New Observations on Inoculation/Introduction
Practice of INOCULATION.
MANY books have been published within half a century, about inoculation; the authors of which, being mostly intent upon proving the benefits of the method, and paying no attention to the improvement of it, have neglected to determine and direct the best way of giving and treating the disorder communicated in this manner.
The rules laid down by the first introducers of the operation in Europe, have been exactly repeated; the way of inoculating taught in books remains what it was fifty years ago; and every where we find nearly the same directions with regard to the preparation, the manner of inserting the variolous matter, and the treatment of the artificial small-pox. I say the same, for it seems of no great consequence, whether the preparation is a little more or less rigorous; the insertion effected by an incision or a blister; the incision somewhat slighter or deeper; whether it is made in the legs or arms; whether the matter is used alone, or dried and powdered, or imbibed in a thread; and lastly, whether the purging is more or less repeated: these differences are too inconsiderable to make any essential distinction between the methods hitherto taught, or to occasion much variety in the success.
The apology of inoculation ought, however, to be attended with, if not preceded by, researches on the best method of inoculating: for if it is a salutary practice, when carried on in a certain way, but becomes fatal to many patients when differently managed, this defence will not be properly supported, unless the particular mode of the operation is previously determined and exactly pointed out.
From the inattention of those who have written upon the subject, might it not be concluded, that there really is but one method of inoculating; or if more, that they are equally good? that, provided the variolous matter be inserted, and the small-pox conveyed, all the rest is of no consequence; and if the operation should be more or less successful, or even if fatal accidents should happen after it, that these effects are to be imputed to nature, to chance, to inoculation itself, but by no means to the particular method which has been followed?
Superficial observations may seem to strengthen this opinion. In looking over the accounts of inoculations performed in different times and countries, it appears, that much the same method has been pursued, both in happy and unfortunate cases; and even that the rules prescibed have been more closely attended to in the latter than in the former.
There is, nevertheless, a safe way of inoculating, and there are improper methods. By the one the disorder is attended with no danger while it lasts, nor any bad consequences when it is over. By the other, the patient is either exposed to a real danger, and a grievous illness, or may apprehend bad, and sometimes lasting, consequences after the termination of the disorder. There is a method by which thousands may be inoculated without the Ioss of any; and there are modes of acting by which the proportion, between those who die and those who escape, is considerable enough to startle the fond parent with regard to his children, and the courageous man with regard to himself.
The following facts will prove this assertion. In the little town of Blandford, 384 persons were inoculated; of whom thirteen died, a great number laboured under a confluent small-pox, and several were in the utmost danger of their lives.
In the course of the two last years, upwards of 9000 persons have been inoculated in Essex, without the loss of a single life, or the appearance of any accident.
I have made choice of these two facts, because they lay before us at one view a great number of inoculations. They are recent; and happened in a state where all disputes about the utility of the method itself are at an end and consequently where truth has nothing more to fear from party-spirit.
Were we to pass a judgment from these two facts, on the supposition that in both cases the method was the same, and the difference in the success the mere effect of chance, we should be apt to conclude, that what has been said for and against inoculation is equally true. It is a salutary practice; it is a murderous scheme; and in this opposition of facts, the wife man might remain in suspence.
But if the methods were not the same, the two propositions ought to be altered into these: inoculation, when managed in a certain manner, may be dangerous; but if managed in another way, it is useful and salutary.
This last conclusion will be admitted by every unprejudiced mind. If the Essex people were inoculated differently from those of Blandford, as in fact they were, we shall be able to assert, that the former were inoculated in a proper, and the latter in an improper, manner; and consequently, that there is a right as well as a wrong method of inoculating.
The history of this practice will hardly furnish any other instance of so great an inequality; but a number of facts may be found differing enough to warrant the same inference; and my own experience would have led me to the same conclusion.
I have attended above a thousand inoculations, either performed by other people, or managed by myself; I have tried every known method; the rules prescribed have sometimes been observed, and sometimes neglected by me. By singular good luck, I have lost not one patient; but all the other accidents imputed to inoculation have fallen under my inspection.
Some have had a confluent small-pox, and been in danger; others have suffered, besides the small-pox, an additional infectious disorder. Many have had troublesome complaints after the operation; wounds not easily healed, erysipetalous tumours, abscesses, imposthumes; and lastly, some thinking themselves safe after having gone through what was thought inoculation, have since caught the distemper in the natural way.
Notwithstanding these inconveniences, I have continued recommending and practising inoculation, both because they are far less considerable than those which attend the chance of the natural small-pox, and because the worst of these mischances happened to me more rarely than to most other inoculators.
I now think, I have discovered the cause of all these accidents. Had I from the first made choice of the best method, every one of my patients would have had a true small-pox, both slight and kind, and attended with no bad symptoms, adventitious disorders, or consequential complaints. I was misled by the rules generally laid down; and an opposite way of acting would always have conducted me safely, as in fact it did, whenever I kept to it.
The following tract is the result both of my experiments and of my reflections. My design is not to apologize for inoculation, but to enquire into the best method of managing it.
I write for gentlemen of the profession, and especially for such as have acquired some experience in the art of inoculating. They alone are capable of forming a true judgment and estimation of my assertions, and can induce the public to adopt my practice. In medical matters, the generality of mankind think not from themselves, but from physicians; and the method which I propose will not be regarded, unless authorized and adopted by them.
But how can I hope for their approbation? My notions seem totally different from those which are commonly received; my rules directly opposite to those which have hitherto been laid down; and, in one word, my aim is to prove that we should think the contrary of what has been thought, and do the reverse of what has been done.
Ever since inoculation has been received in Europe, the practitioners have been of opinion that the essential advantages of the artificial over the natural small-pox were, 1. the preparation; 2. the discharge of the variolous matter by means of the wounds; and 3. the assistance of art in a disorder which is known as soon as it appears.
In opposition to these principles, I shall attempt to prove, that these three pretended advantages have hitherto been so many bars to the perfection of the method, and the source of almost all the miscarriages which have retarded its establishment.
All inoculators have said, prepare your subjects; procure an outlet to the venom; be attentive to administer every help of art, when the disorder shews itself.
I, on the contrary, say, prepare not at all; think of no outlets; and when the disorder comes, trust to nature.
These propositions I purposely premise, that the reader, startled at their seeming absurdity, may the more attentively examine what I have to offer to support them.
Though I should be right, I hardly expert that all operators will, at least for a long while come into my way of thinking. But I entertain better hopes from those physicians, whom knowledge and virtue place above prejudice, trust to time, which sooner or later silences passion, and gets the better of prepossession; and should I be disappointed, I flatter myself to find a sufficient reward in the testimony of my conscience, that I have always fought the good of mankind, and laboured for the discovery of truth.
The doctrine which I endeavour to demonstrate is so plain, that I might have brought it within the compass of a few pages; but it is necessary to explain it, and to establish it upon proofs, in order to remove the prejudices still entertained by many people.
All I have to say will be reduced to three heads. The first regards the preparation; the second, the insertion; the last, the treatment of the disorder. I intend, as much as possible, to forbear any enquiry which does not directly tend to my object, viz. the best method of inoculating.
- These facts have been related in the English news-papers and a more distinct account of the Essex inoculations will be found in a pamphlet intitled, Inoculation made easy, &c. The notice of the Blandford miscarriages is to be seen in Dr. Baker's excellent Inquiry into the merits of inoculating the small-pox, which is now practised in several counties of England.
- The translator would by no means for the exact truth of these facts. A foreigner is not obliged to know the motives which in this country too often affect human testimony.
- This is somewhat exaggerated.