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Gavin Weightman The Great Innoculator

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The Great Inoculator

(Yale University Press, Aug 11 '20)

At a time when medical researchers around the world seek the holy grail of a vaccine to protect against the new and deadly virus Covid-19 The Great Inoculator looks back more than two centuries to the desperate efforts to combat an even more devastating epidemic disease: smallpox. The eighteenth century was an age when quack doctors thrived in a world ignorant of the causes of disease. Yet even then there were practitioners whose claim to be able to render patients immune to smallpox were unquestionably genuine. They called themselves inoculators their skills based on observation and dexterity. What they were practicing was learned not from textbooks but from folk medicine.

In the second half of the eighteenth century among the many hundreds of inoculators one name stood out: Daniel Sutton. Born in 1735 in a Suffolk village he was one of eleven children of a country surgeon. His father found he could make a good living offering to inoculate anyone who could afford his hefty fees. Daniel learned from his father but felt he could do better. And he did....

In 1763 he set up a practice of his own in the Essex village of Ingatestone advertising as an inoculator and brushing aside the fierce opposition locally from innkeepers and those parishioners who thought he would spread smallpox amongst them. Trading at first on his father's reputation, Daniel gained the confidence of patients who booked into his inoculation houses rented away from the village staying for several weeks while they recovered from the inoculation with smallpox.

Daniel's skill was hard to define but his results were indisputable. At the age of twenty-eight so many flocked to his Ingatestone practice that he became a rich man. He was the favourite of the middle classes who could afford his fees. On occasion when invited to rescue communities from an outbreak of smallpox he demonstrated his ability to inoculate whole towns and villages in one or two days, his fee paid for by local gentry and parish councils.

His reputation was soon worldwide and his services in demand in the royal houses of European monarchies. But Sutton's technique was borrowed by others who benefited from the celebrity of what became known as "Suttonian inoculation".

One big problem with smallpox was that those who had recently been inoculated were infectious for several weeks. They could as easily start an epidemic as prevent one unless they were isolated with others who had been inoculated at the same time. In the end this limited the value of Sutton's method. But he paved the way for a safer form of smallpox inoculation introduced at the very end of the eighteenth century. A country doctor, Edward Jenner, asked why some people could not be inoculated as they appeared to be already immune. He guessed it might be because they had been infected by a less virulent disease. A candidate was an infection of cattle known by farmers as cowpox. Jenner gave it a Latin name variola vaccinae, that is smallpox of the cow. In a famous experiment he inoculated a boy with cowpox and then later with smallpox. Astonishingly it worked and vaccination soon became a new word known the world over. For a while in the early 1800s Sutton's inoculation technique vied with Jenner's vaccination but the medical profession sided with Jenner and inoculation with smallpox was outlawed by Parliament in 1840. By that time both pioneers had died. As far as is known they never spoke to each other or had any communication.

Jenner's reputation has survived while Sutton has been lost to medical history.

The Great Inoculator finally gives him his due.

"...exhibits inoculation as something much more than a poor precursor to Jenner; it implicitly tells an intriguing and resonant story about risk management and risk perception; and it treats inoculation as a significant passage in the history of business, making telling use of advertisements and notices in provincial newspapers." - Steven Shapin, London Review of Books, February 2021