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.
Of an Hospital for Inoculation
If the objections that have been noticed should be deemed of sufficient force to set aside all thoughts of partial Inoculations of the poor in London, what is to be done will next become the question? It would be cruel and unreasonable to refuse the benefit of this discovery to the necessitous, who on that very account are most intitled to our assistance; yet how to provide for them, consistent with the safety of their neighbours, seems difficult, though I hope not impracticable.
A desire to see some expedient for this purpose succeed, induces me to submit to the consideration of the public, a proposal that is in my apprehension liable to few objections, and would best answer the purpose.
It is to establish an Hospital for the purpose of Inoculation only.
I am aware that Hospitals have been stigmatized as unhealthy, from the idea that a number of sick persons confined together corrupt the air, and generate contagious putrid diseases. This charge has, I think, been inconsiderately made, so far as relates to Hospitals in and near this metropolis; but as it is no part of my undertaking to dispute the point, I shall confine myself to what concerns an Hospital for Inoculation, which, if every circumstance is duly attended to, will be as little unhealthy as any house in the kingdom.
Let us for a moment drop the offensive name of Hospital, and suppose a large house is provided in a healthy situation, with convenient and airy apartments for the reception of any given number of persons capable of being commodiously contained in it; that to be in a good state of health would be the necessary qualification on the admission of every person, and about three weeks the time of the residence; and that the disease they are to undergo is usually so mild, as to permit most of the patients to be abroad in the open air almost every day, and of a nature not to communicate any putrid injury to others, except its own specific poison. If to these circumstances we add, that the patients will in general be children and young persons, that their cloaths and apartments will be clean, and their food wholesome and such as is proper for their condition, surely one may boldly assert, that a family thus circumstanced will have the fairest prospect of enjoying good health.
Having endeavoured to remove the prejudice that is apt to accompany the idea of an Hospital so far as relates to health, I shall proceed to enumerate the advantages that will most probably be obtained by an institution of this kind; some of these have been already mentioned in the translation, and I shall take the liberty of introducing them again in this place, with little variation, as they relate to the subject.
One, and indeed no inconsiderable advantage to be derived from a plan of this sort will be, that all the patients being collected together in one house, the physician will be enabled to attend a great number at the same time in a proper manner, and can be particularly attentive to such as may more immediately require his assistance.
And it is of no small importance to those who are inoculated, that the necessary regulations in respect to regimen, as well as every other circumstance that requires the physician’s attention, will be there properly observed, and the necessary medicines always at hand, with an able person to direct the manner in which they ought to be administered.
There is likewise another advantage obtained by this method, that with proper caution the Small Pox will not be communicated to others in the natural way of infection.
It is also an encouraging circumstance, that an establishment of this sort will be attended with less expence, in several particulars, than any other Hospital.
One physician will be able to superintend the process of Inoculation in a very great number of patients, provided he is assisted by a resident apothecary to receive his instruction, and to be at hand to assist on extraordinary emergencies.
Few drugs or medicines will be wanted; the expence therefore on these articles will be very trifling.
Few attendants on the sick will be necessary, and not so much as one under the character of a nurse; for there will always be a sufficient number of patients in so good a state of health, as to be able to attend on those who may require assistance; and it should be one condition of their admittance, that they should be willing to assist others when able, as they would wish to be attended themselves when they stand in need of it; and if this injunction is complied with, it may be expected that there will be a sufficient number in a state of health to perform this office for one another. The doing the heavy and dirty part of the work, the care of the children, the attendance of those who may have the disease more severely, and the business of the kitchen, will doubtless require a proper number of healthy maid-servants.
In respect to diet, as it will be chiefly of the vegetable and least expensive kinds of food, this will be a very moderate article in the œconomy of such an establishment.