Inoculation brought into England.

The first that was heard in England of engrafting the smallpox was through a communication by Dr Timoni, a Greek of Constantinople, to Dr Woodward, Gresham professor of physic, who had the paper printed in the Philosophical Transactions of the Royal Society[870]. After a statement that “the Circassians, Georgians and other Asiatics” had brought the practice to Constantinople, and that it had been followed there for forty years by “the Turks and others” (statements never confirmed but on inquiry contradicted by those who knew), he proceeds to matters more within his own competence. During these eight years past “thousands” of subjects have been inoculated, and the value of the practice has now been put beyond all suspicion and doubt. The practice is to take fluid smallpox matter from the pustules of a discrete case of the natural disease, and convey it warm in a stopped phial to the scene of inoculation. A few punctures with a three-edged surgeon’s needle are made in any of the fleshy parts (but preferably over the muscles of the arm or forearm) until the blood comes; a drop of the fluid matter of smallpox is then to be mixed with the blood, and the inoculated part to be protected by a walnut shell bound over it. The symptoms that follow are very slight, some being scarce sensible that they are ill. The pocks that ensue are for the most part distinct, few, and scattered; commonly ten or twenty break out; now and then the patient may have only two or three; few have a hundred. The matter is hardly a thick pus, as in the common sort, but a thinner kind of sanies. There are some in whom no pustules appear except at the points of insertion, where purulent tubercles arise; yet these have never had the smallpox afterwards in their whole lives, though they have consorted with persons having it. On one occasion fifty were inoculated together, and of these four developed smallpox which was nearly confluent; but there was a suspicion that they must have been already infected by contagion. Timoni had never observed any mischievous accident from this incision hitherto; reports of such had sometimes spread abroad among the vulgar, “yet having gone on purpose to the houses whence such rumours have arisen I have found the whole to be absolutely false.” But, to keep nothing back, he will mention two fatalities of children inoculated; both of them were cases of hereditary lues with marasmus, and it was about the fortieth day from their inoculation that death ensued. The rest of Timoni’s paper is printed in the original Latin, being devoted to a theory of engrafting which afterwards passed current:—one attack of smallpox secures from a second, a mild attack serves as well as a severe, as also in the natural way, the reason being that smallpox, in whatever degree, causes a fermentation of the mass of the blood.

A year after this, in 1715, there was published in London An Essay on External Remedies, of which the 37th chapter was “Of the Variolae or Small Pox, the manner of ingrafting or giving them, and of their Cure.” The author was Peter Kennedy, Chir. Med., a Scot of good but impoverished family, who had spent several years in various parts of Europe visiting the schools of medicine and surgery, and had found his way to Constantinople[871]. His account of the engrafting of smallpox, which he had seen or heard of there, differs somewhat from that of Timoni, whom he just refers to: “Dr Timoni, a Grecian who resides there, had taken or followed this same method with his two sisters a little before my arrival at Constantinople.”

Kennedy says that engrafting the smallpox was practised in the Peloponnesus or Morea, “and at this present time is very much used both in Turkey and Persia, where they give it in order to prevent its more severe effects by the early knowledge of its coming; as also probably to prevent them being troubled with it a second time.” In Persia, however, the smallpox was taken internally in a dose of dried powder. In Constantinople the matter was inserted at scarifications upon the forehead, wrists, and ankles. After eight or ten days the smallpox came forward in a kindly manner, and not nearly so numerous as if naturally taken. “The greatest objection commonly proposed is, whether or not it hinders the patient from being infected a second time. But, in answer to this, it is advanced that we do rarely or never find any to have been troubled with this distemper twice in the same manner or the same fulness of malignity”—i.e. we rarely find this in the natural way.

Kennedy’s object was, not to recommend the engrafting of smallpox in England, but to show how easily distempers or contagions, “as well as medicines,” may be communicated to the blood from the surface of the body: “and this is more confirmed by some of the country people in Italy, in the more remote parts from towns, so also in some parts of the highlands of Scotland, where they infect their children by rubbing them with a kindly pock, as they term it.”

Meanwhile Timoni’s essay in the Philosophical Transactions had stirred up Sir Hans Sloane to make farther inquiries[872]. He applied to the British consul at Smyrna, Dr Sherrard, who was fortunately able to get information at first hand from an old Smyrna colleague, Dr Pylarini, consul for Venice, who had practised inoculation at Constantinople in the first years of the century. Pylarini, who had retired to Venice, was induced to draw up an account of what he knew of the beginnings and original methods of engrafting, which was printed at Venice, with a dedication to Sherrard, in 1715, and at once copied into the Philosophical Transactions[873]. This, the most trustworthy account of the Constantinople practice, ignores the earlier essay of Timoni altogether.

Pylarini carries the authentic history of the practice at Constantinople back to the year 1701. Its history before that was obscure; but it is most certain, he says, that it began in Greece, more particularly in Thessaly, and crept gradually from place to place until it reached Constantinople, where it attracted little notice for several years, being rarely practised and only among the lower class. A noble Greek having spoken of it to him in 1701, with a view to the protection of his children from the epidemic then raging, Pylarini had to confess his entire ignorance of it, but being at the Greek’s house four days after he there met a Greek woman who expounded the practice clearly in detail and gave him many instances of persons who had gone through it safely. Pylarini inquired into some of these cases and found them to be genuine; but in that great city he could not search them all out. Soon after this interview, the woman came and operated on the four children of the rich Greek, of whom the three younger had a very mild disease, but the eldest a severe attack, which nearly cost her life. Many other rich Greek families followed suit, so that, says Pylarini in 1715, “every one wishes to have the advantage of transplantation.” He adds, however, that “the Turks have hitherto neglected it.” He confirms Timoni in saying that the pocks raised by transplantation were nearly always of the distinct kind and few in number—ten to twenty or thirty, rarely a hundred, very rarely two hundred,—although he does not reach Timoni’s minimum of “two or three,” or the pustules only at the punctured spots.

These accounts from Constantinople, printed in London in 1714, 1715 and 1716 were regarded, says Douglass, “as virtuoso amusements[874]” until the spring of 1721, when inoculation began to be tried tentatively in London, and in a bold and confident way during the very same weeks at Boston, New England.

Dr Pitcairn, of Edinburgh, had received an account of inoculation from Bellini, an Italian physician, who had read Pylarini’s essay. Douglass says that Pitcairn “was very fond of it, but could not persuade himself to venture it in practice[875].” Sometime in March, 1721, one à Castro had issued in London a pamphlet on inoculation, full of inaccuracies and of no moment[876]. In a lecture on the plague given at the College of Physicians on the 17th of April, 1721, Dr Walter Harris made a passing reference to the Constantinople practice of engrafting smallpox[877]; and shortly after that, or shortly before, the Lady Mary Wortley Montagu set about having her younger child inoculated in London, her elder child having been inoculated at Constantinople three or four years before. This lady had, in 1717, accompanied her husband as ambassador to the Porte, where the embassy remained about a year. During her residence at Pera she heard of the Greek practice of engrafting or transplanting the smallpox; the French ambassador had said in pleasantry to her: “They take the smallpox here by way of diversion, as they take the waters in other countries.” According to her information, there was a set of old women who made it their business to perform the operation every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the smallpox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of matter. Every year thousands undergo the operation (but according to the information of the British embassy in 1755 not more than twenty in a year, which may perhaps mean that it had fallen into disuse[878]). There is no example of anyone that has died of it. She intended to have it performed upon her little son, and had patriotic visions of bringing “this useful invention” into fashion in England. Accordingly her boy, aged five, was inoculated in March, 1717/18, by a Greek woman, under the direction of Maitland, a Scots surgeon who attended the embassy. The child suffered very little inconvenience and, according to Maitland, “had about an hundred pox all upon his body.”

Lady Mary returned to London in 1718; but it was not until some three years after, in the spring of 1721, that she stirred the matter again. Whether it was that she herself was the cause of the talk about inoculation in London in April, 1721, or that she merely had the subject brought back to her mind by the essay of à Castro, the lecture by Harris, or by what others were saying, she sent sometime in April for Maitland, who had assisted at the inoculation of her elder child at Pera, with a view to having the operation done on the younger, who was now four or five years old. In a week or two Maitland found suitable smallpox matter and engrafted the child on both arms; on the tenth night she was a little feverish, but the smallpox began to appear next morning and in a few days she was perfectly recovered. Three physicians of the College visited the case, as well as several ladies and other persons of distinction. One of those physicians, Dr Keith, resolved to have a boy of his own, aged six, engrafted, which was done by Maitland on both arms on the 11th of May, 1721, five ounces of blood having been drawn before the operation.

Among Lady Mary’s intimates was the Princess of Wales, who became interested in the project for the sake of her own children[879]. She proposed to the king (George I.) that he should remit the capital sentence of six Newgate felons on condition that they would submit to be inoculated. The king consulted Sir Hans Sloane, who applied to Dr Terry of Enfield, formerly in practice at Constantinople. Terry’s report was that not more than one in eight hundred had died from the effects of inoculation in Turkey. The upshot was that the six Newgate convicts, three men and three women, were inoculated by Maitland on the 9th of August, 1721, in the presence of several eminent physicians, surgeons, Turkey merchants, and others. The matter was inserted on both arms and on the right leg of each, and the insertion was repeated on the arms of five of them three days after. Dr Mead, having heard that the Chinese procured smallpox by stuffing the matter up their noses, got a pardon for a seventh convict under sentence of death, a young woman, on condition that she would submit to a pledget of cotton dipped in smallpox matter being inserted in her nostril: it produced, besides a fair smallpox, much severe pain along the Schneiderian membrane and the frontal sinuses, and was not thought a satisfactory experiment. The trial upon the other six was reassuring; they all escaped with the slightest possible eruption; “the most that anyone had was sixty pustules.”

The next step was on the part of the Princess of Wales, who procured the inoculation of six charity children of the parish of St James’s. Four of them had smallpox “very favourably”; one did not have it at all, “having evidently had the smallpox before”; and the sixth had not only the prolonged effects of inoculation, but also an attack of the natural smallpox, of a favourable kind, eleven weeks after. This experiment was followed by the inoculation of five more hospital children, from eight to fourteen weeks old, of whom three had no effects, their bodies being “morbid.” The Princess of Wales was at length resolved in April, 1722, to run the risk of the operation on her two daughters, the princess Amelia, aged eleven, and the princess Caroline, aged nine, being urged by the fact that another daughter, the princess Anne, afterwards princess royal of Orange, had just had the natural smallpox so dangerously that Sloane feared for her life. The inoculations were done on the 19th of April, by serjeant-surgeon Amyand under the direction of Sir Hans Sloane. What passed between that physician and the king shows at once the apprehension of danger from a novel operation and the temper in which it was undertaken:

“I told his Majesty,” says Sloane, “that it was impossible to be certain but that, raising such a commotion in the blood, there might happen dangerous accidents not foreseen; but he replied that such might, and had happened, to persons who had lost their lives by bleeding in a pleurisy, and taking physic in any distemper, let never so much care be taken. I told his Majesty that I thought this to be the same case; and the matter was concluded upon, and succeeded as usual, without any danger during the operation, or the least ill symptom or disorder since.”

The news of the successful inoculation of the two princesses had hardly time to create a vogue for the practice, when there came word, in the same month of April, of the death by inoculation of the Earl of Sunderland’s son, aged two and a half, and of Lord Bathurst’s footman, aged nineteen.

Meanwhile, in the autumn of 1721, Maitland had gone down to Hertford, where smallpox would seem to have been more rife than elsewhere, and had done several inoculations. In the family of a Quaker, near Hertford, an infant of two and a half years developed no more than twenty pustules, which lasted only three or four days; but six domestics of the house, four men and two maids, “who all in their turn were wont to hug and caress this child whilst under the operation and the pustules were out upon her” (Maitland), caught natural smallpox in varying degrees of severity, some of them having a narrow escape, while one of the maids died.

The question that people were really anxious about was the immediate risk to the inoculated; and as there were occasional fatalities, especially to the age of childhood, inoculation made little progress. In the first year of its trial in England it was done on the greatest scale by Dr Nettleton, of Halifax, whose practice remains for more particular notice. Apart from his cases, which numbered sixty-one, the following are all that were known in England from the month of April, 1721, to the end of 1722[880]:

ByMr Amyand, surgeon, London 17
"Mr Maitland, surgeon, London and elsewhere 57
"Dr Dover, London 4
"Mr Weymish, London 3
"Rev. Mr Johnson, London 3
"Dr Brady, Portsmouth 4
"Messrs Smith and Dymes, Chichester 13
"Mr Waller, Gosport 3
"A woman at Leicester 8
"Dr Williams, Haverfordwest 6
"Two others near Haverfordwest 2
"Dr French, Bristol 1

The inoculations in all England in 1723 reached the considerable total of 292; but in 1724 they were no more than 40, being distributed among the various operators as follows:

Amyand, London 11
Maitland, London 4
Pemberton, London 3
Cheselden, London 1
Pawlett, London 1
Howman and Offley, Norwich 3
Beeston, Ipswich 3
Lake, Sevenoaks 3
Goodwin, Winchester 1
Mrs Ringe, Shaftesbury 2
Skinner, Ottery St Mary 6
Tolcher, Plymouth 2

In the next two years, 1725-26, Amyand and Maitland had respectively 66 and 37 cases in London, the other known cases in London being 30. Maitland had also 16 cases in Scotland. Sir Thomas Lyttelton had 4 at Hagley. All the known cases in those two years, including Nettleton’s at Halifax, came to 256, with four deaths of somewhat conspicuous persons. In 1727 the inoculations fell to 87, and in 1728 to 37. The total in eight years was 897, with 17 deaths. For the next ten or twelve years none were heard of in Britain. The check, however, was only temporary. The practice revived, extended among the rich, at length reached the common people in some counties, and gave rise to important developments of scientific doctrine. The greater these developments the more interesting the origins, which we shall now examine.