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This chapter assesses the mystery of immunity. Today, Edward Jenner is often referred to as the 'father of immunology'. But really, Jenner had no more claim to that title than Lady Mary Wortley Montagu, or the Greek women inoculating in Constantinople, or Daniel Sutton. None of them knew anything of the micro-organisms that Louis Pasteur and his contemporaries called 'germs'. It took well over a century after the deaths of Sutton and Jenner for an accumulation of scientific investigation to gain some understanding of what had been going on medically when the inoculators and vaccinators sought to bring smallpox under control. And it was a long time after the identification of 'germs', and the detective work that isolated the elements in them that caused specific infections, that it was understood that inoculation and vaccination worked because they triggered an immune response in the patient.

This chapter looks at how, in just four years, from late in 1763 until 1767, Daniel Sutton made a fortune working single-handedly as an inoculator. He did not, as might have been expected, head to London to prosper among the well-to-do. His experience working with his father had taught him that in country towns and villages there was a demand for inoculation and not many country surgeons at that time were willing to offer it. Sutton was sometimes described as a quack because he had no medical qualifications. He was, in the terms of the day, a 'mere empiric'. But what he achieved with his regime was real, effective as a preventive against smallpox, the most devastating disease of the age. He was more successful than his father and brothers because he made inoculation more accessible and less daunting with his relatively easy-going regime. As inoculation had become more acceptable in the 1750s, there were occasional attempts to inoculate whole populations simultaneously to overcome the danger of the infection spreading to those who had not been treated. This provided a new line of business for Sutton.

This chapter assesses how Daniel Sutton became a veritable Georgian parvenu. Greatly admired as he was for his skills as an inoculator, Sutton was aware that he was regarded socially as no more than an avaricious upstart. He belonged to no societies, medical or otherwise; he had no qualifications nor had he published anything more profound than a series of newspaper advertisements. Then, in the spring of 1766, at the age of thirty-two, with his fortune made, he began to take steps to enhance his status and reputation. In just one year he hired a clergyman to officiate at a small chapel he had built in Ingatestone for his pious patients. At the same time, he applied for a Sutton coat of arms, which would cost him a considerable sum in fees. While he maintained his home, Maisonette, in Ingatestone, he took up residence in a grand house in London. His social standing now assured, he married a rich young widow whose parents owned land in the West Indies.

This chapter reflects on a decline in Daniel Sutton's grip on the business he and his family had pioneered. Inoculation had come to be regarded as less of a luxury for those families who could afford it and more of an economic necessity to protect the 'industrious poor' in towns and villages. It was not the end of the road for Daniel and the Sutton family, for their skills were still in demand. But the most lucrative business for which inoculators competed was now in the many schemes being promoted to offer inoculation to the poor. For those parishes that were prepared to pay for an experienced inoculator there was a great deal of choice. Both Daniel and his father had inoculated whole towns and villages before and would be an obvious first choice. Daniel was certainly considered when the village of Glynde in East Sussex was faced with an imminent outbreak of smallpox in 1767.

This chapter addresses how Daniel Sutton's success was never properly acknowledged by his rivals, who quietly went about the business of figuring out how he did it while sneering at his lowly origins. The eminent, fully qualified doctors who sought to discover Sutton's secrets rarely mentioned him or his family of inoculators by name. They were invariably referred to as 'a certain family', as if to identify them would be to bestow a dignity on them that they really did not deserve. After all, the Suttons probably had no idea themselves how they had more or less perfected the art of smallpox inoculation. There was no published theory nor any description. A London doctor, Thomas Ruston, concluded in his research that the chief ingredient was calomel. Calomel played an important part in Suttonian inoculation, administered in small doses, the quantity dependent on the age and perceived health of the patient.

This chapter recounts how, once he had moved out of Sutton House, Daniel Sutton became itinerant, moving from one West End street to another in quick succession. In 1779, he announced that he had been 'engaged by the Governors of the General Inoculation Dispensary' and he had moved nearby to Southampton Street in Bloomsbury. Although he was still inoculating on his own account on his usual terms of 10 guineas, to have any kind of official post was out of character. Times had changed and he made it clear in yet another newspaper advertisement that he was well aware of the waning of his celebrity. Announcing his appointment to the dispensary, he felt it necessary to plead that he was the 'identical person who, in 1767 (by royal approbation) was complimented with a grant of the following honorary Patent for his singular and new method of inoculation'. This method, he claimed, was now 'very materially improved'. Once again the family coat of arms awarded to himself and his family was evoked. The chapter then looks at the publication in 1796 of Daniel's account of his discoveries as an inoculator.

This chapter describes how, by 1766, Daniel Sutton had reached his zenith, apparently untroubled by the competition of Thomas Dimsdale and others who believed they had discovered the secrets of his success. It was then that Sutton learned that a whole new world of riches awaited him and his acolytes across the Channel. Smallpox was rife in Europe and Russia and yet inoculation was rarely practised and fiercely opposed where it was attempted. But news of the success of Suttonian inoculation, promoted indirectly by the translation of Dimsdale's guide to the 'modern method' attracted the attention of royalty, who were as vulnerable to the scourge of smallpox as their subjects. England produced the most skilled inoculators and a demand for their services grew. Sutton's name would be top of the list and an early approach was made to him.

This chapter focuses on Daniel Sutton's method of 'Suttonian' inoculation against smallpox. It is not easy to appreciate now how it might be possible for a 'medical revolution' to take place when it involved absolutely no advance in the understanding of infections, nor any close studies of the effectiveness of different drugs or medical procedures. But 'Suttonian inoculation' was a genuine breakthrough, and was recognised as such at the time by most medical authorities. It evolved from a rejection of customary medical practice and a partial return to the simplicity of the Turkish method of inoculation. Lady Mary's anecdotal accounts of the work of the elderly Greek ladies were probably more influential than any theories about the nature of disease. It was a rustic kind of revolution which began in the Suffolk village of Kenton in the mid-eighteenth century.

This chapter looks at how Daniel Sutton died forgotten at the age of eighty-three on February 3, 1819. There was no institution to carry Sutton's name into the era of vaccination; his family was scattered and none had any connection with medicine. There is not a single Sutton memorial in London or anywhere in the country, or, as far as is known, in the rest of the world. His importance in the defeat of smallpox would not be acknowledged even now if it were not for the interest historians have taken in eighteenth-century medicine in recent years. There was certainly contemporary support for the view that Suttonian inoculation had had a hugely beneficial effect on health in the eighteenth century. While vaccination was hailed as much safer and more successful than Suttonian inoculation, smallpox continued to attack communities throughout the nineteenth century and Edward Jenner's reputation waxed and waned.

This chapter assesses whether Edward Jenner would have discovered the protective power of cowpox even if there had been no inoculation before vaccination. In his account of how he made his discovery, Jenner attributes it directly to his experiences as an inoculator. All the histories Jenner presented to support his case for vaccine inoculation could not have been performed without Suttonian inoculation. And when Jenner came to attempt his first practical experiment with the vaccine, he was already an experienced Suttonian inoculator. He believed the key to Sutton's success was the manner of inserting the infective matter with the lancet barely breaking the skin or drawing blood. That is how he chose to perform his first vaccination.

This chapter highlights how, in 1774, English physician John Haygarth had been involved in the creation of a Smallpox Society in Chester, which aimed to carry out some plan to make inoculation effective through isolation of the infected for a period of time. The society devised what Haygarth called the 'Rules of Prevention'. They were intended not only to minimise contact between the infected and the vulnerable, but also to make sure the infection was not lingering on anything, from clothes to a letter sealed by someone with smallpox. In his ambition to rid the whole nation of smallpox, Haygarth took for granted that the safety and effectiveness of Suttonian inoculation had been demonstrated countless times. Its value was only limited by the political and administrative problems of making it universal. Haygarth maked no mention of Daniel Sutton or his family, as if what they had achieved was too familiar to be remarked upon. Daniel Sutton did not fail to notice that his celebrity was on the wane.

This chapter discusses how vaccination was to conquer the world in a very short space of time, despite the fact that the research on which it was based was very limited and, in some vital respects, faulty. Edward Jenner was ingenious and imaginative but he was not meticulous. This very soon became apparent as experiments were made with the vaccine. There was one great problem when experiments with the effectiveness of cowpox vaccine were begun in earnest in many parts of the world: where to get the necessary infective matter. Ultimately, 'Cowmania' was a wild, worldwide clamour for a medical innovation which had not been subject to more than cursory, and not always satisfactory, scrutiny. Suttonian inoculation, on the other hand, had stood the test of time and there were those who doubted if vaccination offered a great improvement. One, not surprisingly, was Daniel Sutton himself.

This chapter examines how the worldwide excitement for Edward Jenner's vaccine in the first flush of Cowmania promised a new era in which parents would clamour to have their children protected by this new and safe form of inoculation. This would have realised the dream of John Haygarth, who had imagined a national scheme and dismissed it on the grounds that it was unenforceable. But vaccination was not greeted with the enthusiasm that might have been anticipated. In the first decade of the nineteenth century, vaccination was favoured over inoculation by Parliament and by a majority of the medical profession, but not by the public. Faced with the threat of an outbreak of smallpox, the offer of free vaccination was often turned down in favour of tried and trusted inoculation in what was now the 'old method'. Authorities realised that, to be effective, a general inoculation had to offer the public a choice of Sutton or Jenner.

This chapter discusses how Lady Mary Wortley Montagu was struck down by an attack of malignant smallpox in 1715. It was assumed for a while she would not survive, but she pulled through. When her husband, Wortley Montagu, was appointed ambassador to Turkey, Lady Mary joined him. They stayed first in Adrianople, where, for the first time, Lady Mary became aware of the practice of 'transplanting' the smallpox. The simplicity and effectiveness of it seemed miraculous. Elderly women made punctures in the arms of children and rubbed in infectious smallpox matter. The symptoms of the disease as it developed were light, and when the few pustules died away there were no pock marks. Lady Mary's experience was not lost on Daniel Sutton, who, it will be seen was very much influenced by Lady Mary's account of the primitive 'folk' practice of inoculation when he came to devise his own 'Suttonian' method.