Historical accounts of the practice of smallpox inoculation in the late eighteenth century invariably make a distinction between the widespread general inoculations carried out within small rural parishes and the partial inoculations in urban centres such as London, Manchester, Newcastle and Leeds. This distinction, moreover, is generally reinforced by concluding that the rural inoculation programmes were ‘highly effective’ or ‘successful’ in contrast with the urban inoculation schemes, which are often seen as ‘marginally effective’ or indeed ‘failing’. Success or failure tends to be judged by the impact which inoculation had upon reducing mortality from smallpox, but as a result of this demographic focus the motives behind the implementation of urban inoculation have been overlooked. My paper readjusts this balance by looking more closely at motives and by judging success in relation to aims. To achieve this I have taken a new approach towards the history of smallpox inoculation as a whole, and portray the basic idea of giving a person smallpox in order to confer subsequent immunity as being modified in the hands of different people throughout the course of the century. Hence it is possible to trace the development of inoculation from a folk practice carried out within the home with the aim of protecting individuals, to large-scale general inoculations of an entire community, which aimed to eradicate the disease altogether.