Part 2

The public, I am persuaded, must be sufficiently convinced from fact and demonstration, that Inoculation is the only means of preventing the mischiefs arising from the Small Pox.

In a former treatise I have laid down a plan for an effectual method of general practice, by which the spreading of the natural Small Pox will be prevented, and the cure of the inoculated rendered as easy and safe as possible to the patient.

I have therefore nothing more to add but my wishes, that the empire of Russia may meet with the utmost success from this discovery, under the reign of so illustrious and beneficent a Sovereign.

┌──────┬────────────┬───────────┬─────────────┐ │Years.│General List│Deaths from│ Under two │ │ │ of Deaths. │ Small Pox.│Years of Age.│ ├──────┼────────────┼───────────┼─────────────┤ │ 1734│ 26062│ 2688│ 10752│ │ 35│ 23538│ 1594│ 9672│ │ 36│ 27581│ 3014│ 10580│ │ 37│ 27823│ 2084│ 10054│ │ 38│ 25825│ 1590│ 9600│ │ 39│ │ │ │ │ 1740│ 30811│ 2725│ 10765│ │ 41│ 32169│ 1977│ 10456│ │ 42│ 27483│ 1429│ 9030│ │ 43│ 25200│ 2029│ 8621│ │ 44│ 20606│ 1633│ 7394│ │ 45│ 21296│ 1206│ 7689│ │ 46│ 28157│ 3236│ 9503│ │ 47│ 25494│ 1380│ 8741│ │ 48│ 23869│ 1789│ 7637│ │ 49│ 25516│ 2625│ 8504│ │ 1750│ 23727│ 1229│ 8204│ │ 51│ 21028│ 998│ 7483│ │ 52│ 20485│ 3538│ 8239│ │ 53│ 19276│ 774│ 7892│ │ 54│ 22696│ 2359│ 8115│ │ 55│ 21917│ 1988│ 7803│ │ 56│ 20872│ 1608│ 7466│ │ 57│ 21313│ 3296│ 7095│ │ 58│ 17576│ 1273│ 5971│ │ 59│ 19604│ 2596│ 6905│ │ 1760│ 19830│ 2187│ 6838│ │ 61│ 21063│ 1525│ 7699│ │ 62│ 26326│ 2743│ 8372│ │ 63│ │ │ │ │ 64│ 23202│ 2382│ 7637│ │ 65│ 23230│ 2498│ 8073│ │ 66│ 23911│ 2334│ 8035│ │ 67│ 22612│ 2188│ 7668│ ├──────┼────────────┼───────────┼─────────────┤ │ │ 760098│ 66515│ 268529│ └──────┴────────────┴───────────┴─────────────┘

An objection to the practice of Inoculation considered.

From the time that Inoculation was introduced into this country one may date the opposition to its practice; many learned and ingenious men soon entered the field against it, and were encountered by others of equal abilities in its defence. The questions were warmly agitated, and in a short time foreigners of great name became authors on both sides. But the strength of argument on the part of the defenders of Inoculation, supported by the good success of the practice, hath almost silenced opposition; and the concurrence of the courts of Petersburg, Vienna, and France, who have submitted to the operation, and by their illustrious examples encouraged its progress in their dominions, will probably close the dispute in its favour.

One objection alone seems not to have been satisfactorily removed, which, although it does not relate to the safety or health of the patient, is yet of great importance to the community, and well deserves the most attentive consideration.

You have, say the objectors, produced accurate and satisfactory accounts and calculations of the alarming proportion of deaths that happen from the natural Small Pox, and also proved, that the loss sustained under Inoculation is inconsiderable. But admitting what you have advanced to be true, whence comes it that the same Bills of Mortality to which you appeal, prove also a certain increase instead of a diminution of deaths from the Small Pox, and that for such a series of years as to leave no room to dispute the fact? does it not naturally follow, that though almost the whole number of the inoculated recover, the disease must have been spread by their means, and a greater proportion having taken the natural disease, a consequent greater loss has been sustained by the public? If the above is admitted, it will be difficult to exculpate Inoculation from having been hurtful to society[2].

Footnote 2:

Extract from the Bills of Mortality, and a continuation of the estimate from page 19.

│ Total of │ Small │ Under 2 │ │ Deaths. │ Pox. │ Years. │ ──────┼──────────┼───────┼─────────┼──────────────────────── 1768 │ 23639 │ 3028 │ 8229 │ Total Deaths 178807 69 │ 21847 │ 1968 │ 8016 │ Under 2 Years 63056 70 │ 22434 │ 1986 │ 7994 │ ────── 71 │ 21780 │ 1660 │ 7617 │ 18821) 115751 (6 72 │ 26053 │ 3992 │ 9112 │ 2825 73 │ 21656 │ 1039 │ 6850 │ 74 │ 20884 │ 2479 │ 7742 │ 75 │ 20514 │ 2669 │ 7496 │ ├──────────┼───────┼─────────┼──────────────────────── │ 178807 │ 18821 │ 63056 │ Totals.

By the above table it will be found, that with respect to the proportion of infants to the total number of deaths, there is still a surprising agreement with both the former estimates; the number of those under two years of age remains to be somewhat more than one-third of the whole.

But if we pursue the same method as before by subtracting the infants,

178807 63056 ────── the number will be 115751 ══════

which now amounts to somewhat more than one in six; whereas before it was about one in eight.

But if the eight years are divided, it will appear that the deaths from the Small Pox in the first four years are 8642; the medium for each of those years will be 2160.

For the last four years the numbers are 10179, the medium for each 2544; an increase that is truly alarming, and well deserving the attention of the public.—For the _present_ I shall forbear any remarks.

Several attempts have been made to obviate this objection, many of which I have perused; but consistent with my intention of brevity, and avoiding all controversy, I shall decline entering into particulars, or inserting any quotations from authors. It will be sufficient to say, that although the arguments advanced have been ingenious, and in some respects just, they do not in my apprehension remove the objection that has been mentioned.

Let us see then whether the practice may not be fairly chargeable with some blame; and this will appear more evidently, if we take a view of the usual conduct of families on such occasions; which however pertinent to the question, seems hitherto to have been avoided, or not attended to, by the several writers on the subject.

In London it has been the general custom for those who intend to inoculate, to take into account all the circumstances that may be material for the conveniency of their families and friends, and these being settled to their minds, few precautions are thought necessary respecting the security of others: what passes previous to the eruptive fever, does not claim our consideration, since it is universally allowed that no infection can be communicated before that time; but it is after this period the danger begins, and the disease may be spread by the intercourse of visitants, trades people, washerwomen, servants, and others, and in a mild state of the disease, the frequent excursions of the sick by way of airings, and often in hired carriages of various kinds, contribute greatly towards spreading the infection. It would perhaps be deemed a designed omission, if the inoculators were not also supposed to be of the number of those that contribute to spread the disease.

When all these circumstances are duly considered, surely it will be allowed, that the Small Pox is frequently caught from the inoculated; and let it be remembered, that whoever takes the disease from an inoculated patient, has himself the natural Small Pox, with all the circumstances of danger in respect to his own life, and of spreading the contagion to others.

I know it has been said, and even publicly declared, that the Small Pox from Inoculation is so mild, as scarcely to be infectious to others; but if this was true, how comes it that matter, taken from inoculated patients, conveys the distemper with equal certainty, as if it was taken from the natural Small Pox? is it not morally certain, that the effluvia partake of the same infectious quality? No physician of any experience, I am sure, will ever countenance such an opinion. But lest it should prevail, and do mischief among the ignorant and credulous, I think it incumbent on me to contradict so dangerous and unwarrantable an assertion.

In fact, it is certain that the Small Pox is infectious, in proportion to the number and malignity of the pustules; so far there is usually less danger from the artificial disease, than from the natural. But let not this presumption make any one remit their care, or abate their concern for the community; for I can assert from my own knowledge, that[3] many fatal instances have happened from the disease having been spread by the inoculated.

Footnote 3:

Vide note page 9.

Having considered the subject as fully as I am able, it shall be left to the consideration of the public without any comment; only entreating every family that may inoculate, to be extremely careful, and use every possible precaution to prevent spreading the infection during the illness, and to be also particularly attentive, that all furniture and cloaths be well aired. The persons concerned in inoculating should, on their parts, take great care that they do not contribute to the mischief.

If strict attention is paid to these particulars, it may be reasonably hoped, that the only remaining objection to the practice of Inoculation in London among persons of condition, may be much weakened, if not entirely removed.

On general and partial Inoculations in the country.

The preceding translated treatises having been calculated for Russia, which in many circumstances differs from England, and in particular that the will of the Sovereign there is most implicitly obeyed, cannot be expected to contain all that may be necessary to be considered, and attended to in this country.

Nevertheless, the general principle of the regulation, so far as it relates to public Inoculation in towns and villages, may be attended to, and of such places I mean to treat first, and of London and other populous places afterwards, for reasons that will be sufficiently evident in the sequel.

In order to be fully acquainted with the subject, it seems necessary to take into consideration, the mode of conducting this affair in the country, which I do not remember to have ever seen circumstantially published; those who have wrote on the subject, having for the most part contented themselves with representations of their success only.

In the county of Hertford, there have been two methods of public or general Inoculation, one to inoculate, at a low price, as many of the inhabitants of any small town or village, as could be persuaded to submit to it, and at the same time were able to pay, refusing all those who had it not in their power to procure the money demanded.

The other method has been, where the inhabitants of a town, or district, of all denominations, have agreed to be inoculated at the same time, the parish officers, or some neighbouring charitably disposed persons, having first promised to defray the expence, and provide subsistence for such of the poor, as were unable to pay for themselves.

The partial method first mentioned has been attended by much mischief, and sufficiently refuted the absurd opinion endeavoured to be propagated by interested persons, that inoculated persons do not communicate infection; innumerable are the instances which have happened of the disease being caught from the inoculated, and too evident to be denied; and so many of these have died, that an opinion not less absurd than the former prevails in Hertfordshire, that those who take the Small Pox from the inoculated rarely recover.

The method of inoculating every one in the same neighbourhood together has succeeded so happily, that it seems only necessary to determine what is the most reasonable and frugal way of conducting the business; and if joined to this consideration proper attention is paid to airing and cleansing the patients, their cloaths and habitations, as much as possible, from the power of infection, all the benefit that can be derived from general Inoculation will be effected, many valuable lives will be preserved to the community, and the inhabitants made happy, on being released from the apprehensions of a visit from this cruel disease.

As I can from considerable experience speak with some confidence on this subject, I shall proceed to relate the observations that have occurred to me. Assisted by my learned friend Dr. Ingenhouz and my two sons, I inoculated, at different times, the neighbouring parishes of East Berkhamsted, Hertingfordbury, Bayford, and the liberty of Brickenden; in each of these places the whole number of poor were inoculated, with the exception of those who were objectionable. I do not at present remember the exact number, I believe they might be more than 600; but know that they succeeded happily, though there were several very old persons, and women in different periods of gestation; and this mode of practice, as I have been informed, has been also used successfully by many others in different parts of England.

So far as has come to my knowledge, general Inoculations have hitherto been confined to small towns and villages; yet as the further extension is very much to be wished, it may not be improper to relate some particulars of what passed in Hertford, which is doubtless the largest, and most populous town, that has submitted to the experiment of inoculating at the same time the whole number of its inhabitants.

In a former publication, I gave an account of the occasion and success of a general Inoculation at this place; from that time the town was released from any apprehensions of the disease, until the year 1770, when it appeared again, and two or three having died, a few persons were inoculated, and excited an alarm. On this occasion, the poor in my neighbourhood flocked in numbers, beseeching me to extend to them the same charitable assistance, they had formerly experienced; having then my two sons with me to assist, I complied without hesitation.

Nothing shews the increase and state of population so clearly, as an experiment of this kind; we had then upwards of two hundred and fifty patients, some of whom were new inhabitants, but the rest consisted for the most part of very young children. Necessity has often produced useful discoveries; the Inoculation was begun on Midsummer-day, and though the weather proved very hot, I observed no inconvenience from it; they had the free use of air, and seemed as much benefited by it as at any other season of the year; and every one recovered.

In the year 1774 the disease appeared a third time; the same request was renewed, and with the same assistance afforded, the whole town was inoculated once more, and now the number amounted only to about one hundred and twenty; from that time we have heard nothing of Small Pox, and I verily believe, that within these ten years not six persons have died in Hertford of this disease; whereas before the practice was so generally adopted, the Small Pox has frequently been epidemic and destroyed a great number of the inhabitants, besides injuring the market and trade of the town for a considerable time.

The inferences one may fairly draw from these premises are, that in small towns or villages, if some are inoculated and others excluded, unless more precautions are used than may reasonably be apprehended, the consequence will be, that the disease will spread through the vicinage, and be fatal to many.

On the contrary, if by general consent a public Inoculation is agreed on, and the poor are supplied with necessaries, the happiest consequences may be reasonably expected; and further, the good effect of repeated general Inoculations in the town of Hertford demonstrate, that large towns may with great advantage avail themselves of the same means, and, by occasionally repeating the practice, be secured from the ravages of this justly dreaded disease.

On general and partial Inoculations in London, or other large and populous places.

It should be remarked, that what has hitherto been said relates to the conduct of this practice in villages and small towns, who are capable of uniting in a general plan for their common benefit. What I next propose to consider is, how far a practicable method can be adopted for general Inoculation in London, or in other large and populous places, where it is impossible to obtain the consent of all the inhabitants to be inoculated at one and the same time.

To be the more clearly understood, I desire the distinction in the former part of general and partial Inoculations may be remembered; and that by the first I mean, where the whole number of inhabitants of any town or place are inoculated at the same time, with the exception only of such as are not in a proper state of health, and those who may not chuse to submit to that mode of receiving the disease. By the second, where a part only of the inhabitants are inoculated, and the remainder left to take their chance of catching the disease from their inoculated neighbours.

The possibility of performing a general Inoculation on all the inhabitants of this city and suburbs at one time, will scarce bear a moment’s consideration, so many and so insuperable are the difficulties which would occur in a free country. I shall therefore decline entering upon the subject; and quitting all thoughts of a general practice, shall consider how far the inoculation of such poor persons as may make application for this purpose, can be complied with in London, consistent with the safety of themselves and others.

It may reasonably be presumed, that the greater number of these will be persons in narrow circumstances, or in a state of poverty, having nothing beforehand to support an illness, and yet the whole family who have not had the disease are to be inoculated. Whoever has visited the abodes of the poor in and about London, must allow the scene to be truly miserable; their habitations in close alleys, courts, and lanes, generally cold, dirty, and in great want of necessaries, even of bedding itself, a requisite of the greatest use in time of sickness; there are frequently several families under one roof; the men, if industrious, employed in daily labour, the women in washing and assisting in different families, or waiting at markets to carry little burdens as porters, and other unavoidable employments abroad. None of these can remit their occupations to attend the sick, without exposing their families to the distress which the want of the little money their industry earned would infallibly occasion; how or in what manner are patients to be nursed and supplied with food and necessaries during the illness, or who is to be relied on, that the medicines and diet enjoined by the person who attends, shall be regularly complied with?

Can any one be so inconsiderate as to bring disease into a family before healthy, without having first a reasonable expectation, that what their situation may require will certainly be provided? no one acquainted with the general temper of parish officers, will much depend on their assistance; on the contrary, they will most probably oppose the plan to the utmost of their endeavours, from an apprehension that the disease will be spread by these means, and occasion a consequent increase of expence to the parish.

But admitting these objections could be removed, one very important point, that more immediately respects the security of the patients and the public, should be attended to.

One great cause of the success that attends the present practice, is supposed to be the exposure of patients to fresh air; and the more alarming the symptoms, the greater is the necessity of administering this salutary relief. The poor who are inoculated in their own confined dwellings, with perhaps many in family, will assuredly require this reviving ventilation. They have no gardens, areas, or the convenience of carriages; are they to be carried or led about the streets when ill, to the terror and danger of the neighbourhood?

Having suggested a few of the difficulties that must ensue to the patients, it will not be improper to consider, how far the community will be likely to be affected by the practice.

To conduct the business of the Inoculation, some place or places centrically situated must be provided, at which the patients should assemble in order to be inoculated, and to which the several families of the sick must have recourse for the necessary medicines and directions during the distemper. To find one or more such places in the whole city, where the neighbourhood would suffer an office of this kind to be established, at which a great number of the poor must be assembled at noon-day, to receive an infectious and dangerous disease, is hardly possible to conceive; and if we consider that these persons must intermix with others, who are attending to procure the necessary medicines for their diseased families, and who have been obliged to make their way on foot through the public streets, from every quarter of the metropolis, in their infected apparel, the public danger becomes great and inevitable.

But should the poor who are proper to undergo the operation be inoculated, and means for their subsistence be provided, questions will arise respecting the fate of their neighbours, some of whom will be precluded from the same advantage, by being affected with other diseases, and others, who have strong prejudices against it, will be totally averse to the practice. Is it reasonable to bring the Small Pox to the doors of persons thus circumstanced, against their consent? one shudders at the thought of such an insult to humanity! But it is not only the immediate neighbours that would be endangered; to be well informed how far the mischief might be extended, one must take into account the situation and conduct of the patients, and it may safely be asserted from experience, that the following would be found to be a true representation.