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 deter⯑mined 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 fol⯑lowed with ſuch marvellous ſucceſs.

By Dr. SCHULTZ's account of Inocula⯑tion, page 65. note (9), it ſhould ſeem, [2]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 diſcou⯑rage my proceeding with my own, the more eſpecially as that performance is in a foreign language, and may not much be⯑nefit my country.

As many years are elapſed, ſince a theme of this nature has employed my thoughts and attention; I will hope for every favor⯑able indulgence from the candor of that learned and reſpectable Body, to whoſe judgment I moſt readily ſubmit the follow⯑ing 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 Igno⯑rance and Barbariſm; a Truth, remark⯑ably [3]exemplified in the practice of IN⯑OCULATION of the SMALL POX."’—However juſt in general this learned Gen⯑tleman'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 in⯑deed with ſome variations, that will rather illuſtrate the propriety of the preſent Prac⯑tice, and promote the obvious very laud⯑able intention, with which that Gentle⯑man publiſhed his late Eſſay on this inter⯑eſting ſubject.

The general ſtate of this diſtemper in the Provinces of Bengall (to which theſe obſer⯑vations 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 notwith⯑ſtanding the multitudes that are every year inoculated in the uſual ſeaſon, it adds no [4]malignity to the diſeaſe taken in the natu⯑ral way, nor ſpreads the infection, as is commonly imagined in Europe. Every ſe⯑venth 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 pe⯑riodical returns (to four of which I have been a witneſs) the diſeaſe proves univer⯑ſally of the moſt malignant confluent kind, from which few either of the natives or Europeans eſcaped, that took the diſtem⯑per 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 preju⯑dices 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 na⯑tive [5]of the Iſland of St. Helena, man or woman, that was ſeized with this diſtem⯑per 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 ac⯑count 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 epi⯑demic 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 conſide⯑ration (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 [6]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 fundamen⯑tal 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 indiſpu⯑table, let the cauſe be what it will.

Having thus far premiſed touching the general ſtate of this diſtemper in the Pro⯑vinces of Bengall, (which I believe is nearly applicable to every other part of the Em⯑pire) I will only add a few words reſpect⯑ing 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 Aegypt [7]in the time of Omar, ſucceſſor to Maho⯑met: 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 hun⯑dred 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 peo⯑ple Gootee ka Tagooran (the Goddeſs of Spots,) whoſe aid and patronage are in⯑voked 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 dura⯑tion of the Diſeaſe in Indoſtan will mani⯑feſtly appear; and we, may add to the ſagacious conjecture juſt quoted, that not [8]only the Arabians, but the Aegyptians alſo, by their early commerce with India through the Red Sea and Gulf of Mocha, moſt cer⯑tainly 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 travel⯑ling 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 Bengall Pro⯑vinces early in February, although they ſome years do not begin to inoculate be⯑fore March, deferring it untill they conſider the ſtate of the ſeaſon, and acquire infor⯑mation of the ſtate of the diſtemper.

The year in Bengall can properly be di⯑vided into three ſeaſons only, of four [9]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 de⯑ſirable 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 light⯑ning, 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, [10]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 putre⯑faction; and nervous putrid fevers (ap⯑proaching ſometimes to peſtilential) take the lead, and mark the dangerous ſeaſon; from theſe fevers the Natives frequently recover, but the Europeans ſeldom, eſpe⯑cially if they in the preceding May and June indulged too freely in thoſe two be⯑witching 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 [11]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 fa⯑tal. It will not, I hope, be deemed a uſeleſs digreſſion, if I beſtow a few re⯑marks 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 ſpi⯑rited without any apparent cauſe, and can⯑not ſleep as uſual; but having no acute complaint whatſoever, nor preternatural heat, that ſhould indicate a fever, he at⯑tributes the whole to the heat of the ſea⯑ſon, is ſatisfied with faſting and confine⯑ment to his houſe, or goes abroad amongſt his friends to "ſhake it off," as the com⯑mon phraſe is; but on the third day, find⯑ing 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 [12]wherein art might be of any uſe; for in the courſe of eighteen years practice I ne⯑ver 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 at⯑tended 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 re⯑quired 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 ſe⯑venth day; and the conſequence was ex⯑actly the ſame, if Nature, being overloaded, attempted to free herſelf of part of the burden by a natural haemorrhage, or by the inteſtines, on the ſecond or third day, (which I have often ſeen) they proved equally fatal as the launcet. Until the [13]cloſe of the ſixth day the ſkin and urine preſerved a natural ſtate; but if at this period of the fever the ſkin ſuddenly ac⯑quired 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 re⯑gularly 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 cri⯑tical 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 re⯑pelled matter inſtantly fell upon the brain, and convulſions and death followed in a few hours, and ſmall purple ſpots remain⯑ed in the places of the eruptions. Such is the genuine putrid nervous fever of Ben⯑gall, which never gave way properly to any treatment but that of bliſters applied [14]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 harraſ⯑ſed with intermittents or diarrhoeas, and commonly dies in the beginning of the cold ſeaſon; but if he is of a ſtrong con⯑ſtitution, he lingers on, in a dying way, until the month of February, which uſu⯑ally 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 regi⯑men enjoined, whether they determine to be inoculated or not; this preparation con⯑ſiſts 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 [15]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 ſeem⯑ingly 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 [16]eight or ten minutes, then with a ſmall inſtrument he wounds, by many ſlight touches, about the compaſs of a ſilver groat^*, juſt making the ſmalleſt appear⯑ance of blood, then opening a linen dou⯑ble rag (which he always keeps in a cloth round his waiſt) takes from thence a ſmall pledgit of cotton charged with the vari⯑olous matter, which he moiſtens with two or three drops of the Ganges water, and applies it to the wound, fixing it on [17]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 wor⯑ſhip 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 mat⯑ter, 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 treat⯑ment 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 ſuc⯑ceeding 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 down⯑wards, 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 defiſt until the appearance of the erup⯑tions, (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. Con⯑finement to the houſe is abſolutely forbid, and the inoculated are ordered to be ex⯑poſed to every air that blows; and the [19]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 in⯑dulgence. 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 wa⯑ter, 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 Ope⯑rator takes his fee, which from the poor is a pund of cowries, equal to about a pen⯑ny 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 or⯑der, when they are called to attend the diſ⯑eaſe taken in the natural way, is uniform⯑ly the ſame. There uſually begins to be a diſcharge from the ſcarification a day be⯑fore [20]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 ex⯑ceeded two hundred. Since, therefore, this practice of the Eaſt has been followed without variation, and with uniform ſuc⯑ceſs 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 car⯑ried 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 ven⯑ture 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 inſtan⯑ces, 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 pre⯑ſents itſelf of diſplaying the principles on which the Bramins act, and by which [22]they juſtify their ſingular method of prac⯑tice.

It has been already ſaid, that the pre⯑parative 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 excre⯑tory ducts, and to create in the ſtomach and firſt paſſages a tough, ſlimy phlegm, highly injurious to the human conſtitu⯑tion; 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 ac⯑quainted with their reaſoning on the ſub⯑ject. They ſay that milk becomes highly nutritious, not only from its natural qua⯑lities, but principally from its ready admiſ⯑ſion into the blood, and quick aſſimulation with it; and that it conſequently is a warm heating diet, and muſt have a re⯑mote [23]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 pre⯑ternatural fermentation that produces the Small Pox ought to be feared, and guard⯑ed 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 leſ⯑ſon they derive from their Midwives, who are all natives, and generally are inſtruct⯑ed [24]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 pre⯑miſes 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 ſpecu⯑lative, if not chimerical. They lay it [25]down as a principle, that the immediate (or inſtant) cauſe of the Small Pox exiſts in the mortal part of every human and ani⯑mal formIn 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.; that the mediate (or ſecond) acting cauſe, which ſtirs up the firſt, and throws it into a ſtate of fermentation, is multitudes of imperceptible animalculae 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, im⯑perceptible as they are to the human or⯑gans of viſion, impriſon the moſt malig⯑nant tribes of the fallen angelic Spirits: That theſe animalculae touch and adhere to every thing, in greater or leſſer propor⯑tions, according to the nature of the ſur⯑faces which they encounter; that they [26]paſs and repaſs in and out of the bodies of all animals in the act of reſpiration, with⯑out 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 di⯑geſtive faculties of the ſtomach and in⯑teſtines, 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 ſub⯑ſtances, 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 animalculae, 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 dur⯑ing the preparative courſe. They add, that the Small Pox is more or leſs epi⯑demical, more mild or malignant, in pro⯑portion as the air is charged with theſe [27]animalculae, and the quantity of them received with the food. That though we all receive, with our aliment, a por⯑tion of them, yet it is not always ſuffi⯑cient in quantity to raiſe this peculiar fer⯑ment, 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 fer⯑mentation of the ſame kind. That Ino⯑culating for this diſeaſe was originally hinted by the Divinity preſiding over the immediate (inſtant) cauſe, the thought be⯑ing much above the reach of human wiſ⯑dom and foreſight. That the great and obvious benefit accruing from it, conſiſts in this, that the fermentation being ex⯑cited by the action of a ſmall portion of matter (ſimilar to the immediate cauſe) which bad already paſſed through a ſtate of fermentation, the effects muſt be mo⯑derate [28]and benign; whereas the fermen⯑tation raiſed by the malignant juices of the animalculae received into the blood with the aliment, gives neceſſarily addi⯑ditional force and ſtrength to the firſt effi⯑cient cauſe of the diſeaſe.

That noxious animalculae, floating in the atmoſphere, are the cauſe of all peſtilential, and other epidemical diſor⯑ders, is a doctrine the Bramins are not ſingular in; however, ſome of the con⯑cluſions 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 mo⯑ment, 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 pecu⯑liar malignant epidemical diſeaſes, than [29] at others, (which experience manifeſts) I ſee no one that ſo much wears the com⯑plexion of probability, as that of peſtilent animalculae, 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 bane⯑ful effects of theſe inſects in blights, al⯑though 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 ar⯑gument, 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 Inocu⯑lators convey the variolous taint into the blood, has nothing uncommon in it, un⯑leſs we except the preceding friction upon the part intended for Inoculation, and moiſtening the ſaturated pledget, before [30]the application of it; for this practice they alledge the following reaſons; that by friction the circulation in the ſmall ſangui⯑nary 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 ſanc⯑tion 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, how⯑ever, 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 pa⯑tient, and ſo far is very laudable. The reaſons they aſſign for giving the pre⯑ference to matter of the preceding year, are ſingular and judicious; they urge, it is more certain in its effects; that neceſ⯑ſity firſt pointed out the fact, (the vari⯑olous matter ſome years not being procu⯑rable,) and experience confirmed it: they add, that when the matter is effectually ſecured from the air, it undergoes at the [31]return of the ſeaſon an imperceptible fer⯑mentation, which gives freſh vigour to its action. It is no uncommon thing to ino⯑culate 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 prac⯑tice, which offers in the courſe of our diſ⯑cuſſion, 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, be⯑yond controverſy, ſingular: but before we can penetrate the grounds and reaſons for this practice, it becomes neceſſary to be⯑ſtow 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; [32]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 practi⯑tioners, and by conſtant experience found abundantly more efficacious than that by immerſion, in all caſes where that very capital remedy was indicated; notwith⯑ſtanding it has been ever the received opi⯑nion, 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 re⯑markable ſuperior efficacy of this Eaſtern method of cold bathing, can only be ac⯑counted for, from the ſhock being infinite⯑ly 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 feel⯑ings; and I never had a patient that did [33]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 ex⯑hauſted and relaxed, I have found it ab⯑ſolutely 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 circum⯑ſtances of Palſies, Rheumatiſms, general relaxation of the ſolids, and particular re⯑laxation 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 de⯑fence of it, that by the ſudden ſhock of the cold water, and conſequent increaſed motion of the blood, all offenſive princi⯑ples 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 fermenta⯑tion 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 [34]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 re⯑ſume 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-wit⯑neſs 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 appli⯑cation 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 Practi⯑tioners 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) [35]has not been attended to, they refuſe any further attendance.

The next and laſt article of the Eaſtern practice, which falls under our conſidera⯑tion, is that juſt abovementioned, viz. the opening of the Puſtules, whilſt the matter continues in a fluid ſtate. That a circum⯑ſtance ſo important, ſo ſelf-evidently ra⯑tional and eſſential, ſhould have been ſo long unthought of, appears moſt wonder⯑ful! 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 ac⯑curate and benevolent Phyſician has en⯑forced it with ſuch ſtrength of judgment and argument, that he leaves little room (except facts) to add to his pathetic per⯑ſuaſive; 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 ex⯑pectation, "become a general practice;" the more eſpecially, when it is found to have invariable ſucceſs, and venerable an⯑tiquity, 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 com⯑monly ſucceed the diſeaſe, however be⯑nign; 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 ſolli⯑citude; 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 in⯑tirely preventing the ſecond fever, or miti⯑gating 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 [37]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 expelled 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 counter⯑acts 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 expul⯑ſion 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 [38]given in them for the reception of the cir⯑culating 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 ſub⯑duing the ſecond fever is obtained, with a moral certainty; whilſt Phlebotomy and Cathartics, adminiſtred with this view, are both irrational and precarious; as be⯑ing 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 pre⯑ference 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 [39]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 TIS⯑SOT, of clipping the Puſtules with ſharp pointed ſciſſars, is certainly liable to ob⯑jection, 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 con⯑tiguous, and the perforated parts in the confluent kind, fill again before the opera⯑tion 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 [40]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 uni⯑verſal practice, the cool regimen and free ad⯑miſſion of Air, (the contrary having proved the bane of millions,) I ſhall, in either caſe, think the ſmall time and trouble be⯑ſtowed in putting theſe facts together moſt amply recompenced.

Chilton Lodge, Wilts, September 1, 1767.