Angelo Gatti

“ I cannot help observing, that every physician must know this to be the doctrine of Sydenham, Boerhaave, and all the great masters of our art. Not one of them would dare to avow the contrary opinion in print; and yet how many suffer their patients to be stifled up in hot rooms, and debarred from the benefit of cool air, merely in compliance with vulgar prejudice, founded on a mistaken notion that heat drives the humors toward the skin, that cold repels them, and consequently that warmth is beneficial, and cold hurtful in the small-pox? ”

“ Inoculation never will become universal, unless it has that simplicity, that ease, and above all, that safety, which it can acquire by no method than ours; Methinks the advocates for the practice should have been aware that, till it is quite safe, it can never become general; and all computations to shew that a lesser risk ought to be incurred rather than a greater, will be found of little weight with the multitude. Mankind will always be more affected by a present danger, though exceedingly small, than by a much greater one, if remote, and in some degree uncertain. ”

“ From the inattention of those who have written upon the subject, might it not be concluded, that there really is but one method of inoculating; or if more, that they are equally good? that, provided the variolous matter be inserted, and the small-pox conveyed, all the rest is of no consequence; and if the operation should be more or less successful, or even if fatal accidents should happen after it, that these effects are to be imputed to nature, to chance, to inoculation itself, but by no means to the particular method which has been followed? ”

“ We all know what influence the affections of the soul have upon the disorders of the body; and in none is this so conspicuous as in the small-pox. From the apprehensions of the patient, his fate is often pronounced; hence great care is commonly taken to conceal from him the nature of his ailment; and many people decline inoculation, from a persuasion that they should not be terrified by the natural small-pox; so well is every one convinced that fear constitutes the greatest danger of this disorder. ”

“ All that is requisite is to ascertain this disposition, and this is easily done. Health, we all know, is the faculty of exercising constantly, and with ease, all the functions suitable to the age, the sex, or the constitution of each individual. Now any one is able to judge whether a subject has, or has not, that faculty; and the person himself, or those about him, can tell that with more certainty than any physician whom they could consult. A man is in health when no pain or weariness warns him of any disorder in his frame. ”

“ But notwithstanding the obviousness of this truth, many people, accustomed to judge more from their own argumentations than from facts, will hardly be brought to believe that one pustule has the same effect as ten thousand. Though approves of inoculation in general, the bulk of mankind will be afraid of a copious eruption, and uneasy after a sparing one. ”

“ In fact, inoculation is sometimes known to fail, whatever method is used; nor do I think this will happen oftener by this than by any other. We see many patients inoculated with fresh matter, in the usual and strongest manner, yet without any eruption, who afterwards have the small-pox, either in the natural way, or upon a second trial. We likewise daily see people, often and long exposed to the infection, thinking themselves safe, who have afterwards catched the natural disorder. It is certain, there are some who never have it; whole families are free from it for many generations ”

“ If we examine things narrowly, and analyse the sensations of the mind in the first period we shall find some other feelings, which cannot come under the denomination of fear. A dejection will be observed, a sadness, an uneasiness and anxiety; these symptoms more or less apparent, seem to indicate that the active principle which presides over our preservation, is threatened with some imminent danger, and as it were feels the presence and influence of a cause ready to attack health and life in a manner the more alarming, as it shews itself less by external signs. ”

“ Experience has shewn, that this disposition is always attended with a kind small-pox, provided other causes, or some error in the insertion or treatment of it do not increase the disorder, and disturb nature in her operations. Health therefore is all we want in subject intended for inoculation.
Granting this, it is evident that there is no need of preparation for a person in full health; and that for one who is not well, the only preparation must be to make him so. ”

“ The infected thread contains an infinite number of those atoms, one of which is sufficient to give the small-pox; is it likely that so great a difference in the quantity of this poison, should occasion none in the nature of the future wound? Is it not rather certain, that, cæteris paribus, both the inflammation and suppuration, as well as the number of pustules raised round about the incision, are proportionable to the size of the thread? Every inoculator, as well as myself, must have observed this difference, especially when the insertion is made in two places. ”

“ Ever since inoculation has been received in Europe, the practitioners have been of opinion that the essential advantages of the artificial over the natural small-pox were, 1. the preparation; 2. the discharge of the variolous matter by means of the wounds; and 3. the assistance of art in a disorder which is known as soon as it appears.
In opposition to these principles, I shall attempt to prove, that these three pretended advantages have hitherto been so many bars to the perfection of the method, and the source of almost all the miscarriages which have retarded its establishment. ”

“ In those countries, where inoculation has been most successful, where it is attended with little or no danger, where thousands are inoculated, and are hardly sick at all, in a word, throughout the East, the operators only enquire, whether the person is in full health.
The history of inoculation in Europe must convince any man, who does not wilfully shut his eyes against light, both of the inutility and danger of preparations ”

“ Upon reviewing what has been before laid down, it appears, that out of seventy-four, the whole sixty-two persons, who in consequence of inoculation had variolous pustules, had among them in number, two thousand three hundred and sixty-two; somewhat more than thirty-eight to each: an inconsiderable number indeed! as physicians daily see in one limb only of an adult person, labouring under the coherent, not to say confluent natural small-pox, a greater quantity of variolous matter than was found in all these persons put together. ”

“ He certainly had it, since the characteristic of the small-pox, that from which it is denominated in all languages, and by which it is distinguished from all other diseases, is the variolous eruption, not the number of pustules. He is equally safe from a return; for no reason can be alledged why we should have the small-pox but once, that will not equally hold good for one as for ten thousand pustules. ”

“ Many degrees may be conceived from strong to weak health, and from thence down to sickness. A man in the most perfect state is an imaginary being; and between compleat health and the privation of it, or sickness there are numberless middle states, in each of which a man may be said to be well. Therefore, though he is so, some preparation may be proper, if not absolutely necessary, to mend his constitution, and bring it as near as possible to the most perfect state. ”

“ The cold regimen during the course of the small-pox, so much recommended Sydenham, especially in the febrile state of this disease; and put in practice by many persons in our time in an extraordinary manner [1] , was never, by the boldest of them, carried so far as in this instance: nevertheless, though here, from lying in the water, life for some hours seemed extinguished, the small-pox was only for a time interrupted by it; for upon the powers of life returning, the disease went on and completed its natural course in the most desirable manner, and without any supervening accident. ”

“ Such is the state of the facts, from which every person is at liberty to make such deductions as he may think they will admit of. To me it appears, that after ten or twelve days abstinence from animal food and heating liquors, the person being in other respects in good health, it is of no very great importance with what kind of variolous matter he is inoculated; as in every one of the histories before mentioned, though the treatment was so different, the small-pox was so slight as scarce to deserve the name of a disease. ”

“ A man covered with variolous pustules, has all over his body a stratum of the very same matter, an atom of which gave him the small-pox a few days before, and the smallest particle of which will inoculate another, if applied to his skin, or, if conveyed with the air into his lungs, may give him a mortal small-pox. Yet this man, so thoroughly coated with the venom, finds no alteration in his health when the suppuration is over, but what proceeds from his past illness ”

“ He is surely no less so in the second case, when there is no general eruption; for the variolous infection having spent itself in the pustules that first came out at the place of insertion, these can no longer act upon the rest of the body, but are a sure sign that inoculation has produced its whole effect.
It has indeed been questioned, whether a patient who had but very few pustules, or only one, has had the small-pox as truly as one who has been very full, and whether he is equally safe from catching it. ”

“ Oborne sent his servant to see her; she could then turn herself in the bed, was grown much warmer, and had taken a little broth and some bread.
Early in the morning Mr. Oborne visited her, after having been informed by one of the nurses of the workhouse that she was alive, but was broke out all over; and that she was sure it was the small-pox. This indeed heightened his curiosity, as he was hitherto unapprized of her having that disease; and upon examination found the nurse's suggestions strictly true. She had a considerable number of small-pox all over her, but mostly in her face. ”

“ I have many a time seen people violently sea-sick, instantly relieved by some strong impression on their mind. A ship passing by, the sight of land, any object that strikes unexpectedly, will in a moment perform a compleat cure. ”

“ I have tried every known method; the rules prescribed have sometimes been observed, and sometimes neglected by me. By singular good luck, I have lost not one patient; but all the other accidents imputed to inoculation have fallen under my inspection.
Some have had a confluent small-pox, and been in danger; others have suffered, besides the small-pox, an additional infectious disorder. Many have had troublesome complaints after the operation; wounds not easily healed, erysipetalous tumours, abscesses, imposthumes ”

“ In the first period of the London inoculations, great stress was laid upon preparation; the method was complicated and tedious, the patients were worse, and more of them died. But since preparation has been more disregarded, the disorder has been slighter, and fewer have been lost. I could quote some of the most eminent and successful inoculators, who wholly omit preparation, and some who openly declare against it. ”

“ It is to be hoped this problem will one day be solved, when all disputes about the expediency of inoculation are at an end, and we fix our whole attention on the improvement of it.
In order to attain this desirable end, I would recommend the following rules:
1. The freshest: matter is the most effectual [1] . Whenever therefore it can be done, the insertion should be made immediately with a needle just dipped in the pus of a pustule. The beginning of suppuration is preferable to a more advanced state, as the matter is then more fluid, and comes off easier from the needle into the wound. ”

“ I was always struck with the resemblance of the earliest symptoms of this disorder with those of the sea-sickness. The anxiety, nausea, weariness, dejection, head-ach, are in both cases the same, and only differ in point of duration. It even happens sometimes, when a person is long and violently sick at sea, that some small degree of fever will appear at times, and the pulse shall be heavy and intermittent, as in the first period of the small-pox. ”

“ The general expediency of repeated purging at the decline and after the disease, when conducted in this manner, seems to depend entirely upon the state of the punctures, the sores succeeding them, and other indications at the time. The secure side is that of gently, and not violent, purging. If no plaster has been applied, the punctures rarely give any trouble. Particular care must be taken likewise, that, after so long an abstinence from animal food, the patients be, when the pustules are dried away, restored to it by degrees. ”

“ The cool air which is inspired ought, if possible, to be free, and constantly renewed.
2. The drink should be cool, and pleasant to the taste. Cool, for the same reasons with the air; pleasant, to present the sickness and reachings so common in this disorder.
3. The palate of the patent may in general be trusted to for the quantity and quality of the food. The call of nature is a truer and safer guide than any directions. If the patient loaths his food, it is a sign he does not want it; if, on the other hand, his appetite should be but a false craving, he will soon be satisfied. ”

“ Although it is impossible to determine geometrically the degree of health requisite for inoculation, you may safely trust to that indeterminate judgment we commonly pass, when we say, such a one is well: we mean that nothing amiss is observable, nothing at least that attacks the vital functions, nor any tendency to sickness, as in children during dentition, or women during pregnancy, &c. ”

“ In the natural way, the venom dispersed in the air is mostly conveyed by respiration into the lungs, or by deglutition into the stomach. That part of these internal organs which first received the infection, must be affected in the same manner as the external part is by inoculation. But an eruption and inflammation, which affect the animal œconomy but little, if at all, when produced upon the skin of the arm or hand, must be of the utmost consequence when they take place in organs whose action is so necessary to life. ”

“ It is, on the contrary, never so considerable as when the discharge is so, and this always keeps pace with the number of the pustules. He therefore, who desires a copious outlet, wishes for a considerable degree of danger; and whoever is uneasy at the scantiness of the discharge, shews himself ungrateful to nature, and complains of art, when he has most reason to praise it.
Second Objection. ⁠" So slight an insertion does not communicate the small-pox so certainly as the other method." ”

“ 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 ”

“ Jane Brown, aged twenty-three, a poor young woman, was seized with the small-pox and committed to the care of a nurse who used to take in indigent persons under that disease, and lived not far from the New River at Islington. Though the small-pox were come out, she was still delirious, and the nurse being gone out upon some little affairs of her own, the patient, during this absence, got out of bed, ran through the garden, and threw herself into the New River. ”

“ It need not here be observed, that the small-pox, when the contagion is received in what is called the natural way, is frequently one of the most fatal diseases, that infest mankind. By what means the intensity of it is lessened the disease becomes milder by inoculation ”