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.
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.
[10] 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.
[14] The 1720 epidemic hit Foula particularly hard, where it is said "there were scarcely people left to bury the dead",[15] 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.
[10] The 1740 epidemic required the extension of the Lerwick cemetery by 50 feet (15 m), 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.
He would then dry it using peat smoke (which was believed to lessen the virus's virulence),[16] and bury it in the ground with camphor[17] (which has anti-bacterial properties, preventing the matter from decomposing).
[17] 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),[19] nor would he administer any other medicines during the period of infection and recovery.
[17] Notions' inoculation bears a strong similarity to the Suttonian method, which also involved the introduction of weakened smallpox matter into the patient through intradermal means.
Reverend Andrew Dishington, the parish minister for Mid and South Yell, attested to the success of Notions' treatment:Unassisted by education, and unfettered by the rules of art, he stands unrivalled in this business.
[17]In Arthur Edmondston's account, he commented that Notions' work:...met with such unexampled success in his practice, that were I not able to bear testimony to its truth, I should myself be disposed to be sceptical on the subject.
[23] ...Had every practitioner been as uniformly successful in the disease as he was, the small-pox might have been banished from the face of the earth, without injuring the system, or leaving any doubt as to the fact.
Also, it is possible that Notions' treatment may have caused some patients such as Lowrie Tulloch of Burravoe, Yell, or James Park of Fetlar to have been blinded.