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Title: An account of the manner of inoculating for the small pox in the East Indies - With some observations on the practice and mode of treating - that disease in those parts
Author: Holwell, J. Z.
Language: English
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                                   AN

                                ACCOUNT

                            Of the MANNER of

                     Inoculating for the SMALL POX
                          in the EAST INDIES.


                         [Price One Shilling.]



                                   AN
                                ACCOUNT
                            Of the MANNER of
                     Inoculating for the SMALL POX
                          in the EAST INDIES.


                               WITH SOME

                              OBSERVATIONS

                                   ON

                   The PRACTICE and MODE of Treating
                      that DISEASE in those Parts.

                        Inscribed to the Learned

                   The PRESIDENT, and MEMBERS of the
                    COLLEGE of PHYSICIANS in LONDON.

                       By J. Z. HOLWELL, F. R. S.

                                LONDON:

               Printed for T. BECKET, and P. A. DE HONDT,
                   near Surry Street, in the Strand.

                               MDCCLXVII.



                                   AN

                                ACCOUNT

                            Of the MANNER of

                     Inoculating for the SMALL POX
                          in the EAST INDIES.


On perusing lately some tracts upon the subject of Inoculation, I
determined to put together a few notes relative to the manner of
Inoculation, practised, time out of mind, by _the Bramins of Indostan_;
to this I was chiefly instigated, by considering the great benefit that
may arise to mankind from a knowledge of this foreign method, which so
remarkably tends to support the practice now generally followed with
such marvellous success.

By Dr. SCHULTZ's account of Inoculation, page 65, note (9), it should
seem, that the world has been already obliged with a performance of the
kind which I have now undertaken, by a Dutch author, a friend of Mr.
CHAIS; but as this is all I know of that work, it shall not discourage
my proceeding with my own, the more especially as that performance is in
a foreign language, and may not much benefit my country.

As many years are elapsed, since a theme of this nature has employed my
thoughts and attention; I will hope for every favorable indulgence from
the candor of that learned and respectable Body, to whose judgment I
most readily submit the following history and observations.

It has been lately remarked by a learned and judicious ornament of the
College of Physicians, "That the Art of Medicine has, in several
instances, been greatly indebted to Accident; and that some of its most
valuable improvements have been received from the hands of Ignorance and
Barbarism; a Truth, remarkably exemplified in the practice of
INOCULATION of the SMALL POX."—However just _in general_ this learned
Gentleman's remark may be, he will, as to his _particular reference_, be
surprized to find, that nearly the same salutary method, now so happily
pursued in England, (howsoever it has been seemingly blundered upon) has
the sanction of remotest antiquity; but indeed with some variations,
that will rather illustrate the propriety of the present Practice, and
promote the obvious very laudable intention, with which that Gentleman
published his late Essay on this interesting subject.

The general state of this distemper in the Provinces of Bengall (to
which these observations are limited) is such, that for five and
sometimes six years together, it passes in a manner unnoticed, from the
few that are attacked with it; for the complexion of it in these years
is generally so benign as to cause very little alarm; and
notwithstanding the multitudes that are every year inoculated in the
usual season, it adds no malignity to the disease taken in the natural
way, nor spreads the infection, as is commonly imagined in Europe. Every
seventh year, with scarcely any exception, the Small Pox rages
epidemically in these Provinces, during the months of March, April, and
May; and sometimes until the annual returning rains, about the middle of
June, put a stop to its fury. On these periodical returns (to four of
which I have been a witness) the disease proves universally of the most
malignant confluent kind, from which few either of the natives or
Europeans escaped, that took the distemper in the natural way, commonly
dying on the first, second, or third day of the eruption; and yet,
Inoculation in the East, has _natural fears_ and _superstitious
prejudices_ to encounter, as well as in the West. The usual resource of
the Europeans is to fly from the settlements, and retire into the
country before the return of the Small Pox season.

It is singularly worth remarking, that there hardly ever was an instance
of a native of the Island of St. Helena, man or woman, that was seized
with this distemper in the natural way (when resident in Bengall,) who
escaped with life; altho' it is a known fact the disease never yet got
footing upon that Island. Clearly to account for this, is not an easy
matter; I will venture, however, a few conjectures on the occasion.
These people rarely migrate from the Island before they arrive at years
of maturity; the basis of their diet there, from their infancy, is a
root called _yam_, of a _skranshee kind_, a term they use to express its
acrid, unwholesome qualities, which frequently subjects them to epidemic
and dangerous dysenteries, and sometimes epidemic putrid sore throats.
The blood thus charged, must necessarily constitute a most unlucky habit
of body to combat with any acute inflammatory disease whatsoever, but
more especially of the kind under consideration (so frequently attended
with a high degree of putrefaction,) always fatal to these people, even
in those seasons when the disease is mild and favorable to others: But
indeed it is a general remark, that a St. Helenian rarely escapes when
seized with the Small Pox in whatsoever part of the Globe he happens to
reside. The same has been observed of the African Coffries, altho' I
know not what cause to ascribe it to, unless we suppose one similar to
that above mentioned, to wit, some fundamental aggravating principle in
their chief diet. Be this as it may, that these two portions of the
human species seem peculiarly marked as victims to this disease, is a
fact indisputable, let the cause be what it will.

Having thus far premised touching the general state of this distemper in
the Provinces of Bengall, (which I believe is nearly applicable to every
other part of the Empire) I will only add a few words respecting the
duration of it in Indostan, and then hasten to the principal intention
of this short Essay.

The learned Doctor FREIND in his History of Physic from the time of
GALEN, has this remarkable passage: "By the earliest account we have of
the Small Pox, we find it first appeared in _Ægypt_ in the time of
_Omar_, successor to _Mahomet_: though no doubt, since the _Greeks_ knew
nothing of it, the _Arabians_ brought it from their own country, and
might derive it originally from some of the more distant regions of the
_East_." The sagacity of this conclusion, later times and discoveries
has fully verified; at the period in which the _Aughtorrah Bhade_
scriptures of the Gentoos were promulged, (according to the Bramins
three thousand three hundred and sixty six years ago;) this disease must
then have been of some standing, as those scriptures institute a form of
divine worship, with _Poojahs_, or offerings, to a female Divinity,
stiled by the common people _Gootee ka Tagooran_ (the Goddess of Spots,)
whose aid and patronage are invoked during the continuance of the Small
Pox season, also in the Measles, and every cutaneous Eruption that is in
the smallest degree epidemical. Due weight being given to this
circumstance, the long duration of the Disease in Indostan will
manifestly appear; and we may add to the sagacious conjecture just
quoted, that not only the _Arabians_, but the _Ægyptians_ also, by their
early commerce with India through the Red Sea and Gulf of Mocha, most
certainly derived originally the Small Pox (and probably the Measles
likewise) from that country, where those diseases have reigned from the
earliest known times.

Inoculation is performed in Indostan by a particular tribe of Bramins,
who are delegated annually for this service from the different Colleges
of Bindoobund, Eleabas, Banaras, &c. over all the distant Provinces;
dividing themselves into small parties, of three or four each, they plan
their travelling circuits in such wise as to arrive at the places of
their respective destination some weeks before the usual return of the
disease; they arrive commonly in the Bengali Provinces early in
February, although they some years do not begin to inoculate before
March, deferring it until they consider the state of the season, and
acquire information of the state of the distemper.

The year in Bengall can properly be divided into three seasons only, of
four months each; from the middle of June to the middle of October is
the rainy season; from the middle of October to the middle of February
is the cold season, which never rises to a degree of freezing; the whole
globe does not yield a more desirable or delightful climate than Bengall
during these four months; but the freedom of living, which the Europeans
fall into at this season, sow the seeds of those diseases which spring
up in all the succeeding months of the year. From the middle of February
to the middle of June is the hot, windy, dry season; during which no
rain falls but what comes in storms of fierce winds and tremendous
thunder and lightning, called North Westers, the quarter they always
rise from; and the Provinces, particularly Bengall, is more or less
healthy, in proportion to the number of these storms; when in this
season the air is frequently agitated and refreshed with these North
Westers, accompanied with rain, (for they are often dry,) and the
inhabitants do not expose themselves to the intense sun and violent hot
winds that blow in March, April, and May, it is generally found to be
the most healthy of the year; otherwise (as in the year 1744, when we
had no rain from the twentieth of October to the twentieth of June) this
season produces high inflammatory disorders of the liver, breast,
pleura, and intestines, with dysenteries, and a deplorable species of
the Small-Pox.

From the middle of July (the second month of the rainy season) there is
little or no wind, a stagnation of air follows, and during the remainder
of this month, and the months of August and September, the atmosphere is
loaded with suffocating heat and moisture, the parents of putrefaction;
and nervous putrid fevers (approaching sometimes to pestilential) take
the lead, and mark the dangerous season; from these fevers the Natives
frequently recover, but the Europeans seldom, especially if they in the
preceding May and June indulged too freely in those two _bewitching
delicacies, Mangos_ and _Mango Fish_, indiscriminately with the free use
of _flesh_ and _wine_; for these (_all together_) load the whole habit
with impurities, and never fail of yielding Death a plentiful harvest,
in the three last months of this putrid season: If any are seized with
the Small-Pox in these months, it is ever of the most malignant kind,
and usually fatal. It will not, I hope, be deemed a useless digression,
if I bestow a few remarks on the nature of this _Bengall Fever_.

A day or two before the seizure, the patient finds his appetite fall
off, feels an unaccountable lassitude, and failure in the natural
moisture of the mouth, is low spirited without any apparent cause, and
cannot sleep as usual; but having no acute complaint whatsoever, nor
preternatural heat, that should indicate a fever, he attributes the
whole to the heat of the season, is satisfied with fasting and
confinement to his house, or goes abroad amongst his friends to "shake
it off," as the common phrase is; but on the third day, finding every
one of these symptoms increase, he begins to think something is really
the matter with him, and the Physician is called in: thus the only
period is lost wherein art might be of any use; for in the course of
eighteen years practice I never knew an instance of recovery from this
genuine fever, where the first three days had elapsed without
assistance, and the patient in this case dyed on the fifth or seventh
day. In some, this fever is attended with a full, equal, undisturbed
pulse, but obviously greatly _oppressed_; in others, with a low and
_depressed_ one, but equal and undisturbed also, and yet both required
the same treatment. New comers in the profession, have been often
fatally misled by the full pulse, which they thought indicated the loss
of blood; they followed the suggestion, the pulse suddenly fell, and
when that happens from this cause, the art of man can never raise it
again, the patient dies on the fifth or seventh day; and the consequence
was exactly the same, if Nature, being overloaded, attempted to free
herself of part of the burden by a natural hæmorrhage, or by the
intestines, on the second or third day, (which I have often seen) they
proved equally fatal as the launcet. Until the close of the sixth day
the skin and urine preserved a natural state; but if at this period of
the fever the skin suddenly acquired an intense heat, and the urine grew
crude and limpid, it was a sure presage of death on the seventh. The
natural crisis of this fever, when attacked in the very beginning, and
treated judiciously, was regularly on the eleventh day, and appeared in
a multitude of small boils, chiefly upon the head, or in small watery
bladders thrown out upon the surface of the skin, but in the greatest
abundance on the breast, neck, throat, and forehead; both of these
critical appearances are constantly preceded, on the tenth day, by a
copious sediment and separation in the urine. If by any inadvertent
exposure to the cold air, these critical eruptions were struck in, the
repelled matter instantly fell upon the brain, and convulsions and death
followed in a few hours, and small purple spots remained in the places
of the eruptions. Such is the _genuine putrid nervous fever of Bengall_,
which never gave way properly to any treatment but that of blisters
applied universally, supported by the strongest alexipharmics: sometimes
I have seen the crisis (by unskilful management) spun out to the
twenty-first day, but it has been ever imperfect, and the patient is
harrassed with intermittents or diarrhœas, and commonly dies in the
beginning of the cold season; but if he is of a strong constitution, he
lingers on, in a dying way, until the month of February, which usually
gives some turn in his favor, but his health is hardly ever
re-established before the salutary _mango season_, which fruit, eaten
with _milk_, proves an effectual and never-failing restorative. But to
resume our subject.

The inhabitants of Bengall, knowing the usual time when the Inoculating
Bramins annually return, observe strictly the regimen enjoined, whether
they determine to be inoculated or not; this preparation consists only
in abstaining for a month from fish, milk, and ghee, (a kind of butter
made generally of buffalo's milk;) the prohibition of fish respects only
the native Portuguese and Mahomedans, who abound in every Province of
the Empire.

When the Bramins begin to Inoculate, they pass from house to house and
operate at the door, refusing to inoculate any who have not, on a strict
scrutiny, duly observed the preparatory course enjoined them. It is no
uncommon thing for them to ask the Parents how many Pocks they chuse
their Children should have: Vanity, we should think, urged a question on
a matter seemingly so uncertain in the issue; but true it is, that they
hardly ever exceed, or are deficient, in the number required.

They inoculate indifferently on any part, but if left to their choice,
they prefer the outside of the arm, mid-way between the wrist and the
elbow, for the males; and the same between the elbow and the shoulder
for the females. Previous to the operation the Operator takes a piece of
cloth in his hand, (which becomes his perquisite if the family is
opulent,) and with it gives a dry friction upon the part intended for
Inoculation, for the space of eight or ten minutes, then with a small
instrument he wounds, by many slight touches, about the compass of a
silver groat[1], just making the smallest appearance of blood, then
opening a linen double rag (which he always keeps in a cloth round his
waist) takes from thence a small pledgit of cotton charged with the
variolous matter, which he moistens with two or three drops of the
_Ganges_ water, and applies it to the wound, fixing it on with a slight
bandage, and ordering it to remain on for six hours without being moved,
then the bandage to be taken off, and the pledget to remain until it
falls off itself; sometimes (but rarely) he squeezes a drop from the
pledget, upon the part, before he applies it; from the time he begins
the dry-friction, to the tying the knot of the bandage, he never ceases
reciting some portions of the worship appointed, by the _Aughtorrah
Bhade_, to be paid to the female Divinity before-mentioned, nor quits
the most solemn countenance all the while. The cotton, which he
preserves in a double callico rag, is saturated with matter from the
inoculated pustules of the preceding year, for they never inoculate with
fresh matter, nor with matter from the disease caught in the natural
way, however distinct and mild the species. He then proceeds to give
instructions for the treatment of the patient through the course of the
process, which are most religiously observed; these are as follow:

He extends the prohibition of fish, milk, and ghee, for one month from
the day of Inoculation; early on the morning succeeding the operation,
four collons (an earthen pot containing about two gallons) of cold water
are ordered to be thrown over the patient, from the head downwards, and
to be repeated every morning and evening until the fever comes on,
(which usually is about the close of the sixth day from the
Inoculation,) then to desist until the appearance of the eruptions,
(which commonly happens at the close of the third complete day from the
commencement of the fever,) and then to pursue the cold bathing as
before, through the course of the disease, and until the scabs of the
pustules drop off. They are ordered to open all the pustules with a fine
sharp pointed thorn, as soon as they begin to change their colour, and
whilst the matter continues in a fluid state. Confinement to the house
is absolutely forbid, and the inoculated are ordered to be exposed to
every air that blows; and the utmost indulgence they are allowed when
the fever comes on, is to be laid on a mat at the door; but, in fact,
the eruptive fever is generally so inconsiderable and trifling, as very
seldom to require this indulgence. Their regimen is ordered to consist
of all the refrigerating things the climate and season produces, as
plantains, sugar-canes, water-melons, rice, gruel made of white
poppy-seeds, and cold water, or thin rice gruel for their ordinary
drink. These instructions being given, and an injunction laid on the
patients to make a thanksgiving _Poojah_, or Offering, to the Goddess on
their recovery, the Operator takes his fee, which from the poor is a
_pund of cowries_, equal to about a penny sterling, and goes on to
another door, down one side of the street and up on the other, and is
thus employed from morning until night, inoculating sometimes eight or
ten in a house. The regimen they order, when they are called to attend
the disease taken in the natural way, is uniformly the same. There
usually begins to be a discharge from the scarification a day before the
eruption, which continues through the disease, and sometimes after the
scabs of the Pock fall off, and a few pustules generally appear round
the edge of the wound; when these two circumstances appear only, without
a single eruption on any other part of the body, the patient is deemed
as secure from future infection, as if the eruption had been general.

When the before recited treatment of the Inoculated is strictly
followed, it is next to a miracle to hear, that one in a million fails
of receiving the infection, or of one that miscarries under it; of the
multitudes I have seen inoculated in that country, the number of
pustules have been seldom less than fifty, and hardly ever exceeded two
hundred. Since, therefore, this practice of the East has been followed
without variation, and with uniform success from the remotest known
times, it is but justice to conclude, it must have been originally
founded on the basis of rational principles and experiment.

Although I was very early prejudiced in preference of the cool regimen
and free admission of air, in the treatment of this disease, yet, on my
arrival in Bengall, I thought the practice of the Bramins carried _both_
to a bold, rash, and dangerous extreme; but a few years experience gave
me full conviction of the propriety of their method: this influenced my
practice, and the success was adequate; and I will venture to say, that
every gentleman in the Profession who did not adopt the same mode,
(making a necessary distinction and allowance between the constitutions
of the Natives and Europeans,) have lost many a patient, which might
otherwise have been saved; as I could prove in many instances, where I
have been called in too late to be of any assistance. But to form a
judgment of the propriety of this Eastern practice with more precision,
it will be best to analyze it, from the period of the enjoined
preparation, to the end of the process; as thereby an opportunity
presents itself of displaying the principles on which the Bramins act,
and by which they justify their singular method of practice.

It has been already said, that the preparative course consists only in
abstaining from fish, milk, and ghee; respecting the first, it is known
to be a viscid and inflammatory diet, tending to foul and obstruct the
cutaneous glands and excretory ducts, and to create in the stomach and
first passages a tough, slimy phlegm, highly injurious to the human
constitution; as these are the generally supposed qualities of this
diet, it seems forbid upon the justest grounds.

Touching milk, which is the basis (next to rice) of all the natives
food, I confess I was surprized to find it one of the forbidden
articles, until I was made acquainted with their reasoning on the
subject. They say that milk becomes highly nutritious, not only from its
natural qualities, but principally from its ready admission into the
blood, and quick assimulation with it; and that it consequently is a
warm heating diet, and must have a remote tendency to inflammation,
whenever the blood is thrown into any preternatural ferment, and
therefore, that milk is a food highly improper, at a season when the
preternatural fermentation that produces the Small Pox ought to be
feared, and guarded against by every person who knows himself liable to
the disease, or determined to prepare himself for receiving it, either
from nature or art. Upon this principle and reasoning it is, that their
women, during the course of their periodical visitations, are strictly
forbid, and religiously abstain from, the use of milk, lest it should,
upon any accidental cold, dispose the uterus to inflammation and
ulceration; and from the same apprehension, the use of it is as strictly
prohibited during the flow of the lochia, and is avoided as so much
poison; our European women, resident in India, have adopted the same
precaution from experience of the effect, and will not, on any
consideration, at those times, mix the smallest quantity with their tea,
a lesson they derive from their Midwives, who are all natives, and
generally are instructed in their calling by the Bramins, and other
Practitioners in Physic.

Concerning the third interdicted article, they allege, that under _that_
is implied a prohibition of all fat and oily substances, as their
qualities are nearly similar with those of fish, and similar in their
effects of fouling the first passages in a high degree above any other
aliment that is taken into them; that they soon acquire an acrimony in
the course of digestion, and convey the same into the blood and juices;
these premises being granted, which I think can hardly be denied, there
appears sufficient cause for prohibiting the use of the whole tribe; the
more especially, as ghee and oil are the essential ingredients used in
cooking their vegetable diet.

Thus far the system of practice pursued by the Bramins will, I imagine,
appear rational enough, and well founded; but they have other reasons
for particularly prohibiting the use of these three articles, which to
some may appear purely speculative, if not chimerical. They lay it down
as a _principle_, that the _immediate_ (or instant) cause of the Small
Pox exists in the mortal part of every human and _animal_ form[2]; that
the _mediate_ (or second) _acting_ cause, which stirs up the _first_,
and throws it into a state of fermentation, is multitudes of
_imperceptible animalculæ_ floating in the atmosphere; that these are
the cause of all epidemical diseases, but more particularly of the Small
Pox; that they return at particular seasons in greater or lesser
numbers; that these bodies, imperceptible as they are to the human
organs of vision, imprison the most malignant tribes of the _fallen
angelic Spirits_: That these animalculæ touch and adhere to every thing,
in greater or lesser proportions, according to the nature of the
surfaces which they encounter; that they pass and repass in and out of
the bodies of all animals in the act of respiration, without injury to
themselves, or the bodies they pass through; that such is not the case
with those that are taken in with the food, which, by mastication, and
the digestive faculties of the stomach and intestines, are crushed and
assimulated with the chyle, and conveyed into the blood, where, in a
certain time, their malignant juices excite a fermentation peculiar to
the _immediate_ (or _instant_) cause, which ends in an eruption on the
skin. That they adhere more closely, and in greater numbers, to
glutinous, fat, and oily substances, by which they are in a manner taken
prisoners; that _fish_, _milk_, and _ghee_, have these qualities in a
more eminent and dangerous degree, and attach the animalculæ, and convey
them in greater quantities into the blood; and for these reasons, added
to those before assigned, they are forbid to be taken in food during the
preparative course. They add, that the Small Pox is more or less
epidemical, more mild or malignant, in proportion as the air is charged
with these animalculæ, and the quantity of them received with the food.
That though we all receive, with our aliment, a portion of them, yet it
is not always sufficient in quantity to raise this peculiar ferment, and
yet may be equal to setting the seeds of other diseases in motion; hence
the reason why any epidemical disorder seldom appears alone. That when
once this _peculiar_ ferment, which produces the Small Pox, is raised in
the blood, the _immediate (instant) cause_ of the disease is totally
expelled in the eruptions, or by other channels; and hence it is, that
the blood is not susceptible of a second fermentation of the same kind.
That Inoculating for this disease was originally hinted by the
_Divinity_ presiding over the _immediate (instant) cause_, the thought
being much above the reach of human wisdom and foresight. That the great
and obvious benefit accruing from it, consists in this, that the
fermentation being excited by the action of a small portion of matter
(similar to the _immediate_ cause) which _had already passed through_ a
state of fermentation, the effects must be moderate and benign; whereas
the fermentation raised by the malignant juices of the animalculæ
received into the blood with the aliment, gives necessarily additional
force and strength to the first efficient cause of the disease.

That noxious animalculæ, floating in the atmosphere, are the cause of
all pestilential, and other epidemical disorders, is a doctrine the
Bramins are not singular in; however, some of the conclusions drawn from
it, are purely their own. A speculative genius may amuse itself by
assigning this or that efficient cause, or first principle of this
disease; but the best conjecture which the wisdom of man can frame, will
appear vague and uncertain; nor is it of much moment, in the present
case, to puzzle the imagination, by a minute enquiry into the essence of
a cause hidden from us, when the effects are so visible, and chiefly
call for our regard: but if we must assign _a cause_, why every part of
the globe, _at particular seasons_, is more liable to peculiar malignant
epidemical diseases, than _at others_, (which experience manifests) I
see no one that so much wears the complexion of probability, as that of
pestilent animalculæ, driven by stated winds, or generated on the spot
by water and air in a state of stagnation, (and consequently in a state
of putrefaction favourable to their propagation,) and received into the
habit with our food and respiration. We yearly see, in a greater or
lesser degree, the baneful effects of these insects in blights, although
at their first seizure of a plant they are invisible, even with the
assistance of the best glasses; and I hope I shall not be thought to
refine too much on the argument, if I give it as my opinion, that
epidemical blights, and epidemical diseases of one kind or other, may be
observed to go often hand in hand with each other, from the same
identical cause. But to proceed in our analysis.

The mode by which the Eastern Inoculators convey the variolous taint
into the blood, has nothing uncommon in it, unless we except the
preceding friction upon the part intended for Inoculation, and
moistening the saturated pledget, before the application of it; for this
practice they alledge the following reasons; that by _friction_ the
circulation in the small sanguinary vessels is accelerated, and the
matter being _diluted_ by a small portion of _Ganges water_, is, from
both causes, more readily and eagerly received, and the operation at the
same time sanctified. The friction and dilution of the matter, has
certainly the sanction of very good common sense; and the Ganges water,
I doubt not, may have as much efficacy as any other _holy water_
whatsoever. This last circumstance, however, keeps up the piety and
solemnity with which the operation is conducted from the beginning to
the end of it; it tends also to give confidence to the patient, and so
far is very laudable. The reasons they assign for giving the preference
to matter of the _preceding year_, are singular and judicious; they
urge, it is more certain in its effects; that necessity first pointed
out the fact, (the variolous matter some years not being procurable,)
and experience confirmed it: they add, that when the matter is
effectually secured from the air, it undergoes at the return of the
season an _imperceptible fermentation_, which gives fresh vigour to its
action. It is no uncommon thing to inoculate with matter four or five
years old, but they generally prefer that of a year old, conceiving that
the fermentation which constitutes its superiority over fresh matter, is
yearly lessened, and consequently the essential spirit of action
weakened, after the first year.

The next article of the Eastern practice, which offers in the course of
our discussion, is their sluicing their patients over head and ears,
morning and evening, with cold water, until the fever comes on; in which
the inoculating Bramins are, beyond controversy, singular: but before we
can penetrate the grounds and reasons for this practice, it becomes
necessary to bestow a few words on the usual manner of cold bathing in
the East, when medically applied, which is simply this; the water is
taken up over night, in three, four, or five vessels, before described,
(according to the strength of the patient,) and left in the open air, to
receive the dews of the night, which gives it an intense coldness; then
in the morning, before the sun rises, the water is poured without
intermission, by two servants, over the body, from the distance of six
or twelve inches above the head. This mode of cold bathing has been
adopted from the Eastern professors of Physic, by all the European
practitioners, and by constant experience found abundantly more
efficacious than that by immersion, in all cases where that very capital
remedy was indicated; notwithstanding it has been ever the received
opinion, that the success of cold bathing, is as much, or rather more,
owing to the weight and pressure of the circumambient body of water,
than _the shock_. The remarkable superior efficacy of this Eastern
method of cold bathing, can only be accounted for, from _the shock_
being infinitely greater, and of longer continuance, than that received
by immersion; which is a fact indisputable, as will be acknowledged by
every one who goes through a course of both methods; the severity of the
one being nothing comparable to the other: this I assert from my own
personal feelings; and I never had a patient that did not aver the same,
who had undergone both trials: indeed, the shock of this Eastern method
is so great, that, in many cases, when the subject was deeply exhausted
and relaxed, I have found it absolutely necessary to begin the course
only with _a quart_ of water.

If the known effects of cold bathing are attended to, and its sovereign
virtues duly considered, in the very different circumstances of Palsies,
Rheumatisms, general relaxation of the solids, and particular relaxation
of the stomach and intestines, we shall not be long at a loss to account
for this part of the Eastern practice in the course of Inoculation: They
allege in defence of it, that by the sudden shock of the cold water, and
consequent increased motion of the blood, all offensive principles are
forcibly driven from the heart, brain, and other interior parts of the
body, towards the extremities and surface, and at the same time the
intended fermentation is thereby more speedily and certainly promoted;
(hence it probably is, that the fever generally commences so early as
about the close of the sixth day.) When the fever appears, they desist
from the use of the cold water, because when the fermentation is once
begun, the blood should not, they say, receive any additional commotion
until the eruption appears, when they again resume the cold water, and
continue it to the end of the disease; asserting, that the use of it
alone, by the daily fresh _impetus_ it gives to the blood, enables it
utterly to expel and drive out the remainder of the _immediate_ cause of
the disease into the pustules. I have been myself an eye-witness to many
instances of its marvelous effect, where the pustules have sunk, and the
patient appeared in imminent danger, but almost instantly restored by
the application of three or four collans of cold water, which never
fails of filling the Pock, as it were by enchantment; and so great is
the stress laid by the Eastern Practitioners on this preparative, (for
as the three interdicted articles in food is preparative to the
Inoculation, so this may be deemed preparative to the eruption,) that
when they are called in, and find, upon enquiry, that circumstance (and
opening the pustules) has not been attended to, they refuse any further
attendance.

The next and last article of the Eastern practice, which falls under our
consideration, is that just abovementioned, viz. the opening of the
Pustules, whilst the matter continues in a fluid state. That a
circumstance so important, so self-evidently rational and essential,
should have been so long unthought of, appears most wonderful! and if my
memory fails me not, HELVETIUS is the only writer upon the subject of
the Small Pox, that hinted it in practice before Doctor TISSOT; this
accurate and benevolent Physician has enforced it with such strength of
judgment and argument, that he leaves little room (except facts) to add
to his pathetic persuasive; in this he is supported by his learned and
elegant Commentator and Translator Doctor KIRKPATRICK, (page 226 and
227,) and I am not without hopes it will, contrary to Doctor TISSOT'S
expectation, "become a general practice;" the more especially, when it
is found to have invariable success, and venerable antiquity, for its
sanction.

So great is the dependence which the Eastern Practitioners have on
opening the Pustules, in every malignant kind of the disease, that where
the fluid state of the matter has been suffered to elapse without being
evacuated, they pronounce the issue fatal, and it generally proves so;
they order it in every kind, even the most distinct; for although in
these it should seem scarcely necessary, yet they conceive it
effectually prevents inflammation and weakness of the eyes, biles, and
other eruptions and disorders, which so commonly succeed the disease,
however benign; in very critical cases, they will not trust the
operation of opening the Pustules to the nurses or relations, but engage
in it themselves, with amazing patience and solicitude; and I have
frequently known them thus employed for many hours together; and when it
has been zealously persevered in, I hardly ever knew it fail, of either
intirely preventing the _second fever_, or mitigating it in such sort,
as to render it of no consequence; in various instances, which I have
been a witness to, in my own, and others practice, I have seen the
Pustules in the _contiguous_ kind, upon being successively opened, fill
again to the fourth and fifth, and in the _confluent_, to the sixth,
seventh, and eighth time; in the very distinct sort they will not fill
again more than once or twice, and sometimes not at all, which was a
plain indication, that the whole virus of the disease was excelled in
the first eruption.

The Eastern Practitioners, with great modesty, arraign the European
practice of Phlebotomy and Cathartics in any stage of the disease, but
more particularly when designed to prevent, or mitigate the second
fever; alledging, that the _first_ weakens the natural powers, and that
the _latter_ counteracts the regular course of _nature_, which in this
disease invariably tends to throw out the offending cause _upon the
skin_; that she often proves unequal to the intire expulsion of the
enemy, in which case, her wise purposes are to be assisted by art, in
that track, which she herself points out, and not by a diversion of the
usual crisis into another chanel; that this assistance can only be
attempted with propriety, by emptying the Pustules, as thereby fresh
room is given in them for the reception of the circulating matter still
remaining in the blood, and which could not be contained in the first
eruption; by which means every end and purpose of averting, or subduing
the _second fever_ is obtained, with a moral certainty; whilst
Phlebotomy and Cathartics, administered with this view, are both
irrational and precarious; as being opposite to the constant operation
of Nature in her management of this dreadful disease.

It remains only that I add a word or two upon the Eastern manner of
opening the Pustules, which (as before mentioned) is directed to be done
with a very fine sharp pointed thorn: Experience has established the use
of this natural instrument in preference to either the scissars,
launcet, or needle; the Practitioners perforate the most prominent part
of the Pustule, and with the sides of the thorn press out the pus; and
having opened about a dozen, they absorb the matter with a callico rag,
dipt in warm water and milk; and proceed thus until the whole are
discharged: the orifice made by the thorn is so extremely small, that it
closes immediately after the matter is pressed out, so that there is no
admission of the external air into the Pustule, which would suddenly
contract the mouths of the excretory vessels, and consequently the
further secretion of the variolous matter from the blood would be
thereby obstructed; for this consideration, the method recommended by
Doctor TISSOT, of clipping the Pustules with sharp pointed scissars, is
certainly liable to objection, as the aperture would be too large; when
in the true confluent kind, no distinct Pustules present, they perforate
the most prominent and promising parts, in many places, at the distance
of a tenth of an inch, usually beginning at the extremities; and I have
often seen the Pustules in the _contiguous_, and the perforated parts in
the _confluent_ kind, fill again before the operation has been half
over; yet they do not repeat the opening until a few hours elapse,
conceiving it proper that the matter should receive some degree of
concoction in the Pustules before it is again discharged.

If the foregoing Essay on the Eastern mode of treating the Small Pox,
throws any new and beneficial lights upon this cruel and destructive
disease, or leads to support and confirm the present successful and
happy method of Inoculation, in such wise as to introduce, into _regular
and universal practice, the cool regimen and free admission of Air_,
(the contrary having proved the bane of millions,) I shall, in either
case, think the small time and trouble bestowed in putting these facts
together most amply recompensed.

    _Chilton Lodge, Wilts_,

    _September 1, 1767_.

                                 FINIS.

-----

Footnote 1:

  The instrument they make use of, is of iron, about four inches and a
  half long, and of the size of a large crow quill, the middle is
  twisted, and the one end is steeled and flatted about an inch from the
  extremity, and the eighth of an inch broad; this extremity is brought
  to a very keen edge, and two sharp corners; the other end of the
  instrument is an ear-picker, and the instrument is precisely the same
  as the Barbers of Indostan use to cut the nails, and depurate the ears
  of their customers, (for in that country, we are above performing
  either or these operations ourselves.) The Operator of Inoculation
  holds the instrument as we hold a pen, and with dextrous expedition
  gives about fifteen or sixteen minute scarifications (within the
  compass abovementioned) with one of the sharp corners of the
  instrument, and to these various little wounds, I believe may be
  ascribed the discharge which almost constantly flows from the part in
  the progress of the disease. I cannot help thinking that too much has
  been said (pro and con) about nothing, respecting the different
  methods preferred by different Practitioners of performing the
  operation; provided the matter is thrown into the blood, it is
  certainly a consideration of most trivial import by what means it is
  effected; if any claims a preference, I should conclude it should be
  that method which bids fairest for securing a plentiful discharge from
  the ulcer.

Footnote 2:

  In an epidemic season of the confluent Small Pox, Turkeys, Chittygong
  Fowls, Madrass Capons, and other poultry, are carried off by the
  disease in great numbers; and have the symptoms usually accompanying
  every stage of the distemper. I had a favourite Parrot that died of it
  in the year 1744; in him I had a fair opportunity of observing the
  regular progress of the disorder; he sickened, and had an ardent fever
  full two days before the eruption, and died on the seventh day of the
  eruption; on opening him, we found his throat, stomach, and whole
  channel of the first passages, lined as thick with the pustules as the
  surface of his body, where, for the most part, they rose contiguous,
  but in other places they ran together.



------------------------------------------------------------------------



Transcriber's Notes.

This Book is 300 years old and the advice given has been superceded by
more modern methods and is of historical value only.

The original spellings and punctuation have been retained.

Italicized words and phrases are presented by surrounding the text with
underscores.





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