Thomas Dimsdale

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ It is now above fifty years since Inoculation was introduced into this country, and like other new institutions was then opposed; but at present, though it may be impossible to define the numbers that are yearly inoculated, it is certain that most of the wealthy approve and avail themselves of the practice: yet we view the Bills of Mortality with unconcern, though they demonstrate that the number of deaths from this disease is considerably increased; and with the affecting circumstance, that they are probably of the younger part of the people. ”

“ 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 ”

“ 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 ”

“ During the whole of this time, and indeed throughout the whole process, the sick may continue at their own houses. And it may be reasonably presumed, that there will be a sufficient number of such as are but slightly indisposed, who may be able to assist the others, so as to make the expence and trouble of nurses unnecessary. But we must also suppose, that of the very great number inoculated there will be some who may have the disease severely, or whose cases may require more constant attendance than they can possibly have at their own habitations. ”

“ Let us for a moment drop the offensive name of Hospital, and suppose a large house is provided in a healthy situation, with convenient and airy apartments for the reception of any given number of persons capable of being commodiously contained in it; that to be in a good state of health would be the necessary qualification on the admission of every person, and about three weeks the time of the residence ”

“ Another unjustifiable piece of frugality that deserves attention and to be remedied is, that in many places where the whole number of poor have been inoculated at the expence of the parish, illiterate fellows, totally unacquainted with diseases or remedies, have been employed on account of cheapness only; when at the same time the families of the wealthy have been under the care of medical gentlemen of good reputation. ”

“ There are some diseases peculiar to old age, which terminate a life almost entirely spent, and totally useless to the community.
Such diseases, considered in a political sense, are not hurtful to the state. But the Small Pox spreads destruction chiefly upon the younger part of the species, from whose labours in their several callings the public might otherwise have expected advantages beyond all computation. The disappointment and loss incurred is of course neither to be calculated nor conceived. ”

“ 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. ”

“ 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 ”

“ 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 ”

“ If therefore in London, which enjoys the many advantages already recited, more than 2000 persons die annually of the Small Pox, we may surely suppose, that the loss which Russia in its whole extent sustains by this distemper in the same space of time, amounts to two millions of souls. ”

“ It is scarcely to be doubted but that Parliament would chearfully embrace a plan of this nature, which has for its object the preservation of the lives of the poor, and carrying them and their children safely through this terrible disease, without endangering their neighbourhoods. ”

“ 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. ”

“ One great cause of the success that attends the present practice, is supposed to be the exposure of patients to fresh air; and the more alarming the symptoms, the greater is the necessity of administering this salutary relief. The poor who are inoculated in their own confined dwellings, with perhaps many in family, will assuredly require this reviving ventilation. They have no gardens, areas, or the convenience of carriages; are they to be carried or led about the streets when ill, to the terror and danger of the neighbourhood? ”

“ Having considered the subject as fully as I am able, it shall be left to the consideration of the public without any comment; only entreating every family that may inoculate, to be extremely careful, and use every possible precaution to prevent spreading the infection during the illness, and to be also particularly attentive, that all furniture and cloaths be well aired. The persons concerned in inoculating should, on their parts, take great care that they do not contribute to the mischief. ”

“ The few who may be confined with a less favourable disease, will infect the house and their family, and the infection will be spread from the gossiping disposition of the poor, who are generally troublesome visitants, to their sick neighbours, and after all is over, the first sallying forth in their infected cloaths is certain to add to the mischief. ”

“ Among the many objects that have been provided for, it seems matter of astonishment that no one has ever pointed out the Small Pox as a distemper, whose destructive consequences might be in great measure prevented by the interposition of Legislature, and the assistance that would be certainly afforded from private charity. ”

“ The number of those who died of the Small Pox in each of the last four years, on an average is 2544. To suppose that one dies out of every six who have the natural distemper, will be allowed a moderate estimate: it follows then, that the number of those who have passed through the disease in each of the last four years will be 15,264. It will be impossible to determine how many may remain uninfected; but if we suppose that every year one out of eight who have not had the disease is seized with it, the remaining number who have not had the Small Pox will be 122,112 ”

“ If to these circumstances we add, that the patients will in general be children and young persons, that their cloaths and apartments will be clean, and their food wholesome and such as is proper for their condition, surely one may boldly assert, that a family thus circumstanced will have the fairest prospect of enjoying good health. ”

“ It seems hardly necessary to shew, how much the riches and strength of states depend upon the number of inhabitants. But perhaps there is not any country in which the certainty of this position is more indisputable than in Russia; for not only the strength of the empire, but the riches of every individual also, must be in proportion to the degree of population. ”

“ By this well-timed generosity, the minds of the middle rank of people will be made easy, and it will be a great inducement for them also to inoculate their families.
To conclude, I have used my best endeavours to represent the whole that has been treated of in its true light, and recommended the methods that have seemed to me to answer the purposes most effectually. ”

“ None of these can remit their occupations to attend the sick, without exposing their families to the distress which the want of the little money their industry earned would infallibly occasion; how or in what manner are patients to be nursed and supplied with food and necessaries during the illness, or who is to be relied on, that the medicines and diet enjoined by the person who attends, shall be regularly complied with? ”

“ 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. ”

“ 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. ”

“ The method of inoculating every one in the same neighbourhood together has succeeded so happily, that it seems only necessary to determine what is the most reasonable and frugal way of conducting the business ”