Johnnie Notions

Shetland, being a relatively isolated community, was susceptible to outbreaks of smallpox throughout the 18th century that would spread through large proportions of the population due to a lack of immunity to the disease.[2] In 1700, an outbreak of smallpox arrived in Shetland when the son of a local man had visited mainland Britain, where he had contracted the disease and spread it upon his return to Shetland. An estimated one-third of Shetland's population died as the result of this epidemic.[11] The disease was subsequently referred to as "mortal pox", while the 1700 outbreak was used by those born around this time as a reference to calculate their age.[12] Some of the smaller islands of Shetland were particularly hard hit – Fair Isle had previously had between ten and twelve families, but is said to have lost two thirds of its population in the 1700 outbreak, leaving too few to effectively manage their fishing boats;[13] in Fetlar smallpox killed over 90 islanders of whom "most were married people".[2]

Smallpox would continue to strike Shetland every 20 years, with epidemics occurring in 1700, 1720, 1740 and 1760.[14] The 1720 epidemic hit Foula particularly hard, where it is said "there were scarcely people left to bury the dead",[15] whereas in Fetlar a certain amount of resistance is thought to have built up, as most of the 80 who died were under the age of 20.[10]

The 1740 epidemic required the extension of the Lerwick cemetery by 50 feet (15 m), while in Fetlar a further 120 people died – this was exacerbated by a hard frost lasting over a month that prevented the dead from being buried. Approximately one-third of Unst's population was killed by smallpox. It is likely that Notions himself caught smallpox as a child of about ten during this epidemic.[10]

Notions would first collect "matter" – i.e., smallpox pus. He would then dry it using peat smoke (which was believed to lessen the virus's virulence),[16] and bury it in the ground with camphor[17] (which has anti-bacterial properties, preventing the matter from decomposing).[16] Oral history indicates the matter was spread between glass sheets before burial.[18] It would be kept in this state for up to 7 or 8 years to reduce its virulence before being administered to a patient.[17] By using a knife (which Notions made himself) he would cut into the patient's arm intradermally (without drawing blood), insert a small amount of the inoculant, and immediately cover the incision with the patient's skin, before using a cabbage leaf as a plaster.[17] In contrast to contemporaneous quack doctors, Notions would not stipulate any particular resting conditions (such as "hot-treatment" – heating the ill patient in front of a fire, covering them with blankets and allowing them no fresh-air),[19] nor would he administer any other medicines during the period of infection and recovery.[17]

Notions' inoculation bears a strong similarity to the Suttonian method, which also involved the introduction of weakened smallpox matter into the patient through intradermal means. How Notions became aware of this method of inoculation is unclear – it may have been through written account, or through discussion with someone else aware of the technique, such as another physician or a member of the clergy.[16]

It is not known whether the success of the inoculation technique used by Notions was due to its ability to decrease the virulence of the smallpox matter, or to the shallow intradermal insertion of the inoculant.[20] The technique was highly successful and it and Notions was highly esteemed in Shetland.[21]

Notions was revered in contemporary accounts for the work he did. Reverend Andrew Dishington, the parish minister for Mid and South Yell, attested to the success of Notions' treatment:

Unassisted by education, and unfettered by the rules of art, he stands unrivalled in this business. Several thousands have been inoculated by him, and he has not lost a single patient. ...It is particularly remarkable, that there is not a single instance in his practice, where the infection has not taken place, and made its appearance at the usual time.[17]

In Arthur Edmondston's account, he commented that Notions' work:

...met with such unexampled success in his practice, that were I not able to bear testimony to its truth, I should myself be disposed to be sceptical on the subject.[22] ...Had every practitioner been as uniformly successful in the disease as he was, the small-pox might have been banished from the face of the earth, without injuring the system, or leaving any doubt as to the fact.[23]

Oral history recounts that Notions was able to save 16 of the 24 remaining inhabitants of Foula after an epidemic of smallpox struck there, and that he was "greatly honoured" for having saved their lives.[24]

It is not clear how many patients of Notions may have contracted secondary infections following inoculation. Also, it is possible that Notions' treatment may have caused some patients such as Lowrie Tulloch of Burravoe, Yell, or James Park of Fetlar to have been blinded. Notions is believed to have saved many more lives than he caused harm to.[21]