The “Suttonian Method” of Fighting the Smallpox

So what was the Suttonian method of smallpox treatment that Dr. James Latham offered in Salem in 1773-74?

Donald R. Hopkins’s The Greatest Killer: Smallpox in History says this was a medical regimen developed by the English physician Dr. Robert Sutton, and then used and modified by “his six sons.” One of them, Dr. Daniel Sutton, claimed to have changed the treatment and broken with his father in 1763, but other medical men and the public wrote as if there was a single “Suttonian method.”

In Public Health in the Town of Boston, 1630-1822 John B. Blake described the first part of the treatment this way:

the practice involved a diet of puddings, gruel, sago, milk, fruits, and vegetables for nine or ten days proceeding the operation and abstention from meat, butter, cheese, liquor, spices, and other heating foods. The typical patient also received relatively mild dosing with a preparation of mercury and antimony and with Glauber’s salt.

This was actually a shorter period of dieting than what earlier British doctors had insisted on.

Furthermore, in October 1768 Benjamin Rush, then studying medicine in London, wrote that “Dr. Sutton’s method is now universally advocated by most of the physicians in England,” but few patients were taking mercury.

The Suttons’ biggest improvement over previous British forms of inoculation was inserting the virus (though they didn’t know that’s what they were doing) through a shallow cut rather than a deep one. Solomon Drown, a Brown College student, underwent the procedure in New York in 1772. He wrote:

We are inoculated after the Suttonian Method, which is this, the doctor with his lancet just scratches up the skin so as to fetch blood, then fixes a piece of thread, infected with the matter [from a previous patient], into the scratch, upon which, a very tenacious plaister is applied, and a bandage around the arm.

Ironically, as Hopkins points out, the Suttons’ innovations—the shallow cut, less fasting and purging, less of that yummy mercury—brought the procedure closer to what doctors in Turkey had done for centuries. Lady Mary Wortley Montagu had published a description of that treatment in London in 1721.

I think British doctors had chosen to make the inoculation regimen more elaborate and more trying for two reasons. The first might well have been fee-for-service: the more patients saw them doing, the more they got to charge. Second, the eighteenth-century British seem to have believed that if a treatment didn’t cause major, uncomfortable side effects, you couldn’t be sure it was working.

A Dr. Thomas Dimsdale described some of the Suttonian method in print in 1767, and one of his pamphlets was reprinted in New York four years later. The Suttons themselves kept their secrets as long as they could, publishing nothing until 1796. Instead, they trained other doctors, who had to keep the secrets and probably kick back some earnings. William Sutton—presumably another son—licensed Dr. Latham to practice the Suttonian method in the northern American colonies, as described yesterday.

Another Suttonian inoculator I’ve found was an Oxford-educated doctor named Robert Houlton. In 1768 he moved to Dublin and published Indisputable Facts Relative to the Suttonian Art of Inoculation, advertising himself as authorized by the Sutton family to bring their methods to Ireland. Houlton also wrote poems, musical plays, and newspaper essays. His last recorded writing, alas, consisted of pleas for assistance from Fleet Prison in 1796.

At that time, the “Suttonian method” was still the most advanced protection against smallpox in the English-speaking world. But two years later Dr. Edward Jenner published his findings that cowpox protected against smallpox, and inoculation with live smallpox was on its way out. (Of course, some people feared the new method; the caricature above shows small cows bursting from the mouths of people Jenner has just vaccinated.)

Dr. James Latham’s Inoculation Franchise

Yesterday’s posting mentioned Dr. James Latham, a smallpox inoculator working in Salem in 1773-74. He came to town claiming to have a superior method for treating the disease. That probably sounded good to the town leaders at first, but when the people of Essex County turned against those newfangled and exclusive inoculation hospitals, Latham’s secrecy became a liability.

The best source on this doctor is an article by Barbara Tunis called “Dr. James Latham (c. 1734-1799): Pioneer Inoculator in Canada,” published in the Canadian Bulletin of Medical History in 1984. It draws on a 1903 profile in the Boston Medical and Surgical Journal of another physician who worked with Latham and left papers documenting their business relationship.

Tunis writes that Latham enters the historical record as a surgeon’s mate in His Majesty’s 8th Regiment of Foot in 1756, succeeding to the rank of surgeon in 1767. That regiment arrived in Québec in July 1768, and on 15 September Latham advertised his services in inoculating people against the smallpox. This is apparently the first documented example of inoculation in Canada. (That’s a bigger deal in the Canadian Bulletin of Medical History than elsewhere.)

Latham seems to have found enough business to retire from the army, perhaps on half-pay. The next year he moved to Montreal to inoculate people there, and in 1770 to New York. By 1773 Dr. Latham was married with children, living on a large farm in Livingston Manor.

The doctor advertised himself as following the “Suttonian” method of treatment—indeed, he declared, he had the exclusive license to offer that treatment in North America north of Philadelphia. He in turn authorized associates in seven towns and sold them the “Suttonian” medicines, which they had to promise not to try to replicate. They paid him half of all they earned up to £300 and a third above that. The contract started like this:

Whereas, William Sutton of Kensington Lane, in the County of Surrey, in England, hath found out and discovered a method or art of inoculation for the smallpox, and hath also discovered and prepared certain medicines, preparatory and effectual in the cure of that distemper, and, whereas the said William Sutton, in order to extend the benefit of this method to America, did, upon certain conditions, take James Latham into partnership for the carrying on and practising of this said method, art or mystery, and inoculation with the medicines aforesaid in certain districts in America, with power to depute under him other persons within said districts under certain terms and conditions,…

In sum, Dr. Latham set up a smallpox-inoculation franchise.

When the Revolutionary War broke out, Latham apparently tried to remain neutral, at least until he saw which way the fight was going. He resigned his army ties by August 1775, but in the following years Patriots suspected him of trying to smuggle flour to the British army and then of trying to cross enemy lines. In May 1783, with the war winding down, Latham wrote to Gen. Sir Guy Carleton in New York City, professing his continued loyalty to the Crown. Nonetheless, he remained at Livingston Manor with his family.

For a few months in 1786 Dr. Latham went back to Québec to inoculate people, and then in March 1790 he moved and officially became surgeon for the army garrison in Kingston, Ontario (well, it’s now Ontario). Smallpox treatment continued to be a big part of his practice. He died in Kingston on 28 Jan 1799, aged about sixty-five.

(The painting of a doctor inoculating a family above appears on a Scienceblogs posting by PalMD about eighteenth-century scientific wariness of the procedure.)

“Great excitement here against inoculation for small pox.”

When Justice Nathaniel Ropes of Salem came down with smallpox in early 1774, as reported yesterday, Essex County was already in an uproar over the disease and its treatment.

As Andrew Wehrman described here, in late January a crowd from neighboring Marblehead burned down the smallpox hospital on Cat Island (now Children’s Island, shown here via the Marblehead Reporter).

Salem’s selectmen had given their approval to that hospital in the summer of 1773. Then they approved creating a smaller hospital in Salem, according to these quotes from Joseph B. Felt’s Annals of Salem (1827):

Nov. 1 [1773]. Small pox of so mortal a kind had prevailed here, that 16 out of 28, who were seized with it and sent to the Pest house, died. The town grant leave to some of the inhabitants to build a hospital in the S. E. part of great pasture for the purpose of inoculating. . . .

[Dec.] 9th. First class of 132 enter the Hospital for inoculation. James Latham, called the Suttonian Doctor, inoculated them. . . .

Jan. 7th [1774]. Second class of 137 enter the Hospital for inoculation.

The Marblehead hospital went up in flames on 26 Jan 1774. Almost a month later, on 25 February, authorities jailed two men, John Watts and John Gulliard, on suspicion of setting that fire. Felt’s Annals report what happened that night:

In the evening 4 or 500 persons from Marblehead rescued the two men and carry them back. Military companies are ordered out to prevent this, but to no effect.

March 1st. By order of the High Sheriff, his deputy in Salem assembles several hundreds of the people here with arms, for recovering the two prisoners and seizing the principals concerned in their rescue. In the mean while, 6 or 800 were prepared at Marblehead to resist this force. The proprietors of the consumed hospital, fearful that if these two bodies came in collision, lives would be lost, agree to give up the prosecution of their claims for satisfaction. Such an agreement being made known here, the sheriff releases the men, whom he had summoned to enforce the law.

Salem’s town meeting then voted to stop inoculation at their own hospital, promising to reimburse the proprietors.

Two days later, those investors sat down with Dr. Latham to ask some pointed questions about his methods. Rumors said that “his patients had not done so well as those of American physicians.” Did that mean they might still be infectious?

Given all that, it’s no wonder that Felt’s Annals concludes its entry for 9 March with: “Great excitement here against inoculation for small pox.”

And just around that time, the people of Salem must have heard that Justice Ropes had the disease—perhaps even as a result of being inoculated at one hospital or the other. He was already known as a supporter and appointee of the unpopular royal government, and of course he was a rich man.

The common people of Salem might have perceived Ropes as having gotten a form of inoculation they couldn’t afford, then having brought the disease into their town. Such feelings could have been enough to spur a crowd to surround the judge’s house, breaking his windows and decorations—a time-honored way for a New England community to express disapproval of a wealthy citizen.

In any event, the very next item in Felt’s annals after the “Great excitement” over inoculation was Nathaniel Ropes’s death. As I noted yesterday, his family believed that the mobbing had hastened his death. I’m not sure how susceptible a man with late-stage terminal smallpox would be to psychological stress, but that couldn’t have been an easy night for his family.