Root to Mes, July 25, 1872

Gentlemen: Your very complimentary letter of yesterday, asking my views touching the treatment of small-pox, I shall answer with much pleasure, and though unable in the short time I can devote thereto to give you my ideas as fully as I should like, I will endeavor to make what I do say so clear that my suggestions may be easily comprehended; trusting also to your intelligence and kindness for the more symmetrical arrangement of what I am obliged somewhat hurriedly to throw together.

And permit me, in commencing, to state that it is no depreciation of the efforts of the many noble, self-denying individuals, who have given their personal and other services to the alleviation and care of the unfortunate sick, in the terrible epidemic that now afflicts this people, for me to say that your colleagues and co-workers, all those young men preparing themselves for physicians, who have so generously, and with so much self-sacrificing philanthropy, left their homes, where they were surrounded with all that love, health, wealth, and refinement could make attractive, to spend days and nights in the very midst of pestilential and fetid odors, and in the presence of the gravest contagion, disease and death, giving their energies, mental and physical, to the curing of maladies of the severest type, deserve a meed of praise and honorable remembrance which cannot be overestimated. I have too often witnessed their smile of satisfaction, as indications of returning health were visible, and the look of sadness depicted in their countenances as they beheld the unmistakable signs of approaching death in the patients under their care, not to be thoroughly convinced that their noble hearts, as well as intelligent heads, were devoted to their arduous labors. Such scenes, however, are incident to the practice of medicine, and must be prepared for by all who would be perfect in their profession. And well may the city of Santiago congratulate itself, while contemplating the fact that the health of its fast-coming future, to a great extent, must be in the hands of these young men now preparing themselves for the weighty responsibilities of physicians and surgeons.

Allow me also to suggest that no one can be too well prepared for his professional life, and also, no matter how much time has been spent in the preparatory course, every day’s experience of the scientific physician will demonstrate the fact that his education is still incomplete, and there always ought and ever will be an earnest longing for more knowledge.

I also regret to inform you that, as you advance in medical wisdom and seek after truth, no matter from what source it may emanate, you will continually find your way blocked up with the accumulated rubbish of ages, and, unless you have more than ordinary courage, you will give up, like thousands before you, and rest satisfied with what is claimed upon a certain kind of authority to be truth, when you have only obtained a feeble glimmering of the true light of science. The great trouble in your most noble profession is that by far too many men in it advance backward, with their faces ever looking toward the dim and musty past, instead of fronting the bright future with its brilliant omens of progress. While it is well to consult all the learning and read as many books as possible of ancient as well as modern times, it is of great importance to recognize the fact that the great “book of nature” is the only infallible work whose teachings never go astray, and the true student thereof will never tire in his reading of its beautiful pages, or fail to be captivated with the splendid results ever to be expected from closely following its indications.

You will excuse me for these prefatory remarks, made in view of the fact that yet you have not finished your course of medical studies, when I tell you that it has taken me many long years of patient research and practical experience to demonstrate satisfactorily to myself the worse than utter folly of many things I was obliged to learn through the means of standard books, colleges, and the wisest preceptors and professors of my country, before receiving my degree as physician and surgeon. Study for yourselves the cause and reason for everything taught you, improving every opportunity for this purpose; and just now a great lesson may be learned from watching the progress of the epidemic raging in this vicinity, whose fearful consequences have been rapidly decimating the inhabitants of this city; and in accordance with your wishes I will allude to the same, hoping my thoughts and experience may not be without some benefit.

From time to time I have surveyed the whole field here; closely examined every portion of the city, and especially those places devoted to the care of the sick; and, thanks to those who have kindly given me aid and information, I am in possession of the condition of hospitals and patients, and have a very correct knowledge of all the measures, medical and hygienic, adapted for the care and cure of the small-pox patients. Upon examination I found the sanitary condition of most of the hospitals so deplorable that my first effort was to suggest changes in that direction, and I am happy to know that, with one or two exceptions, a great improvement has been made. One prominent hospital, however, has, up to the present time, made no alteration whatever; as, on my first visit about six weeks since, the only room ventilated is the “dead-house,” through which, night and day, fresh air is allowed to circulate freely. Unfortunately, however, for its occupants, the lungs which might have been benefited a few hours earlier thereby have ceased to act.

After doing what seemed within my power for the improvement of the condition of the hospital buildings, I made public my views upon the “treatment of small-pox patients,” which, though you have already perused, I would recommend you again to read, for in It may be found my unchanged ideas upon this important subject—ideas which are the result of many years’ thought and experience in civil and military life, and which, if thoroughly followed, will, I am satisfied, wonderful as it may seem, save ninety-nine one-hundredths of all persons attacked with small-pox. What little one of you has personally seen of my treatment of this disease must tend to confirm this view. But that I may better be understood, I will give you again some of my suggestions.

The exact chemical poison of small-pox is yet a matter of speculation; but of its potency and powder to multiply itself with the most wonderful rapidity and malignancy we have abundant proof from the fact that the most minute portion being taken into the system has the faculty of so increasing itself that, after the lapse of about eight days more or less, the whole system is so impregnated that certain symptoms, usually easily recognized, are the result. After yet a few more days, during which the poison has been unable to find its way from the body, or rather the vital forces have been unable to expel the virulent enemy, certain other symptoms occur. During the first stage there has been more or less fever, and the epidermis or cuticle has become thereby hardened, or rendered slightly impervious to matters passing through the dermis, or skin proper, so that often, when the poison of the disease at this stage is driven to the surface, it finds a barrier sufficient to prevent its entire escape, and soon, from its vicious character, a constantly increasing depot of purulent matter is congregated, affecting, to a greater or less extent, all the tissues in its neighborhood, often leaving, after the recovery of the patient, deep pits to henceforth mark its wrathful demonstrations. Not only is the effect of these aggregations of poisonous pus visible upon the surface of the body, but when from lack of proper and frequent cleansing of the skin these poisonous substances are absorbed, other parts of the system are affected, which, added to the already enfeebled condition of the same by the presence of uneliminated virus, with its consequent effects, tends to threaten the whole economy with rapid destruction, as not only the tegumentary but the osseous, nervous, muscular, vascular, and other systems are sufferers. I have not time, however, to enlarge in this direction. Further along I shall indicate a treatment preventing to a great extent the above condition of the skin.

As it is now a pretty well understood fact that the poison of contagious and infectious diseases may be rendered inert or harmless when they can be reached by certain agents called disinfectants; as, for instance, a room, or the clothing even, filled with the contagion of small-pox, by the proper application of disinfecting agents may be made perfectly sweet and wholesome. Mainly upon this fact rests the theory for my peculiar treatment of small-pox and kindred diseases, which somewhat of an extended practice has demonstrated to be of perfect practicability.

Without the poison of the disease the patient would be well; therefore, all that is needed is to destroy the poison without destroying the patient, as is too often the case. And all the remedies given with the idea of combating simply an inflammation or fever are worse than useless. There are only two methods of treatment which can by any possibility do the patient good. One is to support the strength of the patient while nature fights its venomous enemy, hoping that, eventually, the poisonous intruder may be overcome and expelled, and then allow the enfeebled though victorious vital energies of the poor sufferer to slowly renew their wonted life. The other method, and the one I adopt, is, while doing all in my power to sustain the severely taxed energies of the patient in their great fight with their, malignant foe, at the same time to at once close the contest by instantly, if possible, rendering his poison harmless for evil. And when this is done early, the few repairs needed are too insignificant to cause any trouble whatever. All other theories and practices save these two should be driven from the profession as unworthy the attention of scientific minds. The vast army of antiphlogistic remedies often marshaled against this disease are only too apt to become swift and powerful allies of the same. Of course the golden moments in the treatment of small-pox are the first hours or days of the disease, and he who waits for the disease to fully develop itself before commencing offensive operations against it ought to expect the same fate as the captain who, in war, should wait for his citadel, with its guns and magazines, to be in the hands of the enemy before making any hostile demonstrations against him. Not a moment is to be lost; an expectant treatment will not answer; go at once to work in every judicious way, both outside and inside the body, and in no disease will you find so sure a reward for the labor performed.

But you ask for more details. First, then, omit to give any debilitating medicines, This is very easy, and can be performed by any one.

There are so many remedial agents which may be used that different physicians may be excused for not adopting the same articles, even though desiring the same results.

My general sanatory ideas, relating to heat, ventilation, &c, as well as many of my medical ones, as said before, may be found in my communication on the “treatment of small-pox;” therefore I will omit many things found therein, and give some of my most common practices.

For years I have been in the habit of giving the muriated tincture of iron for erysipelas with decided success, and it occurred to me that, as in small-pox, the inflammation has more or less of an erysipelatous character, this remedy would be of service, and, upon trial, I was charmed with its beneficial results. In the very first stage of this disease I am in the habit of giving it to adults in doses of from five to forty drops, or even in larger quantities, every four, six, eight, or ten hours, as the case may be, and to children in proportionate doses. This medicine acts in many ways; it is highly supporting to the system, aside from having powerful disinfecting properties, and, in connection with other medicines and appliances, reduces often in a marked manner the rapidity of the pulse and other conditions of the patient, and anticipates and prevents one of the most frightful phenomena of the disease, to wit, hemorrhage. I also am in the habit of giving, midway between the doses of this preparation of iron, some alkali; and I have often found the carbonate of lime (prepared chalk) in larger or smaller quantities, according to the age and condition of the patient, a very valuable remedy; the doses being from a few grains to two teaspoonfuls. This remedy acts as an antiseptic, and sometimes, combining with the chlorine, from the hydrochloric acid of the muriated tincture of iron, forms, within the body, the chloride of lime, a powerful disinfectant. Chlorate of potash is also a favorite remedy with me, and sometimes lime-water and charcoal have been used with good effects, and other similar medicines, giving quinine in doses proportioned to the age and condition of patient and stage of the disease.

I generally prefer an enema rather than a purge, when either seems indicated, and a favorite one for an adult is composed of three teaspoonfuls of oil of turpentine, three tablesspoonfuls of castor-oil, from one to two teaspoonful of common salt, (chloride of sodium,) and often an addition of more or less carbonate of lime, with about a pint of tepid water. These quantities can be varied to suit the age and condition of the patient. While giving the chalk and iron it will be found that often a laxative or opposite effect may be produced by lessening the quantity of either the one or the other as may be desired, the acid of the iron preparation, by neutralizing the alkali of the other, often proving a pleasant laxative; or, in case there has been too much chalk given, and a constipated condition of the bowels is the result, lemonade or other acidulated drinks will answer the purpose of a mild aperient. I have frequently administered internally carbolic acid with good results.

Touching nourishment, &c, I shall not speak, as in another place I have referred you for much omitted here.

For the soreness of the throat, which is often very severe, a favorite remedy with me is the tincture of iodine, painted externally over the diseased locality; also a gargle of chlorate of potash. The external treatment, though emphatically spoken of in another place, I cannot refrain from alluding to here, as upon it depends so much to be expected in the curing of small-pox, and without which it is the utmost waste of hope to expect to save a goodly proportion of patients gravely sick.

The skin is one of the greatest emunctories, to which is brought, and on which is deposited, a vast amount of filthy, effete, and diseased emanations and excretions of the body, and there would be just as much sense in confining the body of the patient in an accumulation of all the other excretions of the body as in those of the skin; the effect would be the same, only differing in degree. Therefore, from the first to the last, every portion of the body must be washed from one to many times each twenty-four hours, depending upon the stage of the disease and condition of the patient. I am in the habit of alternating an acid with an alkali; and I like a solution of carbolic acid and water, alternating with a chalk mixture, using each quite warm; and frequently I have found a combination of both very beneficial. Sometimes, in case of extreme heat of the head, thin cloths wet in cold water are of service, always keeping the feet warm; but the habit of suddenly applying cold water, and then allowing the consequent re-action to quickly follow, only adds to heated condition of the part, a fact which may be made of great service in many cases of disease’; but I prefer in this disease tepid or even hot bathings, very frequently as hot as possible to bear, all of which may be, for convenience’ sake, performed by sponge bathings, and great care should always be observed that no chilly sensations are allowed. Either the room should be made quite warm for the purpose, and then only a portion of the body exposed at one time, or, what is better, in a hospital or room with many patients, is a sort of tent made of a light frame covered with thin, white cloth, to be placed over the bed while the bathing is being performed. In this way exposure and currents of air are prevented. An alcohol-lamp, or some other appliance, can be placed under the bed, and the air made quite warm in a few moments, in which case the body may be more readily bathed, shirts and sheets changed, &c; but the general principle must be observed no matter how the bathing is performed. In the early stages of the disease the entire surface of the body should be cleansed in this way at least four times each day, and, in case of great febrile excitement and much delirium, even much oftener, such bathing being always grateful to the patient. One of you may remember the little boy, a patient of mine, whose treatment was witnessed, whose pulse from being one hundred and sixty-eight in the evening, with a grave kind of delirium and a fever coresponding thereto, as he came to his senses at 2 a.m., asking to be bathed again, having a semi-consciousness of what had done him good, having been treated as indicated above, and, in the morning feeling free from pain, even sitting up in bed smilingly, with a pulse sixty-six beats less than a few hours before, looking at an illustrated paper, and past all danger. The poison of the disease having been completely annihilated by the internal and external remedies before the strength of the patient had been reduced, or any serious inroads made on the system, there was no good reason why he should not feel well, and, with only a little care resume his wonted plays. The poison of the disease having been destroyed just at the period when it should have developed itself upon the surface of the body in the shape of pustular eruptions, as a matter of course these latter demonstrations made almost an entire failure to “put in an appearance;” a few faint efforts in this direction were only seen; but, in my opinion, had this child been allowed to remain with all the poisonous fetid emanations of his disease closely around him, and been dosed with all sorts of debilitating sudorifics, purgatives, emetics, &c, given for exactly what purpose no one can tell, except in a blind compliance with the time-honored practice of many very excellent men and even intelligent physicians, or because “the books say so,” said little rosy-cheeked child would in all human probability have joined the army of little children that have gone to the spirit-land from this vicinity during this terrible epidemic.

In this connection I cannot help remembering a statement published only a few days ago, that in one week fourteen children were sent to a hospital in this city, and fourteen of them died; that another week forty children were admitted, and thirty-eight died. Just think, only two out of fifty-four children could be saved. It would seem that such and similar records ought to suggest a change of treatment. Up to this hour not a patient in any of the hospitals of Santiago has been bathed, even, as I have indicated, notwithstanding what has been said and written on the subject, and still more than half who enter these institutions pass from thence to the “Panteon.” I speak not thus desiring any credit for ideas I may entertain differing from other men, or for what I may have done in the case of the child cited above, or others of a similar nature. I am not entirely responsible for my past experience, and wish no praise for the peculiar beliefs I hold, even though proved to be valuable. They are the result of circumstances which I did not create, and if there is anything good in them I trust you may benefit thereby; but permit me to caution you not to adopt anything I may suggest unless it is commended to your intelligence and educated judgment. Never take the dictum of any man or any authority because of its personal claims, and never discard with the cry ofhumbug any idea because of its humble, origin or apparent inconsistency with the prescribed rules of the past. “Prove all things, hold fast that which is good,” is sound teaching.

It is very rarely necessary in this disease to use alcoholic stimulation. This remark may surprise you, as you have witnessed a widely different practice. The patient seldom dies from debility, as that term is commonly used, but from the poison of the disease, and the almost universal use of wines cannot but do harm. When an alcoholic stimulant is indicated it should be one with as little acid as possible; but, with the treatment I have suggested, not one case in a hundred will need any such stimulation. Too much care in this direction cannot be used. Tonics are more indicated than stimulants, and alkalies much more than acids. In proof of the latter it will be found almost universally that all the excretions and secretions of the small-pox patient are of an acid character. This is also not only true of the tears, saliva, perspiration, urine, &c, but of the poisonous purulent accumulations in the pustular eruptions. I have known alkalies administered medicinally, with very unsatisfactory results to the physician, as well as the patient, from the fact that their good tendencies were more than counterbalanced by the acid wines given ostensibly to support the patient, whose real effect, however, was to support the disease. These remarks hold true in most of the exanthematous diseases, and a treatment similar to what I have given for this disease I have used with perfect success in the gravest cases of scarlatina.

The great secret is to exterminate the poison of the disease wherever found, and for this purpose all the needed appliances of science and art, together with every health-giving element of nature, should be brought into service and made to perform its part; and the persistent effort to save the life of the patient should not be given up until every chance for life is absolutely lost. It is not enough that the breathing grows difficult, the circulation of the blood apparently ceasing, together with many other signs of approaching dissolution. Multitudes have been saved in this, as in other diseases, long after the pulse has ceased to give indications of vital power. Never yield the fight with the enemy until the last ray of hope is gone.

In closing, excuse me for remarking that the idea that a person laboring under the distressing influence of small-pox should be still further prostrated with debilitating medicines, condemned to suffer in a dark close room filled with a pestilential atmosphere, without ventilation, without change of clothing, without ever cleaning the vile, fetid infections from the body, &c, &c, is perfectly incomprehensible, and totally at variance with the teachings of nature, science, and reason; and I am sure that when the great benefits to be derived from an opposite treatment are understood, no sane man will be found encouraging or tolerating such unfortunate practice.

Hoping these thoughts, hastily penned, may excite in your minds, already full laudable ambition, yet increased desires for useful and practical knowledge, so soon to be made serviceable to your fellow-men, I remain, gentlemen, your sincere friend.