An Account, or History, of the Procuring the SMALL POX by Incision, or Inoculation; as it has for some time been practised at Constantinople.

Being the Extract of a Letter from Emanuel Timonius, Oxon. & Patav. M.D. S. R. S. dated at Constantinople, December, 1713.

Communicated to the Royal Society by John Woodward, M. D. Profes. Med. Gresh. and S. R. S.

The Writer of this ingenious Discourse observes, in the first place, that the Circassians, Georgians, and other Asiaticks, have introduc'd this Practice of procuring the Small-Pox by a sort of Inoculation, for about the space of forty Years, among the Turks and others at Constantinople.

That altho' at first the more prudent were very cautious in the use of this Practice; yet the happy Success it has been found to have in thousands of Subjects for these eight Years past, has now put it out of all suspicion and doubt; since the Operation having been perform'd on Persons of all Ages, Sexes, and different Temperaments, and even in the worst Constitution of the Air, yet none have been found to die of the Small-Pox; when at the same time it was very mortal when it seized the Patient the common way, of which half the affected dy'd.  This he attests upon his own Observation.

Next he observes, they that have this Inoculation practised upon them, are subject to very slight Symptoms, some being scarce sensible they are ill or sick; and what is valued by the Fair, it never leaves any Scars or Pits in the Face.

The Method of the Operation is thus.  Choice being made of a proper Contagion, the Matter of the Pustules is to be communicated to the Person proposed to take the Infection.  For this purpose they make choice of some Boy, or young Lad, of a sound healthy Temperament, that is seized with the common Small-Pox (of the distinct, not Flux sort) on the twelfth or thirteenth day from the beginning of his Sickness:  they with a Needle prick the Tubercles (chiefly those on the Shins and Hams) and press out the Matter coming from them into some convenient Vessel of Glass, or the like, to receive it; it is convenient to wash and clean the Vessel first with warm Water:  A convenient quantity of this Matter being thus collected, is to be stopp'd close, and kept warm in the Bosom of the Person that carries it, and, as soon as may be, brought to the place of the expecting future Patient.

The Patient therefore being in a warm Chamber, the Operator is to make several little Wounds with a Needle, in one, two or more places of the Skin, till some drops of Blood follow, and immediately drop out some drops of the Matter in the Glass, and mix it well with the Blood issuing out; one drop of the Matter is sufficient for each place prick'd.  These Punctures are made indifferently in any of the fleshy Parts, but succeed best in the Muscles of the Arm or Radius.  The Needle is to be a three-edg'd Surgeon's Needle; it may likewise be perform'd with a Lancet:  The custom is to run the Needle transverse, and rip up the Skin a little, that there may be a convenient dividing of the Part, and the mixing of the Matter with the Blood more easily perform'd; which is done, either with a blunt Stile, or an Ear-picker:  The Wound is cover'd with half a Walnut-shell, or the like Concave Vessel, and bound over, that the Matter be not rub'd off by the Garments; which is all removed in a few Hours.  The Patient is to take care of his Diet.  In this place the Custom is to abstain wholly from Flesh and Broath [f]or 20 or 25 days.

This Operation is perform'd, either in the beginning of the Winter, or in the Spring.

Some, for caution, order the Matter to be brought from the Sick by a third Person, lest any infection should be convey'd by the Cloaths of the Operator; but this is not material.

As to the Process of this Matter, in respect of the Idiosyncrasie; the Small-Pox begins to appear sooner in some than in others, in some with greater, in others with lesser Symptoms; but with happy Success in all.  In this Place the Efflorescence commonly begins at the end of the seventh day which seems to favour the Doctrin[e] of Crises.

It was observ'd, in a Year when the common Small-Pox was very mortal, that those by Incision were also attended with greater Symptoms.  Of 50 Persons, who had the Incision made upon them almost in the same day, four were found in whom the Eruption was too sudden, the Tubercles more, and the Symptoms worse.  There was some suspicion, that these four had caught the common Small Pox before the Incision was made.  It is enough for our present purpose, that there was not one but recovered after the Incision:  In those four the Small-Pox came near the confluent sort.  At other times the inoculated are distinct, few and scatter'd; commonly 10 or 20 break out; here and there one has but 2 or 3, few have 100:  There are some in whom no Pustule rises, but in the Places where the Incision was made, which swell up into purulent Tubercles; yet these have never had the Small-Pox afterwards in their whole Lives; tho' they have cohabited with Persons having it.

It is to be noted, that a no small quantity of Matter runs for several days, from the place of the Incision.

The Pocks arising from this Operation are dry'd up in a short time, and fall off, partly in thin Skins, and partly contrary to the common sort, vanish by an insensible wasting.

The Matter is hardly a thick Pus, as in the common, but a thinner kind of Sanies; whence they rarely pit, except at the place of the Incision, where the Cicatrices left are not to be worn out by time, and whose Matter comes near the nature of Pus....

The way of proceeding in the Small Pox inoculated in New England.  Communicated by Henry Newman, Esq; of the Middle Temple.

1. We make usually a Couple of Incisions in the Arms where we make our Issues, but somewhat larger than for them, some times in one Arm, and one Leg.

2. Into these we put bits of Lint, (the patient at the same time turning his Face another way, and guarding his Nostrils) which have been dipt in some of the Variolous Matter taken in a Vial, from the Pustules of one that has the Small Pox of the more laudable Sort, now turning upon him, and so we cover them with a Plaister of Diachylon.

3. Yet we find the Variolous Matter fetched from those, that have the inoculated Small Pox, altogether as agreeable and effectual as any other.  And so we do what is taken from them that have the confluent Sort.

4. Within Four and Twenty Hours, we throw away the Lint, and the Sores are dressed once or twice every Four and Twenty Hours, with warmed Cabbage Leaves.

5. The Patient continues to do all Things, as at other times, only he exposes not himself unto the Injuries of the Weather, if that be at all Tempestuous.

6. About the Seventh Day the Patient feels the usual Symptoms of the Small Pox coming upon him; and he is now managed as in an ordinary Putrid Fever.  If he cannot hold up, he goes to Bed; if his Head ach[e] too much, we put the common Poultice to his Feet, if he be very Sick at the Stomach, we give him a gentle Vomit, yea, we commonly do these Things almost of Course, whether we find the Patient want them or no.  And we reckon the sooner we do these Things, the better.  If the Fever be too high, in some Constitutions, we Bleed a little:  And finally, to hasten the Eruption, we put on a Couple of Blisters.

7. On or about the Third Day from  the Decumbiture the Eruption begins.  The Number of the Pustules is not alike in all, in some they are a very few, in others they amount to an Hundred, yea, in many they amount unto several Hundreds; frequently unto more than what the Accounts from the Levant say is usual there.

8. The Eruption being made, all Illness vanishes; except perhaps a little of the Vapours in those that are troubled with them; there is nothing more to do, but to keep Warm, drink proper Teas, eat Gruel, Milk Pottage, Panada, Bread, Butter, and almost any thing equally Simple and Innocent.

9. Ordinarily the Patient sits up every Day, and entertains his Friends, yea, ventures upon a Glass of Wine with them.  If he be too Intent upon hard Reading and Study, we take him off.

10. Sometimes, tho' the Patient be on other Accounts easy enough, yet he can't Sleep for divers Nights together.  In this Case we do not give him Anodynes or Opiates, because we find, That they who have taken these Things in the Small Pox are generally pestered with miserable Biles after their being recovered.  So we let them alone; their Sleep will come of it self, as their Strength is coming on.

11. On the Seventh Day the Pustules usually come to their Maturity; and soon after this they go away, as those of the Small Pox in the Distinct Sort use to do.

12. The Patient gets abroad quickly, and is most sensibly Stronger, and in better Health than he was before.  The Transplantation has been given to Women in Child-bed, Eight or Nine Days after their Delivery; and they have got earlier out of their Child-bed; and in better Circumstances, than ever in their Lives.  Those that have had ugly Ulcers long running upon them, have had them healed on, and by this Transplantation.  Some very feeble, crazy, Consumptive People, have upon this Transplantation, grown hearty and got rid of their former Maladies.

13. The Sores of the Incision do seem to dry a little in Three or Four Days of the Feverish Preparation for Eruption.  After this there is a plentiful Discharge at them.  The discharge may continue a little while after the Patient is quite well on other Accounts; But the Sores will soon enough dry up of themselves; but the later, the better, as we think.  If they happen to be inflamed, or otherwise Troublesome, we presently help them in the ways we do any Ordinary Sores.

A Letter from Dr. Nettleton, Physician at Halifax in Yorkshire, to Dr. Whitaker, concerning the Inoculation of the Small Pox.

SIR,
Having too often found with no small Grief and Trouble, how little the Assistance of Art cou'd avail in many Cases of the Small Pox, I was induced to try the Method of Insition or Inoculation, which came so well recommended by several Physicians from Turkey, and which had also been lately practised in London.  This I thought was sufficient to justify the Attempt, and what success it has met with, I have here sent, according to your desire, a faithful Account of, and of every Thing that has been done or observed here, relating to that Affair, which might be worth your Notice.

It was in December last, That I first began to put this Method in Practice, and finding it to succeed beyond my Expectation in the first instance, I was encouraged to repeat it upon some others, and afterwards several, seeing with how much ease these got thro' the Distemper, were desirous to have the same done to themselves or their Children; so that there are now upwards of Forty here, who have received the Small Pox by Insition; who are all got well thro' the Distemper, and are at this time thro' Gods Blessing in very good health.  Only one that was inoculated, did Die; of which I shall give you a particular Relation hereafter, and refer it to your Impartial Judgment, whether that ought to cast any Blemish upon the Operation or no.

What was done by way of Preparation was chiefly purging with Rhubarb for Children, and sometimes Vomiting or Bleeding for grown Persons; and many have had no Preparation at all.  But I always found, as far as I was able to judge, That those, whose Bodies were well prepared by such proper Methods as their different Ages or Constitutions did seem to require, had more favourable Symptoms than others in like Circumstances, where that was omitted.

The Method, which I always took in the Operation, was to make two Incisions, one in the Arm and another in the opposite Leg.  It is not material as to raising the Distemper, whether the Incisions be large or small but I commonly found, that, when they were made pretty large, the quantity of Matter discharged afterwards at those Places was greater; and the more plentiful that Discharge, the more easy the rest of the Symptoms generally are, and they are also by this means the best secured from any inconvenience, which might follow, after the Small Pox are gone off.

At first I collected some of the Matter from the Pustules of one, who had the Small Pox of the natural Sort, into a shell or Vial, and infused two or three drops of it into the Wound; but finding it to be very troublesome and difficult to get any quantity of the Matter, and observing also, that the least imaginable will be sufficient for the Purpose, I commonly take small Pledgets of Cotton, and ripping the Pustules, when they are ripe, with the point of a Lancet, roll the Pledgets over them, till they have imbibed some of the Moisture.  I put one of these upon each Wound, and cover it with any common Plaister till the next Day, when I commonly take away both the Cotton and the Plaister, leaving the Wound to it self, only covering it with a slight linen Roller, to defend it from the Air.  I have sometimes rubb'd the Pledget only once over the Wound, without binding it on, which I found to answer the End as well; and from some other Observations I have made, I have been surprized to see the Small Pox produced this way, when I was very well assured, the quantity of Matter received into the Vessels, cou'd not amount to the hundredth part of a Grain.

The Persons inoculated have not been confin'd to any Regimen, but only to be kept moderately warm; and those, who were grown up, to live very temperate and regular, to keep their Minds easy and composed, and to use proper means to drive away all Fear and Concern.  Some have been obliged from the time of the Insition to abstain from Flesh and all strong Liquors; but I found afterwards, that the Eruption did not proceed so well, when they were obliged to live too low.  Perhaps in warmer Climates, where they are not so much accustomed to live upon Flesh, such Abstinence may be necessary; but here I find it best to let them eat and drink as usual, tho' something more sparingly, till the Fever begins to rise; and then, but not before, we enjoin such a Regimen as is usual in like Cases.

The first Thing that occurr'd after the Insition, was the Inflammation of the Wounds, which commonly happen'd about the fourth Day, when they began to appear very red round about, and to grow a little sore and painful; in about two Days more they began to digest and run.  In some they begin to run sooner, and the quantity discharged is much greater than in others.  I generally found, that in those who discharged most this way, the Fever was more slight, and the Small Pox fewer, tho' I have known some do very well when these places have only appear'd very red, but have scarce run any thing at all, as it usually happens, when the Incision is made so superficial as not to cut thro' the Skin.

About the seventh Day the Symptoms of the Fever begin to come on, which are the very same, that we always observe in the Small Pox of the distinct Kind, in the natural way.  A quick Pulse, a great heat and thirst, pain in the Head and Back and about the region of the Stomach, vomiting, dosedness, startings, and sometimes Convulsions.  All were not seized with all these Symptoms, nor in the same Degree or Continuance; some began on the seventh Day, and continued ill without any Remission till after the eleventh; many not till the eighth or ninth Day; and the Fever in these was more moderate with great Intermissions; and some have scarce had any illness at all.  During all this time the Places of Incision continued to be very sore and swell very much, so as to appear very large and deep, and to discharge a great deal of Matter.

On the tenth Day the Small Pox most commonly did appear, sometimes on the ninth, and sometimes not till the eleventh:  but I never found that any difference of Age, Constitution, or any other Cause ever made them vary above one Day from the tenth.  The Number was very different, in some not above Ten or Twenty, most frequently from Fifty to two Hundred, and some have had more than could well be numbered; but never of the confluent Sort.  Their Appearance was the same with those of the distinct Kind, they commonly came out very round and florid, and many times rose as large as any I have observed of the natural Sort, going off with a yellow Crust or Scab as usual; tho' it sometimes happens, especially when the Sores discharge a very great quantity of Matter, that they are both few in Number, and do not rise to any Bulk; but having made their Appearance for Four or Five Days they wast[e] insensibly away.

After the Small Pox come out, the Feverish Symptoms gradually abate, and when the Eruption is completed, they usually cease, without any second Fever, or any farther trouble in any respect.

While the Pustules were rising, and for some time after they were gone, the Sores continued to swell and to run very much, the longer they did so the better; but they never fail'd to heal up of themselves after a certain Time.

I rarely saw Occasion for any Medicines in the course of the Distemper, only sometimes when the Symptoms ran very high, I have a gentle Anodyne to be repeated as Occasion should require and once or twice I thought it necessary to blister, and to use such Medicines, as are found to be most serviceable in the Small Pox of the natural sort.  After the Pustules are gone away, they have always been purged twice or thrice, and sometimes let Blood, which is all that has been usually done.  But tho' the Practice may seem to be very easy, yet it is an Affair of such a Nature as to require the utmost Care, and I presume it will never be undertaken without the Advice of Physicians to direct a proper Method of Preparation before the Insition is made, as well as a just Regimen afterwards; to watch every Symptom, and lend Nature all proper assistance, when ever it shall be requisite.  Where this is done, with Gods Blessing, it will seldom fail of being attended with happy success.

It has happen'd in one Instance or Two, That the Symptoms in the Distemper have been worse than usual; and some few, after the Small Pox were gone off, have been subject to other indispositions.  Of all which I shall give you a particular Account.

The first that was Inoculated, a Boy (Thomas Thorp's Son of Hallifax.) about a Year and half Old, began to be ill on the Eighth Day, and had a brisk Fever for two Days, then the Pustules began to appear, which were but few in Number, and rose very large.  The Child was soon well, and continued so for about a Month, when being carryed out and kept a long Time in the Cold, he fell into a Feverish disorder accompanied with a Cough, and was ill for Four or Five Days; after that time it went off, and he has ever since been in very good health.

The Second was a Girl (Jer. Turner's Daughter.) two Years of Age, in a Family where they had formerly Bury'd three Children successively of the Small Pox, and this they fear'd might undergo the same Fate.  The Fever came on about the seventh Day, and she continued very ill till the tenth, on which Day about Noon she had a strong convulsive Fit.  In the Evening the Small Pox appear'd, and tho' she had more in Number than usual, yet she grew well as soon as they were fully come out, and has continued so ever since.

The Eighth and Ninth (Mr. John Symson's Children.) were in a Family where they had four Children, none of whom had had the Small Pox.  I was call'd to the Eldest, who was seized in the natural way with the most malignant Sort I ever saw, attended with the worst Symptoms that cou'd be, insomuch that he died on the fourth Day, all full of purple and livid spots.  The Parents were very desirous, that any means might be used to preserve the rest; but here I was in great doubt and perplexity what part to act.  I knew very well, That if I shou'd venture to make the Insition, whatever shou'd happen wou'd be charged upon that, and it was not improbable, but some of them might have already taken the Infection, in which Case it was uncertain what the event might be.  On the other Hand, if it was omitted, I did very much fear they might all Dye, such instances having been known, and the Contagion which was got amongst them, being of such a destructive Nature.  Wherefore I was willing to run the risque of my Reputation, rather than that the Children shou'd all perish.  They were therefore all three inoculated the Day before the eldest died, after having told the Parents that I cou'd not answer for the Success, in Case they had already catch'd the Infection, which would be known if any of them fell ill before the Seventh Day.  According as we fear'd, one of them began on the second Day, much after the same Manner with the Eldest, and the Small Pox appear'd on the third Day, or rather an universal redness all over the Skin, interspersed with many purple spots.  There were none of these spots near the Places of Insition, which began to swell a little, as usual about the fourth Day, and the Small Pox did rise a little more about those Places than elsewhere; but Nature was too far oppress'd with the violence of the Distemper, and tho' this Girl continued longer than her Brother, and was not delir[i]ous as he was, yet she died on the seventh Day.  I did not reckon this Child in the Number of those who received the Distemper by Inoculation; for I thought there was sufficient reason to conclude, that she had taken the Infection before; but of this I must leave you to judge as you please, I only give you a Relation of Facts.  The other two continued well till the eighth Day, when they both fell ill together.  The Small Pox came out on the tenth, of a very good Sort, tho' more in Number than some others had, and they both got very easily thro' the Distemper without any Indisposition since.  It was observable, that the Elder of these Children, about the time of the Eruption, had many Spots appear'd on him of a deep Colour, very much like those of the other two Children, which changed in them to Purples afterwards, which the Mother was very much concern'd at, fearing they wou'd prove the same in this; but when the Small Pox came out, these Spots grew gradually less, and at last quite disappear'd.  The other Child had been very subject to Convulsions for a long Time, when very young, and it was afflicted with the same very much, from the Time that the Fever came on, till the Small Pox appear'd.

The Twenty Seventh was a marry'd Gentlewoman (Mrs. Breara of Eland.) aged about Twenty Six; who got very well thro' the Distemper; but about a Week after was seized with a very great Coldness and Shivering, which were followed by a burning Heat, with a great Pain and Disorder in her Head, which continued for several Hours.  She had some time ago an intermitting Fever, which I took this to be a Paroxysm of, and expected its return, but she felt no more of it, and has ever since continued in good Health.

Of her two Sons, who were both inoculated at the same Time, the Younger got thro' the Distemper with a great deal of ease, the Small Pox being few, and the Symptoms very slight; but the Elder a Boy about five Years old, fared quite otherwise.  The Symptoms before the Eruption were more than usually severe, especially the Vomiting; the Pustules appear'd at the usual Time, but more numerous than ordinary, and when the Eruption was finish'd, the Fever did not cease, as it has done in every instance but this:  on the fifth Day after he was seized, the swelling of his Face began, which was follow'd by a Pain and Swelling in his Throat, and a Salivation, which continuing till the eleventh Day, were succeeded by a Swelling in his Hands and Feet, the usual Symptoms of the distinct Sort when they are very full; and tho' there appear'd some little Signs of Malignity, yet with the Use of Blisters and the milder Cordials and Alexipharmicks, the Pustules rose very large, and all Things went on very well, so that he got thro' the Distemper without any Danger, but with much more Pain and Trouble than any of the rest have endured.  After the Small Pox were gone off, we found a hard Swelling upon his Shoulder, which disabled him for some time from moving his Arm; but by the Use of some common Applications, that is entirely gone.  In this Family the only Child they had before these died of the Small Pox, of a very malignant sort, and this Boy was of an ill habit, and has had many dangerous illnesses

The Twenty-Third, was a Girl (Mr. Js. Hanson's Daughter.) about Nine Months old; in this Child, after she was well of the Small Pox, the Mother discover'd that one of her Thighs was a little swell'd, which was painful to her for some time, and made her unwilling to move that part; there were also some small Tumours in the Groin; but these went off in a few Days, there only remaining a hardness about the Knee, which also disappear'd in a short Time without coming to Suppuration, and the Child is now in perfect Health.

The Thirty Seventh was a Girl (Mr. John Haigh's Daughters.) six Years of Age; she got very easily thro' the Distemper; but before the Small Pox were gone, we found a small Tumor upon the Muscles of the Loins, which ripen'd very speedily, and was open'd and heal'd up in a very short time.  Her Sister, a young Woman about Eighteen had also a Swelling of the same Kind in her Leg, but it lay something deeper, and gave her a great deal of Pain for Three or Four Days; afterwards it discharged a great quantity of Matter, and was heal'd without any farther Trouble.

All the rest, excepting these I have mentioned, got very well thro' the Distemper without any manner of trouble, or Hazard, or any ill Consequence afterward.  Whether those slight Indispositions, which some have been subject to afterward, were owing to the Insition, I have not been able to judge; but I presume what they have endured in the Course of the Distemper, and what has followed after, is not to be put in the Ballance with what is undergone in the common way, by those who are thought to come off very well; and if this Method were more generally practised, 'tis probable some means wou'd be found out, to prevent even these subsequent disorders, which are no more frequent, nor near so bad, as those which follow the natural Sort.

In two Instances the Inoculation had no effect, the Reason of which, in one was because the Child (Mich. Bland's Daughter.) had the Small Pox before, as the Parents did believe; but the Distemper had been so favourable, as to leave it doubtful.  In the other, the Matter was taken, when the Pustules were wither'd, and almost gone, and that little moisture which they contain'd, I suppose, had lost its Virtue; the Boy (William Clark's Son.) to whom it was made use of, was no way affected; the Places of Incision did not at all inflame, or swell as usual, nor did any Pustules appear; but about a Month after, he was seized with the Distemper in the ordinary way, and did very well.

Some of those who have been inoculated, that are grown up, have afterwards attended others in the Small Pox, and it has often happen'd, that in Families where some Children have been inoculated, others have been afterwards seized in the natural way, and they have lain together in the same Bed all the Time; but we have not yet found, that ever any had the Distemper twice; neither is there any Reason to suppose it possible, there being no difference that can be observed, betwixt the Natural and Artificial Sort, (if we may be allow'd to call them so) but only that in the latter the Pustules are commonly fewer in Number, and all the rest of the Symptoms are in the same proportion more favourable.  There is one Observation which I have made, tho' I wou'd not yet lay any great stress upon it, that in Families where any have been inoculated, those who have been afterwards seized, never had an ill sort of Small Pox, but always recovered very well.

Thus, Sir, I have given you a short and plain Account of what has occurr'd to me concerning this Method of Inoculation:  'tis not any pains or care I have taken in writing this Letter, that can recommend it, for I have been solicitous about nothing but Truth, my design being only to give you a short History of the Distemper raised by Inoculation, so far as I have observed it.  The Number might perhaps have been greater, if I wou'd have press'd it; but I only took such as desired it of themselves, being cautious of perswading any Body to it, because I had but little Authority hereabouts to support me; tho' I ought to acknowledge the kindness of many of my Friends, who being convinced, that this Method would be of some use, were very zealous to promote it; and in particular that very learned and worthy Gentleman, Dr. Richardson, did upon all Occasions vindicate this Practice.  I know not whether I shall have an opportunity of doing much more this way at present, the Small Pox being in a great measure gone from this Town and Countrey; but I have already seen so much of it, that I shou'd never be afraid of its success.

There is only one Thing more I am obliged to mention, which I wou'd rather have pass'd over in silence, and that is the vigorous opposition it has met with from many honest well meaning Persons, who cou'd not but fancy that it is an unlawful and unwarrantable Practice.  They have gain'd a great Majority on their side here, a[s] well as in other Places, where it has been practised.  I only wish, that, as they act upon a principle of Conscience, they wou'd have been less busy in raising, or spreading false and groundless Reports, whereby this Matter has been very much misrepresented, and many, entertaining a wrong Notion of it, have been deterr'd from making use of this Method for themselves or their Children, who have since been unhappily taken off by the Small Pox.  But when this Affair is set in a true light, and found to be always safe and effectual, I believe all the Objections raised against it will fall of course.  It wou'd be of the greatest moment that the World shou'd know what you think of it in Town, and how you have found it to succeed; 'tis commonly objected here, that it is not approved of in London; but if those Gentlemen, who have justly gain'd the greatest Honour and Reputation in our Profession, shou'd by finding it successful see cause to declare publickly in its favour, that wou'd be the greatest means to forward it in the Country, and to remove those unreasonable prejudices, which do generally prevail against a Method, which I believe has no where been put in practice with any other Aim, than to do some service to Mankind:  for which Reason I doubt not but this short Narrative will be acceptable unto you from, &c.

Thomas Nettleton.
Halifax, Apr. 3. 1722.

A Letter from the same Learned and Ingenious Gentleman, concerning his farther Progress in inoculating the Small Pox: To Dr. Jurin R. S. Secr.

In Answer to what you require from me, as to what has been farther done, I have only to add that since I writ to Dr. Whitaker, I have made the Insition upon about fifteen Persons, who have all had the Distemper very favourably, and got thro' it with a great deal of ease.  As nothing uncommon or extraordinary did happen in any of these Cases, it will not be necessary to trouble you with a particular Account of any of them:  They were most of them at some distance, the Small Pox being in a great measure gone from this Town and Neighbourhood.

I am very sensible of the Favour done me by the Royal Society, who were pleased to take notice of my Letter to Dr. Whitaker, which you had nothing to move you to besides a generous Disposition to encourage the smallest attempts towards any Thing, that may tend to publick Advantage.  I must own that all the Information I had concerning this Affair, which I have happen'd to be engaged in, was entirely from the Philosophical Transactions.  'Tis now about six Years since the Royal Society did communicate to the World some Letters from two very considerable Physicians residing in Turkey, whose good Sense or Integrity we had no Reason to call in question; these Gentlemen did solemnly assure us, that the Method of Inoculation had been for many Years practised in those parts of the World, with almost constant success.  I had, as well as all others who have been engaged in the Practice, with sufficient Sorrow and concern, been called to many in the Small Pox, whose Cases were so deplorable, as to admit of no relief.  And therefore I cou'd not but be very thoughtful about this Method, which promised to carry Persons thro' that cruel Distemper, with so much ease and safety.  I was so far from knowing that it was a Crime, that I always thought it the Duty of our Profession, to do whatever we could to preserve the Lives of those, who commit themselves to our Care; And I knew no Reason, why we ought not, with all humble thankfulness to Almighty God, to make use of any means, which his good providence shall bring to light conducing to that End.  This Matter, tho' of so great Importance, lying dormant so long after it was known, is, I presume a sufficient proof, that none have been very forward to try Experiments.  But when we had the Account in the Publick Papers, that it had by their Royal Highness's Command been done with success at London, I cou'd not be satisfied without trying it here.  I was soon convinced, that it would be of very great use; and the more experience I have had of it since, the more I am confirm'd in the same opinion.  I believe all others, who have seen any thing of this Practice, are in the same sentiment, and there is no doubt, but in a few Years the World will acknowledge the service, which the Royal Society have done to Mankind, in first revealing to this part of Europe a Thing so beneficial as it will certainly prove; for tho' some few unfortunate accidents may sometimes happen, yet those will be very rare in comparison of the many sad and disastrous Events which this Distemper has been, and ever will be very fruitful of, while it is left to rage in its full force and violence.

Sir, I doubt not but when you have collected a sufficient Number of Observations for it, you will be able to demonstrate, That the Hazard in this Method is very inconsiderable, in proportion to that in the ordinary way by accidental Contagion, so small, that it ought not to deter any Body from making use of it.  In order to satisfy my self, what Proportion the Number of those that die of the Small Pox, might bear to the whole Number that is seized with the distemper, in the natural way, I have made some enquiry hereabouts, and I shall take the freedom to transmit the Accounts to you, because I believe you may depend upon their being taken with sufficient care and impartiality. In Hallifax, since the beginning of last Winter, 276 have had the Small Pox, and out of that Number 43 have died.  In Rochdale, a small Neighbouring Market Town, 177 have had the Distemper, and 38 have died.  In Leeds 792 have had the Small Pox, and 189 have died.  It is to be noted, that in this Town, the Small Pox have been more favourable this Season than usual, and in Leeds they have been more than usually mortal; but upon a Medium in these three Towns, there have died nearly 22 out of every hundred, which, is above a fifth Part, of all that have been infected in the natural way.  I have in these Accounts confined my self to the Limits of the Towns.  The Numbers that have had the Small Pox in the Country roundabout, is vastly greater; but the Proportion of those that die is much the same.  I have made the enquiry in several Country Villages hereabouts, in some I found the Proportion to be greater, in others less, but in the main it is nearly the same, I am, &c.

Thomas Nettleton, Halifax
June 16. 1722.

Part of a Letter from Dr. Nettleton, Physician at Halifax, to Dr. Jurin, R.S. Secr concerning the Inoculation of the Small Pox, and the Mortality of that Distemper in the natural Way.

There are two Propositions advanced by the Favourers of the Practice of Inoculation, concerning which the Publick seems to require more full Satisfaction. That the Distemper rais'd by Inoculation is really the Small Pox; and, That it is much more mild and favourable, and far less mortal, than the natural sort.

The former of these is not so much disputed now, as it was at first, when this Method was introduced, nor can it be made a doubt of by any one, who has seen those that have been inoculated, and has also been much conversant in the natural Small Pox.  There is usually no manner of difference to be observed betwixt the one sort and the other, when the Number of Pustules is nearly the same; but in both there are almost infinite Degrees of the Distemper, according to the difference of that Number.  All the Variation that can be perceived of the Ingrafted Small Pox from the Natural, is, that in the former the Pustules are commonly fewer in Number, and all the rest of the Symptoms are in the same Proportion more favourable.  They exactly resemble what we call the Distinct Sort:  the Symptoms before the Eruption are the very same, and when the Pustules begin to rise, their Appearance is the same, as well as their Periods of Maturation and Declension; they are at first of the same florid, rosy Colour, and when fully ripe, of as fair a yellow.  They commonly rise as round and as large as the other, and when they are very numerous, the Inflammation and swelling of the Face comes on at the usual Time, and is followed by the swelling of the Hands and Feet, and only once I observed a Salivation, tho' the Pustules were distinct.  In the Natural Small Pox, when the Pustules are very few, we sometimes observe, they do not rise to so great a Bulk, neither do they ripen so fully, nor continue so long as usual; and it is the same in the way of Inoculation.  In short, as this Distemper is raised by an Ingraftment from the Small Pox, as it has the very same Appearance, and as it is capable of producing the same by Infection, there seems to be no room to doubt of its being the true and genuine Small Pox.  And if that be allowed, it will follow from thence, as a Corollary, that Those, who have been inoculated, are in no more Danger of receiving the Distemper again, than Those who have had it in the ordinary Way.  And this is also thus far confirmed by Experience.  We are very ready to own, that the Operation may sometimes fail:  those Gentlemen, who first communicated to the Royal Society some Account of this Practice from Turkey, did both of them intimate so much; tho' I believe that will but rarely happen.  In one Instance here, (William Clark's Son.  See Philsoph. Transact. No. 370. p. 45.) I observed no Eruption at all, neither did the Wounds inflame and swell any more than would have follow'd from a common Incision, which made me conclude, that what was apply'd had not taken Effect, and indeed the Reason of it was very well known to me.  In three others, tho' the Wounds did inflame, and swell, and discharge considerably, yet the Eruptions were so imperfect, as to leave me a little in doubt:  but two of these have since been sufficiently try'd, by being constantly with those who had the Small Pox, without receiving any Infection; which makes me inclined to believe they will always be secure from any danger of it.  As to all the rest, neither I nor any body else, who saw them, did in the least question, but that they had the true Small Pox.

As to the latter Proposition, That the Ingrafted Small Pox is far less dangerous than the Natural:  the Truth of this, I suppose, can only be found by making a Comparison, so far as our Experience will extend.  In order to this, I have taken an Account in this Town, and some Part of the Country, and have procured the same from several other Towns hereabouts, where the Small Pox has been Epidemical this last Year, with as much Exactness as was possible, how many have had the Small Pox, and how many out of that Number have died.  Some of these I did send you the last Summer, but I will beg leave to repeat them amongst the rest, that they may be all under one view.
 

I am very sensible you will require a great number of Observations, before you can draw any certain Conclusions.  I would only crave leave to remark, that it appears from these Accounts, that this last Year, in this Part of the Kingdom, almost nineteen out of every hundred, or near one fi[f]th of those, who have had the natural Small Pox, have died; whereas out of sixty one which have been inoculated hereabouts, not one has died; for as to the Case of Mr. John Symson's Daughter, which would have made the sixty second, I leave it out of my Account, and I will refer it to any impartial Judgment, whether I may not justly do so.  (See Philosoph. Transact. No. 370. p. 41, 42.)  The Facts are open to every one's Enquiry, and whoever will give himself the Trouble, may be satisfied as to the Truth of them.

Halifax, Dec. 16. 1722.

A Letter to the Learned Dr. Caleb Cotesworth, F.R.S. of the College of Physicians, London, and Physician to St. Thomas's Hospital; containing a Comparison between the Danger of the Natural Small Pox, and of that given by Inoculation.  By James Jurin, M.D. R.S. Secret.

SIR,
The sincere and disinterested Regard for the Good of Mankind, which you have always manifested, as well in your extensive private Practice, as in that publick Post, which you have so long and so usefully fill'd, must affect you, I am sure, with a great and sensible Concern for the Destruction made among us by that terrible Calamity the Small Pox.  We have seen, for some considerable Time past, above 100 Person per Week in this City and Suburbs, taking one Week with another, to be carry'd off by this Disease; a Consideration certainly that ought to dispose us to enter into any Measures, by which we may reasonably hope to put some Stop to the Progress of so cruel a Distemper.

To this Purpose, Sir, the Method of Inoculation, which has lately been introduced among us, is strongly recommended on the one hand, and has been opposed with a great deal of Warmth and Zeal on the other.

I have no Inclination to enter into this Controversy; it is in better and abler Hands:  but, as the Point in Dispute is of the utmost Importance to Mankind, I heartily wish, that, without Passion, Prejudice, or private Views, it may be fairly and maturely examin'd.  In order to which, if the following Extracts and Computations, concerning the comparative Danger of the Inoculated and Natural Small Pox, may be of any Use to your self, or to other impartial and disinterested Judges, I shall think my Labour well bestowed.

The Number of Persons, who have had the Small Pox by Inoculation here in England, is, by the best Information I have been able to collect, as follows.
 

Out of this Number the Opposers of Inoculation affirm, that two Persons died of the Inoculated Small Pox; the Favourers of this Practice maintain, that their Death was occasioned by other Causes.  If, to avoid dispute, these two be allow'd to have died of Inoculation, we must estimate the hazard of dying of the Inoculated Small Pox, as far as can be collected from our own Experience, to be that of 2 out of 182, or one out of 91.

The Reverend Mr. Mather, in a Letter dated March 10, 1721. from Boston in New England, gives an Account, That of near 300 inoculated there, 5 or 6 died upon it or after it, but from other Diseases and Accidents, chiefly from having taken the Infection in the common way by Inspiration, before it could be given them in this way of Transplantation.

If, as we have done before, to avoid all occasion of dispute, we allow 5 out of these 300 to have died of the Small Pox by Inoculation, notwithstanding what Mr. Mather has said of their dying by other Accidents or Diseases; the hazard of Inoculation will thence be determin'd to be that of 1 in about 60.  But here it must be observ'd, that by all the Accounts from New England, the Operators there appear not to have been so cautious in the choice of their Subjects, as here in England.  For Mr. Mather tells us, that the Persons inoculated were young and old, from 1 Year to 70, weak and strong; and by other relations we are inform'd, that Women with Child, and others even in Childbed, underwent the Operation.  Apparently the Greatness of the Danger they were in, from the Infection in the natural Way, which then raged among them with the utmost Fury, made them the more adventurous.

We come now, Sir, to the second Part of our Design, which is to form an Estimate of the Hazard, which all Mankind, one with another, are under of dying of the natural Small Pox, that, by comparing this with the Hazard of Inoculation, the Publick may be enabled to form a Judgment, whether or no the Practice of Inoculation tends to the Preservation of Mankind, by lessening the Danger to which they are otherwise liable.

With this View I have consulted the Yearly Bills of Mortality, as far back as the Year 1667, being the Year after the Plague and the Fire of London, comprehending to the present Time the Space of 56 Years, from 42 of which I have given Extracts in the two following Tables.

The first of these takes in the first 20 Years, distinguishing for every Year the total Number of Burials, and likewise the Number that died of the Small Pox, in two separate Columns.  The third Column shews, how many died of the Small Pox out of every Thousand that were buried; and the fourth Column represents the Proportion between those that died of the Small Pox, and the whole Number of Burials, by the nearest Vulgar Fraction, having always 1 for the Numerator.

The second Table gives the last 22 Years, after the same manner, and at the bottom of each Table is given the Total Number for each Series of Years, and likewise the Number that died each Year, taken at a Medium, one Year with another:  by which it appears that the Proportion between the Number of those that die of the Small Pox, and the whole Number of Burials, is very nearly the same, upon an Average for each Series of Years.

The 14 intermediate Years between 1686 and 1701 are left out, because in the Bills for those Years, the Accounts of the Small Pox and Measles are not distinguished, as in the preceding and following Years, but are join'd together in one Article, so that from them no certain Account can be drawn of the Number of Persons, that died of the Small Pox.
 

By these Tables it appears, that upwards of seven per Cent. or somewhat more than a fourteenth part of Mankind, die of the Small Pox; and consequently the hazard of dying of that Distemper, to every individual born into the World, is at least that of one in fourteen.  And that this Hazard encreases after the Birth, as the Child advances in Age, will appear from what follows.

From this Estimate it is demonstrable, that, in the Case of Persons actually having the Small Pox, the Hazard that they run, one with another, of dying of that Distemper, is greater than that of one in fourteen; or, which is the same thing, there must be fewer than thirteen, that recover, for one that dies of the Small Pox.  For since one fourteenth part of Mankind die of the Small Pox, and the other thirteen parts die of other Diseases; if these thirteen have all had the Small Pox, and recover'd from it, before they fell ill of those other Diseases of which they died, then just thirteen will have recovered from the Small Pox, for one that dies of that Distemper:  but, as it is notorious, that great Numbers, especially of young Children, die of other Diseases, without ever having the Small Pox, it is plain, that fewer than thirteen must recover from this Distemper, for one that dies of it.

To determine exactly how many of these thirteen Parts of Mankind, die without having the Small Pox, is a very difficult task:  but it is easy to see, that a considerable Deduction is to be made from them.

In the first place, the two Articles of Stil[l]born and Abortive Children, which are put into the yearly Bills, as part of the Number of Burials, are unquestionably to be deducted.

With these two, Sir, you will not I believe, think it unreasonable to join the following Heads, which, by the best Information I can procure, comprehend only very young Children, or at most not above one or two Years of Age:  Overlaid [infants inadvertantly smothered while sleeping with their mothers], Chrysoms [infants less than a month old] and Infants, Convulsions, Horseshoehead [the condition of an infant's skull in which the sutures are too open, the coronal suture presenting the form of a horsehoe], Headmoldshot [the condition of an infant's skull in which the sutures ride, or are shot, over each other], Teeth [death of an infant that is teething], Water in the Head, Worms, Rickets, Livergrown [enlarged liver? colicky restlessness common in premature infants?], Chin-Cough, and Hooping-Cough, which Articles in the Yearly Bills for 22 Years last past, amount at a Medium to 386 in each 1000, of the whole Number of Burials.

It is true indeed, that, in all Probability, some small part of these must have gone thro' the Small Pox, and therefore ought not to be deducted out of the Account:  but then, on the other hand, as it is certain, that of the remaining 614/1000 of Mankind, that are above one or two Years of Age, there are great Numbers, that never have the Small Pox, it will I presume be judged to be no unequal Supposition, if I suppose all that are contain'd under the Heads abovemention'd to have miss'd that Distemper, when by way of Compensation, I allow all the remainder of Mankind to undergo it; which Concession is so large, that it will abundantly make up for what I assume too much in the former Supposition.

Allowing therefore, that out of every 1000 Children that are born, 386 die under one or two Years of Age, without having the Small Pox, and 72 do some time or other die of that Distemper; it follows, that the Hazard of dying of it, to the remainder of Mankind, above one or two Years of Age, who are all supposed to undergo that Disease sooner or later, is that of 72 out of 614, or nearly 2 out of 17:  so that no more, than between 7 and 8, can recover from that Distemper, for one that dies of it.  And if any consi[de]rable part of the aforesaid remainder of Mankind, more than is allow'd for above, do escape having the Small Pox, then the Proportion of those that recover from it, will be still smaller.

This Consideration shews the Fallacy of one plausible Argument, that has been often made use of on occasion of the present Disputes about Inoculation:  Which is, that whatever be the Danger of dying of the Small Pox, to those that actually have that Disease, yet, as great Numbers of Persons never have the Small Pox at all, this Danger is what any particular Person may never be in; and therefore it will be Madness to undergo the hazard of Inoculation, be it great or small, in order to prevent a Disease, which possibly may never befal[l] one.

For if two parts in seventeen of all Mankind, that are above one or two Years of Age, must sooner or later die of the Small Pox, it is plain, that how many parts soever of these seventeen are supposed to escape that Distemper, the Mortality among the remainder, who undergo it, must in proportion be so much the greater.  As for instance, if 7 parts escape having the Small Pox, and 10 undergo it, then 2 out of 10, or 1 out of 5, that have the Small Pox, must die of that Disease.

And as it can never be known, whether or no any particular Person be one of those, that are to have the Small Pox; his Hazard of dying of that Distemper, being made up of the Hazard of having it, and the Hazard of dying of it, if he has it, will be exactly the same, namely, that of 2 in 17, or 1 in 8 or 9, whether the proportion of Mankind, that escape having the Small Pox, be great or small.

But as what has been said concerning the Hazard of the natural Small Pox, is taken from an Account of 42 Years; whereas the Hazard of Inoculation is estimated only from what has happen'd in the space of about 18 Months, since which time it had its first Rise among us; it will perhaps be asked by some Persons, why we do not likewise make the Estimate of the hazard of the natural Small Pox, from the last two Years alone, without running back into so great a number of Years, before Inoculation was begun?

To which we answer, that the Proportion of those that die of the Small Pox, varies so much in different Years, as appears from the Tables above, that it was impossible to come at any Certainty in this point, from the consideration of the two last Years alone:  and if any one suspects us of Partiality in proceeding after the manner we have done, he need only cast his Eyes upon the second Table, where he will find that the Mortality of the natural Small Pox, for the two last Years, has considerably exceeded the Medium we have determin'd from taking in two and fourty Years.

There is another Method, which, if it were put in practice in several large Towns, or Parishes, and for a sufficient Number of Years, would enable us to come at a nearer and still more certain Computation of the Proportion between those that recover, and those that die of the Small Pox:  which is, to send a careful Person once a Year, from house to house, to enquire what Persons have had the Small Pox, and how many have died of it, in the preceding Year.  This has been done by Dr. Nettleton the last Year, at several Towns in Yorkshire, &c. and the same was done at Chichester for the same Year, to the 15th of October last, by a Person of Credit, whose Account was communicated to me by my learned and ingenious Friend, Dr. Whitaker.  Such another Account has been transmitted to me from Haverford West, in South Wales, by the Learned Dr. Perrot Williams, Physician in that Place.  The Sum of these Accounts is as follows.
 

From which it appears, that, upon a Medium between these Accounts, there died of the Small Pox almost 19 per Cent. or nearly one in five, of Persons of all Ages, that underwent that Distemper.  Which is the more to be remarked, for that out of 82 Persons, that had the Small Pox by Inoculation, the same Year, and in the Neighbourhood of the same Places, not one miscarry'd.

Mr. Mather observes, in his Letter mention'd above, that out of more than 5000 Persons that had the Small Pox at Boston in New England, within little more than half a Year, near 900 died, which is more than one in six; and this Account added to those from Yorkshire, Chichester, and Wales, reduces the Proportion of those that die of the Small Pox to somewhat more than 18 per Cent. so that the Hazard of dying of that Distemper, to those who are taken ill of it, is that of one in between five and six, or something above two in eleven.

The Result therefore, Sir, of these Computations is, that, if the same Proportions should still continue, as have hitherto been determin'd by Observation, we must expect,

That of all the Children that are born, there will, some time or other, die of the Small Pox, one in fourteen.

That of Persons of all Ages taken ill of the natural Small Pox, there will die of that Distemper, one in five or six, or two in eleven.

That of Persons of all Ages inoculated, without regard to the Healthiness or Unhealthiness of the Subject, as was practised in New England, there will die one in sixty.

That of Persons inoculated with the same Caution in the choice of the Subjects, as has been used by the several Operators one with another, here in England, (if we allow in the two disputed Cases abovemention'd, that the Persons died of the inoculated Small Pox) there will die one in ninety one.

I am, &c.
James Jurin

Since this Paper was drawn up and communicated to the Royal Society, the following Account of the Success of Inoculation in and about Boston, in New England, was procured at my Desire, by my Ingenious Friend Dr. Nesbitt, from Capt. John Osborne, who resided in that Town and Neighbourhood during the whole time of that Practice.  I think proper to insert it here, as it confirms the Extract given above from Mr. Mather's Relation, and is a more particular Account of the Matter of Fact, than any that I have yet seen.

In May, 1721, the Small Pox was, by the Providence of God, brought into the Town of Boston; in June it began to spread pretty much, and in the Month of July it was got into most parts of the Town, and a considerable Number of People died of it.  At this time Inoculation was first put in practice by Dr. Boyleston, who then perform'd it upon his own Child and a Negro-Servant, who both did well; notwithstanding which, this Attempt gave great Uneasiness to the Neighbours.  However the Practice went on, to the Number of about 40 Persons, one of which was a Woman (Mrs. Dixwell.) of about 40 or 45 Years of Age, who got well over the Small Pox, as her Husband publickly declared, but had been before troubled with Hysterick Fits, of which she died some little time after.  When about 70 Persons had passed under the Operation, myself and Wife, who had hitherto been at a Place called Roxbury, a Mile from Boston, went into Town and received the Small Pox by Inoculation.  We had it with all the Gentleness and Moderation that was possible, neither of us having an hundred Pustules, or being sensible of any Fever worth mentioning; so that we did not find it necessary to keep our Beds for it.

In August the Small Pox in the natural Way proved more mortal, and Inoculation made a greater Progress, the People continuing to come into the Practice of it.  A second Person that died after Inoculation, was an Apothecary's Housekeeper, that was out of Town, till an Indian Maid got the distemper in the same House, and remov'd, and died.  Upon which this Woman coming to Town, her Master undertook to perform the Operation upon her, which by the Way was the first and last that he ever perform'd; and on the third Day after the Inoculation, the Small Pox came out upon her very full; from which it was plain, that she had taken the Infection before, in the common way.

The third Person that died after being inoculated, was a Gentleman (John White, Esq.), that lodged in the same House with my Wife and self at Roxbury, who was under great and extreme Infirmity of Body, as myself was Witness, that we fear'd he would have lived but a short time under it.  His Friends much persuaded him to make use of Inoculation, believing that it would have carry'd off his Illness; but when he made the Experiment, he had not Strength to go thro' with it.  He was about 45 Years of Age, and by the way was a Gentleman of great Worth and Piety.

His Sister (Mrs. Wells.) was the fourth Person that died upon this Operation.  She was about fourty Years of Age, of great Indisposition of Body, and weak, as was her Brother.

The fifth, that died upon Inoculation, was a Woman Servant in a House, where the whole Family, to the number of eight, were inoculated at the same time.  She lay in a cold upper Room during her Illness, and was much neglected, the whole Family being down together, so that she died merely for want of a little Attendance.  This was in the Town of Roxbury, where observe, that 13 Men, Masters of Families, got the Small Pox, and all died; which inclined the People to make use of Inoculation, having before been much against it, and there were 43 Men inoculated there, who all did well.  The Minister of the Town (The Reverend Mr. Walter.) was the first, that put it in Practice there, much against the Mind of his People at first, though afterwards they were very well pleas'd with it, seeing with what great Success it was attended; and then whole Families came into it, and underwent the Operation.  There were in all at least 280 Persons inoculated, that I knew of, and I suppose there might be about 20 or 30 more, but of those I can give no certain Account.

John Osborne.

Part of two Letters concerning a Method of procuring the Small Pox, used in South Wales.  From Perrot Williams, M.D. Physician at Haverford West, to Dr. Samuel Brady, Physician to the Garrison at Portsmouth.

However new the Method of communicating the Small Pox may appear in this Kingdom; yet I am to acquaint you, that it has been commonly practised by the Inhabitants of this Part of Wales (Pembrokeshire) time out of mind, though by another Name, viz. that of buying the Disease, as I have been long ago acquainted by several, who procured the Distemper by that means.  There is a married Woman in the Neighbourhood of this Place, who practised it on her Daughter, about a Year and a half ago, by which Means she had the Small Pox favourably, and is now in perfect Health, notwithstanding she has ever since, without Reserve, conversed with such as have had that Distemper this last Summer.

In order to procure the Distemper to themselves, they either rub the Matter taken from the Pustules when ripe, on several Parts of the Skin of the Arms, &c. or prick those Parts with Pins, or the like, first infected with the same Matter.  And notwithstanding they omit the necessary Evacuations, such as Purging, &c. yet, as I am inform'd, they generally come off well enough; and what's remarkable, I cannot hear of one Instance of their having the Small Pox a second time.

A Learned and very Ingenious Gentleman of this Country told me not long since, that above twenty Years ago, when at School, he and several of his Schoolfellows, (how many I don't exactly remember) infected themselves at the same time, from the same Person, and that not one of them miscarry'd, though he had more of the Small Pox than he design'd.  I am satisfy'd he will readily give a more particular Relation of this Affair, if desired.  I am sorry he happens at present to be at a considerable Distance from this Town, otherwise I would have been more exact in this Account.

Haverford West,
Sept. 28. 1722.

Perrot Williams.

I should have so long omitted the Return of my Thanks, for the Favour of yours of Oct. 15. but that I hitherto waited an Opportunity to speak with the Gentleman, whom I mention'd in my last.  His Name is George Owen, a Counsellor at Law, eldest Son to Dr. Owen, formerly Archdeacon in the Diocese of St. David's.  He solemnly said, rubb'd the Skin off his Left Hand, where the Scar is now very visible, with the back edge of his Penknife, till the Blood began to appear, he apply'd the variolous Matter to that part; which by Degrees growing inflam'd, about a Week afterwards he fell into the Small Pox; and that he has since frequently conversed with such as were sick of that Distemper.  He says also five or six more at least of his Schoolfellows made the like Experiment on themselves, at the same time, with the like Success.

I have since talk'd with several more, who made the like Experiments on themselves, some twenty, some sixteen, &c. Years ago:  who all positively affirm, they never had the Small Pox a second time.

Haverford West,
Nov. 23. 1722.

Perrot Williams.

Part of a Letter from the same Learned and Ingenious Gentleman, upon the same Subject, to Dr. Jurin, R.S. Secret.

The Business of my Profession obliging me to go into the country, as soon as I had the Favour of yours of Jan. 22. prevented my returning an Answer sooner to the Queries you are pleas'd to propose.

I have little to add to what I have already mention'd to Dr. Brady, concerning the manner of communicating the Small Pox, more than that Mr. Owen was about fifteen Years of Age, when he made the Experiment on himself, and that he questionless had the genuine Small Pox; the Signs of 'em on his Face, and the Mark on his Hand, where he apply'd the Matter, being still so very visible, as to put that matter beyond Dispute.  The Physician, who then attended him, is dead.  Tho' I can't pretend to remember how many inform'd me of their procuring the Distemper in this manner; yet I can aver, that within the compass of twenty Years last past, I have been so often assured of the Truth of it, not by Children, but grown Persons of undoubted Credit, that I am entirely satisfied it has been an immemorial Custom in these Parts; and not only practised by Boys when at School, but also by many others of both Sexes more advanced in Years, and consequently capable of distinguishing the Small Pox from other Distempers.  There are now living, in this Town and Neighbourhood, five or six Persons, who undoubtedly had that Distemper after taking the foresaid Method to infect themselves; one of whom, a young Woman aged 23, told me (since I received your Letter) that, about 8 or 9 years ago, in order to infect herself, she held twenty pocky Scabs (taken from one towards the latter end of the Distemper) in the hollow of her Hand, a considerable time; that about ten or twelve Days afterwards she sicken'd, and had upwards of thirty large Pustules in her Face, and other Parts; and that she has since freely conversed with such as have had the Small Pox on them.

To make it appear that Inoculation is a sufficient Preservative against receiving the Small Pox a second time; about six Weeks ago, I caused my two Boys, who had been inoculated this last Summer, not only to see, but even to handle a child, dying of a most malignant sort of Small Pox; who notwithstanding, I thank God, continue in perfect Health.

Upon a very exact Inquiry I find, that out of 227 who have had the Small Pox in the natural way, in this Town and a neighbouring Parish, since the Beginning of June last, 52 have died.

Haverford West,
Feb. 2. 1722/3.

Perrot Williams.

Just as I was concluding my Letter, being sent for by a Gentleman about six Miles off, (where I saw two very melancholy Instances of the Severity of the confluent Small Pox) he took an occasion to inform me, that a near Neighbour of his caus'd his Son, about ten Years of Age, near three Weeks ago, to buy (as he term'd it) the Small Pox, after the manner I described in my first Letter to Dr. Brady.  Carefully viewing the Boy, I found him recovering from the distinct Kind of that Distemper, having not had, as I could perceive, above 40 pretty large Pustules, which were then drying off.  Had I not been scanted in time, I question not but I should have been able to have given a great many Instances of the like Nature; but the hurry I have been continually in, ever since I receiv'd yours, must be my Apology, for that Deficiency, as well as the Uncorrectness of this Letter.

A Letter on the same Subject, from Mr. Richard Wright, Surgeon at Haverford West, to Mr. Sylvanus Bevan, Apothecary in London.

I Received yours the 9th instant, and, in Answer to it, will readily give you all the Satisfaction I can, in relation to a very antient Custom in this Country; commonly called buying the Small Pox, which, upon a strict Inquiry, since I had your Letter, I find to be a common Practice, and of very long standing; being assured by Persons of unquestionable Veracity, and of advanced Age, that they have had the Small Pox commu[n]icated to themselves this way, when about sixteen or seventeen Years of Age, they then being very capable of distinguishing that Distemper from any other; and that they have parted with the Matter contain'd in the Pustules to others, producing the same Effects.  There are two large Villages in this County near the Harbour of Milford, more famous for this Custom than any other, namely, St. Ishmael's and Marloes.  The old Inhabitants of those Villages, (with which they abound, being in a healthful Situation) say, that it has been a common Practice with them time out of mind; and what was more remarkable, one William Allen, of St. Ishmael's, ninety Years of Age, (who died about six Months ago or thereabouts) declared to some Persons of good Sense and Integrity, that this Practice was used all his Time; that he very well remember'd his Mother's telling him, that it was a common Practice all her Time, and that she got the Small Pox that way.  These, together with the many other Informations, I have met with from almost all parts of the County, confirm me in the Belief of its being a very antient and frequent Practice, among the common People; and to prove that this Method is still continued among us, I will give you the relation of an elderly Woman, a Midwife, who accidentally came into Company, when your Letter was reading, whose Name is Joan Jones, aged seventy Years, of good Credit, and perfect Memory.  She solemnly declares, that about fifty four Years ago, having then the Small Pox, one Margaret Brown (to the best of her Remembrance then about twelve or thirteen years of Age) bought the Small Pox of her; that the said Margaret Brown was seized with the Small Pox a few Days afterwards; that the said Margaret Brown had not had the Small Pox a second time, a twelve-Month ago, and she verily, and she verily believes, that she has not had them since.  She farther says, that she has known this way of procuring the Small Pox practised from time to time, above fifty Years; that it has been lately used in her Neighbourhood, and that she knows of but one dying of the said Distemper, when communicated after the Method aforesaid, which Accident happened within these two Years last past; the Person who miscarried (a young Woman about twenty Years of Age) having procured the Distemper from a Man then dying of a very malignant Small Pox.  The above Relation I heard the old Woman declare two Days ago, and she was willing to take her Oath of it before Dr. Williams, who is a Magistrate.  As to what you mention concerning the manner of communicating the infectious Matter to the Blood, by scraping the Skin thin with a Penknife, and so rubbing in the Matter, that was only the Case of one particular Gentleman, Mr. Owen, a Counsellor at Law, whom I heard several times positively affirm, that he bought the Small Pox when at School, and of such a Lady, now living, and gave her three Pence for the Matter contained in 12 Pustules.  That hundreds in this Country have had the Small Pox this way is certain; and it cannot produce one single Instance of their ever having them a second time.

Haverford West,
Feb. 15. 1722/3.

Richard Wright.

• History 135F Home Page

• The Small Pox in Turkey (1717-1718) from the letters of Lady Mary Wortley Montagu (1689-1762);

• An Inquiry into the Causes and Effects of the Variolae Vaccinae.... (1798) by Edward Jenner (1749-1843); and

• "The North Carolina Accident," selected excerpts from The Vaccine Inquirer (1822-1823)

• A Short Account of the Malignant Fever Lately Prevalent in Philadelphia... (1794) by Mathew Carey (1760-1839);

• a letter addressed to "My beloved Sister" (September 25, 1793) written by Margaret (Hill) Morris (1737-1816);

• "An Account of the Bilious Remitting Yellow Fever, as it Appeared in Philadelphia, in the Year 1793," in Vol. III, Medical Inquiries and Observations, 4th ed. (1815) by Dr. Benjamin Rush (1746-1813);

• An Enquiry into, and Observations Upon the Causes and Effects of the Epidemic Disease Which raged in Philadelphia from the month of August till towards the middle of December 1793 (1794) by Dr. Jean Devèze (1753-1829); and

• "Yellow Fever," in Vol. XV, The International Cyclopedia (1898).