Thomas Dimsdale

“ But admitting what you have advanced to be true, whence comes it that the same Bills of Mortality to which you appeal, prove also a certain increase instead of a diminution of deaths from the Small Pox, and that for such a series of years as to leave no room to dispute the fact? does it not naturally follow, that though almost the whole number of the inoculated recover, the disease must have been spread by their means, and a greater proportion having taken the natural disease, a consequent greater loss has been sustained by the public? ”

“ And I know but two cases where I thought the inflammation great enough to require bleeding, and not one where a blister was necessary. So that these complaints, heretofore so frequent and grievous, seem by this new method to be much reduced: a circumstance which, if it does not amount to a proof, admits at least of a fair conjecture, that the state of health is better here, than where those remains of putridity are so evidently existing in the habit.
Discoveries in physic, as in every other science, are in their infancy liable to censure and opposition ”

“ Can any one be so inconsiderate as to bring disease into a family before healthy, without having first a reasonable expectation, that what their situation may require will certainly be provided? no one acquainted with the general temper of parish officers, will much depend on their assistance; on the contrary, they will most probably oppose the plan to the utmost of their endeavours, from an apprehension that the disease will be spread by these means, and occasion a consequent increase of expence to the parish. ”

“ I have often been present at afflicting scenes of this nature; and have reason to think that many children have died of the small-pox in the natural way, merely from the impossibility of prevailing upon them to comply with what was proper, in cases where little or no danger was discoverable, either from the number or species of the pustules, the degree of fever, or any other apparent cause.
It must likewise be taken into consideration, that young children have usually a larger share of pustules from inoculation, than those who are advanced a little farther in life ”

“ Such persons, instead of confining the infection within narrow limits, too often, through want of skill or honesty, are the means of propagating it, to the great terror of many people, the fatal consequences of which, and the destructive tokens, remain in many places in England. For besides the dreadful mortality which the disease itself has occasioned, it has often proved the source of discord and contention among neighbours, and disturbed that harmony and friendship which had before subsisted among the inhabitants. ”

“ But for the best method of treating the small-pox in its most dangerous stage, I mean that of maturation, I must refer to the several learned and eminent practitioners who have professedly written upon the subject, whose opinions and practice I neither pretend to correct or amend. I shall however take the liberty to recommend one medicine to be used in that stage of the disease, which I have found to abate heat, and allay thirst, in such a manner as to afford a very pleasing refreshment. ”

“ On the contrary, if by general consent a public Inoculation is agreed on, and the poor are supplied with necessaries, the happiest consequences may be reasonably expected; and further, the good effect of repeated general Inoculations in the town of Hertford demonstrate, that large towns may with great advantage avail themselves of the same means, and, by occasionally repeating the practice, be secured from the ravages of this justly dreaded disease. ”

“ It gives me real concern to find, on reading the book you favoured me with, that you meet with such opposition in the practice of inoculation, notwithstanding it is so apparently beneficial to mankind; and particularly, that gentlemen of the first rank in the medical profession, should find it so difficult to divest themselves of unreasonable prejudices: but in the end truth will prevail. ”

“ That every parish (with the exception of such large places as should be thought too populous to be included) should be enjoined to offer Inoculation to all their poor who should be willing to admit of it [6] ; that the patients and their families should be maintained during their illness; that the person employed to inoculate should have had some education in medicine as physician, surgeon, or apothecary; and that once in five years the same offer should be renewed, leaving the time of year and other circumstances to the option of the parish. ”

“ First, because a physician, or even medical assistance of any kind, is not often called in till the eruption shews itself; when it is too late to expect all the good effects that might be hoped for, from an earlier trial of this method: and secondly, because the first attack of the small-pox is so much like the beginning of some other fevers as not easily to be distinguished; though a diligent attention to the symptoms, will generally, if we are called in time, enable us to form a pretty certain prognostic. ”

“ I have therefore nothing more to add but my wishes, that the empire of Russia may meet with the utmost success from this discovery, under the reign of so illustrious and beneficent a Sovereign.
An objection to the practice of Inoculation considered. From the time that Inoculation was introduced into this country one may date the opposition to its practice; many learned and ingenious men soon entered the field against it, and were encountered by others of equal abilities in its defence. ”

“ Those who have the disease in the slightest manner first described, viz. without any appearance of eruption but on the inoculated part, are soon allowed to go about their usual affairs; and many instances have happened of very industrious poor men, who have instantly returned to their daily labour, with a caution not to intermix with those who have not had the distemper, for fear of spreading it; and with directions to take two or three times of the purge already directed, or as many doses of Glauber’s salts. Those who have it in a greater degree, are confined somewhat longer ”

“ But such is the obstinacy of some parishes, and the parsimony of others, that it is impossible for the poor who are desirous of being inoculated, to persuade them to advance the small sum that would be necessary to defray the expence; and they are therefore obliged to wait the event of the natural disease, while the principal inhabitants are securing their own families by Inoculation. ”

“ In London it has been the general custom for those who intend to inoculate, to take into account all the circumstances that may be material for the conveniency of their families and friends, and these being settled to their minds, few precautions are thought necessary respecting the security of others: what passes previous to the eruptive fever, does not claim our consideration, since it is universally allowed that no infection can be communicated before that time ”

“ Humanity, as well as a wish to promote the honour and advantage of the art I profess, made me ever attentive to the improvement of this part of my employment. Dissatisfied with the common methods, I had carefully attended to the circumstances that seemed to contribute to the good or ill success of this practice, in the course of my own business, as well as to the best information I could get of the success of others. ”

“ From the foregoing account it appears, that the fever preceding eruption, and the most grievous symptoms accompanying it, are often greatly mitigated by this practice; and I will here add, that the eruption is most certainly retarded, that is, it does not appear so soon after the attack of the disease, nor come out so precipitately when it has begun to appear, as it seemed likely to have done if the natural progress had not been interrupted; an effect, which, however dangerous it may have been thought, may be produced with the utmost safety, and clearly shews the utility of the practice. ”

“ One physician will be able to superintend the process of Inoculation in a very great number of patients, provided he is assisted by a resident apothecary to receive his instruction, and to be at hand to assist on extraordinary emergencies.
Few drugs or medicines will be wanted; the expence therefore on these articles will be very trifling.
Few attendants on the sick will be necessary, and not so much as one under the character of a nurse; for there will always be a sufficient number of patients in so good a state of health, as to be able to attend on those who may require assistance ”

“ For if the attack of the cold fit be pretty severe, and the subsequent fever unusually high; if a nausea and vomiting succeed, together with great pains in the head, back, and loins, especially in the last; if a delirium, great restlessness, disagreeable taste in the mouth, and a peculiar fœtid smell in the breath, or even if several of these symptoms are observed, the small-pox may with great reason be expected; and if upon inquiry, which should always be made, it appears that the patient has been in the way of infection, there will be little reason to doubt it. ”

“ It has been shewn, that to encourage partial Inoculations among such of the poor as might be willing to accept the offer, and should be found in a proper state of health, would be to increase the evil, by spreading the disease in a destructive manner among their neighbours, and be on other accounts dangerous and intolerable. An hospital for the purpose of Inoculation only has been rescued from the unjust charge of being unhealthy, and has been proved to enjoy superior advantages in that respect, and many others ”

“ On the fourth or fifth day, upon applying the finger, a hardness is to be felt by the touch. The patient perceives an itching on the part, which appears slightly inflamed; and under a kind of vesication is seen a little clear fluid; the part resembling a superficial burn. About the sixth, most commonly, some pain and stiffness is felt in the axilla; and this is a very pleasing symptom, as it not only foretells the near approach of the eruptive symptoms, but is a sign of a favourable progress of the disease. ”

“ But it happens not unfrequently that irregular and dangerous symptoms appear, and at other times a different disease attacks the patient at the same time, with some unusual complaints while under Inoculation; these situations would certainly require the assistance of a person who could judge well of the symptoms, and distinguish the diseases properly, and know how to treat them, which a man unacquainted with the principles or the practice of physic could not pretend to, and consequently the patient would be exposed to great danger. ”

“ The first I shall take notice of, and which, though it very rarely happens, sometimes gives much trouble, is great sickness, accompanied with vomiting, coming on during the eruptive state of the distemper. For this complaint it is always necessary in the first place to clear the stomach; which may be effected, either by ordering the patient to drink plentifully of warm liquids to promote vomiting; or, perhaps more properly, by given one grain of emetic tartar to an adult, mixed with ten grains of compound powder of crabs claws; taking care to lessen the dose for very young and weak subjects. ”

“ To conduct the business of the Inoculation, some place or places centrically situated must be provided, at which the patients should assemble in order to be inoculated, and to which the several families of the sick must have recourse for the necessary medicines and directions during the distemper. To find one or more such places in the whole city, where the neighbourhood would suffer an office of this kind to be established, at which a great number of the poor must be assembled at noon-day, to receive an infectious and dangerous disease, is hardly possible to conceive ”

“ I use the term just opportunity, because, if I am not misinformed, endeavours have been used, inconsistent with equity and candour, to rob those who are intitled to our gratitude for assisting us in this important process, of that share of private emolument which is their due, let their title to the discovery be ever so paradoxical. ”

“ I will not here dispute the truth of this assertion; and indeed, if it was not an easy matter to procure more able help, it might be better to continue the practice in that way than to neglect inoculating entirely; but this is not the case. Gentlemen of the profession of good abilities will go very low in their price; and when it is considered that the sum is to be paid but once in the life of each person, surely parishes ought to be compelled to employ one who has had a medical education, and others should be restrained to their own proper business. ”

“ One objection alone seems not to have been satisfactorily removed, which, although it does not relate to the safety or health of the patient, is yet of great importance to the community, and well deserves the most attentive consideration. ”

“ And where the practitioners themselves may see reason to doubt of the event, yet few or none of them have attempted, I believe, to do much towards preventing the danger; for, unless some pressing symptoms call for immediate relief, it is the general practice to wait till maturation comes on, and brings with it such a train of dreadful complaints, as are more than enough to employ, and too often baffle the best abilities. ”

“ Whoever has visited the abodes of the poor in and about London, must allow the scene to be truly miserable; their habitations in close alleys, courts, and lanes, generally cold, dirty, and in great want of necessaries, even of bedding itself, a requisite of the greatest use in time of sickness; there are frequently several families under one roof; the men, if industrious, employed in daily labour, the women in washing and assisting in different families, or waiting at markets to carry little burdens as porters, and other unavoidable employments abroad. ”

“ When the maturation is completed, and it is evident we have nothing further to fear from the distemper, I allow my patients gradually to change their course of diet, from the perfectly cooling kind, to one a little more generous; recommending strictly to all a return to their ordinary animal diet with much caution and restraint upon their appetites, both in respect to food and fermented liquors. ”

“ Experience assures us, that a person in good health may be safely inoculated without any preparation, and that all the regulations in respect to diet and the necessary course of medicine, may be sufficiently complied with in the week that intervenes between the operation and the commencement of the disease. With respect to a double infection, that is, by Inoculation and in the usual course of communication, or an accumulation of the distemper afterwards by living with those who are actually labouring under it, no ill consequence need be feared ”

“ The very great relief which persons under inoculation experience from fresh air, cold water, and evacuations by stool, during the fever preceding eruption, soon determined me to make trial how far the like treatment might be useful to those who might be seized with the small-pox in the natural way; more especially in such cases, where, from the violence of the symptoms, a confluent kind was justly to be apprehended. ”

“ During this time medicine is seldom wanted; the cool air seems the best cordial; and if any uncommon languor happens, a bason of small broth, or a glass of wine, is allowed in the day, or some white-wine whey at bed time; which are indeed at any time allowed to tender, aged, or weakly persons.
With these exceptions, they have hitherto been kept very scrupulously to the diet at first directed. But after the eruption is completed, if occasion requires, they are indulged in a little well-boiled meat of the lightest kind, as chicken, veal, or mutton. ”