Archive for September, 2019

Philosophical Transactions. For the months of April, May and June, 1714 - Part V.

Saturday, September 7th, 2019

V. An account, or history, of the procuring the small pox by incision, or inoculation; as it has for some time been practised at Constantinople.

Being the extract of a letter from Emanuel Timonius, Oxon & Patav M.D. S.R.S. dated at Constantinople, December, 1713.

Communicated to the Royal Society by John Woodward, M.D. Prosef. Med. Gresh and S.R.S.1

The writer of this ingenious discourse observes, in the first place, that the Circassians, Georgians, and other Asiaticks, have introduc'd this practice of procuring the small-pox by a sort of inoculation, for about the space of forty years, among the Turks and others at Constantinople.

That altho' at first the more prudent were very cautious in the use of this practice; yet the happy success it has been found to have in thousands of subjects for these eight years past, has now put it out of all suspicion and doubt; since the operation having been perform'd on persons of all ages, sexes, and different temperaments, and even in the worst constitution of the air, yet none have been found to die of the small-pox; when at the same time it was very mortal when it seized the patient the common way, of which half the affected dy'd. This he attests upon his own observation.

Next he observes, they that have this inoculation practiced upon them, are subject to very slight symptoms, some being scarce sensible they are ill or sick; and what is valued by the fair, it never leaves any scars or pits in the face.

The method of operation is thus. Choice being made of a proper contagion, the matter of the pustules is to be communicated to the person proposed to take the infection; whence it has, metaphorically, the name of the insition or inoculation. For this purpose they make choice of some boy, or young lad, of a sound healthy temperament, that is seized with the common small-pox (of the distinct, not flux sort) on the twelfth or thirteenth day from the beginning of his sickness; they with a needle prick the tubercles (chiefly those on the shins and hams) and press out the matter coming from them into some convenient to wash and clean the vessel first with warm water; a convenient quantity of this matter being thus collected, is to be stop'd close, and kept warm in the bosom of the person that carries it, and, as soon as may be, brought to the place of the expecting future patient.

The patient therefore being in a warm chamber, the operator is to make several little wounds with a needle, in one, or two or more places of the skin, till some drops of blood follow and immediately drop out some drops of the matter in the glass, and mix it well with the blood issuing out; one drop of the matter is sufficient for each place prick'd. These punctures are made indifferently in any of the fleshy parts, but succeed best in the muscles of the arm or radius. The needle is to be a three-edg'd surgeon's needle; it may likewise be perform'd with a lancet; the custom is to run the needle transverse, and rip up the skin a little, that there may be a convenient dividing of the part, and the mixing of the matter with the blood more easily perform'd; which is done, either with a blunt stile, or an ear-picker; the wound is cover'd with half a walnut-shell, or the like concave vessel, and bound over, that the matter be not rub'd off by the garments; which is all removed in a few hours. The patient is to take care of his diet. In this place the custom is to abstain wholly from flesh and broath for 20 or 25 days.

This operation is perform'd, either in the beginning of the winter, or in the spring.

Some, for caution, order the matter to be brought from the sick by a third person, lest any infection should be convey'd by the cloaths of the operator; but this is not material.

As to the process of this matter, in respect of the idiosyncrasie; the small-pox begins to appear sooner in some than in others, in some with greater, in others with lesser symptoms; but with happy success in all. In this place the efflorescence commonly begins at the end of the seventh day, which seems to favour the doctrin of crises.

It was observ'd, in a year when the common small-pox was very mortal, that those by incision were also attended with greater symptoms. Of 50 persons, who had the incision made upon them almost in the same day, four were found in whome the eruption was too sudden, the tubercles more, and the symptoms worse. There was some suspicion, that these four had caught the common small pox before the incision was made. It is enough for our present purpose, that there was not one but recovered after the incision; in those four the small-pox came near the confluent sort. At other times the inoculated are distinct, few and scatter'd; commonly 10 or 20 break out; here and there one has but 2 or 3, few have 100; there are some in whom no pustule rises, but in the places where the incision was made, which swell up into purulent tubercles; yet these have never had the small-pox afterwards in their whole lives; tho' they have cohabited with persons having it.

It is to be noted, that a no small quantity of matter runs for several days, from the place of the incision.

The pocks arising from this operation are dry'd up in a short time, and fall off, partly in thin skins, and partly contrary to the common sort, vanish by an insensible wasting.

The matter is hardly a thick pus, as in the common, but a thinner kind of sanies; whence they rarely pit, except at the place of the incision, where the cicatrices left are not to be worn out by time, and whose matter comes near the nature of pus.

If an aposteme breaks out in any (which infants are most subject to) yet there is nothing to be fear'd, for it is safely heal'd by suppuration. If any other symptom happens, 'tis easily cur'd by the common remedies.

Observe, they scarce ever make use of the matter of the incisious pox for a new incision. If this inoculation be made on persons who have before had the small pox, they find no alteration and the places prick'd presently dry up; except in an ill habit of the body, where possiby a slight inflammation and exulceration may happen for a few days.

To this time, he says, I have known but one boy, on whom the operation was perform'd, and yet he had not the small-pox, but without any mischief; and some months after catching the common sort, he did very well, it is to be observ'd, that the places of the incision did not swell. I suspect this child prevented the insertion of the matter, for he strugled very much under the operation, and there wanted help to hold him still. The matter to be inserted will keep in the glass very well for 12 hours. He goes on.

I have never observ'd any mischievous accident from this incision hitherto; and altho' such reports have been sometimes spread among the vulgar, yet having gone on purpose to the houses whence such rumors have arisen, I have found the whole to be absolutely false.

It is now eight years since I have been an eye-witness of these operations; and to give a greater proof of the sedulity I have used in this disquisition, I shall relate two histories.

There was, in a certain family, a boy of 3 years old, afflicted with the falling-sickness, the king's-evil, an hereditary pox, and a long marasmus. The parents were desirous to have the incision made upon him; the small-pox were thrown off with ease; about the 40th day he dy'd of this marasine. In another family, a girl of 3 years old, troubled with the like fits, strumous, attended with hereditary lues, and labouring under a colliquative loosness for three months. The operation was peform'd on this child; she came off very well of the small-pox, which was all over the 15th day; on the 32d she dy'd of her loosness, which had never left her the whole time.

But it is true, I never maintain'd the inoculation as a panacea, or cure for all diseases; nor do I think it proper to be attempted on persons like to die. Some more quicksighted, imagin'd these two children were, as useless shades sent to Charon by any means that could be made use of. If I could have collected any more concerning this matter, I should have imparted it candidly.

The rest of Dr. Timone's letter contains his reasons for this method of practice; which being the Ætiological part, is publish'd in his own words, as follows.

Ætiologia.

Contagium variolarum per puris insusuionem propagari haud cguidam mirabitar qui aesulapii templum vel d primo limine salutavit, & fermentationis doctrinam subodoraius est; nex obscurior est infitionis modus, qudm panificium, aut ars cerevisiaria, obsurior est infitionis modus, qudm panificium, aut ars cerevisiaria, in qurbus ex admixto fermento massa fermentanda turgescunt; conciliato nimirum mota intestino minimarum particularum principiis active pollentium. si quis quarit interium cur variola periculosa alioquin & persape lethales, ex insitione sine ullo periculo excludantur. dico; variola communes vel concurrente prava aliqua speciali aeris diathesi suscitantur, vel ab essuviis a varioloso corpore emanatious per contagium propagantur. primus casus in paucis individuis accidit, & concurrente quidem vel insigni cacochymia, vel saltem variolos seminii in talibus individuis latitantis acerrima exaltatione; secundus casus communissimus est. In primo casu miasma malignum aereum, in secundo virulenta contagii corpuscula indolis (probabiliter) salino-sulphurca sed specificam fracedinem seu ranciditatem nacta statim ac per respirationem hauriuntur spiritus ipsos, & labe quidem teterrima inficiunt; subsequenter auiem massam sanguineam & lympham vitiarimanifestum est; Spiritus statim infici rationi consentaneum est, tum quia in fontes spirituum, cor scilicet & cerebrum, statim ingressum habent virulentem aporria, tum ratione analogismi inter miasmata & effluvia ista ipsosque spiritus, cum utraque spiritutuoso-aerea textura sint. Deducitur etiam cita & prava spirituum infectio á tot tantisque norvosi systematis symptomatibusque, qua malas plermque comitantur variolas, & pracipué á convulsionibus epilepticis qua infantibus accidunt ipso momento, quo varioloso inficiuntur contagio multo antequam febris illos corripiat. Massam autem sanguineam inquinari prater febrem purulenta tuberculorum exclusio testatur. Lympha veró vitiata fidem faciunt glandularnm in faucibus tumor, screatus, & enormis multoties ptyalismus. Inter bac circularis etiam sequitur noxa. Sed pracipué sanguinis particula ab indebita spiritnum irradiatione in plures ataxias & anomalias perducuntur. Duobus tamen potissplures ataxias & anomalias perducuntur. Duobus tamen potissmum modis in variolis communibus mortem contingere observavi.

Primus est quando paucis erumpentibus variolis, & tardé ad maturitatem procedentibus, mas alia oboriuntur symptomata; secuudus quando nimia tuberculorum copia cadaverosam putredinem inducit. In primo casu maligna vulgo dicuntur variola; causa autem est vel nimia fusio & dissolutio massasanguinea, val ejusdem coagulatio & grumescentia. Si enim impetus spirituum explosivus justo plus augeatur, particula massa sanguinea nimium ad invicem atteruntur, comminuuntur, & tenuissimas nancisuntur acrotitas; sanguis in boc statu sollertis nature mechanismum eludit, cumque nil fœculentioris in glandulis secretoriis cribrisque deponat, œconomia animalis functionibus requisitas filtrationes & transcolationes celebrari baud patirur; improportionata eternim est figura particularum liquidi ad configurationem pororum in tuhulis & colaioriis rations fuhtilitatis nimia filtratione enim defacarentur particula sanguinis si naturalem servarent schcmatismum & molem; hinc dicitur pepsim fieri per incrassationem. Prater hoc cslritas ipsa transius sanguinis in causa est ut nihil deponatur in colatcriis. Torrens ubi nimio impetu & pracipiti cursu fertur aquas iurbidas desacari haud patitur; quia vis centripeta gravitatem admixti terrei sequeus superaturá fortiorum pulsoria virtute aquororum globulorum rapide reenitum; virsus enim fortis, vcrbi gratia, ut unum non poterit lineam perpendicularem describere ubi cirtus fortis ut duo ad lineam horizontaem potrudit sic etiam haud pluit vent o flante intensissimo; eadem geometrica proportione (probabiliter loqundo) sanginis particula aucto ab effranibus spirilus motu, tubulos colitorios preterfluunt nullâ factâ facum depositione. Hac probabilia fiunt á summa pulsûs celeritate, febre intensissima, sudore nullo, & urina cruda. E contra quandoque contingit ut ab acutis, & scindentibus deleterii fermenti particulis frangatur, corrodatur, vel saltem relaxetur elater spirituum; elanguscente igitur spirituum motu torpidiores etiam hebetioresque siunt sanguinis lymphaque particula; igitur dum in labyrinthais tubulorum anfractibus moram indebitam contrabunt alias turmatim invicem complicari, alias autem, congestione factâ, super alias incidere, & diverso ad invicem superficierum suarum contactud naturali configuratione desciscere, & novias induere angulorum dimensiones necesse est. Sic igitur diversa ab illa, quam superius narraviumus, sigerarum ad tubulorum meatus improportione, paritamen calamitatis eventu dadalea natura machinationes irritas fieri contingit. Hac probabilia fiunt á pulsu tardo & raro ac debris carentia quandoque in summa malignitate observatis, paucis & tardé erumpentibus voriolarum pustulis. Ulterius é trepidatoria, su sulsultoria ac tumultuosa furentium spirituum irradiatione inaqualis eodem tempore in diversis partibus masse sanguinea, & arteriarum etiam venarumque contingere potest impulsus. Sive igitur fibrilla alique (ul quidem volunt) reperiantur in sunguine, scu sbili nondum bene assimilati sint portiones usibus peculiaribus dicata; probabiliter istarum motum turbari contingit; bas enim in circulatorio motu secundum longitudinem suam naturaliter moveri necesse est; ab inaquali autem pressione dicta rectilineam siquram perdere, & in spiras ac semicirculos crispari coguntur; bas igitur sic contortas transversaliter postmodum in circulatione raptari, ad invicem implicatas convolvi, &, ramosis schematibus obortis, racematim adeo conglobari necesse est, ut in majusculos tandem grumos coalescant, sive demum fibrilla illa non dentu, certé cujuscumque figura sint massa sanguinea particule, illas á naturali desciscere situatione ex hac motûs inaqualitate contingit; confusa igitur particula ista & ad invicem implicata statim vehiculi sui, seri scilicet globulis per expressionem á suo contubernio explosis, majorem, ratione molis aucta gravitatem nanciscuntur, ideoque impulsiva circulatoria facultatis vim superant; has igitur hîc illic resitare ac stagnare necesse est, prout in hoc velillo loco prima mutua cohasio forte contigerit; hinc livida stigmata, & simul (quod sape observavi in variolis cum petechiis erumpentibus) frequens sequitur mictus, quo limpidissimum serum in magna copia excluditur. En fusio, & coagulatio. Hinc mimmnon est car moriantur aliqui in variolis cum petechiis, convulsionibus syncope, vigiliis nimiis, emorrhegiis, delirio, vomitibus, enormibus, dysenteriis, &c. quamvis haud multa pustularum putrilagine persundantur; in stygium enim veluti characterismum variolarum fermentum multoties evehitur, ita ut quamvis haud magnam crasss puris copiam progignere mala modis vel explicatis vel aliis consimilibus communicare possit, sicque mortem inferre; & hoc ante undecimum plerumque. Veniamurs nunc ad secundum modum. Diversaenim aliquando contingit pernicies & longé alterius generis tragœdia; quamvis enim absint illa symptomata, nimia tamen puris, materia scilicet cadaverisata, copia corpus obruniturpus autem generari probabile est quando sulphureis oleosisque massa sanguinea particulis in fracedine & fusione constitutis acido-salinaram particularum coaffusio contingit. Huic asserto facem accdendunt innumera chymica experimenta quibus manifesté edocemur solutionibus pinguium sulphureorum per alkalia factis acido quolibet coaffuso statim massam albicantis coloris emergere. Multoties igitur miasma seu fermentum variolarum per respirationem haustum ratione indolis propria acerrime & fortassis septica tales in massam sanguineam particularum acido-salinarum & oleoso-sulphurearum producere potest combinationes, ut non seminia solum variolarum, qua omnibus individuis (mole tamen minima) á nativitate indita sunt, agitentr, actuentur, & in purulentam abeant putrilaginem, sed massa, ipsa sanguinea tota acorem contrabat, & motu quodam corruptorio putrescat & cadaverisetur. Sic igitur, incendio veluti coborto, ulterius furere fermentescentes particulas contingit, quam variolosis seminiis per despumitonem eliminandis opus sit; hic motus non est depuratorius heterogeneis secernendis inserviens, sed destructivus & corruptoris, fermento nempe massam totam superante & invertente; fracidis scilicet rebellibusque particulis victoria potitis, & omnes alias in sua castra migrare cogentibus. Hoc manifeste observamus in variis potulentis, in quibus fermentatione aliquando excitatá, motus succedit corruptivus liquores totaliter vitians; hinc videmus aliquos quamvis suprarecensitis symptomatibus immunes, immenso tamen, ut ita dicam, putredinis oceano suffocatos; et hoe periculum usque ad vig simum secundum protrabitar. Ultimo loco considerandum solida etiam & nobiliores partes in hisce casibus pessimé affici, & in spasmos inordinatos fieri; variis horum distortionibus tubulorum meatus vitiari, at functionum munera depravari necesse est; ecce igitur continentia, contenta, & impetum facientia, quorum triamviratu bumani corporis respublica regitur, una eademque ruina ut plurimum involuta; mirabiturne quispiammalorum indea iliadem in hominis perniciem pullulare? Observandum ulterius multis, qui peste laboraverint, eommunibus variolis etiam post annum correptis bubones eosdem intumunisse, qui antea in peste eruperant; nonne hoc etiam summam malignitatem testatur. Insitionem modo ad rationis trutinam revocemus. At hercule longe aliter in hoc contagionis modo rem procedere quis est qui non fateatur? Orimum enim spiritus nullatenus infici manifestum est; deinde non lympha, non sanguini labes illa teterrima inuritur, non solidis vitium aliquod communieator. Hinc symptomata omnia levia, nulla pessima, nulli infantibus epileptici insultus. Contagionis enim hujusce fermentum non spiritale, non aereum & acutum est, sed humorale, iners, ac pigrum; venena autem quo subtiliora eo pejora; ratione igitar improportionis nulla inter fermentum hoc & spiritus esse poterit lucta. Pus equidem variolarum in ipsa substantia sanguini immediaté infusum statim in largum veluti pelagus exceptum diluitur, involvitur, absorbetur, obtunditur; sic illud mitescit, sic in mansuetiorem indolem cicuratur. Contagiosa ista particula sanguinem ingressa statim sibi congeneres variolosi seminii particulas sanguini à nativitate inditas inveniunt; iis igitur confermentescunt, sed invicem combinata ac complexa baud amplius sui juris sunt ut ulteriores excitent turbas, regiam vita petant, spirituum thesauros diripiant; nammutuis compedibus constricta fixantur, pracipitantur, crassioresque & hebetiores fiunt, quam antea fuerint. Statim igitur volubilioribus aquearum particularum globulis tamquam aptis vehiculis superincambentes, sanguinis motu à cetro ad peripheriam tendente, secundo veluti amne, ad ambitum corporis protruduntur, eliminantur. Nonne manifestè videmus haud pus generari in insititiis variolis, sed saniosam, dilutiorem videlicet aqueamque in insititiis variolis, sed saniosam, dilutiorem videlicet aqueamque magis materiam? Nonne ex hoc phanomeno palam est acido-salinas fermenti contagiosi particulas haud oleosas passim sanguinis particulas in cadaverosam purulentiam pervertere, sed blandioribus potius lavioribusque aqueis particulis easdem dilutas & saturatas foras asportari? Ex negatione fovearum & cicatricum nonne manifestum est acres, aculeatas, pungentes & corresivas salini fermenti particulas à balsamicis statim sanguinis globulis obtundi, spiculis suis orbari, & hebetiori figura modificatas, vi veluti mochlica, extra propellia? Integra interim servatur massa sanguinea textura, inviolata consistentia. Nullam hiî vides fusionem, nullam grumescentiam, nullum solummodo sanguis fermentescit, quantum impuro à puri consortio separando, ac per despumationem extrudendo satis est. In hoc fermentationis motu solum per undulationem quandam leviter aliquando afficiuntur spiritus, lympha, & solida partes, & figua ad ista contagii particula perveniunt, certè (quod insitionis adumbrat metaphora) non nisi sylvestri acrimonia privata, ac veluti dulcificata pervenire possunt. Hac tenuitatis mea satis conscius haud praficta fronte obtrudo; non me latet longè meliora emanatura ab illis, queis meliore luto finxit pracoria titan; in historica tamen insitionis hujusce narratione aliquatenus me bene meritum spero.

Censtantinopoli, Anno 1713.
Mense Decembre.

Emanuel Timonius, Constantinopolitanus. In Universitatibus Oxoniensi & patavina Philosophiæ & Medicinæ Doctor.

A pdf version of the entire text of the Philosophical Transactions of the Royal Society of London can be found here (this article begins on page 72).


  1. Titled in the contents page as follows, A letter from Emanuel Timone, Philos. & Med. D. in Univers. Oxon. & Patav. S.R.S. containing the method of inoculating the small pox; practis'd with success at Constantinople, &c. []