Defying Providence

Smallpox and the forgotten 18th Century Medical Revolution.

This book tells the story of inoculation in the West from the 1720s, 70 years before Jenner published his findings on cowpox vaccine.

Before the 18th Century, smallpox was a blight in Western Europe and the American Colonies, particularly among the very young. Frequent epidemics scythed through populations where even survivors were left horrendously scarred and in some cases blinded. It was understood that if you survived the disease, you were thereafter immune, but that was the extent of our knowledge. Yet in parts of Africa and the Near East, people understood and practised inoculation.

This book tells the pre-Jenner story of the pioneers of inoculation against smallpox, in Boston and in England;  how early practitioners took the first tentative steps to inoculate local patients in the face of stiff opposition from jealous professional rivals, nervous civic leaders and religious fundamentalists (hence “Defying Providence”).

Unlike cowpox inoculation from Jenner’s time onwards, early smallpox inoculation introduced pus from existing smallpox sores and was widely practised if not fully understood, in the Near East and Africa. Western tradesmen and diplomats, along with North American slave owners, learned of it from the denizens of those regions. So we have the story of Lady Mary Montague, late of Turkey, having her children inoculated. Meanwhile in Boston, Zabadiel Boylston (one imagines probably an ancestor of the author), hearing of tales from the East and the stories of local slaves, inoculated his own children and proceeded on the lonely battle to spread the practice among Bostonians.

Back in England, experimental inoculation had powerful and influentual patrons in Sir Hans Sloane and the Prince and Princess of Wales. We have the remarkable story of the “Newgate guinea pigs” – felons in the notorious prison, men and women.  who were offered pardons in exchange for being inoculated with smallpox pus – potentially a death sentence in itself. The experiment was a success.

The narrative takes us through the next 60 years, a story both of progress and setbacks, trial and error, slow but sure improvements;  the growth of inoculation hospitals and clinics; how practitioners of inoculation became wealthy, in particular Robert and Daniel Sutton, father and son from Norfolk. They developed the “Suttonian Method” which was distributed via medical apostles using a franchise method.

And finally, of course, we have Jenner, whom the author treats as another player, albeit a significant one, on the long march to the eradication the terrible disease of smallpox. He explains too how it was Jenner’s first biographer who applied the distorting lens to the picture, giving us milkmaids and all the rest of it.

Defying Providence is a fascinating read and Dr Boylston does a great service in providing the whole, brilliant story of the rise and triumph of inoculation from the real beginning and not just the denoument, which to most laymen is the totality of it.

The book is extensively and well-noted but would benefit from a bibliography and index.

Defying Providence by Dr Arthur Boylston MD (282 pp incl footnotes) is available from Amazon for around £8.50.