If the language of eighteenth-century figures is to be relied on, a surprising state of affairs is revealed. By the end of the third decade the contentious novelty inoculation had virtually died out, while the number of deaths from smallpox, as recorded in the London bills of mortality, remained at a steady level. Why had inoculation fallen out of favour? In 1749 the physician Frewen looked back over its vicissitudes during the period:

These questions, Frewen commented, had been answered long ago ‘to the satisfaction of men of learning and candour’, but not, as he avoided saying, to that of the common sort of people, mainly because they were neither consulted nor offered the opportunity to try out the new discovery for themselves. Access to inoculation was and remained for many years the expensive privilege of the well-off, with the corollary pointed out in the early days of controversy by Isaac Massey, apothecary and uncle of the Revd Edmund, in a scornful dismissal of Jurin's conclusions concerning the relative dangers of natural smallpox and the inoculated variety. Those inoculated were, in accordance with Jurin's advice to medical practitioners, selected almost exclusively from the healthy, well-cared-for children of the upper classes, with all the implied built-in statistical bias. ‘He forgets,’ Massey complained, ‘that the inoculated are picked lives. If that's fair: Hang fair!’

Several treatises published towards the middle of the century, when inoculation was recovering from a decade of unpopularity, showed how far in this, as in so much else, the faculty had found ways of improving on the system thought to be adequate by the old Greek women of Constantinople. The operation, in so far as it was carried out at all, had become a time-consuming and costly business.