or Budding, in gardening, is commonly practised upon all sorts of stone fruit; as nectarines, peaches, apricots, plums, cherries, as also upon oranges and jambos; and indeed this is preferable to any sort of grafting for most sorts of fruit. The method of performing it is as follows: You must be provided with a sharp pen-knife with a flat haft, which is to raise the bark of the stock to admit the bud; and some found balsam, which should be soaked in water, to increase its strength, and render it more pliable: then having taken off the cuttings from the trees you would propagate, you must choose a smooth part of the stock, about five or six inches above the surface of the ground, if designed for dwarfs; but if for standards, they should be budded six feet above-ground. Then with your knife make an horizontal cut across the rind of the stock, and from the middle of that cut make a slit downwards, two inches in length, that it may be in the form of a T; but you must be careful not to cut too deep, lest you wound the stock; then having cut off the leaf from the bud, leaving the foot-stalk remaining, you should make a cross cut, about half an inch below the eye, and with your knife slit off the bud, with part of the wood to it: this done, you must with your knife pull off that part of the wood which was taken with the bud, observing whether the eye of the bud be left to it or not; for all those buds which lose their eyes in stripping, are good for nothing: then having gently raised the bark of the stock with the flat haft of your pen-knife clear to the wood, thrust the bud therein, observing to place it smooth between the rind and wood of the stock, cutting off any part of the rind belonging to the bud that may be too long for the slit made in the stock; and so having exactly fitted the bud to the stock, tie them closely round with balsam, beginning at the under part of the slit, and so proceeding to the top, taking care not to bind round the eye of the bud, which should be left open.
When your buds have been inoculated three weeks or a month, those which are fresh and plump you may be sure are joined; and at this time you should loosen the bandage, which if it be not done in time, will injure if not destroy the bud. The March following cut off the stock sloping, about three inches above the bud, and to what is left fasten the shoot which proceeds from the bud: but this must continue no longer than one year; after which the stock must be cut off close above the bud. The time for inoculating is from the middle of June to the middle of August; but the most general rule is, when you observe the buds formed at the extremity of the same year's shoots, which is a sign of their having finished their spring-growth. The first sort commonly inoculated is the apricot; and the last the orange-tree, which should never be done till the latter end of August. And in doing this work, you should always make choice of cloudy weather; for if it be done in the middle of the day, when the weather is hot, the shoots will perspire so fast, as to leave the buds destitute of moisture.
in a physical sense, is used for the transplantation of distempers from one subject to another, particularly for the engraftment of the small-pox; which, though of ancient use in the Eastern countries, is but a modern practice among us, at least under the direction of art.
It is well observed by the Baron Dimsdale, that accident hath furnished the art of medicine with many valuable hints, and some of its greatest improvements have been received from the hands of ignorance and barbarism. This truth is remarkably exemplified in the practice of inoculation of the small-pox: but to the honour of the British physicians, they measured not the value of this practice by the meansness of its origin, but by its real importance and utility; they patronised a barbarous discovery with no less zeal and affection. affection than if it had been their own. Indeed the whole nation might be said to have adopted the practice; for the greatest encouragement it by becoming examples, and the wisest were determined by the general event of the method.
As to the origin of the art of inoculating the smallpox, as well as the time and place in which it was performed, they are equally unknown to all by whom the practice is adopted. Accident probably gave rise to it. Pylarini says, that among the Turks it was not attended to except amongst the meaner sort. Dr Ruffel informs us in the Philosophical Transactions, vol.lviii., p.142, that no mention is made of it by any of the ancient Arabian medical writers that are known in Europe; and the physicians who are natives in and about Arabia, assert, that nothing is to be found regarding it in any of those of a more modern date. He further says, that he engaged some of his learned Turkish friends to make enquiry; but they did not discover any thing on this subject of inoculation either in the writings of physicians, historians, or poets. Until the beginning of the 18th century, all the accounts we have of inoculating the small-pox are merely traditional. The silence on this subject, observed amongst writers in the countries where the practice obtained, Dr Ruffel supposes, with great probability, to be owing to the physicians there never countenancing or engaging in it. It is also remarkable, that before Pylarini's letter to the Royal Society in 1701, nor yet for several years after, this practice is not noticed by any of the most inquisitive travellers. On this Dr Ruffel very justly observes, that customs, the most common in distant countries, are often the least apt to attract the observation of travellers, who, engaged in other pursuits, must be indebted to accident for the knowledge of such things as the natives seldom talk of, upon the belief that they are known to all the world.
The first accounts we have in the learned world concerning inoculation, are from two Italian physicians, viz. Pylarini and Timoni, whose letters on the subject may be seen in the Philosoph. Trans. abr. vol.v., p.375, &c. The first is dated A.D. 1701; the next is dated A.D. 1713. Whether our inquiries are extended abroad or confined to our own country, inoculation hath been practised under one mode or other time immemorial; in Great Britain and its adjacent isles we have well authenticated accounts, extending farther backward than any from the continent. Dr Williams of Haverfordwest, who wrote upon inoculation in 1725, proves, that it had been practised in Wales, though in a form somewhat different, time out of mind. Mr Wright, a surgeon in the same place, says, that buying the small pox is both a common practice, and of long standing in that neighbourhood. He says, that in Pembrokeshire there are two large villages near the harbour of Milford, more famous for this custom than any other, viz. St Ishmael's and Marloes. The old inhabitants of these villages say, that it hath been a common practice; and that Mr William Allen of St Ishmael's, who in 1722 was 90 years of age, declared to some persons of good sense and integrity, that this practice was used all his time; that he well remembered his mother telling him, that it was a common practice all her time, and that she got the small-pox that way; so that at least we go back 160 years or more.
In the Highlands of Scotland and some of the adjacent isles, Dr Alexander Monro senior informs us, that the custom through ages past hath been, to put their children to bed with those who laboured under a favourable small-pox, and to tie worsted threads about their children's wrists, after having drawn them through various pustules.
According to the result of Dr Russell's inquiries, the Arabians assert, that the inoculation of the small-pox has been the common custom of their ancestors, and that they have no doubt of its being as ancient as the disease itself. It is remarkable, that buying the small-pox is the name universally applied in all countries to the method of procuring the disease: it is true that there are other terms; but in Wales and Arabia, as well as many other countries, this is the usual appellation. From the fameness of the name, and the little diversity observable in the manner of performing the operation, it is probable that the practice of inoculation in these countries was originally derived from the same source. From its extensive spread, it is probably of great antiquity too.
In the year 1717, Lady Mary Wortley Montague, wife of the English ambassador at Constantinople, had her son inoculated there at the age of six years; he had but few pustules, and soon recovered. In April 1721, inoculation was successfully tried on seven condemned criminals in London, by permission of his majesty. In 1722, Lady Mary Wortley Montague had a daughter of five years old inoculated in this island; soon after which, the children of the royal family that had not had the small-pox were inoculated with success; then followed some of the nobility, and the practice soon prevailed. And here we date the commencement of inoculation under the direction of art.
From the example of the royal family in England, the practice was adopted in Germany, particularly in Hanover, and its adjacent countries.
After Mr Maitland had succeeded with those he had inoculated in and about London, he introduced the practice into Scotland in the year 1726.
Sweden soon followed the example of the British. Russia lately engaged one of our principal promoters and improvers of this art. And now there are not many countries that do not more or less practise it.
Different Modes of Inoculation. The practice of inoculation having obtained in every part of the world, it may be grateful, at least to curiosity, to have a general account of the different modes that are and have been adopted in that practice.
Inoculation with the blood of various patients hath been tried without effect: the various matter only produces the various disease.
The application of the variolous matter takes place in a sensible part only; the activity of the virus is such, that the smallest atom, though imperceptible to any of our senses, conveys the disease as well as the largest quantity. Hence the most obvious method is the prick of a needle or the point of a lancet dipped in the matter of a variolous pustule.
Cotton or thread is used, that is previously rubbed with powdered variolous scabs; this thread is drawn with... with a needle through the cutis, but not left in. This is the method in some parts of the East Indies. The Indians pass the thread on the outside of the hand, between any of the fingers, or between the fore-finger and thumb. The Thesolian women inoculate in the forehead and chin.
Some abrade the scarf-skin, and rub in the powdered dry scabs which fall from the pustules of patients with the small-pox.
Many of the Greek women make an oblique puncture with a needle, on the middle of the top of the forehead, on each cheek, the chin, each metacarpus, and each metatarsus; then drop in each a little of the pus just taken warm from a patient, and brought in a servant's bosom. Others in Greece make several little wounds with a needle in one, two, or more places, in the skin, till some drops of blood ensue; then the operator pours a drop of warm pus fresh from a pustule, and mixes it with the blood as it issues out; then the wound is covered by some with a bandage, by others with half a walnut shell placed with its concave side over each orifice.
The Chinese convey a pellet of variolated cotton, with the addition of a little musk, into the nostrils of the patient; they collect dry pustules, and keep them in a porcelain bottle well corked; and when they inoculate, they mix a grain of musk with three or four grains of the dry scabs, and roll them in cotton. This method may be called inoculation.
About Bengal, in the East Indies, the person who intends to be inoculated, having found a house where there is a good sort of the small-pox, goes to the bed of the sick person, if he is old enough; or if a child, to one of his relations, and speaks to him as follows: "I am come to buy the small-pox." The answer is, "Buy if you please." A sum of money is accordingly given, and one, three, or five pustules, for the number must always be odd, and not exceeding five, extracted whole, and full of matter. These are immediately rubbed on the skin of the outside of the hand between the forefinger and the thumb; and this suffices to produce the disease. The same custom obtains in Algiers, Tunis, Tripoli, and other countries.
Very similar to the custom amongst the people about Bengal, &c., is that in Arabia, where on some flethly part they make several punctures with a needle imbued in variolous matter, taken from a pustule of a favourable kind. Here they buy the small-pox too, as follows: the child to be inoculated carries a few raisins, dates, sugar-plums, or such like; and showing them to the child from whom the matter is to be taken, asks how many poxes he will give in exchange? The bargain being made, they proceed to the operation; but this buying, though still continued, is not thought necessary to the success of the operation. The Arabs say that any flethly part is proper; but generally they insert the matter between the fore-finger and thumb on the outside of the hand.
The Georgians infect the matter on the fore-arm.
The Armenians introduce the matter on the two thighs. In Wales the practice may be termed infection of the small-pox. There some of the dry pustules are procured by purchase, and are rubbed hard upon the naked arm or leg.
The practice in some places is to prick the skin between some of the fingers by means of two small needles joined to one another; and after having rubbed a little of the matter on the spot, a circle is made by means of several punctures of the bigne's of a common pustule, and matter is again rubbed over it. The operation is finished by dressing the wound with lint. Another custom is to mix a little of the variolous matter with sugar, and give it to be drank in any agreeable liquor.
Incisions have been made in the arms and legs, and thread, cotton, or lint, previously dipped in the variolous matter, was wedged in them. The practice of some is to bathe the feet in warm water, and then secure lint dipped in the variolous matter on the instep, or other part of the foot, where the skin is thin. Others apply a small blistering plaster; and when the scarf-skin is elevated and slipped off, the variolous matter is applied to the surface of the true skin, and confined there by a little lint or plaster. Scratching the skin with a pin or needle, and then rubbing the part with lint, previously dipped in variolous matter, is the custom in some places.
In the Highlands of Scotland they rub some part of the skin with fresh matter, or dip worsted in variolous matter, and tie it about the children's wrists. They observe, that if fresh matter is applied a few days successively, the infection is more certain than by one application.
Objections to Inoculation answered.
I. "It is not lawful."
In answer to this, the Scriptures ask, Is it lawful to save life, or to destroy it? Luke vi. 9. And as it is a difficulty with many serious people, whether to admit of this practice or not, this objection should be considered in a religious view. We should in this case remember, that as the fall of man brought the danger of diseases into the world, so to evade, oppose, or destroy it, is not only his right, but duty, if in his power. And if events imply the cause, a long run of uninterrupted success implies an efficacious remedy. Though some die under this management, it is sufficient to prove the lawfulness of a remedy, that it is proper for and has by experience been found in most cases effectual to the end for which it was used. When danger surrounds us, no conduct is more proper than to inquire into and pursue the means of escape. To neglect our safety is to sink below the brutes, who by instinct avoid the evils to which they are exposed. Inoculation is a means of saving life in many instances, and of moderating the severity of affliction in more. Willfully then to neglect the means of saving life is to be guilty of murder.
II. "It is bringing a distemper on ourselves, and so usurping the sacred prerogative of God."
1. As to the first part of this objection, if by distempers are meant sickness and pain, that is practised daily in other instances, in concurrence with the Scripture dictate, viz. of two evils choose the least. But the supposition of objectors in this instance is not altogether true. For by inoculation, a distemper is not properly said to be communicated. It only excites and frees us from one, which, though latent, is already in us; or (which in effect is the same) inoculation, by an advantageous mode of infecting, &c., frees the patient in all instances from the usual difficulties of the disease; saves the life of most who submit to it; and with the natural small-pox it destroys that disposition in the body, without which the disease cannot take place. It is owned that some hazard attends it; it is sometimes mortal, and indeed it is fit it should be so; it is generally successful, that encourages us to proceed; it sometimes, though rarely fails; hence we are cautious and careful, and led to act with a dependence on Him to whom belong the issues from death.
2. Reflecting the offence given to God; a reliance on Providence does not imply that we are not to prevent or oppose the evils which we foresee, and which we have in our power to guard against by prudent precautions. Would these objectors, in other instances, refuse the means of lessening the malignancy and danger of disease, than which the practice of inoculation is no more? Let these scrupulous persons say, whether, when God permits the discovery of preserving ourselves from an impending evil, he forbids our availing ourselves of that discovery? If our Maker offers us a remedy, it is offending him to reject it.
III. "The decrees of God have fixed the commission of every disease, and our precautions cannot prevent what he hath determined."
However true it is that our days are determined, &c., yet it is God's revealed will, and not his secret purposes, which we are to regard as the rule of duty. God has required of us to have a tender regard to our lives; and those who disobey him herein are guilty of a degree of self-murder, and will never be acquitted of that guilt by the secret determination of Heaven concerning them. Besides, God who has ordained the end, has also determined the means leading to it. St Paul, in his dangerous voyage, had a special revelation to assure him, that all who were with him should escape; and yet when the seamen were getting out of the ship, he declares that if they did not stay in it they could not be saved, Acts xxvii. 31. God purposed to preserve them in the way whereby they were afterwards delivered.
IV. "We should not do evil that good may come."
If inoculation is in its own nature a moral evil, it certainly should be rejected, however great its advantages may seem to be. The prospect of relief from any calamity in life should not tempt us to offend God. But those who make this objection proceed on a mistake. Their principle is true with regard to moral evil, but is not so when applied to physical. It is certainly lawful to pull down a house to save a great number from being burnt; this is a physical evil, which can hardly take place without some degree of moral evil; and many other instances may be pointed out, where, for a greater good, a lesser ill is submitted to. And is the small ill induced by inoculation to be compared with all those evils which are tolerated and authorized by all laws?
V. "The patient may die; and then his last moments are distasteful, and the future reflections of his friends are grievous."
This objection leads many to decline the practice of inoculation, even when they allow the theory of it to be reasonable. They hope to escape the distemper in the natural way, and they have fears of dying in this; and thus they are prevented from going into it. But they should consider what grounds they have for either the one or the other, and what is to be advanced to balance the account, by examining the different degrees of probability that attend their hopes and fears in the use or neglect of inoculation. Dying is a serious thing; but if inoculation be a probable and lawful means of preserving life in a time of danger, it is a duty to comply with it; and what more peaceful reflection than to die in the way of duty?
VI. "Fear is a dangerous passion in the small-pox; but inoculation increases the causes of fear, by lessening our faith and trust in God."
When the small-pox is left to nature, such are its ravages, that not to fear would be to sink beneath humanity; its consequences are too grievous to be treated with neglect. But experience manifests the safety that attends receiving the disease by inoculation; it is therefore so far a remedy to that just fear which enhances the danger when the disease is left to itself. As to faith in God, none is desirable but that which is agreeable to the Scripture; and a disregard to calamities and dangers is never the effect of that. Inoculation is a means of safety; and it is as rational to conclude, that our lives should be preserved without eating and drinking, as that we shall be delivered from danger without a prudent care for our own safety. We are to depend on the care of Providence only in the way of duty. To boast of courage and trust in God, while we omit the means of escaping danger which surrounds us, is not faith, but presumption. Thus, when inoculation becomes a probable means by which to save life, it is a presumption, and not trust, to neglect it.
VII. "Inoculation does not exempt from future infection."
If by inoculation of the small-pox the same disease is produced, the same effects may be expected from it when artificially produced as in the natural way. It is inconceivable, that a contagious substance, the very seminal matter of the small-pox, should propagate, instead of its own, another disease. De Haen is an acute physician, and was a violent opposer of inoculating the small-pox; but he never supposed that the matter of the small-pox will produce any disease but itself. Observation alone determined the opinion, that the natural small-pox does not attack a second time: the same stands good in favour of the artificial disease. And to this numberless trials have been made without effect, to reinfect those in whom the small-pox had taken place by inoculation.
VIII. "Other diseases are communicated with the matter of the small-pox, by inoculating it."
That carelessness or wilfulness in the operator may in some instances give cause for this objection is true; but that by the matter of a variolous pustule, any other disease hath been conveyed, is yet to be proved. As the confluent and malignant small-pox have not yet been observed to produce their own degree and mode of this distemper when infused by inoculation, it is scarcely conceivable that they should transmit another disease essentially different. The venereal disease is known to be as communicable as any; yet several have been inoculated from patients labouring under considerable degrees of the venereal disease, and no ill consequences ever yet were known to follow, none to give the least suspicion of the kind. If the variolous matter may convey another disease in the artificial, it may do the same in the natural way; and even then, advantage is attendant on inoculation, for we can choose a healthy person to take the infection from; but no instance of the kind hath ever occurred.
IX. "Perhaps the disease may never attack in the natural way."
Such objectors should be informed, that this distemper cannot be given to one who never would have it; for they only who are susceptible of it can take it by inoculation, as is evident from numerous experiments made to verify this fact. Again, the small-pox may be said to be general; so few there are who are exempted from it, that they can hardly be considered as an exception to the general law: it is therefore worth while to inoculate, first, to ascertain the safety of the individual from the disease; and, secondly, on account of the general advantages of this practice, in case he should be susceptible of the infection. On this subject Dr Jurin hath inserted an ingenious paper in the Philosophical Transactions; in which he observes, that it is difficult to ascertain the exact number who die without having the small-pox; but that, of all the children that are born, there will some time or other die of the small pox one in fourteen; and that of persons of all ages taken ill of the small-pox, there will die thereby two in eleven. From a table of burials it appears, that in Edinburgh and St Cuthbert's parish, during ten years, about one-tenth of the dead were killed by the small pox. Further, as it cannot be known that any individual is exempted from 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, viz. that of one in eight or nine (whether the proportion of mankind that escape having the small-pox be great or small). In inquiry from house to house for the number of people with the small pox, in several towns, during one year, it appeared that near one in five died who had them; and that of eighty-two persons who were inoculated in these places in the same year, not one died.
X. "It requires much thought to know what we should do with regard to inoculation."
Not to dwell on the absurdity of this objection, and of complaining that consideration is a burden when it is necessary for the preservation of life, it may suffice to point out, that a sacred writer tells us, that "a prudent man foreseeth the evil, and hideth himself; but fools pass on and are punished."
XI. "It endangers others."
Since very few of mankind now escape the small-pox, it must sooner or later come to every place; therefore, if it be true in fact that a much greater number lose their lives by the natural than by the artificial infection, it is of more service to introduce the small-pox in a favourable way and season, than passively to allow it to destroy multitudes. As to spreading the disease by introducing inoculation, it is but of little consequence; for inoculating where the disease does not already exist, is differently circumstanced from this practice, where it already prevails in the natural way; the quantity of the circumambient contagion is less, or the same extent of atmosphere is less impregnated with the infectious principles from inoculated patients, than when it naturally prevails, or the same number of people received it in the natural way.
The most plausible objector on this account is Dr Raft, of Lyons, in France. From his review of the bills of mortality in and about London, he observes, "that more have died by the small-pox in London, since the introduction of inoculation, than in the same time preceding that period, in consequence of the disease thereby being more universally extended and propagated." But to this, Dr Lettsom most satisfactorily replies, "That the late increase of burials cannot depend upon the practice of inoculation, under which, though it is a rare thing to hear of a fatal case, but rather upon the innovation introduced in the treatment of the natural small-pox of exposing the patients to the open air, and a less reserved intercourse amongst the community." Add to this the improvements in medicine in various instances, the police of the city, &c. which by preserving many lives occasion more subjects for the small-pox, and consequently a proportional increase of deaths by this disease, many of those who are preserved by the above named improvements not being favoured with the advantage of inoculation. Besides the care taken in and about London to prevent inconvenience from inoculation, &c. it should be remembered, that the increasing accession of young persons to the capital from the country, easily accounts for the increase of 19 deaths in 1000 more than formerly happened." See a Defence of Inoculation, in Dr Lettsom's Medical Memoirs.
XII. "The practice of inoculation comes from the devil."
The best answers to this seem to be, first, that cavillers will never cease from objecting; and oppositions will be made as long as there are men of wit to devise, or of sophistry to invent. Secondly, that Job was afflicted by the devil with the small-pox, is not a known fact. Thirdly, that if by what is said the principal objections are removed, it is hoped that the reasonable and the religious will be enabled to approve themselves to God in the practice of inoculation. See a discussion of most of the preceding objections in an excellent pamphlet, entitled, "Inoculation impartially considered, and proved to be consistent with Reason and Revelation," by the Rev. Mr David Some, published by Dr. Doddridge in 1750.
Advantages of Inoculation. Though no disease, after it is formed, baffles the powers of medicine more than the small-pox, yet more may be done before-hand to render this disease favourable than in any other we know. The artificial method of producing the small-pox hath almost stripped it of its terrors; in general, hath rendered its aspect mild, its progress uniform, and nearly without hazard to the patient.
Mr Mudge, in his Dissertation on the inoculated Small-pox, enumerates the following sources of danger from this disease, viz. 1. The patient's constitution. 2. The propensity of the patient to be infected. 3. The manner or mode of the infection being communicated. 4. The constitution of the air at the time of infection. And it is the advantage of inoculation, if prudently conducted, almost totally to exempt its subjects from the disadvantages attendant on these sources.
1. "Respecting the habit of body, or state of the patient's constitution at the time of infection." Constitutional or habitual diseases, in general, do not interfere with the course of the small-pox, whether in its natural or its artificial progress; such as scrofulous eruptions on the skin, strumous complaints, itch, scabby eruptions, excoriated ears, &c. The various poisons are therefore a thing sui generis, and nowadays affected by these taints of the juices, or what is usually called a bad habit of body; or at least to inconsiderably, as not to deprive such patients of any of the advantages of inoculation. But the case is much reverted with respect to some accidental diseases. E.g., If on the attack of the small-pox, the habit or its attending circumstances tend to inflammation, or, on the contrary, to a putrid acrimony, the eruptive fever in these aggravated states will load the body with variousious matter, or produce pustules of a very unfavourable kind; in either of these cases (not to enumerate more) the patient will most probably be severely affected. But inoculated subjects may be infected when the constitution is in the best condition to combat with the disease; if either of those indispositions are attendant, or any other which usually endangers, they may soon be refrained or removed.
2. "The different degrees of propensity in the patient, at different times, to be infected."
That different quantities of matter are produced in different persons in the process of the disease, we find true in fact; and there is the strongest reason to believe, that, previous to infection, the quantity of the variousious matter, or rather that principle in the constitution which eventually produces it, ebbs and flows, is more or less vigorous at different times in the same subject, under various combinations of circumstances. The inclinations are not uncommon, where the patient who hath withstood at one time all the ordinary means of infection, nay, who hath industriously, but ineffectually, fought it; yet at another hath had a small-pox so malignant in appearance and effect, that the whole body hath been converted into an offensive variousious putrefaction. If the degree of propensity to receive infection was always the same, it would be inconceivable that any one could pass unaffected when the small-pox became epidemic. From whatever causes, however, this propensity may arise, it is most reasonable to assert, that the increase or decrease of this principle takes place according as the small-pox is epidemic or not. During the continuance of any contagious epidemic disease, we always find that those constitutions which are most congenial with that character, are peculiarly obnoxious to the correspondent distemper. And we may reasonably conclude, that when the constitution of a person not past the small-pox is most saturated with the variousious principle, he is then more particularly subject to infection. Again, it is not only undoubted, that the variousious principle subsists in the constitutions of persons not past the small-pox, but it is more than probable that a part of this principle is produced by the eruptive fever, and the rest of the variousious process. Agreeably to what hath been said, we find, that during the epidemic tendency, those who have not passed the disease, are more open to contagion than in other constitutions of air, when the small-pox is not epidemic, and is consequently a rare disease. Many who have escaped infection from inoculation and other means of contagion, on removal into a situation where the small-pox has been epidemic, have presently after been seized with this disorder. Events of this kind are so common, as to have given rise to the ill-grounded opinion, that any change of air is hazardous to those who have not had the small-pox. If at a time when the propensity to be affected is the greatest, there should be a concurrence of those states of the constitution above noticed, how aggravated will the condition of the patient be!
Reflecting the evasion of these inconveniences by inoculation, it is to be observed, that as the propensity to the disease differs at different times in the same subject, it is reasonable to suppose that the disorder is produced by downright violence, when there subsists in the patient but little of that peculiarity of constitution so essential to the production of the disease (and so general, when the small-pox is epidemical), or, in other words, when the body is indisposed to be poisoned. This consideration, peculiar to the disease when artificially produced, appears to be the true cause of the small quantity of pocky matter, and that general fearcacy of pustules, when compared to the natural small-pox, which has ever accompanied inoculation, and is one of the grand advantages of the discovery. Further, as it is very reasonable to suppose, that this propensity is the greatest when there is an epidemic constitution of the air which favours the production of the disease; and if it be as probable that the severity or mildness of the disease depends in a good degree upon the greater or lesser propensity of the subject to be infected; it will certainly be an eligible step not to bring on the disorder by inoculation during the continuance of an evidently prevailing tendency to the disease. Prudence in this case directs us to take advantage of the absence of such a prevailing tendency, when all the benefits of inoculation may be secured; and not to delay the operation, till such a constitution of air prevails, as at once makes the operation necessary, and deprives it of some of its advantages. To conclude, we may add to this consideration, that by the practice of exposure to cold, the violence of the eruptive fever is so far moderated, as to prevent its forming an additional quantity of variousious matter, which, in a violent and unrestrained state, it would do, by assimilating the juices of the constitution into the nature of the variousious poison.
3. "The manner or mode of the infection being communicated."
In the natural small-pox, the disease may be produced by accidental contagion, or an epidemic influence. Dr Mead says, that the air of this climate never produces the plague, small-pox, or measles; and Dr Arbuthnot says, that the plague itself may be generated by some quality in the air, without any contagion. Be these opinions as they may, it is evident that contagion is sometimes so languid, that it requires the agency of other causes to give it activity, so as to produce the tribe of diseases to which it belongs, and which without this agency would never be brought forth; and though the strongest epidemic tendency may not in Europe create the small-pox, without the concurrence of contagious fomes, yet there is, by the agency of the former, such an alteration made, and propensity brought on the animal juices, as is essentially necessary to continue the existence of the disease. Variolous contagion produces its effects by the actual application of its poison, either externally, through the medium of the skin; or internally, to the gullet, stomach, and guts, in the act of deglutition; or lastly, to the lungs, in the act of respiration. Though there may be a possible admission of the poisonous miasmata into the constitution through the skin, from the principle of absorption; yet the poison very seldom, if ever, exerts its influence upon the habit in this manner. Possibly by a local actual application of the gross matter lodged in the cloaths, or otherwise conveyed, the distemper may sometimes be produced by a kind of inoculation, and then the disorder will probably be favourable. But when the poison, in a more dilute state, only floats in or impregnates the air, it seldom enters the pores of the skin and poisons by way of absorption; for the degrees of activity in which this power is exerted, are most probably in proportion to the aids the constitution may stand in need of from it. However, it is more than probable that the ordinary mode of infection is by the lungs, which from their structure they are well calculated to receive, to entangle, and to retain. When either the lungs or the stomach are first infected by the infectious effluvia, it is most reasonable to believe, that these noble parts, together with the faucets, glottis, wind-pipe, and gullet, will frequently labour under a greater load of pustules than the external surface of the body: for it is observed, that when the patient is infected artificially, the parts to which the poison is applied suffer in a greater degree than the more distant; and that the circumjacent skin, to some extent, is filled with pustules. From this particular application of the morbid matter to the faucets, &c., it is probable, that the large discharge of saliva, &c., arises, which characterizes the confluent small-pox in adults; and as children swallow this saliva, it excites a diarrhoea, which in them answers to the spitting in those more aged. When the internal parts are oppressed with pustules, there is no interval between the eruptive and the subsequent symptomatic fever; and the suffering which the patient labours under from a generally inflamed skin, heightened by the dilated condition of the nobler parts, perpetuates the first fever. This informs us that all is not so well within as otherwise the external appearances might have induced us to believe; but that the nobler parts are rendered unfit for the purposes of life, at least are labouring and lagging behind in the process, so that they have not kept pace with the apparent state of the dilate on the surface of the body: this some have supposed to be the true general cause of the secondary fever, under which the patient, if he sinks, dies peripneumonic. These consequences frequently attend the infection received in the natural way; and if, superadded to these, the unhappy situation of those described under the first and second sources of danger attends the patient, the disorder will be proportionably aggravated, and the chance of life lessened.
But here again inoculation relieves: for by this mode the virus is applied to the external surface of the body, so that the whole constitution (excepting the part immediately surrounding the wound) being affected uniformly, the process of the disease is regularly carried on; and the nobler parts not being particularly affected by a partial application of the variolous fomes to their surface, have no distress to proclaim by a secondary fever, which therefore is scarcely ever seen in inoculated patients.
4. "The constitution of the air at the time of infection."
A powerful source of difficulty and danger in the natural small-pox is, the malignant influence of the air at some seasons, and particularly if it happens at the time or preceding the infection. If this concurs with one or more of the other causes, how dreadful the devastation! Whether this constitution of the air produces its deleterious effects by heightening the natural malignity of the infecting poison, or acts on the constitution itself so as to render the effects of contagion more peculiarly fatal, the consequence of this state of the air is the same. The general characters of a morbid state of the air are the inflammatory and putrid; and it is uniformly observed, that whenever a person is attacked with a fever under either of these prevailing dispositions, it never fails to impress its character upon the disease.
But here also inoculation affords the most benign influence. The judicious practitioner does not expose his patient to the pernicious effects of an air that can stamp its baneful character on the small-pox, but chooses the season best calculated for the safety and welfare of his patient; and hence we rarely see the influence of this evil source attendant on the artificial disease.
Having seen, that from the influence of one or more of these four sources of difficulty and danger, and that from their union will result a natural small-pox, complicated with horrors not less to be dreaded than the plague; how inefficacious must appear that favour of Providence, by which we are freed from the formidable attendants of this disease, viz., inoculation, by which the disorder is rendered mild, and in general less hazardous than a common cold!
From attention to the above sources of ill in the natural small-pox, we perceive with sufficient satisfaction the many instances of relief and security which generally we avail ourselves of by inoculation; a part of which we have seen, and a few others follow.
1. As already observed, it saves the lives of most who are its subjects. From a general calculation it appears, that in the hospitals for small-pox and inoculation, 72 die out of 400 patients having the distemper in the natural way, and only one out of this number when inoculated. 2. It lessens the affliction from both the degree and the number of ill symptoms, even when it proves fatal. It lessens the number of pustules; and, by moderating the virulence of the disease, the marks on the face are not so deep. 3. It is extremely rare that the secondary fever attends it; a symptom productive of much suffering, if the patient is happy enough to escape with life. 4. It produces the disease under the fewest disadvantages, and favours with foresight to prevent many ills not to be guarded against in the natural small-pox. 5. Instead of communicating other disorders with it, many disorders subsequent to the natural are very rarely observed after the artificial small-pox. 6. It effectually removes all just grounds of fear; a passion very injurious in this disease. INQ
7. Soldiers, sailors, and all who would appear abroad, or in public offices, are freed from every anxiety and hazard attendant on the natural small-pox.
8. Servants, women with children at their breasts, pregnant women, magistrates, physicians, &c. are all freed from the most distressing embarrassment, by conformity to inoculation. See Medicine.