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CHAPTER VII.

TRIUMPH OF INOCULATION.

It having come to pass, according to the boast of Dr. Kirkpatrick, that inoculation was regarded as “the most salutary practice ever discovered for restraining a very loathsome and destroying disorder, which it had nearly expunged from the catalogue of mortal diseases,” it was the aim of physicians and patients to reduce the trouble and hazard of the operation to the lowest terms possible. In the words of Dr. Jenner, “There was bleeding till the blood was thin, purging till the body was wasted to a skeleton, and starving on vegetable diet to keep it so;” and practitioners who promised to mitigate these rigours, placed themselves in the line of popularity and prosperity.

Among distinguished easy inoculators was a family named Sutton—“the Suttons” being a familiar name a century ago. Dr. Robert Sutton practised surgery and pharmacy at Debenham, in Suffolk, and went into inoculation with such energy that between 1757 and 1767 he operated on 2514 patients. His son, Robert, set up as inoculator at Bury St. Edmunds, where he did a large business; but a second son, Daniel, was the genius of the household. He had been acting as assistant to Mr. Bumstead at Oxford, and returned to his father in 1763 enthusiastic over a new plan of inoculation whereby the time of preparation was to be shortened, whilst the patients were to live in the open air. Old Sutton showed no favour for the projected innovation, whereon Daniel opened an inoculating house on his own account at Ingatestone, in Essex, advertising himself as inoculator on a new, safe, and sure method. The speculation answered. In 1764 he took 2000 guineas, and in 1765 his receipts were £6300. His fame spread throughout the country, and so many resorted to him that lodgings were scarcely to be had in and around Ingatestone. His practice in Kent was also extensive, and he was obliged to employ assistants. To crown his enterprise, he kept a parson—the Rev. Robert Houlton, to puff his skill and success. According to Houlton, the business of Daniel Sutton during three years was as follows—

to which number was added 6000 inoculated by Sutton’s assistants, making a total of 20,000, without, said Houlton, a single death.[59]

Sutton was denounced as a quack, and if to reserve as one’s own, and to traffic in what is proclaimed to be for the common advantage of mankind, constitutes a quack, Sutton was one. Nevertheless, he was successful, and his success begot so much jealousy that he was indicted at the Chelmsford quarter sessions, but acquitted with the thanks of the grand jury for the lesson he had taught the Faculty.

Much ingenuity was exercised in ferreting out Sutton’s secret. His secret, so far as it was anything, was an open one; and supposing it necessary to infect men’s blood with variolous pus, and then to operate for their recovery, there would be much to say for Sutton’s procedure. His patients were obliged to go through a strict preparatory regimen for a fortnight, during which every kind of animal food, with the exception of milk, and all fermented liquors and spices were forbidden. Fruit of all sorts was allowed, unless on days when purges were taken. In the course of a fortnight a powder was thrice administered at bed-time, and a dose of salts on the succeeding morning. When the days of preparation were accomplished, the patient was taken to the inoculating house, where in the public room was found an array of people in various stages of smallpox. From one of these sufferers, the operator selected a pustule to his mind, opened it with his lancet, and, turning to the patient to be poxed, raised the cuticle on the outer part of his arm with the moist lancet, and pressed it down with his finger. This was the entire operation: no plaster or bandage was applied: and from that moment the patient was pronounced proof against smallpox, even if he should lie in bed with one suffering from the disease. Of course there remained the variolous affection to be dealt with. The regimen of preparation was continued unchanged, and a pill was taken nightly until the fever came on. None were allowed to rest in bed, except for sleep, but had to walk abroad and enjoy fresh air, even in winter weather. If a patient was too sick to go alone, he was supported by attendants; and when the fever was at its height, he was encouraged to drink copiously of cold water.

Much more was attributed to Sutton’s pills and powders than to his regimen, and these were no more than preparations of antimony and mercury, with which practitioners of all orders were only too familiar. Sutton, however, contrived to maintain his mystery until he had no longer occasion for it, and lived to recognise a successor in Jenner. He removed to London in 1767 in hope of enlarging his income, but like many other provincial celebrities, discovered that he had better have remained where he shone without rivals and detractors.

The Sutton regimen, so far as it might be described as “cool,” came into general favour, whilst what was called the hot regimen of warm rooms, bed, and cordials was correspondingly discredited. Contrasting the two methods, Sir George Baker, writing in 1771, observed—

A famous inoculator was Dr. Thomas Dimsdale of Hertford, a Quaker of easy principles. He published in 1766 a treatise entitled The Present Method of Inoculating for the Smallpox—an exposition of the most approved practice of the time, which, by one of those curious felicities of circumstance, conferred on him a European reputation; and in 1781, Tracts on Inoculation—a record of his opinions and adventures at home and abroad.

Dimsdale desired to universalise inoculation, but with circumspection. He recommended that the inhabitants of a suitable district should be dealt with as a whole and at once. That the names of all should be taken, and on a certain day that everyone, who had not had smallpox, should be inoculated. That the district should then continue in quarantine for about three weeks, at the end of which the danger and the fear of smallpox would cease, until an unpolluted generation should afresh accumulate. The project was not mere dreaming. Dimsdale was a man of influence and energy, and effected several complete inoculations of villages and parishes in Hertfordshire according to his plan. In later years, he combined banking with medicine, and the firm of Dimsdale, Fowler, and Co. of Cornhill originated with him and perpetuates his name.

Dimsdale’s practice lay chiefly among the upper classes, to whom he made matters very comfortable. As he wrote—

He was satisfied with administering a powder on the evening of the day on which a patient was inoculated, consisting of calomel, tartar emetic, and crabs’ claws.

Whilst labouring to popularise inoculation, Dimsdale was strongly opposed to the trade therein passing to unauthorised hands—simple, safe, and salutary though he asserted it to be. Thus he averred—

How illiteracy should affect inoculation, he left to conjecture. He apparently forgot that the practice was derived from people who made no pretence to literature, and whose efficiency and success were, moreover, set forth as warrant and encouragement for English imitation.

In 1775 a Society was formed for General Inoculation, and an hospital was opened for the purpose at Battle Bridge, on the site of what is now the Great Northern Railway station, King’s Cross. Dr. Lettsom, a popular Quaker physician, issued an appeal on behalf of the enterprise, and having invoked Dr. Dimsdale’s approval, a lively controversy ensued between the brethren—personal rather than profitable. Dimsdale disapproved of indiscriminate inoculation: he was ready to inoculate the whole world, but systematically, and under strict safe-guards. He pointed out that whatever might be the advantage to the individual, unless the inoculated patient was rigorously secluded, he would diffuse the disease from which he sought to be delivered, and that the price of his life might be the destruction of many. Dimsdale’s warnings were, however, slightly regarded, and inoculation was pursued with criminal recklessness. As Pascal observes, of all the faculties given to man, the most awful in its consequences is the power of standing amid a number of facts, and seeing such as we please to see, and being blind to the rest.

Specially remarkable in connection with the smallpox of last century was the exaggerated terror expressed for it by professional inoculators, and the little real terror manifested by the multitude. It was by no means the most fatal of diseases, nor was it a large factor in the common mortality. Wherever we test the matter by unbiased contemporary evidence, we find the outcry factitious: the dreadful and desolating malady from which Jenner delivered his country is merely a fiction continued by the vaccinators from the inoculators. For proof let us turn to the evidence of Dr. Alexander Monro, Professor of Medicine and Anatomy in the University of Edinburgh. The Faculty of Medicine in Paris had appointed a commission to inquire into the advantages of inoculation, which in the course of duty applied to Monro, who in response produced and published in 1765 An Account of the Inoculation of Smallpox in Scotland. He reported that from the introduction of the practice by Maitland in 1726, there had been 5554 inoculations effected in Scotland with 72 fatalities; that is to say about 140 annually with deaths 1 in 78, according to the confession of the inoculators themselves. Monro further stated that the practice was disliked in Scotland as “a tempting of Providence,” an unwarrantable risk of life for an uncertain advantage. Our present interest, however, is in the statistics of deaths from smallpox in Edinburgh for a series of twenty years thus adduced by Monro.

Here we have a piece of valid experience with every advantage to the smallpox terrorist: for Edinburgh last century was a city contrived as if for the generation and perpetuation of smallpox. The population of 55,000 was lodged thickly in flats, in houses of many storeys, closely built in lanes and courts—a population densely compacted as any in Europe, with arrangements for cleanliness indescribable, at this day perhaps incredible. Yet in conditions so propitious to smallpox, we see before us the total outcome during a series of twenty years; and reprehensible as the result may appear to contemporary sanitarians, who hold, and rightly hold, that all zymotic diseases are preventible, yet it affected Monro with no anxiety or dismay: nor does the rate of mortality of old Edinburgh contrast unfavourably with that of the modern city. The case of Edinburgh, however, serves to show that in all cases when we hear of the ravages of smallpox before Jenner appeared as deliverer, our policy is to insist firmly upon the production of special and adequate evidence: it is monstrous that the assertions of common quacks, whether inoculators or vaccinators, should pass into tradition and be accepted as unquestionable verity.

We have, moreover, to observe that the mortality from smallpox in Edinburgh was infantile mortality: for as Monro testified—

Not only were the habits of the people contributory to the diffusion of eruptive disorders, but likewise their food, of which oatmeal was the staple, whilst vegetables were few, fruit rare, and tea unknown. Hence many maladies had free course; and as Dean Ramsay relates, a girl on her arrival at Mrs. Betty Muirheid’s boarding-school in the Trongate, Glasgow, when asked whether she had had smallpox, replied, “Yes, mem, I’ve had the sma’pox, the nirls [measles], the blabs [nettle-rash], the scaw [itch], the kink-host [whooping-cough], the fever, the branks [mumps], and the worm [toothache].”

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A last word as to Lady Mary Wortley Montagu. After a residence of twenty years in Italy, she returned to England to die, 21st August, 1762. On the west side of the north door in Lichfield Cathedral, there is a female figure, in marble, leaning on an urn inscribed M. W. M. The inscription runs—

Whilst we do not resort to epitaphs for truth, we may discover in them what was taken for truth, or what was wished to be taken for truth. We have in the foregoing epitaph the legend which has caught the popular fancy, and which is likely to survive corrections innumerable. It is the custom of mankind to identify a common movement with some prominent or picturesque figure in the movement, and to suppress the rest. The practice is convenient, but it taints all history with fable.

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It may be said that the practice of inoculation met with no active resistance in England during the last thirty years of last century. How widely and deeply it extended it would be difficult to determine. The probability is, that the mass of the population was untouched, and that inoculation was limited to the upper and middle classes, and to the lower so far as they came under the immediate influence of those above them. We have, perhaps, an index to the condition of affairs in Dr. Wm. Buchan’s Domestic Medicine, first published in 1769, which ran through eighteen editions, amounting to 80,000 copies, in the author’s life-time. It is not uncommon to refer contemptuously to Buchan, but his work was the production of a man of vigorous good sense with faith in the good sense of his readers—a book creditable to the author and to the people who appreciated him.

Buchan was an inoculator, a zealous advocate of inoculation, and earnestly laboured to universalise the practice. In the Domestic Medicine, ed. 1797, he wrote—

Consistently with this opinion, Buchan strongly advocated domestic practice, saying—

Having described the ordinary method of inoculation by incision with a lancet dipped in pus, he goes on to say—

Thus was smallpox made easy!

Buchan appealed to the clergy for co-operation as inoculators—

And as propagandists—

How familiar have vaccinators rendered this line of adjuration! If you do not comply with our prescription, and your children catch smallpox, then are you their murderers.

Here is another passage from Buchan, which with equal accuracy might apply to Vaccination—is indeed what is perpetually asserted to be the truth concerning Vaccination—

In this deliverance, Buchan did not lie, nor did he speak for himself alone, but expressed the medical opinion of his time, precisely as a physician of to-day testifies concerning Vaccination. Yet we all know that Buchan was completely at fault, and substituted what he wished to be true for what was true.

I cannot leave Buchan without a few words in his favour, for, according to his lights, he was a worthy fellow, and the words shall be his own. He wrote—

No: nor with half an inch of thread dipped in pox.