“When once all the adults susceptible of the infection should either have received it or be dead without suffering from it, the very want of the variolous matter would put a stop to both the natural and artificial smallpox. Inoculation then would cease to be necessary, and therefore be laid aside[947].”
Eight years after, in 1775, Dr Lettsom seriously took up the project of inoculating infants in London[948]. He started a Society for Inoculation at the Homes of the People, which effected nothing besides some inoculations done by Lettsom himself during an epidemic “in confined streets and courts.” In 1779 he launched another scheme for a “General Inoculation Dispensary for the benefit of the poor throughout London, Westminster and Southwark, without removing them from their own habitations[949].” That also was frustrated by the active opposition of Dimsdale[950]. The objection to it was that there was no prospect of making the practice universal, and that partial inoculations in the crowded quarters of London would merely serve to keep the contagion of smallpox more active than ever. Lettsom answered that the danger of contagion from inoculated smallpox was more theoretical than real, inasmuch as the amount of smallpox matter produced upon the inoculated was a mere trifle[951].
At Newcastle, Lettsom’s design had at least a trial, under the influence of his friend Dr John Clark[952]. The Dispensary, founded in 1777, was designed from the outset to undertake gratuitous inoculations; but it was not until 13 April, 1786, that it got to work. The “liberality of the public” enabled the managers in that year to offer premiums to parents, to cover the expense of having their children sick from inoculation—five shillings for one child, seven shillings for two, nine shillings for three, and ten shillings for four or more of a family. On the first occasion, 208 children were inoculated, and all recovered. From 1786 to 1801, the cases numbered 3268. It was the aim of Dr Clark to get the operation done in infancy; accordingly in the space of four and a half years (1786-1790), of 1056 inoculations 460 were on infants under one year, 270 from one to two, 122 from two to three, 69 from three to four, 62 from four to five, 66 from five to ten, and 7 from ten to fifteen. This was perhaps the most systematic attempt at infant inoculation from year to year. The other dispensaries at which inoculation was steadily offered to the children of the poor were at Whitehaven (1079 inoculations from 1783 to 1796), at Bath, and at Chester.
Before the society was started at Chester for the purpose, the inoculations were some fifteen or twenty in a year, and these, we may suppose, in the richer families. The society got to work in 1779, but its operations were stopped in 1780 by a singular cause—the general diffusion of smallpox in the town by a regiment of soldiers. The whole inoculations of poor children from the spring of 1780 until September, 1782, were 213, besides which 203 were done in private practice. The year 1781 was tolerably free from epidemic smallpox (8 deaths), but in January, 1782, a very mortal kind prevailed in several parts of the town.
At Liverpool the first gratuitous general inoculation was in the autumn of 1781, to the number of about 517. “The affluent,” says Currie, “being alarmed at the advertisement for this purpose, presented their children also in great numbers, and 161 passed through the disease.” There was a second gratuitous inoculation in the spring of 1782 (to which some of the above numbers may have belonged), and it was intended to continue the same at regular intervals; but there is no record of more than those two[953].
Although Dimsdale opposed “general” inoculations in the large towns, for the reasons mentioned, he was in favour of inoculating together all the susceptible subjects in a smaller place or country district; and that kind of general inoculation was not unfrequently undertaken, sometimes hurriedly at the beginning of an epidemic, at other times after an epidemic had been running its course for months, and here or there, it would seem, during a free interval and by way of general precaution.
Dimsdale himself, with the help of Ingenhousz, carried out on one occasion, in Berkhamstead and three or four other villages of Hertfordshire, a general inoculation to the number, he guesses, of some six hundred persons of all ages, including some quite old persons. In 1765 or 1766 Daniel Sutton at Maldon, Essex, inoculated in one morning 417 of all ages, who were said to be all those in the town that had not had smallpox in the natural way. Some hundreds were also inoculated by him at one time in Maidstone.
In the small Gloucestershire town of Painswick in 1786, a very violent and fatal smallpox broke out during a time of typhus and intermittent fever. In consequence of the epidemic, one surgeon inoculated 738 persons from the 26th of May to the end of June[954]. In another Gloucestershire parish, Dursley, a single surgeon in the spring of 1797 inoculated 1475 persons of all ages, “from a fortnight to seventy years.” But in certain villages near Leeds in 1786-7 a general inoculation, organised by a zealous clergyman and paid for by a nobleman, mustered only eighty. About the same time, during an epidemic of malignant smallpox at Luton, Bedfordshire, 1215 were inoculated, and thereafter about 700 more; the average number annually attacked by smallpox during a period of nine years had been about twenty-five[955].
Inoculation was tried first in Scotland in 1726 by Maitland, during a visit to his native Aberdeenshire, but was not persevered with owing to one or two fatalities among the half-dozen cases. About 1733 it was begun at Dumfries by Gilchrist, who practised it during the next thirty years upon 560 persons, most of them, doubtless, paying patients. The returns made to Professor Monro, of Edinburgh, showed in the chief medical practices 5554 inoculations down to 1765; of which 703 were in Edinburgh and Leith, 950 in Glasgow, 208 in Stirling, 260 in Irvine, 157 in Aberdeen, 310 in Banff, 243 in Thurso, and 560 in Dumfries as above[956]. Seventy-two deaths are put down to the practice. When the Statistical Account of the 938 parishes was compiled in the last decade of the century, a few of the parish ministers made reference to inoculation.
Thus, in Applecross, Ross-shire, and three neighbouring parishes, an uneducated man is said to have inoculated 700 after a very fatal epidemic in 1789; it happened, however, that the pestilence reappeared, whereupon inoculation was “generally adopted[957].” Applecross may have been populous then; now there is not a smoke to be seen in it for miles. Again, the practice is said to have become “universal” in Skye from about 1780[958]. In Durness parish, which the tourist may now traverse for thirteen miles to Cape Wrath without seeing anyone but a shepherd, inoculation was rendered “general” about 1780 by the benevolence of a gentleman belonging to the parish[959]. From October, 1796, to July, 1797, a surgeon of Thurso inoculated 645 in that town and in country parishes of Caithness during a very severe epidemic[960]. In the parish of Jedburgh the cost of an inoculation was defrayed by the heritors, in that of Kirkwall by the kirk session, in another by the commissioners of annexed estates, in Earlstown, Berwickshire (on 70 children) by the chief proprietor. The ministers who mention it at all were mostly strong advocates of it, but they usually imply that the common people were (or had been) apathetic or prejudiced. It was sometimes recommended from the pulpit, and actually done by the ministers; it was even recommended that students of divinity should be instructed in the art. Statements that it had become “general” or “universal” are made for several parishes, mostly in the Highlands or Islands. The very full and trustworthy account of the parish of Banff says that “inoculation is by no means become general among the lower ranks[961];” which is perhaps about the truth for the country at large.