Thomas Dimsdale - Thoughts on General and Partial Inoculations

To preserve the lives and health of the inferior part of mankind has been an object carefully attended to in all civilized and well regulated states, not only from motives of compassion, but because it has been plainly demonstrated that it is the interest of the wealthy in every nation to encourage population, and provide for the wants of the poor.

One would indeed, on the first thought presume, that the unavoidable necessities of the indigent would be voluntarily relieved out of the abundance of their opulent neighbours; but the number of laws that have been made for the provision of the poor, are proofs of the futility of this expectation, and the necessity of compulsion.

Among the many objects that have been provided for, it seems matter of astonishment that no one has ever pointed out the Small Pox as a distemper, whose destructive consequences might be in great measure prevented by the interposition of Legislature, and the assistance that would be certainly afforded from private charity.

It is now above fifty years since Inoculation was introduced into this country, and like other new institutions was then opposed; but at present, though it may be impossible to define the numbers that are yearly inoculated, it is certain that most of the wealthy approve and avail themselves of the practice: yet we view the Bills of Mortality with unconcern, though they demonstrate that the number of deaths from this disease is considerably increased; and with the affecting circumstance, that they are probably of the younger part of the people.

Although this matter has not been attended to here, it did not escape the penetration of the Empress of Russia; who, with a regard to the happiness of her people that deserves much greater commendation than I am able to bestow, was extremely solicitous to render Inoculation general among her subjects: and it was with a view to this that soon after the recovery of the Empress and Grand Duke from this operation, her Majesty was pleased to command me to write their cases, with the principal occurrences during the Inoculation, from an idea that being published they would tend to the removal of prejudices, and the advancement of a practice she had much at heart to encourage.

Her Imperial Majesty also frequently did me the honor to converse freely on several points respecting the natural Small Pox and Inoculation; and having been pleased to approve of the manner in which her enquiries and doubts were answered, I was afterwards commanded at different times to give in writing the substance of what had been advanced on these occasions. These orders were obeyed, the tracts translated into the Russian language, and as I imagined, were only intended for the perusal of the Empress. But in the year 1770, my treatise on Inoculation, with the following tracts, was published at Petersburg by her Majesty’s command:

I. An Account of the Inoculation for the Small Pox of her Imperial Majesty, Autocratrix of all the Russias.

II. An Account of the Inoculation for the Small Pox of his Imperial Highness the Grand Duke, the Heir of all the Russias, by Baron Thomas Dimsdale, first Physician to her Imperial Majesty.

III. Remarks on the Book, intitled, The present Method of Inoculating for the Small Pox, written by the Author now at St. Petersburg.

IV. A short Description of the Methods proposed for extending the salutary Practice of Inoculation through the whole Russian Empire.

V. A short Estimate of the Numbers of those who die of the natural Small Pox, with a View to demonstrate the Advantages that may accrue to Russia from the Practice of Inoculation, &c.

A translation of these tracts, with some further remarks on Inoculation, and a relation of my journey to Russia, has been preparing for the Press; but on some accounts unnecessary to be entered on here, is deferred.

Indeed, my appearance as a writer now is earlier than I intended, on account of a plan that I have seen of a Dispensary for inoculating the poor of London at their own houses, in which some plausible reasons for such an establishment are advanced; but I think they are much more specious than substantial; and that the plan itself is fraught with very dangerous consequences to the community, and not like to answer any good purpose if put in execution. Wherefore I thought it a duty owing to the public to publish these sentiments on the subject, that none should inadvertently misapply their charity so as to do mischief when good was intended.

In pursuance of this design, it seemed not improper to begin with the two last of the tracts that were wrote at Petersburg in the year 1768, as my opinions on the subjects treated of remain the same as at that time. But I desire that what is advanced in them, or may be found in the sequel, that tends to discountenance the practice of Inoculation by persons who have not had a medical education, may not be construed as a design to affect any of the family to whose mode of practice Inoculation is indebted for some considerable improvements; nothing can be farther from my intention, for I have been at all times disposed to do them justice, and allow all the merit that is their due.

In fact, I am an advocate for Inoculation; and wish the design of extending the benefit to the poor may be so conducted, as to afford its enemies as few opportunities of objecting to it on any solid ground as possible; and that the affair may be so well understood, as to make it plain in what manner charitably disposed persons may most usefully employ their benevolence.

For extending the salutary practice of Inoculation through the whole Russian Empire.

Written at Petersburg by her Imperial Majesty’s first Physician Baron Thomas Dimsdale.

In obedience to the orders received from her Imperial Majesty, I shall endeavour to demonstrate in a clear and concise manner the destructive effects of the Small Pox in the natural way, and the safety and advantage of Inoculation, even when performed after the old manner; and afterwards exhibit the improvement of the method, being the same which is now introduced into this great empire.

It will not be in my power to execute this plan with the accuracy I could wish, being engaged in an employment that demands much time and attention. But I will use my best endeavours to describe in the first place a method of propagating the practice of Inoculation, so that it may not be dangerous to those in the neighbourhood, who, either on account of bad health, age, prejudice, or other reasons, are unwilling to submit to the operation, and at the same time render it salutary to such as are proper objects and approve of it.

It is not to be supposed that the method now practised in England so successfully, can be received in Russia without some alteration. The experiments however which I have made in England, in order to ascertain the most commodious manner of conducting the affair, may be of use here; which I shall therefore describe as clearly as possible.

In the original published in Russia, there followed a circumstantial account of the house I had built for the accommodation of my patients in England, and the manner of conducting the process, &c. there; which, as it would be of no consequence or use to insert in this translation, I have omitted.

One, and indeed no inconsiderable advantage derived from a plan of this sort is, that by collecting all the patients together in one house, the physician will be enabled to attend a great number at the same time in a proper manner, and also to pay particular attention to such as may more immediately require his assistance.