John Williamson (), more commonly known by the nickname Johnnie Notions (, ) was a self-taught physician from Shetland, Scotland, who independently developed and administered an inoculation for smallpox to thousands of patients in Shetland during the late 18th century. Despite having only an elementary education and no formal medical background, the treatment he devised had an extremely high success rate, resulting in the immunisation of approximately 3,000 people and the saving of many lives, which had a significant effect on the demographics of the Shetland population at the time. He is reputed not to have lost a single patient.
While Notions administered his inoculation by at least the late 1780s to early 1790s (and likely much earlier), his method was largely overshadowed by the work of Edward Jenner, who pioneered the cowpox-based smallpox vaccine in 1796. Despite this, Notions and his inoculation were held with high regard with Shetlanders at the time, while the same could not be said for the cowpox-based vaccination introduced to Shetland in subsequent years.
Early life
John Williamson was born the son of Andrew Williamson; his mother's name is unknown. It has been suggested that the practice of naming John by his father's own surname, not adopting the patronymics system that was prevalent in Shetland at that time, indicates that his immediate family could be considered progressive and modern for the time. John Williamson's birth year is not known with any certainty – while his tombstone states he was born in 1740, some have suggested he was born as early as 1730. His place of birth is also not certain, but is thought to be Hamnavoe, Eshaness, in which the Williamson family lived from at least the late 1740s and possibly much earlier.
Smallpox inoculation
Background
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. 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. 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. 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; in Fetlar smallpox killed over 90 islanders of whom "most were married people".
Smallpox would continue to strike Shetland every 20 years, with epidemics occurring in 1700, 1720, 1740 and 1760. The 1720 epidemic hit Foula particularly hard, where it is said "there were scarcely people left to bury the dead", 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.
The 1740 epidemic required the extension of the Lerwick cemetery by , 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.
Technique
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), and bury it in the ground with camphor (which has anti-bacterial properties, preventing the matter from decomposing). Oral history indicates the matter was spread between glass sheets before burial. It would be kept in this state for up to 7 or 8 years to reduce its virulence before being administered to a patient. 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. 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), nor would he administer any other medicines during the period of infection and recovery.