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New Observations on Inoculation/Preliminary discourse

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Preliminary Discourse

Containing

A short Account of the present State of Inoculation in France.

I Received this little tract from the author, towards the beginning of last spring, when I was confined to my bed by a severe fit of illness.[1] The reasonable relief which it gave to my mind, induced me to employ my sleepless hours in translating it; and I thought my labour not ill bestowed, if it could afford any entertainment or instruction to English readers.

Whether this piece will be received as well as my ingenious friend Mr. de la Condamine's Discourse on Inoculation, I shall not pretend to determine. To me they appear equally valuablel and the singularity of the present work may recommend it to a people, amongst whom those writers are peculiarly held in esteem, who thinking for themselves dare to print what they think.

In another country, indeed not his own, Dr. Gatti suffered for his boldness. Upon the recommendation of a French lady of distinction,[2] whose son he had most happily inoculated, he was invited over to the court of France. The minister thought him a proper person to establish the practice in that kingdom; and the inhabitants were supposed inclined to receive it from any quarter rather than from a nation at that time engaged in war with them.

Our Italian physician had, like his countryman Pylarini, learned the art of inoculating in the Levant. There he had seen the operation in its primitive dress, performed by Greek women, and recommended by Greek priests. The hand of surgeons was unemployed, the pen of physicians not desired. A needle was the sole instrument; a little matter imbibed in cotton, or dried in powder, the only apparatus. No accidents were known to happen; no troublesome ulcer or disorder to succeed. A gentle fever, during four-and-twenty-hours, was the only symptom; and a small crop of pustules, chiefly upon the part where the pock was rubbed in, without ruffling, lowering, or endangering the patient, secured his life, his organs, and his features.

To great sagacity my friend joined an open and beneficent mind. What he had seen, he proclaimed every where. He was in hopes that a people equally fond of novelty and ease, would readily adopt this new and elegant mode. The great, and especially their leaders, the ladies, he imagined, would be allured by being put to no fright and no pain, unrestrained in their diet, undisturbed in their joys; the people would be drawn in by an operation either chargeable nor confining; all would be glad to enjoy the benefits of inoculation without its risks, and to spread it new fashioned all over the continent:

That eloquence of heart, which never fails to please, and seldom to convince, gave our professor great advantages over his rivals. In defiance of vulgar opinion and physical authority, he attempted to change an operose process into a mere amusement. Dr. Tronchin had had his short, his brilliant day, and Dr. Hosty, instructed in London, inoculated with care, and slowly made some converts. Italian was more prevailing than either. Every body would be inoculated by Gatti; and while he himself declared that any nurse could do well as he, the public imagined nothing well done without him.

This uncommon success soon excited envy. Those, whose trade he obstructed, became enemies. Rumours were propagated, and scruples were infused. To some it was said that he gave not the small-pox; to others, that his patients would carry it every where. The churches and play-houses were now no longer safe, whispered the delicate Abbe; and the still more insinuating doctor, shrugging his shoulders at the toilet, exclaimed against public infatuation.

Perhaps this might have been avoided, if Dr. Gatti had been more reserved, and observant of forms. A dutchess, whom he had inoculated, and who, upon equivocal symptoms without any eruption, had been declared secure against future infection, after three years caught the natural disorder, which, though not hurtful to her, became fatal to him. He displayed the utmost candor in publishing the case; but could by no means recover what he had lost, the support of the great, the confidence of the town. All his former patients took the alarm; he became the object of public abuse, as he had formerly been of general applause; and that salutary practice, which he had endeavoured to render popular, by making it more easy and more safe, fell as it had risen with him.

Indeed, it had already received a severe blow; The discouragement it met with from some eminent physicians, the impetuous attacks of a justly celebrated professor at Vienna[3] and above all, the religious scruples of a Saxon princess, influenced the parliament of France, then, and almost ever, at variance with the court. Upon the representations of the attorney-general, they thought proper to prohibit inoculation in the capital; and having thus prejudged the cause, gave orders to the faculties of divinity and physic to make inquiries into the merits of it.

The physicians took the lead, and doubtless with good reason, as the legality of the thing must ultimately depend upon its usefulness. The college, a numerous body, consisting of above one hundred and twenty doctors, appointed twelve commissaries, to make new researches, and prepare a report, upon this interesting subject. This committee, composed of the leaders of both parties, agreed upon five queries[4] to be sent all over Europe, in order to obtain new lights, and render, if possible, their judgment decisive and [[SIC|unamimous|unanimous}}.

This, however, was not the case; for, though the answers which came, at least from those who were really qualified to give any, were greatly in favour of inoculation, an equal division of opinions still took place amongst the members of the committee; six declared against, and six for, the English practice. The former were the first in giving and publishing their report[5]. This libel, for it deserves no other name, written with great art and no less disingenuousness, contains, besides the old and exploded objections of Wagstaff, Blackmore, Cantwell, and De Haen, a number of facts collected both in France and in Great Britain. The book no sooner appeared, but the most material of these facts, said to have happened in the first of these kingdoms, were publickly contradicted, and proved to be mistakes; and it would be no difficult task to do the same, with respect to most of those sent over from this island, were this a proper place for such a discussion.

Later, but not less keen, were the favourers of inoculation in their answer[6]. The college were induced by this last report, to declare, by a great majority of votes, that inoculation deserved to be tolerated. The parliament, however have hitherto not recalled their first order; the practice remains under the same unnatural interdiction; and it is only out of the walls of Paris, and especially in the provinces, that the people are suffered to save their lives in their own way.

Both to reclaim the thinking part of Paris, and to vindicate his own operations from the contemptuous treatment of his antagonists, Dr. Gatti, at my request, published the present Essay. Uncertain of its effect upon that lively and volatile nation, who received inoculation upon trust, and upon trust rejected it, he was desirous, by this translation of his work, to appeal to their neighbours, in hopes that, if they approve, his method will in time get the better of prejudice and clamour.

Indeed the English have already decided in his favour. Inoculation is very near universally, in this island, what he wished it in France. The choice of the matter, the manner of the operation, the simplicity of the treatment, the attention to amusements, and the injunction of exercise, are so many points, in which his practice coincides with that which is here generally recommended.

Had Dr. Dimsdale's performance (in which this doctrine, for some time industriously concealed by interested operators, was first brough to light) preceded the discourse of Dr. Gatti, or could the one have borrowed from the other, I should not have taken the trouble of translating that of my Italian friend But his piece was prior; and in a former treatise printed three years ago[7], the same principles were already, though explicitly, contained.

But still it may, I know it will, be said, that nothing was to be found here but what we knew before, the Public might have dispensed with this publication, as well as with three-fourths of the many ephemerous pamphlets on the same subject, which this insect-producing summer brought forth. I can only answer, that the different way of considering the same objects, the closeness of the method, and the strength of reasoning, which distinguish the author's manner; the extensiveness of his views and the novelty of his hints, were my motives for publishing his Essay in English. May I add, that I was besides animated by the desire of doing justice to an amiable character cruelly misrepresented, and not in France only injuriously traduced?

In one article, however, he differs from modern, as well as ancient, inoculators. He opposes what they recommend, a formal preparation. Yet, as the mode of this preparation remains still unsettled, and where required, must vary according to the difference of constitutions; and as quicksilver and antimony, so much commended, and so indiscriminately given, by some, are not less warmly condemned, or at least slighted, by others, our author may perhaps trust his apology with the ingenious writer thereof the Trial of Mr. Daniel Sutton, for the high crime of preserving the lives of his majesty's liege subjects, by means of inoculation. He only exclaims against empiric or other medicines, when the subject is in full health; and expresly avers that, if he is not well, his cure ought to precede inoculation.

I am well aware that some other notions of Dr. Gatti may be objected to; but they seem to be of little importance to, and not intimately connected with, the main subject. Hypotheses, I know, are almost universally exploded; but few are the men, who do not except their own from this proscription. It is a matter of some difficulty to destroy old theories, without substituting new ones; to tread upon inchanted ground, and not be tempted to build, and to indulge and leave to posterity no visions of our own.

In translating this work, I allowed myself the liberty of abridging it in some parts, of supplying some things from the preceding treatise of our author referred to by himself, and of adding a few notes. In doing this, I had the advice of some of Dr. Gatti's friends, together with his leave; I followed my own taste, and hope to obtain the approbation of those who may compare the original with this copy.

  1. Quum me ægritudo non solum somno privaret, verum ne vigilare quidem sine summo dolore pateretur. Cic. ad Att. ix. 2.
  2. Spouse to the Count de Durfort, Ambassador at Naples.
  3. Dr. de Haen.
  4. It may not be amiss to insert here these queries.
    I. Quæstio; an à longo tempore invaluerit in vestra regione insitionis variolarum methodus & quo successu? II. An nonnulli inter inoculatos occubuerint? III. An quidam variolarum inoculationem perpessi variolas naturalis postea contraxerint & quo tempore? IV. An vobis compertum suerit simul cum variolis alios diversi generis nonnunquam insertos fuisse morbos? V. An post inoculationem plurimi variis laboraverint ægritudinibus, quæ ex hoc fonte derivari viderentur, & an hoc frequentius rariusve fuerit quam à variolis sponte contractis?
  5. Rapport sur le fait de l'inoculation de la petite vérole lu en présence de la faculté de Médecine de Paris & imprimé par son ordre, pour étre communiqué á tous ses docteurs, avant qu'elle donne sur cette question l'avis que le parlement lui a demandé par son arret du 8 Juin 1765. In 4to. The six opposing docters were, De l'Espine, Astruc, Bouvart, Baron, Verdelhan, and Macquart.
  6. Premier & second Rapport en faveur de l'Inoculation lus dans les Assemblées de la faculté de Médecine de Paris en 1764. & 1766. & imprimés par son ordre. Par M. A. Petit, Docteur Régent de la Faculté de Médecine en l'Université de Paris, &c. Paris 1766. 2 vols, in 8vo. The commissaries who signed this report were besides the author, Dr. Geoffroy, Thierry, Lorry, and Maloet: the sixth, Dr. Cochu, published a separate report equally in favour of inoculation.
  7. Reflexions sur les préjugés qui's'opposent aux progrés & á la perfection de l'inoculation par Mr. Gatti. A. Bruxelles (Paris) 1764. en 8vo.