Episode 3

Smallpox Part 3: Charles Maitland

Welcome back to The Poison Room, and to part three of the story of the very first Anglophone objections to the idea of preventing people getting smallpox. Brought to you courtesy of my incredible ability to vastly underestimate how much I can find to say about a topic.

In part one, we saw some religious objections to the idea of inoculation from Reverend Edmund Massey. In part two, we saw some, uh… scientific objections from Doctor William Wagstaffe.

Now, we’re going to look at Charles Maitland’s response to those two delightful characters. To remind you, Maitland’s the guy who performed the Newgate experiments and published a pamphlet about the results. And he’s not going to let Wagstaffe and Massey attack him without hitting back. He writes a letter to Sir Hans Sloan, then president of the Royal College of Physicians. It runs to 64 pages. The year is still 1722, but the pamphlet has no specific date.

Let’s get right in. He starts by pointing out that, even though Wagstaffe might be very highly regarded as a physician, he presents himself as having very little experience of smallpox. So maybe he’s not actually qualified to speak on the matter. (1-2).

He then points out Wagstaffe’s first contradiction: Wagstaffe thinks we need more data, but also that… we should stop until we get that data. Meaning that… we can never get the data that he wants.

Then Maitland addresses the legal point Wagstaffe makes about this being potentially murder:

If a Person, from Experience of the Fatality of the Small Pox in general, or in his own Family in particular, should resolve to ingraft his Child, any Physician, who should dissuade him from it, might, in a great measure, be chargeable with the fatal Consequences of the Neglect of a Method, which the Parent had propos’d, as the only Means to save his Child’s Life: And he would be still as much to blame, if whet the Parent had resolv’d to ingraft his Child, he should refuse to attend him. It is very common with Parents, not only to leave their Children in Houses infected with the Small Pox, but to bring them into the Room, where heir Brethren or Sisters lye ill of them; and a Parent who does so, conveys the Infection to his Child as deliberately, and according to the Doctor, certainly more than he, who orders him to be Inoculated. (3)

Wagstaffe says it should be classed as murder when someone dies as a result of inoculation. Maitland says it would be murder if a physician refused when someone asked for inoculation for their child, and that child later died of smallpox. Further, people are already deliberately infecting their children with smallpox (kind of like chickenpox parties but… y’know. For smallpox), and that’s definitely sometimes deadly. And if a physician agreed to care for that child, then he should be equally prepared to administer inoculations.

Maitland is jumping completely out of chronological order, here. Wagstaffe doesn’t make his legal argument until page 39. At a guess, I’d suggest Maitland does this because he thinks it’s important to establish the legality and morality of inoculation.

He next reminds Wagstaffe that many useful discoveries are initially treated with suspicion. I.e.: You’re on the wrong side of history, Wagstaffe (3-4). This is definitely true, but I’d also point out that this same argument was used by Elizabeth Holmes in defence of Theranos, so, y’know. It’s not actually necessarily that compelling.

After that he gets to Wagstaffe’s racism, islamophobia, and misogyny. Maitland points out that they’ve accepted new practices in the past that were introduced to important families by barbarous peoples (4), so what’s the problem this time round?

He then argues against Wagstaffe’s logic when it comes to what is appropriate for English blood on the four humors model, finishing nearly every point with a comment along the lines of ‘I would think that you should have concluded the opposite from this’ (4-5, 6-7).

Next Maitland turns to Wagstaffe’s objection that there are bunch of factors that might affect the success of inoculation. Maitland makes the obvious counter that, unlike natural smallpox, with inoculation you can control for those factors (5-6).

After that he dismisses the idea that physicians have never before done things which raise artificial diseases in people. They do it all the time. That’s literally what medicine is at this point. Something is out of balance, and you correct it by making them poop, vomit, or bleed (7-8).

Then he moves on to say that Wagstaffe is just wrong about how much smallpox is in someone’s blood being dependent on how many and how big the pustules are. Remember, Wagstaffe thinks that few, small pustules is bad, because it means all the gunk is in the blood instead. But the fact is that the worst cases of smallpox involve plenty of pustules and leaking gunk. Milder cases involve fewer and smaller pustules, and less gunk (9). C’mon, Wagstaffe. Have you even seen smallpox?

Next Maitland calls out another one of Wagstaffe’s illogical claims. It’s… kind of pedantic. Wagstaffe says inoculation can always be observed to seldom produce big pustules. Which is it? Does it always fail to produce big pustules, or seldom succeed in producing them? (9) And by the way, exactly how many cases has Dr Wagstaffe really observed, to justify such broad claims (9-10)? Because also, by the way, if he’d actually attended many instances of inoculation, he wouldn’t be able to claim that it’s not actually real smallpox that results. He’d know that it was the real sort (10).

Next up, Maitland points out that Wagstaffe’s argument claims that, if people survive, it was not genuine smallpox, but if they die then it was genuine smallpox (10-11). Just make up your mind about the damn cake, Wagstaffe.

Maitland then addresses the claim about lack of knowledge of correct dosage, and simply states that it’s been found not to matter. And anyway, Wagstaffe’s claim might be a reasonable argument for the use of caution, but not to ban inoculation outright. You have to be able to experiment to figure out what the correct dosage is (11-12).

After this, Maitland turns to Wagstaffe’s idea that the milder, different symptoms mean it’s not genuine smallpox being produced, and that it thus cannot possibly be a prevention against smallpox:

Those who are Infected by any Method, I believe, are much in the same Condition, as to their Security from the Disease for the future; for which, I will give the Doctor this one plain Proof, which is sufficient to establish a moral Certainty. This practice of Inoculation has been continu’d for many Years in several countrie; if the Inoculated had been subject to catch the Smallpox a second Time, something of this Kind must have happen’d; and a very few instances of this, must have put an End to the whole Practice: For can any one imagine, that People in their Senses would have continu’d a troublesome Experiment, which was not effectual for the Purpose for which it was design’d?’ (12-13).

Look, if it were the case that it really didn’t prevent people getting smallpox then it just wouldn’t be practiced anywhere at all. Even if it only failed a few times it would definitely have put an end to the practice as a whole, so therefore it can’t possibly have happened much.

It’s a weird argument to make, since he’s acknowledging that just a tiny amount of instances of its failure would indeed be enough to make everyone stop practicing it. And that’s not an argument likely to be convincing to Wagstaffe, who thinks that there are examples of it failing. Does this mean Maitland is just ignoring the evidence of inoculation failing? Has he genuinely somehow never heard of an account? Other than, y’know, the ones provided by Wagstaffe.

Anyway. Since there’s totally not a single example of it failing, there’s no point taking this particular argument further. Let’s move on.

Now, Maitland doesn’t think there’s been a single instance of a successful inoculant later getting smallpox, but he does admit that sometimes the inoculation doesn’t seem to work. Some people just don’t seem susceptible, others might have already had smallpox and just forgotten about it, or been misdiagnose when they had it. But there are a bunch of different medical techniques that don’t have a 100% success rate. Sometimes they give people a purgative and they don’t purge. Does that mean we should stop purging altogether (13-14)? I mean, they really should stop using purging anywhere near as much as they do. But it’ll take a while for medicine to realise that. For now, it’s purges all the way, baby!

Next up he addresses Wagstaffe’s argument that, if the Italians and French haven’t adopted it, despite having greater exposure to it, then they shouldn’t either. And Maitland is pretty sarcastic in his response, here:

I cannot allow it as a solid Argument against Inoculation, that the French and Italians have not begun it; no more, than that the House of Bourbon has never been inoculated. Were the Doctor’s Letter publish’d in Italian too, as it is in very elegant French, both Nations, to be sure, will be sufficiently frighten’d from ever attempting this Practice: And to make the Antidote still more universal, let us have it in Sclavonic, and High-Dutch, Welsh, and Irish also. (14)

Neither the fact that the French and the Italians haven’t been inoculated, nor the fact that the House of Bourbon (y’know, that House that got decimated by smallpox) didn’t get inoculated, are convincing arguments against inoculation. And you’re doing your part to stop it taking off in France, aren’t you, Wagstaffe, given that you published your letter in French as well. Hell, why don’t you just go get it published in a bunch of languages, so you can stop it taking off anywhere!

Sick burn, Maitland, but Wagstaffe would prooobably really like that suggestion, so maybe don’t give him the idea.

After this he addresses Wagstaffe’s argument that you can’t blame it on the victim’s constitution, because that would just mean negligence on the inoculator’s part. It certainly would! But if, if, someone did die, the fact that some people don’t know what they’re doing isn’t an argument against inoculation as a whole, just like it wouldn’t be an argument against purging or vomiting if someone administered those incorrectly. There are people who die every year from incorrect administration of those things, but you’re not arguing against those practices, are ya’, Wagstaffe (14-15)?

Next he addresses Wagstaffe’s claim that they might accidentally communicate another disease as well. Once again, he starts off pretty sarcastically:

This is hard! The Doctor will scarcely allow, that the Matter of the Smallpox will communicate the Smallpox; but it is probable, that it will communicate any other Disease. (15)

Oh! So you don’t want to admit inoculation actually gives people genuine smallpox, but you still want to argue that it might communicate other diseases. How peculiar. But be that as it may, this still just amounts to an argument that we need to be careful, not that we shouldn’t do it at all (15).

And as for the doctor’s argument that the differing accounts discredit the practice? Well, it’s:

Just as strong against the Practice of Physick in General: For if no Body was to take any Medicine ‘till Doctors cease to differ, I believe the Faculty would starve: May we not with more Truth affirm, that the Anti-inoculators (a Word more sonorous, and longer by two Syllables than that of Inoculators) are as inconsistent and changeable in their Opinions? (15-16)

Once again, your argument covers the whole of medicine, Wagstaffe. Besides, the accounts of anti-inoculators are even more inconsistent. Honestly, I included this as a quote just because I love the fact that, pathetic sarcastic dig aside, he calls them ‘anti-inoculators’. If this isn’t the first instance of the term, then it’s certainly one of the first. Can you image if we could tell Maitland today that ‘hey, that inoculation thing was the first step in a process that led to us successfully eradicating smallpox, and we developed methods of immunising people from other diseases too, but oh, by the way, a bunch of people still object to this stuff.

Anyway. Anti-inoculators just attribute anything good that happens to something other than inoculation, and anything bad that happens to inoculation.

Next Maitland declares that there’s nothing of substance in Wagstaffe’s letter until page 62. Which is pretty scathing, but, you might think, gives Maitland a convenient way of skipping a bunch of Wagstaffe’s arguments. But fear not. Despite saying they’re nothing of substance, he does actually address them throughout the course of his letter. So he’s really just saying this for the insult value (16).

On page 62 of his pamphlet, Wagstaffe condemns inoculation as spreading the disease to places where it otherwise wouldn’t have been. Maitland points out that this argument relies on the previously denied premise that inoculation is actually giving someone the smallpox. But Maitland is more concerned with pointing out that if smallpox is rare in some years, it’s more common in others, because there are new people around who haven’t had it. And if smallpox is actually equally common wherever you go, then the only variable is when you will catch it. Which is the part that the masses care about: will it be in a good season, or a bad season? Now, Wagstaffe claimed in his letter that that year, not even one in one hundred people had died of smallpox. If that’s the case, then clearly this is a very favourable time to get smallpox, and inoculation allows us to make that happen (17).

However, that’s not all Maitland has to say about Wagstaffe’s claim of the incredibly low mortality rate of smallpox this year. Because he thinks this figure is bull. And he’s going to prove it with… maths.

Now, I have to admit, I was initially delighted with this. Love me some statistics. But when I tried to actually read it, I just… it took a long time to make sense of it. Like, I spent literally hours trying to figure it out, and I think I’ve got it. So I could just give you the tl;dr, but… I spent literally hours trying to figure this out, so I’m going to make you share my pain.

Part of what makes Maitland’s argument so complicated is that the figure he needs is the mortality rate of smallpox. I.e.: how many of the people who caught smallpox died from it. He doesn’t have that, and with the data he’s got, he can’t calculate it. So he has to try and use the numbers he’s got to MacGyver the number he needs. And the reason it took me so long to realise that is that he doesn’t bother to explain that that’s what he’s doing or why, and he just bombards you with information and statistics and leaves you to figure out why he’s using these numbers.

So, step one: he produces some mortality figures for a twelve-year period in London: 1707 to 1718. For each year, he gives the total death toll from all diseases, and the death toll from smallpox.

It appears that the single Branch of Mortality occasion’d by the Smallpox is some Years 1/8th and in a Circle of twelve Years about 1/12th of the whole Mortality in general; For 21,788 is near 1/12th of 274,615. During this Term of Years, London wanted an Addition of near 22,000 People yearly to keep it equally full. If all Mankind had the Smallpox, then 22,000 People, one Year with another had it; of which 1/12th dy’de of it. Which, by the way, shows the doctor to be out in his Calculation; for if only 1000 die this Year, as perhaps may appear by the Bills, 100,000 must have been sick of the Distemper, to make his Assertion true, that one only of a hundred dy’d: If he means it only of Children, it is a strong Argument for Inoculation, because it allows to be a favourable age.

Did you follow all that? If you did, you’re doing better than I did.

Let’s go through it.

The first part is simple: during a twelve-year period, the single branch of Mortality that is Smallpox accounted for 1/12th of those total deaths. There are 22,000 deaths per year, and, on average, 1,800 of those are from smallpox. Now this tells you how likely it is that that the disease that kills you, if you die of a disease, will be smallpox, as oppose to some other disease, but it doesn’t tell you how likely you are to catch smallpox, how likely you are to die of it if you do, or how likely you are to die of it at all. Now, if Maitland knew the total population of London, he’d be able to use that to reverse engineer some numbers to get to the mortality rate. But that’s another number Maitland doesn’t have.

So the second thing he needs to do is find a way to generate a number for the total population. To do that, he establishes that during the twelve-year period, London will need to gain 22,000 replacement people per year in order to keep the population stable. That’s the average of the total deaths by all diseases per year, so yes, you need to be making up for those 22,000 deaths.

Armed with these facts and figures, Maitland creates a hypothetical situation in which he can use these numbers to generate information on the mortality rate.

This hypothetical situation is a model in which all of mankind has already had the smallpox. This means that they can’t catch it again, and thus they can’t die of smallpox.

Now, if the next year 22,000 new people appear, any new smallpox cases must be in that new population. But 22,000 people is the replacement population London needs, not that all mankind needs. So why on earth is he bringing in all mankind? It’s because he wants to rule out any possible impact from migration. If he didn’t account for migration, then one could argue that 22,000 can’t be considered the total population of potential smallpox victims because people who’d had smallpox could migrate out of the city, and people who hadn’t had smallpox could migrate in. The hypothetical would fall apart.

But if all mankind already had smallpox, then migration doesn’t matter. Everyone coming in and out of the city has had smallpox. So the only people who haven’t had smallpox is that new population of 22,000. Which also means that all 22,000 of them must be births.

Now he can finally generate some numbers for possible mortality rates. If all of that new population of 22,000 also get smallpox the year they’re born, then 22,000 becomes the total number of people that caught smallpox. We know that on average 1,800 of them will die that year of smallpox, so that gives us a mortality rate of… 8%. Or 1/12th.

But why should we agree to the claim that all 22,000 of them caught smallpox? Why indeed? Because look what happens when we tinker with the number of total smallpox cases: if we assume that only half of them got the smallpox, then the mortality rate jumps to one in six. Instead of those 1,800 deaths being a fraction of 22,000, they’re now a fraction of 11,000. And if only 11,000 babies catch smallpox, then the mortality rate has to increase in order to meet the 1,800 death toll.

So assuming that everyone caught smallpox actually gives you the best possible mortality rate. And it’s not one in one hundred. And this is why Wagstaffe is wrong in his calculations. If Wagstaffe is claiming that only one in one hundred died of it this year, and we know how many died, we can see how many people would have had to catch the disease to meet that death toll. And that’s 100,000 people. That’s a lot more people than the 22,000 that are actually capable of getting smallpox. London would have had to be in the middle of an incredible population boom. And it wasn’t.

Similarly, if you’re only getting 22,000 people in, and they all catch smallpox, and the mortality rate is only one in one hundred, then only 180 people should have died of smallpox.

Wagstaffe’s out by a factor of ten.

Now, obviously, Maitland’s argument depends on you accepting that the only people in the world who will be susceptible to smallpox are those 22,000 new babies. If you reject that premise then Maitland loses his only way of calculating a mortality rate. Unfortunately, I think it’s pretty reasonable to reject it, especially when you’re dealing with London, a hub of commerce and trade, where migration is definitely A Thing and there are plenty of visitors from around the world.

But we’re not done with the maths. If we continue to accept Maitland’s anti-immigration clause for a second, then he can finesse his mortality rate:

By the bills of Mortality of Breslaw it appears, that the Mass of Mankind lose above 25% before they are a year old; that is, of a 100 that are born, more than 25 die that first year: I may say with great probability that not 1/9th of those have the smallpox at all; but die of other diseases, and that in the Account, as it stands before us, 8 of 9 infants may be reckon’d neither subjects of the distemper, nor of this Practice, but as it were non-entities. Therefore out of the 22,000 people, the yearly recruits of London abovementioned, subtracting 4000 there remains 18000, of which yearly there died above 1,800 of the smallpox, that is, 1/10th, so that the smallpox may be reckon’d to cut off 1/10th of Mankind above the Age of one Year. I wish the World is not malicious enough to say, that Physicians (like the Clergy) are now struggling for their Tenths. (19)

Clear as day, right?

Breslaw (Breslau) is today in Poland, by the way. Modern day Wrocław. We know from the bills of Mortality for this place that the infant mortality rate is 25%. Yeah. 25%. It sucks. But also: the hell, Maitland? You don’t have the data on London’s population size, or its infant mortality rate, but you do have the Bills of Mortality for Breslaw? Okay. Sure. I mean, I am actually kind of delighted that he has this information, ‘cause it suggests I would love his library, but… seriously? You can get a hold of the information for Breslaw, but not London?

Anyway. That was a simple start. 25% infant mortality rate for the first year of life. Gotcha.

Now, if 25% of infants will die in that year, then the 22,000 figure would have to be total births where the child survives. You’d actually need 29,333 births per year to keep your population stable. He also throws in that not one ninth of those 25% of infant deaths under one year will be caused by smallpox. He doesn’t provide any explanation for that figure, but trust him, he can say it with great probability. If the figures were in the Breslaw account, why not just say that, or even give the numbers themselves? The fact that he says he can in all probability say that not one ninth dies suggests that he’s calculated this figure somehow. But I don’t know how, if he is.

To get to a 1/9th figure, Maitland needs to know the smallpox death number and the total death number. The total death number is 25% of the population. But that’s not enough info to figure out the smallpox death number.

Now, if the total number of births was 22,000, then the total death number is 5,500. Which would mean the number of deaths from smallpox would be around 611, and non-smallpox deaths would be around 4,889, to get the 1/9th figure.

But if 22,000 is the surviving 75% of the infants, then the total death number is 7,333, because the initial population size would have been 29,333. And if the total death number is 7,333, then the total of smallpox deaths is 814 and the non-smallpox deaths would be around 6,518.

I’m throwing all these numbers at you because the next thing Maitland does is subtract 4,000 from the 22,000 babies. And I cannot figure out where he is getting this 4,000 from. So that’s two things I cannot figure out: where he’s getting 1/9th from, and where he’s getting 4,000 from. If you can figure out where he’s getting these from, please, pleaaaase let me know. There’s a reward of a photo of two kittens if you can explain them. Photo of one kitten if you can just explain one of them.

But if we just accept this 4,000 figure for now, and therefore accept the new population total of 18,000 new inhabitants, who are all babies, and we know that yearly 1,800 people died of smallpox, then we know that 1,800 out of 18,000 are dying of smallpox.

Which means that even if all of them catch smallpox, the mortality rate – the lowest the mortality rate can get - is one in ten, not one in one hundred. Wagstaffe’s maths, again, is out by a factor of 10, at least.

But again, this still requires you to accept the premise that everyone else has already had smallpox, so all new cases will be in those 18,000 new inhabitants, because everyone migrating in and out of the city has already had smallpox. And asking people to assume that in an international port city of trade and commerce is a big ask. It’s just not reasonable to expect people to agree that all smallpox cases will be in the new birth group alone.

Sorry guys, still not done with the maths, but we’re done with the confusing parts. Maitland turns to the figures provided by Dr Nettleton, who recorded both how many people died of smallpox in a small town in Yorkshire, and how many people actually caught it. It was 22% (20). Just another statistic that differs significantly from Wagstaffe’s 1%. An actual statistic that’s reliable, though, and doesn’t require some weird hypothetical scenario. Which like… why didn’t you lead with this one, Maitland?????

All of this so far has been about showing Wagstaffe’s statistic is, very probably, one he pulled out of a certain orifice. Maitland does also point out that, given all this, if Wagstaffe’s 1 in 100 figure had been specifically for children, then actually, that shows that it’s a really good age to inoculate people, because any type of smallpox is less fatal at that age (19).

Maitland has one final use for his maths: if you think there’s not much chance of even catching smallpox, why should you risk inoculation? Basically, because we know roughly how many people die of smallpox, how common it is to catch smallpox doesn’t actually matter, because the less likely you are to catch it, the more likely you are to die from it if you do. Your chance of dying of smallpox remains at one in ten.

That’s five and a half pages of text it’s taken me to explain three pages of Maitland’s maths, and I get a lot more words per page than he does. And that’s not accounting for any of the things I wrote and then deleted along the way as I figured out what on earth he was actually saying. Basically, I was stuck trying to figure out whether the problem was with his maths, his logic, or his language. Turns out it’s kinda all three. The logic requires an unreasonable starting premise, but his language really isn’t clear, he doesn’t explain why he’s doing what he’s doing, he insists on doing his maths in fractions, and I cannot figure out where he’s getting some of his numbers from. If you tuned out for all of that, all you need to know is that Maitland does some overly-complicated maths to show something he could have demonstrated far more simply, and the most solid figure is from Dr Nettleton, who recorded a mortality rate of 22% for smallpox.

Maitland has to do things the way he does in part because he doesn’t have the bills of mortality for London in 1721 or 1722. But guess who does have them? Uh-huh. In 1721, 2,375 people died of smallpox. That’s 9% of all deaths. In 1722, it was 2,167, which is around 8.5%. So yeah, for Wagstaffe’s claim of 1 in 100 deaths to be true, more people than actually lived in London at the time would have to have caught smallpox.

I’d like to take a moment here to apologise profoundly to the many people who had to put up with me bombarding them with quotes, maths, and possible interpretations as I figured all this out.

NOW. If we compare the mortality rate of natural smallpox with that of inoculation, we see that out of about 500 operations performed that have been recorded so far, only three named people can be said to have died from it, if you accept that they died of smallpox. Which Maitland doesn’t. Obviously (20-21). Inoculation is, ironically, very roughly cutting the death rate from one in ten to one in one hundred (21). If everyone in the city got inoculated, 1,500 fewer people would die per year.

Now, up to this point, Maitland has gone through Wagstaffe’s letter, but missed out addressing the actual cases Wagstaffe talks about. But he gets to that now, and goes through them all in turn, starting with the Newgate prisoners.

Maitland is, shockingly, preeetty sure he’s not the one who’s wrong in his account of the Newgate experiment. He refers the reader back to his earlier pamphlet, and just goes through all of Wagstaffe’s details saying ‘no, that’s not what happened’ (23-24).

He points to Eliza Harrison, the one who was made to tend to a servant and a boy who both had smallpox. She’s now nursed 20 people, apparently, and still hasn’t caught the disease (24).

As to Mr. Redacted, the one who Wagstaffe claims didn’t get any reaction at all from inoculation, Maitland is apparently familiar with the case. He acknowledges it is true, and patiently explains that one instance where the inoculation did not take is not proof that it never works. Just that it didn’t work this one time, on this one person (24).

And what about the guy in St. Thomas’s hospital? The one Wagstaffe claims had already had smallpox, and caught it again from inoculation? Maitland visited him, and saw no symptoms whatsoever. He asked the attending doctor, one Doctor Wadsworth, whether the sores this guy had looked anything like the ones on the Newgate prisoners. Wadsworth agreed that they did not. Maitland visited him again a week later, and there were still no eruptions (24-25).

The next case Wagstaffe mentions is that of Mr. Batt’s family, where the six servants got smallpox after the child was inoculated. This was another case presented by Maitland in his first pamphlet, and expressly presented as a case where inoculation had caused smallpox in others. If you remember, he actually presents it as part of his proof that the thing inoculation is producing really is smallpox.

But here he acknowledges that it seemed probable that they caught it from the inoculated child, but it was well known that the town was already in the middle of a smallpox outbreak. He doesn’t explicitly claim that therefore they caught it elsewhere, but that’s the possibility he raises. It’s a weird backtrack to make, but Maitland suddenly has a far more pressing argument to answer.

If you remember, Wagstaffe accuses him of introducing the smallpox that wracked the town of Hertford. The year before Maitland got there, lots of people had died of smallpox, and people were dying again that year. Maitland inoculated the Batt’s daughter and the two sons of Mr. Heath (these are the kids where Maitland really doesn’t like one of them, but thinks the other one is fine [1722b: 25-26]). These two boys were isolated from the rest of the town, so they couldn’t have caused the outbreak, and if the servants probably already had smallpox from elsewhere, then, with all due politeness, Wagstaffe and his accusation can bugger off.

What about Mr. Degraves’s daughter? Who, Maitland notes, Wagstaffe dedicates four pages of his discussion to. This is the girl that Wagstaffe claims was inoculated, the surgeon declared the inoculation a success, but then after three months of being ill, the girl erupted in a case of the genuine smallpox, which Wagstaffe claims that he himself verified. In his first pamphlet Maitland provides sworn testimony from many of his cases. This isn’t one that he provided such testimony for, but he attaches it at the end of this pamphlet (26-27).

Here’s the tl;dr of the father’s account: She was inoculated at the same time as two others, but whilst they broke out in something readily identifiable as smallpox, she had only got periods of being hot, flushing, sometimes had a headache, sometimes a quickened pulse, and at other times no symptoms at all (51). She didn’t develop anything recognisable as smallpox. She was released from quarantine three weeks later. At this point it was suspected that she was just somehow naturally immune to smallpox, because she’d been exposed to it twice before as a child and not caught it, and now the inoculation seemed to have failed, too (52). But even after she came home she continued to have intermittent hot flushes, though to a lesser degree. Meat made her feel sick and she was having nightmares. She got a few boils, but none of this stopped her carrying on life as usual.

About two months later, the proper smallpox rash broke out (53). Three days before this happened she had apparently strenuously exerted herself: she walked to ‘the camp’ and back again on a very warm day; the next day she walked to the ‘Charter House’ and back with her brother, and the third day she went and sat at the ‘Play-House’ in the ‘Lincolns-Inn-Fields’. And it was while she was there that the rash appeared (53-54). Despite the sudden rash, the girl seemed totally fine, and hadn’t experienced any symptoms before the rash broke out. When the spots appeared she regained her appetite for meat and stopped having nightmares. She was better again in eight day’s time. The father is convinced that, even though this was very different from the usual side effects of inoculation, this was caused by the inoculation, which had been successful (53).

Gotta’ admit, sudden-onset vegetarianism and nightmares are very unusual side-effects, but hey.

Wagstaffe claimed that this was a case of a successful inoculation not working because the girl got smallpox later. So either inoculation doesn’t prevent smallpox even when supposedly successful, or it can sometimes be unsuccessful and therefore is basically useless. But Maitland claims it’s option three: the inoculation was successful all along, even if it took longer than usual. Honestly, I’m not sure where I stand on this one. It’s a definite stretch to say that the incubation period was 77 days, when we know that it’s usually 10-14 days. But the fact that the weird symptoms appeared immediately after she was inoculated, and continued until the smallpox appeared suggests that maybe she did have smallpox all that time, and for some reason it just took a lot longer to appear. Possibly because she really did have some level of natural resistance to it.

Anyway. Maitland finishes up by stating that one instance of it not working isn’t enough to dismiss the whole thing. You’ve really got to stop saying that, Wagstaffe (27). And even the letter from Wagstaffe’s ally over in Boston admits that of the three hundred odd people inoculated in a five to sixth month period, not one of them had reported having caught smallpox since.

Maitland then turns to the story of Captain Hussart. Now. Up until now I had assumed that the letter Maitland referred to just now for the Boston figures was the one from Douglass that Wagstaffe attached as a postscript. But here, Maitland refers to the story of Captain Hussart as ‘his second story’. But Douglass doesn’t mention Captain Hussart; it’s Dolhonde’s story. So I don’t know if Maitland just got confused, or if he actually had access to Dolhonde’s whole testimony.

Anyway, what does he have to say about Captain Hussart? It’s a ridiculous story, that’s what. I mean, if you’d tried to be inoculated twice already and both had failed, why would you even try it a third time, let alone a fourth, fifth, or sixth time (28)? C’mon, Wagstaffe, this is embarrassing.

And what exactly does Wagstaffe think this story proves, anyway? It suggests that someone who couldn’t catch smallpox by inoculation could still catch it the natural way. That doesn’t prove that someone who’s been successfully inoculated can catch smallpox, but hey, if Wagstaffe wants to believe this and Dolhonde’s other stories, then good luck to you, mate (29).

After this, Maitland turns back to Dr Nettleton. Wagstaffe mentioned him briefly in his own letter (Wagstaffe 1722: 17), and claims that Nettleton states that only a quarter of inoculated patients developed anything identifiable as smallpox. Maitland has read over Nettleton’s letter quite carefully, and can’t find where it supposedly says this. In fact, Nettleton gives a glowing review of inoculation (29-30). As I mentioned last episode, I checked too, and it really doesn’t say this. So who knows what Wagstaffe’s talking about, or where he got this idea.

Next up, Maitland basically says that Wagstaffe’s second-hand reports just aren’t as reliable as those, such as himself, who are providing first-hand accounts of the matter. So maybe Wagstaffe should at least cite the cases properly, and tell us who the actual doctors involved were (30). He goes through the cases that Wagstaffe mentions where Maitland himself was involved in, providing attached testimony as to what really happened (30).

And as to the vague allusion Wagstaffe makes to the members of some unspecified high-ranking families, who got intermittent fevers or diseased bones? If Maitland is right in guessing who he’s talking about, then one of them is perfectly well, actually. And the abscess which he had cleaned up just fine without some intermittent fever or, uh, ‘exfoliation of the bones’ (31). I don’t know if Maitland was right in his guess as to who Wagstaffe is talking about, but Wagstaffe talks about instances in plural, and Maitland seems to only be able to figure out who one of them is.

After this he turns to Wagstaffe’s postscript.

As for the three letters from Boston in New England, printed by Way of Appendix to the Doctor’s, It might suffice to say, that they are only a severe, and perhaps a just Invective, against the Clergy and others, for meddling in this Branch of the Physicians Practice: Upon which Encroachment, some of the Faculty invoke the Vengeance of the Civil Magistrate; and threaten the Offenders, as Poisoners and Spreaders of Infection, with Prisons and Gibbet’s [sic]: And if the Laws in being are somewhat deficient, modestly call, as some others have done, upon the Legislature for new Ones. This general Consideration is sufficient to invalidate the Credit of any Thing that is said by a Person so strongly interested. (30-31)

Douglass’ argument is perhaps a justifiable criticism against clergy members for meddling in medicine, but, Maitland thinks, this personal disgruntlement against the encroachment of the clergy is enough to dismiss Douglass’ account altogether – he’s biased against inoculation and his disapproval is to spite the clergy, not because of any genuine problem with the practice itself.

Not sure what I think of this. Is it a possibility? Certainly. But it’s also possible that Douglass was both upset at the clergy and genuinely thought inoculation was bad. Or that he was so upset at the clergy precisely because he thought it was bad. Is it enough to dismiss everything he says? No. Though it’s perhaps worth noting that later in life, Douglass did come around to the idea of inoculation.

Luckily, Maitland doesn’t actually just dismiss it, even if he thinks it is dismissible. He has arguments against many of Douglass’ points: first he points out that Douglass claims that inoculation was being managed by unskilful people who didn’t pay attention to the season, or the state of the inoculant’s body, and even inoculated pregnant people. And even Douglass himself suggests that those people might have fared better had it been managed by a skilful physician (32).

Next he notes that despite Douglass stating that two or three hundred had been inoculated, he gives Wagstaffe only a single redacted name as an instance of someone dying of it (32-33). And then Maitland whips out a nice bit of snark:

He says at Random, that others dy’d of it, whom Time may bring to Light. Were the Bodies of those Inoculated Persons hid under Dunghills? Had they not Christian Burial? (33)

What does Douglass even mean, that time may bring them to light? Did someone hide the bodies or something?

Next up is Douglass’s claim that people who got inoculated ‘suffered much’. But so does someone who has the actual smallpox, and Douglass himself even acknowledges that inoculation frequently produces more favourable cases.

Next we return to the fact that not one of those two to three hundred inoculants is reported as having caught smallpox in the five or sixth months following, despite the town being in the middle of a smallpox epidemic (33-34). Given how vehemently Douglass opposes inoculation, if he had known of any such case, he would surely have mentioned it. Douglass’ evidence actually makes a great argument for inoculation.

What about Douglass’s claims that inoculation helped spread smallpox? Maitland’s already answered that. Well. He hasn’t. He’s defended himself, not entirely convincingly, of having caused an outbreak in one town (34).

Then Maitland turns back to the legal issue, in light of the fact that in Boston they’re trying to ban inoculation. Maitland says it would actually be far more prudent to legislate for mandatory inoculation. In later decades the issue of mandatory immunisation will play a big role, as it does today. And actually, Maitland would probably be on the side of those arguing against making it mandatory. He thinks that it violates people’s natural rights to deny them being able to get inoculated, but, he also thinks, it would equally be a violation of their rights to make it mandatory by law (35).

Moving on, Maitland addresses Douglass’s claim that the sores of the inoculated smell bad. What does Maitland make of this? Well, it’s just proof that Douglass doesn’t know what he’s talking about and has probably never even seen an inoculation take place (35).

Maitland then quotes Cotton Mather’s letter extensively to provide a different account of what was happening in Boston, about what caused the outbreak, and about how many people died (36-37). Also, once again, Douglass’ arguments could have been used to prevent even the best medical advance in its infancy, kind of like how they’re apparently against the idea of using a certain bark to prevent or cure agues (38). Which is apparently a thing they were against.

Finally, he points out that Douglass does not speak for all the physicians in Boston, and that there are plenty who want the experiments to carry on (40).

40 pages in and Maitland is now done with Wagstaffe and Douglass. So let’s just take a moment to summarise what he’s said so far:

Hoofta, that was a lot of arguments. Mostly good ones, but there are some duds in there. Especially when it comes to trying to dismiss the idea that inoculants are contagious. Probably because they were contagious.

That’s all Maitland has to say about Wagstaffe’s pamphlet. What about Edmund Massey? Well, his response to Massey is shorter, but it’s still too much stuff to address without this episode getting super long. So you’ll just have to wait until next episode to hear that. It’s a real cliff-hanger, I know.

But let’s just skip the response to Massey for a second to talk about the end of the pamphlet. Once again, Maitland provides signed testimony from some of the cases he talked about in the pamphlet. This includes a far fuller description of the autopsy results of one of the cases Wagstaffe mentioned. Wagstaffe said that they found a polypus in the heart, and water in the ventricles of the brain. In Maitland’s fuller description, we learn that the patient died after a seizure, that there were actually two polypi in the heart, and one had branched out into the pulmonary artery. As to brain. Apparently they found the whole surface of the brain full of water, the ventricles full to bursting, the plexus choroides white from being soaked in the water, and the base of the brain also full of water. And there was a long and fairly big polypus in both the longitudinal sinus and the lateral sinus. The cerebellum was fine, though.

Now, we should always take retrospective diagnoses with a huge grain of salt – they can’t even be more than speculation. But this kinda’ sounds like hydrocephalus. Which you can get after stroke, a brain tumour, meningitis, or a serious head wound. It can cause convulsions, and can lead to death if untreated. Unfortunately, for all his detail, Maitland doesn’t give a patient history, so if it was this, we have no way of guessing what caused it. I guess we can rule out tumour, since they’d notice that in the autopsy. Though he did note blood clots in the sinuses of the brain. Anyway. Just speculation.

He also attaches the letters from both Nettleton and Mather, in which, I remind you purely because it delights me, that the latter compared those raging against inoculation as behaving in a way akin to satanic possession. Salem guy says that.

For the record, Maitland is far from the only person who replies to Wagstaffe’s pamphlet. A bunch of people respond. And were this a podcast aiming at providing a commentary on all surviving pamphlets from the London pamphlet war of 1722, I’d include them. But it’s not, so I won’t. However, they’ll be listed in the bibliography, with links if they’re publicly available, should you want to read them yourself.

That’s it for this episode. If you like the show, please subscribe on whatever podcatcher you use. Rate and review the show, especially on iTunes. If you’re the type of person who can be convinced to leave a review for the prospect of getting a shout-out, start the review with the words ‘all mankind’ and I will bless you with this most esteemed honour.

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Maitland, C., (1722a) Mr. Maitland’s Account of Inoculating the Small Pox, London.

--- (1722b) Mr. Maitland’s Account of Inoculating the Small Pox Vindicated, From Dr. Wagstaffe’s Misrepresentations of that Practice, with some Remarks on Mr. Massey’s Sermon., J. Peele.