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-The Project Gutenberg EBook of An account of the manner of inoculating for
-the small pox in the East Indies, by J. Z. Holwell
-
-This eBook is for the use of anyone anywhere in the United States and most
-other parts of the world at no cost and with almost no restrictions
-whatsoever.  You may copy it, give it away or re-use it under the terms of
-the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org.  If you are not located in the United States, you'll have
-to check the laws of the country where you are located before using this ebook.
-
-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: J. Z. Holwell
-
-Release Date: August 4, 2016 [EBook #52722]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK INOCULATING FOR THE SMALL POX ***
-
-
-
-
-Produced by readbueno and the Online Distributed
-Proofreading Team at http://www.pgdp.net (This file was
-produced from images generously made available by The
-Internet Archive)
-
-
-
-
-
-
-
-
-
-                                   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.
-
-
-
-
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-
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-
-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.
-
-
-
-
-
-End of the Project Gutenberg EBook of An account of the manner of
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