Smallpox is spoken of as an excess of heat, the pustules being the visible signs of an overboiling blood erupting through the skin, the fever indicating that the excess heat is escaping through the skin. This excess heat is also the language used to speak of the anger of the goddess. In the continuous chain of beings material substances transform and refine themselves into feelings, thoughts, and consciousness. Heat out of congruence is disease, which is the anger of the goddess. One should not assume from this that worshippers of Sitala are incapable of distinguishing between the literal and the metaphorical, but rather that they have an awareness of what the linguistic philosopher J.L. Austin has called the illocutionary and perlocutionary power of words.
Words can do things, can change the world can create new realities.
She embodies a humoral conception of disease as an imbalance between basically three humors that correlate with a language of hot and cold. Such a conception of illness is very different from a viral conception where health is the absolute absence of the disease causing agent and therefore health and illness are absolute opposites and could not possibly be metaphorized by one and the same image. In 1812 in a district of Bengal he declared that the adoption of variolation rendered the introduction of vaccine of very little importance. The British government outlawing of variolation and forceful imposition of vaccination, a practice continued by the independent Indian government, was based on an identification of the indigenous practice surrounding smallpox as superstitious. I have tried to argue that these practices embody a different style of cognition, one in which the human body, the land and the deities are all continuous with each other.