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

by J. Z. Holwell

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.