Dr. Thomas Nettleton, of Halifax, Yorkshire, was an early and energetic inoculator. He prepared his patients by vomiting, purging, and bleeding. He disliked Maitland’s small punctures, and made gashes an inch long—one in the arm and one in the opposite leg, and inserted bits of cotton steeped in pus, and covered them up with plaster and rollers. It was his design to produce large wounds with copious discharges, so that peccant matter might be freely evacuated. He was well satisfied with his heroic practice, and a record of his cases was sent to the Royal Society[42]—a record from which any reader will be apt to conclude that there was little to choose between Nettleton’s inoculations and smallpox itself. He made no pretence that inoculation induced a trifling ailment, but only one less serious than the spontaneous disease, congratulating himself on having conveyed some sixty inoculated patients through grave peril; whilst, he wrote—
In Halifax, since the beginning of last winter, 276 have had the smallpox, and out of that number 43 have died. In Rochdale, a small neighbouring market town, 177 have had the distemper, and 38 have died. It is to be noted that in this town [Halifax] the smallpox have been more favourable this season than usual, and in Leeds they have been more than usually mortal; but upon a medium there have died nearly 22 out of every 100 in these three towns, which is about a fifth part of all that have been infected in the natural way.[43]
English experience quickly made an end of the fiction under cover of which inoculation had been introduced—that it was attended with no risk, and might be performed by any old woman. Dr. Jurin, secretary of the Royal Society, and a steady advocate of the practice, thus laid down the conditions considered essential to success—conditions arrived at through stress of suffering and disaster—
Great care ought to be taken to inoculate none but persons of a good habit of body, and free, not only from any apparent, but, as far as can be judged, from any latent disease.
The body, especially if plethoric, ought to be prepared by proper evacuations—as bleeding, purging, vomiting, etc.—though in many cases there will be occasion for very little or none of these, it being sufficient to enjoin a temperate diet and proper regimen. But this must be left to the judgment of the physician.
The utmost caution ought to be used in the choice of proper matter to communicate the infection. It should be taken from a young subject, otherwise perfectly sound and healthful, who has the smallpox in the most favourable manner. When the pustules are properly maturated, and just upon the turn, or soon after, two or three of them should be ripped with a glover’s needle or small lancet, and a couple of small pledgets of lint or cotton are to be well moistened with the matter, and immediately put into a little vial or box, and carried in the warm hand or bosom of the operator to the house of the person to be inoculated.[44]
The publication of these conditions was little short of a practical surrender, and the opponents of inoculation were not slow to avail themselves of the advantage. What had been proclaimed the easy and universal defence against smallpox proved hedged about with precautions and preparations for which only health with wealth was equal. Where was the profit, argued Francis Howgrave, of a practice which leaves the feeble and delicate and poor to their fate, which makes the well sick, and wounds those that are whole, whilst smallpox in the natural way very rarely affects life where the habit of body and constitution are good.[45] Isaac Massey was especially indignant over Jurin’s comparison of the mortality of smallpox with the mortality of inoculation. Jurin reckoned that out of every 100 who took smallpox, 20 died, whilst only 2 in 100 died from the effects of inoculation. “He forgets,” said Massey, “that the inoculated are picked lives. If this be fair, Hang fair!” Massey was right. It was absurd to institute a comparison between the common smallpox, comprising that of the poor and neglected, and the well-fed and carefully tended subjects of inoculation. Massey, too, was strong in his own experience, saying—
I have a list of the names of 32 children, who are all that have had the smallpox during the last two years [1727] in Christ’s Hospital, and every one recovered. I have had, besides, 17 or 18 more in my private business, of whom only one died. Here, then, we have 49 cases of natural smallpox and but 1 death.[46]