Everywhere after the middle of the eighteenth century inoculation was coming into fashion again. In France it was lauded by the philosophes, while it was scouted by the medical faculty. La Condamine, a mathematician who had acquired fame by his journey to the Amazon to measure the three first degrees of the meridian, became interested in the subject by hearing from a credulous Carmelite missionary at Para how he had saved half of his Indian converts by inoculation after the other half had been destroyed by the natural smallpox. The mathematical philosopher on his return became an enthusiast for inoculation, and twice harangued the Académie des Sciences thereon. “The practice of inoculation,” he said, “was improved during the time of its disgrace.” What this improvement consisted in he also explained: “Neither the eruption is essential to the natural nor the pustules to the artificial smallpox: and perhaps art will one day come to effect what one hopes for and what Boerhaave and Lobb have even tried—I mean a change in the external form of this malady without any increase of its danger[926].”
The Suttonian Inoculation.
Daniel Sutton, though an empiric, has given his name to the slight and safe method of inoculation which had been used in England for a good many years before his advent. So completely was his name joined to the practice of smallpox inoculation in its later period that in a Bill before Parliament in 1808 it is called “the Suttonian inoculation,” to distinguish it from cowpox inoculation. The idea of attenuating the virus used for inoculation, and of making the effects minimal, was not his. It had been reached empirically years before by Mowbray, of Charleston, in 1738, who carried inoculation from arm to arm to the fifth remove, by Frewen, of Rye, in 1749, who was satisfied with an abstract “variolosity” of the incisions, in cases where there was no eruption at all or only a few pustules that did not fill, by Kirkpatrick, “the most scientific inoculator in London,” who endorsed the doctrine of variolosity, by La Condamine, and most of all by Gatti of Paris.
Gatti used the unripe matter from a previous inoculation and inserted a most minute quantity of it at a very small puncture; and, to make sure that no general eruption should follow, he used the cooling regimen in various ways, including the prolonged immersion of the hands in cold water. Thus he promised his clients “the benefits of inoculation without its risks.” But Gatti’s career of prosperity was cut short by a series of conspicuous failures of his artificial smallpox to prevent the natural or real disease when it was epidemic. One of his patients, the Duchess de Boufflers, a great lady whose salon was frequented by the philosophes and beaux esprits, fell into the natural smallpox two years and a half after her inoculation[927]. So many others in Paris had the same disappointment that a discussion arose in the Faculty of Medicine, the result of which was that the Parliament of Paris prohibited the practice of inoculation, for various reasons, within the limits of the capital.
Gatti’s friend and correspondent in London was Dr Maty, who, “though born in Holland might be considered a Frenchman, but he was fixed in London by the practice of physic and an office in the British Museum[928].” Having conducted the foreign correspondence of the Royal Society, he became in 1765 its secretary in ordinary, and about the same time Principal Librarian of the British Museum. His interest in inoculation, which was shown by his translating La Condamine’s first discourse on that subject in 1755, led him in 1765 to suggest to Gatti that he should write an essay for publication in England, “both to reclaim the thinking part of Paris, and to vindicate his own operations from the contemptuous treatment of his antagonists.” The essay was written in due course, and Maty brought it out in English[929].
Gatti’s own experiments and those which had previously been made in England by the most experienced inoculators had satisfied him of the truth of what he had long suspected, namely, that the operation could be made “still more harmless, though not less efficacious” (p. 29). There would be hardly any fever, certainly a very slight eruption and perhaps none at all (p. 68), It had, indeed, been questioned whether a patient who had but very few pustules, or only one, has had the smallpox as truly as one who has been very full, and whether he is equally safe from catching it. He answers in the affirmative, according to the doctrine of variolosity: “No reason can be alleged, why we should have the smallpox but once, that will not equally hold good for one as for ten thousand pustules” (p. 69). Some, however, will not believe that one pustule is as good as ten thousand, “notwithstanding the obviousness of this truth.” If one were absolutely bent upon giving a certain number of pustules, he would advise to inoculate according to his method (insertion with a needle) at twenty, thirty, or fifty places: “then you would be sure of one pustule at least at each puncture, and, probably, of many more in other parts.” He would do this, however, only to humour prejudice, and with a feeling that he was doing the patient “more harm than was necessary.” He was seriously satisfied of the “sufficiency of a single pustule,” and believed that every wise man should run the venture of it and “embrace the method here laid down.”
There was no theoretical objection to this method, but there was the practical one, that it might be too slight in its effects. Patients could hardly rest satisfied with so little to show for smallpox; and inoculators themselves found that they might have all their work to do over again. An eminent Irish physician wrote in 1765 to Dr Andrew, of Exeter, that crude matter from a previous inoculation was “less communicative of the disorder and more apt to disappoint us” than matter from a natural smallpox eruption taken “five or six days before the maturation of it[930].” It was also the experience of Salmade, of Paris, in 1798, that serous matter, taken from arm to arm through a long succession of cases, was apt to go off altogether, or to be “weakened to the point of nullity,” whereby it disappointed the operator[931]. Reid, of Chelsea Hospital, was said to have carried the succession to thirty removes from the natural smallpox. Bromfeild knew for certain of matter being used at the sixteenth remove.
So long as the operation held at all, and had not to be repeated, Dr Andrew believed that effects which “no one would have taken for the smallpox,” were “sufficient security against any future infection[932].” Heberden, indeed, has recorded a case adverse to that view; but one case is not enough, even if it had been in as eminent a person as Madame de Boufflers[933].
Daniel Sutton, who gave his name to the slighter kind of smallpox inoculation, was not a regular practitioner. His father, a doctor of medicine in Suffolk, was a specialist inoculator, as others of the regular profession here and there were becoming, and had operated upon 2514 patients from 1757 to 1767. In 1763 Daniel began business on his own account at Ingatestone in Essex, where patients from all parts were boarded and subjected to his regimen, as at a water-cure. In 1764 he made 2000 guineas, and in 1765 £6300. In the three years 1764-66 he inoculated 13,792 persons, and his assistants some 6000 more—without a single death. Sutton kept his method at first a secret, and for that reason was looked at askance by eminent physicians. He used pills and powders, which were found, by the analysis of Ruston, to be a preparation of antimony and mercury, the drugs supposed to be antidotes to natural smallpox, or the means of preventing its pustular eruption. But the essence of his method was found to be, in Chandler’s words, “the taking of the infective humour in a crude state [from a previous inoculation] before it has been, if I may allow the expression, variolated by the succeeding fever[934],” or, in Dimsdale’s words, “inoculating with recent fluid matter,” or in Sir George Baker’s words, “with the moisture taken from the arm before the eruption of the smallpox, nay, within four days after the operation has been performed[935].”