Smallpox Inoculation in 18th Century France

In France in the 1700s, there was great opposition to a person getting a smallpox inoculation. Part of the problem was doctors could not ensure the inoculations worked because of too many variables. For instance, to create an inoculation, doctors collected pus or scabs from someone infected with smallpox and then introduced this infected matter into a person by scratching the surface of the skin (usually on the person’s arm). If the person was lucky, the inoculation worked, and, if unlucky, the person developed a full-fledged case of smallpox.

Because smallpox inoculations sometimes failed, there was large opposition by the French to them, and the opposition became stronger with “any little miscarriage.” These miscarriages usually happened because of a doctor’s inexperience or because the doctor made a mistake. One mistake that created a furor among the French public happened in 1765. However, the story began two years earlier when Marie Anne Philippine Therese of Montmorency-Logny, Duchess of Boufflers (not the Countess of Boufflers) got a smallpox inoculation.

Her inoculation did not work, and she came down with smallpox. Dr. Angelo Gatti had administered the smallpox inoculation likely using the following technique:

“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.”[1]

When the inoculation failed, critics noted that Gatti’s mistake would likely discourage Frenchmen from getting smallpox inoculations. The Scottish philosopher David Hume knew about Gatti’s mistake and wrote:

“Never was man in such agonies of despair: he has all the sensibility of an honest man, whose reputation is unjustly attacked, and who finds the world against him. He talks of leaving the world of flying instantly from Paris, of throwing up life: you would have been moved with compassion for him, and could not have entertained a good option of his character. After all, what has he been guilty of? A Mistake. Good God! reproach a physician with a mistake; as if they were not, all of them in danger of a mistake, in every judgement which they form.”[2]

Gatti wanted to stop public opposition to inoculations, and, so, he thought it best to explain why the Duchess came down with smallpox. He wrote a letter to his friend about what happened and obtained a signed affidavit from the Duchess, which he included with his letter. Here is Gatti’s letter and the affidavit almost verbatim:

“It is but too true, that the Duchess of Boufflers, whom I inoculated, about two years and an half ago, is just recovered from the natural small pox, which proved to be a distinct and favourable sort. This event having greatly excited the attention of the public, I thought it my duty to give the world a particular account of the Duchess’s inoculation; and she has, upon my application, been please to recollect all the circumstance, and to favour me with the following certification signed with her own name.

On the 12th of March 1763, I was inoculated for the small pox; and about four or five days afterwards, a redness appeared round the orifice, which Mons. Gatti called an inflammation, and assured me was a sign that the small ox had taken effect. These were the very terms he used. This redness or inflammation increased every day; and about the seventh or eighth day, the wound began to suppurate. There appeared also about the wound six small risings, or pimples, which successively suppurated, and disappeared the next day. Mons. Gatti, upon these appearances again assured me, that the small pox had taken effect. In the afternoon of the eleventh or twelfth day of my inoculation, I felt a general uneasiness and emotion; a pain my head, and my back, and about my heart; in consequence of which, I went to bed sooner than ordinary; I slept well, however, and rose without any disorder in the morning. These symptoms Mons. Gatti assured me were the forerunners of the eruption. The next day a pretty large rising, or pimple, appeared in my forehead; which came to a head, turned white, and then dried away, leaving a mark which continued many days. The wound in my arm continued to suppurate seven or eight days, and Mons. Gatti now assured me that I had nothing to fear from the small pox; and upon this assurance I relieved without the least doubt and continued in perfect confidence of my security till the natural small pox appeared. I continued very well during the whole of my inoculation, except one, as mentioned above, and I went out every day.

[Signed] Montmorency, D. de Boufflers

It is very true that I assured the Duchess, she had nothing to fear from the small pox; but the event has proved that I was mistaken.

I considered the accidents or symptoms which followed the incision, as certain signs that the inoculation had taken effect: as the characteristic symptoms of the inoculated small pox did not follow, I mean a fever succeeded by a suppuration of the wound, a suppuration different from that which might take place before the fever, I thought that the action of the variolous virus could produce no other effect in the patient, than what appeared round the incision, and that she was therefore secure from the small pox; and I was confirmed in this opinion, by her continuing exposure to the contagion with her daughter and another lady who were inoculated at the same time, and had the small pox with the usual symptoms.

I was persuaded, according to the general opinion, that when signs of the small pox have been taken, appear round the incision, that disease will certainly follow, supposing the patient to be susceptible of it; and that if the disease does not then follow, the patient is not susceptible of it. The case of the Duchess proves that this opinion is false, whether the signs of the small pox having been taken are equivocal, or whether the virus may act upon that particular part without spreading to the rest of the body. I make no account of the pimple which appeared upon her forehead; because it had neither the form, or the course of variolous pustule; and the Duchess herself, who has now good reason to be well acquainted with variolous pustules, is of the same opinion.

As the same thing that has happened to the Duchess has happened also to many others where inoculation is frequent, and as it may and must happen again, it is of great importance to prevent the mistakes and calm the anxieties that it may produce: and for this purpose I have always thought that every patient who has received the real small pox by inoculation, ought to have a certificate of it given them by their physician. — I have given many such certificates, and I should be glad if every person whom I have inoculated would apply to me for one.”[3]

Despite the uproar over Gatti’s mistake, the smallpox inoculation eventually became more accepted in France. It happened after Louis XV died from the disease and Louis XVI and his brothers got a smallpox inoculation, partly because Marie Antoinette encouraged it. Their bravery created a fad or a craze among nobility. Moreover, Marie Antoinette celebrated the King’s inoculation by commissioning a special towering headdress that became known as the coiffure à l’inoculation and included a serpent wrapped around an olive tree.

References:

• [1] Creighton, Charles, A History of Epidemics in Britain, 1894, p. 495.
• [2] Hume, David, The Letters of David Hume, Volume 1, 2011, p. 525.
• [3] The Gentleman’s Magazine, Volume 35, 1765, p. 495-496.