Asthis Management is necessary with Respect to thePoorandmeanerSort of People; so theRich, who have Conveniences, may, instead of being carried toLazaretto’s, be obliged to go to their Country-Houses: provided that Care be always taken to keep theSoundseparated from theInfected. Andat the same Time all the Inhabitants who are yet well, should be permitted, nay encouraged to leave the Town, which, the thinner it is, will be the more healthy.
Nomanner ofCompassionandCareshould be wanting to theDiseased; to whom, when lodged incleanandairyHabitations, there would, with due Cautions, be no great Danger in giving Attendance. All Expences should be paid by the Publick, and no Charges ought to be thought great, which are counterbalanced with the saving a Nation from the greatest of Calamities. Nor does it seem to me at all unreasonable, that aRewardshould be given to the Person, that makes the first Discovery ofInfectionin any Place: since it is undeniable, that the making known theEviltothose, who are provided with proper Methods against it, is the first and main Step towards the overcoming it.
Althoughthe Methods taken in other Countries, as well as in our own, have generally been different from what we have here recommended; yet there are not wanting some Instances of extraordinary Success attending these Measures, whenever they have happened to be put in Practice.
TheMagistrates of the City ofFerrarainItalyin the Year 1630, when all the Country round about them was infected with thePlague, observing the ill Success of the Conduct of their Neighbours, who, for Fear of losing their Commerce, did all they could to conceal the Disease, by keeping the Sick in their Houses,resolved, whenever occasion should require, to take a different Method. Accordingly, as soon as they received Information, that one had died in their City of thePestilence, they immediately removed the whole Family he belonged to into aLazaretto, where all, being seven in Number, likewise died. But though the Disease was thus malignant, it went no farther, being suppressed at once by this Method. Within the Space of a Year the same Case returned seven or eight Times, and this Management as often put a Stop to it. The Example of thisCitywas afterwards followed more than once by some other Towns in the same Territory with so good Success, that it was thought expedient, for the common Good, to publish in theMemoirsof the People ofFerrarathis Declaration:That the only Remedy against the Plague is to make the mostearly Discovery of it, that is possible, and thus to extinguish it in the very Beginning[80].
Noless remarkable than this Occurrence atFerrara, is what happened atRomein thePlague, I have taken Notice of before, in the Year 1657. When the Disease had spread itself among both Rich and Poor, and raged in the most violent Manner; thePopeappointed CardinalGastaldi, to be Commissary General of Health, giving him for a Time the Power of the wholeSacred College, with full Commission to do whatever he should judge necessary. Hereupon he gave strict Orders, that no sick or suspected Persons should stay in their own Houses. TheSickhe removed, upon the first Notice, to aLazarettoin theIslandof theTyber; and all who were in the same Houses with them to otherHospitalsjust without the City, in order to be sent to theIsland, if they should fall sick. At the same Time he took diligent Care to send away theirGoodsto an airy Place to be cleansed. He executed these Regulations with so much Strictness, that no Persons of the highest Quality were exempted from this Treatment; which occasioned at first great Complaints against theCardinalfor his Severity; but soon after he had general Thanks: for in two Months Time, by this means, he entirely cleared the City of thePestilence, which had continued in it almost two Years. And it was particularly observed, that whereas before, when once the Disease had got into a House, it seldom ended without seizing the whole Family; in this Management scarce five out of anhundred of the sound Persons removed were infected[81].
I cannotbut take Notice, that thePlaguewas stopp’d atMarseillesa full Fortnight by the same Measures, and probably might have been wholly extinguished, had not new Force been given it by the unseasonable Confidence of the Inhabitants upon this Intermission: which, we are informed, was so great, that they would not believe thePestilencehad been at all among them, and publickly upbraided the Physicians and Surgeons for frighting them causlesly[82]. At this Time, no doubt, they must have neglected the Cautions necessary for their Security so much, as to leave us noroom to be surprized, that the Disease should after this break out again with too great Violence to be a second Time overcome.
But, besides these Examples in foreign Countries, we have one Instance of the same Nature nearer Home. When thePlaguewas last here inEngland, upon its first Entrance intoPooleinDorsetshire, the Magistrates immediately suppress’d it, by removing theSickintoPest-Houses, without the Town, as is well remember’d there to this Time. A very remarkable Occurrence has greatly contributed towards preserving all the Circumstances of this Transaction in Memory. They found some Difficulty in procuring any one to attend upon theSickafter their Removal: which obliged the Town to engage ayoung Woman, then under Sentence of Death, inthat Service, on a Promise to use their Interest for obtaining her Pardon. The young Woman escaped the Disease, but neglecting to solicite the Corporation for the Accomplishment of their Engagement with her, three or four Months after she was barbarously hanged by theMayorupon a Quarrel between them.
I wouldhave it here observed, that as the Advice I have been giving is founded upon this Principle, that the best Method for stopping Infection, is to separate theHealthyfrom theDiseased; so in small Towns and Villages, where it is practicable, if theSoundremove themselves intoBarracks, or the like airy Habitations, it may probably be even more useful, than to remove theSick. This Method has been found beneficial inFranceafter all others have failed. But the Success of this proves the Method ofRemoving the Sick, where this other cannot be practised, to be the most proper of any.
Whenthesick Familiesare gone, all the Goods of the Houses, in which they were, should beburieddeep under Ground. This I prefer toburningthem: because, especially in a close Place, some infectious Particles may possibly be dispersed by the Smoak through the Neighbourhood; according to whatMercurialisrelates, that thePlagueinVenicewas augmented by burning a large Quantity of infected Goods in the City[83]. A learned Physician of my Acquaintance lately communicated to me the Relation of a Case, (given to him by an Apothecary,who was at the Place when the Thing happened) very proper to be here mentioned. The Story is this. AtShipston, a little Town upon the RiverStourinWorcestershire, a poor Vagabond was seen walking in the Streets with theSmall-Poxupon him. The People frightened took Care to have him carried to a little House, seated upon a Hill, at some Distance from the Town, providing him with Necessaries. In a few Days the Man died. They ordered him to be buried deep in the Ground, and the House with his Cloaths to be burnt. The Wind, being pretty high, blew the Smoak upon the Houses on one Side of the Town: In that Part, a few Days after, eight Persons were seized with theSmall-Pox. So dangerous isHeatin all Kinds of pestilential Distempers, and so diffusive of Contagion. And moreover the Housesthemselves may likewise be demolished or pulled down, if that can conveniently be done; that is, if they are remote enough from others: otherwise it may suffice to have them thoroughly cleansed, and then plastered up. And after this, all possible Care ought still to be taken to remove whatever Causes are found to breed and promoteContagion. In order to this, theOverseersof the Poor (who might be assisted herein by other Officers) should visit the Dwellings of all the meaner Sort of the Inhabitants; and where they find themstifled up too closeandnasty, should lessen their Number by sending some into better Lodgings, and should take Care, by all Manner of Provision and Encouragement, to make them morecleanlyandsweet.
Nogood Work carries its ownReward with it so much as this kind ofCharity: and therefore, be the Expence what it will, it must never be thought unreasonable. For nothing approaches so near to the first Original of thePlague, as Air pent up, loaded with Damps, and corrupted with the Filthiness, that proceeds fromAnimal Bodies.
Ourcommon Prisonsafford us an Instance of something like this, where very few escape what they call theGoal Fever, which is always attended with a Degree ofMalignityin Proportion to theClosenessandStenchof the Place: and it would certainly very well become the Wisdom of the Government, as well with regard to the Health of theTown, as in Compassion to thePrisoners, to take Care, that allHouses of Confinementshould bekept as airy and clean, as is consistent with the Use, to which they are designed.
TheBlack AssiseatOxford, held in the Castle there in the Year 1577, will never be forgot[84]; at which theJudges,Gentry, and almost all that were present, to the Number of three hundred, were killed by apoisonous Steam, thought by some to have broken forth from theEarth; but by anobleandgreatPhilosopher[85]more justly supposed to have been brought by thePrisonersout of theGoalintoCourt; it being observed, that they alone were not injured by it.
Atthe same Time, that thisCare is taken ofHouses, the proper Officers should be strictly charged to see that theStreetsbe washed and kept clean fromFilth,Carrion, and all manner ofNusances; which should be carried away in theNight Time: nor should theLaystallsbe suffered to be too near the City.Beggersandidle Personsshould be taken up, and such miserable Objects, as are neither fit for the commonHospitals, norWork-Houses, should be provided for in anHospital of Incurables.
Ordersindeed of this Kind are necessary to be observed at all Times, especially in populous Cities; and therefore I am sorry to take Notice, that in these ofLondonandWestminsterthere is no goodPoliceestablished in these Respects: for want of which the Citizens and Gentryare every Day annoyed more ways than one.
Ifthese earlyPrecautions, we have mentioned, prove successful, there will be no need of any Methods forCorrecting the Air,Purifying Houses, or ofRules for preserving particular Persons from Infection: to all which, if thePlagueget head, so that theSickare too many to be removed (as they will be when the Disease has raged for a considerable Time) Regard must be had.
Asto thefirst:Firehas been almost universally recommended for this Purpose, both by the Ancients and Moderns; who have advised to make frequent and numerousFiresin the Towns infected. ThisPrecept, I think, is almost entirely founded upon a Tradition, thatHippocratesput a stop to aPlagueinGreeceby this means. But it is to be observed, that there is no mention made of any Thing like it in the Works ofHippocrates. The best Authority we have for it, is the Testimony ofGalen, though it is also mentioned by other Authors.Galen, recommendingTheriacaagainst thePestilence, has thought fit, it seems, to compare it toFire; and, upon this Conceit, relates, thatHippocratescured aPlague, which came fromÆthiopiaintoGreece, by purifying the Air withFires; into which were thrown sweet-scented Herbs, and Flowers, together with Ointments of the finest Flavour. It is remarkable, that among theEpistlesascribed toHippocrates, which, though not genuine, yet are older thanGalen, there is aDecreesaid to be made by theAtheniansin Honour of this Father of Physicians,which, making mention of the Service he had done his Country in aPlague, says only, that he sent his Scholars into several Parts, with proper Instructions to cure the Disease. By which it should seem, that this Story of theFireswas hardly or not at all known at the Time, when theseLetterswere compiled. AndSoranusmay yet more confirm us, that it was framed long after the Death ofHippocrates: forSoranusonly says in general, thatHippocratesforetold the coming of thePestilence, and took care of the Cities ofGreece; without any mention of having used this particular Expedient.Plutarchindeed speaks of a Practice like this as commonly approved among Physicians, which he makes use of to illustrate a certain Custom of theEgyptians: of whom he says, that theypurifythe Air by the Fumes ofResinandMyrrh, as Physicians correct the Foulness, and attenuate the Thickness thereof in Times ofPestilence, byburning Sweet-Woods,Juniper,Cypress[86]&c.
ThisI take to be the Sum of what can be learned from Antiquity in Relation to this Point; from whence we may see, that Writers have concluded a little too hastily for the use ofcommon Firesin this Case, upon the Authority and Example ofHippocrates, though we should allow the Fact as related byGalen: when it will not from thence appear thatHippocrateshimself relied upon them; since he thought it necessary to take in the Assistance ofaromatic Fumes. But as this Fact is not grounded uponsufficient Authority, so it is needless to insist long upon it. The Passage I have brought fromPlutarchwill better explain what was the Sentiment of those Physicians who approved the Practice. It seems they expected from thence to dispel the Thickness and Foulness of the Air. And no doubt but such evil Dispositions of the Air, as proceed fromDamps,Exhalations, and the like, may be corrected even bycommon Fires, and the Predisposition of it from these Causes to receive Infection sometimes removed. But I think this Method, if it be necessary, should be put in Practice before the coming of thePestilence. For when the Distemper is actuallybegun, and rages, since it is known tospreadandincreasedby theHeatof theSummer, and on the contrary checked by theColdinWinter; undoubtedly, whatever increases thatHeat,will so far add Force to the Disease: asMercurialistakes notice, thatSmiths, and all those who worked at theFirewere most severely used in thePlagueatVenicein his Time[87]. Whether the ServiceFiresmay do by correcting any other ill Qualities of the Air, will counterbalance the Inconvenience upon this Account, Experience only can determine: and the fatal Success of the Trials made here in the lastPlague, is more than sufficient to discourage any farther Attempts of this Nature. ForFiresbeing ordered in all theStreetsfor three Days together, there died in one Night following no less than four thousand (if we may believe Dr.Hodges:) whereas in any single Week before or after, never twice thatNumber were carried off[88]. And we find that upon making the same Experiment in the lastPlagueatMarseilles, the Contagion was every Day spread more and more thro’ the City with increas’d Rage and Violence[89].
Whathas been said ofFires, is likewise to be understood ofFiring of Guns, which some have too rashly advised. The proper Correction of the Air would be to make itfreshandcool: Accordingly theArabians[90], who were best acquainted with the Nature ofPestilences, advise People to keep themselves asairyas possible, and to chuse Dwellings exposed to the Wind, situate high, and refreshed with running Waters.
AsforHouses, the first Care ought to be to keep themclean: for asNastinessis a great Source ofInfection, soCleanlinessis the greatest Preservative; which shews us the true Reason, why thePoorare most obnoxious toContagious Diseases. It is remarked of thePersians, that though their Country is surrounded every Year with thePlague, they seldom or never suffer any Thing by it themselves: and it is likewise known, that they are the mostcleanlyPeople of any in the World, and that many among them make it a great Part of their Religion to removeFilthinessandNusancesofevery Kind from all Places about their Cities and Dwellings[91].
Besidesthis, theArabiansadvise the keeping Housescool, as another Method of theirPurification, and therefore, to answer this End more fully, they directed to strew them withcoolingHerbs, asRoses,Violets,Water-Lilies, &c. and to be washed withWaterandVinegar: than all which, especially the last, nothing more proper can be proposed. I think it not improper likewise tofumeHouses withVinegar, either alone or together withNitre, by throwing it upon ahot IronorTile; though this be directly contrary to what modern Authors mostly advise, which is to make Fumes with hot things, asBenzoin,Frankincense,Storax, &c. from which I see no reason to expect any Virtue to destroy the Matter ofInfection, or to keep particular Places from a Disposition to receive it; which are the only things here to be aimed at. TheSmoakofSulphur, perhaps, as it abounds with anacid Spirit, which is found by Experience to be verypenetrating, and to have a great Power to repressFermentations, may promise some Service this way.
Ashot Fumes appear to be generallyuseless, so the Steams ofPoisonous Mineralsought to be reckoneddangerous: and therefore I cannot but dissuade the use of allFumigationswithMercuryorArsenic. Much less would I advise, as some have done, the wearingArsenicupon thePitof theStomachas anAmulet: since this Practice has been often attended with very ill Consequences,and is not grounded upon any good Authority, but probably derived from an Error in mistaking theArabianWordDarsini, which signifiesCinnamon, for theLatin de Arsenico, as I have formerly shewn[92].
Thenext thing after thePurifying of Houses, is to consider by what Means particularPersonsmay best defend themselves againstContagion: for the certain doing of which, it would be necessary to put theHumoursof theBodyinto such a State, as not to be alterable by theMatter of Infection. But since this is no more to be hoped for, than aSpecific Preservativefrom theSmall-Pox; the most that can be done, will be to keep the Body in such Order, that it may suffer as little as possible. Thefirst Steptowards which, is to maintain a good State of Health, in which we are always least liable to suffer by any external Injuries; and not to weaken the Body by Evacuations. Thenextis, to guard against allDejection of Spirits, andimmoderate Passions: for these we daily observe do expose Persons to the more commonContagionof theSmall-Pox. These Ends will be best answered by living with Temperance upon a good generous Diet, and by avoidingFastings,Watchings,extreme Weariness, &c.AnotherDefence is, to use whatever Means are proper to keep theBloodfromInflaming. This, if it does not secure fromcontracting Infection, will at least make theEffectsof it less violent. The most proper Means for this, according to the Advice of theArabianPhysicians, is the repeated Use ofacid Fruits, asPomegranates,Sevil Oranges,Lemons,Tart Apples, &c. But above all, ofWine Vinegarin small Quantities, rendered grateful to the Stomach by the Infusion of some such Ingredients asGentian Root,Galangal,Zedoary,Juniper Berries, &c. Which Medicines by correcting theVinegar, and taking off some ill Effects it might otherwise have upon the Stomach, will be of good Use: but these, and all other hotaromaticDrugs, though much recommended by Authors, if used alone, are most likely to do hurt byover-heatingthe Blood.
I cannotbut recommend likewise the Use ofIssues. The properest Place for them I take to be the inside of the Thigh a little above the Knee. Besides, the smoakingTobacco, much applauded by some, since it may be put in Practice withoutany great Inconvenience, need not, I think, be neglected.
Butsince none of these Methods promise any certain Protection; asleavingthe Place infected is the surestPreservative, so the next to it is to avoid, as much as may be, thenear Approachto theSick, or to such as have butlately recovered. For the greater Security herein, it will be adviseable to avoid allCrouds of People. Nay, it should be the Care of theMagistrateto prohibit all unnecessaryAssemblies: and likewise to oblige all, who get over the Disease, toconfinethemselves for some time, before they appear abroad.
TheAdvice to keep at a Distance from theSick, is also to be understood of theDead Bodies; which should beburiedat as greata Distance from Dwelling-Houses, as may be; putdeepin the Earth; andcoveredwith the exactest Care; but not withQuick-Limethrown in with them, as has been the Manner abroad: For I cannot but think thatThis, byFermentingwith the putrefying Humours of the Carcases, may give rise to noxious Exhalations from the Ground. They should likewise becarried outin theNight, while they are yet fresh and free fromPutrefaction: Because a Carcase not yet beginning to corrupt, if kept from the Heat of the Day, hardly emits any kind of Steam or Vapour.
Asfor those, who must of necessity attend theSick; some farther Directions should be added for their Use. These may be comprehended in two short Precepts.Oneis, not toswallow their Spittlewhilethey are about theSick, but rather tospitit out:The other, not so much as todraw in their Breath, when they are very near them. The reason for both these appears from what has been said above concerning the Manner, in which a sound Person receives the Infection. But in case it be too difficult constantly to comply with theseCautions,washingtheMouthfrequently withVinegar, andholdingto theNostrilsaSpongewet with the same, may in some measure supply their Place.
Thisis the Sum of what I think most likely to stop the Progress of theDiseasein any Place, where it shall have got Admittance. If some few of these Rules refer more particularly to the City ofLondon, with small Alteration they may be applied to any otherPlace. It nowremains therefore only to lay down some Directions to hinder the Distemper’s spreading fromTowntoTown. The best Method for which, where it can be done, (for this is not practicable in very great Cities) is to cast up aLineabout theTown infected, at a convenient Distance; and by placing aGuard, to hinder People’s passing from it without due Regulation, to other Towns: but not absolutely to forbid any to withdraw themselves, as was done inFrance, according to the usual Practice abroad; which is an unnecessary Severity, not to call it a Cruelty. I think it will be enough, if all, who desire to pass theLine, be permitted to do it, upon Condition they first performQuarantainefor about twenty Days inTents, or other more convenientHabitations. But the greatest care must be taken, that none pass withoutconforming themselves to this Order; both by keeping diligentWatch, and bypunishing, with the utmost Severity, any that shall either have done so, or attempt it. And the better to discoversuch, it will be requisite to oblige all, who travel in any Part of the Country, under the same Penalties, to carry with themCertificateseither of their coming from Places notinfected, or of their passing theLineby Permission.
ThisI take to be a more effectual Method to keep theInfectionfrom spreading, than the absolute refusing a Passage to People upon any Terms. For when Men are in such imminent Danger of their Lives where they are, many, no doubt, if not otherwise allowed to escape, will use Endeavours to do it secretly, let the Hazard be ever so great. And it can hardly be, butsome will succeed in their Attempts; as we see it has often happen’d inFrance, notwithstanding all their Care. But one that gets off thus clandestinely, will be more likely to carry the Distemper with him, than twenty, nay a hundred, that go away under the preceding Restrictions: especially because theInfectionof the Place, he flies from, will by this Management be rendered much more intense. For confining People, and shutting them up together in great Numbers, will make the Distemper rage with augmented Force, even to the increasing it beyond what can be easily imagined: as appears from the Account which the learnedGassendus[93]has given us of a memorablePlague, which happened atDigneinProvence, where he lived, in the Year 1629. This was so terrible, that in oneSummer, out often thousandInhabitants, it left butfifteen hundred, and of them all butfiveorsixhad gone through theDisease. And he assignsthis, as the principal Cause of the great Destruction, that the Citizens were too closely confined, and not suffered so much as to go to their Country-Houses. Whereas in anotherPestilence, which broke out in the same Place a Year and an half after, more Liberty being allowed, there did not die aboveone hundredPersons.
Forthese Reasons, I think, to allow People with properCautionsto remove from an infected Place, is the best Means to suppress theContagion, as well as the most humane Treatment of the present Sufferers: and, under these Limitations,the Method ofinvestingTowns infected, which is certainly the most proper, that can be advised, to keep the Disease from spreading, will be no Inconvenience to the Placessurrounded. On the contrary, it will rather be useful to them; since the Guard may establish suchRegulationsfor the Safety of those, who shall bring Provisions, as shall remove the Fears, which might otherwise discourage them.
Thesecuring against all Apprehensions of this Kind, is of so great Importance, that inCitiestoo large to be invested, as, for Example, this City ofLondon, theMagistratesmust use all possible Diligence to supply this Defect, not only by setting upBarrierswithout their City, but by making it in the most particular manner their Care to appoint suchOrdersto be observedat them, as they shall judge will be most satisfactory to the Country about.
ThoughLiberty ought to be given to thePeople, yet no sort ofGoodsmust by any means be suffered to be carried over theLine, which are made ofMaterialsretentive ofInfection. For in the present Case, whenInfectionhas seized any Part of a Country, much greater Care ought to be taken, that noSeedsof theContagionbe conveyed about, than when the Distemper is at a great Distance: because aBale of Goods, which shall have imbibed theContagious Aurawhen pack’d up inTurky, or any remote Parts, when unpack’d here, may chance to meet with so healthful a Temperament of our Air, that it shall not do much hurt. But when the Air of any one of our Townsshall be so corrupted, as to maintain and spread thePestilencein it, there will be little Reason to believe, that the Air of the rest of the Country is in a much better State.
Forthe same ReasonQuarantainesshould more strictly be enjoined, when thePlagueis in a bordering Kingdom, than when it is more remote.
TheAdvice here given with respect toGoods, is not only abundantly confirmed from the Proofs, I have given above, thatGoodshave a Power of spreadingContagionto distant Places; but might be farther illustrated by many Instances of ill Effects from the Neglect of this Caution in Times of thePlague. I shall mention two, which happen’d among us during the lastPlague. I have had occasion already toobserve, that thePlaguewas inPoole. It was carried to that Place by someGoodscontained in aPedlar’s Pack. ThePlaguewas likewise atEhamin the Peak ofDerbyshire, being brought thither by means of a Box sent fromLondonto a Taylor in that Village, containing some Materials relating to his Trade. There being several Incidents in this latter Instance, that will not only serve to establish in particular the Precepts I have been giving, in relation to Goods, but likewise all the rest of the Directions, that have been set down, for stopping the Progress of thePlaguefrom one Town to another; I shall finish this Chapter with a particular Relation of what passed in that Place. A Servant, who first opened the foresaidBox, complaining that the Goods were damp, was ordered to dry them at the Fire; but in doing it,was seized with thePlague, and died: the same Misfortune extended itself to all the rest of the Family, except the Taylor’s Wife, who alone survived. From hence the Distemper spread about and destroyed in that Village, and the rest of the Parish, though a small one, between two and three hundred Persons. But notwithstanding this so great Violence of the Disease, it was restrained from reaching beyond that Parish by the Care of the Rector; from whose Son, and another worthy Gentleman, I have the Relation. This Clergyman advised, that theSickshould be removed intoHuttsorBarracksbuilt upon theCommon; and procuring by the Interest of the then Earl ofDevonshire, that the People should be well furnished with Provisions, he took effectual Care, that no one shouldgo out of the Parish: and by this means he protected his Neighbours from Infection with compleat Success.
I have now gone through the chief Branches ofPreservationagainst thePlague, and shall conclude with some general Directions concerning theCure.
Itappears, from what has been said in the beginning of this Discourse, that thePlagueand theSmall-Poxare Diseases, which bear a great Similitude to each other: both beingContagious FeversfromAfrica, and both attended with certainEruptions. And as theEruptionsorPustulesin theSmall-Poxare of two Kinds, which has caused the Distemper to be divided into two Species, thedistinctandconfluent; so we have shewn two Sorts ofEruptionsorTumorslikewise to attend thePlague. In the first and mildest Kind of theSmall-PoxthePustulesrise high above the Surface of the Skin, and contain a digestedPus; but in the other, thePustuleslie flat, and are filled with an indigestedSanies. The two kinds of criticalTumorsin thePlagueare yet more different. In the most favourable Case theMorbific Matteris thrown upon some of the softestGlandsnear the Surface of the Body, as upon theinguinal,axillary,parotid, ormaxillaryGlands: the first Appearance of which is a small Induration, great Heat, Redness, and sharp Pain near those Glands. TheseTumors, if the Patientrecover, like thePustulesof the distinctSmall-Pox, come to a just Suppuration, and thereby discharge the Disease. In worse Cases of the Distemper, either instead of theseTumors, or together with them,Carbunclesare raised. The first Appearance of them is a very small induratedTumor, not situate near any of the fore-mention’d Glands, with a dusky Redness, violent Heat, vast Pain, and a blackishSpotin the middle of theTumor. ThisSpotis the beginning of aGangrene, which spreads itself more and more as theTumorincreases.
But, besides the Agreement in these critical Discharges, the two Distempers have yet a more manifest Likeness in thoselividandblack Spots, which are frequent in thePlague, and the Signs of speedy Death: for the same are sometimesfound to attend theSmall-Poxwith as fatal a Consequence; nay, I have seen Cases, when almost everyPustulehas taken this Appearance. Moreover, in both Diseases, when eminently malignant, Blood is sometimes voided by the Mouth, by Urine, or the like[94]. And we may farther add, that in both Death is usually caused by Mortifications in theViscera. This has constantly been found in thePlagueby the Physicians inFrance: and I am convinced, from Accounts I have by me, of the Dissection of a great many, who had died of theSmall-Pox, that it is the same in that Distemper.
ThisAnalogy between the twoDiseases, not only shews us, that we cannot expect to cure thePlagueany more than theSmall-Pox, byAntidotesandSpecific Medicines; but will likewise direct us in the Cure of the Distemper, with which we are less acquainted, by the Methods found useful in the other Disease, which is more familiar to us.
Inshort, as in theSmall-Pox, the chief Part of the Management consists in clearing thePrimæ Viæin the beginning; in regulating the Fever; and in promoting the natural Discharges: so in thePlaguethe same Indications will have Place. The great Difference lies in this, that in thePlaguethe Fever is often much more acute than in the other Distemper; the Stomach and Bowels are sometimes inflamed; and the Eruptions require external Applications,which to thePustulesof theSmall-Poxare not necessary.
Whenthe Fever is very acute, a coolRegimen, commonly so beneficial in theSmall-Pox, is here still more necessary. But whenever the Pulse is languid, and the Heat not excessive, moderate Cordials must be used.
TheDisposition of the Stomach and Bowels to be inflamed, makesVomitingnot so generally safe in thePlagueas in theSmall-Pox. The most gentleEmeticsought to be used, none better thanIpecacuanha; and great Caution must be had, that the Stomach or Bowels are not inflamed, when they are administer’d: for if they are, nothing but certain Death can be expected from them: otherwise at the beginning they will be always useful.Therefore upon the first Illness of the Patient it must carefully be considered, whether there appear any Symptoms of an Inflammation having seized these Parts: if there are any Marks of this, allVomitsmust be omitted; if not, the Stomach ought to be gently moved.
TheEruptions, whetherglandular Tumors, orCarbuncles, must not be left to the Course of Nature, as is done in theSmall-Pox; but all Diligence must be used, by external Applications, to bring them toSuppurate. Both theseTumorsare to be treated in most respects alike. As soon as either of them appears, fix aCupping-Glassto it withoutscarifying; and when that is removed, apply asuppurative Cataplasm, orPlasterof warm Gums.
IftheTumorsdo not come toSuppuration, which theCarbuncleseldom or never does; but if a thinIchoror Matter exudes through the Pores; or if theTumorfeel soft to the Touch; or lastly, if it has a blackCrustupon it, then it must beopenedbyIncision, either according to the length of theTumor, or by acrucial Section. And if there is any Partmortified, as is usually in theCarbuncle, it must bescarified. This being done, it will be necessary to stop the Bleeding, and dry up theMoisturewith anactual Cautery, dressing the Wound afterwards withDossils, andPledgitsspread with the commonDigestivemade withTerebinth. cum Vitel. Ov.and dip’d in a Mixture of two Parts of warmed Oil ofTurpentine, and one Part ofSp. Sal. Ammon.or inBals.Terebinth.and over all must be put aCataplasm of Theriac. Lond.
Thenext Day the Wound ought to be wellbathedwith aFomentationmade of warmaromaticPlants with Spirit of Wine in it; in order, if possible, to make the Wound digest, by which theSloughswill separate. After this theUlcermay be treated as one from an ordinaryAbscess.
Farther, in theglandular Tumors, when they suppurate, we ought not to wait, till theMatterhas made its way to the outer Skin, but to open it as soon as it is risen to any Bigness: because theseTumorsbegin deep in the Gland, and often mortify, before the Suppuration has reached the Skin, as the Physicians inFrancehave found upon dissecting many dead Bodies.
Thisis the Method in which thePlaguemust be treated in following the natural Course of the Distemper. But the Patient in most Cases runs so great Hazard in this way, notwithstanding the utmost Care, that it would be of the greatest Service to Mankind under this Calamity, if some artificial Discharge for the corrupted Humours could be found out, not liable to so great Hazard, as the natural Way. To this Purposelarge Bleedingandprofuse Sweatingare recommended to us upon some Experience.
Dr.Sydenhamtried both these Evacuations with good Success, and has made two very judicious Remarks upon them. Thefirstis, that they ought not to be attempted unless in the Beginning of the Sickness, before the natural Courseof the Distemper has long taken Place: because otherwise we can only expect to put all into Confusion without any Advantage. HisotherObservation is, that we cannot expect any prosperous Event from either of these Evacuations, unless they are very copious: there being no Prospect of surmounting so violent a Malignity without bolder Methods than must be taken in ordinary Cases.
AsforBleeding, by some Accounts fromFrance, I have been informed, that some of the Physicians there have carried this Practice so far, as upon the first Day of the Distemper to begin with bleeding about twelve Ounces, and then to take away four or five Ounces every two Hours after. They pretend to extraordinary Success from this Method, with theAssistance only of coolingPtisanes, and such like Drinks, which they give plentifully at the same Time. Such profuse Bleeding as this may perhaps not suit with our Constitutions so well as with theirs; for in common Cases they use this Practice much more freely than we: Yet we must draw Blood with a more liberal Hand than in any other Case, if we expect Success from it. I shall excuse myself from defining exactly how large a Quantity of Blood is requisite to be drawn, for want of particular Experience: but I think fit to give this Admonition, that, in so desperate a Case as this, it is more prudent to run some hazard of exceeding, than to let the Patient perish for want of due Evacuation.
AsforSweating, which is the other Method proposed, it ought,no doubt, to be continued without Intermission full twenty-four Hours, as Dr.Sydenhamadvises. He is so particular in his Directions about it, that I need say little. I shall only add, thatTheriaca, and the like solid Medicines, being offensive to the Stomach, are not the most properSudorifics. I should rather commend an Infusion in boiling Water ofVirginia Snake-Root, or, in want of this, of some other warmAromatic, with the Addition of about a fourth Part ofAqua Theriacalis, and a proper Quantity of Syrup of Lemons to sweeten it. From which, in Illnesses of the same kind with theGoal Fever, which approaches the nearest to thePestilence, I have seen very good Effects.
Whethereither of these Methods, ofBleeding, or ofSweating,will answer the Purpose intended by them, must be left to a larger Experience to determine; and the Trial ought by no means to be neglected, especially in those Cases, which promise but little Success from the natural Course of the Disease.