Building a Medical Practice: Smallpox, Inoculation, and Community, 1775–83

The usual story told about smallpox in Revolutionary America is one of public health threat: epidemics attacking urban populations and undermining military strength. While smallpox remained a frightening and dangerous disease, in this paper I tell a different story: how smallpox inoculation helped physicians build their practices and enabled rural communities to protect themselves. Eighteenth-century America medical practice is often seen as the chaotic prelude to the nineteenth and twentieth century professionalization of medicine. I move away from this professionalization narrative and examine how medical practices worked, or what constituted the business of medicine, in the late eighteenth century. In this paper I examine the role smallpox played in the development of Dr. John Archer’s rural medical practice in Harford County, Maryland during the Revolutionary War. John Archer (1741-1810) was a founding member of the Medical and Chirurgical Society of Maryland, and involved in county, state, and national politics throughout his career. His patients spanned a wide swath of society, including gentlemen and paupers, slaves, women, and children. Using ledgers, casebooks, and letters, I show how Archer used the procedure of smallpox inoculation to attract new patients, and cement relationships with families already under his care. A careful look at the geography and timing of inoculation reveals that Archer’s community can be understood to have protected itself against the dread disease by adopting inoculation in targeted ways. Inoculation was, thus, a technology used by rural communities to protect them from disease and by medical men to build their practices in a competitive medical marketplace.