Thoughts on General and Partial Inoculations. Dimsdale Thomas

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      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.

      Notwithstanding all these conveniencies it will doubtless happen here, as it did in my neighbourhood, that many persons of distinction will rather prefer the inoculation of their families at their own houses. In this case it is submitted to the wisdom of government, whether it would not be proper to give orders that such persons should give public notice of their intention to inoculate, mentioning the time when the operation is to be performed, and also of their perfect recovery. By these means such as have not had the Small Pox, will have it in their power to avoid the infection.

      So much with regard to the accommodation of persons of rank, who may be inoculated under one or the other abovementioned regulations. But the poor cannot enjoy those advantages. Humanity however and the interest of the state equally demand, that all possible attention should be bestowed for their assistance and preservation.

      In order to attain this end, I know of no better or more certain method than that which I followed, on charitable motives only, in my own neighbourhood, by inoculating all the inhabitants of a village who had never had the Small Pox, on the same day: and, if this be performed in a proper manner, they might be all duly visited, and proper medicines administered at a moderate expence, and the whole be over in about three weeks: after which, this village would have nothing to apprehend from the Small Pox for some years. According to this plan, it will be unavoidably necessary that every child should be inoculated for the Small Pox soon after its birth, or that inoculation should be performed in every town or village once in five or six years. This last method I would rather recommend, and therefore, in order to make this proposal perfectly intelligible, I shall endeavour to explain it more particularly.

      A list of the names and ages of such inhabitants of every town and village as have not had the Small Pox, is the first necessary step to be taken; and marks should be made against the names of those who on account of their ill state of health, or other reasons, are not thought fit subjects for the operation in the judgment of the inoculator; and such persons should be provided with a separate place of abode, where they may not be in danger of receiving the infection: the rest should be collected together in one place, inoculated at one time, and proper medicines, with directions specifying the time and manner in which they are to be taken, should be distributed to each individual. On the fourth day after the inoculation they should again be assembled together, the punctures examined, and such farther medicines given as the inoculator may think proper. After the seventh the patients should be examined daily; for from that time to the eleventh, or perhaps fourteenth, is a period that requires more particular attention. 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. To provide for such extraordinary instances, therefore, a proper house and other conveniencies should be previously appointed, to which they should be removed when thought necessary.

      It will be impossible to determine precisely how many patients may want such attendance, and consequently difficult to provide exactly the necessary accommodations; but I imagine there will not be more than four or five out of one hundred.

      The diet of all should consist of vegetables, milk, bread, and the like; and in some cases a little mutton-broth may be allowed. The drink should be nothing but water, unless by the particular direction of the inoculator.

      But in order to secure the observance of this regimen more exactly, all salted provision and every kind of strong liquor ought to be removed from the place, and every necessary precaution taken to prevent the patients from procuring any. In respect to medicines, the prescriptions being agreed on by the faculty, a sufficient quantity should be prepared, and proper doses; agreeable to the different age and constitution, put up separately, and distributed by the inoculator among the patients, with directions in what manner they should be administered; and their recovery should be completed with some proper purgative.

      A licence or exclusive permission ought to be granted to such physicians or surgeons as undertake to inoculate for the Small Pox; for the mischief arising from the practice of inoculation by the illiterate and ignorant is beyond conception1. Such persons, instead of confining the infection within narrow limits, too often, through want of skill or honesty, are the means of propagating it, to the great terror of many people, the fatal consequences of which, and the destructive tokens, remain in many places in England. For besides the dreadful mortality which the disease itself has occasioned, it has often proved the source of discord and contention among neighbours, and disturbed that harmony and friendship which had before subsisted among the inhabitants.

      To conclude, I beg this small treatise may be considered only as an imperfect sketch drawn up in haste; but if it should be approved of, and her Imperial Majesty be pleased to command me to enter into farther particulars, I will employ my utmost endeavours to render it more perfect, and also assist in the execution of any part of what has been therein proposed.

      A short estimate of the number of those who die of the natural Small Pox, with a view to demonstrate the advantages that may accrue to Russia, from the practice of inoculation.

      It is needless to expatiate upon the havock which the Small Pox makes in most parts of the known world: probably there is not a country, city, or smaller community, which has not experienced its devastations in its turn. The very idea of it is insupportable; but its real effects, in places unapprised and unacquainted with the proper treatment and remedies against it, are not less general and fatal than the plague itself.

      Though this fact is generally allowed, yet many, I think, are ignorant of the immense loss mankind sustains by this distemper. It may not be amiss therefore to shew, from well attested accounts, the proportion of persons who die of the natural Small Pox: for which purpose it will be necessary to chuse some country or city where an exact register of the births and deaths, as well as an accurate list of diseases, is regularly kept.

      Dr. Jurin, secretary to the Royal Society in London, carried this into execution in 1722, soon after Inoculation had been introduced into England, being desirous of shewing the different effects of the natural and inoculated Small Pox.

      I shall not here insert all that was published by this ingenious author, as the whole may be found in the Philosophical Transactions of the Royal Society, under № 374. The following extract will be sufficient for my present purpose.

      The Doctor for forty-two years selected from the Bills of Mortality in London, such as died there of the Small Pox and other distempers. His observation may appear perhaps somewhat extraordinary: nevertheless he makes it plain, that out of 1000 infants, 386 die under two years of age, which is considerably more than one third. He then deducts such as he supposes die of the diseases natural to infancy; and afterwards proceeds to demonstrate, that if the whole bulk of mankind be taken at the age of two years, the eighth part will die of the natural Small Pox; and that of such as have it in the natural way, one in five or six dies.

      With respect to my own calculations on this subject, I endeavoured to find out whether the Small Pox proved equally fatal after the time mentioned by the Doctor. With this view, before I left England, I procured the Bills of Mortality of the City of London for the last thirty-four years, excepting two, which could not be found. Of these I made a table, which I have added at the end of this treatise. I was surprized to find the number for these thirty-two years past tally so exactly with the observations made by Dr. Jurin.

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