Some Observations on Smallpox Inoculation

Some Observations On Receiving the SMALL-POX BY Ingrafting or Inoculating.

WHEN I first had the Account of this common Practice in the Levant, and of the wonderful Success of it there, given by Gentlemen of Learning to such a Body as that of the Royal Society in London, I could not but give Credit to their Testimony, in a Matter of fact whereof they were Eye-Witnesses. Immediately the little Philosophy I am Master of led me into the apparent Reasons of the thing. The more readily & easily these occur'd to me, the more I was affected with the Goodness of GOD Almighty therein to a Miserable World. I immediately thought with myself, and said to some Superior Persons in the Town, (who possibly may remember it) What an astonishing Mercy to Us in this Land, this Discovery of a Gracious Providence might prove. The more I mus'd upon the thing, and discoursed upon it, the more light I had, or seemed to myself to have. It appeared to me as rational as it was surprising, and gave me great pleasure in the prospect of so great a Benefit to Mankind. For I had not forgot the terrors of the Small-Pox when it was here the two last times, Nineteen and near Thirty Years since; though' it was nothing so Mortal either time as it had been before, (1678.) and has been now again. Besides it being now nineteen Years since the Small-Pox had been in the Town, it gave us a very dreadful prospect of Distress and Deaths, whenever it should come among us; all the Children and all the Young People born in the Town, or come into it from the Country, within that long term of time having it before them. Now in proportion to the distress fore seen and expected by us, my Joy naturally rose upon the Discovery of such a Way of Relief as seemed Opening before us, by the favor of GOD to us. In this simplicity of heart (I speak before GOD who searches it) I gave into a kind Opinion of this New Method; My Affection to my Country and the saving the Lives of my People being the Sole Motive to me, under the Glory that should thence redound unto the Name of GOD. I freely spake my Thoughts in Company and on Occasions as it seemed proper to me, and when some publicly demanded of us, " Whether People could trust in GOD in using this Means of self-preservation? I openly answered (among my Brethren ) in the Affirmative, that I judged they might. This was after that Dr. Boylstone had begun the practice, which I never put him upon, nor had I light to dissuade him from it. According to my hope and Expectation it succeeded; altho' the first Experiment was the most discouraging; for Mrs. Boylstone being in the Country and the Doctor taken up abroad among his Patients, the Children were too much exposed & neglected, and from my house (which faces into the Doctors yard) One of them was seen three or four days after their being Inoculated dabling in the cold water under the Pump. This or the like disorders in the first Inoculated Child threw him, as well they might, into a high and threatening fever. The cause was apparent to the Dr. and so did not discourage him, nor at all disgrace the practice with us that saw it. It was a pleasure however to see that the Small-Pox might be communicated, as the Gentlemen from the Levant had informed us. The next Experiments were made with more care, and accordingly more answered the Accounts which they had given us of a very light fever and few pustles. By this time the Town was full of the Sickness, and the Deaths that began to multiply led a few more into this Means of safety; as they hoped by the favor of GOD to find it. The Blessing of GOD went along with it; they found ease and sweetness, and lay praising GOD on their Beds, or rather sat up in their Chairs doing so. Their friends stood smiling about them. Their tongues were filled with laughter, and ours with Thanks-giving on their account when we went to see 'em. We saw them recover fast; the communicated Distemper working uniformly upon them, and as one would desire. We saw this with wonder and Joy at what GOD had wroit for us. We saw Scores thus recover, even as many as went into the happy practice, and it appeared to us more and more to be the Lord's Doing and marvelous in our eyes. They were as discreet and religious a number of People, and Persons of as good sense and understanding, and of as much caution and fear as their Nei'bours, who made these Experiments; and they did it with meekness and humility, patience and silence, and many prayers, under much provocation from too many. Only one Gentlewoman has yet died out of an hundred, who have now passed thro' the Operation. But as you must needs suppose in a Town so full of Infection as this has been, some ten or twelve of this number appeared to have taken the Infection in the common way; (among whom the Person deceased was evidently one) and accordingly they had it of the Confluent Kind, or in a fullness of the distinct sort, not known among the Inoculated in the Levant. This will be so far from seeming strange to you, that indeed it would be next to a Miracle had it been otherwise. At the same time it must be allowed, that a good number of those that passed so favourably thro' the Inoculation, would probably have had it very favourably in the common way. But that so many should pass so favourably and easily, as well as safely, thro' the Inoculation; while their Nei'bours had so many in every hundred that suffered so much, as well as died, is a sufficient Distinction put by Providence on the Method which we praise GOD for; and commend unto others, as GOD has commended it unto us.

FOR my own part I would not willingly, (at least unnecessarily) say a word that should grieve, much less offend any one, in this present Essay, which I honestly mean to serve my Country, and not provoke my Nei'bours. I have no Interest to serve by appearing for this Practice; but the contrary. If I knew anything in prejudice against it, which might justly be said, GOD knows I would offer it. Boston can now little be served by it, to what it might have been a few Months past, and I may seem to have been too long silent. But what I have seen of this dreadful Visitation, from one Sick and Dying Chamber to another, (and it may be scarce any one has seen more) awakens me now to write for the sake of other Towns, where the Sickness is prevailing, or whither it may come; that they may not put from them the Mercy of GOD in this particular, as it seems to me that we have done. I can call upon my Brethren, the Ministers of Boston, who the most of them have at times passed from the many sad Spectacles of Woe, Corruption, Anguish and Distraction, to the Chambers of the Inoculated, to say in what ease and sweetness and serenity these have lay. As the passing out of darkness into light, or from a tempestuous Sea into a Calm Haven, or from a place of horror, into a a Garden of pleasure, so it has been to us. A thousand Comparisons here offer themselves to mind, which I suppress because they would seem odious to some, however just in themselves.

I come now to say, What I have seen in the Chambers of the Inoculated; for I have made it my Business to visit some of them, and to observe the Work of GOD to his praise; And what I blame in others is, that they have not visited them, and without prejudice or passion, or regard to any private Interest or pique, informed themselves as they might easily have done of this great Thing which GOD has brought to light in our Day; and if I may serve to set it in any true light before others, I shall account myself honored of GOD therein.

KNOW then, That the Incision which the Dr. makes in the Arm or Leg, are the least you can well imagine, and but Skin deep; the quantity of the variolous matter which I have seen him use to good effect, has been but a single and very small drop upon a bit of Lint. After twenty four hours we threw it entirely away and put on a dressing of Cabbage leaf from day today: for six and sometimes eight days the Patient continues perfectly well; then a gentle Fever rises, accompanied with all the Symptoms of the Small-Pox, but in a low degree, an aching head and back, and pains in in the bones, &c. This makes him dull and heavy for a Day or two, and presently he finds himself well and the Pock appears, rises, turns, and goes off without anymore illness or pain, save what the burning and soreness of the Pock may occasion to him, or some external Fever in the Flesh without any inward one. For the first six days I have found the Issues opened very little; and seemed to vent but little; yet in some bodies more than in others; but as the Fever comes on and the Pock begins to appear in the Skin, the Incisions of their own accord begin to open and discharge, and as the Pock fills and ripens the Issues every Day widen and run more and more, till at the turning of the Pock the sixth or seventh Day, they come to their fullest flowing; and after two Days more they gradually decrease and abate and quickly heal of themselves under the same dressing of Cabbage-leaf, which had before drawn them. So gentle and perfect is Nature in this its own Work, without the Assistance of Medicine ordinarily, and almost any need of Nursing. Neither is there need scarce of a Watcher by night, no more than of a Nurse by Day, the Patient feels and eats so well by Day, and sleeps so well by night. He rarely complains of any pain in his Head, oppression at his Breast, sore Throat, or Thirst; and is seldom offended with his own smell.

BUT that which is the greatest Benefit by Inoculation, and indeed the apparent Cause of all the ease and sweetness experienced under it, is this, That as it moderates the first Fever and the Symptoms before the Eruption of the Pock, so it seems totally to prevent the second Fever at the turning of it, which is the fatal thing and time unto so many: The evident reason whereof is, because the Oil or putid matter that should be the Fuel within the Body for the flame or fever keeps running out from Day to Day at the Incisions: And besides, the Body not being covered with the Pock, and consequently not with scabs (and corruption under the same) when the Pock turns; as it has enjoyed a free perspiration by the Pores, so there is no foul mass upon it to return in, and mix with the juices and blood; by which it is that in the confluent and fluxy sort, the Body is tainted a second time, as well as the perspiring (so necessary unto Life) is prevented. The Consequence of this again is exceeding happy to the Inoculated, which is, That they have no After-blains and boils upon their bodies, which are so frequent and terrible after the suffering of the Small-Pox in the confluent kind: the reason whereof is apparent, Namely, Because the 〈◊〉 keep open and running at and after the turning of the Pock, and so discharge freely and fully all the Ill ferment or humor, which if it where in part retained in the body would cause swellings and boils. So that whereas there is in the other way very often a return in of some of the ejected poisons, which taints the blood again; so here is an easy gentle perpetual flow out, with a continued perspiration of the body, which prevents after boils, as well as the kindling any present consuming flame within the patient.

IT is now some Months, four or five, since many of the Inoculated are come abroad, and they find neither boil nor sore upon them; but are in as good a state of health as ever they enjoyed in their Life: Nay some have found a much better Complexion and Stomach than ever they had before; and particularly my own Child has found so thro' the favor of GOD.

I can tell too of a Woman in the weakness of Child-bed, who eight days after her Delivery came under the Inoculation to avoid the Small-Pox the common-way, GOD sending it then into the house where she was; and though' she had many more pustles than is usual in this Method, yet she went cheerfully thro' the Visitation, and even gained strength while the Pock rose to as fine and large a head, of the distinct kind, as I ever saw.

WHEN the Patient in the common way of Infection would have but few pustles, he has to be sure fewer, under the Inoculation: When he would else be exceeding full it greatly abates and lessens the number of the Pock; and when it would be the confluent and fluxy kind we have all the reason in the World to think that it prevents the same, and brings on a distinct sort; which sort has but little danger attending it in the common way of Infection, and which only are proper to the Inoculation according to the Account given by the Gentlemen from the Levant. Sometimes the Inoculated whom I have seen have had a large and angry Pock and a good number of 'em too; sometimes when there have not been many I have observed some of those that have appeared and risen for two or three days to sink away and disappear; yet have they created no feverish disorder when they have done so, which looks as if they discharged and vented themselves by the Incisions. Once I found a Young Man under the Inoculation full eno' to have given distress and danger as I apprehended, but his cheerful eye and smiles immediately put me out of pain; professing to me that he felt himself so well within, that were it safe or proper he thought he could go about his worldly business as well as ever in his Life. In others their fever has been high and burning in the 〈…〉 when inwardly they have found no disorder; neither in head nor breast, but could breathe and sleep even as if in health, or next to it.

I boldly profess concerning as many as I have seen under the Inoculation, even when their Pock came to the height, scarce the smell of sickness has passed on them, in comparison of what others undergo in the common way. In some the Issues scarce smell at all, so much as to them that dress 'em. It has seemed to me nothing more than what a Cabbage-leaf upon a common Issue must needs cause at the end of 24 hours. Where the Patient would have many Pock in the common way, and consequently have the more under the Inoculation, there the Issues must be supposed to run the more. Where the Patient is fullest under the Inoculation I affirm I could never smell their Issues at their Bed-side; no not when I have lean'd over their Bed on purpose to do it. Yet certainly the Issues do smell more or less as the degree of the Distemper is upon the Patient. And where the Infection is taken the common way, and the Confluent kind comes in the Eruption, there the Issues you may well think find much more to vent, and the Discharge is more noisome, like the running of the fluxy kind. But at the worst, even in this case, the hours excepted wherein kidneys have been sometimes applied to neck or feet, it is nothing, that I could ever find or hear, in comparison of that prodigious stench which is so common for many days together under the fluxy sort, wherein one can hardly bear the Rooms.

IT therefore appears to me one of the boldest Impositions on our Senses and Reason, that has been attempted since the Day wherein Transubstantiation was obtruded and forced upon the Christian World, to bear us down as some would, " That the Inoculation has caused the dreadful Malignity and Infection which has been in the Town. To say this to Us who have been called from day today to the many noxious Chambers, each of which have had poison eno' in 'em to have spread the Town over, and which have been continually by day and night filling the Air with Infection by the Chimneys and doors, till at last the Windows have been thrown open too upon the Souls leaving the corrupted Body,—requires an Assurance indeed. Our Nei'bours must forgive us if we contemn it as a most foolish Opinion, and ridiculous Imputation. We must call it so, if not worse; or we must forego our sense, and the common understanding which GOD has given us. On the contrary, I must constantly think that the Inoculation has been an Abatement, and Prevention of the greater Malignity that would have been by more of the confluent and fluxy sort. Besides, In fact, the Malignity and Mortality has not been now so great, in proportion to our present numbers, as it was three and forty Year ago, when in about fourteen Months we are told Eight hundred People died of it; which I suppose was a greater Mortality than if Eighteen hundred had died of it now. Some who were then Adult tell me what great numbers were then buried in a Week: Families were then desolated and broken up, and the very flesh rotted off the bones of some. And we at last find too by sad experience, that They understood as well the managing the Distemper then as we do now: For when the Malignity comes to a Height, we find that we know very little or nothing what to do.

NOR does it appear to me at all reasonable to think, that what the Issues of the Inoculated do discharge, is at all Malignant like what is vented by a fluxy Maturated Pock, and after it turns and lies stinking on the body: It is not filthy and putid, that ever I saw, like the running Pock: It has not the time to come to the venom of that before it is thrown out, and then it is immediately taken away; and consequently as it arrives to no such Malignity and Infection, so it can communicate none such.

MUCH has been said too, and dark hints given at times, about the Purple Spots in the skin, or blewish stains which have been upon many and commonly are the sure and fatal signs of their approaching death. But as these are spoken of by them that have wrote of the Small-Pox before our days; so I very much question whether the Bodies which I have seen so stained do yield any Malignant Infection equal to the corrupted and noisome Bodies of others that lie and putrefy under the fluxy kind. I am sure to my senses they have not at all seemed equally noxious. And when I reason upon the Cause of these stains in the skin, it seems generally to be the suppression of the Pock under it, which wants to come freely forth, but being obstructed by the Stagnation of the Blood it rises no higher than to discolour the skin; which though' it may well argue more Malignity within and may give a more poisonous breath to the Patient while he lives; yet Methinks the Pores of the Body do by no means breathe out the like Malignity as if the Pock rises & breaks & stinks. How the case may be in Spotted Fevers I know not, and whether I am right in what I have here advanced I submit to the Physicians, and am ready to stand corrected by their Judgment.

THERE yet remains three or four things which have occurred to me, which I think meet to observe or relate,

ONE is, That I am at present strong in the Opinion, that those Persons who had taken the Infection before they were Inoculated, yet were greatly served in their Sickness by the running of their Issues, which vented much of the Inflamatory matter that would have increased their Fevers. Some who have recovered have thought so themselves, and so have all about them. And as to the Gentlewoman that died, her Husband has told me that in his opinion the Incisions did much toward the preserving his Wife so long, and so far as she was preserved thro' her sore Visitation.

NEXTLY, I would observe, That in case the Infection be taken the common way, and the Eruption would not have been in some Weeks; As we certainly know that it will lie in the Body sometimes a Month before it breaks out; yet the infected Person coming under the Inoculation, it will bring on the Distemper at the usual time of seven or eight days. Not only the reason but the necessity of this seems very plain; and it accounts for a Difficulty with some, which is, Why the Sickness comes at the period proper to the Inoculation, and yet it proves the confluent kind which is not proper to it.

I lately met with a Treatise on the Small-Pox wherein the Author advances this Rule or Maxim,

I carried on the Hypothesis in my own mind a little further, by that Modern Observation which has been made of a Multitude of Animalcula on every Pustle of the Small-Pox: These they tell us their Glasses have discovered; and that our common Infection is by swarms of these. If so, Methoit these living Minute Particles, these Animated Atoms if I might so speak, may much more easily find their way into our Pores & so into our bodies, than if they were Inanimate.

BUT if one Hypothesis or other may be at all admitted, with this further & most reasonable thought upon them, that these venomous Particles or Animalcules do also flow into our nostrils, throat and blood by our breath; then may they not give us a Reason why the Small-Pox communicated by Incisions in the way of Inoculation, does not produce so many Pock, and such a flame & corruption in the body, as in the common way of Infection it ordinarily does? Because in this way not so many enter▪ • or immediately into such parts of hazard and • i • t • ess, as in the nostrils, throat & inwards?— But I pretend not to argue, on Principles or Premises, which are themselves uncertain; and lie open to many Objections which I could never answer.

I will only add upon all a plain, but to me pleasing & informing discourse I lately had with a poor Negro, whom I found at work where I made a visit, and the Gentleman of the House told me the Fellow had been Inoculated in his own Country. Whereupon I put several questions to him, in answer to which he told me, That he lived in a great Town in his own Country, and when the Small-Pox came into it they did what they could to prevent the spreading of it; that the Families that were first visited usually died among them; but when the Sickness got into five or six houses, so that the People began to despair of being able to stop it, then all who had not had it went presently & received it in the way of Inoculation, (as we call it) and that not one more died of it thro' the whole Town.

WE do not stay therefore (said he) till the Town be infected, and People have many of them got the Sickness within them, and then go & take it; but a whole place takes it in a Week & are well in a Week. (I use but some of his words here, giving the true sense of what he said to me.)

HE went on in answer to the questions I put to him, and told me, "That he never knew of any blains or boils following this practice in his Country; that as to himself none had troubled him, anymore than what others are subject to; & that He never heard of any bodies having it again in his Country; but to prove that his Country men think themselves as secure from it as any of us may do, he told me, That sometimes when Young men among them wanted to go a trading two or three hundred Miles off, but were afraid because they had not yet had the Small-Pox, it was common for them to inquire where it was, & go to the place & be Inoculated, & then go & trade anywhere without fear. When I asked him (what I did not at all suppose he could imform me in) How his Country-men came into the knowledge of this way of giving the Small-Pox? & how long it had been among them? he told me he knew nothing of those things; he supposed it was long before he was born; and no doubt" but GOD told it to poor Negroes to save their lives; for they had not knowledge & skill as we have.

I believe I shall be scoffed at for telling this Simple story, but I think it very pertinent & much to the purpose here; and whosoever seeks the Truth & desires to be informed will not despise it. And he that has learnt anything as he ought, has this—to be willing to learn of the poorest Slave in the Town.

UPON the whole, I do not think that I at all go out of my Line in the present Essay. The plain intent of it is to serve unto the preserving of Life, and to minister unto the comfort of Families. This is a Care beseeming me, or any one else, if it be managed with modesty & decency. My care to do it so, is I think visible eno' in the present writing. I have avoided any appearance of seeming learned in Physic. I am not: Nor shall I matter it at all, if I have betrayed my Ignorance therein. I write with another design, & if that be answered I have all my desire; or if it be rejected with scorn and reviled I shall be satisfied in this, That I have again endeavored the Good of this People.

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