Curiosities of Medical Experience

by J. G. Millingen

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 Cæsar’s Commentaries, when speaking of the shipping of the Gauls,—“Anchoræ, pro funibus, ferreis catenis revinctæ:” 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.”