The first description we have of this dreadful disease is to be found in
the writings of Almansor of Rhazes, published about the end of the ninth
or the beginning of the tenth century. He, however, quotes an Alexandrian
physician of the name of Aaron, who had treated the same subject so early
as the year 622. There is no substantial ground to warrant a belief that
it was known to the Greeks or Romans. The opinion of Hahn, who considered
it to have been their anthrax, is absurd. Had this pestilence prevailed
amongst the ancients, and left the traces of its ravages,--which have
marked most fearfully so many individuals,--it is probable that these
impressions would have been attached to their names, as they were in the
habit of designating many of their illustrious personages by their
physical peculiarities, either natural or accidental. Hence we find
Ovidius _Naso_, Tullius _Cicero_, Horatius _Cocles_, Scipio _Nasica_,
Curius _Dentatus_.
The term _variolae_, which this disease bears, was first applied to a
malady presenting the same symptoms, by Marius, bishop of Avanches, and
appears to be derived from _varius_, spotted. Howbeit, to whatever region
we may be indebted for this scourge, it appears that it existed in Asia,
and especially in China, long before its introduction into Europe. About
the middle of the sixth century, it was supposed to have been carried from
India to Arabia by trading vessels, where no doubt the Arabian and
Saracenic armies introduced it into the Levant, Spain, and Sicily. In 640,
under the caliphate of Omar, the Saracens spread the contagion over Syria,
Chaldaea, Mesopotamia, Egypt, and Persia. Its appearance in Europe may be
referred to the eighth century. In the ninth century, as I have stated, we
find it described by the Arabian physicians. In the tenth century we find
it described by other Arabian writers, chiefly Avicenna and Hali Abbas. In
962, Count Baudouin of Flanders, died from its attack. It appears certain
that it prevailed in Gaul long before; we find in the works of Marius,
already mentioned, the following passage: "Hoc anno (570) morbus validus,
cum profluvio ventris et _variolis_, Italiam Galliamque valde afflixit."
About the same period we find Dagobert and Clodobert, sons of Chilperic,
falling victims to the disorder; and Austregilda, wife of Gontran King of
Burgundy, died of it in 580, at the age of thirty-two, so enraged with her
physicians, Nicholas and Donet, that she insisted that they should
accompany her to the other world, to reward them for causing her untimely
end. Her affectionate and disconsolate husband Gontran of course had both
their throats cut upon her tomb.
In the eleventh and twelfth centuries we find the smallpox in all the
southern parts of Europe. The north was for a long time tolerably exempted
from the scourge, until the Holy War introduced it into those regions; and
it appears to have been the only trophy that the English and Germans
brought home to commemorate their exploits in the Crusades.
In the thirteenth century the Muscovites, Laplanders, and Norwegians were
free from the disorder, the progress of which seemed to have been delayed
by the cold; although at the same time, according to the relation of
Gordon, it was most destructive all over France. Most physicians at this
period partook of the opinion of the Arabians, who considered the disease
as being in the blood, thrown by it into a state of ebullition,
particularly in childhood and youth. According to the Arabian Auaron, or
Ahron, it sometimes affected the same individual twice. This doctrine of
the boiling up and bubbling forth of the blood to throw out its peccant
qualities, tended not a little to increase the mortality and exasperate
the disease; as the physicians, to encourage this concoction, were in the
habit of wrapping up their patients in warm clothing, and keeping their
apartments as hot as possible;--a fatal practice that subsequent
experience has rejected as destructive.
In 1517 the Spaniards carried it to St. Domingo, nearly depopulating the
country. South America soon received this additional visitation, said to
have been carried amongst them by a negro. So terrific were the ravages of
this pestilence, that the Americans considered its invasion as one of the
_data_ of their melancholy chronicles. The brother of the noble Montezuma
was one of its earliest victims; worthy attendant on the Spanish banners,
it accompanied their detested hordes in all their conquests.
The northern districts of America were free from the contagion, when the
English carried it with their commercial productions amongst the natives
of Boston in 1649, and subsequently to Virginia and Carolina, and the
remaining provinces. The Spaniards infected Nootka Sound, and the Russians
desolated Kamtschatka about the same period.
Inoculation appears nearly as ancient as the disease, if we can credit the
missionaries, who were sent into China by the Church of Rome, and who,
from their address and insinuation, gained access to the historical
records: they have transmitted detailed accounts of the history of the
Chinese, and of their knowledge in various branches of science. There is a
memoir written on the smallpox by the missionaries at Pekin, the substance
of which is extracted from Chinese medical books, and especially from a
work published by the Imperial College of Medicine, for the instruction of
the physicians of the empire. This book is entitled _Teou-tchin-fa_, or a
treatise from the heart to the smallpox; which states that the disease was
unknown in the very early ages, and did not appear until the dynasty of
Tcheou, which was about 1122 years before Christ. The Chinese name for the
malady is a singular one, _Tai-tou_, or venom from the mother's breast;
and a description is given of the fever, the eruption of the pustules,
their increase, flattening, and crusting. In the same Chinese book there
is also an account of a species of inoculation discovered seven centuries
previously; but, according to a tradition, it had been revealed in the
dynasty of Long, that is, about 590 years before Christ. Father
d'Entrecolles, the Jesuit, in his correspondence from China, gives some
information respecting the smallpox, which confirms the material part of
the above information; for he notices having read some Chinese work which
mentions the smallpox as a disease of the earliest ages. He also describes
a method of communicating the disease, which was called _sowing the
smallpox_; this was generally performed by planting some of the crusts
upon the nose,--an operation which was approved of by some but disapproved
by others.
Although the tradition of the smallpox being a disease originally
transmitted to man by camels may be fanciful, yet the existence of the
vaccine in cows might give some probability to its having been the case.
Moore thus expresses himself on the subject: "This notion probably took
its rise from the circumstance that land commerce from Egypt to India was
only practicable by means of this animal. But such kind of traffic was
tedious and difficult, and it is conjectured that no person known to have
the smallpox would ever have been suffered to join himself to a caravan."
Now this observation would rather confirm the fact than invalidate it;
since, if no individual affected with the malady could have carried the
contagion, the disease might have been spread by their camels.
In regard to the antiquity of the practice of inoculation amongst the
Chinese, I cannot do better than give Mr. Moore's own words on so very
interesting a subject. "No account is handed down of the origin of this
custom; but the reverence in which agriculture is held by the Chinese may
have suggested the name (sowing of the smallpox) and the usual manner of
performing the operation: for they took a few full dried smallpox crusts,
as if they were seeds, and planted them in the nose; a bit of musk was
added in order to correct the virulence of the poison, and the whole was
wrapped up in a bit of cotton to prevent it dropping from the nostrils.
The crusts employed were always taken from a healthy person who had had
the smallpox favourably; and, with the vain hope of mitigating their
acrimony, they were sometimes kept in close jars for years, and at other
times fumigated with salutary plants. Some physicians beat these crusts
into powder, and advised their patients to take a pinch of this snuff; and
when they could not prevail upon them, they mixed it with water into a
paste, and applied it in that form. In Hindostan, if tradition may be
relied upon, inoculation has been practised from remote antiquity. The
practice was in the hands of a particular tribe of Brahmins, who were
delegated from various religious colleges, and who travelled through the
provinces for this purpose. The natives were strictly enjoined to abstain
during a preparatory month from milk and butter; and, when the Arabians
and Portuguese appeared in that country, they were prohibited from taking
animal food also. These were commonly inoculated on the arm; but the
girls, not liking to have their arms disfigured, chose that it should be
done low on the shoulder: and whatever part was fixed upon was well rubbed
with a piece of cloth, which afterwards became a perquisite of the
Brahmin. He then made a few slight scratches on the skin with a sharp
instrument, and took a bit of cotton, which had been soaked the preceding
year in variolous matter, moistened it with a drop or two of the holy
water of the Ganges, and bound it upon the punctures. During the whole of
this ceremony, the Brahmin always preserved a solemn countenance, and
recited the prayers appointed in the _Attharna Veda_, to propitiate the
goddess who superintended the smallpox. The Brahmin then gave his
instructions, which were regularly observed. In six hours the bandage was
to be taken off, and the pledget allowed to drop spontaneously. Early next
morning, cold water was to be poured upon the patient's head and
shoulders, and this was to be repeated until the fever came on. The
ablution was then to be omitted; but, as soon as the eruption appeared, it
was to be resumed and persevered in every morning and evening till the
crusts should fall off. Confinement to the house was absolutely forbidden;
the inoculated were to be freely exposed to every air that blew; but when
the fever was upon them, they were sometimes permitted to lie on a mat at
the door. Their regimen was to consist of the most refrigerating
productions of the climate; as plantains, water-melons, thin gruel made of
rice or poppy-seeds, cold water, and rice."
While sowing the disease was thus prevalent in some countries, selling and
buying it was adopted in others, when children bartered fruit in exchange
for the infection. It does not appear that the faculty took any notice of
inoculation until the year 1703, when Dr. Emmanuel Timoni Alpeck wrote an
account of his observations in Constantinople, in a letter to Woodward: a
Venetian physician, of the name of Pylamus, about the same time noticed
the success of the practice in Turkey. Lady Mary Wortley Montagu pursued
the inquiry in her voyage to that country, by causing her son Edward to be
inoculated by Maitland, surgeon to the embassy, and, on her return to
England in 1722, had the operation tried with successful results on her
daughter. Still, although two of the princesses of the royal family had
also been inoculated with equal benefit, inoculation was furiously opposed
by the profession, and even from the pulpit; and so successful was this
opposition, that it succeeded in bringing it into disuse both in England
and throughout Europe, many cases of smallpox of a confluent character
having made their appearance after inoculation, and in 1740 the practice
had nearly fallen into disuse. In this virulent controversy, a singular
circumstance was observed: while regular practitioners stated the practice
to be unsuccessful, whenever it was adopted by quacks, monks, and old
women, the result was invariably favourable; and the report that reached
Europe of a Carmelite friar having inoculated thousands of Indians, an old
woman being equally fortunate in Greece, while at the same time a planter
in St. Christopher's inoculated three hundred persons without the loss of
a single patient, the practice was again resumed, chiefly in our seaports,
and gradually extended over the country. Mead materially assisted its
progress by stating that the Circassian ladies chiefly owed their beauty
to this salutary preservative. In the year 1763, Daniel Sutton, son of a
surgeon in Suffolk, recommended the practice, modified, however, in the
treatment of the malady, and brought inoculation into general repute.
It appears, however, that inoculation was by no means a novel introduction
even in England, as it had been long practised in Pembrokeshire and
several parts of Wales. On the Continent it had been tried at Cleves.
Bartholinus mentions it as adopted in Denmark; and traces of its adoption
were evident in Auvergne and Perigord.
Various modes of performing this operation were adopted. The Arabians
inserted the virus with a pointed instrument between the thumb and the
index; the Georgians on the fore-arm; and the Armenians on the thigh. The
traveller Motraye mentions a Circassian old woman who used to inoculate
with three pins tied together. It appears that this practice was generally
prevalent in Turkey in 1673. Trinoni and Pilarini observed that the
natural smallpox was generally fatal in Constantinople, while the disease
produced artificially was most benign. Bruce relates that from time
immemorial inoculation was practised in Nubia by old Negresses or Arabs.
Strange to say, it was only in 1727 that inoculation became general in
France; and its adoption was materially forwarded by Voltaire, who also
took special care to acquaint the fair sex that it was to this practice
that the Circassian and Georgian odalisks owed their beauty.
The terrific mortality that attended this disease was much increased by
the injudicious treatment to which patients were submitted. Instead of
adopting the natural plan resorted to by eastern nations, and allowing
the patients a free current of air, with a refrigerant diet, cordials and
a hot regimen were enforced, under which the disorder soon assumed a
destructive malignity. Cold affusion, which has also been extolled by
modern physicians as a recent improvement in medical practice, we have
seen, was also employed centuries ago. Sutton, who is generally, but
erroneously, considered as being the introducer of inoculation, did
nothing more, as I have already observed, than modify the treatment of the
disorder. Thus do we daily see impudence and quackery receiving rewards
for supposed discoveries, and the keepers of the public purse on such
occasions seem much less careful of it than of their own. In our days, for
instance, chain-cables have been decreed a discovery, and their inventor
entitled to a national recompence, whereas we read the following passage
in Caesar's Commentaries, when speaking of the shipping of the
Gauls,--"Anchorae, pro funibus, ferreis catenis revinctae:" any schoolboy
could have given this information to our sapient legislators.
The reappearance or supposed increased prevalence of the smallpox after
vaccination, for the last few years, may call for some observation. Ever
since the year 1804 a belief was entertained by many persons that the
cowpox only afforded a temporary security. This doubt, however, never did
rest upon any solid foundation. Dr. Jenner maintained in the most
strenuous manner, that to render the cowpox efficient, it was absolutely
necessary to attend most carefully to the character of the pustule, and
the time and quality of the lymph taken from it; on the very same
principle inoculation of the smallpox also failed. For it must be clearly
understood, that Jenner considered the smallpox and the cowpox as identic
maladies, and by no means dissimilar in their nature: on this important
subject I feel much gratification in quoting a passage from a late
valuable publication,[51] to which I refer the reader. "It was then
clearly ascertained, that there were deviations from the usual course of
smallpox, which were quite as common and infinitely more disastrous than
those which took place in vaccination. These deviations regarded two
apparently different states of the constitution. In the one the
susceptibility of smallpox, was not taken away by previous infection,
while, on the other hand some constitutions seem to be unsusceptible of
smallpox infection altogether. It was found, that similar occurrences
took place in the practice of vaccination, but as the security which the
latter afforded was never more likely to be interfered with by slight
causes than the former, it became absolutely necessary that great care
should be shown in watching the progress and character of the pustule. Dr.
Jenner had from the beginning felt the propriety of this watchfulness; and
had distinctly announced that it was possible to propagate an infection by
inoculation conveying different degrees of security, according as that
affection approached to or receded from the full and perfect standard. He
also clearly stated that the cause of the vaccine pustule might be so
modified as to deprive it of its efficacy. That inoculation from such a
source might communicate an inefficient protection, and that all those who
were thus vaccinated were more or less liable to the subsequent smallpox."
Dr. Bacon is of opinion that the cowpox is now what it was at the
beginning. There are instances, in which it has passed from one human
subject to another for more than thirty years, consequently through
fifteen or sixteen hundred individuals, but yet in which no degeneration
has taken place. He nevertheless admits that recent lymph from the cow
should be preferred, when it can be procured; he is further of opinion
that the occurrence of smallpox after inoculation does not exceed in
number the cases of smallpox after smallpox. My own experience confirms
these views. I was in practice in Bordeaux during the prevalence of what
is called smallpox in vaccinated cases,--the cases were rare, doubtful,
and very seldom fatal.
There is little doubt that the smallpox would sweep away thousands of our
dense population but for the protecting power of vaccination, the failure
of which, ought more frequently to be attributed to the vaccinator, or the
constitution of the patient, than to Jenner's immortal discovery. Dr.
Severn has just published an essay on this most important subject, and it
appears by his statistical tables, that such has been the decrease of
mortality since the introduction of vaccination, that the number of
patients admitted into the smallpox hospital from 1775 to 1800,--were
7017--the deaths 2277--whereas from the year 1800 to the year 1825, the
number admitted was 3943, and the deaths 1118--not half the number,
although the population of London had doubled during that period. Dr.
Severn further calculates that the proportion of failures is 6 in 3000.
We read with feelings of deep regret in his late bibliography, that the
man at whose intercession the magic of his name obtained the liberation of
Napoleon's prisoners, could not obtain an appointment for the members of
his own family from the British Government; nay, the College of Physicians
despite the exertions of Dr. Baillie, refused to admit him to a fellowship
in their learned body. It was when reflecting on such national
ingratitude, that he wrote to a friend, "Never aim, my friend at being a
public character, if you love domestic peace." And not long before he
terminated his invaluable career he made this remarkable expression: "I am
not surprised that men are not thankful to me; but I wonder that they are
not grateful to God for the good which he has made me the instrument of
conveying to my fellow-creatures."
It is in vain that France with her usual _jactance_ pretends that the
first idea of vaccination arose in that country, they have no more claim
to the discovery than their Marshals to Wellington's immortal glory.