Thoughts on General and Partial Inoculations

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.