(fays the author) in the beginning of fevers, it will ever be proper, if poffible, to render the whole ftate of the veffels pervious, for which purpofe, fuch evacuations and fuch deobftruents must be used, as the nature of the disease requires; and whenever a fever is arifing from obftruction, it will fometimes be prevented by this means alone. But if, notwithstand. ing this treatment, affifted by the free ufe of cool fresh air, the fever, without fhewing any favourable Symptom, should increase ; have we not, in order to prevent its confequences, authority enough to fupprefs it, by a proper degree of cold, as the most certain antidote to heat? for, befides what we have already referred to upon this subject, it has also been obferved, that people feized with fevers, having been by mistake expofed to the cold air, &c. have received manifeft advantage.

Proper evacuations being made, if the patient is incapable of moving into the open air, he may perhaps, with equal advantage, be exposed to cold air in his room, provided proper fteps are taken by medicines to guard against any inconvenience, that may arise from want of action; for stirring about; during the use of cold air, tends at leaft to prevent its chilling the blood, or having other bad confequences. But; we must not content ourselves with throwing open a casement only, and fuffering the patient to breathe a purer air; but he must also receive air upon his body, fufficiently cool to take off his fever. And therefore the practice of giving cold water must likewife be purfued, if the violence of the difeafe require it.

"When these are not fufficient to extinguish the fever, may not the patients, in our climate, have cold water poured upon them, in the manner of the Perfians and Neapolitans, till the fever is fubdued; taking care, by giving proper medicines, that a regular motion in the blood be preferved; left, where extreme cold is neceffary, life fhould be extinguished with the heat? An ardent fever, we fee, has been cured by this method, even in Scotland; and it only feems neceflary to adapt the proportion of cold to the degree of heat, which cannot fail of being right in every climate. And we may observe, once for all, that whenever cold, in any way, is ufed, a due degree of ftrength fhould alfo be preferved, that the morbific matter may be properly expelled.'

The author, foreseeing that an objection might be raised against his doctrine of the inutility of a fever for expelling acrimonious humours, from the falutary effects often attending warm medicines which increase the fever, ingeniously obviates it, by fuppofing, that though warm cordials have increased the fever, and done remarkable fervice, the advantage derived from the ufe of them was not owing to their increasing the

fever, but to their stimulating the almost inactive nerves, and thereby caufing the small veffels to carry, with proper vigour, the contained fluids to their extremities.

The doctrine of this Effay, erected on no whimfical theory, and fupported by the practice of the ancients, is equally, the production of genius and judgment. It is fortified on all fides from the attack of opponents, and, what is no inconfiderable proof of an hypothefis being founded in nature, is intirely confiftent with itself. Should the doctrine here recommended be found to ftand the teft of future experience, as well as of critical investigation, and pave the way to a more speedy extinction of fevers, it must be regarded as one of the most important bleflings that phyfic ever conferred on mankind, and be productive of a revolution in practice, unexpected in the medical world.

IX. An Account of the Manner of Inoculating for the Small-Pox in the Eaft Indies. With fome Obfervations on the Practice and Mode of Treating that Disease in thofe Purts. Infcribed to the Learned the Prefident, and Members of the College of Phyficians, in London. By J. Z. Holwell, F. R. S. 8vo. Pr. IS. Becket.

A

Ta time when the fmall-pox fo much engages the attention of the public, it must afford fatisfa&ion to every medical inquirer, to be informed of the method of inoculation practised in remote countries from time immemorial, and founded not on the bafis of fpecious theory, but long and certain obfervation. Such a comparative view (allowance being made for the variation of different climates) is one of the moft unquestionable tefts of the merit of any new mode of practice, and calculated either to fupport or explode an innovation, from afcertaining its conformity to the laws of the human conftitution, and invariable experience of ages. Though the world no longer acknowledges the authority of the Indian Bramins in matters of fpeculative philofophy, reafon will always juftify a regard to their phyfical practice when fuccefsful, however debafed by fuperftitious concomitant ceremonies, or vifionary notions. Simple nature may be discovered without the penetration of deep fcience, and exotic obfervations on diseases prove as valuable as exotic medicines. By the fhort treatife now before us, we find that inoculation is performed in Indoftan by a particular tribe of Bramins, who are delegated annually for that fervice from the Colleges of Bindeobund, Eleabas, Banaras, &c. over all the diftant provinces. Of the courfe of the preparation, manner of inoculation, and future

manage

management of the diforder, the author gives us the following

account:

The inhabitants of Bengal, 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 confifts only in abftaining 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, refufing 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 afk the parents how many pocks they chufe their children-fhould have vanity, we fhould think, urged a question on a matter feemingly fo uncertain in the iffue; 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 outfide of the arm, mid-way between the wrift and the elbow, for the males; and the fame between the elbow and the fhoulder for the females. Previous to the operation the operator takes a piece of cloth in his hand (which becomes his perquifite 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 fmall inftrument he wounds, by many flight touches, about the compafs of a filver groat, juft making the smallest appearance of blood; then opening a linen double rag (which he always keeps in a cloth round his waift) takes from thence a small pledget of cotton charged with the variolous matter, which he moiftens with two or three drops of the Ganges water, and applies it to the wound, fixing it on with a flight bandage, and ordering it to remain on for fix hours without being moved, then the bandage to be taken off, and the pledget to remain until it falls off itfelf; fometimes (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 ceafes reciting fome portions of the worship appointed, by the Aughtorrah Bhade, to be paid to the female Divinity beforementioned, nor quits the most folemn countenance all the while. The cotton, which he pre. serves in a double callico rag, is faturated with matter from the inoculated puftules of the preceding year, for they never ino

*Gootee ka Tagooran, the Goddefs of Spots.

culate

culate with fresh matter, nor with matter from the disease caught in the natural way, however diftinct and mild the fpecies, He then proceeds to give inftructions for the treatment of the patient through the courfe of the process, which are most religioufly obferved; thefe are as follow:

་

He extends the prohibition of fifh, milk, and ghee, for one month from the day of inoculation; early on the morning fucceeding 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 ufually is about the clofe of the fixth day from the inoculation), then to defift 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 courfe of the difeafe, and until the scabs of the puftules drop off. They are ordered to open all the puftules with a fine fharp-pointed thorn, as foon as they begin to change their colour, and whilft the matter continues in a fluid state. Confinement to the house is abfolutely forbid, and the inoculated are ordered to be exposed to every air that blows; and the utmoft 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 fo inconfiderable and trifling, as very feldom to require this indulgence. Their regimen is ordered to confift of all the refrigerating things the climate and feafon produces, as plantains, fugar-canes, water-melons, rice, gruel made of white poppy-feeds, and cold water, or thin rice gruel for their ordinary drink. These inftructions being given, and an injunction laid on the patients to make a thanksgiving Poojah, or offering, to the godde's on their recovery, the operator takes his fee, which from the poor is a pund of cowries, equal to about a penny fterling, and goes on to another door, down one fide of the street and up on the other, and is thus employed from morning until night, inoculating fometimes eight or ten in a houfe.. The regimen they order, when they are called to attend the difeafe taken in the natural way, is uniformly the fame. There ufually begins to be a discharge from the fcarification a day before the eruption, which continues through the difeafe, and fometimes after the fcabs of the pock fall off, and a few puftules generally appear round the edge of the wound; when thefe two circumstances appear only, without a fingle eruption on any other part of the body, the patient is deemed as fecure from future infection, as if the eruption had been general.

VOL. XXIV. Nov. 1767. B.b

When

• When the before recited treatment of the inoculated is ftrialy 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 feen inoculated in that country, the number of puftules have been seldom less than fifty, and hardly ever exceeded two hundred.'

The method of bathing the patients in cold water is very remarkable: at the fame time the author informs us, "that himfelf has been an eye-witness to many inftances of its marvelous effect, where the puftules have funk, and the patient appeared in imminent danger, but almost inftantly restored by the application of three or four collons 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, fo this may be deemed preparative to the eruption), that when they are called in, and find, upon 'enquiry, that circumftance (and opening the puftules) has not been attended to, they refuse any farther attendance.'

The practice of immerfing the fick in cold water, to promote the crifis in febrile diforders, had its abettors among celebrated phyficians of ancient times; but though fuch a method has been generally exploded as precarious, and full of danger, it is rational to conclude, that cold bathing may be more advantageous to the relaxed constitutions of the Indians, than the nations of Europe.

Opening the puftules while the matter continues in a fluid ftate, is confonant to the doctrine of the Arabians, and has been recommended with great strength of argument by fome modern writers. Such a practice, likewife, may be more particularly beneficial in the Indian climates, by preventing, or mitigating the fecondary fever, which in thofe countries might rife to a higher degree of exacerbation, from the acrimony of the variolous matter which would otherwise be abforbed.

The dietetical regimen enjoined by the Bramins is partly founded on the most rational principles; but it would be inconfiftent with the character of thefe philofophers, to be intirely restrained in their physical researches within the bounds of material causes. Accordingly we find that they have other reafons for prohibiting the ufe of fish, ghee, and milk, than what are derived from their fenfible qualities and effects.

They lay it down as a principle, that the immediate (or inftant) cause of the small-pox exifts in the mortal part of every human and animal form; that the mediate (or fecond) acting cause, which stirs up the first, and throws it into a state of fer

mentation,