Early 18th century evidence synthesis

Abstract

Clarke has given an interesting synopsis of his involvement in the development of evidence synthesis and its continuing evolution.¹ He cites James Lind as an early example of this approach. I wish to draw attention to an even earlier and more wide ranging example. Between 1722 and 1729, the Royal Society collected data regarding the mortality of inoculated smallpox compared to that of the natural disease.² The results were published every year and culminated in a compilation of all available information in 1729.³ Included were the results from England, colonial Massachusetts, Hanover, Dublin and Pyrmont, a total of 1166 individuals inoculated by over 30 different operators. Of these, 26 had died while 3008 of the 18229 patients suffering from natural smallpox had died. This represented a reduction in mortality from about 1 in 6 to about 1 in 40. The author argued that this strongly supported the value of the new treatment of inoculation.

By compiling data from several sites and many operators, I believe that this paper should be considered a very early example of evidence synthesis as described by Clarke.

Footnotes

References

Clarke

. History of evidence synthesis to assess treatment effects: personal reflections on something very much alive. J R Soc Med 2016; 109: 154–163.

Boylston

. Defying providence: smallpox and the forgotten 18th century medical revolution, Create Space, 2012, 2012.

Scheuzer JG. An account of the success of inoculating the small-pox in Great Britain, for the years 1727 and 1728. London: J. Peele, 1729.