path: root/49476-0.txt

*** START OF THE PROJECT GUTENBERG EBOOK 49476 ***

                                THOUGHTS
                                   ON
                          GENERAL AND PARTIAL
                             INOCULATIONS.

                               CONTAINING

    A Translation of Two Treatises written when the Author was
        at Petersburg, and published there, by Command of her
        Imperial Majesty, in the Russian Language.

                                  ALSO

                         OUTLINES OF TWO PLANS:

    One, for the general Inoculation of the Poor in small Towns
        and Villages.

    The other, for the general Inoculation of the Poor in
        London, and other large and populous Places.

                           BY THE HONOURABLE

                         BARON THOMAS DIMSDALE,

     First Physician and Actual Counsellor of State to her Imperial
          Majesty the Empress of all the Russias, and F. R. S.


                                LONDON:

                     Printed by WILLIAM RICHARDSON;

       For W. OWEN, in Fleet-street; and T. CARNAN and F. NEWBERY
                 jun. Nᵒ 65, in St. Paul’s Church-yard.

                             M. DCC. LXXVI.

                  [Price One Shilling and Six Pence.]




------------------------------------------------------------------------




                                 TO THE

                              LEGISLATURE

                                   OF

                             GREAT BRITAIN,

                             THESE TRACTS,

                   ON A SUBJECT EXTREMELY INTERESTING
                           TO THE COMMUNITY,

                   ARE MOST RESPECTFULLY ADDRESSED BY

                                        THE AUTHOR.




------------------------------------------------------------------------




                             INTRODUCTION.


To preserve the lives and health of the inferior part of mankind has
been an object carefully attended to in all civilized and well regulated
states, not only from motives of compassion, but because it has been
plainly demonstrated that it is the interest of the wealthy in every
nation to encourage population, and provide for the wants of the poor.

One would indeed, on the first thought presume, that the unavoidable
necessities of the indigent would be voluntarily relieved out of the
abundance of their opulent neighbours; but the number of laws that have
been made for the provision of the poor, are proofs of the futility of
this expectation, and the necessity of compulsion.

Among the many objects that have been provided for, it seems matter of
astonishment that no one has ever pointed out the Small Pox as a
distemper, whose destructive consequences might be in great measure
prevented by the interposition of Legislature, and the assistance that
would be certainly afforded from private charity.

It is now above fifty years since Inoculation was introduced into this
country, and like other new institutions was then opposed; but at
present, though it may be impossible to define the numbers that are
yearly inoculated, it is certain that most of the wealthy approve and
avail themselves of the practice: yet we view the Bills of Mortality
with unconcern, though they demonstrate that the number of deaths from
this disease is considerably increased; and with the affecting
circumstance, that they are probably of the younger part of the people.

Although this matter has not been attended to here, it did not escape
the penetration of the Empress of Russia; who, with a regard to the
happiness of her people that deserves much greater commendation than I
am able to bestow, was extremely solicitous to render Inoculation
general among her subjects: and it was with a view to this that soon
after the recovery of the Empress and Grand Duke from this operation,
her Majesty was pleased to command me to write their cases, with the
principal occurrences during the Inoculation, from an idea that being
published they would tend to the removal of prejudices, and the
advancement of a practice she had much at heart to encourage.

Her Imperial Majesty also frequently did me the honor to converse freely
on several points respecting the natural Small Pox and Inoculation; and
having been pleased to approve of the manner in which her enquiries and
doubts were answered, I was afterwards commanded at different times to
give in writing the substance of what had been advanced on these
occasions. These orders were obeyed, the tracts translated into the
Russian language, and as I imagined, were only intended for the perusal
of the Empress. But in the year 1770, my treatise on Inoculation, with
the following tracts, was published at Petersburg by her Majesty’s
command:

I. An Account of the Inoculation for the Small Pox of her Imperial
    Majesty, Autocratrix of all the Russias.

II. An Account of the Inoculation for the Small Pox of his Imperial
    Highness the Grand Duke, the Heir of all the Russias, by Baron
    Thomas Dimsdale, first Physician to her Imperial Majesty.

III. Remarks on the Book, intitled, The present Method of
    Inoculating for the Small Pox, written by the Author now at St.
    Petersburg.

IV. A short Description of the Methods proposed for extending the
    salutary Practice of Inoculation through the whole Russian
    Empire.

V. A short Estimate of the Numbers of those who die of the natural
    Small Pox, with a View to demonstrate the Advantages that may
    accrue to Russia from the Practice of Inoculation, &c.

A translation of these tracts, with some further remarks on Inoculation,
and a relation of my journey to Russia, has been preparing for the
Press; but on some accounts unnecessary to be entered on here, is
deferred.

Indeed, my appearance as a writer now is earlier than I intended, on
account of a plan that I have seen of a Dispensary for inoculating the
poor of London at their own houses, in which some plausible reasons for
such an establishment are advanced; but I think they are much more
specious than substantial; and that the plan itself is fraught with very
dangerous consequences to the community, and not like to answer any good
purpose if put in execution. Wherefore I thought it a duty owing to the
public to publish these sentiments on the subject, that none should
inadvertently misapply their charity so as to do mischief when good was
intended.

In pursuance of this design, it seemed not improper to begin with the
two last of the tracts that were wrote at Petersburg in the year 1768,
as my opinions on the subjects treated of remain the same as at that
time. But I desire that what is advanced in them, or may be found in the
sequel, that tends to discountenance the practice of Inoculation by
persons who have not had a medical education, may not be construed as a
design to affect any of the family to whose mode of practice Inoculation
is indebted for some considerable improvements; nothing can be farther
from my intention, for I have been at all times disposed to do them
justice, and allow all the merit that is their due.

In fact, I am an advocate for Inoculation; and wish the design of
extending the benefit to the poor may be so conducted, as to afford its
enemies as few opportunities of objecting to it on any solid ground as
possible; and that the affair may be so well understood, as to make it
plain in what manner charitably disposed persons may most usefully
employ their benevolence.

------------------------------------------------------------------------




                          A Description of the

                                METHODS

                                PROPOSED

For extending the salutary practice of Inoculation through the whole
    Russian Empire.

_Written at Petersburg by her Imperial Majesty’s first Physician
    Baron_ THOMAS DIMSDALE.


In obedience to the orders received from her Imperial Majesty, I shall
endeavour to demonstrate in a clear and concise manner the destructive
effects of the Small Pox in the natural way, and the safety and
advantage of Inoculation, even when performed after the old manner; and
afterwards exhibit the improvement of the method, being the same which
is now introduced into this great empire.

It will not be in my power to execute this plan with the accuracy I
could wish, being engaged in an employment that demands much time and
attention. But I will use my best endeavours to describe in the first
place a method of propagating the practice of Inoculation, so that it
may not be dangerous to those in the neighbourhood, who, either on
account of bad health, age, prejudice, or other reasons, are unwilling
to submit to the operation, and at the same time render it salutary to
such as are proper objects and approve of it.

It is not to be supposed that the method now practised in England so
successfully, can be received in Russia without some alteration. The
experiments however which I have made in England, in order to ascertain
the most commodious manner of conducting the affair, may be of use here;
which I shall therefore describe as clearly as possible.   *           *
*          *           *           *           *           *           *
*          *           *           *           *           *           *
*          *           *           *           *           *           *

In the original published in Russia, there followed a circumstantial
account of the house I had built for the accommodation of my patients in
England, and the manner of conducting the process, &c. there; which, as
it would be of no consequence or use to insert in this translation, I
have omitted.          *           *           *           *           *
*          *           *           *           *           *           *
*          *           *           *           *           *           *
*          *           *           *           *           *           *

One, and indeed no inconsiderable advantage derived from a plan of this
sort is, that by collecting all the patients together in one house, the
physician will be enabled to attend a great number at the same time in a
proper manner, and also to pay particular attention to such as may more
immediately require his assistance.

And it is of no small importance to those who have been inoculated, that
the necessary regulations in respect to regimen, as well as every other
circumstance that requires the physician’s attention, may here be
properly observed.

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.

Notwithstanding all these conveniencies it will doubtless happen here,
as it did in my neighbourhood, that many persons of distinction will
rather prefer the inoculation of their families at their own houses. In
this case it is submitted to the wisdom of government, whether it would
not be proper to give orders that such persons should give public notice
of their intention to inoculate, mentioning the time when the operation
is to be performed, and also of their perfect recovery. By these means
such as have not had the Small Pox, will have it in their power to avoid
the infection.

So much with regard to the accommodation of persons of rank, who may be
inoculated under one or the other abovementioned regulations. But the
poor cannot enjoy those advantages. Humanity however and the interest of
the state equally demand, that all possible attention should be bestowed
for their assistance and preservation.

In order to attain this end, I know of no better or more certain method
than that which I followed, on charitable motives only, in my own
neighbourhood, by inoculating all the inhabitants of a village who had
never had the Small Pox, on the same day: and, if this be performed in a
proper manner, they might be all duly visited, and proper medicines
administered at a moderate expence, and the whole be over in about three
weeks: after which, this village would have nothing to apprehend from
the Small Pox for some years. According to this plan, it will be
unavoidably necessary that every child should be inoculated for the
Small Pox soon after its birth, or that inoculation should be performed
in every town or village once in five or six years. This last method I
would rather recommend, and therefore, in order to make this proposal
perfectly intelligible, I shall endeavour to explain it more
particularly.

A list of the names and ages of such inhabitants of every town and
village as have not had the Small Pox, is the first necessary step to be
taken; and marks should be made against the names of those who on
account of their ill state of health, or other reasons, are not thought
fit subjects for the operation in the judgment of the inoculator; and
such persons should be provided with a separate place of abode, where
they may not be in danger of receiving the infection: the rest should be
collected together in one place, inoculated at one time, and proper
medicines, with directions specifying the time and manner in which they
are to be taken, should be distributed to each individual. On the fourth
day after the inoculation they should again be assembled together, the
punctures examined, and such farther medicines given as the inoculator
may think proper. After the seventh the patients should be examined
daily; for from that time to the eleventh, or perhaps fourteenth, is a
period that requires more particular attention. During the whole of this
time, and indeed throughout the whole process, the sick may continue at
their own houses. And it may be reasonably presumed, that there will be
a sufficient number of such as are but slightly indisposed, who may be
able to assist the others, so as to make the expence and trouble of
nurses unnecessary. But we must also suppose, that of the very great
number inoculated there will be some who may have the disease severely,
or whose cases may require more constant attendance than they can
possibly have at their own habitations. To provide for such
extraordinary instances, therefore, a proper house and other
conveniencies should be previously appointed, to which they should be
removed when thought necessary.

It will be impossible to determine precisely how many patients may want
such attendance, and consequently difficult to provide exactly the
necessary accommodations; but I imagine there will not be more than four
or five out of one hundred.

The diet of all should consist of vegetables, milk, bread, and the like;
and in some cases a little mutton-broth may be allowed. The drink should
be nothing but water, unless by the particular direction of the
inoculator.

But in order to secure the observance of this regimen more exactly, all
salted provision and every kind of strong liquor ought to be removed
from the place, and every necessary precaution taken to prevent the
patients from procuring any. In respect to medicines, the prescriptions
being agreed on by the faculty, a sufficient quantity should be
prepared, and proper doses; agreeable to the different age and
constitution, put up separately, and distributed by the inoculator among
the patients, with directions in what manner they should be
administered; and their recovery should be completed with some proper
purgative.

A licence or exclusive permission ought to be granted to such physicians
or surgeons as undertake to inoculate for the Small Pox; for the
mischief arising from the practice of inoculation by the illiterate and
ignorant is beyond conception[1]. Such persons, instead of confining the
infection within narrow limits, too often, through want of skill or
honesty, are the means of propagating it, to the great terror of many
people, the fatal consequences of which, and the destructive tokens,
remain in many places in England. For besides the dreadful mortality
which the disease itself has occasioned, it has often proved the source
of discord and contention among neighbours, and disturbed that harmony
and friendship which had before subsisted among the inhabitants.

-----

Footnote 1:

  To enumerate the instances that have happened within my own knowledge
  to confirm this assertion, would be almost endless; I shall only
  mention a few that are remarkable.

  I was desired to visit a young woman about ten miles distant; I found
  her dying from the inoculation of a man, who, upon the credit of
  having been my coachman, had set up inoculator: he was gone on the
  pretence of procuring my assistance, but in fact had ran away; this
  was his thirteenth patient.

  Another illiterate person in my neighbourhood began the practice; but
  a child he had inoculated happening to have a fit, he was so frighted
  as to elope till he was informed that his patient was out of danger.

  I received a letter from a poor man who kept a school about eight
  miles from Hertford, to inform me, that not being able to pay a proper
  person, he had ventured to inoculate his own family himself, and
  begging a visit on account of one of his children who he feared was in
  danger: I complied with his request, and found one child dying of a
  confluent pock; but my compassion abated, on finding his house filled
  with some poor neighbours from whom he received a small gratuity for
  their inoculation, one of which had lost an eye under his care. This
  man’s residence was in a small town, and from his patients several
  caught the Small Pox, and some died.

  I saw a poor woman dying of a confluent disease; her husband had
  raised money for his own inoculation, and having had the disease
  favourably, was assured by a farmer who inoculated him, that he might
  safely go home to his family. The wife died, leaving five children,
  who all had the disease and recovered.

  At a village not far from Hertford, the same farmer inoculated as many
  of the parish as could raise five shillings and three-pence, informing
  the others that the Small Pox was not catching from the inoculated;
  but the whole neighbourhood became infected, and several died.

-----

To conclude, I beg this small treatise may be considered only as an
imperfect sketch drawn up in haste; but if it should be approved of, and
her Imperial Majesty be pleased to command me to enter into farther
particulars, I will employ my utmost endeavours to render it more
perfect, and also assist in the execution of any part of what has been
therein proposed.


_A short estimate of the number of those who die of the natural
    Small Pox, with a view to demonstrate the advantages that may
    accrue to Russia, from the practice of inoculation._

It is needless to expatiate upon the havock which the Small Pox makes in
most parts of the known world: probably there is not a country, city, or
smaller community, which has not experienced its devastations in its
turn. The very idea of it is insupportable; but its real effects, in
places unapprised and unacquainted with the proper treatment and
remedies against it, are not less general and fatal than the plague
itself.

Though this fact is generally allowed, yet many, I think, are ignorant
of the immense loss mankind sustains by this distemper. It may not be
amiss therefore to shew, from well attested accounts, the proportion of
persons who die of the natural Small Pox: for which purpose it will be
necessary to chuse some country or city where an exact register of the
births and deaths, as well as an accurate list of diseases, is regularly
kept.

Dr. Jurin, secretary to the Royal Society in London, carried this into
execution in 1722, soon after Inoculation had been introduced into
England, being desirous of shewing the different effects of the natural
and inoculated Small Pox.

I shall not here insert all that was published by this ingenious author,
as the whole may be found in the Philosophical Transactions of the Royal
Society, under Nᵒ 374. The following extract will be sufficient for my
present purpose.

The Doctor for forty-two years selected from the Bills of Mortality in
London, such as died there of the Small Pox and other distempers. His
observation may appear perhaps somewhat extraordinary: nevertheless he
makes it plain, that out of 1000 infants, 386 die under two years of
age, which is considerably more than one third. He then deducts such as
he supposes die of the diseases natural to infancy; and afterwards
proceeds to demonstrate, that if the whole bulk of mankind be taken at
the age of two years, the eighth part will die of the natural Small Pox;
and that of such as have it in the natural way, one in five or six dies.

With respect to my own calculations on this subject, I endeavoured to
find out whether the Small Pox proved equally fatal after the time
mentioned by the Doctor. With this view, before I left England, I
procured the Bills of Mortality of the City of London for the last
thirty-four years, excepting two, which could not be found. Of these I
made a table, which I have added at the end of this treatise. I was
surprized to find the number for these thirty-two years past tally so
exactly with the observations made by Dr. Jurin.

On examining the table it appears, that within these last thirty-two
years 760,098 persons have died, and of those 268,529 have been infants
under two years of age, which agrees with Dr. Jurin’s calculation, in
being rather more than one-third of the whole.

I suppose, with Dr. Jurin, that the deaths of these were occasioned by
different diseases incidental to infancy, and I deduct them out of the
whole number, viz.

                                         760,098
                                         268,529
                                         ───────
                        The remainder is 491,569

It appears likewise that in the same course of time there died of the
Small Pox 66,515, which confirms Dr. Jurin’s account, and indeed exceeds
the eighth part. Hence we may fairly conclude, that in general the Small
Pox carried off the eighth part of those who died in London in the
period abovementioned. I procured also the best accounts I possibly
could of the whole number of those who had had the disease from places
where the Small Pox had raged most, and found, that near one out of five
died who had had the disease in the natural way. This also agrees with
Dr. Jurin’s observations. We see then that even in London, where the
climate is temperate, the disease well known, and the treatment of the
sick very ably conducted, this single disease destroyed more than the
eighth part of the inhabitants.

But if we turn our eyes towards other dominions, and give credit to the
accounts told us, we shall find the disease still more fatal, and in
some cities it is almost as destructive as the plague.

It is impossible for me to ascertain with any degree of certainty, the
precise number of persons who die annually of the Small Pox in Russia. I
am persuaded however, both from good intelligence as well as my own
observations, that it is exceeding fatal here. Though I cannot confirm
this assertion by proofs, yet from some conversation with the learned I
am credibly informed, that of those who have the Small Pox in the
natural way one-half die, including the rich and poor.

It seems hardly necessary to shew, how much the riches and strength of
states depend upon the number of inhabitants. But perhaps there is not
any country in which the certainty of this position is more indisputable
than in Russia; for not only the strength of the empire, but the riches
of every individual also, must be in proportion to the degree of
population. If therefore in London, which enjoys the many advantages
already recited, more than 2000 persons die annually of the Small Pox,
we may surely suppose, that the loss which Russia in its whole extent
sustains by this distemper in the same space of time, amounts to two
millions of souls. And this havock must greatly retard the increase of
the human species.

There are some diseases peculiar to old age, which terminate a life
almost entirely spent, and totally useless to the community.

Such diseases, considered in a political sense, are not hurtful to the
state. But the Small Pox spreads destruction chiefly upon the younger
part of the species, from whose labours in their several callings the
public might otherwise have expected advantages beyond all computation.
The disappointment and loss incurred is of course neither to be
calculated nor conceived.

A discourse upon this subject might be extended to a great length; but
it seems unnecessary to enlarge, especially when I consider to whose
judgment this essay is with all humility submitted.

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.

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.

-----

If these obligatory clauses were obtained, general Inoculations in the
country might be carried on at a very moderate expence.

------------------------------------------------------------------------




                              CONCLUSION.


On a review of what has been advanced it will appear, that the practice
of Inoculation has been upon the whole rather hurtful than advantageous
to the city of London, and that the mortality from Small Pox has lately
increased to an alarming degree: that it may be presumed this loss has
not been sustained by the wealthy, who have availed themselves of their
easy circumstances, and by timely Inoculation have secured their
families; but that the loss has fallen principally among those who are
not the least useful members of the community, viz. on young persons,
the offspring of inferior trades-people, and the labouring poor.

It has been shewn, that to encourage partial Inoculations among such of
the poor as might be willing to accept the offer, and should be found in
a proper state of health, would be to increase the evil, by spreading
the disease in a destructive manner among their neighbours, and be on
other accounts dangerous and intolerable. An hospital for the purpose of
Inoculation _only_ has been rescued from the unjust charge of being
unhealthy, and has been proved to enjoy superior advantages in that
respect, and many others; and that a well-regulated plan of this kind
would effectually answer the purposes of abating the mortality, and
securing the community from being infected by the patients.

An application therefore to the Legislature for approbation and
assistance seems highly expedient; and it is not to be doubted but the
generous and humane would readily be induced to raise by subscription a
fund sufficient to carry these good designs into execution; so that as
we are the first European nation who received and encouraged
Inoculation, we may also have the honour of being the first who have
generously diffused the benefit of it to the community at large, and
transmitted it to posterity.

We have thus far only taken into consideration what respects the two
extremes of society, the opulent and indigent; but there still remains a
numerous and respectable part of the community unnoticed, I mean,
persons who are in but moderate circumstances, yet above accepting the
charity of an hospital.

Persons thus circumstanced seem to have a claim upon the humanity of
such practitioners as are eminent in their profession; who, from that
motive, we doubt not, will chearfully give their attendance on such
terms as families can afford. By this well-timed generosity, the minds
of the middle rank of people will be made easy, and it will be a great
inducement for them also to inoculate their families.

To conclude, I have used my best endeavours to represent the whole that
has been treated of in its true light, and recommended the methods that
have seemed to me to answer the purposes most effectually. It may
probably happen, that zeal in the cause may have carried me too far, or
that through inadvertency some errors may have been made. If they are
pointed out, I will acknowledge them with thanks to the informer, having
nothing more in view than the good of the public, and that the practice
recommended may be so conducted as to afford its opposers as few
objections, on any solid ground, as possible.

It is so truly the cause of humanity, and so certain of answering the
purpose, that I most earnestly recommend a liberal support to all
charitably disposed persons, and more especially to such in affluent
circumstances, who may have experienced the happy effects of Inoculation
in their own families, concluding with the words constantly used by a
beggar in Turky,

                         WHAT THOU DOEST, THOU
                           DOEST TO THYSELF.


                                 FINIS.

------------------------------------------------------------------------




                                ERRATA.


    Page 1. _before_ Methods, _read_ A Description of the.
            l. 9. _for_ Agreeable, _read_ In obedience.
        20. l. 11. _for_ have, _read_ hath.
        26. l. 4. _dele_ one.
        48. l. 4. from the bottom, _dele_ the inverted Commas.
        49. l. 13. _after_ manner _dele_ that, _and read_ in which.
        50. l. 8. _for_ the, _read_ these.
        49, 50, 51. _dele_ the inverted Commas.

------------------------------------------------------------------------

                          Transcriber’s note:

All items in the Errata have been applied.

Page 29, ‘subsistance’ changed to ‘subsistence,’ “and provide
subsistence for such of”

Page 60, space following ‘age of’ present in original.

Page 60, ‘cheerfully’ changed to ‘chearfully,’ “Parliament would
chearfully embrace a”

Errata, ‘49’ changed to ‘48,’ “48. l. 4. from the bottom, dele the
inverted Commas.”

Errata, ‘50, 51’ changed to ‘49, 50, 51,’ “49, 50, 51. dele the inverted
Commas.”





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Inoculations, by Thomas Dimsdale

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