REPORT OF THE ROYAL VACCINATION COMMISSION. 669 



eighteenth century. Attention was directed to the matter by letters 

 from Timoni of Athens (dated 1713) and Pylarini, published in the 

 29th volume of the Philosophical Transactions (1716), and especially 

 by a letter from Lady Mary Wortley Montagu in 1717. Though 

 there are indications that in Great Britain and Ireland, as in other 

 countries, some sort of inoculation had occasionally been practised at 

 a much earlier date, the first clearly recorded case in England is that 

 of the daughter of Lady Mary Wortley Montagu (whose son had some 

 time before been inoculated at Constantinople), inoculated by Maitland, 

 in London, in April 1721. Other cases soon followed in England, and 

 about the same time the practice was also introduced in other countries 

 of western Europe, and into the United States of America, namely, at 

 Boston. 



It was found that the attacks induced by inoculation were as a rule 

 milder, and very much less fatal, than the attacks of the "natural'' 

 disease, the fever and constitutional disturbance being less and of shorter 

 duration, and the eruptive pustules much fewer : the number of these 

 varied, being commonly a dozen or two, somitines only two or three, 

 sometimes a hundred or more. In som i cases there was no eruption 

 at all, the effect being limited to constitutional disturbances and to 

 changes in the wounds of inoculation themselves ; it was maintained that 

 in such cases the disease had really been taken, and immunity against 

 a subsequent attack secured, as in case? of natural small-pox or of 

 inoculated small-pox manifesting itself in an eruption of pustules. 



In England the practice of inoculation at its introduction, though 

 much lauded and strongly urged by some, was bitterly opposed by others. 

 Moreover, the initial enthusiasm in favour of it soon declined, so that 

 in the years 1730-40 very little inoculation seems to have been practised. 

 About 1740, however, a revival appears to have taken place : in 1746 

 an Inoculation and Small-pox Hospital was started in London ; and 

 during the whole of the latter half of the eighteenth century the practice 

 may be said to have been very general. It was especially so during the 

 last quarter of the century, the increase being at least largely due 

 to the "improved methods" of inoculation introduced by one Sutton 

 in 1763, and known as " the Suttonian method." 



Since an inoculated person was infectious, each inoculation was 

 a source of danger to those, not protected by a previous attack, who 

 came into the company of, or even near, the inoculated person during 

 the attack ; and this danger was increased by the fact that the mild 

 character of the inoculated disease permitted, in many cases at least, 

 the patient to move about among his fellows. Moreover, as Haygarth, 

 himself a zealous advocate of inoculation in a systematic regulated 

 manner, points out, the beneficial results of inoculation had robbed 

 the disease of its terrors to so great an extent that the rich and powerful 

 no longer made the efforts which they formerly did to prevent its 

 entrance into, or its spread in, their neighbourhood, and thus favoured 

 its spread among the unprotected poor ; so that inoculation " though 

 eminently useful to the rich appeared to be injurious to the poor." 

 Adding, therefore, together the cases of inoculated small-pox, and the 



