142. In one of his cases Willis was at first uncertain as to the

diagnosis, because “the smallpox had never been in that place.” [818] _Histor. MSS. Commis._ V. 156-154. Sutherland Letters. [819] Sutherland Letters, u. s. Andrew Newport to Sir R. Leveson at Trentham. [820] Mary Barker to Abel Barker, 26 May and 2 June, 1661. _Hist. MSS. Com._ V. 398: “There is many dy out in this town, and many abroad that we heare of”; the squire’s mother is living “within a yard of the smallpox, which is also in the house of my nearest neighbour”; her own children had whooping cough, but do not appear to have taken smallpox. [821] _Hactenus Inaudita, or Animadversions upon the new found way of curing the Smallpox._ London, 1663. Dated 10 July, 1662. The burden of his own complaint is of a prominent personage in the smallpox who was killed, as he maintains, by enormous doses of diacodium, an opiate with oil of vitriol, much in request among the partisans of the cooling regimen. [822] His first book was Περὶ ὑδροποσίας, or _A Discourse of Waters, their Qualities and Effects, Diaeteticall, Pathologicall and Pharmacuiticall_. By Tobias Whitaker, Doctor in Physicke of Norwich. Lond. 1834. In 1638, being then Doctor in Physick of London, he published _The Tree of Humane Life, or the Bloud of the Grape. Proving the Possibilitie of maintaining humane life from infancy to extreame old age without any sicknesse by the use of wine._ An enlarged edition in Latin was published at Frankfurt in 1655, and reprinted at the Hague in 1660, and again in 1663. The passages cited in the text occur in his _Opinions on the Smallpox_. London, 1661. [823] His only reference to the deaths in the royal family, which were currently set down to professional mismanagement, comes in where he opposes the prescription of Riverius to bathe the hands and feet in cold water: “this hath proved fatall,” he says, “in such as have rare and tender skins, as is proved by the bathing of the illustrious Princess Royal. Therefore I shall rather ordain aperient fomentations in their bed, to assist their eruption and move sweat.” [824] _Pyretologia_, II. 94, 112. [825] Walter Harris, M.D., _De morbis acutis infantum_, 1689. There were several editions, some in English. [826] Jurin, _Letter to Cotesworth_. Lond. 1723, p. 11. [827] Speaking of malignant sore-throat, he says: “The younger the patients are, the greater is their danger, which is contrary to what happens in the measles and smallpox.” _Commentaries on Diseases_, p. 25. [828] Andrew’s _Practice of Inoculation impartially considered_. Exeter, 1765, p. 60. [829] Duvillard (_Analyse et Tableaux de l’Influence de la Petite Vérole sur la Mortalité à chaque Age._ Paris, 1806) gives the ages at which 6792 persons died of smallpox at Geneva from 1580 to 1760, according to the registers of burials: Total at all ages. 0-1, -2, -3, -4, -5, -6, -7, -8, -9, -10, -15, -20, -25, -30. 6792 1376 1300 1290 898 603 381 301 189 109 78 126 54 39 31 The public health of Geneva altered very much for the better in the course of two centuries from 1561 to 1760. From 1561 to 1600, in every hundred children born, 30·9 died before nine months, on an annual average, and 50 before five years. From 1601 to 1700 the ratios were 27·7 under nine months, and 46 before five years. From 1701 to 1760 the deaths under nine months had fallen to 17·2 per cent., and under five years to 33·6 per cent. (Calculated from a table in the _Bibliothèque Britannique_, Sciences et Arts, IV. 327.) Thus, with an increasing probability of life, the age-incidence of fatal smallpox may have varied a good deal within the period from 1580 to 1760. It is given by Duvillard separately for the years 1700-1783 (inclusive of measles): during which limited period a smaller ratio died under nine months, and a larger ratio above the age of five years, than in the aggregate of the whole period from 1580 to 1760. Whatever may have been the rule at Geneva, it cannot be applied to English towns; for, while some 30 per cent. of the smallpox deaths were at ages above five in the Swiss city (1700-1783), only 12 per cent. were above five in English towns such as Chester and Warrington in 1773-4. [830] _Pyretologia_, 2 vols. Lond. 1692-94, vol. II. [831] _Natural History of Oxfordshire._ Oxford, 1677, p. 23. [832] In his _Diary_, under the year 1646, homeward journey from Rome. [833] The physician was “a very learned old man,” Dr Le Chat, who had counted among his patients at Geneva such eminent personages as Gustavus Adolphus and the duke of Buckingham. [834] Dr Dover has left us an account of Sydenham’s practice in the smallpox as he himself experienced it: “Whilst I lived with Dr Sydenham, I had myself the smallpox, and fell ill on the twelfth day. In the beginning I lost twenty ounces of blood. He gave me a vomit, but I find by experience purging much better. I went abroad, by his direction, till I was blind, and then took to my bed. I had no fire allowed in my room, my windows were constantly open, my bedclothes were ordered to be laid no higher than my waist. He made me take twelve bottles of small beer, acidulated with spirit of vitriol, every twenty-four hours. I had of this anomalous kind to a very great degree, yet never lost my senses one moment.” _The Ancient Physician’s Legacy._ London, 1732, p. 114. [835] _Scotia Illustrata._ Lib. II., cap. 10. [836] _De Febribus &c._, Lond. 1657: cap. ix. “De Variolis et Morbillis,” p. 141. [837] “First of all,” he says, “let the patient be kept with all care and diligence from cold air, especially in winter, so that the pores of the skin may be opened and the pocks assisted to come out. Therefore let him be kept in a room well closed, into which cold air is in no manner to enter, and let him be sedulously covered up in bed.... I desire the more to admonish my friends in this matter, for that Robert Cage, esquire, my dear sister’s husband,” etc. [838] Besides cases to show the ill effects of blooding, vomits, purges and cooling medicines such as spirit of vitriol, he gives examples as if to refute Sydenham’s favourite notion that salivation, diarrhoea and menstrual haemorrhage were relieving or salutary. Morton’s chief object was to bring out the eruption, and to get it to maturate kindly; an eruption which languished, or did not rise and fill, was for him the most untoward of events. Sydenham, on the other hand, argued that the danger was in proportion to the number of pustules and to the total quantity of matter contained in them; and he sought, accordingly, to restrain cases which threatened to be confluent by an evacuant treatment or repressive regimen. [839] Walter Lynn, M.B., _A more easy and safe Method of Cure in the Smallpox founded upon Experiments, and a Review of Dr Sydenham’s Works_, Lond. 1714; _Some Reflections upon the Modern Practice of Physic in Relation to the Smallpox_, Lond. 1715. F. Bellinger, _A Treatise concerning the Smallpox_, Lond. 1721. [840] Letter from Woodward to the _Weekly Journal_, 20 June, 1719, in Nichols, _Lit. Anecd._ VI. 641. [841] Rev. Dr Mangey to Dr Waller, 4 March, 1720, London. Nichols’ _Lit. Anecd._ I. 135. [842] Huxham, _Phil. Trans._ XXXII. (1725), 379. [843] _Gent. Magaz._, Sept. 1752. [844] John Barker, M.D., _Agreement betwixt Ancient and Modern Physicians_, Lond. 1747. Also two French editions. It is on Van Helmont that Barker pours his scorn for “breaking down the two pillars of ancient medicine--bleeding and purging in acute diseases.” That upsetting person forbore to bleed even in pleurisy; the only thing that he took from the ancient medicine was a thin diet in fevers; “and yet this scheme, as wild and absurd as it seems, had its admirers for a time.” [845] Lynn (u. s. 1714-15) agrees as to the matter of fact, namely, that the mortality from smallpox was greater among the richer classes, who were too much pampered and heated in their cure, than among the poorer, who had not the means to fee physicians and pay apothecaries’ bills. [846] He was under the tutelage of John Churchill, duke of Marlborough, who does not give a name to the malady (Coxe’s _Life of Marlborough_). Dr James Johnstone, junr., of Worcester, in his _Treatise on the Malignant Angina_, 1779, p. 78, claims the death of the Duke of Gloucester as from that cause, on the evidence of Bishop Kennet’s account. [847] In the _Gentleman’s Magazine_, under the dates. [848] _A Direct Method of ordering and curing People of that Loathsome Disease the Smallpox, being the twenty years’ practical experience of John Lamport alias Lampard_, London, 1685. The writer was probably an empiric, “Practitioner in Chyrurgery and Physick,” dwelling at Havant, and attending the George at Chichester on Mondays, Wednesdays and Fridays, the Half Moon at Petersfield on Saturdays. He says: “One great cause of this disease being so mortal in the country is because the infection doth make many physicians backward to visit such patients, either for fear of taking the disease themselves or transferring the infection to others.” He has another fling at the regular faculty: “Do not run madding to Dr Dunce or his assistance to be let bloud.” Empirics, although they were commonly right about blood-letting, were under the suspicion of not speaking the truth about their cures. [849] Macaulay, _History of England_, IV. 532. The moving passage on the former horrors of smallpox, _à propos_ of the death of Queen Mary in 1694, is familiar to most, but it may be cited once more in the context of a professional history: “That disease, over which science has since achieved a succession of glorious and beneficent victories, was then the most terrible of all the ministers of death. The havoc of the plague had been far more rapid: but plague had visited our shores only once or twice within living memory; and the smallpox was always present, filling the churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.” It is not given to us all to write like this; but it is possible that the loss of picturesqueness may be balanced by a gain of accuracy and correctness. [850] Kellwaye, u. s., 1593. [851] Dr Richard Holland in 1730 (_A Short View of the Smallpox_, p. 75), says: “A lady of distinction told me that she and her three sisters had their faces saved in a bad smallpox by wearing light silk masks during the distemper.” [852] As I do not intend to come back to the subject of pockmarked faces, I shall add here that I have found nothing in medical writings of the 18th century, nor in its fiction or memoirs, to show that pockpitting was more than an occasional blemish of the countenance. At that time most had smallpox in infancy or childhood, when the chances of permanent marking would be less. The disappearance of pockpitted faces was discovered long ago. The report of the National Vaccine Board for 1822 says: “We confidently appeal to all who frequent theatres and crowded assemblies to admit that they do not discover in the rising generation any longer that disfigurement of the human face which was obvious everywhere some years since.” The members of this board were probably seniors who remembered the 18th century; and it is quite true that the first quarter of the 19th century was singularly free from smallpox in England except in the epidemic of 1817-19. But the above passage became stereotyped in the reports: exactly the same phrase, appealing to what they all remembered “some years since,” was used in the report for 1825, a year which had more smallpox in London than any since the 18th century, and again in the report for 1837, the first year of an epidemic which caused forty thousand deaths in England and Wales. These stereotyped reminiscences are apt to be as lasting a blemish as the pockholes themselves. [853] Collinson, _Hist. of Somerset_, III. 226, citing Aubrey’s _Miscellanies_, 33. [854] Blomefield, _Hist. of Norfolk_, III. 417. [855] Thoresby, _Ducatus Leodiensis_, ed. Whitaker. App. p. 151. [856] _Cal. Le Fleming MSS._ p. 408 (_Hist. MSS. Com._). There are also many references to smallpox from 1676 onwards in the letters of the Duke of Rutland at Belvoir, lately calendared for the Historical MSS. Commission. [857] In the _London Gazette_ of 11-14 May, 1674, the Vice-Chancellor and two doctors of medicine of the University of Cambridge contradicted by advertisement a report that smallpox and other infections were prevalent in the university. [858] Marquis of Worcester to the Marchioness, [London] 8 June, 1675 (Beaufort MSS. _Hist. MSS. Commis._ XII. App. 9, p. 85): “They will have it heere that the smallpox and purple feaver is at the Bath, and the Dutchesse of Portsmouth puts off her journey upon it. The king askt me about it as soon as I came to towne. Pray enquire, and lett me know the truth.” The _London Gazette_ of 17-21 June and 28 June-1 July, 1775, had advertisements “that it hath been certified under the hands of several persons of quality” that Bath and the country adjacent was wholly free of the plague or any other contagious distempers whatsoever. [859] Burnet, _History of his own Time_, IV. 240. [860] Walter Harris, M.D., _De morbis acutis infantum_. Ed. of 1720, p. 161. [861] John Cury, M.D., _An Essay on Ordinary Fever_. Lond. 1743, p. 40. [862] See p. 438. [863] Macaulay hardly realized the anomalous character of the queen’s attack of smallpox. “The physicians,” he says, “contradicted each other and themselves in a way which sufficiently indicates the state of medical science in that day. The disease was measles; it was scarlet fever; it was spotted fever; it was erysipelas.... Radcliffe’s opinion proved to be right.” There had been some doubt on the first appearance of the eruption whether it would turn to measles or smallpox. Sydenham says that it was often difficult to make the diagnosis at that stage, and in the queen’s case the first signs were anomalous as well. Next day, however, the eruption all over the body became “smallpox in its proper and distinct form.” But it did not long remain so; the livid spots, into which the pustules subsided, again raised doubts in the minds of some of the physicians whether it was not measles after all; and there was undoubtedly erysipelas of the face. Harris took the middle course of diagnosing “smallpox and measles mingled,” a name by which the form that we now call haemorrhagic smallpox had been known from the early part of the seventeenth century. It was at this late and ominous stage of the illness that Radcliffe was called in; it is not correct to say, as the historian says, that he was the first to pronounce “the more alarming name of smallpox.” The diagnosis was then a matter of little moment, for the queen was dying. He declared that “her majesty was a dead woman, for it was impossible to do any good in her case when remedies had been given that were so contrary to the nature of her distemper; yet he would endeavour to do all that lay in his power to give her ease.” (Munk’s _Roll of the College of Physicians_, II. 458.) For some unexplained reason Radcliffe was made to bear the blame of the queen’s death, an accusation which he deserved as little as he deserved the credit given him by the historian of having been the only physician to make the correct diagnosis. Macaulay is equally unfortunate in his remark that smallpox “was then the most terrible of all the ministers of death,” in his comparison of it to plague, and in his rhetoric generally. The haemorrhagic form, of which the queen died, was rare. Dover adds it as a fourth variety, but admits that he had seen only five cases of it. Ferguson, of Aberdeen, as late as 1808, in a paper on measles (_Med. and Phys. Journal_, XXI. 359), described a haemorrhagic case of smallpox which he once saw, without knowing that it was a recognized variety of smallpox at all. However terrible a minister of death smallpox may sometimes have been, it happened that there was comparatively little of it in London during the period covered by Macaulay’s history; and it certainly did not “fill the churchyards,” as he might have found out by referring to that not altogether recondite source, the bills of mortality. From 1694 to 1700 fevers caused three and a half times more deaths than smallpox. In the year 1696, when “the distress of the common people was severe,” the smallpox deaths in London were 196, or about one-hundredth part of the mortality from all causes. [864] Blomefield, III. 432. The following are two cases from the London epidemic of 1710: June, 15.--“Lord Ashburnham’s brother has the smallpox, and the first, concluding he had had it, went to him, and now himself very ill of them. Doctor Garth, who says none has them twice, examined the servants, and they tell him he was but six days ill then; so he concludes that was not the smallpox.” _Cal. Belvoir MSS._, II. 190. [865] Lynn, u. s. He recalls a remark made by a writer in 1710 that the severity of that epidemic “was not due to a peculiar state of the air, but to a defect in some of our great physicians, who, being too fully employed, could not give due attendance to all or even to any of their patients through the multiplicity of them: for want of which, and the severity of their injunctions, which hindered others from applying anything in their absence, many persons were lost who might otherwise have been saved with due care.” [866] John Woodward, M.D., _The State of Physick and Diseases, with an inquiry into the causes of the late increase of them, but more particularly of the Smallpox; with some considerations on the new practice of purging in that disease_. London, 1718. [867] See the account of the Dispensary of the College of Physicians in Warwick Lane, in Munk’s _Roll of the Coll. of Phys._ II. 499, under the head of Sir Samuel Garth. The dispensary was started in 1687 and languished until 1724. The General Dispensary in Aldersgate Street was opened in 1770 with Dr Hulme as physician, and Dr Lettsom as additional physician in 1773. [868] Letter of 27 March, year not given. _Hist. MSS. Com._ V. 618. See also the letter of 4 March, 1720, from Mangey to Waller, cited above, p. 450. [869] Dr Philip Rose, of Bedfordbury (“over against a baker, next door to the Old Black Horse, two doors from Chandos Street, St Martin’s parish”), having been called by Lady Wyche to see her butler, pronounced him to be in the smallpox; whereupon the lady informed the physician that “she knew an eminent nurse who had managed above twenty of my Lord Cheyney’s servants in the smallpox, and every one of them had recovered.” Her butler was accordingly carried to this nurse’s house in a by street near Swallow Street. _An Essay on the Smallpox._ By Philip Rose, M.D. Lond. 1724, p. 18. [870] “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. et Patav. M.D., S.R.S., dated at Constantinople, December, 1713. Communicated to _Phil. Trans._ XXIX. (Jan.-March, 1714) 72, by Dr Woodward, Gresham Professor of Physic. Timoni had been in England in 1703, and had been incorporated a doctor of medicine at Oxford on his Padua degree: hence, perhaps, his correspondence. [871] _An Essay on External Remedies_, Lond. 1715, p. 153. Kennedy settled in practice in London as an ophthalmic surgeon, and appears to have enjoyed the patronage of Arbuthnot. His other work, _Ophthalmographia, or Treatise of the Eye and its Diseases, with appendix on Diseases of the Ear_, Lond. 1723, which is dedicated to Arbuthnot, shows a knowledge of optics and of the structure of the parts concerned in operations on the eye. [872] Sloane, _Phil. Trans._ XLIX. (1756), p. 516, “An Account of Inoculation given to Mr Ranby to be published, anno 1736.” [873] Jacobus Pylarinus, _Nova et Tuta Variolas excitandi per Transplantationem Methodus, nuper inventa et in usum tracta, qua rite peracta immunia in posterum praeservantur ab hujusmodi contagio corpora_. Venetiis, 1715. Privilege dated 10 Nov., 1715. Reprinted in _Phil. Trans._ XXIX. (Jan.-March, 1716), p. 393. [874] _A Dissertation concerning Inoculation of Smallpox._ By W. D[ouglass], Boston, 1730. [875] _loc. cit._ [876] Published under the initials J. C., M.D. [877] _De Peste dissertatio habita Apr. 17, 1721, cui accessit descriptio inoculationis Variolarum_, a Gualt. Harris, Lond. 1721. [878] _Phil. Trans._ XLIX. 104. [879] Sloane, u. s., 1736. [880] Jurin, _Account of the Success of Inoculating the Smallpox_. Annual reports from 1723 to 1726. [881] Alexander Monro, primus, _An Account of the Inoculation of the Smallpox in Scotland_. Edin. 1765 (Reply to circular of queries issued by the dean and delegates of the Faculty of Medicine of Paris). [882] _Phil. Trans._ 1722: papers by Perrot Williams, M.D. (p. 262), and Richard Wright (p. 267). [883] _Voyages du Sr. A. de la Motraye._ Tome II. La Haye, 1727, Chap. III. p. 98. He saw Timoni at Constantinople on his return from the Caucasus. Timoni used “a three-edged surgeon’s needle,” which is more intelligible than three needles tied together. La Motraye’s travellers’ tales have not enjoyed the best credit. But this of the inoculation in Circassia has been made by Voltaire the sole basis of his spirited account of inoculation as the national practice of that country (_Lettres sur les Anglais_, Lettre XI. “Sur l’insertion de la petite-vérole,” 1727, reprinted as the article “Inoculation” in his _Dict. Philosophique_, 1764). There has never been a grosser instance of a myth constructed in cold blood. The fable does not need refutation because it is mere assertion, in the manner of a _philosophe_. But the British ambassador at Constantinople made inquiries concerning the alleged Georgian or “Circassian” practice in 1755, at the instance of Maty, the foreign secretary of the Royal Society (_Phil. Trans._ XLIX. 104). A Capuchin friar, “a grave sober man” who had returned shortly before from a sixteen years’ residence in Georgia and “gives an account of the virtues and vices, good and evil, of that country with plainness and candour,” solemnly declared to Mr Porter that he never heard of inoculation “at Akalsike, Imiritte or Tiflis,” and was persuaded that it had never been known in the Caucasus. It was impossible that either the public or private practice of inoculation could have been concealed from him, as he went in and out among the people practising physic. He had often attended them in the smallpox, which, he said, was unusually severe there. On the other hand La Motraye says: “I found the Circassians becoming more beautiful as we penetrated into the mountains. As I saw no one marked with the smallpox, it occurred to me to ask if they had any secret to protect them from the ravages which this enemy of beauty makes among all nations. They told me, Yes; and gave me to understand that it was inoculating, or communicating it to those whom they wished to preserve by taking the matter from one who had it and mixing the same with the blood at incisions which they made. On this I resolved to see the operation, if it were possible, and made inquiry in every village that we passed through if there was anyone about to have it done. I soon found an opportunity in a village named Degliad, where I heard that they were going to inoculate a young girl of four or five years old just as we were passing.” This was published fifteen years after, Timoni’s account being given in an Appendix. [884] _Travels_, IV. 484. See also for Algiers, _Lond. Med. Journ._ XI.