Part 3

The inoculated may be divided into two classes. One in whom the distemper is so mild as to admit the parties to go abroad; the other, where the number of pustules is so considerable as to confine the patients at home; by far the greater number will be of the first sort; and whatever orders may be given to the contrary, it will be impossible to restrain them from taking undue liberties; the children who are of an age for it will be found in the streets with their former playfellows, and the men and women who are able, will be endeavouring to get into their former employments to earn a little money, without regarding the injury they may occasion to others. The few who may be confined with a less favourable disease, will infect the house and their family, and the infection will be spread from the gossiping disposition of the poor, who are generally troublesome visitants, to their sick neighbours, and after all is over, the first sallying forth in their infected cloaths is certain to add to the mischief.

It is unnecessary to dwell any longer on the consequences of such a conduct to the residents in such alleys; but there are others who claim our regard.

Country people who are obliged to come to town to transact their business, and others who bring their families to visit relations, or to entertain them with the pleasures of the town, are generally under dreadful apprehensions of the Small Pox; how would their fears and danger be increased, if the poor were continually under inoculation?

Another thoughtless, but most useful race of men, are well entitled to our best endeavours for the preservation of their healths and lives: I mean, sailors and sea-faring men, of our own and other countries; it is well known that our shores, on both sides of the river, are continually crouded with these, during their stay in this country.

Many of them have not had the Small Pox, and their mode of living is the reverse of due preparation; if Inoculation should be practised in the houses of the poor, it cannot be doubted that many of these would catch this distemper?

Is it possible to reflect without horror on the situation of such of those unhappy fellows, who should fall ill of the Small Pox in the miserable lodgings they usually inhabit, perhaps without a friend to take the least care of them? or of the still more calamitous state of others, who being infected on shore should fall sick at sea, where neither medicine nor proper attendance can be had, and carry likewise with them in their unwashed cloaths, the fatal distemper into distant climates?

I have been informed, that a child who had received the infection was taken on board an East Indiaman many years ago. The disease was violent; the linen, &c. were put into a box, and carried to the Cape of Good Hope: it was sent on shore; the Small Pox immediately broke out in the place, and carried off vast numbers of the inhabitants.

In the foregoing pages, some of the objections to partial Inoculations of the poor in this city have been stated; but the possibility of extending the practice to any good purpose, even if those objections were removed, has not been taken notice of: to elucidate this point, which is certainly a material one, the following remarks are submitted to consideration.

The number of those who died of the Small Pox in each of the last four years, on an average is 2544. To suppose that one dies out of every six who have the natural distemper, will be allowed a moderate estimate: it follows then, that the number of those who have passed through the disease in each of the last four years will be 15,264. It will be impossible to determine how many may remain uninfected; but if we suppose that every year one out of eight who have not had the disease is seized with it, the remaining number who have not had the Small Pox will be 122,112; and it must be taken into account, that the annual recruits by births will probably be about 20,000, besides others that are continually arriving out of the country to seek employment.

To form a scheme, however beneficial to a few, that would probably spread the disease, and involve so great a number of others in a danger that they would otherwise be much less exposed to, is an object of great moment; and most certainly the Legislature ought first to be consulted.

Great liberty may be taken in our free state; but we ought not to endanger the public safety, because no legal provision is made against it.

Of an Hospital for Inoculation.

If the objections that have been noticed should be deemed of sufficient force to set aside all thoughts of partial Inoculations of the poor in London, what is to be done will next become the question? It would be cruel and unreasonable to refuse the benefit of this discovery to the necessitous, who on that very account are most intitled to our assistance; yet how to provide for them, consistent with the safety of their neighbours, seems difficult, though I hope not impracticable.

A desire to see some expedient for this purpose succeed, induces me to submit to the consideration of the public, a proposal that is in my apprehension liable to few objections, and would best answer the purpose.

It is to establish an Hospital for the purpose of Inoculation only.

I am aware that Hospitals have been stigmatized as unhealthy, from the idea that a number of sick persons confined together corrupt the air, and generate contagious putrid diseases. This charge has, I think, been inconsiderately made, so far as relates to Hospitals in and near this metropolis; but as it is no part of my undertaking to dispute the point, I shall confine myself to what concerns an Hospital for Inoculation, which, if every circumstance is duly attended to, will be as little unhealthy as any house in the kingdom.

Let us for a moment drop the offensive name of Hospital, and suppose a large house is provided in a healthy situation, with convenient and airy apartments for the reception of any given number of persons capable of being commodiously contained in it; that to be in a good state of health would be the necessary qualification on the admission of every person, and about three weeks the time of the residence; and that the disease they are to undergo is usually so mild, as to permit most of the patients to be abroad in the open air almost every day, and of a nature not to communicate any putrid injury to others, except its own specific poison. If to these circumstances we add, that the patients will in general be children and young persons, that their cloaths and apartments will be clean, and their food wholesome and such as is proper for their condition, surely one may boldly assert, that a family thus circumstanced will have the fairest prospect of enjoying good health.

Having endeavoured to remove the prejudice that is apt to accompany the idea of an Hospital so far as relates to health, I shall proceed to enumerate the advantages that will most probably be obtained by an institution of this kind; some of these have been already mentioned in the translation, and I shall take the liberty of introducing them again in this place, with little variation, as they relate to the subject.

One, and indeed no inconsiderable advantage to be derived from a plan of this sort will be, that all the patients being collected together in one house, the physician will be enabled to attend a great number at the same time in a proper manner, and can be particularly attentive to such as may more immediately require his assistance.

And it is of no small importance to those who are inoculated, that the necessary regulations in respect to regimen, as well as every other circumstance that requires the physician’s attention, will be there properly observed, and the necessary medicines always at hand, with an able person to direct the manner in which they ought to be administered.

There is likewise another advantage obtained by this method, that with proper caution the Small Pox will not be communicated to others in the natural way of infection.

It is also an encouraging circumstance, that an establishment of this sort will be attended with less expence, in several particulars, than any other Hospital.

One physician will be able to superintend the process of Inoculation in a very great number of patients, provided he is assisted by a resident apothecary to receive his instruction, and to be at hand to assist on extraordinary emergencies.

Few drugs or medicines will be wanted; the expence therefore on these articles will be very trifling.

Few attendants on the sick will be necessary, and not so much as one under the character of a nurse; for there will always be a sufficient number of patients in so good a state of health, as to be able to attend on those who may require assistance; and it should be one condition of their admittance, that they should be willing to assist others when able, as they would wish to be attended themselves when they stand in need of it; and if this injunction is complied with, it may be expected that there will be a sufficient number in a state of health to perform this office for one another. The doing the heavy and dirty part of the work, the care of the children, the attendance of those who may have the disease more severely, and the business of the kitchen, will doubtless require a proper number of healthy maid-servants.

In respect to diet, as it will be chiefly of the vegetable and least expensive kinds of food, this will be a very moderate article in the œconomy of such an establishment.

On the Hospitals at Pancras.

The Hospitals for Small Pox in the natural way and Inoculation were instituted in 1746, and have been supported by voluntary subscription.

These Hospitals consist of two houses at a sufficient distance from each other, and in airy situations.

That for preparing the patients for inoculation at Pancras contains 100 beds; and that for receiving them when the disease appears, and for admitting those who are seized with the Small Pox in the natural way, in Cold Bath Fields, 130 beds.

All who are destitute of friends or money and are attacked with this disease, or are desirous of being inoculated, if seven years old or upwards, are proper objects of this charity.

Patients in the natural way are received every day, if there is room for them; and to prevent the danger and expence of a disappointment, enquiry should be first made. Patients for Inoculation are also received every day at Pancras before nine in the morning.

Strangers are forbid to visit the patients.

Cloaths are provided for the patients, while their own cloaths are freed from infection before their discharge.

As the first outline of every attempt towards a new institution has for the most part been imperfect, it is not to be wondered at if the plan and regulations of these Hospitals should admit of improvements; and the following remarks will perhaps point out some regulations that deserve attention.

It is now near thirty years since the first establishment of this charity; at which time it was the received opinion that a strict regimen ought to be observed, and a course of medicine complied with, by way of preparing the most healthy previous to their Inoculation. It was also believed, that there was some risque of taking the natural infection injuriously at the time of being inoculated, and danger of accumulation by residing with others who had the disease; and the inoculators of that time who made use of infected thread and lint, sometimes failed infecting on the first trial, and in such case the patient would probably catch the natural distemper by cohabiting with the sick.

These opinions, it is presumed, joined with the design of admitting patients in the natural Small Pox, determined the first Governors to have two Hospitals; one, to contain all such who were actually undergoing the disease in either way, and in a state to infect others: the other to be appropriated to such only who were under preparation, or having been inoculated had as yet no appearance of the usual eruptive symptoms, and were not in a condition to infect one another. But these opinions have not been verified by experience; on the contrary, it has turned out that the precautions were not necessary. Experience assures us, that a person in good health may be safely inoculated without any preparation, and that all the regulations in respect to diet and the necessary course of medicine, may be sufficiently complied with in the week that intervenes between the operation and the commencement of the disease. With respect to a double infection, that is, by Inoculation and in the usual course of communication, or an accumulation of the distemper afterwards by living with those who are actually labouring under it, no ill consequence need be feared; for I am perfectly satisfied, that after Inoculation is effectually performed, no injury can be sustained by living with others in the most infectious state. And even if the first Inoculation should fail infecting (which if proper care is taken will scarce ever happen) the failure may be discovered on the third or fourth day, and the patient may be inoculated again; and even then, should there be a moral certainty that the natural infection has been taken, it will be in time to prevent any ill effects; the inoculated disease will as it were supercede and annihilate the former infection, and the patient have the Small Pox from Inoculation only.

I am aware that some apology is necessary on publishing opinions that may be deemed improbable in so laconic a manner; this is no place to pursue the subject: but I mean soon to support these assertions by relating certain facts on which they are founded. It is probable, that from a deliberate consideration of these circumstances, some considerable improvements may be made in the regulations of the Hospital.

A principal one should be, to quit the practice of bringing the inoculated patients to reside with those who have the natural disease; a circumstance that could not have been consented to but from the former mistaken opinions which have been noticed. A considerable advantage will also be gained to the œconomy of the Hospital, on account of the time of the patients residence being shortened; by which means a greater number may be inoculated at the same expence.

I hope to stand excused from having made these remarks here, as in the sequel I mean to propose an enlargement of the Hospital at Pancras.

Having taken notice of the most material articles that have occurred relative to this subject, I shall venture, though with much diffidence, to submit some outlines of an Hospital for Inoculation to the public, premising, that in respect to situation, the environs of London do not seem to afford a better spot than that on which the inoculating Hospital at Pancras is built, which, with the ground adjoining to it being four acres, is sufficient for the accommodation of any number of patients for the benefit of the air; in short, every local advantage would be there enjoyed in great perfection: the present building is not however capacious enough for such a purpose, but it may be enlarged, and the whole extent of ground ought to be walled in, to prevent all intercourse with others, or giving any offence to the public; and I have not the least doubt of the acquiescence and assistance of the present governors, to any scheme for the extension of this noble and useful charity, as they have, with a most distinguished application and disinterestedness, employed their best endeavours to promote the interest of the present establishment.

But previous to every other step, an application to Parliament for encouragement, and proper powers to carry this design into execution, seems necessary; for it will not be sufficient to open an Hospital for Inoculation, without offering something as an inducement to invite those who are proper objects to accept of the benefits intended. Amongst the lower classes of people in the metropolis, as well as in many other places, the voice of the generality is against Inoculation; prejudices are not easily removed; nor is it to be expected that the many will attend to the advantages that will result to their children, unless some present benefits were to be connected with them[4].

Footnote 4:

While the Empress was under Inoculation at Sarsco-celo, some of the poor of the adjoining village were also, on the encouragement she had given, inoculated.

I remember the Empress said to me, with that vivacity and liberality of sentiment for which she is remarkably distinguished, “If I was to order the poor of this neighbourhood to be inoculated, it would be complied with, and be beneficial to them; but I love to use persuasive means, rather than authority; on this account I have advanced a rouble (about four shillings) to each that would consent, and several have accepted it and recovered; but I find they now talk of raising the price to two roubles, which I must consent to as a further encouragement, for I wish the practice may be advanced by the mildest methods.”

If parish officers were obliged by Act of Parliament to apply to the Hospital for the admission of every man or woman who should either on their own account, or on behalf of their children, express a desire of being inoculated, and on their being taken in to supply each with two new shirts or shifts, and sign an obligation to provide decent new cloathing for every one on their receiving notice of their recovery and time of dismission, and also to give a small gratuity (suppose half a crown) to every person of the age of and to the parents of every child, on producing a certificate of their having behaved decently, and complied with the rules of the house, signed by the physician, it would probably be a sufficient inducement, and at the same time the fresh cloathing would effectually prevent the spreading the disease to others. And this could not be reasonably deemed a hardship, since some of the most respectable old Hospitals exact as much on admission of parish patients[5].

Footnote 5:

At St. Thomas’s Hospital, every patient on admission pays 2s. 6d. if clean, or 10s. 6d. if venereal; and the overseer or churchwarden of the parish signs an obligation that he will find clean body linen every week, and pay four pence a day so long as he continues in the Hospital, and receive him when discharged, or take away the body, or pay the burial fees to the steward of the Hospital, in case of death.

It is scarcely to be doubted but that Parliament would chearfully embrace a plan of this nature, which has for its object the preservation of the lives of the poor, and carrying them and their children safely through this terrible disease, without endangering their neighbourhoods.

Parishes would likewise find their account in it: by a known moderate charge they would be released from the contingent great expence of maintaining many sick families, occasionally afflicted with the Small Pox in the natural way; oftentimes to the great injury of trade and manufactures: and this by a trifling advance to be bestowed but once during the life of an individual, who would be maintained about three weeks without any further expence, and return home to wear the cloaths they had bestowed on him.

Thus much I have thought necessary to state, from a moral certainty that some provision of this sort should be made; to proceed, would be entering into minute matters that would more properly belong to the governors, who will be best able to make such regulations as may be for the general benefit of the charity.

So much has already been said on general Inoculations in the country, that it seems unnecessary to enter on the subject again in this place. But such is the obstinacy of some parishes, and the parsimony of others, that it is impossible for the poor who are desirous of being inoculated, to persuade them to advance the small sum that would be necessary to defray the expence; and they are therefore obliged to wait the event of the natural disease, while the principal inhabitants are securing their own families by Inoculation.

Another unjustifiable piece of frugality that deserves attention and to be remedied is, that in many places where the whole number of poor have been inoculated at the expence of the parish, illiterate fellows, totally unacquainted with diseases or remedies, have been employed on account of cheapness only; when at the same time the families of the wealthy have been under the care of medical gentlemen of good reputation. To insert all the instances that might be produced of parochial meanness would be tedious; I shall mention the following only, which may be relied on as an indisputable truth. The inhabitants of a certain parish had a meeting to agree on inoculating all the poor; some medical gentlemen in the neighbourhood offered to undertake the business at a very low price; but as cheapness was the only object of consideration, the parish was about to agree with a blacksmith at eighteen pence a head, when one of the most frugal started this objection: It is very probable that under this man’s care we may have some die, and the expence of their burial may cost the parish so much, that it might be as well to agree with a better man. This objection was thus removed by the smith:—“Come, I’ll tell you what I’ll do with you.—Give me half a crown a head, and them that die I will carry to the church-yard without putting the parish to any further expence.”

Thus to trifle with the lives of their indigent fellow creatures, must be an indelible reproach to any people. I know it will be said, that many instances can be produced, where whole parishes of poor have been inoculated, and have succeeded very well, under the care of persons who were totally unacquainted with medicine.

I will not here dispute the truth of this assertion; and indeed, if it was not an easy matter to procure more able help, it might be better to continue the practice in that way than to neglect inoculating entirely; but this is not the case. Gentlemen of the profession of good abilities will go very low in their price; and when it is considered that the sum is to be paid but once in the life of each person, surely parishes ought to be compelled to employ one who has had a medical education, and others should be restrained to their own proper business.

But it happens not unfrequently that irregular and dangerous symptoms appear, and at other times a different disease attacks the patient at the same time, with some unusual complaints while under Inoculation; these situations would certainly require the assistance of a person who could judge well of the symptoms, and distinguish the diseases properly, and know how to treat them, which a man unacquainted with the principles or the practice of physic could not pretend to, and consequently the patient would be exposed to great danger. Should an Act of Parliament be procured, it would be necessary to provide for the following circumstances.

That every parish (with the exception of such large places as should be thought too populous to be included) should be enjoined to offer Inoculation to all their poor who should be willing to admit of it[6]; that the patients and their families should be maintained during their illness; that the person employed to inoculate should have had some education in medicine as physician, surgeon, or apothecary; and that once in five years the same offer should be renewed, leaving the time of year and other circumstances to the option of the parish.

Footnote 6:

Vide Page 3, &c.