hecquet, Observations sur la saignée du pied, et sur la purgation au commencement de la petite verole, des fievres malignes & des grandes maladies. Preuves de decadence dans la pratique de medecine, confirmées par de justes raisons de doute contre l’inoculation (Paris, 1724), title page.
Blackmore was however, correct in one of his assertions: some Continental Europeans also had reservations about the procedure:
‘The French and Dutch are not so stupid and incapable of Reflection and useful Observation, but they would certainly have imported this Invention from Constantinople, where some of them have, as Ministers, or Merchants, constantly resided, had they not discovered some unanswerable Objections to the Practice of it’.[24]
Certainly not all agreed that the new procedure was quite such a Godsend and Worth owned a second text criticizing the procedure: Philippe Hecquet’s Observations sur la saignée du pied, et sur la purgation au commencement de la petite verole, des fievres malignes & des grandes maladies. Preuves de decadence dans la pratique de medecine, confirmées par de justes raisons de doute contre l’inoculation (Paris, 1724).
Hecquet (1661–1737), a French physician, and his medical colleagues at the Sorbonne, took a decidedly dim view of the new procedure and, as a result, it did not gain ground in France as it did in either England or America. As Courgeau relates, there had been a few brief years in the early 1720s when the Sorbonne had expressed interest in trialling inoculation but the death of the Regent, Philippe II, Duke of Orléans (1674–1723), brought an end to the initiative.[25] Hecquet’s vituperative attack on the procedure followed in the following year. The fact that the author was then Dean of the Faculty of Medicine ensured that his view (and, for that matter, the Faculty’s), held sway.
Hecquet was, in any case, an unlikely advocate of innovation for, as Brockliss relates, he was not known for any innovative research.[26] He was, however, famous (throughout Europe) as a proponent of the iatromechanical school of thought, and an opponent of iatrochemistry, and it is clear that he was a committed Jansenist, an attitude which, as Brockliss suggests, influenced his sometimes moralistic critique of his medical colleagues, allowing him to ‘equate iatrochemists and interlopers with libertines’.[27] Hecquet looked askance at the new development, declaring his surprise that ‘a practice of the people, a remedy of a woman, picked by an ignorant people; and we want to glorify this practice’.[28] Clearly societal prejudices were at play here as well as professional competition.
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.
Sources
Blackmore, Sir Richard, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation (London, 1723).
Blake, John B., ‘The inoculation controversy in Boston: 1721–1722’, The New England Quarterly, 25, no. 4 (1952), 489–506.
Boylston, Arthur, ‘The origins of inoculation’, Journal of the Royal Society of Medicine, 105 (2012), 309–13.
Brockliss, L.W.B., ‘The medico-religious universe of an early eighteenth-century Parisian doctor: the case of Philippe Hecquet’, in French, Roger and Andrew Wear (eds), The medical revolution of the seventeenth century (Cambridge, 2008), pp 191–221.
Courgeau, Daniel, ‘Inoculation, vaccination and public hygiene against smallpox’, INED (2018): (Institut national d’études démographiques).
Gregori, Flavia, ‘Sir Richard Blackmore (1654–1729), physician and writer’, Oxford Dictionary of National Biography (ODNB).
Gronim, Sara Stidstone, ‘Imagining Inoculation: smallpox, the body, and social relations of healing in the eighteenth century’, Bulletin of the History of Medicine, 80, no. 2 (2006), 247–68.
Meyer, Victoria N., ‘Innovations from the Levant: smallpox inoculation and perceptions of scientific medicine’, The British Journal for the History of Science, 55 (2022), 423–44.
Miller, Genevieve, The adoption of inoculation for smallpox in England and France (University of Pennsylvania Press, 1957).
Okie, Laird, ‘Neal, Daniel (1678–1743), Independent minister and historian’, Oxford Dictionary of National Biography (ODNB).
Timonius, Emmanuel, ‘An account of history, of the procuring the small pox by incision, or inoculation: as it has for some time been practised at Constantinople. Being the extract of a Letter from Emanuel Timonius, Oxon and Patav. M.D. FRS, dated at Constantinople, December 1713’, Phil. Trans. R. Soc., 29 (1714), 72–82.
Van de Wetering, Maxine, ‘A reconsideration of the inoculation controversy’, The New England Quarterly, 59, no. 1 (1985), 46–67.
*None of these medicines and operations should be attempted!
[1] Blackmore, Sir Richard, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723), p. 109.
[2] As Van de Wetering notes, the procedure was in fact known for over one hundred years prior to its first use in Boston and England: Van de Wetering, Maxine, ‘A reconsideration of the inoculation controversy’, The New England Quarterly, 59, no. 1 (1985), 47–8.
[3] Okie, Laird, ‘Neal, Daniel (1678–1743), Independent minister and historian’, Oxford Dictionary of National Biography (ODNB).
[4] Blake, John B., ‘The inoculation controversy in Boston: 1721–1722’, The New England Quarterly, 25, no. 4 (1952), 490.
[5] Ibid., 491–2.
[6] Courgeau, Daniel, ‘Inoculation, vaccination and public hygiene against smallpox’, INED (2018): (Institut national d’études démographiques).
[7] On this see Blake, ‘The inoculation controversy in Boston: 1721–1722’, 489–506, and Van de Wetering, Maxine, ‘A reconsideration of the inoculation controversy’, The New England Quarterly, 59, no. 1 (1985), 47.
[8] Meyer, Victoria N., ‘Innovations from the Levant: smallpox inoculation and perceptions of scientific medicine’, The British Journal for the History of Science, 55 (2022), 430.
[9] On the role of Jurin see Miller, Genevieve, The adoption of inoculation for smallpox in England and France (University of Pennsylvania Press, 1957), pp 114–8.
[10] Van de Wetering, ‘A reconsideration of the inoculation controversy’, 48; Meyer mentions that an earlier report arrived in 1711: Meyer, ‘Innovations from the Levant: smallpox inoculation and perceptions of scientific medicine’, 426.
[11] Timonius, Emmanuel, ‘An account of history, of the procuring the small pox by incision, or inoculation: as it has for some time been practised at Constantinople. Being the extract of a Letter from Emanuel Timonius, Oxon and Patav M.D. FRS, dated at Constantinople, December 1713’, Phil. Trans. R. Soc., 29 (1714), 72.
[12] Boylston, Arthur, ‘The origins of inoculation’, Journal of the Royal Society of Medicine, 105 (2012), 310.
[13] Miller, The adoption of inoculation for smallpox in England and France, p 103.
[14] Gregori, Flavia, ‘Sir Richard Blackmore (1654–1729), physician and writer’, Oxford Dictionary of National Biography (ODNB).
[15] Blackmore, Sir Richard, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723), pp 82–3.
[16] On this see Blackmore’s text.
[17] Ibid., pp 84, 91.
[18] Ibid., pp 85–6.
[19] Ibid., p. 95.
[20] Blake, ‘The inoculation controversy in Boston: 1721–1722’, 490.
[21] Miller, The adoption of inoculation, p. 109.
[22] Ibid., p. 121.
[23] Ibid., p. 122.
[24] Blackmore, A treatise upon the small-pox, in two parts, p. 113.
[25] Courgeau, ‘Inoculation, vaccination and public hygiene against smallpox’.
[26] Brockliss, L.W.B., ‘The medico-religious universe of an early eighteenth-century Parisian doctor: the case of Philippe Hecquet’, in French, Roger and Andrew Wear (eds), The medical revolution of the seventeenth century (Cambridge, 2008), p. 191.
[27] Ibid., pp 195, 211.
[28] Quoted in Meyer, ‘Innovations from the Levant: smallpox inoculation and perceptions of scientific medicine’, 434.