An account of the manner of inoculating for the smallpox in the East Indies, by J. Z. Holwell, M.D., F.R.S.

Addressed to the President and Members of the College of Physicians in London

"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, Benares, & c. over all the distant provinces: dividing themselves into small parties, of three or four each, they plan their traveling circuits in such wise as to arrive at the places of the operation 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 choose 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, midway between the elbow and 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 grout.

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 eight 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. The operators of inoculation holds the instrument as we hold a pen and with dexterous expedition gives about fifteen or sixteen minute scarifications 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 form a 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 preferences, I should conclude it should be that method which bids fairest for securing a plentiful discharge from the ulcer.

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 pledget of cotton charged with the variolous matter, which he moistens with two or three drops of 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 it applies it; from the time he begins the dry friction, to 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 in a double calico rag, is saturated with matter from the inoculated pustules of the preceding year, for they never inoculate with natural way, however distinct and mild the species. He than proceeds to give instructions for the treatment of the patient through the course of the process, which are most religiously observed; these are as follows:

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 collans (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 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 thanks giving Poojah, or offering, to the goddess 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.

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 smallpox exists in the mortal part of every human and animal form; 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 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 animalculae received into the blood with the ailment, gives necessarily additional force and strength to the first efficient cause of the disease."


Holwell, J. Z., M.D., An Account of the Manner of Inoculating for the Smallpox in the East Indies, London, 1767.