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This chapter considers the changes taking place in preventive medicine in the army and in civilian life in the run up to the First World War. It shows how various elements of preventive medicine were enmeshed with emergent notions of citizenship and ideas of masculinity and morality. It begins by examining various aspects of sanitation and hygiene from the battlefield and the trenches, through to hygienic education and relations with civilians and imperial labour corps. It then moves on to consider inoculation against typhoid — the disease which claimed so many lives during the South African War — and the army's fight against those who were opposed to the measure on grounds of principle. It ends by looking at the problem of venereal disease in France and Belgium and the awkward political compromises into which the army was forced when dealing with it.

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.

While Lady Mary's Turkish adventures dropped behind her, new and problematic adventures awaited. Nicolas–Francois Rémond, whom she had met in Paris in 1718, had been pursuing her ever since. Rémond wrote as an anglophile of English politics, literature, and theatre, and as a virtuoso of ancient and modern literature and the respective merits of rhyme and blank verse. In May 1720, as the South Sea boom was gathering steam, Rémond arrived in London to make her ‘a visit, against my will’. Though Lady Mary had survived herself and protected her son, smallpox remained ever threatening. On her return from Turkey she also found ‘a veritable smallpox war’—about treatment, not prevention—being waged among doctors.

Lady Mary's days of exotic journeys seemed far away. Now her trips were short and sober. In the London area she visited Lord Ilay's Kenwood House, with Lady Oxford, and the spa at Islington, with young Mary. Her heroic battle for inoculation surfaced in memory from time to time, often with pain and regret, when some child died after the operation. Lady Mary was firmly committed to the gentle methods which she had seen practised in Turkey, and opposed to the more draconian English approach. The family deaths of the 1720s were succeeded in the 1730s by deaths of friends.

This chapter explores the practice of Suttonian inoculation in America. In Britain, there were not really any challenges to the Suttons' claim of their inoculation method's originality. However, most of those who practised the new method in Britain were members of the Sutton family or practitioners who were credited, having bought the Sutton seal of approval. Not many tried their luck abroad. In particular, there seemed to be little incentive to set up in practice in the American colonies. Smallpox inoculation had been pioneered in Boston in 1721, the same year as the Newgate trial in London. In some of the thirteen counties of colonial America it had been banned altogether, in others it had been practised with considerable success. Why cross the Atlantic for such an unpromising venture? One who did was James Latham, an army sergeant who, before he was posted to Quebec with the threat of revolution growing in the colonies to the south, had got himself accredited as a Suttonian inoculator.

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 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 illustrates the complicated relations between colonialism, medicine, and the production of knowledge about gender, through the specific problem of inoculation versus vaccination, an ongoing medical and governmental problem throughout the 18th and 20th centuries.

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 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 studies how, asserting his right to be regarded as the chief of the dynasty, 63-year-old Robert Sutton put an advertisement in the London Evening Post on May 9, 1771, to complain of 'many imposters who have assumed the Suttonian art of inoculation, and likewise my name'. He felt he was 'under the necessity of informing the public where my sons and partners reside to practise inoculation'. A lengthy list included accredited Suttonians not only in Britain, but in France, America, and the Caribbean. Top of the list were all family: seven sons and two sons-in-law. A tenth family member might have been included: Daniel Sutton's father-in-law Simeon Worlock. He had been practising as a Suttonian since 1769, but he was not on the list. He was, in fact, the most blatant imposter ever to usurp the name of Sutton, safe in the knowledge that he could not be brought to book because he had quietly slipped across the Channel to Paris where, for several years, he enjoyed considerable celebrity.

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 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 examines the interlinked histories of inoculation and print during the 1721 Boston inoculation controversy. Cotton Mather claimed that he learned about inoculation from his slave Onesimus, and he advocated for it as a treatment during smallpox epidemics. Following the lead of William Douglass, anti-inoculists engaged Mather and his supporters in a wide-ranging exchange that Perry Miller eventually dismissed as a “tiff about style.” While the controversy initially focused on the procedure’s effectiveness and safety, it quickly devolved into an exchange of satires and parodies of opposing viewpoints. This chapter investigates the formal and stylistic concerns at the heart of the controversy, and reveals how these rely on representations of Native Americans and Africans, who unwittingly became vehicles for medical arguments. The formal qualities of African speech took on epistemological significance, and were held up as proof of the relative truth and falsity of scientific evidence. The positioning of Africans in the debate engages modern assumptions about the liberalizing tendencies of eighteenth-century medicine and print culture, underscoring the exclusionary practices that mark those Africans as the objects—rather than subjects—of liberalism.

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.

This chapter examines how Princess Caroline an extraordinary medical experiment to take place in London's notorious Newgate Gaol. It was this bold — and by today's standards quite unethical — trial of the safety of inoculation that first introduced the novel procedure to the public. The Newgate trial was a success, yet most of the medical profession disapproved. The Newgate experiment for 'saving the lives of the Quality' only served to stir controversy over the value of inoculation and it did not persuade Princess Caroline or her medical advisers that she should follow Lady Mary's example. A question raised by William Wagstaffe, the Barts physician fiercely opposed to inoculation, was whether or not the Newgate prisoners had suffered from 'genuine' smallpox. If they had not, they would still not be immune to the true disease. This was a worrying question for Princess Caroline and her royal doctors.

This chapter details how Princess Caroline finally decided to have her children inoculated. Thereafter, the inoculation of royal and aristocratic children was covered in daily bulletins by newspapers. However, there were other privileged infants who developed full–blown smallpox from their inoculation and did not survive. These cases were also reported in the newspapers. In these cases, the name of the surgeon who carried out the inoculation was not mentioned. Thus, it was impossible to judge the dangers of 'this new practice' because the technique of inoculation was not described or disclosed. Lady Mary, in her diatribe in the Flying Post, believed doctors were 'murdering' their patients (her term was censored by the editor) because the potions and purges they used only served to weaken the latter. She went as far to suggest that the medical profession was deliberately making inoculation dangerous to protect their incomes, which came from treating the disease.