V. Child Health

In the early eighteenth century, medically speaking the concept of child health hardly existed. Children, though they suffered particularly from the absence of medical knowledge and from various epidemics, were treated like their elders. Young and old alike fought sick- ness by drinking exotic concoctions of herbs and other vegetable and animal matter and by alternately dieting and bleeding, purging and sweating. Two eminent physicians and practical philosophers, John Locke and William Cadogan, advised parents to preserve their children's health by hardening them to the environment. Cadogan wrote encouragingly, "There are many instances, both ancient and modern, of infants exposed and deserted, that have lived several days." [1a]

Whether from this advice or for other reasons, the mortality rate for infants and children was high. "Tis a frequent thing for parents to bury their children," said Cotton Mather in 1711. "Else we could not see, as they say we do, at least half the children of men dying short of twenty." [1b] Smallpox, diphtheria, and yellow fever appeared in epidemic forms and, of these, diphtheria particularly affected children. Those children who survived epidemics were some- times left without one or both parents. The prevailing belief that original sin was the ultimate cause of illness often discouraged remedial action such as inoculation of children against smallpox. On the other hand, Mather, a firm believer in original sin, surmounted dogma to support inoculation. Still, in 1735 a diphtheria epidemic, particularly severe among younger people in Kingston, New Hampshire, was attributed to "the holy displeasure of almighty God."

The dismal state of obstetrical care also contributed to the high rate of infant and maternal mortality. Pregnant women were left to the care of often ignorant and superstitious midwives and, as a result, they frequently perished along with their infants. After 1750, this tragedy was partially mitigated with the introduction of English obstetrical methods based upon better knowledge of gestation and delivery. William Smellie, the leading English authority on midwifery, trained or influenced many of the first American obstetricians, including James Lloyd of Boston, William Shippen, Jr., of Philadelphia, and William Moultrie of Charlestown.

Children who escaped unskilled midwives often suffered at the hands of ignorant doctors. "Our practitioners deal much in quackery and quackish medicines," wrote the Boston physician William Douglass in 1751. [1c] To fight quackery, New York City (ca. 1760) and the province of New Jersey (1772) adopted examination and licensing programs for physicians. Here too developments in English medicine improved American practice. Many skilled Scottish physicians like William Moultrie emigrated to the colonies seeking better opportunities than were available to them in Britain.

During the latter half of the eighteenth century, some children also benefited from the availability and improved quality of hospital care in a few urban centers. Hospital departments existed in the larger public almshouses prior to this time, but the first charter for a hospital was issued in 1751 to Dr. Thomas Bond and the other founders of the Pennsylvania Hospital. Modeled after English hospitals, this institution admitted charity cases while depending upon philanthropic donors and fee paying patients. New York Hospital, a similar institution built "upon the plan of the Royal Infirmiry at Edinburgh," was destroyed by fire shortly before its scheduled opening in 1775 but was rebuilt in 1791 with the aid of state and city funds. In 1765 children began to benefit specifically from the Pennsylvania Hospital when Dr. William Shippen, Jr., opened a private school of midwifery; however, a lying-in department was not officially added to the hospital until 1803.

Similarly, children profited from the improved professional standards which resulted from the founding of medical schools at the College of Philadelphia (1765), King's College (1767), and Harvard University (1782). Here, practitioners began to develop obstetrics and child care into fields of specialized and precise inquiry. Dr. Samuel Bard of Columbia, formerly King's College, gave an original account of diphtheria; Benjamin Rush, the leading clinician of his time and a member of the staff of both the College of Philadelphia and its successor, the University of Pennsylvania, described cholera infantum and influenza. In 1796 Rush's pupil, Charles Caldwell, wrote the first monograph on pediatrics to be submitted as a dissertation for the medical degree.

The most important medical advance of the early nineteenth century was the prevention and control of smallpox by vaccination, introduced into this country by Benjamin Waterhouse of Harvard Medical School. In contrast to the response to inoculation, vaccination was gratefully accepted, not only by the medical profession but also by the public and by the national and state governments. Waterhouse was less interested in the moral condition of the sufferer and more concerned with "the unspeakable advantages that might accrue to this country" with the development of the technique. Vaccination, therefore, represented both a medical breakthrough and a change in attitudes toward disease.

1a. William Cadogan, "An Essay upon Nursing and the Management of Children, from their Birth to Three Years of Age," in Logan Clendening, comp., Sourcebook of Medical History (New York, 1942), p.270.

1b. Cotton Mather, Orphanotrophium. Or, Orphans Well-provided for (Boston, 1711), p. 11.

1c. William Douglass, A Summary, Historical and Political, of the First Planting, Progressive Improvements, and Present State of the British Settlements in North America; . . , II (Boston, 1751), 351-352.

1. John Locke's rules for preserving and improving health in children, 1690.

Locke, "Some Thoughts Concerning Education," Works, IX, section 4-7, 23, 27.

Locke was a physician as well as philosopher. He wrote this essay in 1690 with the needs of a young English gentleman in mind, but his advice on raising healthy, reasonable children was pertinent to the simpler social and cultural setting of the American colonies in the eighteenth century.

The consideration I shall here have, of health, shall be, not what a physician ought to do, with a sick or crazy child; but what the parents, without the help of physic, should do for the preservation and improvement of an healthy, or, at least, not sickly constitution, in their children: and this perhaps might be all despatched in this one short rule; viz. that gentlemen should use their children as the honest farmers and substantial yeomen do theirs. But because the mothers, possibly, may think this a little too hard, and the fathers, too short, I shall explain myself more particularly; only laying down this, as a general and certain observation for the women to consider, viz. that most children's constitutions are either spoiled, or at least harmed, by cockering and tenderness.

The first thing to be taken care of is, that children be not too warmly clad or covered, winter or summer. The face, when we are born, is no less tender than any other part of the body: it is use alone hardens it, and makes it more able to endure the cold. . . Our bodies will endure any thing, that from the beginning they are accustomed to.

Give me leave, therefore, to advise you not to fence too carefully against the cold of this our climate: there are those in England, who wear the same clothes winter and summer, and that without any inconvenience, or more sense of cold than others find. But if the mother will needs have an allowance for frost and snow, for fear of harm, and the father, for fear of censure, be sure let not his winter-clothing be too warm; and amongst other things remember, that when nature has so well covered his head with hair, and strengthened it with a year or two's age, that he can run about by day without a cap, it is best that by night a child should also lie without one; there being nothing that more exposes to head-ach, colds, catarrhs, coughs, and several other diseases, than keeping the head warm.

I have said [he] here, because the principal aim of my discourse is, how a young gentleman should be brought up from his infancy, which in all things will not so perfectly suit the education of daughters; though, where the difference of sex requires different treatment, it will be no hard matter to distinguish.

I would also advise his feet to be washed every day in cold water; and to have his shoes so thin, that they might leak and let in water, whenever he comes near it. Here, I fear, I shall have the mistress, and maids too, against me. One will think it too filthy; and the other, perhaps, too much pains to make clean his stockings. But yet truth will have it, that his health is much more worth than all such considerations, and ten times as much more. And he that considers how mischievous and mortal a thing taking wet in the feet is, to those who have been bred nicely, will wish he had, with the poor people's children, gone barefoot; who, by that means, come to be so reconciled by custom, to wet their feet, that they take no more cold or harm by it than if they were wet in their hands. And what is it, I pray, that makes this great difference between the hands and the feet in others, but only custom? I doubt not, but if a man from his cradle had been always used to go barefoot, whilst his hands were constantly wrapped up in warm mittins, and covered with handshoes, as the Dutch call gloves; I doubt not, I say, but such a custom would make taking wet in his hands as dangerous to him, as now taking wet in their feet is to a great many others. The way to prevent this, is to have his shoes made so as to leak water, and his feet washed constantly every day in cold water. It is recommendable for its cleanliness: but that, which I aim at in it, is health. And therefore I limit it not precisely to any time of the day. I have known it used every night with very good success, and that all the winter, without the omitting it so much as one night, in extreme cold weather: when thick ice covered the water, the child bathed his legs and feet in it; though he was of an age not big enough to rub and wipe them himself; and when he began this custom, was puling and very tender. But the great end being to harden those parts, by a frequent and familiar use of cold water, and thereby to prevent the mischiefs that usually attend accidental taking wet in the feet, in those who are bred otherwise; I think it may be left to the prudence and convenience of the parents, to choose either night or morning. The time I deem indifferent, so the thing be effectually done. The health and hardiness procured by it would be a good purchase at a much dearer rate. To which if I add the preventing of corns, that to some men would be a very valuable consideration. But begin first in the spring with lukewarm, and so colder and colder every time, till in a few days you come to perfectly cold water, and then continue it so, winter and summer. For it is to be observed in this, as in all other alterations from our ordinary way of living, the changes must be made by gentle and insensible degrees; and so we may bring our bodies to any thing, without pain, and without danger.

One thing more there is, which hath a great influence upon the health, and that is going to stool regularly; people that are very loose have seldom strong thoughts, or strong bodies. But the cure of this, both by diet and medicine, being much more easy than the contrary evil, there needs not much to be said about it; for if it come to threaten, either by its violence or duration, it will soon enough, and sometimes too soon, make a physician be sent for: and if it be moderate or short, it is commonly best to leave it to nature. On the other side, costiveness has too its ill effects, and is much harder to be dealt with by physic; purging medicines, which seem to give relief, rather increasing than removing the evil.

I would therefore advise, that this course should be taken with a child every day, presently after he has eaten his breakfast. Let him be set upon the stool, as if disburdening were as much in his power as filling his belly; and let not him or his maid know any thing to the contrary, but that it is so: and if he be forced to endeavour, by being hindered from his play, or eating again till he has been effectually at stool, or at least done his utmost, I doubt not but in a little while it will become natural to him. For there is reason to suspect that children being usually intent on their play, and very heedless of any thing else, often let pass those motions of nature, when she calls them but gently; and so they, neglecting the seasonable offers, do by degrees bring themselves into an habitual costiveness. That by this method costiveness may be prevented, I do more than guess: having known, by the constant practice of it for some time, a child brought to have a stool regularly after his breakfast, every morning.

2. "Children in general are over-cloathed and over-fed"

William Cadogan, "An Essay upon Nursing and the Management of Children, from their Birth to Three Years of Age," in Clendening, Sourcebook of Medical History, pp. 269-273.

Cadogan (1711-1797), a London physician who specialized in cures for gout, wrote this treatise in 1748. It was well received in both England and the colonies.

You perceive, Sir, by the hints I have al- ready dropped, what I am going to complain of is, that Children in general are over-cloathed and over-fed; and fed and cloathed improperly. To these causes I impute almost all their diseases. But to be a little more explicit. The illst great mistake is, that they think a new-born infant cannot be kept too warm: from this prejudice they load and bind it with flannels, wrappers, swathes, stays, &c. which altogether are almost equal to it's own weight; by which means a healthy child in a month's time is made so tender and chilly, it cannot bear the external air; and if, by any accident of a door or window left carelessly open too long, a refreshing breeze be admitted into the suffocating atmosphere of the lying-in bed-chamber, the child and Mother sometimes catches irrecoverable colds. But, what is worse than this, at the end of the month, if things go on apparently well, this hotbed plant is sent out into the country to be reared in a leaky house, that lets in wind and rain from every quarter. Is it any wonder the child never thrives afterwards? The truth is, a new-born Child cannot well be too cool and loose in its dress; it wants less cloathing than a grown person in proportion, because it is naturally warmer, as appears by the thermometer, and would therefore bear the cold of a winter's night much better than any adult person whatever. There are many instances, both antient and modern, of infants exposed and deserted, that have lived several days. As it was the practice of antient times, in many parts of the world, to expose all those whom the parents did not care to be incumbered with; that were deformed, or born under evil stars; not to mention the many Foundlings picked up in LONDON streets. These instances may serve to shew, that Nature has made Children able to bear even great hardships, before they are made weak and sickly by their mistaken Nurses. But, besides the mischief arising from the weight and heat of these swaddling-cloaths, they are put on so tight, and the Child is so cramped by them, that its bowels have not room, nor the limbs any liberty, to act and exert themselves in the free easy manner they ought. This is a very hurtful circumstance; for limbs that are not used will never be strong, and such tender bodies cannot bear much pressure: the circulation restrained by the compression of anyone part, must produce unnatural swellings in some other, especially as the fibres of infants are so easily distended. To which doubtless are owing the many distortions and deformities we meet with everywhere; chiefly among Women, who suffer more in this particular than the Men.

I would recommend the following dress: A little flannel waistcoast, without sleeves, made to fit the body, and tie loosely behind; to which there should be a petticoat sewed, and over this a kind of gown of the same material, or any other that is light, thin, and flimsey. The petticoat should not be quite so long as the Child, the gown a few inches longer; with one cap only on the head, which may be made double if it be thought not warm enough. What I mean is, that the whole coiffure should be so contrived, that it might be put on at once, and neither bind nor press the head at all: the linen as usual. This I think would be abundantly sufficient for the day; laying aside all those swathes, bandages, stays, and contrivances that are most ridiculously used to close and keep the head in it's place, and support the body. As if Nature, exact Nature, had produced her chief work, a human creature, so carelessly unfinished as to want those idle aids to make it perfect. Shoes and stockings are very needless incumbrances, besides that they keep the legs wet and nasty, if they are not changed every hour, and often cramp and hurt the feet: a child would stand firmer, and learn to walk much sooner without them. I think they cannot be necessary till it runs out in the dirt. There should be a thin flannel shirt for the night, which ought to be every way quite loose. Children in this simple, pleasant dress, which may be readily put on and off without teazing them, would find themselves perfectly easy and happy, enjoying the free use of their limbs and faculties, which they would very soon begin to employ when they are thus left at liberty. I would have them put into it as soon as they are born, and continued in it till they are three years old; when it may be changed for any other more genteel and fashionable: tho' I could wish it was not the custom to wear stays at all; not because I see no beauty in the sugar-loaf shape, but that I am apprehensive it is often procured at the expence of the health and strength of the body. There is an odd notion enough entertained about change, and the keeping of children clean. Some imagine that clean linen and fresh cloaths draw, and rob them of their nourishing juices. I cannot see that they do any thing more than imbibe a little of that moisture which their bodies exhale. Were it, as is supposed, it would be of service to them; since are always too abundantly supplied, and therefore I think they cannot be changed too often, and would have them clean every day; as it would free them from stinks and sournesses, which are not only offensive, but very prejudicial to the tender state of infancy.

The feeding of Children properly is of much greater importance to them than their cloathing. We ought to take great care to be right in this material article, and that nothing ,be given them but what is wholesome and good for them, and in such quantity as the body calls for to- wards it's support and growth; not a grain more. Let us consider what Nature directs in the case: if we follow Nature, instead of leading or driving it, we cannot err. In the business of Nursing, as well as Physick, Art is ever destructive, if it does not exactly copy this original. When a Child is first born, there seems to be no provisions at all made for it; for the Mother's milk, as it is now managed, seldom comes till the third day; so that according to this appearance of Nature a Child would be left a day and a half, or two days, without any food. Were this really the case, it would be a sufficient proof that it wanted notte; as indeed it does not immediately; for it is born full of blood, full of excrement, it's appetites not awake, nor it's senses opened; and requires some intermediate time of abstinence and rest to compose and recover the struggle of the birth and the change of circulation (the blood running into new channels), which always put it into a little fever. However extraordinary this might appear, I am sure it would be better that the Child was not fed even all that time, than as it generally is fed; for it would sleep the greatest part of the time, and, when the milk was ready for it, would be very hungry, and suck with more eagerness; which is often necessary, for it seldom comes freely at first. But let me endeavour to reconcile this difficulty, that a Child should be born thus apparently unprovided for. I say apparently, for in reality it is not so. Nature neither intended that a Child should be kept so long fasting, nor that we should feed it for her. Her design is broke in upon, and a difficulty raised that is wholly owing to mistaken management. The Child, as soon as it is born, is taken from the Mother, and not suffered to suck till the Milk comes of itself; but is either fed with strange and improper things, or put to suck some other Woman, whose Milk flowing in a full stream, over- powers the newborn infant, that has not yet learnt to swallow, and sets it a coughing, or gives it a hiccup; the Mother is left to struggle with the load of her Milk, unassisted by the sucking of the Child. Thus two great evils are produced, the one a prejudice to the Child's health, the other, the danger 'of the Mother's life, at least the retarding her recovery, by causing what is called a milk-fever; which has been thought to be natural, but so far from it, that it is entirely owing to this misconduct. I am confident, from experience, that there would be no fever at all, were things managed rightly; were the Child kept without food of any kind, till it was hungry, which it is impossible it should be just after the birth, and then applied to the Mother's breasts; it would suck with strength enough, after a few repeated trials, to make the milk flow gradually, in due pro- portion to the Child's unexercised faculty of swallowing, and the call of it's stomach. Thus the Child would not only provide for itself the best of nourishment, but, by opening a free passage for it, would take off the Mother's load, as it increased, before it could oppress or hurt her; and therefore effectually prevent the fever; which is caused only by the painful distension of the lacteal vessels of the breasts, when the milk is injudiciously suffered to accumulate. . . .

There is usually milk enough with the first Child; sometimes more than it can take: it is poured forth from an exuberant, overflowing urn, by a bountiful hand, that never provides sparingly. The call of Nature should be waited for to feed it with any thing more substantial, and the appetite ever precede the food; not only with regard to the daily meals, but those changes of diet, which opening, increasing life requires. But this is never done in either case, which is one of the greatest mistakes of all Nurses. Thus far Nature, if she be not interrupted, will do the whole business perfectly well; and there seems to be nothing left for a Nurse to do, but to keep the Child clean and sweet, and to tumble and toss it about a good deal, play with it, and keep it in good humour.

When the Child requires more solid sustenance, we are to enquire what, and how much, is most proper to give it. We may be well assured, there is a great mistake either in the quantity or quality of Children's food, or both, as it is usually given them; because they are made sick by it; for to this mistake I cannot help imputing nine in ten of all their diseases. . . .

It is not common for people to complain of ails they think hereditary, 'till they are grown up; that is, 'till they have contributed to them by their own irregularities and excesses, and then are glad to throw their own faults back upon their Parents, and lament a bad constitution, when they have spoiled a very good one.

The inoculation controversy, Boston, 1721

Cotton Mather, although patiently submitting to the will of God, was quick to adopt and advocate measures to avert un- necessary death. During the severe smallpox epidemic of 1721, Mather, concerned about the safety of his children, induced  Dr. Zabdiel Boylston to try the experiment of inoculation as a means of preventing fatal cases of the disease. Boylston inoculated both his own and Mather's children. For many years after 1721 the practice of inoculation remained a controversial issue, defended and attacked on both theological and medical grounds. [2a]

2a. On the inoculation controversy see John Duffy, Epidemics in Colonial America (Baton Rouge, 1953), pp. 23-40.

1. The introduction of smallpox inoculation, 1721

Zabdiel Boylston, An Historical Account of the Smallpox Inoculated in New Eng- land, Upon All Sorts of Persons, Whites, Blacks, and of All Ages and Constitutions . . . (London, 1726; Boston, 1730), pp. ii-vi.

I began the practice indeed from a short consideration thereof; for my children, whose lives were very dear to me, were daily in danger of taking the infection, by my visiting the sick in the natural way; and although there arose such a cloud of opposers at the beginning, yet finding my account in the success, and easy circumstances of my patients (with the encouragement of the good ministers), I resolved to carry it on for the saving of lives, not regarding any, or all the menaces, and opposition that were made against it.

I have not, in this practice, left room for anyone to cavil, and say, that my experiments have not been fair, and full proofs, that inoculating the smallpox is a certain means of moderating that distemper, to the greatest demonstration. This, the warmest opposers of that practice, who have seen any fair trials made, are convinced of; and the only difficulty of convincing all mankind, is how to make them eye-witnesses to a number sick of the small- pox in both ways of infection; and this would do it at once, and very much to their satisfaction in, and approbation of this method. And here it should be considered how rashly our patients, even whole families together, rushed into this practice. . .

I have not used this practice only to the healthful and strong, but to the weak and diseased, the aged and the young. Not only to the rich, but have carried it into the houses of the poor, and laid down whole families; and though through my own hurry in business, and their living out of town, I have been forced to leave them to the management of unexperienced nurses, yet they all did well.

We met with no . . . terrible effects (save that death is terrible in all its shapes) from the smallpox inoculated, as was common amongst us in the natural way, viz. purple spots, convulsion fits, bloody urine, violent inflammations in the eyes, throat, and other parts, scarred faces, some who had lost both eyes, and, as it has been thought, near an hundred one eye, with many more melancholy symptoms too tedious here to enumerate; not to mention parents being left childless, children without parents, and sometimes parents and children's being both carried off, and many families broken up by the destruction the smallpox made in the natural way. Indeed, we had some resemblance of those effects; but in none where it was not evident, that they were infected in the natural way before; and though we met with but five or six cases that bordered on, or resembled more or less those symptoms, yet it would not have been strange had there been six times that number; for in Boston, and in the middle of Roxbury, no one knew who were, or who were not infected, before inoculated; and I verily believe that twenty five, if not thirty of my patients were infected before inoculated. And this reason I can give for every one's believing so, that in all and everyone whom I inoculated, and that had not been ex- posed to an infected air, and which were above one hundred, not any of them had the least shadow of such symptoms upon them, through the whole course of their distemper. However, I do not recommend this practice to be carried on and managed by old women and nurses; no, I would have it carried on and managed by good physicians and surgeons, where they are to be had; but rather than the people should be left a prey to the smallpox in the natural way, let it be managed by nurses, for I cannot help thinking that even in their hands, many less would die of the smallpox by inoculation, than there does in the natural way, though in the best of hands, and under the best of care.

I do not call upon or exhort the physicians and surgeons who are already in the practice, and have used their endeavors to promote it, nor do I pretend to inform or instruct them. My design is only to stir up ,.those who have not yet come into and used this method, and to lay before the people a fair state of the distemper in both ways of infection, that they may be apprized of the danger in the one, and the reasonable expectation they have of doing well in the other. My reasonings and opinions I submit to those of better judgment, but as we are rational creatures, we do, or should delight in acting upon principles of reason; and those who consider this method, and make use of it, I think may be said so to act.

I hope the reader will excuse me for troubling him with some of the difficulties that I met with. I have been basely used and treated by some who were enemies to this method, and have suffered much in my reputation and in my business too, from the odiums and reflections cast upon me for beginning and carrying on this practice in New England; which ill usage I think justly entitles me to make the necessary reflections, and relate matters of fact in my own justification, and to recommend and do justice to the method, which was so exposed and condemned by their misrepresentations, which have been spread abroad in the world; and to set things in a good light, that the world may impartially judge between the parties (if I may be allowed the term) which of the two have acted most like men and Christians, viz. whether those who have opposed and ex- claimed against this method without due consideration of, or knowing scarce anything about it; or those who have considered well, been in the practice of, and have proved by their own experience, or that have seen the good effects and benefit of it, and from such reasons have recommended it to others?

Indeed I can easily forgive and pity those who through tenderness, or in point of con- science, have refused the offered mercy, and that have gently appeared against it. Such, with the assistance of a divine, together with the exercise of their own reason upon it, may easily get through their difficulties. But for those who out of private piques, or views, have exclaimed and railed against it, and who have trumpt up the groundless ill consequences that would attend or follow it. Such I leave to sweat it out with just reflection and due repentance. As for my own part, I know of no better way of judging between moral and immoral methods of medical practice, than from the good or ill success that does, or may attend them.

2. Inoculation is a "lawful practice and . . . has been blessed by GOD," 1721

Increase Mather, Several Reasons Proving that Inoculating or Transplanting the Small Pox, is a Lawful Practice, and that it has been Blessed by God for the Saving of Many a Life (Boston, 1721).

It has been questioned, whether inoculating the small pox be a lawful practice. I incline to the affirmative, for these reasons.

I. Because I have read, that in Smyrna, Constantinople, and other places, thousands of lives have been saved by inoculation, and not one of thousands has miscarried by it. This is related by wise and learned men who would not have imposed on the world a false narrative. Which also has been published by the Royal Society; therefore a great regard is due to it.

II. We hear that several physicians, have recommended the practice hereof to His Majesty, as a means to preserve the lives of his subjects, and that His wise and excellent Majesty King George, as also His Royal Highness the Prince have approved hereof, and that it is now coming into practice in the nation. In one of the public prints are these words, "Inoculating the small pox is a safe and universally useful experiment." Several worthy persons lately arrived from England inform us, that it is a successful practice there: If wise and learned men in England, declare their approbation of this practice, for us to declare our disapprobation will not be for our honor.

III. GOD has graciously owned the practice of inoculation, among us in Boston, where some scores, yes above an hundred have been inoculated, and not one miscarried; but they bless GOD, for His discovering this experiment to them. It has been objected, that one that was inoculated, died, viz. Mrs. D---- ; but she had the small pox, in the common way before, and her friends and nearest relations declare that she received no hurt by inoculation, but was by a fright put into fits that caused her Death. It is then a wonderful providence of GOD, that all that were inoculated should have their lives preserved; so that the safety and usefulness of this experiment is confirmed to us by ocular demonstration: I confess I am afraid, that the discouraging of this practice, may cause many a life to be lost, which for my own part, I should be loth to have any hand in, because of the Sixth Commandment.

IV. It cannot be denied but that some wise and judicious persons among us, approve of inoculation, both magistrates and ministers; among ministers I am one, who have been a poor preacher of the gospel in Boston above threescore years, and am the most aged, weak and unworthy minister now in New England. My sentiments, and my son's also, about this matter are well known. Also we hear that the reverend and learned Mr. Solomon Stoddard of Northampton concurs with us; so doth the Reverend Mr. Wise of Ipswich, and many other younger divines, not only in Boston, but in the country, join with their fathers. Furthermore, I have made some inquiry, whether there are many persons of a profane life and conversation, that do approve and defend inoculation, and I have been answered, that they know but of very few such. This is to me a weighty consideration. But on the other hand, though there are some worthy persons, that are not clear about it; nevertheless, it cannot be denied, but that the known children of the wicked one, are generally fierce enemies to inoculation. . . For my part I should be ashamed to join with such persons; O my soul come not thou into their secret, unto their assembly be not thou united. I am far from reflecting upon all that are against inoculation. I know there are very worthy persons (with whom I desire to live and die) that are not clear in their judgments for it, and they are greatly to be commended and honored in that they will not act against a doubting conscience; yet it may be some of them might change their minds, if they would advise with those who are best able to afford them scripture light in this as well as in other cases of conscience.

A most successful, and allowable method of preventing Death, and many other grievous miseries, by the small pox, is not only lawful but a Duty, to be used by those who apprehend their lives immediately endangered by the terrible distemper.

3. A physician's criticism of "inoculation, practised at random," 1722

Jared Sparks, ed., "Letters from Dr. William Douglass to Dr. Cadwallader Colden of New York," in Collections of the Massachusetts Historical Society, 4th ser., 11(1854),168-171; hereafter cited as MHS Collections.

William Douglass (ca. 1691-1752), born in Scotland and trained in medicine in Edinburgh, Leyden, and Paris, settled in Boston in 1718. For a fuller statement of his views see A Dissertation Concerning Inoculation of the Small-Pox (Boston, 1730). By 1751 he had become convinced of the beneficial results of the practice of inoculation. Cadwallader Colden (1688-1776), a noted botanist and physicist, was a leading advocate of public health measures in New York City. He served as lieutenant-governor of the colony from 1760 to 1774.

May 1,1722.

After nineteen years intermission we received via Saltertudas from Barbadoes the small-pox, middle of April 1721, and by the January following it was nearly over, having affected only Boston and two or three adjacent Towns. . .

Our small-pox burials were as follows, May 1; June 8; July 20; August 26; September 101; October 402; November 249; December 31; January 6; in all 844 persons in Boston. Last February an exact scrutiny was made, it was found that Boston consisted of 10,565 souls whereof 6,000 have now had the small-pox and of those 899 dyd; about 700 who never had it escaped and a few who remained in the country are free of it.

Having, sometime before the small-pox arrived, lent to a credulous vain preacher Mather, Jr., the philosophical Transactions No. 339 and 377 which contain Timonius' and Pylermus' accounts of Inoculation from the Levant; that he might have something to send home to the Royal Society who had long neglected his communications as he complained; he sets inoculation to work in month of June; by 18th of November one hundred were inoculated, and by January in all some few more than 250 in Town and Country. Whereof some have been inoculated oftener than once before it took effect; with some it never wrought; they all complained much of head disorders, even with those who had but very few and these imperfect pustules their incisions grew up in a few days as in common superficial wounds of the skin; but about the seventh or eighth day generally they begin to complain (some few sooner or later), are feverish, their incisions inflame, open, and discharge profusely with a peculiar noisome fetor, and continue running some weeks after their small-pox pimples are dried up and they abroad about their affairs infect wherever they go (this spreading the infection and consequently rendering it more intense is a great objection against inoculation practised at random in a place whose greatest part of the people are liable to the distemper). We all knew of nine or ten inoculation deaths besides abortions that could not be concealed, we suspect more who died in the height of the small-pox, it being only known to their nearest relations whether they died of inoculation or in the natural way. . .

I oppose this novel and dubious practice not being sufficiently assured of its safety and consequences; in short I reckon it a sin against society to propagate infection by this means and bring on my neighbor a distemper which might prove fatal and which perhaps he might escape (as many have done) in the ordinary way, and which he might certainly secure himself against by removal in this Country where it prevails seldom. However many of our clergy had got into it and they scorn to retract; I had them to appease, which occasioned great heats (you may perhaps admire how they reconcile this with their doctrine of predestination) . . . Our People at present are generally averse to it.

July 25,1722. We are now clear of the small-pox, and inoculation here made a poor exit; for the last six inoculated persons were in danger of violence from the people. They were by warrant of the Justices removed out of the town and sent two leagues down the Bay to an island, and were afterwards, though well, confined there by a resolve of the Assembly till the beginning of July; the three grown persons were very full of the small-pox, one of them was in danger of his life, the three children had the distemper favorable. The number of all that have been inoculated in New-England is circiter 240 persons.

1. Measles in New York City, 1729

James Alexander to Cadwallader Colden, March 14 and March 26, 1729, Cadwallader Colden Papers, I, Collections of the New-York Historical Society (1917), 276-277.

Alexander (1691-1756) was a New York lawyer and member of the Council of New York.

[March 14, 1729]

There was never So great a mortality here Since I came to this place as now, theres no day but what theres numbers of buryings, Some of the measles but most of the pain of the Side there's hardly a house in town but what had severals Sick of the one or other of these Distempers Some have half a Score at a time four of our children have had the Measles two almost quite recovered two Sick as yet, our negro Jupiter had them Struck out yesterday which is comeing more deliberatly than in most other familys we have three children more & three more negroes which we Expect Every day to have them, So you may Easyly think the town is in not a little Distress

[March 26, 1729]

My wife is brought Low with the Measles & dare not come out of her room yet, Johnie is ill of a Relapse after them, Mattie's measles were at the height yesterday but I think is in no danger, Jammee was dangerously ill, but now Sets up & plays, Billie was taken yester- night wt a fever I Suppose its the Measles, my children at Nurse have had them & are not quite recovered yet, four of our Negroes have the Measles, & one we are afraid is getting them this day, So that there is but davie & my Self of whites & one black wench that I can call well in our family, but if Something alleviats the Distress that we are not Singular few families in toun being much better off, In all my days I never saw So generall a Sickness in a place nor a greater mortality

2. A public fast for "the younger people [that] have been removed by death," in the "throat distemper" epidemic, 1735

Massachusetts Bay (Province), Governor, Bv His Excellency Jonathan Belcher, Esq. Captain-General and Governour in Chief,

In and Over His Majesty's Province of the Massachusetts-Bay in New England. A Proclamation for a Publick Fast (Boston,

1735).

The fast was proclaimed on the occasion of the first major epidemic of "throat distemper" (diphtheria and scarlet fever), which broke out in Kingston, New Hampshire, in May 1735 and gradually spread through New England. The chief victims were young children. In the parish of Hampton Falls, New Hampshire, twenty families buried all their children. Within one year the community lost 210 persons out of a population of about 1,200; 95 per cent of the victims were below the age of twenty. [3a]

Whereas among other tokens of the holy displeasure of almighty GOD towards this sinful people, He hath been pleased to visit several of the towns within this province with a very unusual, malignant and mortal distemper, by which great numbers, especially of the younger people, have been removed by death; and there is great danger that the said sickness will become more epidemical so as to spread throughout the land.

I have therefore thought fit, with the advice of Majesty's Council, and at the desire of the representatives, in the present session, to appoint Thursday the eighth day of January next, to be observed as a day of solemn prayer and humiliation with fasting, throughout this province; hereby, exhorting both ministers and people devoutly to attend the same, by humble and penitent confession of their sins, and sincere and fervent supplications to the GOD of all grace, that in his infinite mercy, he would spare this unworthy people, and put a stop to the progress of this mortal distemper, or restrain the malignity thereof, and command the destroying angel to stay his hand; and above all, that he would sanctify this visitation to the spiritual good and advantage of this people; and that the fruit of all may be to purge away our sin and make us the partakers of his holiness; that he would pour out his holy spirit upon all orders of men among us, and especially on the rising generation, that they may seek the Lord GOD of their fathers, and serve Him with a perfect heart and willing mind; and likewise that he would be pleased to give light and direction to the government of this province in all their administrations, and graciously protect all our religious and civil interests: And that he would hasten the coming and kingdom of our lord and saviour JESUS CHRIST, and fill the whole earth with his glory.

3a.  Duffy, Epidemics in Colonial America, pp. 117- 118.

3. Worm fever in South Carolina, 1770

D. Milligan, "A Short Description of the Province of South Carolina," in B. R. Carroll, comp., Historical Collections of South Carolina, II (1836),511.

Worm-fevers are very frequent, and common to all ages, though children under 5 years of age suffer most, particularly in the spring and beginning of summer. The sweet potato, Indian corn or maize, and pompion, all much used in diet, seem to have a larger share of the eggs of these mischievous insects, than the rest of the farinaceous or leguminous kind.

When a fever, in young people particularly, is attended with irregular symptoms, and is of a longer duration than usual, not easily otherwise accounted for, we may be assured that worms are the cause of them: In such cases I know of no medicine more likely to be of service than the decoction of pink-root. . . to be continued till the disease terminates; blisters, and other medicines proper for particular symptoms that may occur, are not to be neglected.

4. Yellow fever in Philadelphia, 1793

Benjamin Rush, An Account of the Bilious Remitting Yellow Fever, as it Appeared in the City of Philadelphia, in the Year 1793

. . . (Philadelphia, 1794), pp. 122-128.

Between 1760 and 1793 the United States was free of yellow fever. In the latter year a fearful epidemic of the disease broke out in Philadelphia. One-tenth of the city's population died in the epidemic. Benjamin Rush (1745-1813) was the city's leading physician, a prolific writer, and promoter of humanitarian reforms. The practice of "depletion" (heavy bleeding) which Rush advocated and employed probably helped increase mortality rates in the epidemic.

Thus far have I delivered the history of the yellow fever as it affected the human body with sickness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked, that the first reports of the existence of this fever were treated with neglect or contempt. A strange apathy pervaded all classes of people. While I bore my share of reproach for "terrifying our citizens with imaginary danger," I answered it by lamenting "that they were not terrified enough." The publication from the college of physicians soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, remote from the spot where it originated; although in every instance it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crowded with families flying in every direction for safety to the country. Business began to languish. Water Street between Market and Race Streets became a desert. The poor were the first victims of the fever. From the sudden interruption of business, they suffered for awhile from poverty, as well as disease. A large and airy house at Bush-hill about a mile from the city, was opened for their reception. This house, after it became the charge of a committee appointed by the citizens on the 14th of September, was regulated and governed with the order and cleanliness of an old and established hospital. An American and French physician had the exclusive medical care of it after the 22d of September.

The contagion after the second week in September, spared no rank of citizens. Whole families were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians from the desertion of some, and the sickness and death of others. At one time, there were only three physicians who were able to do business out of their houses, and at this time, there were probably not less than 6,000 persons ill with the fever.

During the first three or four weeks of the prevalence of the disorder, I seldom went into a house the first time, without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlor, who came to ask for advice for their relations. Grief, after awhile descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends, without shedding a tear, or manifesting any other of the common signs of grief. .

A cheerful countenance was scarcely to be seen in the city for six weeks. I recollect once in entering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear upon my recovery, that the father and mother of this little creature died, a few days after my last visit to them.

The streets everywhere discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading, or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night.

But a more serious source of the distress of the city arose from the dissentions of the physicians, about the nature and treatment of the fever. It was considered by some, as a modification of the influenza, and by others as the jail fever. Its various grades, and symptoms were considered as so many different diseases, all originating from different causes. There was the same contrariety in the practice of the physicians that there was in their principles. The newspapers conveyed accounts of both to the public every day. The minds of the citizens were distracted by them, and hundreds suffered and died from the delays which were produced by an erroneous opinion of a plurality of diseases in the city, or by indecision in the choice, or a want of confidence in the remedies of their physician.

The science of medicine is related to everything, and the philosopher as well as the Christian will be gratified by knowing the effects of a great and mortal epidemic upon the morals of a people. It was some alleviation of the distress produced by it, to observe its influence upon the obligations of morality and religion. It was remarked during this time, by many people that the name of the Supreme Being was seldom profaned either in the streets, or in the intercourse of the citizens with each other. Two robberies only, and those of a trifling nature, occurred in nearly two months, although many hundred houses were exposed to plunder, every hour of the day and night. Many of the religious societies met two or three times a week, and some of them every evening, to implore the interposition of heaven to save the city from desolation. Humanity and charity kept pace with devotion. The public have already seen accounts of their benevolent exercises in other publications. It was my lot to witness the uncommon activity of those virtues upon a smaller scale. I saw little to blame, but much to admire and praise in persons of different professions, both sexes, and of all colors. It would be foreign to the design of this work, to draw from the obscurity which they sought, the many acts of humanity and charity, of fortitude, patience, and perseverance which came under my notice. They will be made public, and applauded elsewhere.

But the virtues which were excited by our calamity, were not confined to the city of Philadelphia. The United States wept for the distresses of their capital. In several of the states, and in many cities, and villages, days of humiliation and prayer were set apart to sup- plicate the father of mercies in behalf of our afflicted city. Nor was this all. From nearly every state in the union, the most liberal contributions of money, provisions, and fuel, were poured in for the relief and support of such as had been reduced to want, by the suspension of business, as well as by sickness, and the death of friends.

1. Dr. William Shippen, Jr., of Philadelphia proposes a course in midwifery

Pennsylvania Gazette, Jan. 31, 1765.

Shippen (1736-1808) received his M.D. at Edinburgh in 1761. His first class, held at the Pennsylvania Hospital, stimulated the establishment of the Medical School of the College of Philadelphia (1765), later the University of Pennsylvania. In 1791 Shippen was appointed professor of anatomy, surgery and midwifery at the University.

Dr. Shippen Jr., having been lately called to the assistance of a number of women in the country, in difficult labors, most of which was made so by the unskillful old women about them, the poor women having suffered extremely, and their innocent little ones being entirely destroyed, whose lives might have been easily saved by proper management, and being informed of several desperate cases in the different neighborhoods which had proved fatal to the mothers as to their infants, and were attended with the most painful circumstances too dismal to be related, he thought it his duty immediately to begin his intended courses in Midwifery, and has prepared a proper apparatus for that purpose, in order to instruct those women who have virtue enough to own their ignorance and apply for instructions, as well as those young gentlemen now engaged in the study of that useful and necessary branch of surgery, who are taking pains to qualify themselves to practice in different parts of the country with safety and advantage to their fellow citizens.

The Doctor proposes to begin his first course as soon as a number of pupils sufficient to defray necessary expence shall apply. . .

In order to make the course more perfect, a convenient lodging is provided for the accommodation of a few poor women, who otherwise might suffer for want of the common necessaries on those occasions, to be under the care of a sober honest matron, well acquainted with lying-in women, employed by the Doctor for that purpose. [4a]

4a. On July 17, 1765, "a female child of Martha Robinson a poor patient" became the first child born within the hospital. See Thomas G. Morton, The History of the Pennsylvania Hospital, 1751-1895 (Philadelphia, 1895), p. 234.

2. Pennsylvania authorizes "a lying-in and foundling hospital," 1793

" An act for extending the benefits experienced from the institution of the Pennsylvania Hospital," 1791-1793 - ch. 1693, Statutes at Large of Pennsylvania, XIV (Harrisburg, 1909), 440.

The managers of the Hospital, reluctant to assume the financial burden of caring for pregnant women without means, did not establish a lying-in department until 1803. The new department accommodated forty patients without charge.

Be it further enacted. . . That as the relief of unfortunate women laboring in child birth and not able to provide for the expenses necessarily incident thereto, and also the misfortunes of suffering and forsaken infancy, are objects very deserving of some humane provision, it shall and may be lawful for the managers of the Pennsylvania Hospital to provide commodious apartments, for the purpose of answering the ends intended by a lying-in and foundling hospital, whenever moneys shall be placed in their hands for such a purpose, and that they are hereby authorized to call for any such sums as may now be detained for such an use, whenever they shall be in a situation to carry the benevolent design, for which such moneys were granted, into full effect, anything in the constitution or charter of the said hospital to the contrary thereof notwithstanding.

3. Childbearing, 1795

Journal of Elizabeth Sandwith Drinker, April 6-7, 1795, in Cecil K. Drinker, Not So Long Ago: A Chronicle of Medicine and Doctors in Colonial Philadelphia (New York, 1937), pp. 51-52.

Elizabeth Drinker (1735-1807), wife of a Quaker merchant, was interested in health and disease and filled her journal with accounts of various medical incidents. Here she describes the labor of her eldest daughter, Sally Downing. Dr. William Shippen, Jr., in the custom of the day, attended Mrs. Downing at home.

[April 6, 1795] There was a time, that if either of my beloved children were in the situation that my dear Sally is at present, I could not have found in my heart to have made a memorandum; is it that as we grow in years our feelings become blunted and callous? or does pain and experience cause resignation? 'tis now past eleven at night my dear afflicted child has just taken anodoyne from Dr. Shippen, she has been all this evening in afflictive pain 'tho unprofitable, I came here yesterday afternoon, went to bed at eleven o'clock. Jacob [Downing] call'd me up after two this morning when I had just fallen a sleep, Sally being rather worse, before four o'clock Jacob went for Hannah Yerkes. After breakfast we sent for Dr. Shippen, he felt her pulse, said he hoped she was in a good way - he din'd with us, and as Sally did not wish his stay, he left us, saying he would return in the evening. She continu'd in pain at times, all day, was worse towards evening, Neighbor Wain, H. Yerkes and sister with us - sent for the Doctor who soon came, towards night we perceived that all things were not right, I did not venture to question the Doctor, but poor Sally was not sparing in that particular - she suffer'd much to little purpose, - when the anodoyne was given, two opium pills, the Doctor went to lay down, when all was quiet for a short time, but poor Sally who instead of being compos'd grew worse. The Doctor was call'd, when he came I quited the room, knowing that matters must 'eer long come to a crisis, I was down stairs in back parlor by myself an hour and half as near as I can judge, when observing that my dear child ceas'd her lamentation and a bustle ensu'd - with a fluttering heart I went up stairs, in a state of suspense, not knowing if the child was born, or Sally in a fit, as I heard no crying of a child. - It was mercy fully born, the Doctor blowing in its mouth and slapping it, it came to and cry'd. - The Doctor then told us, that a wrong presentation had taken place; which with poor Sally's usual difficulties call'd for his skill more particularly; by good management he brought on a footling labour, which 'tho severe, has terminated by divine favour, I trust, safely, -

[April 7, 1795] Heavy rain in the night with some thunder and lightning - wind N .E. - Henry Downing, the second of the name, was born in the seventh of the fourth month, between one and two in the morning on the third day of the week - Sally is this morning as well as can be all things consider'd - the effects of the anodoyne not gone off.

1. Sickness and accidents among children on immigrant ships, ca. 1750

Mittelberger, Journey to Pennsylvania, pp. 14-15.

One can scarcely conceive what happens at sea to women in childbirth and to their innocent offspring. Very few escape with their lives; and mother and child, as soon as they have died, are thrown into the water. On board our ship, on a day on which we had a great storm, a woman about to give birth and unable to deliver under the circumstances, was pushed through one of the portholes into the sea because her corpse was far back in the stem and could not be brought forward to the deck.

Children between the ages of one and seven seldom survive the sea voyage; and parents must often watch their offspring suffer miserably, die, and be thrown into the ocean, from want, hunger, thirst, and the like. I myself, alas, saw such a pitiful fate overtake thirty-two children on board our vessel, all of whom were finally thrown into the sea. Their parents grieve all the more, since their children do not find repose in the earth, but are devoured by the predatory fish of the ocean. It is also worth noting that children who have not had either measles or smallpox usually get them on board the ship and for the most part perish as a result.

On one of these voyages a father often becomes infected by his wife and children, or a mother by her small children, or even both parents by their children, or sometimes whole families one by the other, so that many times numerous corpses lie on the cots next to those who are still alive, especially when contagious diseases rage on board.

Many other accidents also occur on these ships, especially falls in which people become totally crippled and can never be completely made whole again. Many also tumble into the sea.

It is not surprising that many passengers fall ill, because in addition to all the other troubles and miseries, warm food is served only three times a week, and at that is very bad, very small in quantity, and so dirty as to be hardly palatable at all. And the water distributed in these ships is often very black, thick with dirt, and full of worms. Even when very thirsty, one is almost unable to drink it without loathing. It is certainly true that at sea one would often spend a great deal of money just for one good piece of bread, or one good drink of water - not even to speak of a good glass of wine - if one could only obtain them.

2. Acadian children exposed to "contagious distempers" in America

George S. Brookes, Friend Anthony Benezet (Philadelphia, 1937), pp. 477-478.

The Acadians or French residents of Nova Scotia were forcibly displaced by the Crown at the outbreak of the Seven Years War (1755) and scattered throughout the American colonies. As foreign-speaking Catholics, their arrival was often resented. In Philadelphia, however, Benezet (1713-1784), the famous educator and anti-slavery leader, aided their settlement and prepared this memorial for them.

EXTRACT OF THE MEMORIAL TO THE KING OF GREAT BRITAIN IN BEHALF OF THE ACADIANS, DRAFTED AT THEIR REQUEST, IN THE YEAR 1760

. . . We were transported into the English colonies; and this was done in so much haste, and with so little regard to our necessities, and the tenderest ties of nature, that from the most social enjoyments and affluent circumstances, many found themselves destitute of the necessaries of life, and separated parents from children and husbands from wives, some of whom have not to this day met again. We were so crowded in the transport vessels, that we had not room even for all our bodies to lay down at once; and consequently were prevented from carrying with us proper necessaries, especially for the comfort, and support of the aged and weak; many of whom quickly ended their misery with their lives. And even those amongst us who had suffered deeply for your Majesty, on account of their attachment to your Majesty, were equally involved in the common calamity, of which Rene Lablanc, the notary public. . . is a remarkable instance.

He was seized, confined, and brought away among the rest of the people; and his family, consisting of twenty children, and about one hundred and fifty grandchildren, were scattered in different colonies, so that he was put on shore at New York with only his wife and two youngest children, in an infirm state of health, from whence he joined three more of his children at Philadelphia; where he died without any more notice being taken of him than any of us, notwithstanding his many years labour, and deep suffering for your Majesty's service.

The miseries we have since endured, are scarce sufficiently to be expressed; being reduced for a livelihood to toil and hard labour, in a southern climate, so disagreeable to our constitutions, that most of us have been prevented by sickness from procuring the necessary subsistence for our families; and therefore are threatened with that which we esteem the greatest aggravation of all our sufferings; even of having our children forced from us and bound out to strangers, and exposed to contagious distempers unknown in our native country. This compared with the affluence and ease we enjoyed, shows our condition to be extremely wretched. We have already seen in this province two hundred and fifty of our people, half the number that were landed here, perish through misery and various diseases.

3. Poor father seeks release of daughter from Pennsylvania Hospital, 1765

Morton, History of Pennsylvania Hospital, pp. 134-135.

To the Managers of the Pennsylvania Hospital

The Petition of Conrad I. Doer the Father of Mary Elizabeth Doer, a Child about 13 years of Age, a Convalescent in your Hospital.

Give me leave Gentlemen to lay before you a true State of my Case. To represent to you my deep Concern for my said Daughter and that I may endeavour to move your goodness to gratify the natural desire of a Father by restoring to him his darling Child which is now in a better Condition than when she was committed to your Charitable Care.

I embarked on board the Ship Hero with my late dear Wife and four Children. My said Wife and one Child died when we were in the Mouth of the River Maase and my unhappy Daughter was at the moment of her parting with her dear Mother seized with so violent a Grief as would not yield to any Comfort, her Mind was disturbed and she cried Day and Night etc.

In this Condition we arrived in the Port of Philadelphia, when Ralph Foster the Commander of the Ship told me she must be brought to the Hospital and that her Cure and Maintenance should not cost me a Penny, In which particular I never mistrusted the Captain As the General notion we entertain of Hospitals in Germany is that they are founded by public or private Benevolence for the relief of the poor unhappy sick and that never anything is charged to their Account, Except in the Case of Rich Pensioners whose relations sometimes agree with the Governors of such Hospitals for a better accommodation than common.

I then settled with the Owners of the Ship, all the Freight money for my poor Family was paid to them So that the Contract between the Owners of the Ship and me is entirely ended. I was bound a Servant for the Term of 3 years to . . . Patten Esq. but I agreed with my Master that I would Serve him one Year longer in Case he would suffer a little Child of mine 3 years Old to live with his Family during the Term of my Servitude.

When I lately had an Account from Philadelphia that my Daughter in the Hospital was pretty well again, I addressed my kind Master to give me leave to fetch my Child up to his House and he gave me leave that she might stay six Months at his House and I agreed with a Neighbour of my Master to maintain her till I was free. So having provided every thing for the reception of my Daughter and flattering myself how soon I would have her near me and see her daily, I came to the Philadelphia Hospital and was told that the Managers would deliver up the Girl to the Owners of the Ship who had assumed to pay for her cure and Accommodation and that these Merchants would sell her for the Charges of the Hospital. As I expect that the Captain will have forgot his Word he gave me when I gave up my Daughter to the Hospital, or put me off with an Equivocation that it will not cost me Money but that it must cost me my Daughter who is as dear to me as my own Life, As I expect no Mercy from the Merchants, who look upon poor Germans as upon other Merchandize and as the obtaining of Justice against them if they should attempt to sell my Child against my will is too expensive for a poor Stranger, All My hopes is in you Gentlemen who preside over the Contributions of a Wealthy and charitable people in this and the neighbouring Provinces.

And your petitioner humbly prayeth that you will be pleased to forgive the Cost of Curing and Maintaining my poor Child and not to commit me to an Argument with Merchants in which they might get the better of me when I being a poor Servent myself may be unable to support my natural Right to my Daughter.

And your Petitioner shall every pray.

Conrad I. Doer

4. Mistreatment of German redemptioners on the American ship General Wayne. 1805

Report of Andreas Geyer, Jr., to the Hon. H. Muhlenberg, president of the German Society of Philadelphia, April 27, 1805, "On the Conditions of German Redemptioners on Board of the American ship General Wayne," in Friedrich Kapp, Immigration and the Commissioners of Emigration of the State of New York (New York, 1870), pp. 183-186.

I went to visit those unfortunate people, and in truth they may be called unfortunate. And I must confess I have seen a number of vessels at Philadelphia with redemptioners, but never did I see such a set of miserable beings in my life. Death, to make use of the expression, appeared to be staring them in the face.

They. . . set sail [from Hamburg in November 1804] and after fourteen days had elapsed the captain informed them that they would get nothing to eat except two biscuits, one pint of water, and the eighth part of a pound of meat per day. This regulation continued for two or three weeks, when they one and all declared they could not any longer exist on the small allowance they received; that they must, without doubt, perish. The hunger and thirst being at this time so great, and the children continually crying out for bread and drink, some of the men resolved, at all events, to procure bread, broke open the apartment wherein it was kept, and took some. This was discovered by the captain, as were also those who did the same, when each of them was ordered to, and actually did, receive, after being first tied, a number of lashes on their bare backs well laid on. The whole of the passengers were also punished for this offence. The men received no bread, the women but one biscuit. This continued for nine days, when the men were again allowed one biscuit per day; however, the captain would at least make or proclaim a fast day. In this situation their condition became dreadful, so much so that five and twenty men, women, and children actually perished for the want of bread. . . The hunger was so great on board that all the bones about the ship were hunted up by them, pounded with a hammer and eaten; and what is more lamentable, some of the deceased persons, not many hours before their death, crawled on their hands and feet to the captain, and begged him, for God's sake, to give them a mouthful of bread or a drop of water to keep them from perishing, but their supplications were in vain; he most obstinately refused, and thus did they perish. The cry of the children for bread was, as I am informed, so great that it would be impossible for man to describe it, nor can the passengers believe that any other person excepting Captain Conklin would be found whose heart would not have melted with compassion to hear those little inoffensive ones cry for bread. The number of passengers, when the ship arrived at Amboy, amounted to one hundred and thirty-two. Fifty-one remained there still; the others have been disposed of.

The passengers further state that they did not receive the tobacco, the fish, nor the potatoes, as they ought to have received, and which they were entitled to as by their contract with the captain, neither did they receive their dram but four or five times during their passage, and no butter after they left the British port until within three or four days ago.

Observations on insanity in children, 1812

Benjamin Rush, Medical Inquiries and Observations, Upon the Diseases of the Mind (Philadelphia, 1812), pp. 51-57.

For twenty years after 1783, Rush was a member of the staff of the Pennsylvania Hospital. His book on diseases of the mind was based on his work with the insane at the Hospital.

There are severeal peculiarities which attend this disease [madness], where the predisposition to it is hereditary, which deserve our notice.

1. It is excited by more feeble causes than in persons in whom this predisposition has been acquired.

2. It generally attacks in those stages of life in which it has appeared in the patient's ancestors. . .

3. Children born previously to the attack of madness in their parents are less liable to inherit it than those who are born after it.

4. Dr. Burton, in his Anatomy of Melancholy, remarks, that children born of parents who are in the decline of life, are more predisposed to one of the forms of partial insanity than children born under contrary circumstances.

5. A predisposition to certain diseases seated in parts contiguous to the seat of madness, often descends from parents to their children. Thus we sometimes see madness in a son whose father or mother had been afflicted only with hysteria, or habitual headache. The reverse of this remark likewise sometimes takes place. . .

6. There are instances of families in which madness has existed, where the disease has passed by the understanding in their posterity, and appeared in great strength and eccentricity of the memory, and of the passions, or in great perversion of their moral faculties. Sometimes it passes by all the faculties of the mind, and appears only in the nervous system, in persons descended from deranged parents, and again we see madness in children whose parents were remarkable only for eccentricity of mind.

There are several diseases which attack the children of the same family, which did not exist in their ancestors. I have called them filial diseases. They are chiefly consumption and epilepsy. . .

Madness, it has been said, seldom occurs under puberty. To the small number of instances of it that are upon record, I shall add four more. Two boys, the one of eleven, and the other of seven years of age, were admitted into our Hospital with this disease (the latter during the time of my attendance in 1799) and both discharged cured. I have since seen an instance of it in the year 1803, in a child of two years old, that had been affected with cholera infantum; and another in a child of the same age, in the year 1808, that was affected with internal dropsy of the brain. They both discovered the countenance of madness, and they both attempted to bite, first their mothers, and afterwards their own flesh. The reason why children and persons under puberty are so rarely affected with madness must be ascribed to mental impressions, which are its most frequent cause, being too transient in their effects, from the instability of their minds, to excite their brains into permanently diseased actions. . .

During the first decade of the nineteenth century, vaccination, developed by Edward Jenner in the 1790's, replaced inoculation as the preventive of smallpox. Dr. Benjamin Waterhouse (1754-1846), professor of the theory and practice of medicine at Harvard, played a large part in publicizing the new method.

1. Vaccination tested on children, 1800

Benjamin Waterhouse, A Prospect of Exterminating the Small-Pox; The History of the Kine-Pox, commonly called the

Cow-Pox {Cambridge, Mass., 1800), pp. 3-4,18-21,23-25.

In the beginning of the year 1799, I received from my friend Dr. Lettsom of London, a copy of Dr. Edward Jenner's "inquiry into the causes and effects of the Variolae Vaccinae, or Cow-Pox," a disease totally unknown in this quarter of the world. On perusing this work, I was struck with the unspeakable advantages that might accrue to this country, and indeed to the human race at large, from the discovery of a mild distemper that would ever after secure the constitution from that terrible scourge, the small-pox.

Under a serious impression of effecting a public benefit, and conceiving it, moreover, a duty in my official situation in this University, I sent to England for some of the vaccine or cow-pox-matter for trial. After several fruitless attempts, I obtained some by a short passage from Bristol, and with it I inoculated all the younger part of my family.

The first of my children that I inoculated, was a boy of five years old, named Daniel Oliver Waterhouse. I made a slight incision in the usual place for inoculation in the arm, inserted a small portion of the infected thread, and covered it with a sticking-plaster. It exhibited no other appearances than what would have arisen from any other extraneous substance, until the 6th day, when an encreased redness called forth my attention. On the 8th, he complained of pain under the inoculated arm, and on the 9th, the inoculated part exhibited evident signs of virulency. By the 10th, anyone, much experienced in the inoculated small-pox, would have pronounced the arm infected. The pain and swelling under his arm went on, gradually encreasing, and by the 11th day from inoculation, his febrile symptoms were pretty strongly marked. The sore in the arm proceeded exactly as Drs. Jenner and Woodville describe, and appeared to the eye very like the second plate in Dr. Jenner's elegant publication. In short, the appearance and symptoms of this disease, in the old world, and in the new, were more completely alike than I expected. . .

The inoculated part in this boy, was surrounded by an efflorescence which extended from his shoulder to his elbow, which made it necessary to apply some remedies to lessen it; but the "symptoms," as they are called, scarcely drew him from his play more than an hour or two; and he went through the disease in so light a manner, as hardly ever to express any marks of peevishness. . .

Satisfied with the appearances and symptoms in this boy, I inoculated another of three years of age, with matter taken from his brother's arm, for he had no pustles on his body. He likewise went through the disease in a perfect and very satisfactory manner. This child pursued his amusements with as little interruption as his brother. Then I inoculated a servant boy of about 12 years of age, with some of the infected thread from England. His arm was pretty sore, and his "symptoms" pretty severe. He treated himself rather harshly by exercising unnecessarily in the garden, when the weather was extremely hot (Farht. Thermr. 96, in the shade!) and then washing his head and upper parts of his body under the pump, and setting, in short, all rules at defiance, in my absence. Nevertheless, this boy went through the disorder without any other accident than a sore throat and a stiffness of the muscles of the neck, all which soon vanished by the help of a few remedies.

From a full maturated pustle in my little boy of three years old, I inoculated his infant sister, already weaned, of one year. At the same time, and from the same pustle, I inoculated its nursery maid. They both went through the disease with equal regularity. As this woman was the first adult person on whom I had performed the operation, I was more constant in my enquiries, and more careful to note symptoms as they arose. They were very similar to those of the lighter kind from inoculation for the small-pox, viz. a slight dizziness and nausea, watery eyes, chilliness, soreness of the flesh, usually called by the common people in this country, "bones'-ache," a general lassitude, transient pains in the region of the stomach, loins and head, with a disinclination to animal food and exercise; yet none of these symptoms were so oppressive as to diminish for a moment her attention to her little charge, whose symptoms, we conjectured, kept pace with those of its nurse.

Having thus traced the most important facts respecting the causes and effects of the kine- pox up to their source in England, and having confirmed most of them by actual experiment in America, one experiment only remained behind to complete the business. To effect this, I wrote the following letter to Dr. Aspinwall, physician to the small-pox hospital in the neighbourhood of Boston.

                                            Cambridge, Aug. 2d, 1800.

Dear Doctor,

You have doubtless heard of the newly discribed disorder, known in England by the name of the cow-pox, which so nearly resembles the small-pox, that it is now agreed in Great-Britain, that the former will pass for the latter.

I have collected every thing that has been printed, and all the information I could procure from my correspondents, respecting this distemper, and have been so thoroughly convinced of its importance to humanity, that I have procured some of the vaccine matter, and therewith inoculated seven of my family. The inoculation has proceeded in six of them exactly as described by WoodvilIe and Jenner; but my desire is to confirm the doctrine by having some of them inoculated by you.

I can obtain variolous matter, and inoculate them privately, but I wish to do it in the most open and public way possible. As I have imported a new distemper, I conceive that the public have a right to know exactly every step I take in it. I write this, therefore, to enquire whether you will, on philanthropic principles, try the experiment of inoculating some of my children who have already undergone the cow-pox. If you accede to my proposal, I shall consider it as an experiment in which we have co-operated for the good of our fellow-citizens, and relate it as such in the pamphlet I mean to publish on the subject.

I am &c. &c.

B.W

Hon. William Aspinwall, Esq.

Brookline.

To this letter the Dr. returned a polite answer, assuring me of his readiness to give any assistance in his power, to ascertain whether the cow-pox would prevent the small-pox; observing, that he had at that time fresh matter that he could depend on, and desiring me to send the children to the hospital for that purpose. Of the three which I offered, the Dr. chose to try the experiment on the boy of 12 years of age, mentioned in page 20, whom he inoculated in my presence by two punctures, and with matter taken that moment from a patient who had it pretty full upon him. He at the same time, inserted an infected thread, and then put him into the hospital, where was one patient with it the natural way. On the 4th day, the Dr. pronounced the arm to be infected. It became every hour sorer, but in a day or two it dried off, and grew well, without producing the slightest trace of a disease; so that the boy was dismissed from the hospital and returned home the 12th day after the experiment. One fact, in such cases, is worth a thousand arguments. [5a]

5a. Five more of my family, including three of my children, are now in Dr. Aspinwall's hospital. [Waterhouse's note.]

2. Massachusetts vaccination law, 1810

Massachusetts, The Cow Pox Act, with the Order of the Legislature; and a Communication, Relative to the Subject, from the Selectmen of the Town of Milton (Boston, 1810).

. . . It shall be the duty of every Town, District, or Plantation, within this Commonwealth, wherein no Board of Health shall be established by law, at their annual meeting in the months of March or April, annually, to choose in the manner in which other officers are by law chosen, three or more suitable persons, whose duty it shall be, to superintend the inoculation of the inhabitants of such Town, District, or Plantation with the Cow Pox.

Amongst the multiplied instances of the love of a kind Providence, none seems to be more evident, than the admirable dispensation, which has bestowed on Man, the means of a perfect security against the small pox. The nature of the benefit is so great and so simple, that no one can mistake the source. . .

To diffuse the blessing among every class of our fellow citizens appears to be an object highly desirable, and it will be found that a public inoculation of the Cow Pox, if pursued with zeal, is easy and rapid in its progress, but method will facilitate the process and render it more safe in its operation; to that effect we would wish to offer to the consideration of our fellow citizens, the propriety of the following arrangements.

It is therefore proposed, that in every County the inoculation should begin in the Shire, or other conveniently situated Towns, as early in June as possible, and that as soon as the people there are under the operation of the disease, the other Towns should send, for a supply of Vaccine matter, to begin their inoculation with. The month of June, appears to be peculiarly favourable for the inoculation; the state of the weather being in general steady and moderate, the inoculated would be less exposed to casual disorders, which by interfering its operation; but the friends of Vaccination, should use every caution to secure that credit by judicious arrangements.

The inoculation from arm to arm, is more likely to take, and to produce the real disease, than when performed with dry matter; it is recommended therefore, that individuals under the operation of the disease, should volunteer to go, and transmit to their friends in the neighbouring Towns, the benefit which they have secured for themselves.

The Superintendants are invited to call upon every family, and use their best exertions, to persuade all that are exposed to the small pox, to attend. . . and it is presumed, that in every Town, the arrangements would be such, as to secure the Benefit at the expense of the Town, to such of the inhabitants as may be destitute.

On the day appointed for the inoculation, it is proposed, that the superintendants should make a note of the names and age of every person inoculated, with a number to it, and should give to every such person, a ticket with the corresponding number, as per form No.2.

That they should appoint a second meeting eight days after, for the physicians to deter- mine the result of the inoculation. That, at this second meeting, they should add to the notes first taken, the result of the inoculation of every person, and that said result should be written on the back of the respective tickets, and signed by the physician.

If the attainment of so great an end, as a security against the small pox, is desirable for every Town, it is equally so, that much caution should be used, to avoid being deceived into a false security. The security will depend upon using genuine Cow Pox matter, and employing physicians, who have had an opportunity to acquire a practical knowledge of the characters of the disease.

In the ordinary course of life, every Parent who has procured the security of his children against the small pox, by successive inoculations, cannot do otherwise than feel grateful and happy, he cannot be otherwise than an honourable object of praise and imitation; exalting is the thought of the numerous family of a Commonwealth, where not one life would be suffered to go to waste, by that dreaded Pestilence; annual inoculations in every Town would procure that happy result.

Amongst the officers which we are in the habit of electing annually in our Towns, is there any, whose trust is of equal interest to that, of those Superintendants, who would warn the Mother of the danger of her Child, who would annually contribute to the safety and welfare of the State, by preserving its inhabitants? Can any Town feel safe, without the annual appointment of such officers?

3. Federal law to encourage vaccination, 1813

"An act to encourage vaccination," Annals of the Congress of the United States, 12 Cong., 2 Sess. (1813), pp. 1336-1337.

The President of the United States. . . is hereby authorized to appoint an agent to preserve the genuine vaccine matter, and to furnish the same to any citizen of the United States, whenever it may be applied for, through the medium of the post office; and such agent shall, previous to his entering upon the execution of the duties assigned to him by this act, and before he shall be entitled to the privilege of franking any letter or package as herein allowed, take and subscribe the following oath or affirmation, before some magistrate, and cause a certificate thereof to be filed in the General Post Office: "I, A.B., do swear (or affirm, as the case may be) that I will faithfully use my best exertions to preserve the genuine vaccine matter, and to furnish the same to the citizens of the United States; and also, that I will abstain from everything prohibited in relation to the establishment of the post office of the United States." And it shall be the duty of the said agent to transmit to the several postmasters in the United States a copy of this act; and he shall also forward to them a public notice, directing how and where all application shall be made to him for vaccine matter.

. . . All letters or packages, not exceeding half an ounce in weight, containing vaccine matter, or relating to the subject of vaccination, and that alone, shall be carried by the United States' mail free of any postage, either to or from the agent who may be appointed to carry the provisions of this act into effect: Provided always, That the said agent, before he delivers any letter for transmission by the mail, shall, in his own proper handwriting, on the outside thereof, endorse the word "vaccination," and thereto subscribe his name, and shall previously furnish the postmaster of the office where he shall deposite the same with a specimen of his signature. . .