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diff --git a/old/52722-0.txt b/old/52722-0.txt deleted file mode 100644 index 0d1f843..0000000 --- a/old/52722-0.txt +++ /dev/null @@ -1,1153 +0,0 @@ -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. - - - - ------------------------------------------------------------------------- - - - - -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 -inoculating for the small p, by J. 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