CHAP. II.

The first individual in England on whom the operation of inoculation for Small Pox was performed, was the daughter of the celebrated Lady Mary Wortley Montague. She had witnessed, when in Turkey, the mildness of this disease as produced by inoculation, and her son had already passed through the process with safety. “The engraftment of her son having succeeded; after Lady M. W. M. returned to London in 1722, she sent for Mr. Maitland, the surgeon, who had attended the boy at Constantinople; and desired him to engraft her daughter with Small Pox. He solicited a delay, on account of the weather, and entreated that two physicians should be consulted. These requests were refused, yet he obeyed her Ladyship’s injunctions; but when the fever commenced, an old family apothecary and three physicians were permitted to witness the process. As the success was complete, Dr. Keith, one of the above physicians, was tempted to request Mr. Maitland to engraft his child also, which likewise succeeded; and these cases were rumoured through the town.”[5]—An experiment was afterwards tried, at the request of the Princess of Wales, upon “six condemned felons” with success, and her own children passed through the operation with safety. After this, inoculation was partially employed for some years, and was again discontinued—but, about the middle of the last century, great exertions were made to bring it into general use, and with a considerable degree of success. We shall presently endeavour to ascertain what influence it exerted over the prevalence and fatality of Small Pox. But, in the first place, I think it will be useful to enquire into some of the arguments which were adduced in support of the practice; and, it may be, to allude to a few which were opposed to it.

5.Moore’s History of Small Pox, p. 228-9.

The principal arguments, on which the employment of inoculation for Small Pox was supported, appear to have been the following:—

1. The infectious nature of the disease, which was so virulent as to permit few individuals to pass through life without being at one time or other affected by it.

2. Its fatality—destroying at least one in five or six of those attacked by it.

3. The generally received opinion that no individual could be affected by it oftener than once. And

4. That, when communicated by inoculation, it was rendered comparatively mild and devoid of danger, while it afforded equal security against any future attack of the disease.

The two former of these positions need not engage our attention in this place—the highly infectious nature of Small Pox has always been admitted; and I have already brought forward sufficient proof of the danger to human life which it occasions.

The third proposition is of most material importance; for I am well convinced that upon a proper understanding of this question depended the true value of inoculation as far as regardedindividuals;and on it also rests the true value of Vaccination as regardssociety in general.

It was unfortunate for the cause of inoculation that its early advocates maintained the absolute impossibility of Small Pox occurring a second time in the same individual. They thus furnished their opponents with weapons against themselves, in the cases, which repeatedly occurred, of those who had passed through the process of inoculation being afterwards affected by the natural Small Pox; and were put to the necessity of having recourse to expedients equally unmanly and uncandid—either of denying that the second disease was genuine Small Pox, or of asserting that the inoculating process had been imperfectly performed. Whereas a little attentive observation and research into the former history of Small Pox, might have satisfied them, that although in a great majority of cases this formidable disease did not occur a second time in the same person, yet that repeated instances took place wherein it did so occur. And that while it might be assumed as a general rule that the same individual would be affected once only with Small Pox—it was a rule admitting of exceptions.

That a second attack of Small Pox may take place in the same individual, may be proved by a mass of evidence which appears to me to be perfectly irresistible; and as I consider it very important to the object of this enquiry that every doubt should be removed on the subject, I must be permitted to dwell on it longer perhaps than may at first sight appear necessary. I have great pleasure in acknowledging my obligation to the valuable “Historical Sketch of Small Pox,” by Professor Thomson of Edinburgh, for a large share of the evidence which I shall lay before my readers, to prove the frequency of the recurrence of Small Pox. Soon after the introduction of inoculation into France, “a son of M. Delatour, about nine years of age, was inoculated in 1756 for Small Pox, by Surgeon Martin, under the inspection of M. Tronchin, and passed through the disease in a satisfactory manner. This boy remained in good health for upwards of two years, when an eruption, supposed by some to be Small Pox, appeared upon him, as well as upon four of his companions in the same boarding-school. The different opinions formed of the nature of this eruption by the medical practitioners who saw it, and who seem to have judged of it according to the preconceived notions they entertained with regard to the possibility of the recurrence of Small Pox, present (says Dr. Thomson) so true a picture of what has occurred in similar cases since the introduction of Vaccination, and of the manner in which doubtful cases of varioloid eruptions continue still to be judged of, that I cannot avoid giving you an abstract of the discussions to which this case gave rise.”[6]—Dr. Thomson goes on to say, that “M. Gaulard, Physician in ordinary to the King, was called to see the son of Delatour on the third day of the eruption, which he declared to be a mild case of Small Pox, of the kind commonly called, he says, though improperly so, Chicken Pox, and the disease in the boy’s companions he considered of the same nature.”—Four physicians were called in to consult with Mons. Gaulard, who[7]“gave an account of the progress of the disease which contains a description of varioloid eruptions, very similar to those which have of late been described under the denomination of modified Small Pox.

6.Dr. Thomson’s Sketch, &c. p. 53.

7.Dr. Thomson’s Sketch, &c., p. 54.

“These gentlemen mention also, thattwoof the other children affected, had previously passed through natural Small Pox; and conclude with declaring that, from these circumstances, they believe that the disease in Delatour and his companions,was neither the Small Pox nor the Chicken Pox, but a chrystaline eruption, with which they were well acquainted.”

It is, I think, from this sufficiently evident, that nothing but the preconceived opinions of the physicians consulted in these cases could have prevented their acknowledging the true nature of the disease; and there cannot, I conceive, be a doubt, that it was no other than Small Pox rendered milder in its character by the previous occurrence of it in these children. It is of importance too to remember that they afford examples of the recurrence of the disease after bothnaturalandinoculatedSmall Pox. Delatour had been inoculated upwards of two years before, and “two of the other children affected had previously passed through natural Small Pox.” I shall here adduce some further extracts from Dr. Thomson’s work. He tells us that “M. Hosty, who had been sent over to England in 1755, to acquire information upon the subject of inoculation,” “enters into a discussion with respect to the recurrence of secondary Small Pox, in which he allows that there are several eruptive diseases with which a person may be affected,so like the Small Pox, as scarcely to be distinguishable from them, and, on that account, liable to give rise to many mistakes; and he states, that although he does not deny absolutely the possibility of the recurrence of Small Pox, he believes this to be rare,” (p. 55-6). “To Hosty’s opinion, with regard to the unfrequency of the occurrence of secondary Small Pox, Gaulard replied, that he had at that time under his charge two unequivocal examples of secondary natural Small Pox, and that a nephew of the Archbishop of Paris, had a month before passed through the Small Pox, under the care of the celebrated M. Astruc, although he bore marks on his body of having formerly undergone the disease.”—(p. 59.)

Gaulard then declares, “that though reason dictates, andexperience actually demonstrates, that this process (inoculation for Small Pox) does not infallibly afford protection against a subsequent attack of natural Small Pox, he was still disposed to believe that it may be possessed of some real advantages” (p. 59). “Dr. Cantwell, in 1755, published a dissertation upon inoculation, the avowed object of which was toundeceivethose who believed in the efficacy of that practice. In this Essay, a great number of cases of Small Pox, which had occurred both after natural and inoculated Small Pox, are mentioned” (p. 64). “He (Dr. Cantwell) seems to have been well acquainted with those varioloid eruptions which, previous to the introduction of inoculation, had received a variety of names, such as Swine Pox, Chicken Pox, &c. and which were considered not as specifically different from Small Pox, but as spurious and bastard species of that disease. These eruptions, in his opinion, were nothing else than mild varieties of the true Small Pox. His own words are” (p. 37), “after all, what are the Swine Pox, the Duck Pox, and the Chicken Pox, which are observed among the English and the Irish? What is thepetite verole volantewhich is seen in France? Many distinguished authors attest, that they have seen Small Pox occur twice in the same individual; and have not we reason to believe that, in these cases, the second attack was true Small Pox, of which the infection was slight, and in which the vital actions were too weak to carry it to a certain extent?” All this appears to me most strictly consistent with truth. But Dr. Cantwell was arguing against the use of inoculation. How then did he account for the fact that “the infection was slight,” and that “the vital actions were too weak to carry it to a certain extent,” if it did not arise from these individuals having already passed through the disease of Small Pox?

“De Haen (a celebrated physician of Vienna,)” says Dr. Thomson (p. 68), “collected into a body the numerous cases of secondary Small Pox, which are to be found in the writings of physicians, who lived previous to, and in the infancy of, the practice of inoculation in Europe. Had the number of these cases, and the respectability of the individuals by whom they are related, been duly considered, they surely were more than sufficient to have satisfied the minds of the most incredulous, of the possibility, and even of the frequency of secondary Small Pox.” De Haen, however, was an opposer of inoculation, and the facts he adduced were not permitted to have the weight which they merited, in consequence of the arguments he deduced from them.

I shall conclude my extracts from the fund of evidence collected in the work of Professor Thomson, with the following:—

“M. Strack, professor of medicine at Mayence, in a letter upon inoculation, addressed to M. Roux in 1765, (Journ. de Med. tom. xxii.) maintains that natural Small Pox do not, any more than the artificial, protect against a second attack. In proof of his opinion, he mentions six cases of secondary Small Pox which he himself had attended. The argument which he uses in support of inoculation, in opposition to those who were hostile to that practice, and who asserted that it does not protect against a subsequent attack, though novel at the time it was employed, has since been sufficiently confirmed by repeated observation. He says, that those who have passed through the Small Pox twice, whether naturally or artificially, have, in general, escaped without danger; those patients, he adds, who have had the Small Pox at two different periods, are fortunate, because if the variolous miasma had operated with its full force during the first attack, they probably would have fallen victims to the disease” (p. 77).

Mr. Moore remarks (Hist. of Small Pox, p. 278) that, “besides the foreign authorities, the English Medical Journals contain several authentic examples of persons whose faces were strongly pitted with Small Pox, and who were afterwards destroyed by a second attack of that disease,”—he goes on (p. 279) to relate “an incident frequently repeated by the late Dr. Reynolds, Physician to his Majesty, who was sent for by a lady unknown to him, and conducted by her maid, rather mysteriously, into a handsome bed-chamber; where he saw, lying in a splendid bed, a lady masked. Being a good deal surprised, the maid stifled a laugh, while her mistress, in a soft toned voice, apologised for concealing herself even from a professional gentleman. This (she said) had become proper, from the peculiarity of her situation. At present she stood greatly in need of his superior medical talents, and was extremely anxious for his opinion on her case, which she understood from others, was a very rare one. The doctor being thus put upon his guard, enquired minutely into all the symptoms, and examined critically a pustular eruption which was spread over the lady’s person: he then pronounced the disease to be, without all doubt, the Small Pox. On which the patient unmasked, and displayed features seamed with the disorder.”

Dr. Thomson (in his Historical Sketch, p. 279) informs us, that out ofeight hundred and thirteencases of Small Pox, which had come under his notice since June, 1818, “seventy-onehad previously passed through Small Pox.” And in the sequel many other instances will be referred to.

In a late number of the London Medical Repository, Dr. Carter, of Canterbury, gives the details of a case of secondary Small Pox occurring in a girl, which proved fatal. And a young lady (a family connection of my own), who had satisfactorily passed through the disease, from inoculation, when young, had a second attack of Small Pox, when on a visit at Liverpool, to which she very nearly fell a sacrifice. To this mass of evidence I shall add the case to which I have before alluded, as having come under my own notice. In this young woman the eruption was confined to the shoulders and face, and was not numerous, but it was preceded for several days by considerable feverishness and head-ache; and although it did not proceed beyond the fourth or fifth day, I consider the nature of the disorder as quite unequivocal; if what I conceive to be the only true test of this be admitted, namely, that it was produced by Small Pox infection, and was capable of communicating it to others. Fortunately this test was left incomplete in this instance, no other individuals having become infected in consequence; but the following facts which have since come to my knowledge, seem to warrant the inference, that this might have happened had any unprotected persons been allowed to have communication with the patient.

A lady, residing at Gateshead, who passed through inoculated Small Pox many years ago, became lately (during her confinement) affected a second time with this disease. And notwithstanding that it was of the same mild character as in the last case, and that the eruption turned on the eighth day, her infant caught the infection. The eruption in the child was of the confluent kind, and occasioned its death eight days after the appearance of the disease.

Having succeeded, I trust, in proving to the entire satisfaction of every candid enquirer the possibility, if not the frequency, of the occurrence of Small Pox a second time in the same individual, it would be both interesting and useful, were it possible to ascertain what proportion such cases bear to those who escape a second attack; but many insurmountable difficulties present themselves in making such a calculation. Dr. Thomson tells us (p. 67), that “according to Tissot, the proportion of cases of secondary Small Pox, is as 1 in 100; according to Heberden, as 1 in 5000; and, according to Condamine, as 1 in 10,000. How uncertain the data!”—It is, however, enough to know, that while the relative number is sufficiently great to prevent the rule, That no individual can be affected by Small Pox oftener than once,—from being considered absolute, it is yet too small reasonably to shake our confidence in the fact, that a very large proportion will escape a recurrence of that disease. One other fact of considerable importance has, I trust, been also established by the preceding enquiry—That when secondary Small Pox does take place, it is usually a very mild disease, unattended with danger.

The fourth argument in support of the employment of inoculation for Small Pox,—that it was rendered comparatively mild and devoid of danger, while it afforded equal security against any future attack of the disease with natural Small Pox itself, need not detain us long.—The latter part of the proposition has been generally admitted; and its truth or falsity will not affect the object of our present enquiry. Mr. Moore (History of Small Pox, p. 302) tells us, that “at the commencement of inoculation in England, the proportion of fatal cases appears to have been fully one in fifty. But after the last improvement in treatment had been established, probably not more than one in two hundred were lost.”—Mr. Moore continues—“of those who contract the casual Small Pox, and are treated with medical care, it has been admitted that generally about one in six are lost: but in countries where the medical arts are unknown, the Small Pox is so fatal a disease that few of those who are seized with it survive its malignity.” The immense difference between these proportions is amply sufficient to prove the great advantage derived from inoculation by those on whom it was practised.

Such then were the data on which the practice of inoculation for Small Pox was established. But it will be remembered, that on its introduction, and for many years after it had been extensively used, it met with a very warm opposition both from medical men and others, especially from some zealous divines, who stigmatised it as “a diabolical invention of Satan,” and uttered anathemas against all who should practise it. I shall not enter into any examination of the arguments made use of by the opposers of inoculation; some of them have been already alluded to, and their fallacy pointed out. Taken altogether, it is remarkable how nearly they resembled those which have been opposed to the introduction of Vaccination. Now, that distance of time has enabled us to view the facts of the case with coolness, and to reason upon them without prejudice, while we admit the individual security which arose from the practice of inoculation, we must in candour confess its tendency to encrease the general destruction of life from Small Pox, by forming so many new sources of infection. This was the only rational argument against inoculation, but it was certainly one of great force, and the actual encrease of deaths from Small Pox during the prevalence of inoculation, seems to prove that it was never sufficiently considered. The encreased number of deaths from Small Pox in 1723 and 1725, might fairly be imputed to this cause, although it was denied at the time by Dr. Jurin. Mr. Moore (History of Small Pox, p. 243) very satisfactorily replies to Dr. Jurin’s argument in the following extract. “And as in the year 1723 a great increase of the mortality by Small Pox took place in London; Dr. Jurin expressed his opinion that this ought not be imputed to inoculation, as the numbers who had been inoculated did not exceed sixty. This was a very inadequate answer. A single person may bring the plague into a town or into a nation, and be the cause of the destruction of an innumerable multitude. The Small Pox is fully as infectious a disease as the plague; and sixty inoculations were more than sufficient to account for the augmented mortality, and were probably the cause of it.”

If we refer to the tables (No. 1 and 2), we shall find that from the years 1752 to 1798 inclusive (the period during which inoculation was most extensively employed in this country), the average mortality from Small Pox, during periods of five years each, was occasionally so high as one in eight of the whole, and rarely less than one in ten. And that during individual years, it three times (in 1752, 1781, and 1796) amounted to nearly one in five; and in 1772 was little less than one in six. This is surely a fearful encrease on Dr. Jurin’s calculation—“That of all the children that are born, there will some time or other die of Small Poxone in fourteen.” There can be no doubt, however, that this immense encrease of mortality from Small Pox was owing to the extended practice of inoculation; and until this could have been pursued more generally, and with greater precautions, so as at once to diminish the numbers capable of being infected by the inoculated, and the hazard of the latter coming into contact with the unprotected, I am disposed to think this fact was in itself sufficient ground for discontinuing inoculation for Small Pox altogether. Could every child have been subjected to the process of inoculation, before any exposure to the infection of natural Small Pox had taken place, the case would have been widely different: but it can scarcely be considered either just or politic to render one individual secure at the risk of endangering many, or with a certainty of destroying some. It may fairly be concluded, then, that inoculation for Small Pox, as practised for the last fifty years of the eighteenth century, although certainlya great individual good, was, in reality, without a doubt, amost serious general evil.

From what has been hitherto stated, I conceive, we are authorised in assuming the following as facts, which will furnish a satisfactory answer to the first of the questions proposed, What were the destructive consequences of Small Pox previous to the introduction of Vaccination?

1. Small Pox is a disease of so infectious a nature, that few individuals passed through life without suffering from an attack of it.

2. It was attended with so much danger as to occasion the death of one in five or six of those affected by it in the natural way; and previous to the use of inoculation, one in fourteen of the whole number of children born, at one time or other, died of the Small Pox.

3. Of those who recovered, many suffered materially from its effects, not only in the disfigurement of countenance occasioned by it, but frequently in the loss of one or both eyes, or in irreparable injury of their constitutions.

4. After having been once affected by Small Pox, a very considerable proportion of individuals resist entirely a second attack: but still in very many instances a recurrence of the disease is proved to have taken place.

5. Secondary Small Pox is, for the most part, very mild in its symptoms, and of shorter duration than a first attack, insomuch as to have frequently given rise to doubts respecting the real nature of the disease.

6. Secondary attacks of Small Pox have, nevertheless, occasionally proved fatal.

7. When artificially produced by inoculation, the Small Pox is rendered materially milder in its character, so that one in two hundred only of those to whom the disease has been thus communicated, have been found to die in consequence.

8. The Small Pox, when communicated by inoculation, is probably as secure a preventive of any future attack of the disease as when it has taken place naturally.

9. Notwithstanding the undeniable advantages which accrued to those who passed through the process, it was, nevertheless, the direct effect of inoculation, by multiplying the sources of infection, materially to encrease the aggregate mortality occasioned by Small Pox.

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