On general and partial Inoculations in London, or other large and populous places.

It should be remarked, that what has hitherto been said relates to the conduct of this practice in villages and small towns, who are capable of uniting in a general plan for their common benefit. What I next propose to consider is, how far a practicable method can be adopted for general Inoculation in London, or in other large and populous places, where it is impossible to obtain the consent of all the inhabitants to be inoculated at one and the same time.

To be the more clearly understood, I desire the distinction in the former part of general and partial Inoculations may be remembered; and that by the first I mean, where the whole number of inhabitants of any town or place are inoculated at the same time, with the exception only of such as are not in a proper state of health, and those who may not chuse to submit to that mode of receiving the disease. By the second, where a part only of the inhabitants are inoculated, and the remainder left to take their chance of catching the disease from their inoculated neighbours.

The possibility of performing a general Inoculation on all the inhabitants of this city and suburbs at one time, will scarce bear a moment’s consideration, so many and so insuperable are the difficulties which would occur in a free country. I shall therefore decline entering upon the subject; and quitting all thoughts of a general practice, shall consider how far the inoculation of such poor persons as may make application for this purpose, can be complied with in London, consistent with the safety of themselves and others.

It may reasonably be presumed, that the greater number of these will be persons in narrow circumstances, or in a state of poverty, having nothing beforehand to support an illness, and yet the whole family who have not had the disease are to be inoculated. Whoever has visited the abodes of the poor in and about London, must allow the scene to be truly miserable; their habitations in close alleys, courts, and lanes, generally cold, dirty, and in great want of necessaries, even of bedding itself, a requisite of the greatest use in time of sickness; there are frequently several families under one roof; the men, if industrious, employed in daily labour, the women in washing and assisting in different families, or waiting at markets to carry little burdens as porters, and other unavoidable employments abroad. None of these can remit their occupations to attend the sick, without exposing their families to the distress which the want of the little money their industry earned would infallibly occasion; how or in what manner are patients to be nursed and supplied with food and necessaries during the illness, or who is to be relied on, that the medicines and diet enjoined by the person who attends, shall be regularly complied with?

Can any one be so inconsiderate as to bring disease into a family before healthy, without having first a reasonable expectation, that what their situation may require will certainly be provided? no one acquainted with the general temper of parish officers, will much depend on their assistance; on the contrary, they will most probably oppose the plan to the utmost of their endeavours, from an apprehension that the disease will be spread by these means, and occasion a consequent increase of expence to the parish.

But admitting these objections could be removed, one very important point, that more immediately respects the security of the patients and the public, should be attended to.

One great cause of the success that attends the present practice, is supposed to be the exposure of patients to fresh air; and the more alarming the symptoms, the greater is the necessity of administering this salutary relief. The poor who are inoculated in their own confined dwellings, with perhaps many in family, will assuredly require this reviving ventilation. They have no gardens, areas, or the convenience of carriages; are they to be carried or led about the streets when ill, to the terror and danger of the neighbourhood?

Having suggested a few of the difficulties that must ensue to the patients, it will not be improper to consider, how far the community will be likely to be affected by the practice.

To conduct the business of the Inoculation, some place or places centrically situated must be provided, at which the patients should assemble in order to be inoculated, and to which the several families of the sick must have recourse for the necessary medicines and directions during the distemper. To find one or more such places in the whole city, where the neighbourhood would suffer an office of this kind to be established, at which a great number of the poor must be assembled at noon-day, to receive an infectious and dangerous disease, is hardly possible to conceive; and if we consider that these persons must intermix with others, who are attending to procure the necessary medicines for their diseased families, and who have been obliged to make their way on foot through the public streets, from every quarter of the metropolis, in their infected apparel, the public danger becomes great and inevitable.

But should the poor who are proper to undergo the operation be inoculated, and means for their subsistence be provided, questions will arise respecting the fate of their neighbours, some of whom will be precluded from the same advantage, by being affected with other diseases, and others, who have strong prejudices against it, will be totally averse to the practice. Is it reasonable to bring the Small Pox to the doors of persons thus circumstanced, against their consent? one shudders at the thought of such an insult to humanity! But it is not only the immediate neighbours that would be endangered; to be well informed how far the mischief might be extended, one must take into account the situation and conduct of the patients, and it may safely be asserted from experience, that the following would be found to be a true representation.

The inoculated may be divided into two classes. One in whom the distemper is so mild as to admit the parties to go abroad; the other, where the number of pustules is so considerable as to confine the patients at home; by far the greater number will be of the first sort; and whatever orders may be given to the contrary, it will be impossible to restrain them from taking undue liberties; the children who are of an age for it will be found in the streets with their former playfellows, and the men and women who are able, will be endeavouring to get into their former employments to earn a little money, without regarding the injury they may occasion to others. The few who may be confined with a less favourable disease, will infect the house and their family, and the infection will be spread from the gossiping disposition of the poor, who are generally troublesome visitants, to their sick neighbours, and after all is over, the first sallying forth in their infected cloaths is certain to add to the mischief.

It is unnecessary to dwell any longer on the consequences of such a conduct to the residents in such alleys; but there are others who claim our regard.

Country people who are obliged to come to town to transact their business, and others who bring their families to visit relations, or to entertain them with the pleasures of the town, are generally under dreadful apprehensions of the Small Pox; how would their fears and danger be increased, if the poor were continually under inoculation?

Another thoughtless, but most useful race of men, are well entitled to our best endeavours for the preservation of their healths and lives: I mean, sailors and sea-faring men, of our own and other countries; it is well known that our shores, on both sides of the river, are continually crouded with these, during their stay in this country.

Many of them have not had the Small Pox, and their mode of living is the reverse of due preparation; if Inoculation should be practised in the houses of the poor, it cannot be doubted that many of these would catch this distemper?

Is it possible to reflect without horror on the situation of such of those unhappy fellows, who should fall ill of the Small Pox in the miserable lodgings they usually inhabit, perhaps without a friend to take the least care of them? or of the still more calamitous state of others, who being infected on shore should fall sick at sea, where neither medicine nor proper attendance can be had, and carry likewise with them in their unwashed cloaths, the fatal distemper into distant climates?

I have been informed, that a child who had received the infection was taken on board an East Indiaman many years ago. The disease was violent; the linen, &c. were put into a box, and carried to the Cape of Good Hope: it was sent on shore; the Small Pox immediately broke out in the place, and carried off vast numbers of the inhabitants.

In the foregoing pages, some of the objections to partial Inoculations of the poor in this city have been stated; but the possibility of extending the practice to any good purpose, even if those objections were removed, has not been taken notice of: to elucidate this point, which is certainly a material one, the following remarks are submitted to consideration.

The number of those who died of the Small Pox in each of the last four years, on an average is 2544. To suppose that one dies out of every six who have the natural distemper, will be allowed a moderate estimate: it follows then, that the number of those who have passed through the disease in each of the last four years will be 15,264. It will be impossible to determine how many may remain uninfected; but if we suppose that every year one out of eight who have not had the disease is seized with it, the remaining number who have not had the Small Pox will be 122,112; and it must be taken into account, that the annual recruits by births will probably be about 20,000, besides others that are continually arriving out of the country to seek employment.

To form a scheme, however beneficial to a few, that would probably spread the disease, and involve so great a number of others in a danger that they would otherwise be much less exposed to, is an object of great moment; and most certainly the Legislature ought first to be consulted.

Great liberty may be taken in our free state; but we ought not to endanger the public safety, because no legal provision is made against it.