Chapter IV: The First Opponents of Inoculation

As we have seen, it is part of the legend that the introduction of inoculation was fanatically resisted by physicians, clergy, and mob; but the resistance was neither fanatical nor extensive, and is chiefly the invention of the romancing biographers who represent Lady Mary Wortley Montagu as a heroine and martyr of science. To do that shrewd and brilliant woman justice, she made no pretence to the character imputed to her, and in her copious correspondence, there is not a hint of annoyance on the score of her patronage of the Turkish modification of smallpox. On the contrary, it would appear that inoculation brought her a large share of that veiled notoriety in which she had sincere pleasure. Writing to the Countess of Mar in 1723, she says--

Lady Byng has inoculated both her children, and since that
experiment has not had any ill effect, the whole town are doing
the same thing; and I am so much pulled about, and solicited to
visit people, that I am forced to run into the country to hide
myself.[25]

Lady Mary understood her countrymen thoroughly, and, thirty years after her exploits in inoculation, she wrote to Mr. Wortley Montagu as follows--

BRESCIA, 24th April, 1748.

I find Tar Water succeeded to Ward’s Drop. ’Tis possible, by
this time, that some other quackery has taken place of that.
The English are easier than any other nation infatuated by the
prospect of universal medicines, nor is there any country in the
world where the doctors raise such immense fortunes. I attribute
it to the fund of credulity which is in all mankind. We have
no longer faith in miracles and relics, and therefore with the
same fury run after recipes and physicians. The same money which
three hundred years ago was given for the health of the soul is
now given for the health of the body, and by the same sort of
people--women and half-witted men.[26]

Those who fancy there could be any wide or effective resistance to inoculation in 1721 misapprehend the conditions of the time. There was no scientific knowledge of the laws of health; diseases were generally regarded as mysterious dispensations of Providence over which the sufferers had little control; and a great part of medicine was a combination of absurdity with nastiness. It would not be difficult to compile a series of recipes from the pharmacopœia of that day which would alternately excite amusement, surprise, and disgust, and to describe medical practice from which it is marvellous that ever patient escaped alive; but so much must pass without saying. Suffice it to assert, that to inoculation there was little material for opposition, rational or irrational; and that what we might think the natural horror of transfusing the filth of smallpox into the blood of health, was neutralised by the currency of a multitude of popular remedies which seemed to owe their fascination to their outrageous and loathsome characteristics.

Moreover, as the dates prove, the interval was brief between the introduction of inoculation and its authoritative acceptance. The girl Montagu was privately inoculated in April, 1721, Dr. Keith’s boy on the 11th of May, the Newgate experiment took place on the 9th of August, a variety of experiments followed, and lastly the Princesses Amelia and Caroline were inoculated on the 19th of April, 1722--sharp work for one year. There was not time for opposition. The citadel of social approval was carried with a rush. As a contemporary observed--

I could not but take notice with what united force and zeal the
practice was pushed on upon the life and reputation it received
from its admission to the Royal Palace; all pens and weekly
papers at work to recommend and publish it; and it was rightly
judged, then or never was the time; and had it not been for some
unlucky miscarriages, the Inoculators would have had the best
chance for full practice and full pockets that ever fell into the
hands of so small a set of men.[27]

The royal approval was assiduously worked, and there were not wanting hints that to question the goodness of inoculation was equivalent to disloyalty; and thus we find the Rev. E. Massey protesting in a letter to Mr. Maitland--

I wish the Doctor more candour toward those who differ from him
than to insinuate that they are guilty of high treason, and a
better argument for this practice than the cry, Inoculation! and
King George for ever![28]

Bad reasons are often advanced against bad policy, and whilst it is probable that some silly things were uttered against inoculation, yet I think every candid mind would be impressed with the moderation of Maitland’s chief adversaries. There was Isaac Massey, for instance, apothecary to Christ’s Hospital, who published several pamphlets in opposition, wherein candour and good sense are throughout conspicuous. He defined--

Inoculation as an art of giving the smallpox to persons in
health, who might otherwise have lived many years, and perhaps
to a very old age without it, whereby some unhappily come to an
untimely death.[29]

He objected to the exaggerated dangers of smallpox wherewith the Inoculators operated on the public fears, and appealed to his own experience in Christ’s Hospital--

Where there are generally near 600 children, the nurseries at
Ware and Hertford constantly filling the places of those who go
off. It hath sometimes happened that great numbers have been down
of the smallpox, and ’tis but seldom that the House is free, or
not long so: yet I daresay, and Sir Hans Sloane, I presume, will
say so too, that in twenty years there have not died above five
or six at most of the distemper, and in the last eight years
there died but one.[30]

So lightly did he regard the peril of smallpox to the young that he delivered this challenge--

Suppose that twenty-five Bluecoat Hospital boys at a medium, one
year with another, taken ill of the smallpox.

Suppose we likewise, that the Inoculators take out of the several
wards, yearly, as they find them, twenty-five boys, which are
inoculated.

Quere, What the difference of success? I solemnly protest that if
this could be put in practice, I would lay two to one against the
inoculated.

For, as I have said before, we have lost but one smallpox patient
these nine years [writing in 1723] although 1800 children have
been in the House during that time, and I declare to have met
with no unequal success in other families amongst children about
the same ages (that is between 8 and 15) where I have been
concerned, and I doubt not but many of the Learned Faculty, as
well as some others of my profession, can say as much from their
own experience and observation.[31]

To appreciate Massey’s contention on this point, we have to remember that smallpox is the designation of a disease of many degrees of intensity; a consideration which Dr. Wagstaffe, another opponent of inoculation, thus enforced--

There is scarcely, I believe, so great a difference between any
two distempers in the world, as between the best and worse sort
of smallpox, in respect to the dangers which attend them.... So
true is that common observation, that there is one sort in which
a nurse cannot kill, and another which even a physician can never
cure.[32]

Of course the Bills of Mortality were appealed to in evidence of the extent and fatality of smallpox; and as it is matter of common belief that prior to inoculation and Jenner (there is always a haze about the date) people were mown down with smallpox, it may be worth while reviving the table of relative mortality in London during the first twenty-two years of the 18th century.

Burials from all Diseases. From Smallpox.
1701 20,471 1095
1702 19,481 311
1703 20,720 898
1704 22,684 1501
1705 22,097 1095
1706 19,847 721
1707 21,600 1078
1708 21,291 1687
1709 21,800 1024
1710 24,620 3138
1711 19,833 915
1712 21,198 1943
1713 21,057 1614
1714 26,569 2810
1715 22,232 1057
1716 24,436 2427
1717 23,446 2211
1718 26,523 1884
1719 28,347 3229
1720 25,454 1440
1721 26,142 2375
1722 25,750 2167
------- ------
505,598 36,620

By these tables [wrote Dr. Jurin] it appears that upwards of 7
per cent., or somewhat more than a fourteenth part of mankind,
die of the smallpox; and consequently the hazard of dying of that
distemper, to every individual born into the world, is at least
that of 1 in 14.[33]

This large induction from London to universal mankind is noteworthy, because, as we shall see, it came to be often made, and involved a serious fallacy; for unless universal mankind dwelt in conditions similar to Londoners, it was idle to infer a common rate of disease and mortality. The population of London in 1701 was estimated at about 500,000 (there was no exact census), rising to about 600,000 in 1720. It was closely packed and lodged over cess-pools; the water supply was insufficient, and there was no effective drainage. The vast multitude was disposed, as if by design, for the generation and propagation of zymotic disease, and specially smallpox. Little attention was paid to personal cleanliness, and still less to ventilation, to light, to exercise. The condition of a large urban community a century ago is almost inconceivable at the present day. Londoners were then only slowly and blindly rising out of those modes of existence which made the Plague of 1665, and other plagues, possible. Hence we need not be astonished that smallpox was a common and persistent affliction; but it was less prevalent and less deadly than it is the custom to assert; and had the disease not been attended with injury to feminine beauty, there might have been no more fuss made about it than about any other form of eruptive fever.

It has also to be observed, that smallpox as a cause of death was probably much exaggerated in the Bills of Mortality; for as Isaac Massey pointed out--

These Bills are founded on the ignorance or skill of old women,
who are the searchers in every parish, and their reports (very
often what they are bid to say) must necessarily be very
erroneous. Many distempers which prove mortal, are mistaken
for the smallpox, namely, scarlet and malignant fevers with
eruptions, swinepox, measles, St. Anthony’s fire, and such like
appearances, which if they destroy in three or four days (as
frequently happeneth) the distemper can only be guessed at, yet
is generally put down by the searchers as smallpox, especially if
they are told the deceased never had them.[34]

Massey, in the same spirit of good sense, objected to generalisations about smallpox from the Bills of Mortality, as if all who died were slain by the disease and by nothing else.

There ought to be no comparison [he said] between sick people,
well regimented with diet and medicine, and those who have no
assistance, or scarcely the necessaries of life.

The miserable poor and parish children make up a great part, at
least one-half of the Bills of Mortality; to confirm this I have
examined several yearly bills, and I find that the out-parishes
generally bury more than the ninety-seven parishes within the
walls, and the parish of Stepney singly, very near as many as the
City of London yearly; this sufficiently shows what little help
and care are taken of the poor sick, which so much abound in all
those places.[35]

Of course there lurks a fallacy in all statistics of disease wherein conditions of life are not discriminated. Whether patients survive or die from any zymotic ailment depends upon their breed, their circumstances, their habits, and their medical treatment and nursing--all essential particulars, yet difficult to define and register on a large scale. It would appear that in sound constitutions, and with fair treatment, smallpox in 1721 was by no means deadly, whilst in bad constitutions, and with exposure and neglect, it was extensively fatal. Yet of these differences, little account was taken by the Inoculators, and the malady was measured and discussed as though it were something uniform like water or gold. Massey in one year had 49 cases of smallpox and one death; in Stepney an equal number of cases might have shown a mortality of 20 or 30 per cent.; whilst Dr. Nettleton reported that of 1245 cases in Halifax and adjacent towns in Yorkshire, there died 270, or about 22 per cent.[36]

One of Massey’s fears in relation to inoculation was the risk of poisoning the blood with more than smallpox. He was not disinclined to experiment with “duly prepared children infected with smallpox by inspiration,” for then--

They will run no hazard of being infected by a leprous, venereal,
or scrofulous taint that may, for aught we know, be transplanted
by inoculation.[37]

Massey’s prescience has been woefully verified; is indeed under perpetual verification in the pollution and destruction of multitudes of infants. The notion that virus with a complex of qualities can be transferred from one body to another, and operate with the single quality the operator is pleased to favour, is a notion that might pass muster in a manual of magic or folk-lore, but which never can have any warrant in human physiology.

Of course the chief strength of the opponents of inoculation (ere experience gave them stronger ground) lay in the assertion of the folly of incurring a certain injury for an uncertain advantage. Whatever the risk of smallpox to those who have it, yet large numbers, it was argued, pass through life untouched; and why should they make themselves sick, and risk their lives in order to obtain a superfluous security![38]

The frequent assertion that the clergy thundered against inoculation is untrue and invented for effect. The Rev. Edmund Massey, Lecturer of St. Alban, Wood Street, did preach a sermon against the new practice, and a fair sermon it was, according to the standard of sermons. Maitland published some remarks on the sermon, to which Massey rejoined; and if I select a passage from the rejoinder it will prove, better than any description, that the divine was more than a match for the surgeon. Said Massey to Maitland--

Inoculation, in your sense, is an engraftment of a corrupted body
into a sound one; an attempt to give a man a disease, who is in
perfect health, which disease may prove mortal.

This I said was tempting Providence.

To which you reply, It resembles that of a person who leaps
out of a window for fear of fire; and surely that can never be
reckoned a mistrust of Providence.

No, certainly, Sir, if his house be really on fire, and the
stairs burnt. ’Tis the only probable way of safety left; and if
the leap should kill him, the action could neither be called
sinful or imprudent. But what should we say to a man, who jumped
out of the window when his house was not a-fire, only to try
what he might perhaps be forced to do hereafter? This mad action
exactly hits the case between us. For if my house be not on fire,
that is, if I am in no apparent danger, what need I jump out at
the window? What occasion is there to inoculate me?

To carry on your own allegory, I would ask you, Sir, what human
or divine authority you have to set a man’s house on fire, that
is, put a man who is in perfect health in danger of his life by a
fit of illness? His own consent is not sufficient, because he has
no more lawful power over his own life or health than you have,
to put either of them in hazard.[39]

In short, nothing can be more unfounded than the assumption in literature, popular and professional, that Maitland and Montagu were confronted by a crowd of howling fanatics over whom they triumphed as light over darkness. Marvellous is the imbecility wherewith biographers and historians reproduce the fables of any inventive predecessor.

I shall now proceed to show that the practice of inoculation introduced by Cotton Mather to New England, and by Maitland to England, collapsed in a few years under stress of the mischiefs and fatalities which attended it; that it was revived in a subsequent generation; that it proved a curse wherever practised; and that finally it was abandoned with execration in the Western world.

FOOTNOTES:

[25] _Letters and Works of Lady M. W. Montagu_, Vol. i. p. 468, edition 1861.

[26] _Ibid._ Vol. ii. p. 161.

[27] _A Short and Plain Account of Inoculation._ By Isaac Massey. London, 1724.

[28] _Letter to Mr. Maitland._ By Edmund Massey. London, 1722.

[29] _A Short and Plain Account of Inoculation_, p. 1.

[30] _Ibid._ p. 21.

[31] _Letter to Dr. Jurin._ By Isaac Massey. London, 1723.

[32] _Letter to Dr. Freind._ By W. Wagstaffe, M.D., F.R.S., one of the physicians of St. Bartholomew’s Hospital. London, 1722.

[33] _A letter to Caleb Cotsworth, M.D._ By James Jurin, M.D. London, 1723.

[34] _Letter to Dr. Jurin._ London, 1723.

[35] _Ibid._

[36] _Mr. Maitland’s Account of Inoculating the Smallpox Vindicated._ London, 1722, p. 20.

[37] _Letter to Dr. Jurin_, p. 12.

[38] Jurin’s _Yearly Account of Inoculation_, p. 13.

[39] _Letter to Mr. Maitland in Vindication of the Sermon against Inoculation._ London, 1722.