Mr. Houlton’s opinion was, that it is owing to certain secrets in the art; but it hath plainly appeared in the course of our proceedings that no such secrets exist.
Dr. Baker was of opinion, that the success is principally to be ascribed to the free use of cold air; but in answer to this, I must observe, that there have been cases, particularly one related by Dr. Glass, in his late pamphlet, in which this was found insufficient.
Mr. Chandler attributes it to the practice of communicating the disorder with crude lymph; but Dr. Dimsdale informed you, from long experience, that the mode of communication is a matter of indifference.
Dr. Glass ascribes it to the effect of sudorifics, administered at the period of eruption; but Mr. Chandler told you, that the Suttonian practice requires no such effect from the medicines; and Dr. Dimsdale pursues a contrary method.
As to preparation, it evidently appears from the Levant practice, from that of the Somersetshire operator, and from Dr. Dimsdale’s confession, that it is a matter of much less importance than hath generally been supposed; or rather, it appears to be of no importance at all. Nevertheless, we are obliged to acknowledge, that fewer patients have died under inoculation within those few years, than formerly, when the practice was in its infancy. It should therefore seem natural to conclude, that some considerable improvement has been made; but the nature of this improvement appears, from the proceedings of this day, to be yet in nubibus. That this new method of inoculation hath been amazingly successful, is beyond all contradiction; but that this success is not confined to the Prisoner at the bar, is equally indisputable. None of our patients die. The success is universal. Whether we prepare our patients or not; whether we give them mercury, or no mercury; whether we inoculate with crude lymph, or with matter ultimately variolated; whether we sweat them in the eruptive fever, or send them into the cold air; in short, let us proceed as we will, to kill a patient by inoculation, seems to be out of our power.
From these data, I think, you may rationally conclude, that the Prisoner himself is totally ignorant of the real cause of his successful practice; and if you are of that opinion, this being a Court of equity, you must necessarily acquit him of the crimes laid to his charge. But as judge of this Court, for the sake of truth, and the more effectually to exculpate the Prisoner at the bar, I shall now endeavour to explain this mysterious affair.
The small-pox hath been generally ranked among inflammatory diseases, and certainly with propriety, if we consider it only in it’s first stage; but that, in it’s natural progress, it becomes a putrid disorder, is indisputably true. Let us now suppose a number of patients ill of a malignant putrid disease, the jail fever for instance. Let us suppose these unhappy beings pent up in the close ward of an hospital, swallowing hot medicines, and denied the use of fresh air. In such a state the disease would certainly exert it’s utmost virulence, and very few of the patients would recover. Let us farther suppose a number of patients, in a contiguous ward, receiving the infection from the others; but let us imagine their medicines less inflammatory, and the air less confined: is there a physician here present, who has the least doubt that the disorder, in this case, would be less malignant and less fatal? Let us yet farther suppose a third ward, contiguous to the second, and the patients, infected from the second ward, treated more on the anti-phlogistic and antiseptic plan, and particularly indulged with fresh air: such patients, I say, having caught a milder disease, and being more rationally treated, would more generally escape. But if we carry our supposition still farther, as we gradually recede from the first ward, we shall find, by a parity of reasoning, that the disease will at last retain no more of it’s original malignity, than is barely sufficient to communicate the infection. The disorder will now assume so mild an aspect as hardly to appear of the same genus with that from which it originally sprung.
What hath been said of the jail fever, will evidently apply to the small-pox. We Europeans received it a malignant, a fatal disease; the fatality and malignancy of which, by the general practice of nurses, and, indeed, of most physicians, hath, perhaps, been rather increased than diminished: for, if an infectious disease may be rendered more mild by judicious treatment, it is no less certain, that a mild disorder may, by a series of improprieties, be gradually raised to such a height of virulence, as to assume a new aspect, and exhibit phenomena so different from those of it’s parent disease, that, in the end, it will constitute a new genus. If this be admitted as a possibility, perhaps it might be no difficult matter to trace many of our disorders to their origin, and to prove, that a considerable number are of our own creation; they are the offspring of medicine, the children of dulness or chimera, begotten upon old women.
The small-pox, by a treatment diametrically opposite to that which reason, and a perfect knowledge of the nature of the disease, would have dictated, hath, through a series of many ages, preserved all the virulence with which it first burst into Europe. But experience hath taught us, that, when produced by inoculation, it is much less fatal. Why? Is it because those that are inoculated are previously prepared? No: that is a very insufficient reason; for you have heard, that, in the Levant, preparation is disregarded; and also, that some of the most successful operators in this nation think it of little importance. We must therefore search for another cause; to the discovery of which let us consider, in what respect the communication by inoculation differs from that in the natural way. In the latter case the variolous miasmata are conveyed into the body either with the air into the lungs, or with the saliva into the stomach: in the former, it is received into the system by means of the lymphatic vessels which are distributed over the surface of the body. There is yet another difference, perhaps a very essential one, namely, that in the natural infection, it is communicated by volatile particles, which probably may be in their nature more virulent than those which are fixed. For my own part, I am of opinion that the small-pox is a disease of the lymphatic system only, and my opinion seems to be confirmed by the impossibility of communicating the infection by inoculating with the blood. Be this as it may, it is indisputably true, that the crude lymph is sufficient to give the infection, and that there is no necessity to draw blood at the time of incision. Add to this, the frequent tumour of the lymphatic glands in the axilla soon after the operation.
From these premises, it seems rational to conclude, that the general success of inoculation is chiefly to be attributed to our mixing the fixed variolous ferment with the lymph on the surface of the body, by which means the viscera, most essential to our existence, are less affected, and the poison rendered less virulent by dilution. But the wonderful success of the present practice of inoculation remains yet to be accounted for.