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The great leveller: humanity's struggle against infectious disease

Haygarth on smallpox

John Haygarth (1740-1827) was regarded as an outstanding medical practitioner. His far-sighted ideas on the control of smallpox were never put into practice, but they helped to lay the foundations for the public health reforms of the following century.

Chart showing names and observations on smallpox patientsRegister of the small-pox in ChesterAlthough he was an Anglican, his political and social sympathies lay with a network of Dissenting physicians, including Thomas Percival, James Currie, John Fothergill and John Coakley Lettsom. These men worked actively to improve public health, sanitation and conditions in factories and prisons and to make medical care more systematically available to the poor.

They tended to avoid many orthodox remedies like bleeding or purging and the rigidly humoural physiology on which they were based. Haygarth, like others in this group, had an expansive view of his responsibilities as a medical practitioner, and promoted education and savings banks for the poor.

Haygarth founded the Smallpox Society in Chester in 1778, to promote inoculation and to prevent contraction of the disease. In order to persuade poor families to accept the risks of inoculation and to abide by ‘rules of prevention’ and inspections, he offered monetary rewards. His methods caused the halving of deaths from smallpox in Chester by 1782, and his election to the Royal Society. In contrast to many other practitioners, Haygarth insisted that isolation of patients and washing of affected items be part of his regimen.

The reason for this was that pre-Jennerian smallpox inoculation often led to infection of those who had come into contact with the inoculated person but who had not themselves been inoculated. This applied particularly to the poor, who were usually not given the care before and after the inoculation which the wealthy could afford.  These measures, along with Jennerian vaccination, helped to eradicate smallpox in the 20th century.The image shown here of a register of smallpox cases in Chester in 1778, demonstrates his concern for the health of the poor, which was unusual among physicians at this time.

Haygarth’s efforts were only the beginning of his projected comprehensive national plan to eliminate the disease, which he publicised in a book published in 1793. According to his scheme, 500 surgeon or apothecary ‘inspectors’, one for each health district, would conduct house-to-house inspections in order to enforce rules of smallpox prevention. These would be supervised by a board of 50 physicians. Thanks to Haygarth’s unconcealed admiration for the French Revolution, these proposals had no immediate impact on public policy. However, their influence, and the proposals of such reformers as Thomas Beddoes, can be seen in the work of such figures as Sir John Simon in the following century.

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