of the poor in this city have been stated; but the possibility of
extending the practice to any good purpose, even if those objections
were removed, has not been taken notice of: to elucidate this point,
which is certainly a material one, the following remarks are submitted
to consideration.
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; and it must be taken into account, that the annual recruits
by births will probably be about 20,000, besides others that are
continually arriving out of the country to seek employment.
To form a scheme, however beneficial to a few, that would probably
spread the disease, and involve so great a number of others in a danger
that they would otherwise be much less exposed to, is an object of great
moment; and most certainly the Legislature ought first to be consulted.
Great liberty may be taken in our free state; but we ought not to
endanger the public safety, because no legal provision is made against
it.
------------------------------------------------------------------------
Of an Hospital for Inoculation.
If the objections that have been noticed should be deemed of sufficient
force to set aside all thoughts of partial Inoculations of the poor in
London, what is to be done will next become the question? It would be
cruel and unreasonable to refuse the benefit of this discovery to the
necessitous, who on that very account are most intitled to our
assistance; yet how to provide for them, consistent with the safety of
their neighbours, seems difficult, though I hope not impracticable.
A desire to see some expedient for this purpose succeed, induces me to
submit to the consideration of the public, a proposal that is in my
apprehension liable to few objections, and would best answer the
purpose.
It is to establish an Hospital for the purpose of Inoculation only.
I am aware that Hospitals have been stigmatized as unhealthy, from the
idea that a number of sick persons confined together corrupt the air,
and generate contagious putrid diseases. This charge has, I think, been
inconsiderately made, so far as relates to Hospitals in and near this
metropolis; but as it is no part of my undertaking to dispute the point,
I shall confine myself to what concerns an Hospital for Inoculation,
which, if every circumstance is duly attended to, will be as little
unhealthy as any house in the kingdom.
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; and that the disease
they are to undergo is usually so mild, as to permit most of the
patients to be abroad in the open air almost every day, and of a nature
not to communicate any putrid injury to others, except its own specific
poison. 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.
Having endeavoured to remove the prejudice that is apt to accompany the
idea of an Hospital so far as relates to health, I shall proceed to
enumerate the advantages that will most probably be obtained by an
institution of this kind; some of these have been already mentioned in
the translation, and I shall take the liberty of introducing them again
in this place, with little variation, as they relate to the subject.
One, and indeed no inconsiderable advantage to be derived from a plan of
this sort will be, that all the patients being collected together in one
house, the physician will be enabled to attend a great number at the
same time in a proper manner, and can be particularly attentive to such
as may more immediately require his assistance.
And it is of no small importance to those who are inoculated, that the
necessary regulations in respect to regimen, as well as every other
circumstance that requires the physician’s attention, will be there
properly observed, and the necessary medicines always at hand, with an
able person to direct the manner in which they ought to be administered.
There is likewise another advantage obtained by this method, that with
proper caution the Small Pox will not be communicated to others in the
natural way of infection.
It is also an encouraging circumstance, that an establishment of this
sort will be attended with less expence, in several particulars, than
any other Hospital.
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; and it should be one condition of
their admittance, that they should be willing to assist others when
able, as they would wish to be attended themselves when they stand in
need of it; and if this injunction is complied with, it may be expected
that there will be a sufficient number in a state of health to perform
this office for one another. The doing the heavy and dirty part of the
work, the care of the children, the attendance of those who may have the
disease more severely, and the business of the kitchen, will doubtless
require a proper number of healthy maid-servants.
In respect to diet, as it will be chiefly of the vegetable and least
expensive kinds of food, this will be a very moderate article in the
œconomy of such an establishment.
------------------------------------------------------------------------
On the Hospitals at Pancras.
The Hospitals for Small Pox in the natural way and Inoculation were
instituted in 1746, and have been supported by voluntary subscription.
These Hospitals consist of two houses at a sufficient distance from each
other, and in airy situations.
That for preparing the patients for inoculation at Pancras contains 100
beds; and that for receiving them when the disease appears, and for
admitting those who are seized with the Small Pox in the natural way, in
Cold Bath Fields, 130 beds.
All who are destitute of friends or money and are attacked with this
disease, or are desirous of being inoculated, if seven years old or
upwards, are proper objects of this charity.
Patients in the natural way are received every day, if there is room for
them; and to prevent the danger and expence of a disappointment, enquiry
should be first made. Patients for Inoculation are also received every
day at Pancras before nine in the morning.
Strangers are forbid to visit the patients.
Cloaths are provided for the patients, while their own cloaths are freed
from infection before their discharge.
As the first outline of every attempt towards a new institution has for
the most part been imperfect, it is not to be wondered at if the plan
and regulations of these Hospitals should admit of improvements; and the
following remarks will perhaps point out some regulations that deserve
attention.
It is now near thirty years since the first establishment of this
charity; at which time it was the received opinion that a strict regimen
ought to be observed, and a course of medicine complied with, by way of
preparing the most healthy previous to their Inoculation. It was also
believed, that there was some risque of taking the natural infection
injuriously at the time of being inoculated, and danger of accumulation
by residing with others who had the disease; and the inoculators of that
time who made use of infected thread and lint, sometimes failed
infecting on the first trial, and in such case the patient would
probably catch the natural distemper by cohabiting with the sick.
These opinions, it is presumed, joined with the design of admitting
patients in the natural Small Pox, determined the first Governors to
have two Hospitals; one, to contain all such who were actually
undergoing the disease in either way, and in a state to infect others:
the other to be appropriated to such only who were under preparation, or
having been inoculated had as yet no appearance of the usual eruptive
symptoms, and were not in a condition to infect one another. But these
opinions have not been verified by experience; on the contrary, it has
turned out that the precautions were not necessary. 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; for I am perfectly
satisfied, that after Inoculation is effectually performed, no injury
can be sustained by living with others in the most infectious state. And
even if the first Inoculation should fail infecting (which if proper
care is taken will scarce ever happen) the failure may be discovered on
the third or fourth day, and the patient may be inoculated again; and
even then, should there be a moral certainty that the natural infection
has been taken, it will be in time to prevent any ill effects; the
inoculated disease will as it were supercede and annihilate the former
infection, and the patient have the Small Pox from Inoculation only.
I am aware that some apology is necessary on publishing opinions that
may be deemed improbable in so laconic a manner; this is no place to
pursue the subject: but I mean soon to support these assertions by
relating certain facts on which they are founded. It is probable, that
from a deliberate consideration of these circumstances, some
considerable improvements may be made in the regulations of the
Hospital.
A principal one should be, to quit the practice of bringing the
inoculated patients to reside with those who have the natural disease; a
circumstance that could not have been consented to but from the former
mistaken opinions which have been noticed. A considerable advantage will
also be gained to the œconomy of the Hospital, on account of the time of
the patients residence being shortened; by which means a greater number
may be inoculated at the same expence.
I hope to stand excused from having made these remarks here, as in the
sequel I mean to propose an enlargement of the Hospital at Pancras.
Having taken notice of the most material articles that have occurred
relative to this subject, I shall venture, though with much diffidence,
to submit some outlines of an Hospital for Inoculation to the public,
premising, that in respect to situation, the environs of London do not
seem to afford a better spot than that on which the inoculating Hospital
at Pancras is built, which, with the ground adjoining to it being four
acres, is sufficient for the accommodation of any number of patients for
the benefit of the air; in short, every local advantage would be there
enjoyed in great perfection: the present building is not however
capacious enough for such a purpose, but it may be enlarged, and the
whole extent of ground ought to be walled in, to prevent all intercourse
with others, or giving any offence to the public; and I have not the
least doubt of the acquiescence and assistance of the present governors,
to any scheme for the extension of this noble and useful charity, as
they have, with a most distinguished application and disinterestedness,
employed their best endeavours to promote the interest of the present
establishment.
But previous to every other step, an application to Parliament for
encouragement, and proper powers to carry this design into execution,
seems necessary; for it will not be sufficient to open an Hospital for
Inoculation, without offering something as an inducement to invite those
who are proper objects to accept of the benefits intended. Amongst the
lower classes of people in the metropolis, as well as in many other
places, the voice of the generality is against Inoculation; prejudices
are not easily removed; nor is it to be expected that the many will
attend to the advantages that will result to their children, unless some
present benefits were to be connected with them[4].
-----
Footnote 4:
While the Empress was under Inoculation at Sarsco-celo, some of the
poor of the adjoining village were also, on the encouragement she had
given, inoculated.
I remember the Empress said to me, with that vivacity and liberality
of sentiment for which she is remarkably distinguished, “If I was to
order the poor of this neighbourhood to be inoculated, it would be
complied with, and be beneficial to them; but I love to use persuasive
means, rather than authority; on this account I have advanced a rouble
(about four shillings) to each that would consent, and several have
accepted it and recovered; but I find they now talk of raising the
price to two roubles, which I must consent to as a further
encouragement, for I wish the practice may be advanced by the mildest
methods.”
-----
If parish officers were obliged by Act of Parliament to apply to the
Hospital for the admission of every man or woman who should either on
their own account, or on behalf of their children, express a desire of
being inoculated, and on their being taken in to supply each with two
new shirts or shifts, and sign an obligation to provide decent new
cloathing for every one on their receiving notice of their recovery and
time of dismission, and also to give a small gratuity (suppose half a
crown) to every person of the age of and to the parents of
every child, on producing a certificate of their having behaved
decently, and complied with the rules of the house, signed by the
physician, it would probably be a sufficient inducement, and at the same
time the fresh cloathing would effectually prevent the spreading the
disease to others. And this could not be reasonably deemed a hardship,
since some of the most respectable old Hospitals exact as much on
admission of parish patients[5].
-----
Footnote 5:
At St. Thomas’s Hospital, every patient on admission pays 2s. 6d. if
clean, or 10s. 6d. if venereal; and the overseer or churchwarden of
the parish signs an obligation that he will find clean body linen
every week, and pay four pence a day so long as he continues in the
Hospital, and receive him when discharged, or take away the body, or
pay the burial fees to the steward of the Hospital, in case of death.
-----
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.
Parishes would likewise find their account in it: by a known moderate
charge they would be released from the contingent great expence of
maintaining many sick families, occasionally afflicted with the Small
Pox in the natural way; oftentimes to the great injury of trade and
manufactures: and this by a trifling advance to be bestowed but once
during the life of an individual, who would be maintained about three
weeks without any further expence, and return home to wear the cloaths
they had bestowed on him.
Thus much I have thought necessary to state, from a moral certainty that
some provision of this sort should be made; to proceed, would be
entering into minute matters that would more properly belong to the
governors, who will be best able to make such regulations as may be for
the general benefit of the charity.
So much has already been said on general Inoculations in the country,
that it seems unnecessary to enter on the subject again in this place.
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.
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. To insert all the instances that might be produced of
parochial meanness would be tedious; I shall mention the following only,
which may be relied on as an indisputable truth. The inhabitants of a
certain parish had a meeting to agree on inoculating all the poor; some
medical gentlemen in the neighbourhood offered to undertake the business
at a very low price; but as cheapness was the only object of
consideration, the parish was about to agree with a blacksmith at
eighteen pence a head, when one of the most frugal started this
objection: It is very probable that under this man’s care we may have
some die, and the expence of their burial may cost the parish so much,
that it might be as well to agree with a better man. This objection was
thus removed by the smith:—“Come, I’ll tell you what I’ll do with
you.—Give me half a crown a head, and them that die I will carry to the
church-yard without putting the parish to any further expence.”
Thus to trifle with the lives of their indigent fellow creatures, must
be an indelible reproach to any people. I know it will be said, that
many instances can be produced, where whole parishes of poor have been
inoculated, and have succeeded very well, under the care of persons who
were totally unacquainted with medicine.
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.
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. Should an Act of Parliament be
procured, it would be necessary to provide for the following
circumstances.
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.
-----
Footnote 6:
Vide Page 3, &c.
-----
If these obligatory clauses were obtained, general Inoculations in the
country might be carried on at a very moderate expence.
------------------------------------------------------------------------
CONCLUSION.
On a review of what has been advanced it will appear, that the practice
of Inoculation has been upon the whole rather hurtful than advantageous
to the city of London, and that the mortality from Small Pox has lately
increased to an alarming degree: that it may be presumed this loss has
not been sustained by the wealthy, who have availed themselves of their
easy circumstances, and by timely Inoculation have secured their
families; but that the loss has fallen principally among those who are
not the least useful members of the community, viz. on young persons,
the offspring of inferior trades-people, and the labouring poor.
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; and that a well-regulated plan of this kind
would effectually answer the purposes of abating the mortality, and
securing the community from being infected by the patients.
An application therefore to the Legislature for approbation and
assistance seems highly expedient; and it is not to be doubted but the
generous and humane would readily be induced to raise by subscription a
fund sufficient to carry these good designs into execution; so that as
we are the first European nation who received and encouraged
Inoculation, we may also have the honour of being the first who have
generously diffused the benefit of it to the community at large, and
transmitted it to posterity.
We have thus far only taken into consideration what respects the two
extremes of society, the opulent and indigent; but there still remains a
numerous and respectable part of the community unnoticed, I mean,
persons who are in but moderate circumstances, yet above accepting the
charity of an hospital.
Persons thus circumstanced seem to have a claim upon the humanity of
such practitioners as are eminent in their profession; who, from that
motive, we doubt not, will chearfully give their attendance on such
terms as families can afford. 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. It may
probably happen, that zeal in the cause may have carried me too far, or
that through inadvertency some errors may have been made. If they are
pointed out, I will acknowledge them with thanks to the informer, having
nothing more in view than the good of the public, and that the practice
recommended may be so conducted as to afford its opposers as few
objections, on any solid ground, as possible.