A Treatise upon the Small-Pox/Part 2

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Fleuron page 109 A Treatise upon the Small-Pox.jpg

Part II.

A

DISSERTATION

Upon the

Modern Practice of Inoculation.

 
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The INTRODUCTION.

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T has been long observed of the Natives of South Britain, that from an inbred Curiosity, they are passionate Lovers of Novelty, and ready to embrace Notions out of the common Way of Thinking, and Practices contrary to the Customs of their Country. This evidently appears in their proneness to entertain new Doctrines in Religion; for there can hardly be broached any Schemes, or Speculations, though ever so wild and extravagant, but there will be found Numbers of Persons of an odd and whimsical turn of Mind, ready to espouse and defend them; whence arises that wonderful Variety of enthusiastical Sects, with which this Nation has so much abounded, and still abounds; who are distinguished from sober and well-instructed Christians, and from one another by their several specifick and peculiar Deviations from Truth and common Sense. Nor are the Professors and Practicers of Physick less divided in their Systems and Opinions; for besides the Differences among the regular Physicians, Men of good Sense, and a liberal Education, a great Diversity of Quacks, fanatical Chymists, and confident Pretenders to this Art, swarm in this populous Kingdom, and over-spread the neighbouring Nations. Nor do these various Denominations want their Admirers, and zealous Followers; nor are the illiterate Vulgar only apt to crowd about these Empericks, but I know not how it comes to pass, Persons of the highest Rank do often cry them up, trust their Healths and Lives in their Hands, and are frequently the first spreaders of their Fame, promoters of their Interest, and protectors of their Reputation: And therefore I do not wonder, if the celebrated Mountebank Pontæus should say, as I have observed in another Writing, that of all the Nations in Europe, where he had practised his Art, he found England the most disposed to favour and encourage Men of his Character. And though the Individuals of the several Species of Empericks, and ignorant Pretenders to the Cure of the Gout, Stone, and other great Distempers, whether Natives, or Foreigners, have only blaz’d a while like empty Meteors, and as soon disappeared, and sunk into their former Obscurity, which holds good even from the Quacks favoured by King Charles the second, down to the Syringer, and the late Coal-Heaver; notwithstanding, I say, the People soon found out the Delusion of these Impostors successively, yet this credulous and good natured Nation, are still ready to hearken to any bold Fellow, that shall confidently assert his never-failing Abilities, and roundly assure them, that his Powder is infallible.

I was not therefore surprised, that when the novel Practice of Inoculation of the Small-Pox was first introduced into this Kingdom, it should meet with many Friends and Patrons; though I acknowledge, that considering the Advantage it had of being so great a Novelty, and brought from such a Distance, as Constantinople, it is surprising, that it did not make a quicker Progress, and meet with a more ready Reception; for notwithstanding the People catch at any Thing entirely new with such greediness, yet to the Generality, it at first appeared so bold an Undertaking, and so shocking to Nature, that they expressed an Aversion to it. Multitudes looked upon the Practice as inconsistent with the Christian Religion, that forbids its Followers to tempt Providence, and run into unwarrantable Hazards; and many more thought it a prudent and discreet Part to stand by as Spectators and Observers, to see if this Method could be justified, and settled by a sufficient Number of successful Tryals, before they would make the Experiment in their own Families, and venture upon such a nice and unknown Method, till they had received this just Satisfaction. For my own Part, when I was asked by my Friends, and Patients, what my Opinion was of this new Practice; my constant Reply was, that I looked upon my self obliged to wait, and see if this Method would be established by good Experience, and to learn whether the Promises of the Inoculators would be made good by an answerable Event; that I could not build a general Affirmation upon a few Instances, and that therefore a considerable Time must be allowed, to make Observations on the Matters of Fact, before I could form any setled Judgment upon this new Way. Nor do I think that the Number of Experiments already made are enough to establish a Conclusion on either side of the Question. For besides the unfair Shifts, and evasive Arts, that have been used with great Care and Industry, to cover Miscarriages in this Operation, and conceal the true Matter of Fact, which makes the History of the Events uncertain; there has not yet been Time enough spent to decide the Controversy by sufficient Tryals, considering that several of them make against the Inoculators.

But however, not knowing how long we must wait for this Satisfaction, I am willing in the mean Time to publish my Sentiments upon this litigated Subject.

 
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An Inquiry, whether those Persons, who first introduced into this Kingdom the foreign and novel Practice of Inoculating the Small-Pox, have made good what they promised and pretended to effect by this Operation.

THE Undertakers, that imported from Turkey this extraordinary Invention, and intended by it the Service of their native Country, as it is charitable to believe, told the People first, that this Operation would produce the Small-Pox in the Persons that never had them before.

In the second Place, that if it did not bring forth the true Small-Pox in its proper Forms, but Flushings and a Rash of a different Size and Figure, yet these spurious Eruptions, together with a copious Serum, or thin Matter, that issues from the Wound, would so intirely eradicate and carry off the Seeds and Principles of the Small-Pox contained in the Blood, that the Person should never, during his Life, afterwards be attacked or seized by this Distemper, but that this irregular Discharge would be as effectual to all Intents and Purposes as the true and genuine. And

Thirdly, they gave out with great Assurance, that the Small-Pox, propagated by Inoculation, should always be of the mild and distinct Kind, and that therefore all their Patients should recover.

As to the first Article, I am very credibly informed, that sometimes this Operation neither produces the Small-Pox, nor any Thing else, but the Undertaker leaves the Patient as he found him.

As to their second Promise, that in Case the Inoculation does not bring forth the Small-Pox, but Eruptions very different, yet this Discharge shall certainly prevent their falling into that Disease for ever after; this Assertion is not founded upon just Observation and Experience. On the contrary, two Things are alledged against it, one is, that notwithstanding this ingenuine and pretended Small-Pox, altogether unlike the true, has been undergone, yet the genuine and regular Sort has broke out upon such inoculated Persons several Months after the Operation; which is a full Demonstration that the Seeds of that Disease are not always carried off with those Impurities, which were discharged by the Inoculation. And the second Thing alledged is, that this Operation performed on Persons, who have already had the Small-Pox, will bring forth the same Eruptions, and be accompanied with the same Gleet discharged from the Wound, which happens to those who never had that Distemper before, and now only an imperfect Imitation of it; whence one may reasonably argue, that these false Eruptions may be wholly unmixt and unconcerned with the Principles of the Small-Pox, since they alike follow upon Inoculation, whether the Person has ever had or had not that Distemper before. And since this can only be made appear by Instances or Examples, I shall take that Method of proving the Assertion. To prove the first I shall relate the following History.

A Girl of twelve Years old, well grown, and of a swarthy Complexion, after her being inoculated had a pretty large Flushing, or Efflorescence, spread over her Skin, and was disordered by feverish Heat; the tenth or eleventh Day three or four Pimples, or Pustules, broke forth upon the Head, and there was a large Discharge of Matter from the Wound: This Maitland, the Inoculator, affirmed would as effectually secure her from the Small-Pox for the future, as if she had had them in a fair genuine Way. Awhile after, the Gentleman, to whom the Operator gave this Assurance, hearing that the Girl had undergone the true Small-Pox, from a just Curiosity of being rightly informed, applied himself to her Father, one Degrave, a Surgeon in Berwick-Street, who consented that his Name should be made use of on this Occasion. The Girl was at this Time in the Country. The Account which the Father gave of the Matter, is as follows. Before she came home she had a Sort of Itch, which, as he said, he cured. Three Weeks after the Inoculation she had a large Boil upon her Ham, another upon her Side, which ran plentifully for a Fortnight or three Weeks. She had been purged twice before the first Boil appeared. The Suffusions, or Flushings, that discoloured the Skin, remained as at first, sometimes more, sometimes less, for the Space of twelve Days after the Inoculation. She had a Nausea, loss of Appetite, was weak, listless, giddy, and had terrible Frights in her Sleep; and so continued till about twelve Weeks after the Operation: Then she was seized with a Pain in her Back, tho’ not so violent as to confine her, and three Days after the Small-Pox came out: Her Hands and Arms were full, a pretty many appeared upon her Legs, but she had few on her Body, and only two on her Face, and they were all fully ripened the seventh Day after the Eruption. Now by this History it is evident, that the false Eruptions and Flushing, with the Help of the issuing Matter from the Wound did not bring forth the Stamina, or Principles of the Small-Pox from the Blood; for not till after those Symptoms disappeared, even twelve Weeks, did the Distemper break out in a true and regular Manner. If any Man shall adventure to say, that this was all along the Small-Pox stirred up in the Blood, though it did not appear till three Months after, this will not favour the Inoculator’s Cause; for first must be allowed, that the Gleet and the Eruptions were not concerned nor complicated with the Seeds of the Small-Pox, nor were they the Conveyancers that brought them out. This Point being settled, it will follow, that all these irregular and false Symptoms to which is attributed such a healing Virtue, may all appear without the lead Matter of the Small-Pox in their Company, which will be left to be excluded with another Set of Eruptions and other Symptoms proper to the true Distemper. Who then is unconvinced, that the inoculated Matter sent into the Veins to search after, seize and bring forth the Seeds of this Disease inhabiting in the Blood, may come back, re infectâ, and without doing the lead Part of its Errand, while it only causes a Gleet and Disorder by Suffusions and Appearances on the Face and Body; and that the Task of Separating from the Blood the true Seeds, may evidently be reserv’d for the genuine Symptoms, which will afterwards be employed for that Purpose?

Besides, it should be considered, that supposing the inoculated Matter did only awaken and stir up the Seeds of the Small-Pox contained in the Blood, but could not bring them out by the false Symptoms before-mentioned, but left them to be digested by a long Course of Time, and after three Months to be expelled with the true Eruptions, how great a Danger of his Life the Patient must run all this Time, while he feels the Struggles and Strife of Nature to concoct the Matter, and bring it to a perfect Disease! for not knowing his Condition and the Reason of his various Complaints, and having receiv’d Assurance before from the Operator, that by the Appearances and Discharges, which happened soon after the Inoculation, he was fully secured from ever having the Small-Pox, either out of Negligence and want of due Care of himself, or by taking improper or prejudicial Medicines, not dreaming that he is breeding the Small-Pox, he may fall into the greatest Hazard. Hence it is plain, that sometimes all the Effects of Inoculation are insignificant, and leave behind them the Materials, or Rudiments of the Small-Pox in the Blood; how then can we be assured, that the false Eruptions have at any Time brought forth with them the Principles of that Disease; for in the Instance now before us, they certainly brought out none? It is therefore not only possible, but probable, that the Matter called forth into the Skin in those Suffusions, or Flushings, which are by no Means the true Small-Pox, may be intirely free from all Mixture and Combination with the proper Seeds of that Disease; and therefore the sanguine Undertakers can give no Security, that the Patient shall not be seized with the genuine and real Distemper in Time to come.

It is by this History very evident, that the anomalous and irregular Suffusions on the Skin, and the copious Gleet from the Place where the purulent Matter was inserted, may happen, and yet leave the Seeds and Principles of the Small-Pox untouched. And since one Person, and it is likely many more, who are not come to my Knowledge; (for great Care and disingenuous Diligence has been used to stifle such Examples; but not surely from a Zeal to promote true and useful History,) have, notwithstanding such disorderly Evacuations, afterwards gone thro’ that Disease in all its regular Forms; what Assurance can we have that those shall not be infected with the true Small-Pox hereafter, who can produce no other Evidence of their having had this Distemper already, but this, that after Inoculation a Rash, or Flushings, accompanied with Matter issuing from the Wound, were disperst and diffused over the Skin, which are no more the true Small-Pox, than the Itch is so? The Operator however assured them, that this Discharge would do as well, and serve for the Small-Pox instead of a better: But may not such a Person many Years after be infected with the genuine and uncontested Kind, that may prove fatal? The Numbers therefore, that have escaped the Small-Pox by Inoculation, cannot be computed, and the Balance settled, till hereafter it shall appear how many of those, who had only such spurious Symptoms, as before-mentioned, shall suffer the right and undisputed Sort in Time to come; for it appears by this Example, that the inoculated Person is not infallibly protected against all future Contagion of this Nature, since those Suffusions and irregular Breakings-out upon the Skin, attended with issuing Matter, which the Inoculators substitute as an Equivalent, or Succedaneum in the Room of the true Distemper, not only proved ineffectual and insignificant, but hurtful and dangerous.

The Instance I shall bring to make good the second Assertion is what Mr. Tanner, an experienced and judicious Surgeon, belonging to St. Thomas's Hospital, communicated to me. He affirmed, that to discover the Truth in this Matter, the following Experiment was performed in their House. A Person, who, as it was very evident, had undergone the Small-Pox before, was inoculated in due Form, and the Effect of the Operation was a Discharge from the Orifice of the Wound, and the irregular and anomalous Eruptions before described, that is, such as appear when the genuine Distemper is not produced; whence it is plain, that such Appearances may happen upon Inoculation, which bring forth with them no Seeds of the Small-Pox, and then they cannot always deliver the Patient from being afterwards infected with the true Kind.

As to the Production of the mild Kind only, and the Certainty of Recovery in all Instances, where this Operation is performed, that Point, it is certain, must be given up; for notwithstanding the Undertakers positively affirm, that by this Practice the Confluent or Dangerous Sort is never propagated, it is past all Contradiction that sometimes the Event has been otherwise, and Examples of this are so well known, that I forbear to set them down.

It is in vain to give this Matter another more favourable Turn for the Operators, by saying, the Patient was of a weakly Constitution, and full of ill Humours, or that he was of a froward and perverse Temper, and died by a Fit of Peevishness, or that he was carried off by terrible Convulsions, and not by the Small-Pox; for Men of the least Sagacity must see thro’ these ridiculous Evasions invented to cover true History and defeat our Inquiry into Matter of Fact, and to buttress up the Reputation of the Inoculators. Let it be supposed, that the Person is of a weakly Constitution, and that he labours too under some other Diseases or Indispositions, why would the Operator undertake to procure in such a Person this Distemper? why would he not chuse to set him by, and tell his Relations that by Reason of his unhealthful Complexion it was a dangerous Thing to meddle with him? But what if after all, this be no more than a mere Pretence and Subterfuge never thought on or spoken of till after the unhappy Event? And to say that the Patient had indeed the Small-Pox, but died of Convulsions, is only a Contrivance of the same Nature, to save the Credit of the Undertaker; it might as well be alledged, that he died by loss of Strength and vital Heat, or for want of Breath, of which great Numbers miscarry in all Diseases; for is there any Thing more common, than for mortal Distempers after the Spirits are exhausted to end in Convulsions? And since those Convulsions are the Effect of the Distemper, that has ruin’d the Patient’s Vigour and laid all Nature waste; must not the Distemper be charged with the fatal Event? To say that the Small-Pox, which the Convulsions attended, was not the Cause of the Patient’s Death, but the Convulsions, is the same Thing as to affirm that the Axe that cuts off a Traytor’s Head, is by no means the Cause of his Death, but the Effusion of Blood and trembling Motions of the Body, that followed the Separation.

To sum up what has been laid concerning the Inoculator’s Performance of his Promises; it is very evident that he is guilty of the Breach of his Word and Honour, which he plighted in the most solemn Manner, and with consummate Assurance: For if he does not always bring forth the Small-Pox, but sometimes fails, even of producing any Thing, but his own Shame: If when he brings forth upon the Skin any Pimples, Flushings, or Tetter-like Patches, which often happens, but are not the Small-Pox, nor will prove a Preservative against the Invasion of that Distemper afterwards; if he does not always by his inoculated Charm call up a mild, Distinct Kind, but sometimes a frightful Confluent Sort, contrary to his Intention, will appear; if the inoculated Persons do not always recover, but several of them fall by and under the Operation, then it is plain that the Undertakers have not made good any one of their Promises. And I must acknowledge that I was at first prejudiced against them, by their boastful and Quack-like Conduct, while they roundly and with intrepid Confidence affirmed, that their unerring Method would always propagate a safe and Distinct Kind, not guarding themselves by any saving Exceptions, or Limitations; this, I say, was such an arrogant and emperical Manner, that it made me suspect the Operators were either ignorant or unfaithful.

What has hitherto been said, was to demonstrate the Risk the Persons themselves run, who submit to this Operation: But the following Remark will shew the Injury, that it is always probable, and sometimes certain, they will bring upon others. It is well known that several Diseases are propagated from one Person to another, and from one House to another, and therefore are named Infectious; for in those Cases the corrupt Particles, or noxious Effluvia flowing from the Body of the sick Person, being conveyed by the Mediation of the Air, will be communicated to others, and inspire into their Blood the Contagion, and this is the Nature of the Small-Pox: And therefore when any Person out of Choice brings into his House or elsewhere this Distemper, it is highly probable, if not certain, that he will propagate the Infection among the nearest Inhabitants, who will convey it to others, and so on, till the Distemper rages thro' the whole Village, or City, which, I am informed, has befaln the unhappy Sufferers in the Town of Hertford; and this Event is inevitable from the infectious Quality of the Disease: And notwithstanding the Inoculators should produce in their Patients only the Mild and Distinct, yet the Neighbours that shall be infected by it, may suffer the Confluent and most fatal Kind; for it is common to observe that in the same Family, where are many Children, if the first that falls sick, has a very mild Sort, the second that is infected by this mild Sort, shall have a Confluent and dangerous Kind, the third again a gentle and safe Sort, and the fourth, one not only Confluent, but Mortal: So that I cannot see but those who submit themselves or their Relations to this Operation, are guilty of great Injustice and Wrong to many, whose Lives by their Means are put in Danger. And tho' Persons of Quality and Distinction may provide Places remote from others for their Children, and therefore may be in a great Measure excused; yet still there may be some Danger, though not so great, that the Distemper may be communicated by the Conveyance of the Air, or by infectious Goods and Garments; but if this Practice be encouraged and grows common, this Provision cannot be made by the generality of the People. Our Governours formerly thought fit to make a Law, that obliged the Person in whose House a Fire should break out, though by Accident and without his Contrivance, to make good the Damages of his Neighbours, whose Dwellings should be burnt down by the spreading Flames: It is true, that Act is since repealed, but when it was made, there was a great Appearance of Reason and Equity in it, otherwise it had not been enacted. But how much more to be condemned are such, who design and contribute their Endeavours to bring about such a Mischief; and therefore there is a Statute still in Force, that makes it Felony for any Man willingly to burn his own House; the Reason is founded on this, that by so doing he may probably destroy the Dwellings, and perhaps the Lives, of adjoining Inhabitants; And is it not a parallel Case, if a Man from a free and deliberate Choice, sets his own Veins on Fire, and inflames his Blood with the Small-Pox, which by its contagious Quality may endanger the Lives of many others? Either that Disease must be declared not infectious, or the Consequence is unavoidable; and though he has made Provision for himself, and by that Means has undergone a mild and safe Distemper, yet, as I said before, when the Infection spreads in the Neighbourhood, many may be seized with a dangerous and fatal Kind: And one would think that this Reflection should stagger a Man of Prudence and Virtue, and make him hesitate and consider well with himself, before he ventures upon a Practice, that seems a great Breach of Christian Charity, and a Violation of Justice.

After all it must be acknowledged, that though the Operators were inconsiderate and rash in their boastful Promises, yet if it can be made appear, that their Method has produced a safe and mild Kind far more frequently than Nature alone, or assisted, has done; that they never propagate the dangerous Confluent Sort, and that exceeding few have miscarried, if compared with the immense Number, that have escaped: If this Comparison, I say, be adjusted, between Nature and the inoculating Art, and by a regular Calculation, the Amount is so much superior on the Inoculator’s Side, then indeed a great deal might be said to encourage this Operation; but to proceed in this Computation by a reasonable Method, it must be considered first, what great Numbers recover by Nature singly, or assisted by Art, without being Inoculated; then what Numbers more might never have had the Small-Pox, had they never undergone that Operation; and lastly, how many of those, who have been Inoculated, may notwithstanding several Years after, fall into that Distemper: And till this be done, it will be difficult to settle the Balance on either side; and therefore it would be a desireable Thing to learn how many fall sick and dye of the Small-Pox, in each Parish of this City in a Week, and then to compare them with the Number of those who escape, though this in one Respect would not be strictly just, for a great many in poor and needy Families might have died for want of proper Remedies, due Care, and the Conveniencies and Necessaries of Life. If this be considered, and the Deductions granted, it is probable it might appear that the Proportion of those that escaped by Inoculation, especially if Allowance be made for those that may have them afterwards, as observed before, it will be uncertain whether the Persons recovered by Inoculation, exceed the Number of those that escape otherwise, or that might have escaped, had they not wanted the necessary Means of Food and Physick: For by this Computation, the Number of the last may amount to fourscore or a hundred, to one that dies, according to Dr. Wagstaffe's Conjecture; for a certain Calculation cannot be made: And if a Discount be allowed for those of the inoculated Persons, who otherwise might never have had the Small-Pox, or that may hereafter die of this Distemper, tho' they had been inoculated, the Proportion of each Side may be brought nearer to an Equality; and then what Advantage can accrue to the People from this novel Practice? And if this be so, what wise and considerate Person would venture upon Inoculation, when there is an equal Chance for his Life, if he lets it alone?

But I have two Things more to offer, that may discourage this Operation in the Judgment of impartial and reflecting Persons, the first is this; It is confidently affirmed, that Inoculation always calls forth a mild and favourable Sort, and by this Means prevents the Patient's falling into the Confluent Kind, which is always dangerous, and often mortal. Let us search into the Reason and Nature of Things, that we may learn how this Event can be accomplished. It is evident that if the operative inoculated Matter makes that a mild and safe Small-Pox, that otherwise might have been of a dangerous Sort; this must be effected by Angling out and separating the gentle and inoffensive Particles from the more noxious and malignant, with which they were combined and complicated, and to employ only the first in the Formation of the Disease; for if at the Time of Inoculation, no such putred Parts did adhere to the mild and friendly Matter, then the Small-Pox, which Way ever it had been produced, whether by Inoculation, by Nature, or the common Way of Infection, must have been of the safe and gentle Sort, being constituted wholly of mild and safe Materials; and therefore, that it is a mild Sort is not owing to Inoculation, for it could not have been otherwise; let it then be supposed, that a Separation being made by the inoculated Matter, only the mild and kindly Particles were called forth and beckned, I know not how, to come away; which starting from those of a malignant Quality, and uniting together, conspired to form the Small-Pox, and determined to admit none of the dangerous and putred Particles into their Company: Let this be granted, tho' it might puzzle a considerable Philosopher to account for such an Effect, and tell the World how this can be done, that is, how the Inoculated Matter of a mild and gentle Nature should be endowed with so much Sagacity and Choice, as to stir up and assemble only friendly and gentle Particles like its own, having first disengaged them from their Union with others of a noxious Nature; I demand what is become of those malignant Parts, which would have made a terrible Disease, had they not been disengaged and divided from the others of a mild Disposition? The Answer must be, that they are left behind in the Blood; for it cannot be pretended, that they were any Way conquered, digested and expelled thence by this Operation; and if they are left behind in the Blood, must not the adhering of those putred Particles to the Seeds and Principles of any other Disease, acute or chronical, be afterwards of a dangerous Consequence, either by improving or heightning a simple and safe Fever, into one ill conditioned and of a hazardous Event, or by associating with the Principles of any other Diseases, and adding their Putrefaction to them make those Diseases to be of the word Kind, and then what has the Patient got by the Inoculation? Suppose he has escaped a dangerous Small-Pox, that is, one that would have been so, had it not happily been prevented by this Operation; yet is he not still obnoxious either to a violent Fever, or other Distempers equally hazardous, from the putred and malignant Particles that were separated from the mild and gentle Seeds of the Small-Pox by Inoculation, but still left in the Blood to produce in Time a no less terrible Disease than the Confluent Kind of that of which we are discoursing.

If it be said, that the Operation made upon Children and young Persons, does not prevent a Small-Pox from being Confluent, by separating the Matter of it from any putred Parts at that Time; but while the Patient is young, the Inoculation calls forth the Matter, while it is mild and unhurtful, which if the Child grew up and became adult, would by the Addition of ill Humours afterwards contracted, prove a very bad, and perhaps a fatal Sort: I answer, that still the same Difficulty recurs, as will presently appear. It must be allowed that the Principles, or Seeds of the Small-Pox, either are actually interwoven with the Stamina, or Principles of Life, and so are inbred and coeval with our Beings, or else there are such particular Impurities at first complicated with the Blood, that are soon improved and heightened into this Distemper, or are readily disposed and prepared to receive infection from abroad: And it must be granted, that these Seeds are at first mild and apt to produce the safe Distinct Kind, which appears from this, that Children have for the most part this gentle and temperate Sort, for generally speaking the Seeds are friendly at first; but afterwards, when they have by long Continuance in the Blood associated many other noxious Particles, and assimilated them into their own Nature, by the Adhesion of these, and the perpetual Access of more, they grow putred and malignant, which were mild and unhurtful before. Hence it comes to pass, that the longer it is before Men have this Distemper, the more dangerous it proves; and this likewise is the Reason why the Confluent Kind is so rife among those who inflame their Blood with excess of Wine and strong Liquors, and fare deliciously every Day: These luxurious Persons, that live high, and use little Exercise to purify and free the Blood, are full of noxious Impurities, which combined with the Seeds of the Small-Pox, raise them to a malignant and pernicious Nature. It is plain then that the safe and Distinct Kind, far exceeding in Number the dangerous and Confluent, shews that the Materials of the Small-Pox are at first gentle and benign, and continue so till corrupted and depraved by the impure Humours it from Time meets and unites within the Body, by which unhappy Confederacy it becomes dangerous, and often destructive. Now let it be granted, that the Inoculation performed on Children, prevents the Danger of having a bad Sort in riper Years, when many ill and putrefied Humours generated in the Blood after Childhood, might have produced, as it often does, the worst Sort, by adhering to, and combining with the Seeds of the Small-Pox, at first mild and favourable: Now, as I said, the same Difficulty recurs; for those ill Humours which will be generated and collected in riper Years, will unite or joyn themselves with the Principles, though not of the Small-Pox, yet of some other Disease, from which the Danger will by that Means be as great, as if the Patient had laboured under the Confluent Kind of the Small-Pox: So that it is very evident, that should it be granted, that a gentle and kindly Disease will be always the Consequence of Inoculation in young Persons; yet since afterwards many putred and noxious Humours may be produced in the Blood, which it is allowed would have rendred the Small-Pox putred and malignant, by uniting with them, had not the Inoculation prevented it; is it not clear, that those noxious, or putred Humours bred afterwards in the Body will join their Forces and strike in as easily with the Ferments and Principles of other Distempers, as they might have done with the original Seeds of the Small-Pox:, had they remained there, and raised them to as dangerous a Nature. Upon the Whole it appears, that though it be granted that Inoculation always propagates a kindly Sort of Small-Pox, and saves Children from the Danger of a Flux, or Confluent Kind, which they might contrast in riper Years, yet it leaves them altogether in as great Hazard of being attacked by other terrible Distempers, which become so by the Accession or Adhesion of the putred malignant Particles of the Blood, which could not be carried off by Inoculation, before they were bred: So that if the Operation delivers the Patient from a Confluent, and Hazardous Small-Pox, it does but transfer the Danger to some other Disease with which the malignant Particles afterwards generated will combine; suppose a simple Fever, or any other unhurtful Distemper, which by that Addition may prove malignant and mortal.

If it were true, that any putrid Particles lurking in the Blood, were carried off by Inoculation, which, it is clear, they are not, for otherwise the Disease would always be of the Putred and Confluent Kind; or if it could prevent the breeding of noxious Humours in the Blood for the future, which may be as dangerous by combining and taking Part with the next Disease, that is stirred up there, this Operation would be of admirable use, but since that is not to be hoped for, I cannot see what Benefit it brings to Mankind. I ask Pardon of the Reader for being so diffusive and copious on this Argument; for I thought it necessary to be so, not only because the Subject is new, but because a thorough Discussion of it sets this Controversy in a true and clear Light.

My second Objection against Inoculation, which was suggested to me by Dr. Wats, a Gentleman of superior Abilities, Integrity, and great Diligence in his Profession, is this, that it is very probable, that the Seeds of other Distempers may be communicated together with those of the Small-Pox, contained in the purulent Matter, taken from the ripe Pustules of the Patient, and Inoculated upon one that never had the Disease. The Principles of Diseases are of the minutest Size, and some of them, that were lodged in the Blood, may well be supposed to adhere to the Matter that produced and fed the Pustules, and still to be contained in the inoculated Matter conveyed to another. It is allowed, that the Principles of the Kings Evil, of Consumptions, Lunacy, and Venereal Diseases, are conveyed from Fathers to their Children successively through many Generations: and are therefore called Hereditary; a sad Inheritance! And may not some of the Seeds of these grievous Distempers, intangled and complicated with those of the Small-Pox, be excluded to form and increase the Pustules, and be after conveyed with that Matter, which is taken from them, and so be inoculated together with the Small-Pox? And though none of these Diseases presently appear; may not their Seeds operate by Degrees and shew themselves, when they have acquired greater Vigour by assimulating and corrupting such Parts of the Blood and Humours, which they find there, that approach nearest to themselves in their Quality, and by such daily Accessions grow in Strength, and at Length break out in a formal Distemper; which, may likewise be said of several other Diseases, though not Hereditary? There is nothing unnatural or repugnant to Reason in this Supposition; whence it will follow, that the Operator intending to convey but one Disease, may transfuse several at the same Time into the Veins of a sound and healthful Patient, and thereby sow the Seeds of many dreadful Productions.

It may here properly be enquired, why our Inoculators have not extended their Operation to the Plague, since the Parity of Reason so much encourages it: There are many intermediate Degrees between the most malignant and the mildest, or least dangerous Kind of that terrible Disease. It is plain, that at Constantinople this Disease is not so virulent and destructive as it is usually in this Country, and as it lately was in a neighbouring Kingdom: For in these Parts it often cuts off in a Summer vast Numbers more than it does in Turkey; and I am informed by those who have resided many Years in Constantinople, that the Plague there is not attended with those Tokens of Putrefaction and Malignancy, I mean, Carbuncles, Tumours, blue Spots and Blanes, which are the Symptoms that accompany this Distemper here; and therefore, though it happens often in Turkey, yet it does not make such Havock and Devaluation among their People as it does among ours. It is observed, when a raging Plague of the most virulent Nature has by Degrees spent its Fury, it grows less destructive, and Multitudes more escape now than before: And at this Time, when the Plague is weakened, it throws it self out in Boils or inflammatory Tumours, which Nature, assisted by the Surgeon’s Art, often ripens, and brings to Suppuration, and this seasonable Discharge frequently delivers the Patient, and sets him out of Danger: Now suppose a small Portion of this ripe Matter should be inoculated on a sound Person; is there not the same Reason to expect that this Inoculation should produce a moderate Plague, that is, one of less Malignancy and Danger, whereby vast Numbers may escape in populous Towns and Countries where the Infection rages, being delivered from all Apprehensions of catching afterwards the highest and most fatal Contagion? Is not this, I say, as reasonable, as that the Matter taken from one that lyes ill of the gentlest and most kindly Small-Pox, should propagate only that Sort, and not the dangerous? If this Arguing be not close and conclusive, let the Weakness of it, and the Disparity of Reason, be made appear: But if it be just and valid, then if the Inoculators are by their Operation highly useful and beneficial to the World, as their Promoters affirm, then, I say, I have refined upon that Invention, and have started a Practice of greater Importance, and far more extensive Benefit to Mankind, and shall leave it to them to make their Advantage of it.

But if, notwithstanding what I have alledged in this Dissertation, to discourage a Practice newly introduced into this Country, it shall still make its Way, and grow in Fashion; I have another Method of propagating the Small Pox, that is altogether as effectual, much more clean and decent, and which is freer from several Objections that lye against Inoculation, and that is the Conveyance or Communication of the Small-Pox from one to another, by a voluntary and designed Infection, which is this: Let any one, desirous to catch the Contagion, be carried to a sick Person when the Pustules are filling, or fully ripe, let him sit by the Patient's Bed, and let a Handkercheif or Piece of Linen, taken out of the Patient's Bosom, be smelt to, and let the Person to be infected wear it in his own Bosom, and let this be repeated several Times, and let him carry the Linen home in his Breast; or let him bend himself down to the Patient, while he breaths upon him several Times, and there is no Reason to doubt but the Infection will generally be caught; for some particular Persons are not by Nature disposed ever to receive it, but pass a long Life uninfected, tho' frequently conversant with the Small-Pox.

As involuntary and undesigned Infection received from others, is the common Way of propagating this Distemper, so it may likewise he communicated as certainly, when by Choice and Purpose, any Person who has a Mind to be infected, will visit and nearly converse with Persons, that actually are sick of this Disease. And this has really been Matter of Fact; for I know it was customary with Dr. Sydenham, when there was a mild and favourable Small-Pox going about, to carry young Persons, his Relations or Friends, to visit one of his Patients, to sit by him, and converse with him, and he seldom failed of his Design; the Visitor generally caught a favourable Small-Pox, and soon recovered. As to what the Operators alledge, that they prepare before hand the Person to be inoculated, and being apprised what the Disease is, when it makes its full Attack, they know the better how to manage for the Patient’s Security: And is not the Case the same, if a Physician should carry his willing Friend, or Relation, to catch the Infection from one that has a mild distinct Sort, may he not prepare him by purging, bleeding or vomiting, or how he thinks fit; and does he not know what Disease he must expect, when, the Patient shall begin to complain? Here all Things are on an equal Foot; but the Method I propose has in other Respects many Advantages over that of Inoculation; for it is not only a more decent and elegant Manner of conveying the Contagion from one to another, but it does never delude you by bringing forth an imaginary mock Small-Pox, confiding in Itch-like Appearances, and various Flushings of the Face and Skin, after which the Sufferer, notwithstanding the Operator’s Promise, is still obnoxious to the real Kind; this low and defective Imitation of the Small Pox is an extraordinary Production, not of Nature, but of Art, reserved for the Honour of the Inoculator. Nor is this Way liable to another Objection that I have brought against, this Operation, which is, that the gross and purulent Matter, that is inoculated, may contain in it the Seeds of various other Distempers, for they, being of a minute Size, and small beyond Conception, thousands of them may lodge together with the Principles of the Small Pox; and therefore must together with them be communicated to the Veins of the Person inoculated; for the Effluvia, or infectious Particles, that flow from the Body of the sick Person are very little, even unperceptible, and cannot admit those Combinations with the Seeds of other Distempers, as before-mentioned; or if they can, it must be in a far inferior Degree than that which the inoculated Matter is capable of; neither is it, as that is, conveyed immediately into the Blood by a Wound made for that Purpose, which must needs communicate them in greater Plenty.

I have thus set down the Objections and reasonable Prejudices, which I have conceived against Inoculation; and it is very probable, that for some of these Reasons, among others, the Inoculators who practise upon the Greeks and Armenians in Constantinople, have not yet propagated their Art among the Musselmans; for, as I am informed, this Invention does not obtain among the Native Turks, but is confined to the Nations before-mentioned, who inhabit with them; and tho’ from a Principle of Predestination they forbear the Use of Medicines, or other Preservatives while the Plague reigns, yet, notwithstanding that Principle, they have Recourse to Remedies in other Distempers acute and chronical; and probably then in the Small-Pox: And from such Exceptions it is likely, that the Christian Nations, who lye upon the Frontier of Turky and must have been soon and well acquainted with this Operation, were never drawn in to imitate their Example. One would have thought, that these Neighbours, who had great Opportunities of informing themselves thorowly of the Success of this Practice would have introduced it into their own Country, and have propagated it over Christendom; and therefore it must be very wonderful, what Grounds and Motives the Germans and Hungarians, near Neighbours to Turky, go upon, while they refuse to follow this beneficial Method of Inoculation, and have by that Neglect shewn themselves Enemies to their own Country, unless they proceeded upon the Arguments before set down, and perhaps others as convincing. The French and Dutch are not so stupid and incapable of Reflection and useful Observation, but they would certainly have imported this Invention from Constantinople, where some of them have, as Ministers, or Merchants, constantly resided, had they not discovered some unanswerable Objections to the Practice of it. And though this is not a downright Demonstration, yet it is, however, a very reasonable prejudice against Inoculation, that all the Nations of Christendom, who must be allowed to have a Principle of Self-Preservation, and to be concerned for their own Health, as well as the Safety and Good of their Friends and Relations, and the Benefit of Mankind, as much as the People of Great Britain, have universally refused to introduce this innovation in Physick, into their Native Countries.

FINIS.

Fleuron page 142 A Treatise upon the Small-Pox.jpg

THE

CONTENTS.

PART I.

OF the Nature of the Small-Pox,
Page 7
That it is a Fever,
ibid.
What a Fever is,
p. 8
Of the several Sorts of Fevers,
ibid.
The Small-Pox is a Fever of the Inflammatory Kind,
p. 11
An Account of its efficient and material Causes,
p. 12
How it is distinguished from other inflammatory Fevers,
ibid.
How this Distemper is first introduced into the Body,
p. 13
The animal Spirits receive the first Impressions of it,
ibid.
Of the several Sorts, or Species of the Small-Pox, (viz.) the Distinct, Middle, and Confluent, or Flux Kind,
p. 14