Now! Then! Thomas Nettleton of Halifax recounts to James Jurin his success in inoculating against smallpox

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There are two propositions advanced by the favourers of the practice of inoculation, concerning which the public seems to require more full satisfaction. That the distemper raised by inoculation is really the smallpox; and, that it is much more mild and favourable, and far less mortal, than the natural sort.

The former of these is not so much disputed now, as it was at first, when this method was introduced, nor can it be made a doubt of by any one, who has seen those that have been inoculated, and has also been much conversant in the natural smallpox. There is usually no manner of difference to be observed betwixt the one sort and the other, when the number of pustules is nearly the same; but in both there are almost infinite degrees of the distemper, according to the difference of that number. All the variation that can be perceived of the engrafted smallpox from the natural, is, that in the former the pustules are commonly fewer in number, and all the rest of the symptoms are in the same proportion more favourable. They exactly resemble what we call the distinct sort: the symptoms before the eruption are the very same, and when the pustules begin to rise, their appearance is the same, as well as their periods of maturation and declension; they are at first of the same florid, rosy colour, and when fully ripe, of as fair a yellow. They commonly rise as round and as large as the other, and when they are very numerous, the inflammation and swelling of the face comes on at the usual time, and is followed by the swelling of the hands and feet, and only once I observed a salivation, though the pustules were distinct. In the natural smallpox, when the pustules are very few, we sometimes observe, they do not rise to so great a bulk, neither do they ripen so fully, nor continue so long as usual; and it is the same in the way of inoculation. In short, as this distemper is raised by an engraftment from the smallpox, as it has the very same appearance, and as it is capable of producing the same by infection, there seems to be no room to doubt of its being the true and genuine smallpox. And if that be allowed, it will follow from thence, as a corollary, that those, who have been inoculated, are in no more danger of receiving the distemper again, than Those who have had it in the ordinary way. And this is also thus far confirmed by experience. We are very ready to own, that the Operation may sometimes fail: those gentlemen, who first communicated to the Royal Society some account of this practice from Turkey, did both of them intimate so much; though I believe that will but rarely happen. In one instance here (William Clark’s son. See Philsoph. Transact. No. 370. p. 45.), I observed no eruption at all, neither did the wounds inflame and swell any more than would have followed from a common incision, which made me conclude, that what was applied had not taken effect, and indeed the reason of it was very well known to me. In three others, though the wounds did inflame, and swell, and discharge considerably, yet the eruptions were so imperfect, as to leave me a little in doubt: but two of these have since been sufficiently tried, by being constantly with those who had the smallpox, without receiving any infection; which makes me inclined to believe they will always be secure from any danger of it. As to all the rest, neither I nor any body else, who saw them, did in the least question, but that they had the true smallpox.

As to the latter proposition, that the engrafted smallpox is far less dangerous than the natural: the truth of this, I suppose, can only be found by making a comparison, so far as our experience will extend. In order to this, I have taken an account in this town, and some part of the country, and have procured the same from several other towns hereabouts, where the smallpox has been epidemical this last year, with as much exactness as was possible, how many have had the smallpox, and how many out of that number have died. Some of these I did send you the last summer, but I will beg leave to repeat them amongst the rest, that they may be all under one view.

	Have had the smallpox	Died
In Halifax	276	43
In a part of the Parish of Halifax, stretching towards Bradford	297	59
In another part of the same Parish	268	28
In Bradford	129	36
In Leeds	792	189
In Wakefield	418	57
In Rochdale	177	38
In Ashton under Lyme, a small market-town in Lancashire, including two neighbouring villages	279	56
In Macclesfield	302	37
In Stockport	287	73
In Hatherfield	180	20
Total	3405	636

I am very sensible you will require a great number of observations, before you can draw any certain conclusions. I would only crave leave to remark, that it appears from these accounts, that this last year, in this part of the kingdom, almost nineteen out of every hundred, or near one fi[f]th of those, who have had the natural smallpox, have died; whereas out of sixty one which have been inoculated hereabouts, not one has died; for as to the case of Mr. John Symson’s daughter, which would have made the sixty second, I leave it out of my account, and I will refer it to any impartial judgement, whether I may not justly do so. (See Philosoph. Transact. No. 370. p. 41, 42.) The facts are open to every one’s enquiry, and whoever will give himself the trouble, may be satisfied as to the truth of them.

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To facilitate reading, the spelling and punctuation of elderly excerpts have generally been modernised, and distracting excision scars concealed. My selections, translations, and editions are copyright.

Abbreviations

Comment

The UCI page lists a good selection of contemporary articles on smallpox inoculation 1714-23. Wikipedia describes the transmission of variolation in 1718-21 from the Constantinople Greeks via Mary Montagu and Charles Maitland to England.

Cudworth devotes a chapter to Nettleton (Cudworth 1889).

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Original

There are two propositions advanced by the favourers of the practice of inoculation, concerning which the public seems to require more full satisfaction. That the distemper raised by inoculation is really the smallpox; and, that it is much more mild and favourable, and far less mortal, than the natural sort.

The former of these is not so much disputed now, as it was at first, when this method was introduced, nor can it be made a doubt of by any one, who has seen those that have been inoculated, and has also been much conversant in the natural smallpox. There is usually no manner of difference to be observed betwixt the one sort and the other, when the number of pustules is nearly the same; but in both there are almost infinite degrees of the distemper, according to the difference of that number. All the variation that can be perceived of the engrafted smallpox from the natural, is, that in the former the pustules are commonly fewer in number, and all the rest of the symptoms are in the same proportion more favourable. They exactly resemble what we call the distinct sort: the symptoms before the eruption are the very same, and when the pustules begin to rise, their appearance is the same, as well as their periods of maturation and declension; they are at first of the same florid, rosy colour, and when fully ripe, of as fair a yellow. They commonly rise as round and as large as the other, and when they are very numerous, the inflammation and swelling of the face comes on at the usual time, and is followed by the swelling of the hands and feet, and only once I observed a salivation, though the pustules were distinct. In the natural smallpox, when the pustules are very few, we sometimes observe, they do not rise to so great a bulk, neither do they ripen so fully, nor continue so long as usual; and it is the same in the way of inoculation. In short, as this distemper is raised by an engraftment from the smallpox, as it has the very same appearance, and as it is capable of producing the same by infection, there seems to be no room to doubt of its being the true and genuine smallpox. And if that be allowed, it will follow from thence, as a corollary, that those, who have been inoculated, are in no more danger of receiving the distemper again, than Those who have had it in the ordinary way. And this is also thus far confirmed by experience. We are very ready to own, that the Operation may sometimes fail: those gentlemen, who first communicated to the Royal Society some account of this practice from Turkey, did both of them intimate so much; though I believe that will but rarely happen. In one instance here (William Clark’s son. See Philsoph. Transact. No. 370. p. 45.), I observed no eruption at all, neither did the wounds inflame and swell any more than would have followed from a common incision, which made me conclude, that what was applied had not taken effect, and indeed the reason of it was very well known to me. In three others, though the wounds did inflame, and swell, and discharge considerably, yet the eruptions were so imperfect, as to leave me a little in doubt: but two of these have since been sufficiently tried, by being constantly with those who had the smallpox, without receiving any infection; which makes me inclined to believe they will always be secure from any danger of it. As to all the rest, neither I nor any body else, who saw them, did in the least question, but that they had the true smallpox.

As to the latter proposition, that the engrafted smallpox is far less dangerous than the natural: the truth of this, I suppose, can only be found by making a comparison, so far as our experience will extend. In order to this, I have taken an account in this town, and some part of the country, and have procured the same from several other towns hereabouts, where the smallpox has been epidemical this last year, with as much exactness as was possible, how many have had the smallpox, and how many out of that number have died. Some of these I did send you the last summer, but I will beg leave to repeat them amongst the rest, that they may be all under one view.

	Have had the smallpox	Died
In Halifax	276	43
In a part of the Parish of Halifax, stretching towards Bradford	297	59
In another part of the same Parish	268	28
In Bradford	129	36
In Leeds	792	189
In Wakefield	418	57
In Rochdale	177	38
In Ashton under Lyme, a small market-town in Lancashire, including two neighbouring villages	279	56
In Macclesfield	302	37
In Stockport	287	73
In Hatherfield	180	20
Total	3405	636

I am very sensible you will require a great number of observations, before you can draw any certain conclusions. I would only crave leave to remark, that it appears from these accounts, that this last year, in this part of the kingdom, almost nineteen out of every hundred, or near one fi[f]th of those, who have had the natural smallpox, have died; whereas out of sixty one which have been inoculated hereabouts, not one has died; for as to the case of Mr. John Symson’s daughter, which would have made the sixty second, I leave it out of my account, and I will refer it to any impartial judgement, whether I may not justly do so. (See Philosoph. Transact. No. 370. p. 41, 42.) The facts are open to every one’s enquiry, and whoever will give himself the trouble, may be satisfied as to the truth of them.

1053 words.