The Dawn of Modern Medicine / An Account of the Revival of the Science and Art of Medicine Which Took Place in Western Europe During the Latter Half of the Eighteenth Century and the First Part of the Nineteenth

by Albert H. Buck

I. Inoculation

About the year 922 of the present era the Arabian physician Rhazes wrote and published (in MS.) the earliest known report of the malady now called Variola or Small-Pox. From this fact the inference should not be drawn that the disease first came into existence in the time of Rhazes, for it can scarcely be doubted that it had already existed in the East for ages before the period mentioned. Since the thirteenth century it has appeared repeatedly in epidemic form in widely separated countries, causing, especially among the eastern nations, a fearful mortality. Sydenham, the great English physician, succeeded during the seventeenth century in devising a method of treatment that in some degree diminished the mortality of this affection, at least in Great Britain. It was, however, in no sense a preventive procedure, and the spread of small-pox continued unchecked until Jenner, in 1796, introduced vaccination; and even then the efficiency of this method was not promptly acknowledged by the Medical Profession; indeed, several years had to elapse before even the best London physicians, the men who possessed the most complete facilities for ascertaining the whole truth with regard to Jenner and his new method, became convinced that a great and most efficacious protection against small-pox had at last been found. In the meantime—that is, for almost half a century—the procedure known as “inoculation” was accepted by the upper classes of the community in all parts of Europe as affording the maximum amount of protection attainable against the disease.

There were in Europe, during the last half of the eighteenth century, two physicians—Baron Thomas Dimsdale, an Englishman, and Dr. Théodore Tronchin, of Geneva and Paris—who obtained considerable celebrity as inoculators.

The first-named, Baron Thomas Dimsdale, was born in 1712 and began to practice his profession in 1734 at Hertford, twenty-four miles north of London. Already as early as in 1741 he had acquired so great a reputation for his success, both in performing the operation and in carrying the patient safely through the resulting infection,—that is, through the attack of small-pox thus artificially produced,—that he was sent for to inoculate first the Czarina of Russia, then the Grand Duke Paul, and subsequently the children of many of the first families of the Russian Empire. Shortly after his return to England he was made a member of the Royal Society, and at a still later date the city of Hertford chose him as their representative in the House of Commons. In 1781, on the occasion of his second visit to Russia, he inoculated the Czar Alexander and the Grand Duke Constantine. His death occurred on December 30, 1800.

Among Dimsdale’s published works relating to small-pox and inoculation the following deserve to receive special mention: “The Present Method of Inoculating for the Small-Pox”, London, 1766, 1767 and 1772; “Thoughts on General and Partial Inoculation,” London, 1776; and “Account of a Voyage to Russia and Report of the Procedure Carried out in the Cases of Catherine and Paul.”

Baron Dimsdale, it seems scarcely necessary to add, was not the inventor of the practice of inoculation but simply the individual who revived and made popular, first in England and afterward on the continent of Europe (more particularly in Russia), a practice which long before had been employed in China.

Medal commemorating the discovery of vaccination. From Eugen Hollaender’s “Medizin und Plastik,” by permission.

Théodore Tronchin, the second inoculator mentioned above, was a native of Geneva, Switzerland,[^[15]] and was highly esteemed in France as a practitioner of medicine during the period that is now under consideration (1750–1785). Furthermore, it was widely known that he was the family physician of Louis Philippe, Duke of Orleans, as well as the medical adviser and intimate friend of Voltaire, both of which facts undoubtedly aided him in gaining popularity among the members of the fashionable set of Paris. It is therefore easy to understand why, when he espoused the cause of inoculation, he should have so rapidly attained celebrity as a successful inoculator, not only in Paris but also throughout Europe. On the other hand, it is not at all clear why the inoculation method should have been looked upon with any favor by the educated classes, for it soon became increasingly evident that the operation was attended with considerable risk through the danger of introducing other infective agents into the system; and, in addition, no satisfactory evidence was forthcoming that these inoculations possessed the slightest degree of genuine protective power. To-day we are unable to discover in this procedure any other advantages than the following:—The patient is thereby enabled to select the time when, and the surroundings in which, he or she will submit to an attack of small-pox; for, it must be remembered, no well-grounded hope was held out by the inoculators of the eighteenth century that the artificially produced disease would prove less fatal than that which is acquired accidentally. And yet some such hope was apparently cherished by the people of that period, for Benjamin Franklin, writing in 1788, makes the following remark in relation to this very question:—

In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret, that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they never should forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.

These bitter regrets expressed by Franklin show plainly that he, like others of his time, had strong confidence in the efficiency of inoculation.