Preface to Dr. Heberden’s Pamphlet on Inoculation
London, Feb. 16, 1759.
Having been desired by my greatly esteemed
friend Dr. William Heberden, F. R. S. one of the principal
Physicians of this city, to communicate what account I had of the
success of Inoculation in Boston, New-England, I some time since
wrote and sent to him the following paper, viz.
About 1753 or 54, the Small-pox made its
appearance in Boston, New-England. It had not spread in the town
for many years before, so that there were a great number of the
inhabitants to have it. At first, endeavours were used to prevent
its spreading, by removing the sick, or guarding the houses in
which they were; and with the same view Inoculation was forbidden;
but when it was found that these endeavours were fruitless, the
distemper breaking out in different quarters of the town, and
increasing, Inoculation was then permitted.
Upon this, all that inclined to Inoculation for
themselves or families hurried into it precipitately, fearing the
infection might otherwise be taken in the common way; the numbers
inoculated in every neighbourhood spread the infection likewise
more speedily among those who did not chuse Inoculation; so that in
a few months, the distemper went thro’ the town, and was extinct;
and the trade of the town suffered only a short interruption,
compar’d with what had been usual in former times, the country
people during the seasons of that sickness fearing all intercourse
with the town.
|
Whites |
Blacks |
Whites |
Blacks |
Whites |
Blacks |
Whites |
Blacks |
|
5059 |
485 |
452 |
62 |
1974 |
139 |
23 |
7 |
It appeared by this account that the deaths of
persons inoculated, were more in proportion at this time than had
been formerly observed, being something more than one in a hundred.
The favourers of Inoculation however would not allow that this was
owing to any error in the former accounts, but rather to the
Inoculating at this time many unfit subjects, partly through the
impatience of people who would not wait the necessary preparation,
lest they should take it in the common way; and partly from the
importunity of parents prevailing with the Surgeons against their
judgement and advice to inoculate weak children, labouring under
other disorders; because the parents could not immediately remove
them out of the way of the distemper, and thought they would at
least stand a better chance by being inoculated, than in taking the
infection, as they would probably do, in the common way. The
Surgeons and Physicians were also suddenly oppress’d with the great
hurry of business, which so hasty and general an Inoculation and
spreading of the distemper in the common way must occasion, and
probably could not so particularly attend to the circumstances of
the patients offered for Inoculation.
Inoculation was first practised in Boston by
Dr. Boylstone in 1720. It was not used before in any part of
America, and not in Philadelphia till 1730. Some years since, an
enquiry was made in Philadelphia of the several Surgeons and
Physicians who had practis’d Inoculation, what numbers had been by
each inoculated, and what was the success. The result of this
enquiry was, that upwards of 800, (I forget the exact number) had
been inoculated at different times, and that only four of them had
died. If this account was true, as I believe it was, the reason of
greater success there than had been found in Boston, where the
general loss by Inoculation used to be estimated at about one in
100, may probably be from this circumstance; that in Boston they
always keep the distemper out as long as they can, so that when it
comes, it finds a greater number of adult subjects than in
Philadelphia, where since 1730 it has gone through the town once in
four or five years, so that the greatest number of subjects for
Inoculation must be under that age.
Notwithstanding the now uncontroverted success
of Inoculation, it does not seem to make that progress among the
common people in America, which at first was expected. Scruples
of conscience weigh with many, concerning the lawfulness
of the practice: And if one parent or near relation is against it,
the other does not chuse to inoculate a child without free consent
of all parties, lest in case of a disastrous event, perpetual blame
should follow. These scruples a sensible Clergy may
in time remove. The expence of having the operation
perform’d by a Surgeon, weighs with others, for that has been
pretty high in some parts of America; and where a common tradesman
or artificer has a number in his family to have the distemper, it
amounts to more money than he can well spare. Many of these, rather
than own the true motive for declining Inoculation, join
with the scrupulous in the cry against it, and influence
others. A small Pamphlet wrote in plain language by some skilful
Physician, and publish’d, directing what preparations of the body
should be used before the Inoculation of children, what precautions
to avoid giving the infection at the same time in the common way,
and how the operation is to be performed, the incisions dress’d,
the patient treated, and on the appearance of what symptoms a
Physician is to be called, &c. might be encouraging parents to
inoculate their own children, be a means of removing that objection
of the expence, render the practice much more general, and thereby
save the lives of thousands.
The Doctor, after perusing and considering the
above, humanely took the trouble (tho’ his extensive practice
affords him scarce any time to spare) of writing the following
Plain Instructions, and generously, at his
own private expence, printed a very large impression of them, which
was put into my hands to be distributed gratis in America.
Not aiming at the praise which however is justly due to such
disinterested benevolence, he has omitted his name; but as I
thought the advice of a nameless Physician might possibly on that
account be less regarded, I have without his knowledge here
divulg’d it. And I have prefix’d to his small but valuable work
these pages, containing the facts that gave rise to it; because
facts generally have, as indeed they ought to have, great
weight in persuading to the practice they favour. To these I may
also add an account I have been favoured with by Dr. Archer,
physician to the Small-pox Hospital here, viz.
By this account it appears, that in the way of
Inoculation there has died but one patient in 267, whereas
in the common way there had died more than one in
four. The mortality indeed in the latter case appears to
have been greater than usual, (one in seven, when the distemper is
not very favourable, being reckon’d the common loss in towns by the
Small-pox, all ages and ranks taken together) but these patients
were mostly adults, and were received, it is said, into the
Hospital, after great irregularities had been committed. By the
Boston account it appears, that, Whites and Blacks taken together,
but about one in eleven died in the common way, and the distemper
then was therefore reckon’d uncommonly favourable. I have also
obtain’d from the Foundling Hospital, (where all the children
admitted, that have not had the Small-pox, are inoculated at the
age of five years) an account to this time of the success of that
practice there, which stands thus, viz.
On the whole, if the chance were only as
two to one in favour of the practice among children,
would it not be sufficient to induce a tender parent to lay hold of
the advantage? But when it is so much greater, as it appears to be
by these accounts (in some even as thirty to one)
surely parents will no longer refuse to accept and thankfully use a
discovery God in his mercy has been pleased
to bless mankind with; whereby some check may now be put to the
ravages that cruel disease has been accustomed to make, and the
human species be again suffered to increase as it did before the
Small-pox made its appearance. This increase has indeed been more
obstructed by that distemper than is usually imagin’d: For the loss
of one in ten thereby is not merely the loss of so many persons,
but the accumulated loss of all the children and childrens children
the deceased might have had, multiplied by successive
generations.