Chapter IX: Asiatic Cholera (9)

[834] Dr Dover has left us an account of Sydenham’s practice in the smallpox as he himself experienced it: “Whilst I lived with Dr Sydenham, I had myself the smallpox, and fell ill on the twelfth day. In the beginning I lost twenty ounces of blood. He gave me a vomit, but I find by experience purging much better. I went abroad, by his direction, till I was blind, and then took to my bed. I had no fire allowed in my room, my windows were constantly open, my bedclothes were ordered to be laid no higher than my waist. He made me take twelve bottles of small beer, acidulated with spirit of vitriol, every twenty-four hours. I had of this anomalous kind to a very great degree, yet never lost my senses one moment.” _The Ancient Physician’s Legacy._ London, 1732, p. 114.

[835] _Scotia Illustrata._ Lib. II., cap. 10.

[836] _De Febribus &c._, Lond. 1657: cap. ix. “De Variolis et Morbillis,” p. 141.

[837] “First of all,” he says, “let the patient be kept with all care and diligence from cold air, especially in winter, so that the pores of the skin may be opened and the pocks assisted to come out. Therefore let him be kept in a room well closed, into which cold air is in no manner to enter, and let him be sedulously covered up in bed.... I desire the more to admonish my friends in this matter, for that Robert Cage, esquire, my dear sister’s husband,” etc.

[838] Besides cases to show the ill effects of blooding, vomits, purges and cooling medicines such as spirit of vitriol, he gives examples as if to refute Sydenham’s favourite notion that salivation, diarrhoea and menstrual haemorrhage were relieving or salutary. Morton’s chief object was to bring out the eruption, and to get it to maturate kindly; an eruption which languished, or did not rise and fill, was for him the most untoward of events. Sydenham, on the other hand, argued that the danger was in proportion to the number of pustules and to the total quantity of matter contained in them; and he sought, accordingly, to restrain cases which threatened to be confluent by an evacuant treatment or repressive regimen.

[839] Walter Lynn, M.B., _A more easy and safe Method of Cure in the Smallpox founded upon Experiments, and a Review of Dr Sydenham’s Works_, Lond. 1714; _Some Reflections upon the Modern Practice of Physic in Relation to the Smallpox_, Lond. 1715. F. Bellinger, _A Treatise concerning the Smallpox_, Lond. 1721.

[840] Letter from Woodward to the _Weekly Journal_, 20 June, 1719, in Nichols, _Lit. Anecd._ VI. 641.

[841] Rev. Dr Mangey to Dr Waller, 4 March, 1720, London. Nichols’ _Lit. Anecd._ I. 135.

[842] Huxham, _Phil. Trans._ XXXII. (1725), 379.

[843] _Gent. Magaz._, Sept. 1752.

[844] John Barker, M.D., _Agreement betwixt Ancient and Modern Physicians_, Lond. 1747. Also two French editions. It is on Van Helmont that Barker pours his scorn for “breaking down the two pillars of ancient medicine--bleeding and purging in acute diseases.” That upsetting person forbore to bleed even in pleurisy; the only thing that he took from the ancient medicine was a thin diet in fevers; “and yet this scheme, as wild and absurd as it seems, had its admirers for a time.”

[845] Lynn (u. s. 1714-15) agrees as to the matter of fact, namely, that the mortality from smallpox was greater among the richer classes, who were too much pampered and heated in their cure, than among the poorer, who had not the means to fee physicians and pay apothecaries’ bills.

[846] He was under the tutelage of John Churchill, duke of Marlborough, who does not give a name to the malady (Coxe’s _Life of Marlborough_). Dr James Johnstone, junr., of Worcester, in his _Treatise on the Malignant Angina_, 1779, p. 78, claims the death of the Duke of Gloucester as from that cause, on the evidence of Bishop Kennet’s account.

[847] In the _Gentleman’s Magazine_, under the dates.

[848] _A Direct Method of ordering and curing People of that Loathsome Disease the Smallpox, being the twenty years’ practical experience of John Lamport alias Lampard_, London, 1685. The writer was probably an empiric, “Practitioner in Chyrurgery and Physick,” dwelling at Havant, and attending the George at Chichester on Mondays, Wednesdays and Fridays, the Half Moon at Petersfield on Saturdays. He says: “One great cause of this disease being so mortal in the country is because the infection doth make many physicians backward to visit such patients, either for fear of taking the disease themselves or transferring the infection to others.” He has another fling at the regular faculty: “Do not run madding to Dr Dunce or his assistance to be let bloud.” Empirics, although they were commonly right about blood-letting, were under the suspicion of not speaking the truth about their cures.

[849] Macaulay, _History of England_, IV. 532. The moving passage on the former horrors of smallpox, _à propos_ of the death of Queen Mary in 1694, is familiar to most, but it may be cited once more in the context of a professional history: “That disease, over which science has since achieved a succession of glorious and beneficent victories, was then the most terrible of all the ministers of death. The havoc of the plague had been far more rapid: but plague had visited our shores only once or twice within living memory; and the smallpox was always present, filling the churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.” It is not given to us all to write like this; but it is possible that the loss of picturesqueness may be balanced by a gain of accuracy and correctness.

[850] Kellwaye, u. s., 1593.

[851] Dr Richard Holland in 1730 (_A Short View of the Smallpox_, p. 75), says: “A lady of distinction told me that she and her three sisters had their faces saved in a bad smallpox by wearing light silk masks during the distemper.”

[852] As I do not intend to come back to the subject of pockmarked faces, I shall add here that I have found nothing in medical writings of the 18th century, nor in its fiction or memoirs, to show that pockpitting was more than an occasional blemish of the countenance. At that time most had smallpox in infancy or childhood, when the chances of permanent marking would be less. The disappearance of pockpitted faces was discovered long ago. The report of the National Vaccine Board for 1822 says: “We confidently appeal to all who frequent theatres and crowded assemblies to admit that they do not discover in the rising generation any longer that disfigurement of the human face which was obvious everywhere some years since.” The members of this board were probably seniors who remembered the 18th century; and it is quite true that the first quarter of the 19th century was singularly free from smallpox in England except in the epidemic of 1817-19. But the above passage became stereotyped in the reports: exactly the same phrase, appealing to what they all remembered “some years since,” was used in the report for 1825, a year which had more smallpox in London than any since the 18th century, and again in the report for 1837, the first year of an epidemic which caused forty thousand deaths in England and Wales. These stereotyped reminiscences are apt to be as lasting a blemish as the pockholes themselves.

[853] Collinson, _Hist. of Somerset_, III. 226, citing Aubrey’s _Miscellanies_, 33.

[854] Blomefield, _Hist. of Norfolk_, III. 417.

[855] Thoresby, _Ducatus Leodiensis_, ed. Whitaker. App. p. 151.

[856] _Cal. Le Fleming MSS._ p. 408 (_Hist. MSS. Com._). There are also many references to smallpox from 1676 onwards in the letters of the Duke of Rutland at Belvoir, lately calendared for the Historical MSS. Commission.

[857] In the _London Gazette_ of 11-14 May, 1674, the Vice-Chancellor and two doctors of medicine of the University of Cambridge contradicted by advertisement a report that smallpox and other infections were prevalent in the university.

[858] Marquis of Worcester to the Marchioness, [London] 8 June, 1675 (Beaufort MSS. _Hist. MSS. Commis._ XII. App. 9, p. 85): “They will have it heere that the smallpox and purple feaver is at the Bath, and the Dutchesse of Portsmouth puts off her journey upon it. The king askt me about it as soon as I came to towne. Pray enquire, and lett me know the truth.” The _London Gazette_ of 17-21 June and 28 June-1 July, 1775, had advertisements “that it hath been certified under the hands of several persons of quality” that Bath and the country adjacent was wholly free of the plague or any other contagious distempers whatsoever.

[859] Burnet, _History of his own Time_, IV. 240.

[860] Walter Harris, M.D., _De morbis acutis infantum_. Ed. of 1720, p. 161.

[861] John Cury, M.D., _An Essay on Ordinary Fever_. Lond. 1743, p. 40.

[862] See p. 438.

[863] Macaulay hardly realized the anomalous character of the queen’s attack of smallpox. “The physicians,” he says, “contradicted each other and themselves in a way which sufficiently indicates the state of medical science in that day. The disease was measles; it was scarlet fever; it was spotted fever; it was erysipelas.... Radcliffe’s opinion proved to be right.” There had been some doubt on the first appearance of the eruption whether it would turn to measles or smallpox. Sydenham says that it was often difficult to make the diagnosis at that stage, and in the queen’s case the first signs were anomalous as well. Next day, however, the eruption all over the body became “smallpox in its proper and distinct form.” But it did not long remain so; the livid spots, into which the pustules subsided, again raised doubts in the minds of some of the physicians whether it was not measles after all; and there was undoubtedly erysipelas of the face. Harris took the middle course of diagnosing “smallpox and measles mingled,” a name by which the form that we now call haemorrhagic smallpox had been known from the early part of the seventeenth century. It was at this late and ominous stage of the illness that Radcliffe was called in; it is not correct to say, as the historian says, that he was the first to pronounce “the more alarming name of smallpox.” The diagnosis was then a matter of little moment, for the queen was dying. He declared that “her majesty was a dead woman, for it was impossible to do any good in her case when remedies had been given that were so contrary to the nature of her distemper; yet he would endeavour to do all that lay in his power to give her ease.” (Munk’s _Roll of the College of Physicians_, II. 458.) For some unexplained reason Radcliffe was made to bear the blame of the queen’s death, an accusation which he deserved as little as he deserved the credit given him by the historian of having been the only physician to make the correct diagnosis.

Macaulay is equally unfortunate in his remark that smallpox “was then the most terrible of all the ministers of death,” in his comparison of it to plague, and in his rhetoric generally. The haemorrhagic form, of which the queen died, was rare. Dover adds it as a fourth variety, but admits that he had seen only five cases of it. Ferguson, of Aberdeen, as late as 1808, in a paper on measles (_Med. and Phys. Journal_, XXI. 359), described a haemorrhagic case of smallpox which he once saw, without knowing that it was a recognized variety of smallpox at all. However terrible a minister of death smallpox may sometimes have been, it happened that there was comparatively little of it in London during the period covered by Macaulay’s history; and it certainly did not “fill the churchyards,” as he might have found out by referring to that not altogether recondite source, the bills of mortality. From 1694 to 1700 fevers caused three and a half times more deaths than smallpox. In the year 1696, when “the distress of the common people was severe,” the smallpox deaths in London were 196, or about one-hundredth part of the mortality from all causes.

[864] Blomefield, III. 432. The following are two cases from the London epidemic of 1710: June, 15.--“Lord Ashburnham’s brother has the smallpox, and the first, concluding he had had it, went to him, and now himself very ill of them. Doctor Garth, who says none has them twice, examined the servants, and they tell him he was but six days ill then; so he concludes that was not the smallpox.” _Cal. Belvoir MSS._, II. 190.

[865] Lynn, u. s. He recalls a remark made by a writer in 1710 that the severity of that epidemic “was not due to a peculiar state of the air, but to a defect in some of our great physicians, who, being too fully employed, could not give due attendance to all or even to any of their patients through the multiplicity of them: for want of which, and the severity of their injunctions, which hindered others from applying anything in their absence, many persons were lost who might otherwise have been saved with due care.”

[866] John Woodward, M.D., _The State of Physick and Diseases, with an inquiry into the causes of the late increase of them, but more particularly of the Smallpox; with some considerations on the new practice of purging in that disease_. London, 1718.

[867] See the account of the Dispensary of the College of Physicians in Warwick Lane, in Munk’s _Roll of the Coll. of Phys._ II. 499, under the head of Sir Samuel Garth. The dispensary was started in 1687 and languished until 1724. The General Dispensary in Aldersgate Street was opened in 1770 with Dr Hulme as physician, and Dr Lettsom as additional physician in 1773.

[868] Letter of 27 March, year not given. _Hist. MSS. Com._ V. 618. See also the letter of 4 March, 1720, from Mangey to Waller, cited above, p. 450.

[869] Dr Philip Rose, of Bedfordbury (“over against a baker, next door to the Old Black Horse, two doors from Chandos Street, St Martin’s parish”), having been called by Lady Wyche to see her butler, pronounced him to be in the smallpox; whereupon the lady informed the physician that “she knew an eminent nurse who had managed above twenty of my Lord Cheyney’s servants in the smallpox, and every one of them had recovered.” Her butler was accordingly carried to this nurse’s house in a by street near Swallow Street. _An Essay on the Smallpox._ By Philip Rose, M.D. Lond. 1724, p. 18.

[870] “An Account or History of the Procuring the Small Pox by Incision, or Inoculation; as it has for some time been practised at Constantinople.” Being the Extract of a Letter from Emanuel Timonius, Oxon. et Patav. M.D., S.R.S., dated at Constantinople, December, 1713. Communicated to _Phil. Trans._ XXIX. (Jan.-March, 1714) 72, by Dr Woodward, Gresham Professor of Physic. Timoni had been in England in 1703, and had been incorporated a doctor of medicine at Oxford on his Padua degree: hence, perhaps, his correspondence.

[871] _An Essay on External Remedies_, Lond. 1715, p. 153. Kennedy settled in practice in London as an ophthalmic surgeon, and appears to have enjoyed the patronage of Arbuthnot. His other work, _Ophthalmographia, or Treatise of the Eye and its Diseases, with appendix on Diseases of the Ear_, Lond. 1723, which is dedicated to Arbuthnot, shows a knowledge of optics and of the structure of the parts concerned in operations on the eye.

[872] Sloane, _Phil. Trans._ XLIX. (1756), p. 516, “An Account of Inoculation given to Mr Ranby to be published, anno 1736.”

[873] Jacobus Pylarinus, _Nova et Tuta Variolas excitandi per Transplantationem Methodus, nuper inventa et in usum tracta, qua rite peracta immunia in posterum praeservantur ab hujusmodi contagio corpora_. Venetiis, 1715. Privilege dated 10 Nov., 1715. Reprinted in _Phil. Trans._ XXIX. (Jan.-March, 1716), p. 393.

[874] _A Dissertation concerning Inoculation of Smallpox._ By W. D[ouglass], Boston, 1730.

[875] _loc. cit._

[876] Published under the initials J. C., M.D.

[877] _De Peste dissertatio habita Apr. 17, 1721, cui accessit descriptio inoculationis Variolarum_, a Gualt. Harris, Lond. 1721.

[878] _Phil. Trans._ XLIX. 104.

[879] Sloane, u. s., 1736.

[880] Jurin, _Account of the Success of Inoculating the Smallpox_. Annual reports from 1723 to 1726.

[881] Alexander Monro, primus, _An Account of the Inoculation of the Smallpox in Scotland_. Edin. 1765 (Reply to circular of queries issued by the dean and delegates of the Faculty of Medicine of Paris).

[882] _Phil. Trans._ 1722: papers by Perrot Williams, M.D. (p. 262), and Richard Wright (p. 267).

[883] _Voyages du Sr. A. de la Motraye._ Tome II. La Haye, 1727, Chap. III. p. 98. He saw Timoni at Constantinople on his return from the Caucasus. Timoni used “a three-edged surgeon’s needle,” which is more intelligible than three needles tied together. La Motraye’s travellers’ tales have not enjoyed the best credit. But this of the inoculation in Circassia has been made by Voltaire the sole basis of his spirited account of inoculation as the national practice of that country (_Lettres sur les Anglais_, Lettre XI. “Sur l’insertion de la petite-vérole,” 1727, reprinted as the article “Inoculation” in his _Dict. Philosophique_, 1764). There has never been a grosser instance of a myth constructed in cold blood. The fable does not need refutation because it is mere assertion, in the manner of a _philosophe_. But the British ambassador at Constantinople made inquiries concerning the alleged Georgian or “Circassian” practice in 1755, at the instance of Maty, the foreign secretary of the Royal Society (_Phil. Trans._ XLIX. 104). A Capuchin friar, “a grave sober man” who had returned shortly before from a sixteen years’ residence in Georgia and “gives an account of the virtues and vices, good and evil, of that country with plainness and candour,” solemnly declared to Mr Porter that he never heard of inoculation “at Akalsike, Imiritte or Tiflis,” and was persuaded that it had never been known in the Caucasus. It was impossible that either the public or private practice of inoculation could have been concealed from him, as he went in and out among the people practising physic. He had often attended them in the smallpox, which, he said, was unusually severe there. On the other hand La Motraye says: “I found the Circassians becoming more beautiful as we penetrated into the mountains. As I saw no one marked with the smallpox, it occurred to me to ask if they had any secret to protect them from the ravages which this enemy of beauty makes among all nations. They told me, Yes; and gave me to understand that it was inoculating, or communicating it to those whom they wished to preserve by taking the matter from one who had it and mixing the same with the blood at incisions which they made. On this I resolved to see the operation, if it were possible, and made inquiry in every village that we passed through if there was anyone about to have it done. I soon found an opportunity in a village named Degliad, where I heard that they were going to inoculate a young girl of four or five years old just as we were passing.” This was published fifteen years after, Timoni’s account being given in an Appendix.

[884] _Travels_, IV. 484. See also for Algiers, _Lond. Med. Journ._ XI. 141. In those cases there was no inoculation by puncture or otherwise.

[885] _Miscell. Curiosa s. Ephemer. Med.-Phys. Acad. Nat. Curios._ Decuria I., An. 2, Obs. CLXV. 1671. D. Thomae Bartholini, “Febris ex Imaginatione.” Scholion by D. Henr. Vollgnad, Vratislaviae practicus.

[886] _Miscell. Curiosa_, _l. c._ 1677.

[887] See Drage, _Pyretologia_. Lond. 1665.

[888] Nuremberg, 1662, p. 529.

[889] La Condamine cites Bartholin’s essay on Transplantation as if it really contained the germ of inoculation, which it does not, the single reference in it to smallpox being in a passage where the contagion of that, as well as of plague, syphilis and dysentery, is said to be capable of being turned aside from one to another.

[890] Drage (_Pyretologia_) gives a case where an ague passed from one person to another in the fumes of blood drawn in phlebotomy. He says also (_Sicknesses and Diseases from Witchcraft_, 1665, p. 21) that a witch could be made to take back a disease by scratching her and drawing blood.

[891] _De Transplantatione Morborum._ Hafniae, 1673, p. 24.

[892] _De Febribus_, u. s. In the plague, a live cock applied to the botch was thought to draw the venom; the cock was then to be buried. Also crusts of hot ryeloaf hung in the room where one had died of plague absorbed the venom. Gabelhover, _The Boock of Physicke_, Dort, 1599, p. 298. Bread was used for the same purpose in fevers as late as 1765. Muret, _Mém. par la Société Econom. de Berne_, 1766.

[893] _Dissertationes in Inoculationem Variolarum_, a J. à Castro, G. Harris, et A. le Duc. Lugd. Bat. 1722.

[894] Gardiner’s _Triall of Tabacco_. London, 1610, fol. 38.

[895] _Ibid._ fol. 43. _The City Remembrancer_, 1769, a work claiming to be Gideon Harvey’s, says that in the Great Plague of London, 1665, some low persons contracted the French pox of purpose to keep off the infection of plague.

[896] _Inquiry how to prevent the Smallpox_, Chester, 1785:--“No care was taken to prevent the spreading; but on the contrary there seemed to be a general wish that all the children might have it.” Cited from Mr Edwards, surgeon, of Upton, near Chester. Again (_Sketch of a Plan, &c._, 1793, p. 491), “They neither feared it nor shunned it. Much more frequently, by voluntary and intentional intercourse, they endeavoured to catch the infection.”

[897] _History of Physic_, Lond. 1725-26, II. 288. This was written at a time when the novelty of inoculation had passed off, and may be taken as Freind’s mature opinion. Douglass, of Boston, writing in 1730, implies that Freind’s objections had been overcome; which may mean no more than he says in general: “Yet from repeated tryals the Anti-Inoculators do now acknowledge that inoculation, generally speaking, is a more easy way of undergoing the smallpox.” Condamine, in his French essay of 1755, counts Freind among the original supporters of inoculation, and ridicules the opposition to it. Munk, in citing the title of Wagstaffe’s _Letter to Dr Freind showing the danger and uncertainty of Inoculating the Smallpox_ (London, 1722), omits the words “to Dr Freind,” at the same time describing the pamphlet as “specious.” There seems no reason to doubt that Freind shared Wagstaffe’s views.

[898] Hecquet, of Paris, who is supposed to have been the original of Dr Sangrado in ‘Gil Bias,’ gave the following reasons against inoculation (_Raisons de doutes contre l’Inoculation_): “Its antiquity is not sufficiently ascertained: the operation rests upon false facts: it is unjust, void of art, destitute of rules: ... it doth not prevent the natural smallpox: ... it bears no likeness to physic, and savours strongly of magic.”

[899] James Jurin, M.D., _Account of the Success of Inoculation_, 1724, p. 3.

[900] G. Baker, M.D., _Oratio Harveiana_, 1761, p. 24.

[901] _Sloane, Phil. Trans._ XLIX. 516.

[902] They are given in Maitland’s _Vindication_, 1722, and in one of Jurin’s papers.

[903] In regard to the last of them, when Frewen in 1759 was controverting the fancy of Boerhaave and Cheyne that smallpox might be hindered from coming on in a person exposed to contagion by a timely use of the Aethiops mineral, he said there was a fallacy in the evidence, because many persons ordinarily escape smallpox “who had been supposed to be in the greatest danger of taking it.” Huxham also pointed out that a person might be susceptible at one time but not at another, or insusceptible altogether; and the elder Heberden wrote: “Many instances have occurred to me which show that one who had never had the smallpox may safely associate, and even be in the same bed with a variolous patient for the first two or three days of the eruption without any danger of receiving the infection.” William Heberden, sen., M.D., _Commentaries on Disease_, 1802, p. 437.

[904] Dr James Jurin was educated at Cambridge, and elected a fellow of Trinity College. He became a schoolmaster at Newcastle, where he also gave scientific lectures. Coming to London, with a Leyden medical degree, he devoted himself to the Newtonian mathematics and was made one of the secretaries of the Royal Society, Newton being the president. He was one of the original physicians of the new hospital founded in the Borough by Guy, the rich bookseller. He made a fortune by medical practice, and was elected president of the College of Physicians a few weeks before he died. In medicine his name is associated with the inoculation statistics, the idea of which, as well as most of the substance, he got from Nettleton, and with “Jurin’s Lixivium Lithontripticum,” or solvent for the stone, the idea of which belonged originally to Mrs Johanna Stevens, and was sold by her to the State for five thousand pounds on the 16th of June, 1739, the prescriptions having been made public in the _London Gazette_ of 19th June. On the 15th of December, 1744, Jurin was called to see the Earl of Orford (Sir Robert Walpole), who was suffering from stone, either renal or vesical. He began administering his alkaline solvent, “four times stronger than the strongest capital soap-lye,” and during the six weeks of his attendance had given his patient thirty-six ounces of it. Horace Walpole made him angry by arguing on the medicine: “It is of so great violence that it is to split a stone when it arrives at it, and yet it is to do no damage to all the tender intestines through which it must first pass. I told him I thought it was like an admiral going on a secret expedition of war with instructions which are not to be opened till he arrives in such a latitude.” (_Letters of Horace Walpole_, Cunningham, I. 339.) His services were at length dispensed with, and the earl, whose case was probably hopeless before, died in a few weeks. A war of pamphlets followed, Ranby, the serjeant-surgeon, maintaining that the patient had “died of the lixivium.” Mead, also, expressed himself strongly upon the attempt to use a modification of Mrs Stevens’s solvent.

[905] The fatalities are given somewhat fully in Jurin’s annual accounts of the _Success of Inoculation_, 1723-27.

[906] John Wreden, body-surgeon to the Prince of Wales, author of _An Essay on the Inoculation of the Smallpox_ (Lond. 1779), may also be counted among those who gave a more real smallpox. See especially his cases at Hanover.

[907] H. Newman, “Way of Proceeding in the Smallpox Inoculation in New England.” _Phil. Trans._ XXXII. (1722), p. 33.

[908] Thomas Nettleton, Letter to Whitaker. _Ibid._ p. 39.

[909] _Phil. Trans._ _l. c._ p. 46. A remark follows which is not quite clear: “There is one observation which I have made, tho’ I would not yet lay any great stress upon it, that in families where any have been inoculated, those who have been afterwards seized never had an ill sort of smallpox, but always recovered very well.”

[910] _Phil. Trans._ 1722, p. 209. Dated from Halifax, 16 Dec. 1722.

[911] Dr William Douglass to Dr Cadwallader Colden, 28 July, 1721, and 1 May, 1722, in _Massachu. Hist. Soc. Collections_, Series 4, vol. II. pp. 166-9. Also _A Dissertation concerning Inoculation of Smallpox_. By W. D[ouglass]. Boston, 1730; and _A Practical Essay concerning the Smallpox_. By William Douglass, M.D. Boston, 1730.

[912] Boylston, _Account of the Smallpox inoculated in New England_. London, 1726.

[913] This was admitted, in a manner, for the great Boston epidemic of 1752, by the Rev. T. Prince, _Gent. Magaz._ Sept. 1753, p. 414. The epidemic attacked 5545 (in a population of 15,684), and cut off 569. The numbers inoculated were 2124 (including 139 negroes), of which number 30 died and were included in the total of 569. Many of the inoculated, says Prince, were not careful to avoid catching the infection in the natural way; “for I have known some, as soon as inoculated, receive visits from their friends, who had been with the sick of the same disease and ’tis likely carried infection with them; it seems highly probable that the inoculated received the infection from them into their vitals.” It may be supposed that the inoculated who were more careful formed a part of the 1843 who “moved out of town.” More than a third of the population took natural smallpox in some four months (April to July) of 1752, more than a third had had it before, a severe epidemic having occurred in 1730 as well as in 1721.

[914] Clinch, _Rise and Progress of the Smallpox, with an Appendix to prove that Inoculation is no Security from the Natural Smallpox_. 2nd ed. 1725.

[915] C. Deering, M.D., _An Account of an Improved Method of treating the Smallpox_. Nottingham, 1736, p. 27. Woodville appears to accept this case as authentic.

[916] Pierce Dod, M.D., F.R.S., _Several Cases in Physic_. London, 1746.

[917] Kirkpatrick, and after him Woodville, treat the alleged experience of Jones as pure fiction.

[918] La Condamine, of Paris, an amateur enthusiast for inoculation, did all he could to upset the case. He got his friend Dr Maty, foreign secretary of the Royal Society, to make inquiry through the British ambassador to the Porte. It happened that Angelo Timoni, son of the inoculator, was at that time an interpreter at the British Embassy; he applied to his mother, who re-affirmed the facts as to the inoculation of her child in infancy, and her death by the natural smallpox twenty-four years after. The only defence left was that the inoculation had not been done by Dr Timoni’s own hand. La Condamine, _Mémoires pour servir à l’Histoire de l’Inoculation_. 2me Mémoire. Paris, 1768.

[919] Rush to Lettsom, Philadelphia, 17 June, 1808, in Pettigrew’s _Memoirs of Lettsom_, III. 201.

[920] Fuller, in his _Exanthematalogia_, makes a somewhat late defence of it in 1729. But Richard Holland, who published in 1730 _A Short View of the Smallpox_, does not mention inoculation, and in the following passage he writes of smallpox as if the extravagant hopes of the preceding years had vanished: “This last season having afforded too many melancholy instances of the fatal effects of the distemper, though under the care and direction of the most eminent physicians, since the disease, notwithstanding the plainness of its symptoms, is become the _opprobrium medicinae_,” _&c._ (p. 3).

[921] _Phil. Trans._ Jan.-March, 1722: “The way of proceeding in the Small Pox inoculated in New England.” Communicated by Henry Newman, Esq. of the Middle Temple, p. 33, § 3: “Yet we find the variolous matter fetched from those that have the inoculated smallpox altogether as agreeable and effectual as any other.”

[922] _An Essay on Inoculation: occasioned by the Smallpox being brought into S. Carolina in the year 1738._ By J. Kilpatrick. London, 1743, p. 50. The essay had been “first printed in South Carolina,” the London edition of 1743 having an Appendix dealing historically with the Charleston epidemic of 1738.

[923] Thomas Frewen, M.D., _The Practice and Theory of Inoculation_. London, 1749.

[924] J. Kirkpatrick, M.D., _Analysis of Inoculation, with a consideration of the most remarkable appearances in the Small Pocks_. Lond. 1754.

[925] Kirkpatrick, _Analysis_.

[926] La Condamine, _Mémoires pour servir, &c._ (Deuxième Discours), 1768, p. 91. It matters little what Lobb may or may not have done. But it does not appear that Boerhaave ever tried to get rid of the eruption of smallpox by means of drugs. In the chapter of his _Aphorisms_, “De Variolis” (§ 1392) he says that he imagines a specific might be found, in the class of antidotes, to correct and destroy the variolous virus, indicating antimony and mercury as likely agents for the purpose owing to certain physical properties of the medicinal preparations of them. Ruston (_An Essay on Inoculation_, 3rd ed. 1768) says that Boerhaave, who died in 1738, “never practised it himself; nor seems to have understood the manner in which these medicines operate to produce their salutary effects.” However they were known as the Boerhaavian antidotes to smallpox, and were used in Rhode Island, it is said with great success and as a secret. Ruston used them in England, and discovered by an analysis that Sutton’s secret powders were the same. They seem also to have been used by Cheyne to prevent the development of smallpox in persons who had been exposed to contagion and had presumably taken the contagion. Frewen, in 1759, published a pamphlet to show the improbability of antimony and mercury having any such action, and the fallacy of the claims made for their success.

[927] The Duchess gave the following account of her own case (_Gent. Magaz._ Nov. 1765, p. 495, sent by Gatti to a friend in London): “On the 12th of March, 1763, I was inoculated for the smallpox, and about four or five days afterwards a redness appeared round the orifice, which Mons. Gatti called an inflammation, and assured me was a sign that the smallpox had taken effect: these were the very terms he used. The redness or inflammation increased every day, and about the seventh or eighth day, the wound began to suppurate. There appeared also about the wound six small risings, or pimples, which successively suppurated and disappeared the next day. Mons. Gatti, upon their appearance, again assured me that the smallpox had taken effect. In the afternoon of the eleventh or twelfth day of my inoculation I felt a general uneasiness and emotion, a pain in my head and my back, and about my heart, in consequence of which I went to bed sooner than ordinary. I slept well, however, and rose without any disorder in the morning. These symptoms Mons. Gatti assured me were the forerunners of the eruption. The next day a pretty large rising or pimple appeared in my forehead, turned white, and then died away, leaving a mark which continued many days.

“The wound in my arm continued to suppurate seven or eight days, and Mons. Gatti now assured me that I had nothing to fear from the smallpox; and upon this assurance I relied without the least doubt, and continued in perfect confidence of my security till the natural smallpox appeared. I continued very well during the whole time of my inoculation, except one day, as mentioned above, and I went out every day.

“Monmorency, D. de Boufflers.”

[928] Gibbon’s _Autobiography_. It was to Dr Maty that Gibbon, in 1759, submitted his French essay on the Study of Literature, having had a fair copy of it transcribed by one of the French prisoners at Petersfield. Of Maty he says: “His reputation was justly founded on the eighteen volumes of the _Journal Britannique_, which he had supported almost alone, with perseverance and success. This humble though useful labour, which had once been dignified by the genius of Bayle and the learning of Le Clerc, was not disgraced by the taste, the knowledge and the judgment of Maty.”

[929] Angelo Gatti, M.D., _New Observations on Inoculation_. Translated from the French by M. Maty. Lond. 1768. The French edition was published at Brussels in 1767.

[930] John Andrew, M.D., _The Practice of Inoculation impartially considered_. Dated 17 June, 1765, Exeter, p. 61.

[931] _La Pratique de l’Inoculation._ Paris, An. VII. (1798), p 51.

[932] Andrew, u. s. p. 53.

[933] “I am sorry to have found that this operation has not always secured the patient from having the smallpox afterwards, if the eruptions have been imperfect without maturation. I attended one in a very full smallpox, which ran through all its stages in the usual manner; yet this patient had been inoculated ten years before, and, on the 5th day after inoculation, began to be feverish, with a headache, followed by a slight eruption, which eruption soon went off without coming to suppuration; the place of inoculation had inflamed and remained open ten days, leaving a deep scar, which I saw.” William Heberden, Senr., M.D., _Commentaries on Disease_ (p. 436). This was published in 1802, after the author’s death; but as he was in the height of his practice from 1760 onwards, the case, which is undated, may be taken as illustrating Heberden’s position in the Suttonian controversy.

[934] Benj. Chandler, M.D., _An Essay on the Present Method of Inoculation_. Lond. 1767.

[935] _Method of Inoculating the Smallpox._ Lond. 1766. Baker thought he was “an enemy of improvement and no philosopher,” who stood upon the antecedent improbability of securing the patient by a minimal inoculation such as Sutton used.

[936] Giles Watts, M.D., _Vindication of the Method of Inoculating_. London, 1767.

[937] William Bromfeild, _Thoughts on the Method of treating Persons Inoculated for the Smallpox_. Lond. 1767. He was a Court surgeon and a man of some eminence. Morgagni dedicated one of the books of his _De Sedibus et Causis Morborum_ to him as representing the Royal Society.

[938] W. Langton, M.D., _Address to the Public on the present Method of Inoculation_. London and Salisbury, 1767. Dr Thomas Glass, of Exeter, replied in 1767 to Bromfeild and Langton, in _A Letter to Dr Baker on the Means of procuring a Distinct and Favourable Kind of Smallpox_. Lond. 1767, and in a _Second Letter to Dr Baker_, 1767.

[939] W. Watson, M.D., _An Account of a Series of Experiments instituted with a view of ascertaining the most successful Method of Inoculating the Smallpox_. London, 1768.

[940] John Mudge, Surgeon at Plymouth, _A Dissertation on the Inoculated Smallpox_. London, 1777. A copy of this essay was found in the library of Dr Samuel Johnson. The Doctor was a friend of the author’s father, the Rev. Archdeacon Mudge, whose published sermons he has characterized in one of his most amusing balanced sentences of praise qualified with blame. Johnson stood godfather to one of John Mudge’s children. Notes on “Dr Johnson’s Library,” by A. W. Hutton.

[941] Edward Jenner, M.D., _Inquiry into the Causes and Effects of the Variolae Vaccinae, or Cowpox_. Lond. 1798, p. 56. See also his _Further Observations on the Cowpox_. 1799.

[942] Langton cites the following advertisement put out on 18 June, 1767, in his own district by Messrs Slatter and Duke, surgeons, of Ringwood, Hants: “The first objection I shall take notice of is that the disorder being in general so light, it is imagined there is danger of a second infection [i.e. a natural attack]. Whenever this has been supposed to have happened, I am certain the operation has failed, which not being discovered by the operator, proves to me that he was not experienced in the practice; for it may always be determined in four, five, or six days, sometimes sooner; and if there is the least reason to doubt, it is very easy to inoculate a second, third or fourth time, which may be done without the least inconvenience. I have inoculated several patients three or four times for their own satisfaction, having very little or perhaps no eruption.”

[943] _Mem. Med. Soc. Lond._ IV. 114.

[944] John Covey, of Basingstoke, 8 May, 1786, in _London Medical Journal_, VII. p. 180.

[945] _Address to the Inhabitants of Liverpool on the subject of a General Inoculation for the Smallpox._ 1 September, 1781.

[946] The account of the London charity is taken from the _History of Inoculation in Great Britain_ (1796) by Woodville, who became physician to it in 1791.

[947] _Med. Obs. and Inquiries_, III. (1767), p. 287. The passage quoted (p. 306, _note_) is almost exactly in the words of Hufeland long after, with reference to the probable extinction of smallpox by cowpox. See his _Journal_, X. pt. 2, p. 189.

[948] J. C. Lettsom, _A Letter to Sir Robert Barker, F.R.S. and G. Stacpoole, Esq. upon General Inoculation_. London, 1778.

[949] _A Plan of the General Inoculating Dispensary, &c._ Lond. (no date).

[950] T. Dimsdale, _Thoughts on General and Partial Inoculation_. Lond. 1776. _An Introduction to the Plan of the Inoculation Dispensary._ 1778. _Remarks on Dr Lettsom’s letter to Barker and Stacpoole._ 1779.

[951] Lettsom, _Obs. on Baron Dimsdale’s Remarks, &c._ 1779; and other pamphlets on both sides.

[952] Clark, _Report of the Newcastle Dispensary_. 1789.

[953] Currie to Haygarth, 28 Nov. 1791, in _Sketch of a Plan, etc._, pp. 451, 207.

[954] J. C. Jenner, “An Account of a General Inoculation at Painswick.” _Lond. Med. Journ._ VII. 163-8.

[955] _Gent. Magaz._ April, 1788, reported by the Hon. and Rev. Mr Stuart, who was a grandson of Lady Mary Wortley Montagu.

[956] Monro, _Account of Inoculation in Scotland_, 1765; in his _Works_. Edin. 1781, p. 693.

[957] _Statistical Account of Scotland._ 1791-99, III. 376.

[958] _Ibid._ IV. 130. It was about the year 1782 that the College of Physicians of Edinburgh appointed a committee to inquire into the mode of conducting the gratis inoculations of the poor, which had been tried at Chester, Leeds, Liverpool, &c. in 1781-82. Haygarth, u. s. 1784, p. 207.

[959] _Ibid._ III. 582.

[960] _Ibid._ XX. 502-7.

[961] _Ibid._ XX. 348. Account by Rev. Abercromby Gordon, who gives in a note (p. 349) the following instance of professional zeal: “A surgeon in the north, presuming that self-interest has a stronger hold on man than superstition, has lately opened a policy of insurance for the smallpox! If a subscriber gives him two guineas for inoculating his child, the surgeon in the event of the child’s death pays ten guineas to the parent; for every guinea subscribed, four guineas, for half a guinea, two guineas, and for a crown one guinea.”

[962] James Lucas, _Lond. Med. Journ._ X. 269.

[963] Currie to Haygarth, 28 Nov. 1791, in the latter’s _Sketch of a Plan, &c._ p. 453.

[964] _A Conscious View of Circumstances and Proceedings respecting Vaccine Inoculation._ Bath, 1800. The author was probably James Nooth, senior surgeon to the Bath Hospital, who removed to London and practised in Queen Anne Street, holding the appointment of surgeon to the Duke of Kent. He wrote on cancer of the breast.

[965] _Tracts on Inoculation._ London, 1781.

[966] R. Pulteney, M.D., in a letter of 21 June, 1766, to Dr G. Baker, given in his _Inquiry into the Merits of a Method of Inoculating the Smallpox_. Lond. 1766.

[967] Pulteney, “Births, Deaths and Marriages of Blandford Forum, 1733-1772.” _Phil. Trans._ LXVIII. 615.

[968] Pulteney to Baker, App. to _Inquiry into the method of Inoculating_. 1766; Hutchins, _Dorsetshire_, I. 217.

[969] On 23 July, 1785, the apothecary makes a note in his book: “Some inspectors are not sufficiently careful to send information to the Hospital when children have had the smallpox.” MS. Records.

[970] _Experiments, &c._ 1768.

[971] Sir W. Watson, M.D., F.R.S., “On the Putrid Measles of London, 1763 and 1768.” _Med. Obs. and Inquiries_, IV. 153.

[972] Charles Kite, surgeon, Gravesend, “An Account of some anomalous Appearances consequent to Inoculation of Smallpox.” _Memoirs Med. Soc. Lond._ IV. (1794), p. 114.

[973] Fosbroke, _Lond. Med. Repository_. June, 1819, p. 466.

[974] Jenner to James Moore, in Baron’s _Life of Jenner_, II. 401: “Is not that a precious anecdote for your new work?” See also _Court and Private Life of Queen Charlotte_ (Journals of Mrs Papendiek). Lond. 1887, I. 41, 70, 270.

[975] In Baron, u. s.

[976] _A Conscious View, &c._ u. s.

[977] Earle, in Jenner’s _Further Observations_. 1799.

[978] T. Adams to Richard Pew, M.D., of Sherborne. _Lond. Med. and Phys. Journ._ April, 1829.

[979] John Forbes, M.D., “Some Account of the Smallpox lately prevalent in Chichester and its vicinity.” _Lond. Med. Reposit._ Sept. 1822, p. 218.

[980] _Discourse on Inoculation._ Eng. Transl. 1755.

[981] _A Series of Experiments, &c._ 1768.

[982] John Haygarth, M.B., _Inquiry how to prevent the Smallpox_. Chester, 1784, p. 154.

[983] _History of Inoculation in Britain._ Vol. I. London, 1796, p. 33.

[984] _History of Edinburgh._ Edin. 1779, p. 260.

[985] W. Hillary, _Rational and mechanical Essay on the Smallpox_. Lond. 1735.

[986] J. Barker, _The Nature of Inoculation explained and its Merits stated_. London, 1769, p. 33. He taught that a depraved habit, by ill diet, &c., “serves for a nidus wherein the variolous matter rests.” If the variolous matter to be expelled is small, “by reason of natural health, temperance, or the power of preparation,” the disease is of the distinct kind; when large, of the confluent. “And wise indeed must he be who can find out any laws respecting the reception and expulsion of diseases superior on the whole to those which are original.” p. 9.

[987] “I have taken an account in this town [Halifax], and some parts of the country, and have procured the same from several other towns hereabouts, where the smallpox has been epidemical this last year, with as much exactness as was possible.” _Phil. Trans._ XXXII. 211.

[988] “A small neighbouring market town.”

[989] “More than usually mortal.”

[990] “A small market town in Lancashire, including two neighbouring villages.”

[991] Account taken “by a person of credit” and sent to Dr Whitaker. Jurin says, more generally: “Taken in several places by a careful enquiry from house to house.” _Account, &c._ 1724, p. 7.

[992] “At Uxbridge and in the neighbourhood, the smallpox having been exceedingly fatal all thereabouts.”

[993] _Mr Maitland’s Account of Inoculating the Smallpox vindicated._ 2nd ed. Lond. 1722.

[994] _Phil. Trans._ XXXIII. 379. “A short account of the Anomalous Epidemic Smallpox beginning at Plymouth in August, 1724, and continuing to the month of June, 1725, By the learned and ingenious Dr Huxham, physician at Plymouth.”

[995] The totals are given in Jurin’s _Account_ for 1725. The ages are in the original communication of the Rev. Mr Wasse, among the MS. papers which Jurin had deposited with the Royal Society.

[996] The most singular thing in the Aynho experience is that there should have been no cases in infants under two years. It was observed, however, some two generations after this, that smallpox attacked children at the earliest ages in the great towns (Haygarth, _Sketch of a Plan, &c._, 1793, p. 31), and even in the worst conditions of infancy it has attacked relatively few in the first three months of life. Again, it is nearly as remarkable that there should have been only three cases at Aynho in the third year of life and only four in the fourth. However, the fewness of cases in the five first years of life must be taken as exceptional, even for a village epidemic. If Nettleton, who made the first of these censuses of smallpox epidemics and suggested to Jurin that they should be carried out elsewhere, had given the ages, he would certainly have included some in infancy, for he mentions, in the course of his inoculation experiences, particular cases at nine months, eighteen months, etc.

[997] Frewen, _Phil. Trans._ XXXVII. 108.

[998] See above, pp. 485-6 and 490-1.

[999] Deering, _Nottingham vetus et nova_. 1751, pp. 78, 82. He says, in an essay on smallpox (_Improved Method of treating Smallpox._ Nottingham, 1737) that he treated fifty-one cases in the epidemic of 1736, of which only three proved fatal.

[1000] _Gent. Magaz._ 1741, p. 704.

[1001] Alex. Monro, primus, in his Report to the Dean of the Faculty of Medicine of Paris on Inoculation in Scotland, 1765. Reprinted in his _Works_. Edin. 1781, p. 485. He does not give ages, but an inspection of the burial registers is said to show that they were nearly all under five.

[1002] _Gent. Magaz._ 1742, p. 704. Blomefield gives 1710 and 1731 as great smallpox years in Norwich.

[1003] _Ibid._ 1747, p. 623. The population of Northampton in 1746 was 5136. Price, _Revers. Payments_. 4th ed. I. 353.

[1004] Part of the account extracted from the parish registers by the Rev. Samuel Partridge, F.S.A., vicar of Boston, and sent to Dr George Pearson, who published it in the _Report of the Vaccine Pock Institution for 1800-1802_. London, 1803, p. 100.

[1005] J. C. M’Vail, M.D. in _Proc. Philos. Soc. Glasgow_, XIII. 1882, p. 381, from a MS. register kept by the session clerk of Kilmarnock, now in the General Register House, Edinburgh. The baptisms and burials have not been extended from the MS. for more years than the table shows.

[1006] _Statist. Acct. of Scotland._

[1007] _Sketch of a Plan, &c._ 1793, pp. 33-34.

[1008] The following is the Ackworth bill given by Price, _Phil. Trans._ LXV. 443.

1747-57 1757-67
Christened 127 212
Buried 107 156
----------------------------
Consumption 23 38
Dropsy 5 3
Fevers 35 23
Infancy 13 13
Old age 24 30
Smallpox 1 13
Chincough -- 2
Convulsions -- 6
Dysentery -- 2
Measles -- 2
Sundries 6 24
----------------------------
Total deaths
in ten years 107 156

[1009] The following are some examples of rural fecundity and health: Middleton, near Manchester, 1763-72, births 1560, deaths 993, average of 4·75 children to a marriage. Tattenhall, near Chester, 1764-73, births 280, deaths 130; Waverton, same county and years, births 193, deaths 84. Stoke Damerel (now the dockyard near Plymouth), in 1733 (in part an influenza-year), births 122, deaths 62, population 3361. Landward townships of Manchester in 1772, births 401, deaths 246. Darwen, in 1774-80, births 508, deaths 233, population 1850. From Papers in _Phil. Trans._ by Percival and others.

[1010] _Statist. Acct. of Scot._ I. 155.

[1011] Hoare’s _Wiltshire_, VI. 521. There had been a general inoculation to the number of 422, from 13 August, 1751, to February, 1752, just before the epidemic. Brown to Watson, in _Phil. Trans._ XLVII. 570.

[1012] Huxham, _Ulcerous Sore-throat_, 1757.

[1013] _Gent. Magaz._ 1751, Supplement, p. 577. See also June, 1751, p. 244, and letter of “Devoniensis,” _ibid._ 1752, p. 159. The subject had been raised by Corbyn Morris in his _Observations on the past growth and present state of London_, and was discussed, from an actuary’s point of view, by Dodson in _Phil. Trans._ XLVII. (Jan. 1752), p. 333.

[1014] The weekly average deaths for eight weeks of September and October is 30·5 from two to five years and 11·1 from five to ten, which are about half the average at each age period during the maximum prevalence of smallpox.

[1015] W. Black, M.D. (_Observations Medical and Political on the Smallpox, etc._ London, 1781, p. 100) says: “I am induced by various considerations to believe that whatever share of smallpox mortality takes place in London amongst persons turned of twenty years of age, is almost solely confined to the new annual settlers or recruits, who are necessary to repair the waste of London, and the majority of whom arrive in the capital from twenty to forty years of age.”

[1016] Maddox, bishop of Worcester, preaching a sermon in 1752 for the Smallpox and Inoculation Charity, enforced his pleading by relating the recent case of “a poor man sick of this distemper, of which his wife lay dead in the same room, with four children around her catching the dreadful infection, but destitute of all relief, till they found _some_ in that too narrow building which now importunately begs your compassionate bounty to enlarge its dimensions.”

[1017] The _Gent. Magaz._ Sept. 1752, p. 402, contains a long letter to refute the very prevailing notion among many people that there is very little occasion for doctors and apothecaries in smallpox, but that a good nurse is all the assistance that is usually wanted. “Whence this notion took its rise I cannot conceive, unless it was from the disease being visible, so that every one who has been at all used to it knows it when they see it.”

[1018] This was an argument used in the first writings on Inoculation, so as to prove the real hazard of dying by the natural smallpox. Thus, Maitland in his _Vindication_ of 1722, which Arbuthnot is said to have had a hand in, deducts a quarter of the annual London deaths before he begins to estimate the ratio of smallpox among them, for the reason that eight out of nine infants who die in their first year are “non-entities” _quâ_ smallpox, other causes of death having had the priority (p. 19). Jurin used the same argument for the same purpose in his _Letter to Caleb Cotesworth, M.D._, 1723, p. 11: “It is notorious that great numbers, especially of young children, die of other diseases without ever having the smallpox”; and again, “very young children, or at most not above one or two years of age,” including the stillborn, abortives and overlaid, chrisoms and infants, and those dead of convulsions. “It is true, indeed, that in all probability some small part of these must have gone through the smallpox, and therefore ought not to be deducted out of the account”; but he does deduct 386 in every 1000 London deaths before he estimates the ratio of smallpox deaths, which so comes out 2 in 17.

[1019] Percival, _Med. Obs. and Inquiries_, V. 1776, p. 287; population in _Phil. Trans._ LXIV. 54.

[1020] Haygarth, _Inquiry how to prevent the Smallpox_, 1784.

[1021] Haygarth, _Sketch of a plan to exterminate the Natural Smallpox_. Lond. 1793, p. 139.