The Mysterious Dr. Kilpatrick

In 1717, a man calling himself James Kilpatrick (sometimes spelled Killpatrick) arrived in Charleston, South Carolina. His exact date of birth is unknown but was sometime in the 1690s. He joined his uncle, David Kilpatrick, who already lived in the colony. 

James Kilpatrick claimed to be a native of Ireland. He set himself up as a doctor, a profession in demand in the feverish colony. He had studied medicine at the University of Edinburgh but had not completed the MD.  

His lack of a medical degree was not a significant problem in the young colony, which lacked any kind of licensing system. The medical "profession" in Charleston at the time included people with little formal medical training, or none at all.   

Kilpatrick achieved some financial success. St. Philip's Parish vestry appointed him visiting physician to the parish poor. He established a pharmacy in the early 1730s -- something that modern doctors cannot do. 

In 1727 he wed Elizabeth Hepworth, an heiress and the daughter of the secretary of the colony. They were married at St. Philip's Church. A few years later he received a joint grant of more than 200 acres, and presumably engaged in a bit of rice planting. 

During Charleston's smallpox epidemic in 1738 Kilpatrick was one of the first doctors to employ the practise of inoculation. One of his children had died of the disease, and he decided to inoculate the rest of his family. He then inoculated several hundred residents. 

He vigorously defended his use of the procedure in the town's newspaper and in pamphlets. His efforts aroused controversy but enhanced his reputation in the long term. 

Upon the outbreak of war with Spain later that year -- the wonderfully named War of Jenkins' Ear -- he enlisted as ship's surgeon. He accompanied General James Oglethorpe's failed expedition in 1740 against St. Augustine, the Spanish stronghold in Florida. [Image: James Oglethorpe]

Around 1742, Kilpatrick moved to London with his wife and children. He established himself in medical practise and completed an MD from Edinburgh. Mysteriously, he also changed his name from Kilpatrick to Kirkpatrick.  

Why did he change his name? An old argument is that he decided that a name that began with "Kill" was not a good one for a doctor. That may be, but there is a more compelling reason: Kirkpatrick was his real name. 

That raises another question: Why did he change it to Kilpatrick on coming to South Carolina? The answer lies in British politics in the early 18th century. The Kirkpatricks were a Scots family who backed the wrong side in the Jacobite Rebellion of 1715.

The aim of the rebellion, and a couple more that followed, was to place the Catholic Stuart claimant "James III" (The Old Pretender) on the British throne, in place of the Hanoverian George I, who had just arrived from Germany.

The rebellion failed. People who had supported it, or were even suspect, were denounced as rebels. Many fled or tried to change their identity. James Kirkpatrick seems to have done both. 

He claimed to have been born in Ireland. Perhaps he was. But his family was Scottish, and he may have been born in Scotland. He attended Edinburgh University shortly before the 1715 Jacobite Rebellion. 

Did he take part in it? Possibly, or perhaps he was assumed to have done so because others in his family did. In any case, the political danger may have made a change of name seem like a good idea. The same goes for his migration to South Carolina. In a frontier colony, it was easier bury one's past and start afresh. The colony's promoters welcomed white men to a place where enslaved Africans already made up a majority of the population.  

When Kilpatrick changed his name back to Kirkpatrick, nearly 30 years had passed since the rebellion in which he may have been involved. Another, and more serious Jacobite rebellion took place in 1745, but no one could argue that he had taken any part in that. In any case, the Jacobite threat ended with the defeat of the army of "Bonnie Prince Charlie" at Culloden in April 1746. It was the last battle fought on British soil. [Image: Culloden]

 

Moreover, while in South Carolina, he had demonstrated his loyalty to the British government by serving as a naval surgeon in the Oglethorpe Expedition to St. Augustine. 

After arriving in London, he published an account of the 1738 smallpox epidemic in Charleston, highlighting the success of inoculation in the epidemic and his own role within it. 

When a smallpox epidemic broke out in London in 1746, Kirkpatrick helped found the innovative Smallpox and Inoculation Hospital, believed to be the first in Europe to specialize in that area. It provided free treatment to the working class. [Image: Smallpox and Inoculation Hospital,  Coldbath Fields, London]

Kirkpatrick collaborated on the hospital project with Isaac Maddox, Bishop of Worcester. Maddox later helped him to publish The Analysis of Inoculation (1754), a treatise on its history, theories, and practise. The book was translated into several languages and gained him a reputation as an expert on the subject. 

In the Analysis, he claimed to have revived inoculation in Britain after it had fallen into disuse. This was exaggeration, but he did help to popularize it, especially in France and the Continent. He inoculated members of the French and British aristocracies. 

Kilpatrick/Kirkpatrick harbored poetic as well as medical ambitions. He used them to celebrate the maritime and naval achievements of the British Empire, in a long poem entitled The Sea-Piece. He had composed it, he said, in South Carolina between 1717 and 1738. He published it in London in 1750. 

He praised the works of Alexander Pope, whom he called the poetic lord of the British empire. He wrote several poems commending and defending Pope and an elegy on Pope after his death in 1744. 

Kirkpatrick died in London in 1770. His son James became a high-ranking officer in the British East India Company. He was known as the "Handsome Colonel." Two of the colonel's sons, William and James Achilles Kirkpatrick, also attained high rank in the Company. 

James married an Indian princess in Hyderabad. The marriage ended in tragedy; a story superbly told by William Dalrymple in White Mughals.  

Further Reading: 

James Kilpatrick, An Essay on the Small-Pox Being Brought Into South Carolina in the Year 1738. (London, 1743)

James Kirkpatrick, The Analysis of Inoculation. (London, 1754). 

Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry. (New York and Cambridge: 2011, 2014)

William Dalrymple, White Mughals. (London, 2002)

David S. Shields, Oracles of Empire: Poetry, Politics, and Commerce in British America, 1690-1750. (Chicago: The University of Chicago Press,1990)

 

Smallpox Inoculation in Charleston, South Carolina, Part One: 1738

Few people may be aware that Charleston, South Carolina was an early western pioneer in the use of inoculation to prevent death from smallpox. 

Inoculation for smallpox was not vaccination but a kind of proto-vaccination. It involved infecting people with the actual disease, usually by placing matter from smallpox pustules in a small incision in the skin. It was done in hopes of producing a mild case and subsequent immunity. It was the inspiration for today's vaccines. [Image: Inoculating for the Smallpox, 18th century]

Inoculation was essentially unknown in the West at the beginning of the 18th century. It had been practised in the Ottoman Empire and in parts of Africa for some time. Shortly before 1720 knowledge of the procedure arrived in England and in New England, most famously via an English aristocrat, Lady Mary Wortley Montagu, and an African, Onesimus, slave to Rev. Cotton Mather of Boston, Massachusetts. [See Lady Mary Wortley Montagu and Smallpox Inoculation]

The British were slow to adopt inoculation, partly because the disease was endemic, at least in the more densely populated areas. This meant that it was always present. Most people became infected as children. Those that survived were immune. It did not fundamentally disrupt the normal patterns of life and work.

Moreover, inoculation was dangerous. It meant giving someone the disease, hopefully in a milder form. But sometimes, it killed or  disfigured the recipients. It could also spread the disease if the inoculated were not carefully isolated. They were contagious until they had passed through the disease. Many people demanded that inoculation be banned or at least strictly regulated, especially when the disease was not present in their communities.

There was also a religious objection. Many of the devout denounced it as an interference with Divine Providence: if God wanted you to have smallpox he would give it to you. Whether you lived or died was God's Will. 

That argument lost much of its power after a few decades, however. The 18th century was, after all, the Age of Enlightenment. A counter argument quickly developed, embraced by many religious leaders: Inoculation  was a gift from God. By the mid-18th century, some British inoculators were making substantial incomes from the practice.

One of the reasons for an increased uptake of inoculation in Britain (and somewhat later, on the Continent) was the success of the procedure in the British colonies in North America. 

The colonists were more receptive to inoculation than people in Britain and Europe. Ironically, in part this was because in the colonies smallpox was normally absent from their lives. It arrived in epidemic waves, generally about twenty or so years apart. 

This meant that whenever smallpox arrived, a large proportion of the population was vulnerable. Large numbers would become ill and many would die. 

Mortality rates were often 20 percent or higher. Survivors were often left with pock marked faces, and some became deaf or blind. Young women's marriage prospects could be blighted by the pocks. [Image: A severe case of smallpox, early 20th century]

These tragedies aside, economies and everyday life were severely disrupted by quarantines. These differences led to the colonies becoming a kind of experimental laboratory testing the efficacy of inoculation. 

The first such "experiment" took place during a smallpox epidemic in Boston in 1721. Mather, armed with knowledge from Onesimus and probably having read some accounts of its in Ottoman lands, convinced a local surgeon, Zabdiel Boylston, to try the method. 

Boylston inoculated 287 people. Six of them died, about 2 percent. That may sound terrible. But nearly 6000 contracted the natural disease, of which 844 died, or about 14 percent. Boylston published a famous account of his results, which emboldened others to employ inoculation, especially in the colonies. [Image: Title page of Boylston's Account, 1726]

One of the first places to do so was Charleston, South Carolina. During a minor outbreak in 1732, the South Carolina Gazette published an article describing inoculation. The author claimed that it was effective, but recommended against its use for concern that the inoculated could spread the disease. No one in Charleston seems to have adopted the procedure.

Six years later, another, much more severe outbreak struck Charleston. It began in May and appears to have spread from a newly arrived ship, the London Frigate. On this occasion, a local surgeon, Arthur Mowbray, began to inoculate. His action provoked a lively debate over inoculation, not just the prudence of doing so, but also the proper way of doing it. [image: Charleston Harbor, c.1770]

The South Carolina Gazette published letters by locals, mostly medical men, about inoculation. The doctors were divided. The paper's editor, Lewis Timothy, opposed the procedure as unproven and dangerous. The most vocal advocate of it was a feisty and somewhat mysterious surgeon, James Kilpatrick. 

He claimed to be from Ulster in Ireland, and he may have been born there around 1700, but he was a Scot. His real name was not Kilpatrick, but Kirkpatrick. His family had been implicated in Jacobite plots against the Hanoverian monarchy that had replaced the Stuart dynasty in 1714. 

He came to South Carolina in the early 1720s, possibly fearing prosecution, which may account for the name change. He had matriculated at the University of Edinburgh prior to his departure.

Kilpatrick wrote an account of inoculation after the 1738 epidemic in Charleston. He gave credit to Mowbray for having begun inoculation, and credit to himself for taking it up and defending it. There was a personal side to his account. One of his children died of smallpox in the early stages of the outbreak. He quickly inoculated the others and his wife.

During and after the epidemic Kilpatrick conducted a rancorous pamphlet duel with another local doctor, Thomas Dale, who accused him (and Mowbray) of spreading the epidemic through careless inoculation. Kilpatrick accused Dale of being ignorant of the disease and inoculating solely for profit. The dispute was not just a matter of income, but of professional rivalry and personal pride. It is likely that both men distorted the facts. 

Unfortunately, only one of the pamphlets has survived, by Kilpatrick, and his Essay on Inoculation (1743) is the only first-hand account of the epidemic. Nevertheless, Charlestonians who remembered the events decades later agreed on one thing: inoculation in 1738 had been a great success. 

Kilpatrick estimated that about 1 percent of the 800 to 1000 persons inoculated in Charleston in 1738 died. The population of the city was then about 6000. Lewis Timothy, a critic of inoculation, claimed that the death rate among the inoculated was closer to 3 percent. These figures are similar to those reported in Boston and other places within the empire around this time. 

These were excellent results, given that smallpox often produced mortality rates of 20 percent or higher. Among Native Americans, it was often much higher, because so few of them had ever been exposed to this Old World disease. In 1738 smallpox was estimated to have killed about 50 percent of the Catawba Nation. Differential immunities of this magnitude helped to cement European dominance of the Americas. 

Despite inoculation's success in 1738, the state assembly moved to restrict inoculation several months into the epidemic, by which time it was dying out. The rationale was that inoculation itself could spread the infection and keep the outbreak alive. The assembly did not prohibit it, but mandated that it could not be performed within two miles of Charleston. 

The motives behind this restriction were as much economic and military as medical. The epidemic had stifled trade for months due to strict quarantine and country peoples' fear of coming into town. 

Also, war had broken out with Spain that year, the War of Jenkins' Ear. The assemblymen feared that as long as cases of smallpox were present in Charleston, they could not rely on country folk to come to the city's defense in case of a Spanish attack.

By the end of 1738, smallpox had retreated from Charleston. It would not return for more than twenty years, once again during war. On this occasion, the demand for inoculation would be much greater, and the opposition much less. The procedure had proved its value. [Continued in Part Two: ]

P.S. James Kilpatrick moved to London in the early 1740s, where he published his Essay on Inoculation about the 1738 epidemic. He established a successful practice in inoculation and obtained his M.D, from Edinburgh University. He published a much longer work on the procedure, An Analysis of Inoculation, in 1754, under the name Kirkpatrick. He died in 1771. One of his sons had a successful career in the British East India Company, and rose to the rank of Colonel. Two of his sons also became ranking officers in the company, and one of them, James Achilles, married an Indian princess. Their story can be followed in William Dalrymple's magnificent and highly informative White Mughals (London, 2002) [Image: James Achilles Kirkpatrick, the grandson of James Kilpatrick/Kirkpatrick of Charleston.

Sources: All the sources for this post may be found in Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (New York and Cambridge: 2011, 2014)

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Slavery, Disease, and Suffering

“offers an unparalleled look at the early history of Charleston and the economic region of which it was a part. Focusing on the close relationship between the pursuit of wealth and the risk of death, McCandless forces readers to reassess the economic, demographic, and moral foundations of South Carolina’s past. A riveting, if sobering, work by a masterful historian.”  
Peter Coclanis, University of North Carolina – Chapel Hill, author of Shadow of a Dream

“compassionate, compelling history ... Peter McCandless writes with wisdom and humanity, inspiring us not just to think differently about the past, but also to ask how similar forces are shaping the world today.”  
Elizabeth Fenn, Duke University, author of Pox Americana

“This meticulously researched and smoothly written book provides the first comprehensive history of the Carolina lowcountry’s ferocious disease environment. It navigates masterfully among social, economic, cultural, religious, demographic, military, and medical history, from the 1670s to the Civil War, exploring every aspect of the deadly struggles with malaria, yellow fever, and smallpox.” 
J. R. McNeill, Georgetown University, author of Mosquito Empires

“McCandless does more than provide sound and accessible medical history. He adds an important social and economic twist. The knot that he deftly ties between slavery, disease, and the Lowcountry environment has devastating and lasting implications that stretch far beyond South Carolina. McCandless is quick to absorb and ponder the irony that the continent’s least healthy place swiftly became its wealthiest. Rice, indigo, and then cotton yielded huge profits to a tiny minority of intermarried merchant and planter families, while “most of the population experienced pestilence without prosperity.” Peter Wood, Duke University, author of Black Majority. 

In Slavery, Disease, and Suffering in the Southern Lowcountry, Peter McCandless paints a startling portrait of the troubled and troubling history of disease in the South of the United States from the colonial period to the first half of the nineteenth century....Due to his impressive grasp of a variety of sources, McCandless uncovers the problematic reporting of disease and the convoluted ways that Southern physicians often misdiagnosed illness. This analytical move elevates his book from a mere survey of sickness in the South to a sophisticated evaluation of the representation of disease; Slavery, Disease, and Suffering in the Southern Lowcountry can thus serve as a primer on how to research the history of public health before the microbiological revolution." Jim Downs, Connecticut College, author of Sick from Freedom: African American Illness and Suffering During the Civil War and Reconstruction 

Link: Slavery, Disease, and Suffering