I have at present nothing farther to recommend; but what has been said will I presume be sufficient, with the cases annexed (in which the method will be more plainly described) to justify farther trials of the cooling, repelling, and evacuating practice in the beginning, at least, of the natural small-pox, till the eruption is completed; especially where the physician has an opportunity of making the trial before the eruption appears, and can be pretty certain, or has good reason to conclude, that his patient’s disorder is variolous. And the more violent the symptoms are in this stage of the disease, the more we should be induced to employ the means which have been attended with so much success, in the same stage of the disease after inoculation.
But it may be asked, if I was called to a patient in a bad confluent small-pox, and finding the eruption completed, whether in such a case I should venture to give and continue the use of the alterative and purgative medicine; and advise the patient to go out, if he can bear it, into the open air in cold weather, or direct air to be let in through a window even while the mercurial purge may be operating.
Before I give a direct answer to this question, let me first ask the most experienced practitioner, whether he knows any method of cure which may in bad cases be safely relied on, to avert the impending danger, and save his patients? The too well known fatality of all kinds of small-pox, very clearly proves that he does not, and that no such method has yet been discovered. And if this be the case, surely a bold, and even hazardous practice, is very justifiable towards any such unhappy patients, who lie as it were under sentence of a cruel death, not to be prevented by what are called the regular and usual methods. But still it may be urged, that no impending danger, however great, can sufficiently justify the trial of any hazardous experiment, unless supported by some degree of reason or experience. Happy, indeed, it is, when we have these two guides before us; but when they are separated, the latter is certainly most to be relied on, and her I have endeavoured hitherto to follow.
For in the practice of inoculation experience has taught me, that after as well as before the eruption, persons may safely take mercurial purges, and go out during their operation (though I have seldom advised any to do so) into the cold air, in inclement weather, without suffering the least harm or subsequent ill consequence from it. And by this experience I was led, though with great caution, to try whether the same practice might not be safely employed in the cure of the natural small-pox, as well as the inoculated; nor have the trials been unsuccessful: for though among the patients I have treated in this manner, some had confluent sorts, yet were the complaints unusually moderate throughout the whole progress of the disease, and the maturation was completed, without such troublesome and alarming symptoms and events as might be expected under any other known method of treatment; nor did any secondary fever ensue.
I would not, however, be understood to entertain so good an opinion of this method, as to insinuate that it will save all who have the bad confluent kind; too many of these are incurable; but I am not without hopes, that it may give a chance of recovery, hitherto untried, to many: and even if this alterative and evacuating course in the early part of the disease should not succeed, so as to avert the approaching danger, I think there is great reason to suppose that nourishment, cordials, and opiates, which may be wanted in the state of maturation, will be administered with more advantage and security after it, than if that method had not been previously taken.
It seems necessary, however, to declare, that nothing which has been said is meant to relate to practice in the bleeding or purple small-pox; though very cold repellent methods may perhaps deserve to be tried in these hitherto fatal cases, provided it can be done early; but the mercurial evacuating course seems quite improper.
Upon the whole, what has been said on the natural small-pox, must wait the award of time and experience, the only tests of the utility of any practice; for I have lived long enough to have seen several instances where very ingenious and well-meaning men have been greatly mistaken, by relying too much on the first impressions made by a few successful experiments.