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Copyright © 2014 Pearson Education, Inc.
Diff: 2 Page Ref: 6
9) The systems development environment in the late 1990s focused on systems integration.
Answer: TRUE
Diff: 2 Page Ref: 6
10) In many cases, organizations do not run applications in-house, choosing instead to use an
application on a per-use basis by accessing through an application service provider.
Answer: TRUE
Diff: 2 Page Ref: 7
11) A systems development methodology is a standard process followed in an organization to
conduct all the steps necessary to analyze, design, implement, and maintain information systems.
Answer: TRUE
Diff: 2 Page Ref: 7
12) The systems development life cycle is the traditional methodology used to develop, maintain,
and replace information systems.
Answer: TRUE
Diff: 2 Page Ref: 7
13) The systems development life cycle is a sequentially ordered set of phases.
Answer: FALSE
Diff: 2 Page Ref: 7
14) In the systems development life cycle, it is possible to complete some activities in one phase
in parallel with some activities of another phase.
Answer: TRUE
Diff: 2 Page Ref: 7
15) Sometimes the systems development life cycle is iterative.
Answer: TRUE
Diff: 1 Page Ref: 8
16) The skills required of a systems analyst apply to only some of the life-cycle models.
Answer: FALSE
Diff: 2 Page Ref: 8
17) Every medium to large corporation and every custom software producer will have its own
specific life cycle or systems development methodology in place.
Answer: TRUE
Diff: 2 Page Ref: 8
18) The first phase in the systems development life cycle (SDLC) is planning.
Answer: TRUE
Diff: 2 Page Ref: 9

3
19) During the analysis phase, someone identifies the need for a new or enhanced system.
Answer: FALSE
Diff: 2 Page Ref: 10
20) During the design phase, analysts convert the description of the recommended alternative
solution into logical and physical system specifications.
Answer: TRUE

4
21) The second subphase in systems analysis is to investigate the system and determine the
proposed system's scope.
Answer: FALSE
22) Design is the second phase of the SDLC in which the current system is studied and
alternative replacement systems are proposed.
Answer: FALSE
23) Often the choices of language, database, and platform are already decided by the
organization or by the client, and these information technologies must be taken into account in
the physical design of the system.
Answer: FALSE
24) Logical design is tied to a specific hardware and software platform.
Answer: FALSE
25) During physical design, the logical specifications of the system from the logical design are
transformed into technology-specific details from which all programming and system
construction can be accomplished.
Answer: TRUE
26) Implementation is the fourth phase of the SDLC in which the information system is coded,
tested, installed, and supported in the organization.
Answer: TRUE
Diff: 2 Page Ref: 10-11
27) Documentation is not considered to be part of the implementation phase.
Answer: FALSE
28) During installation, the new system becomes part of the daily activities of the organization.
Answer: TRUE
29) Documentation and training programs are finalized during the physical design phase.
Answer: FALSE
30) The maintenance phase often resembles the life cycle itself.
Answer: TRUE

5
31) The amount of time and effort devoted to maintenance depends a great deal on the
performance of the previous phases of the life cycle.
Answer: TRUE
32) A description of the current system identifying where problems or opportunities are with a
general recommendation on how to fix, enhance, or replace the current system is a product of the
design phase.
Answer: FALSE
33) Maintenance is the final phase of the SDLC in which an information system is systematically
repaired and improved.
Answer: TRUE
34) Microsoft's Security Development Lifecycle is an example of a specialized SDLC.
Answer: TRUE
35) Current practice keeps all phases of the SDLC as discrete activities.
Answer: FALSE
36) Extreme Programming is an example of Rapid Application Development (RAD).
Answer: TRUE
37) The traditional waterfall SDLC narrowly defines the end user or customer's role.
Answer: TRUE
38) One of the criticisms of the traditional SDLC is that it focuses on milestone deadlines,
leading to too little focus on doing good analysis and design.
Answer: TRUE
39) A criticism of the traditional SDLC is that the role of system users or customers is too
broadly defined.
Answer: FALSE
40) Suitcase tools provide automated support for some portions of the SDLC.
Answer: FALSE

6
41) CASE refers to software tools that provide automated support for some portion of the
systems development process.
Answer: TRUE
42) CASE tools are built around a central repository for system descriptions and specifications.
Answer: TRUE
43) CASE Analysis tools help to prototype how systems will look and feel.
Answer: FALSE
44) CASE helps programmers and analysts do their jobs more efficiently and effectively.
Answer: TRUE
45) The ready availability of increasingly powerful software tools created to support RAD
decreased interest in this approach.
Answer: FALSE
46) RAD is becoming less and less a legitimate way to develop information systems.
Answer: FALSE
47) Joint Application Development is a systems development methodology created to radically
decrease the time needed to design and implement information systems.
Answer: FALSE
48) RAD follows the traditional SDLC phases, but the phases are shortened and combined with
each other to produce a more streamlined development technique.
Answer: TRUE
49) Involving the end user in analysis and design is a key advantage to the prototyping
technique.
Answer: TRUE
50) Planning for cutover must begin early because the RAD approach is so fast.
Answer: TRUE

7
51) One of the primary disadvantages of RAD is longer development time.
Answer: FALSE
52) The three key principles of Agile Methodologies include a focus on adaptive rather than
predictive methodologies, a focus on people rather than roles, and a focus on self-adaptive
processes.
Answer: TRUE
53) Proponents of the Agile Methodology state that techniques that work well for stable projects,
such as building a bridge, work well for software projects.
Answer: FALSE
54) Iterative development focuses on the frequent production of working versions of a system
that have a subset of the total number of required features.
Answer: TRUE
55) The Agile Methodologies promote a self-reflective software development process.
Answer: FALSE
56) Agile Methodologies work well for projects with unpredictable or dynamic requirements.
Answer: TRUE
57) eXtreme Programming is not one of the Agile Methodologies.
Answer: FALSE
58) eXtreme Programming is distinguished by its short cycles, incremental planning approach,
focus on automated tests and a reliance on an evolutionary approach to development.
Answer: TRUE
59) eXtreme Programming always involves developers working by themselves.
Answer: FALSE
60) Object-oriented analysis and design (OOAD) is becoming less popular.
Answer: FALSE

8
61) The object-oriented approach combines data and processes into single entities called objects.
Answer: TRUE
62) In OOAD, objects are organized into object courses.
Answer: FALSE
63) The goal of OOAD is to make system elements more reusable.
Answer: TRUE
64) The Rational Unified Process (RUP) is an object-oriented methodology that establishes four
phases of development.
Answer: TRUE
65) Destruction is the third phase of RUP.
Answer: FALSE
66) During the inception phase of RUP, the scope and feasibility of the project is determined.
Answer: TRUE
67) The transition phase of RUP involves only coding of the project.
Answer: FALSE
68) The complex organizational process through which computer-based information systems are
developed and maintained best defines:
A) information systems analysis and design
B) joint application design
C) prototyping
D) none of the above
Answer: A
Diff: 2 Page Ref: 4
69) Software designed to support the payroll function would best be classified as:
A) application software
B) system software
C) design software
D) analysis software
Answer: A
Diff: 2 Page Ref: 4

9
70) Computer software designed to support organizational functions or processes best defines:
A) system software
B) application software
C) design software
D) analysis software
Answer: B
Diff: 2 Page Ref: 4
71) Comprehensive, multiple-step approaches to systems development that will guide your work
and influence the quality of your final product defines:
A) techniques
B) tools
C) methodologies
D) data flows
Answer: C
Diff: 2 Page Ref: 4
72) The particular processes that an analyst will follow to help ensure that his work is complete,
well-done, and understood by project team members best defines:
A) techniques
B) tools
C) methodologies
D) data flows
Answer: A
Diff: 2 Page Ref: 5
73) The person in an organization who has the primary responsibility for systems analysis and
design is the:
A) systems analyst
B) end user
C) internal auditor
D) business manager
Answer: A
Diff: 2 Page Ref: 5
74) Large, complex systems that consist of a series of independent system modules best
describes:
A) transaction processing systems
B) customer relationship management systems
C) supply chain management systems
D) enterprisewide systems
Answer: D
Diff: 2 Page Ref: 6

10
75) Which of the following are true statements regarding today's analysis and design of
information systems?
A) More and more systems implementation involves a three-tier design.
B) There is a movement to wireless system components.
C) There is a continued focus on developing systems for the Internet and for firms' intranets and
extranets.
D) All of the above.
Answer: D
76) The traditional methodology used to develop, maintain, and replace information systems best
defines:
A) SDLC
B) RAD
C) OOAD
D) prototyping
Answer: A
Diff: 2 Page Ref: 7
77) Which of the following is a true statement regarding the SDLC phases?
A) The life cycle is a sequentially ordered set of phases.
B) It is not possible to complete some activities in one phase in parallel with those of another
phase.
C) The SDLC is not iterative.
D) The life cycle can be thought of as a circular process in which the end of the useful life of one
system leads to the beginning of another project to develop a new version of or replace an
existing system.
Answer: D
Diff: 3 Page Ref: 7
78) During the SDLC planning phase, which of the following activities is undertaken?
A) New system requirements are identified.
B) A formal, preliminary investigation is undertaken.
C) A presentation of why the system should or should not be developed by the organization is
given.
D) Both B and C.
Answer: D
Diff: 2 Page Ref: 9
79) The second phase of the SDLC in which system requirements are studied and structured best
defines:
A) planning
B) analysis
C) design
D) implementation
Answer: B

11
80) The output for the analysis phase is the:
A) description of the alternative solution
B) physical system specifications
C) work plan for the project
D) priorities for systems and projects proposal
Answer: A
81) Analysts convert the description of the recommended alternative solution into logical and
then physical system specifications during:
A) planning
B) implementation
C) analysis
D) design
Answer: D
82) The part of the design phase of the SDLC in which the logical specifications of the system
from logical design are transformed into technology-specific details from which all programming
and system construction can be accomplished best describes:
A) implementation
B) object modeling
C) physical design
D) logical design
Answer: C
83) Which of the following is a true statement regarding logical design?
A) Logical design is tied to a specific hardware and software platform.
B) Logical design does not concentrate on the business aspects of the system.
C) Technical specifications are developed.
D) All functional features of the system chosen for development in analysis are described
independently of any computer platform.
Answer: D
84) Turning system specifications into a working system that is tested and then put into use
describes:
A) implementation
B) physical design
C) maintenance
D) analysis
Answer: A

12
85) The phase of the SDLC in which an information system is systematically repaired and
improved is referred to as:
A) analysis
B) implementation
C) maintenance
D) physical repair
Answer: C
86) Which of the following are deliverables for the planning phase?
A) functional, detailed specifications of all system elements
B) priorities for systems and projects; an architecture for data, networks, and selection hardware,
and IS management are the result of associated systems
C) description of current system and where problems and opportunities are with a general
recommendation on how to fix, enhance, or replace current system
D) code, documentation, training procedures, and support capabilities
Answer: B
87) Which of the following are deliverables for the analysis phase?
Answer: C
88) Which of the following are deliverables for the implementation phase?
Answer: D
89) All of the following are true about the SDLC EXCEPT:
A) the different phases are clearly defined
B) it is a rapid method to prototype and develop an application
C) the relationships between phases are well specified
D) the sequencing of phases has a compelling logic
Answer: B

13
90) One criticism of the traditional waterfall SDLC approach is that:
A) it is too short of a process
B) the process is too chaotic
C) users are locked into requirements
D) there are no criticisms
Answer: C
91) A specialized systems development life cycle is useful for :
A) all organizations
B) an organization that does not need all phases of the systems development life cycle or needs
to modify phases
C) an organization that needs only one phase of the SDLC
D) none of the above
Answer: B
92) All of the following are criticisms of the traditional waterfall SDLC EXCEPT:
A) users are locked into requirements
B) prototypes do not work properly
C) the role of customers is narrowly defined
D) intangible processes are given hard and fast dates
Answer: B
93) An integrated and standard database used in CASE to provide product and tool integration is
called a:
A) Transaction Processing System
B) Data Mart
C) Repository
D) Armory
Answer: C
94) All of the following are types of CASE tools EXCEPT:
A) Diagramming Tools
B) Display and Report Generators
C) Debuggers
D) Analysis Tools
Answer: C

14
95) Which type of CASE tool is used for the analysis phase of the SDLC?
A) Documentation generators
B) Form generators
C) Report generators
D) Diagramming
Answer: D
96) Which of the following is a true statement about RAD?
A) The focus of RAD is on system integration.
B) The bulk of the work in RAD takes place in the requirements planning phase.
C) RAD requires moderate user involvement.
D) The emphasis in RAD is generally less on the sequence and structure of processes in the life
cycle and more on doing different tasks in parallel with each other and on using prototyping
extensively.
Answer: D
97) Which of the following grew out of the convergence of the increased speed and turbulence of
doing business in the late 1980s and early 1990s and the ready availability of high-powered,
computer-based tools to support systems development and easy maintenance?
A) JAD
B) RAD
C) Object-oriented programming
D) CASE
Answer: B
98) Which of the following is a systems development methodology created to radically decrease
the time needed to design and implement information systems?
A) eXtreme Programming
B) OOAD
C) RAD
D) JAD
Answer: C
99) The three key principles shared by the Agile Methodologies include:
A) a focus on predictive methodologies
B) a focus on roles
C) a focus on self-adaptive processes
D) all of the above
Answer: C

15
100) Principles identified in the Agile Manifesto include:
A) our highest priority is to satisfy the customer through early and continuous delivery of
valuable software
B) welcome changing requirements, even late in development. Agile processes harness change
for the customer's competitive advantage
C) deliver working software frequently, from a couple of weeks to a couple of months, with a
preference to the shorter timescale
D) all of the above
Answer: D
101) Fowler recommends using an agile process when your project involves:
A) unpredictable or dynamic requirements
B) responsible and motivated developers
C) customers who understand the process and will get involved
D) all of the above
Answer: D
102) Critical factors that distinguish Agile and traditional approaches to the systems
development life cycle include:
A) size
B) dynamism
C) personnel
D) all of the above
Answer: D
103) Which of the following is a true statement about eXtreme Programming?
A) eXtreme Programming's overall philosophy is that code will be integrated into the system it is
being developed for and tested within a few hours after it has been written.
B) eXtreme Programming minimizes customer involvement during each of its phases.
C) eXtreme Programming distinguishes and separates the planning, analysis, design, and
construction phases.
D) eXtreme Programming uses an approach similar to the traditional SDLC for capturing and
presenting system requirements and design specifications.
Answer: A
104) All of the following are advantages of eXtreme Programming EXCEPT:
A) more communication among the developers
B) higher levels of productivity
C) reinforcement of the code-and-test discipline
D) lower quality code
Answer: D

16
105) Systems development methodologies and techniques based on objects rather than data or
processes best defines:
A) objects
B) participatory design
C) object-oriented analysis and design
D) entity analysis and design
Answer: C
106) Which of the following is a structure that encapsulates attributes and methods that operate
on those attributes?
A) module
B) object
C) container
D) case
Answer: B
107) A logical grouping of objects that have the same attributes and behaviors best defines:
A) attribute
B) module
C) object class
D) object
Answer: C
108) The property that occurs when entity types or object classes are arranged in a hierarchy and
each entity type or object class assumes the attributes and methods of its ancestors best defines:
A) inheritance
B) polymorphism
C) aggregation
D) generalization
Answer: A
109) Which of the following is based on an iterative, incremental approach to systems
development and has inception, elaboration, construction, and transition phases?
A) JAD
B) RAD
C) RUP
D) eXtreme Programming
Answer: C

17
110) Which of the following programming languages could be used for OOAD?
A) Java
B) C++
C) FORTRAN
D) both A and B
Answer: D
111) During which of the following RUP phases will analysts define the scope, determine the
feasibility of the project, understand user requirements, and prepare a software development
plan?
A) transition
B) construction
C) elaboration
D) inception
Answer: D
112) Which of the following RUP phases provides an architecture for the project at the end of its
phase?
A) elaboration
B) transition
C) inception
D) construction
Answer: A
113) Which of the following RUP phases involves correcting problems, beta testing, user
training, and conversion of the project?
A) elaboration
B) transition
C) inception
D) construction
Answer: B
114) ________ is the complex organizational process whereby computer-based information
systems are developed and maintained.
Answer: Information systems analysis and design
Diff: 1 Page Ref: 4
115) ________ is computer software designed to support organizational functions or processes.
Answer: Application software
Diff: 2 Page Ref: 4

18
116) ________ is the organizational role most responsible for the analysis and design of
information systems.
Answer: Systems analyst
Diff: 2 Page Ref: 5
117) A ________ is a standard process followed in an organization to conduct all the steps
necessary to analyze, design, implement, and maintain information systems.
Answer: systems development methodology
Diff: 1 Page Ref: 7
118) The ________ is the traditional methodology used to develop, maintain, and replace
information systems.
Answer: systems development life cycle
Diff: 1 Page Ref: 7
119) ________ is the first phase of the SDLC in which an organization's total information system
needs are identified, analyzed, prioritized, and arranged.
Answer: Planning
Diff: 2 Page Ref: 9
120) ________ is the second phase of the SDLC in which system requirements are studied and
structured.
Answer: Analysis
121) ________ is the third phase of the SDLC in which the description of the recommended
solution is converted into logical and then physical system specifications.
Answer: Design
122) ________ is the part of the design phase of the SDLC in which all functional features of the
system chosen for development in analysis are described independently of any computer
platform.
Answer: Logical design
123) ________ is the part of the design phase of the SDLC in which the logical specifications of
the system from logical design are transformed into technology-specific details from which all
programming and system construction can be accomplished.
Answer: Physical design
124) ________ is the fourth phase of the SDLC in which the information system is coded, tested,
installed, and supported in the organization.
Answer: Implementation

19
125) ________ is the final phase of the SDLC in which an information system is systematically
repaired and improved.
Answer: Maintenance
126) Applying the SDLC to very specific aspects of the process is called a ________.
Answer: Specialized Systems Development Life Cycle
127) The traditional waterfall life cycle locked users into ________ that had been previously
determined.
Answer: requirements
128) One criticism of the traditional waterfall SDLC is that the role of ________ was narrowly
defined.
Answer: customers
129) ________ are software tools that provide automated support for some portion of the
systems development process.
Answer: Computer-aided software engineering tools
130) ________ tools enable system process, data and control structures to be represented
graphically.
Answer: Diagramming
131) Computer display and report generators help prototype how systems ________ and
________.
Answer: look, feel
132) A central ________ enables the integrated storage of specifications, diagrams, reports and
project management information.
Answer: repository
133) ________ is an approach to develop information systems that promises better and cheaper
systems as well as rapid deployment.
Answer: Rapid Application Development
134) RAD depends on extensive ________ involvement.
Answer: user

20
135) The Agile Methodologies focus on ________ rather than predictive methodologies.
Answer: adaptive
136) The Agile Methodologies focus on people rather than ________.
Answer: roles
137) Agile Methodologies are recommended for a project if it has responsible and motivated
________.
Answer: developers
138) eXtreme Programming involves programmers working in ________.
Answer: pairs
139) One of the advantages of eXtreme programming is higher levels of ________.
Answer: productivity
140) ________ refers to systems development methodologies and techniques based on objects
rather than data or processes.
Answer: Object-oriented analysis and design
141) An ________ is a structure that encapsulates attributes and methods that operate on those
attributes.
Answer: object
142) ________ is the property that occurs when entity types or object classes are arranged in a
hierarchy and each entity type or object class assumes the attributes and methods of its ancestors.
Answer: Inheritance
143) An ________ is a logical grouping of objects that have the same (or similar) attributes and
behaviors (methods).
Answer: object class
144) The ________ is an object-oriented systems development methodology; it establishes four
phases of development.
Answer: Rational Unified Process

21
145) During the ________ of RUP, analysts define the scope, determine the feasibility of the
project, understand user requirements, and prepare a software development plan.
Answer: inception phase
146) During the ________ phase of RUP, the software is actually coded, tested, and documented.
Answer: construction
147) During the ________ phase of RUP, analysts detail user requirements and develop a
baseline architecture.
Answer: elaboration
148) The four phases of RUP include ________, ________, ________, and ________.
Answer: inception, elaboration, construction, transition.
149) List and define the five major SDLC phases.
Answer: The major SDLC phases include planning, analysis, design, implementation, and
maintenance. Planning is the first phase of the SDLC in which an organization's total information
system needs are identified, analyzed, prioritized, and arranged. Analysis is the second phase of
the SDLC in which system requirements are studied and structured. During the third phase, the
design phase, a description of the recommended solution is converted into logical and then
physical system specifications. Implementation is the fourth phase of the SDLC in which the
information system is coded, tested, installed, and supported in the organization. Maintenance is
the fifth and final phase of the SDLC in which an information system is systematically repaired
and improved.
150) What are methodologies, techniques, and tools?
Answer: Methodologies are comprehensive, multiple-step approaches to systems development.
Techniques are particular processes that you follow to help ensure that your work is complete,
well done, and understood by others. Tools are typically computer programs that make it easier
to use and benefit from techniques and to follow faithfully the guidelines of the overall
development methodology. The techniques and tools should support the chosen methodology.
Methodologies, techniques, and tools work together to form an organizational approach to
systems analysis and design.

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Test Bank for Modern Systems Analysis and Design 6th Edition by Hoffer

The Project Gutenberg eBook of An account of
the manner of inoculating for the small pox in
the East Indies

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Title: An account of the manner of inoculating for the small pox
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Author: J. Z. Holwell
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*** START OF THE PROJECT GUTENBERG EBOOK AN ACCOUNT OF
THE MANNER OF INOCULATING FOR THE SMALL POX IN THE EAST
INDIES ***

This cover was produced by the Transcriber
and is in the public domain.
AN
ACCOUNT
Of the Manner of
Inoculating for the Small Pox
in the East Indies.
[Price One Shilling.]

AN
ACCOUNT
Of the Manner of
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
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.

FOOTNOTES:
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.
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.

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