Rationalizing disease: James Kilpatrick's Atlantic struggles with smallpox inoculation

Abstract

This essay uses the career of the inoculating physician James Kilpatrick as an example of how itinerant medical entrepreneurs navigated the various knowledge spaces of the British Atlantic World. Moving from Ireland to Charleston and finally to London, Kilpatrick's involvement with smallpox inoculation in the diverse peripheries of the British empire in the early eighteenth century provided him with the experience of controversy and experiment that paved the way for his ascent as a philosopher of inoculation within metropolitan and continental medical circles. This article focuses in particular on Kilpatrick's time in Charleston, an area rich in African and British migrants and then an important outpost of medical information and experimental inquiry within the interrelated medical circuits of the Atlantic world. This article shows how Kilpatrick leveraged the circuits of information that defined the town in order to promote the practice of inoculation and to create a medical and scientific persona that fit the expectations of Lowcountry audiences. Kilpatrick's efforts to promote inoculation in Charleston ultimately failed, but he put his colonial experiences to work in the service of building a metropolitan identity, traveling to London and publishing a pamphlet on the practice of inoculation in Charleston. This paper argues that it was experiences of controversy and failure on the British periphery that taught individuals such as Kilpatrick how to establish their authority as they navigated the medical cultures of the Atlantic world.

Keywords:

• smallpox
• inoculation
• medicine
• print
• Charleston
• slavery
• London

Acknowledgements

The author would like to thank Philip Morgan, Toby Ditz, Justin Roberts, and David Schley for their thoughtful comments on this essay. She also thanks the anonymous reviewers of Atlantic Studies for their helpful suggestions, as well as the participants at the 2009 International Seminar on the History of the Atlantic World at Harvard University, whose comments were invaluable in shaping the article.

Notes

1. See “London Frigate.”

2. Though writers in the South Carolina Gazette (SCG) described the distemper as “epidemical” in mid July, by October of 1738 it had nearly died out as the newspaper reported that it was then “found to be in only 10 houses.” SCG, October 5, 1738.

3. These numbers are derived from “Extract of a Letter.”

4. Throughout the course of his career, Kilpatrick appeared in print alternatively as Kilpatrick, Killpatrick, and Kirkpatrick. For the sake of clarity, this essay uses his name Kilpatrick throughout. In the citations, however, I use the spelling of his name as it corresponds with each particular work.

5. We know that Kilpatrick authored the essay that appeared in the 7 June and 15 June 1738 editions of the Gazette because these passages were reprinted nearly verbatim in his Essay on Inoculation. It is uncertain whether Kilpatrick authored all of the other essays or short submissions that appeared in the Gazette in support of inoculation, particularly the 6 and 20 July and 10 August 1738 submissions, which are cited in the following discussion. Thus, when discussing essays with uncertain authorship, I use the term “Kilpatrick and his allies,” with the caveat that while Kilpatrick may not in fact be the author of these essays, they were written by either Kilpatrick or others supportive of his ambitions to promote inoculation.

6. For the professionalization of medicine in colonial South Carolina over the course of the eighteenth century, see Sydenham, “Practitioner and Patient.”

7. Smallpox inoculation was first banned in Charleston in 1738. During a subsequent smallpox outbreak in 1760, smallpox inoculation was banned again in Charleston and adjacent parishes as part of a general statute aimed at preventing the spread of the distemper in the colony. In 1768, lawmakers extended the 1760 Act banning smallpox inoculation for an additional seven years. For the 1738 Act, see Cooper and McCord, Statutes at Large, 3: 513–7; for the Act of 1760 and its 1768 extension, see Cooper and McCord, Statutes at Large, 4: 106–9, 294–5.

8. Kirkpatrick, Essay on Inoculation, 30–1.

9. SCG, May 25, 1738.

10. See Duffy, Epidemics in Colonial America, 16–112; Minardi, “Boston Inoculation Controversy”; Stewart, “Edge of Utility”; Stidstone Gronim, “Imagining Inoculation”; and Van De Wetering, “Reconstruction.”

11. The literature incorporating the Atlantic world in the analysis of early modern science and medicine is large and rapidly expanding. A good overview is the edited collection by Delbourgo and Dew, Science and Empire. Other significant works that point to the importance of early modern colonies as players in the history of early modern science and medicine include: Cañizares-Esguerra, How to Write; Murphy, “Portals of Nature”; Safier, Measuring the New World; and Schiebinger, Plants and Empire.

12. Fairly little is known about Kilpatrick prior to his arrival in Charleston. In Ireland, Kilpatrick attempted to practice medicine in Irish towns. He later matriculated in a philosophical course at the University of Edinburgh in 1708, but departed without completing his degree. After the prohibition of inoculation in Charleston, Kilpatrick was appointed as a physician for General Oglethorpe's expedition against the Spanish. Kilpatrick departed South Carolina around 1740 for St Augustine, Florida. Kilpatrick later traveled to the British Isles under the auspices of Admiral Charles Thomson of the West Indies, arriving in London around 1743. See Matthew and Harrison, Oxford Dictionary of National Biography, s.v. “Kirkpatrick, James.”

13. Outside of private patronage, the colony officially recognized Kilpatrick's medical competence – he was employed by the St Philips Church Hospital to attend the poor. See Waring, History of Medicine, 204.

14. David Shields discusses the Dale and Kilpatrick rivalry at length. See Shields, Civil Tongues, 281–95.

15. At some point prior to 1754 Kilpatrick obtained an MD, presumably from Edinburgh, as the title appeared after his name in The Analysis of Inoculation's frontispiece.

16. In casting Kilpatrick as someone who moves between different zones of authority and transforms from a Creole empiric to a medical philosopher, I am indebted to the recent literature on go-betweens, specifically Delbourgo's chapter, “Fugitive Colours,” in Schaffer et al., Brokered World. My interpretation of Kilpatrick, however, departs from Delbourgo's discussion of Bancroft. Unlike Bancroft, Kilpatrick did not remake himself within the imperial center by identifying completely as a resident outsider. Instead, the formation of Kilpatrick's metropolitan scientific persona was dialectic, the result of both his participation in debates and controversy in the Lowcountry and his familiarity with metropolitan medical genres and discourses. In addition, my argument stresses Kilpatrick's deliberate transformation of the basis of his knowledge at different points in his career, a strategy that allowed him to tailor his epistemic claims according to the expectations of different audiences.

17. Cooper and McCord, Statutes at Large, 2: 382–3.

18. Barbados implemented the first maritime quarantine law in the British colonies in 1647 and Massachusetts followed with a general land and maritime quarantine law in 1701. See Tandy, “Local Quarantine.”

19. See Ordahl Kupperman, “Fear of Hot Climates.”

20. SCG, June 8, 1738.

21. Newspaper print came to the colony in 1732. In early 1733, Lewis Timothy became the colony's official printer and editor of the newspaper. Lewis continued to operate the press until his death in late 1738, when his wife, Elizabeth Timothy, assumed control over the newspaper and the press. Although the colophon and other pamphlets produced in the colony announced as early as 1739 that they were printed by Peter Timothy, the then 13-year-old son of Lewis and Elizabeth, Peter, did not take over the Gazette and the printing office until 1746. For more on the various printers of the Gazette, see Frasca, Benjamin Franklin's Printing Network, 64–77.

22. Prior to 1738, the Gazette's printers articulated in prefaces a specific vision of the rational public they believed the newspaper was creating. See, for example, SCG, February 19, 1732.

23. The commentaries and essays addressing inoculation appeared in the SCG on the following dates in 1738: Thursday 1, 8, 15, and 29 June; 6, 13, 20, and 27 July; 3, 10, 17, 24, and 31 August; and 14 September.

24. See Seibels, “Thomas Dale.”

25. Shields, Civil Tongues, 281.

26. Kilpatrick instigated the battle with his publication of a pamphlet titled The Case of Miss Mary Roche, Who Was Inoculated June 28, 1738. Dale, in response, published The Case of Miss Mary Roche, More Fairly Related. Responding to Dale's formal accusations in print, Kilpatrick published A Full and Clear Reply to Doct. Thomas Dale (Charlestown, 1739). The Case of Miss Mary Roche, Who Was Inoculated June 28, 1738 is no longer extant, but it was likely published soon after the death of Roche. In October of 1738, Dale's pamphlet, The Case of Miss Mary Roche, More Fairly Related (Charleston, 1738), was advertised as for sale in the Gazette. In January of 1739, the Gazette announced the availability of Kilpatrick's second pamphlet, A Full and Clear Reply to Doct. Thomas Dale. In response to A Full and Clear Reply, Dale threatened to publish a sarcastic rejoinder entitled The Puff; or A Proper Reply to Skimmington's Last Crudities, which was announced in the same issue of the Gazette as A Full and Clear Reply. Scholars have questioned, however, whether Dale's Puff was ever published, beyond its announcement in the newspaper. For the announcements of Dale's and Kilpatrick's pamphlets, see SCG, October 12, 1738 and January 15, 1739.

27. For more on the body as a site of interpretation and contest among laypeople and experts in the Anglo-American world, see Brown, Foul Bodies, 1–14, 58–96, and Moore Lindman and Liste Tarter, Center of Wonders.

28. SCG, June 1, 1738.

29. SCG, June 15, 1738.

30. Providential thought was popular in many regions of early America. On the prominence of providential thought in colonial New England, see Hall, Worlds of Wonder; on providential thought in the colonial tidewater, see Murphy, “Prodigies and Portents.”

31. SCG, August 3, 1738.

32. SCG, June 29, 1738.

33. On the role of prudential wisdom in constituting medical authority, see Shapin, “Trusting George Cheyene.”

34. SCG, June 8, 1738. Kilpatrick had lost his youngest son to natural smallpox and he subsequently inoculated the rest of his children. His discussion of parents who grappled with the perils of natural and inoculated smallpox thus referenced his own experience and potentially augmented the epistemological weight of the inoculation of his remaining family members.

35. SCG, June 15, 1738.

36. The Royal Society's journal, Philosophical Transactions, for example, published information from physician correspondents on the barbaric methods of artificially inducing smallpox found in communities living in the so-called “Celtic Fringe.” See Williams, “Part of a Letter” and “Part of Two Letters,” and Wright, “A Letter.”

37. SCG, June 15, 1738.

38. See Minardi, “Boston Inoculation Controversy,” 54, 72–4.

39. On the skills required for the cultivation of rice and indigo, see Chaplin, Anxious Pursuit, 187–262. Max Edelson describes the personal qualities that Charleston's plantership pointed to in the cultivation of their scientific authority in his work Plantation Enterprise, 166–77.

40. On the spread of quantification in the early modern world, see Headrick, When Information, 59–63. For the popularity of quantification for tracking, recording, and predicting the weather, particularly within Anglo-American correspondence networks, see Golinski, British Weather.

41. The quantification and comparison of deaths from inoculated and natural smallpox, for example, had become evidence for debate over inoculation's safety in Boston's controversy. See Cline Cohen, Calculating People, 81–115. In London, the work of James Jurin, an inoculating physician and member of the Royal Society, popularized quantification as an instrument of medical prediction. Jurin's tabulations compared deaths from inoculated and natural smallpox in Britain in order to show the low chances of dying from an inoculation. On James Jurin's project of quantifying the risk of inoculated smallpox, see Rusnock, Vital Accounts, 49–55, and notes 80 and 82 in this article.

42. SCG, June 8, 1738.

43. SCG, July 6, 1738.

44. In October, the Gazette published a comprehensive tabulation of the mortality of whites and blacks who had inoculated or natural smallpox over the course of the summer of 1738. The chart informed colonists that of the 647 whites who had caught smallpox naturally, some 151 had died. Of the 1028 blacks who had the distemper by natural causes, 138 had perished. This was contrasted with the 186 inoculated whites, of whom only 9 had died. For the 251 inoculated blacks, only 7 did not survive. See SCG, October 5, 1738.

45. For the essayist's attack on the accuracy of the quantitative evidence of inoculation's safety presented in the newspaper, see SCG, July 13, 1738; for the proponent's defense of his data, see SCG, July 20, 1738.

46. Roche's death was mentioned in the newspaper as an example of the perils of inoculation. See SCG, July 20, 1738.

47. See note 26 for the titles and publication dates of Dale's and Kilpatrick's pamphlets.

48. The two disputed specifically Kilpatrick's movement of Roche to a more insulated house, his implementation of a “cold regimen” and, against the advice of Dale, his refusal to blister the young patient. This discussion of what was claimed in the earlier pamphlets, which are no longer extant, is based on Kilpatrick's recapitulation of the principle arguments in Killpatrick, Full and Clear Reply, 3–4, 9–10.

49. Delbourgo, “Fugitive Colours,” 274.

50. Killpatrick, Full and Clear Reply, 37.

51. On human experimentation in medical testing and slaves as test subjects, see Schiebinger, “Human Experimentation.”

52. For more on the importance of disinterest as an epistemic virtue, particularly in the realm of scientific experiment in early modern England, see Shapin, Social History of Truth.

53. Killpatrick, Full and Clear Reply, 37.

54. Killpatrick, Full and Clear Reply, 38.

55. Killpatrick, Full and Clear Reply, 38.

56. On illness as an event involving family, household, and community in colonial New England, see Mutschler, “Province of Affliction.”

57. Sarah Blakeway, “the first person who admitted inoculation into her family in Charles-Town,” for example, had “her two daughters, and Miss Baker, a very young lady who boarded with her,” all inoculated on 21 May 1738. See Kirkpatrick, Essay on Inoculation, 44–5.

58. Physicians in Charleston acknowledged the role played by nurses in healing smallpox patients. Alexander Garden, a Lowcountry physician, noted in the Gazette on 11 May 1738 that when dealing with “the regular small-pox, it has been said by the ablest physicians that it may be safely trusted to the care of an experience'd nurse, unless some sudden alteration of symptoms requires better judgment.” Women's pivotal role in producing health in medieval and early modern Europe is discussed in Fissell, “Introduction.”

59. Although just as often as colonists credited Africans’ and Creoles’ knowledge, formal printed discussions of New World natural curiosities relegated the status of Africans to that of collectors. For examples of the role of Africans in the production of Enlightenment botanical knowledge and colonists’ ambivalence about Africans’ capacity for interpretation, see Murphy, “Portals of Nature,” chap. 3; Parrish, American Curiosity, chap. 7; and Schiebinger, Plants and Empire, chap. 3. In Charleston, slaves were skilled in caring for and interpreting those afflicted with smallpox. But as was the case with many natural histories, printed discussions of inoculated and natural smallpox and its effects often dismissed Africans’ interpretive authority, focusing instead on the difficulty that physicians encountered in reading Africans’ complexions. See, for example, Killpatrick, Full and Clear Reply, 37–8.

60. On the vital role of enslaved healers in British slave societies, see Morgan, Slave Counterpoint, 324–5, 626–7; Paugh, “Rationalizing Reproduction”; and Weaver, Medical Revolutionaries.

61. Sarah Blakeway, for example, announced in the Gazette that she had “a house wench that's a good nurse in the small-pox” for hire. Elizabeth Timothy also advertised “a very good likely negro wench this country born, fit for any house work … she has had the small-pox” for sale in the newspaper. See SCG, August 17, 1738 and September 21, 1738, respectively.

62. for a major mainland colonial city, Charleston was relatively small in terms of its physical geography compared to other mainland entrepôts such as Boston, Philadelphia, and New York. See McCusker and Menard, Economy of British America.

63. Unlike their Virginian counterparts, wealthy Lowcountry colonists lived in town rather than in the country. See Edelson, Plantation Enterprise, 126–65.

64. for another example of an urban environment that mediated early modern natural inquiry, particularly disputes among neighbors, artisans, and guilds, see Harkness, Jewel House.

65. Killpatrick, Full and Clear Reply, 5.

66. See Waring, “James Kilpatrick,” 304.

67. Killpatrick, Full and Clear Reply, 9.

68. Killpatrick, Full and Clear Reply, 9–10.

69. See Harmon, Trade and Privateering.

70. Cooper and McCord, Statutes at Large, 3: 513–15.

71. The movement of slaves between port and parish was a defining characteristic of South Carolina and slaves’ movement was perceived by whites as a constant, problematic, yet necessary feature of life in the Lowcountry. For colonists’ concern with mobile slaves, particularly runaways, see Meaders, “South Carolina Fugitives.”

72. Cooper and McCord, Statutes at Large, 3: 514.

73. Cooper and McCord, Statutes at Large, 3: 514.

74. Waring, “James Kilpatrick,” 301–8.

75. The first third of the book made causal arguments about the ways in which inoculation worked. The remainder of Analysis of Inoculation, a compendium of other physicians’ experiences with inoculation, functioned as a textbook of inoculation for practitioners that offered proof for Kilpatrick's theory, examining how the factors of age, constitution, and season interacted with the general principals he had laid out. The fact that Kilpatrick made causal arguments about the nature of smallpox suggests his aspirations to metropolitan philosophy, as the making of a causal argument was, according to Delbourgo, “a privilege denied Creole Americans and reserved to metropolitan intellectuals.” See Delbourgo, “Newtonian Slave Body” and Kirkpatrick, Analysis of Inoculation, 37–9.

76. Iatromechanical theory was a system of medicine based on Newton's mechanical view of the body. The hallmark of this theory was “a view of the blood as a congeries of particles in corpuscular agitation and of the body as a set of tubes, engines, and implements,” whose behavior followed the laws of physics. See Brown, “College of Physicians,” 12.

77. On the role of iatromechanism in differentiating professional physicians from empirics, see Shapin, “Trusting George Cheyene,” 269–70.

78. Analysis of Inoculation extended Kilpatrick's influence beyond London to continental medical circles. It was translated and reprinted in German (Leipzig, 1756), French (Paris, 1757), and Dutch (Rotterdam, 1735) within three years of its initial publication. On the reprinting of the Analysis and its citation among French theorists of smallpox inoculation, see Miller, Adoption of Smallpox Inoculation, 214–15, 301.

79. The inoculations of Lady Mary Montagu's daughter and other members of the royal family in 1721 galvanized professional interest and secured a modicum of public acceptance for the practice. In the years following, the Crown sanctioned inoculation experiments upon six Newgate prisoners and the results of these experiments were published in British newspapers. For the publicity and reports surrounding the Newgate prisoners, see Miller, Adoption of Smallpox Inoculation, 80–91.

80. See Jurin, “Account of the Remarkable Instance” and “Letter to the Learned Dr. Caleb-Cotes-Worth”; Nettleton, “Letter from Dr. Nettleton,” “Letter from the Same Learned,” and “Part of a Letter”; and Newman, “Way of Proceeding.” In addition to Philosophical Transactions, the literate public learned about inoculation from its other proponents, who had begun to publish the findings of colonial experimenters, such as Cotton Mather and Nathaniel Boylston, in independent pamphlets. See, for example, Boylston, An Historical Account; Douglass, Practical Essay; [Mather,] Account; and Neal, Narrative.

81. Opposition grew, especially in the wake of the well-publicized deaths of the Earl of Sunderland's son and Lord Bathurst's servant from inoculation. There are a large number of pamphlets opposing and supporting inoculation in Britain during the 1720s. For a general overview, see Miller, Adoption of Smallpox Inoculation, 99–133. One particularly influential pamphlet was William Wagstaffe's Letter to Dr. Friend, which was cited by Kilpatrick in the preface to his Essay on Inoculation.

82. For an example of the case studies accompanying Jurin's inoculation accounts, see Jurin, Account for the Success.

83. Subsequently, inoculating physicians describing the practice in print urged other physicians to account for these idiosyncrasies. Kirkpatrick's Analysis of Inoculation, for example, contained a chapter titled “Of the Most Eligible Time of Life, and Season of the Year, for Inoculation; and the Most Proper and Improper Subjects of It.” See Kirkpatrick, Analysis of Inoculation, sect. 8.

84. Daston and Galison, Objectivity, 19.

85. On the phenomenon of virtual witnessing, see Shapin and Schaeffer, Leviathan, 55–72.

86. Kilpatrick's explanation of inoculation's effects on the body in An Essay on Inoculation departed from a corpuscular theory of pox, which viewed the body as a machine, and posited that smallpox was caused by contagious particles which, in their interaction with the body, followed the laws of physics and thus interacted with all bodies in the same fashion. Kilpatrick would later incorporate this corpuscular view of smallpox and the mechanistic body into his explanation in Analysis of Inoculation. The various theories of smallpox's origins and inoculation's role in changing these ideas are discussed in Miller, Adoption of Smallpox Inoculation, chap. 9.

87. Kirkpatrick, Essay on Inoculation, 23.

88. On colonists’ belief that hot climates produced natural abundance, see Ordahl Kupperman, “Fear of Hot Climates,” 217.

89. Kirkpatrick, Essay on Inoculation, 25–6.

90. Kirkpatrick, Essay on Inoculation, 2.

91. Kirkpatrick, Essay on Inoculation, 31. Kilpatrick estimated that 800 individuals in Charleston had been inoculated, an amount that, he bragged, was “considerably short of the lowest estimate I have heard of.” Kirkpatrick, Essay on Inoculation, 34.

92. Kirkpatrick, Essay on Inoculation, 32.

93. On South Carolina, particularly its natural world, in London's print culture, see Smith, “South Carolina.”

94. Kirkpatrick, Essay on Inoculation, 30.