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A licence or exclusive permission ought to be granted to such physicians or surgeons as undertake to inoculate for the Small Pox; for the mischief arising from the practice of inoculation by the illiterate and ignorant is beyond conception¹. Such persons, instead of confining the infection within narrow limits, too often, through want of skill or honesty, are the means of propagating it, to the great terror of many people, the fatal consequences of which, and the destructive tokens, remain in many places in England. For besides the dreadful mortality which the disease itself has occasioned, it has often proved the source of discord and contention among neighbours, and disturbed that harmony and friendship which had before subsisted among the inhabitants.

To conclude, I beg this small treatise may be considered only as an imperfect sketch drawn up in haste; but if it should be approved of, and her Imperial Majesty be pleased to command me to enter into farther particulars, I will employ my utmost endeavours to render it more perfect, and also assist in the execution of any part of what has been therein proposed.

A short estimate of the number of those who die of the natural Small Pox, with a view to demonstrate the advantages that may accrue to Russia, from the practice of inoculation.

It is needless to expatiate upon the havock which the Small Pox makes in most parts of the known world: probably there is not a country, city, or smaller community, which has not experienced its devastations in its turn. The very idea of it is insupportable; but its real effects, in places unapprised and unacquainted with the proper treatment and remedies against it, are not less general and fatal than the plague itself.

Though this fact is generally allowed, yet many, I think, are ignorant of the immense loss mankind sustains by this distemper. It may not be amiss therefore to shew, from well attested accounts, the proportion of persons who die of the natural Small Pox: for which purpose it will be necessary to chuse some country or city where an exact register of the births and deaths, as well as an accurate list of diseases, is regularly kept.

Dr. Jurin, secretary to the Royal Society in London, carried this into execution in 1722, soon after Inoculation had been introduced into England, being desirous of shewing the different effects of the natural and inoculated Small Pox.

I shall not here insert all that was published by this ingenious author, as the whole may be found in the Philosophical Transactions of the Royal Society, under № 374. The following extract will be sufficient for my present purpose.

The Doctor for forty-two years selected from the Bills of Mortality in London, such as died there of the Small Pox and other distempers. His observation may appear perhaps somewhat extraordinary: nevertheless he makes it plain, that out of 1000 infants, 386 die under two years of age, which is considerably more than one third. He then deducts such as he supposes die of the diseases natural to infancy; and afterwards proceeds to demonstrate, that if the whole bulk of mankind be taken at the age of two years, the eighth part will die of the natural Small Pox; and that of such as have it in the natural way, one in five or six dies.

With respect to my own calculations on this subject, I endeavoured to find out whether the Small Pox proved equally fatal after the time mentioned by the Doctor. With this view, before I left England, I procured the Bills of Mortality of the City of London for the last thirty-four years, excepting two, which could not be found. Of these I made a table, which I have added at the end of this treatise. I was surprized to find the number for these thirty-two years past tally so exactly with the observations made by Dr. Jurin.

On examining the table it appears, that within these last thirty-two years 760,098 persons have died, and of those 268,529 have been infants under two years of age, which agrees with Dr. Jurin’s calculation, in being rather more than one-third of the whole.

I suppose, with Dr. Jurin, that the deaths of these were occasioned by different diseases incidental to infancy, and I deduct them out of the whole number, viz.

It appears likewise that in the same course of time there died of the Small Pox 66,515, which confirms Dr. Jurin’s account, and indeed exceeds the eighth part. Hence we may fairly conclude, that in general the Small Pox carried off the eighth part of those who died in London in the period abovementioned. I procured also the best accounts I possibly could of the whole number of those who had had the disease from places where the Small Pox had raged most, and found, that near one out of five died who had had the disease in the natural way. This also agrees with Dr. Jurin’s observations. We see then that even in London, where the climate is temperate, the disease well known, and the treatment of the sick very ably conducted, this single disease destroyed more than the eighth part of the inhabitants.

But if we turn our eyes towards other dominions, and give credit to the accounts told us, we shall find the disease still more fatal, and in some cities it is almost as destructive as the plague.

It is impossible for me to ascertain with any degree of certainty, the precise number of persons who die annually of the Small Pox in Russia. I am persuaded however, both from good intelligence as well as my own observations, that it is exceeding fatal here. Though I cannot confirm this assertion by proofs, yet from some conversation with the learned I am credibly informed, that of those who have the Small Pox in the natural way one-half die, including the rich and poor.

It seems hardly necessary to shew, how much the riches and strength of states depend upon the number of inhabitants. But perhaps there is not any country in which the certainty of this position is more indisputable than in Russia; for not only the strength of the empire, but the riches of every individual also, must be in proportion to the degree of population. If therefore in London, which enjoys the many advantages already recited, more than 2000 persons die annually of the Small Pox, we may surely suppose, that the loss which Russia in its whole extent sustains by this distemper in the same space of time, amounts to two millions of souls. And this havock must greatly retard the increase of the human species.

There are some diseases peculiar to old age, which terminate a life almost entirely spent, and totally useless to the community.

Such diseases, considered in a political sense, are not hurtful to the state. But the Small Pox spreads destruction chiefly upon the younger part of the species, from whose labours in their several callings the public might otherwise have expected advantages beyond all computation. The disappointment and loss incurred is of course neither to be calculated nor conceived.

A discourse upon this subject might be extended to a great length; but it seems unnecessary to enlarge, especially when I consider to whose judgment this essay is with all humility submitted.

The public, I am persuaded, must be sufficiently convinced from fact and demonstration, that Inoculation is the only means of preventing the mischiefs arising from the Small Pox.

In a former treatise I have laid down a plan for an effectual method of general practice, by which the spreading of the natural Small Pox will be prevented, and the cure of the inoculated rendered as easy and safe as possible to the patient.

I have therefore nothing more to add but my wishes, that the empire of Russia may meet with the utmost success from this discovery, under the reign of so illustrious and beneficent a Sovereign.

An objection to the practice of Inoculation considered

From the time that Inoculation was introduced into this country one may date the opposition to its practice; many learned and ingenious men soon entered the field against it, and were encountered by others of equal abilities in its defence. The questions were warmly agitated, and in a short time foreigners of great name became authors on both sides. But the strength of argument on the part of the defenders of Inoculation, supported by the good success of the practice, hath almost silenced opposition; and the concurrence of the courts of Petersburg, Vienna, and France, who have submitted to the operZation, and by their illustrious examples encouraged its progress in their dominions, will probably close the dispute in its favour.

One objection alone seems not to have been satisfactorily removed, which, although it does not relate to the safety or health of the patient, is yet of great importance to the community, and well deserves the most attentive consideration.

You have, say the objectors, produced accurate and satisfactory accounts and calculations of the alarming proportion of deaths that happen from the natural Small Pox, and also proved, that the loss sustained under Inoculation is inconsiderable. But admitting what you have advanced to be true, whence comes it that the same Bills of Mortality to which you appeal, prove also a certain increase instead of a diminution of deaths from the Small Pox, and that for such a series of years as to leave no room to dispute the fact? does it not naturally follow, that though almost the whole number of the inoculated recover, the disease must have been spread by their means, and a greater proportion having taken the natural disease, a consequent greater loss has been sustained by the public? If the above is admitted, it will be difficult to exculpate Inoculation from having been hurtful to society².

Several attempts have been made to obviate this objection, many of which I have perused; but consistent with my intention of brevity, and avoiding all controversy, I shall decline entering into particulars, or inserting any quotations from authors. It will be sufficient to say, that although the arguments advanced have been ingenious, and in some respects just, they do not in my apprehension remove the objection that has been mentioned.

Let us see then whether the practice may not be fairly chargeable with some blame; and this will appear more evidently, if we take a view of the usual conduct of families on such occasions; which however pertinent to the question, seems hitherto to have been avoided, or not attended to, by the several writers on the subject.

In London it has been the general custom for those who intend to inoculate, to take into account all the circumstances that may be material for the conveniency of their families and friends, and these being settled to their minds, few precautions are thought necessary respecting the security of others: what passes previous to the eruptive fever, does not claim our consideration, since it is universally allowed that no infection can be communicated before that time; but it is after this period the danger begins, and the disease may be spread by the intercourse of visitants, trades people, washerwomen, servants, and others, and in a mild state of the disease, the frequent excursions of the sick by way of airings, and often in hired carriages of various kinds, contribute greatly towards spreading the infection. It would perhaps be deemed a designed omission, if the inoculators were not also supposed to be of the number of those that contribute to spread the disease.

When all these circumstances are duly considered, surely it will be allowed, that the Small Pox is frequently caught from the inoculated; and let it be remembered, that whoever takes the disease from an inoculated patient, has himself the natural Small Pox, with all the circumstances of danger in respect to his own life, and of spreading the contagion to others.

I know it has been said, and even publicly declared, that the Small Pox from Inoculation is so mild, as scarcely to be infectious to others; but if this was true, how comes it that matter, taken from inoculated patients, conveys the distemper with equal certainty, as if it was taken from the natural Small Pox? is it not morally certain, that the effluvia partake of the same infectious quality? No physician of any experience, I am sure, will ever countenance such an opinion. But lest it should prevail, and do mischief among the ignorant and credulous, I think it incumbent on me to contradict so dangerous and unwarrantable an assertion.

In fact, it is certain that the Small Pox is infectious, in proportion to the number and malignity of the pustules; so far there is usually less danger from the artificial disease, than from the natural. But let not this presumption make any one remit their care, or abate their concern for the community; for I can assert from my own knowledge, that³ many fatal instances have happened from the disease having been spread by the inoculated.