NoVII.
Set of Queries furnished by DoctorsAikinandJebb;and by Mr.Howardput to several foreign Physicians, during his tour; with their Opinions concerning the Plague.
1. Is the infection of the plague frequently received by the French?
Answer, byRaymond, physician at Marseilles: Sometimes it is.——Demollins, surgeon do: In the lazaretto some have touched infected bodies and things with impunity. Attributed to the temperament of the body.——Giovanelli, physician to the Leghorn lazaretto: The plague cannot be communicated but by very near approach, or touch: air cannot be the vehicle.——They, physician to the Malta lazaretto: It may happen that one person may inhabit the same chamber, or even touch an infected person, with impunity; of which I have known instances; but all who approach the atmosphere of an infected body may receive the infection by respiration. Contagion is almost always received before touching or approaching the infected person.——Morandi, physician at Venice: Contact is one of the most powerful and dangerous means of communicating the infection; but for the developement of its effects a predisposition in the receiving body is necessary.——Verdoni, physician at Trieste: It is most frequently communicated by the touch. It has been given by a flower held and smelt at, first by two persons who remained free; and then by a third, who sickened and died in 24 hours.——Jewphysician at Smyrna: The infection is in reality communicated by the touch alone; for all who keep from contact of infected persons or things remain free. To the effect of contact, however, a certain disposition of the air is necessary; for we often see infected persons arrive from other countries, yet the disease does not spread. But what this disposition is can scarcely be conceived. Commonly in this climate, the disease appears at the end of spring, and continues to the middle of summer; with this particularity, that, in cloudy weather, and during thesiroccowinds, the attacks are more frequent. Also in the same diathesis of the air some receive the infection, while others exposed to the same dangers escape it. From observation it appears, that cachectic persons, and those of constitutions abounding in acid, do not readily take it. The contagious miasmata may be dormant in the body for some time without doing the least harm, till set in motion by sudden fear, or the excessive heat of a bath.——Fra. Luigi di Pavia, prior of the hospital of San Antonio at Smyrna: The plague is communicated by contact, according to all the observations I have been able to make for eighteen years.
2. Does the plague ever rise spontaneously?
Raymond: Incontestible experience shows that it only proceeds from contact.——Demollins: From all ages the plague has been brought to Marseillesby merchandise or persons beyond sea.——Giovanelli: As the disease always appears with the same symptoms, it is not probably spontaneous, but the consequence of a particular contagion.——They: Some contagious fevers come of themselves; others proceed from the communication of contagion. The plague is thought to have originated in Egypt, and spread itself from thence.——Morandi: Contagious fevers do not arise of themselves, but are always the product of a peculiar poison—Verdoni: I know no fever that can properly be called contagious, and doubt if even the plague can be considered as such. My reasons are drawn from the very different manner in which the plague appears in different years, and the different degree in which it spreads. I therefore conclude that contagious fevers come of themselves.——Jewphysician: According to the most ancient authorities, the plague has always been brought to Smyrna by contagion, and was never produced here.——Fra. Luigi: Ancient and common observation in this city prove that the plague is derivedsolelyfrom contagion.
3. To what distance is the air infected? How far does actual contact, wearing infected clothes, or touching other things, produce the disease?
Raymond: The infected are safely conversed with across a barrier, which separates them only a few paces.——Demollins: The air round the patient is infected more or less according to the degree of poison which exhales. Here in the lazaretto they are spoken with across two barriers, a few paces from each other, without fear of contagion. Hence it would appear that the plague is communicated only by the touch, or still more by wearing infected clothes.——Giovanelli: If one speaks of an infected person shut up in an unventilated chamber, it may be said that the whole chamber is dangerous; but if one speaks of a patient exposed to the open air, it has been proved that the infection does not extend beyond five geometrical paces from the body. Beyond this distance one is in safety. The actual touch of an infected person or thing is proved to be very dangerous by fatal experience; but to what degree, is not ascertained.——They: The infection extends only some paces; and the miasms, at the distance of about ten paces, are so corrected by the air as to lose all their activity. It may be communicated by touching infected things, especially of a porous nature, as cloth, wool, skins, &c.——Verdoni: From the moment of infection to the time when nature has entirely dissipated the contagious principle, which usually happens in forty days, there is always a capacity of communicating the infection. The degree of infection is in proportion to the volume of air surrounding the patient; the air being what absorbs, dissipates and communicates the contagious principle. Infected substances communicate the disease for many years, in proportion to the ventilation they have undergone, or of which they are susceptible.——Jewphysician: The degree of infection in the air about the sick depends upon the greater or less malignity of the disease, and other circumstances. The air about poor patients is more infectious than about the rich. These things being established, I am of opinion that, in the greatest contagion, we may securely see a patient at the distance of two ells, if the chamber windows be not all shut.——Fra. Luigi: The infection is greater or less in proportion to the virulence of the contagion; but I have made no observation as to the distance. The disease is communicated by contact of all infected things, and by close inspiration of the breath of the sick.
4. What are the seasons in which the plague chiefly appears; and what is the interval between the infection and the disease?
Raymond: The plague shows itself at all seasons, but less at the two solstices.——Demollins: Great ravages may be made in all seasons, but principally in the greatest heats of summer. From the infection to the disease is two or three days.——Giovanelli: The plague appears at all times, in the same manner as poisons at all times produce their effects. But observations show that its ravages are greater in hot seasons than in cold; and it seems that summer and the first months of autumn are most to be dreaded. There is no certainty as to the interval between the infection and the disease, as it depends on the particular constitution of the patient.——They: Warm, moist seasons contribute to the production of all infectious diseases. The interval from the infection to the seizure is various, according to the virulence of the poison,and the constitution of the patient. Sometimes it acts slowly, sometimes like a stroke of lightning.——Verdoni: The spring is the principal season. Generally the disease shows itself at the instant of touch, like an electrical shock. Sometimes a person retains the contagious principle without any sensible effect, and then unknowingly communicates it to a third, in whom, if predisposed to the disease, it becomes active; or, otherwise, it may be communicated to others successively in the same way, till it becomes dissipated and annihilated, as happened at Smyrna in 1783. In bodies predisposed it very rarely conceals itself till the third day.——Jewphysician: Answered in the first.——Fra Luigi: The plague is most fatal in Smyrna from April to July; and it is constantly observed that great colds and heats much diminish it, and copious dews extinguish it. The infection shows itself in 24 hours, more or less, according to the difference of temperament.
5. What are the first symptoms of plague? Are they not frequently a swelling in the glands of the groin and armpit?
Raymond: The plague often conceals itself under the form of an inflammatory, ardent or malignant fever. Tumours of the glands are often its first symptom.——Demollins: The first symptoms of the plague vary; but the most common are, buboes in the armpit and groin; parotids and carbuncles in various parts of the body.——Giovanelli: The first symptoms are, debility, fever, excessive thirst, followed by great heat; after which carbuncles or buboes appear in the armpits, groin and parotids. The groin is sooner attacked than the armpit.——They: Swellings in the armpits and groin are indeed the characteristics of the plague; yet they are not the sole nor the first symptoms, and often are not seen at all; as when the plague disguises itself under the form of other diseases.——Morandi: Glandular swellings are properly the symptom of the second stage, and are preceded by those febrile symptoms which are immediately the consequence of receiving the infection; such as pain in the head, drowsiness, great prostration of strength, dryness of the tongue, vomiting, hiccough, tremor, diarrhœa.——Verdoni: Its first symptoms are relative to the constitution of the year, and of the body seized, and the place where it was produced, or whence it came. In 1783 all the parts of Natolia were infected; and the disease transported to Smyrna, which is the centre, was extinguished without the loss of a single person. Generally the plague of Constantinople, transported to Smyrna, does little harm. That of Egypt causes havock, as in every country. That of the Thebais is always cruel, and, carried to Lower Egypt, is fatal. The inguinal glands are most generally affected.——Jewphysician: The swelling of the glands is seldom the first symptom. Patients are every day seen who, being supposed ill of another disorder, in two, three or more days show glandular swellings, or carbuncles, by which the plague is manifested. On the contrary, many, who from the usual signs are supposed to have the plague, become well in a day or two, without any external swelling. The first symptoms are, horripilation, or actual shivering, nausea or vomiting, loss of strength, and fever. These are common to many diseases; but the pathognomic signs are, a difference in the pulsations of the two sides, with this circumstance, that from the diversity a prognostic arises; it having been observed that if the pulse on the side of the tumour or carbuncle be greater or more frequent, it bodes well; whereas, if it be smaller, it shows greater malignity, and more is to be feared. Further, there is observed among the first symptoms a visible pulsation in the carotids, greatest on the affected side; and also a crystalline vivacity in the eyes, with a kind of contraction or diminution of the eye on the affected side.——Fra. Luigi: The most remarkable symptoms of the plague are, turbidness and sparkling of the eyes, the tongue furred with a white mucus, and very red at its tip, frequent biting of the lips, violent pain in the head, and inability to hold it up; a sense of great cold in the loins, vomiting, debility. Swellings of the glands are not among the first symptoms.
6. Is it true that there are two distinct fevers with nearly the same symptoms, one of which is properly termed the plague, and is communicated from a distance by the air, and without contact; while the other, which is properly termed contagion, is only communicated by the touch, or at least by near approach to infected persons or things?
Morandi: It is certain, from multiplied observations, that there are two sorts of pestilential fevers, similar in appearance; one of which proceeds from the contamination of the air alone, and is communicable to any distance; the other is produced alone by contact, or near approach. The former of these is properly termed a pestilential fever, the latter a contagious one.——Verdoni: The distinction of these fevers is useless; since the same which is communicated by the touch, is that also conveyed by the air to a certain distance, especially in a close place.——Jewphysician: That there are two kinds of plague is absolutely to be denied; yet sometimes it happens that persons are attacked with the plague without knowing from whence it came.——Fra. Luigi: I hold it for certain that there is only one species of plague, though differing in malignity.
7. What is the method of treatment in the first stage; what in the more advanced periods? What is known concerning bark, snakeroot, opium, wine, pure air, the application of cold water?
Raymond: The disease is treated as inflammatory. No specific has been discovered for it.——Demollins: At the beginning, bleeding, vomiting, purgatives, diluents, refrigerants and antiseptics are used; afterwards antiseptics and cordials, relatively to the temperament and symptoms——Giovanelli: The plague causing always a disposition to inflammation and putrefaction, it is always proper to bleed proportionally to the strength, and to use a cooling regimen, with the vegetable acids. The repeated use of emetics is also proper, both to clean the first passages, and to dispose the virus to pass off by the skin. In the progress it is necessary to favour the evacuation of the virus by that issue which nature seems to point at. Thus either antiphlogistic purgatives are given, if nature points that way, or suppurative plasters are to be applied to any tumours which may appear. Epispastics to the extremities are proper where nature wants rousing. The vitriolic acid in large doses has been found very serviceable in the plague at Moscow, attended with carbuncles. When the inflammation is over, and marks of suppuration appear, the bark, with wine and other cordials, is proper. The surgeon’s assistance is proper in the treatment of boils and anthraces, which last are seldom cured without the actual cautery.——They: In the beginning of pestilential fevers bleeding is sometimes proper, and vomits almost always. In their progress frequent subacid and cold drinks, the bark given liberally, and vitriolic acid, have been found powerful remedies when there was a dissolution of the blood——Morandi: In the first period, evacuations, according to the particular circumstances of the case, are proper: in the second, bark mixed with wine, and opium as a temporary sedative. Pure air is very necessary; and fire as a corrective, with the burning of antiseptic and aromatic substances.——Verdoni: As soon as a Christian finds he has got the plague, he eats caviare, garlic and pork; drinks brandy, vinegar and the like, to raise the buboes. Upon these he applies greasy wool, caviare, honey of roses, dried figs, &c. to bring them to suppuration. The Turks and Arabs drink bezoar in powder with milk, and other sudorifics, in order to expel the virus. They vomit, and possibly a second time. At Cairo they take opium, and cover themselves with mattresses in order to excite sweat; and, though parched with heat and thirst, they drink nothing. They open the immature buboes with a red hot iron. At Constantinople and Smyrna they eat nothing, and drink much water and lemonade. The Jews drink a decoction of citron seeds, lemon or Seville orange peel, and their own urine. They abstain scrupulously from animal food. In 1700 a physician in Smyrna found bleeding very useful. Another, in another year, cured the plague by bleeding, and an antiphlogistic regimen. My brother in Cairo treated it like a biliary fever, with vomits, saponaceous attenuants, and antiphlogistics; and successfully. Some sailors at Constantinople in the frenzy of the plague have thrown themselves into the sea; and it is said that on being taken out of it they have recovered. My opinion upon the whole is, that the treatment ought to be relative to the constitution of the year, and of the patient, by which the nature of the disease itself is greatly altered.——Jewphysician: Bleeding in many cases may be serviceable, as I have known patients, who were bled by mistake, recover; and others recovered from a most desperate condition by a spontaneous hemorrhage. On the other hand,persons have been apparently injured by both these circumstances. The difference of effect seems to depend on the state of the blood, whether it be disposed to coagulation or dissolution. In the former, bleeding is useful, in the latter, hurtful. Vomits, according to my experience, have not succeeded; yet I should not hesitate to try ipecacuanha in substance, exhibiting half a scruple at two or three times, in the expectation that in this manner it would not run down. Bark may be useful in dissolutions of the blood; and also small doses of opium, and other medicines prudently administered. In excessive watchfulness I have known relief procured by anointing the temples with ung. populeon. In a case of hiccough the liquor anod. miner. Hoffmanni succeeded with one. The Turks, in the violence of the fever, take handfuls of snow, and apply it all over their bodies, and also eat it; and sometimes throw cold water on their feet. But whether this is of service or not cannot be determined; as these people in other respects pay no regard to rules of diet.——Fra. Luigi: They who practise empirically in the plague use none of the recited methods, but only strong sudorifics, and ventilation of the air; and complete the cure by proper treatment of the sores by suppuration.
8. When the plague prevails, do the physicians prescribe to those who have the disorder a more generous, or a more abstemious diet? and do they prescribe any thing to the uninfected?
Jewphysician: In times of the plague, many are accustomed to eat no flesh; others, no fish; but I know not whether by the advice of physicians. For myself, I have been in many plague years, but have made no alteration in the management of myself.——Fra Luigi: In Smyrna the plague is generally treated with a rigorous diet. They only use rice and vermicelli boiled in water; and sometimes, when the patient is too costive, juices and herbs boiled without seasoning. From time to time they give some acid preserves, and raisins, and, in great heats, some slender lemonade; and a dish of good coffee with a biscuit every day. For drink they only use toast and water; and they follow this abstemious regimen till the fortieth day of the disease is completed, after which they take chicken broth, lamb, and other food of easy digestion.
9. Are convalescents subject to repeated attacks from the same infection?
Raymond: Not unless they touch something infected.——Demollins: Convalescents are sent to fumigated chambers, and there is no instance of relapse.——Giovanelli: No instance of relapse, after being well recovered from the first attack, have come to my knowledge; but they are liable to fall into other disorders, such as consumption, hæmoptoe, &c.——They: Convalescents are without doubt liable to a relapse, and authors are full of instances of it. In the plague of Messina M. Cotogno says that a man had successively fourteen buboes, and was cured at last.——Morandi: All convalescents may relapse.——Verdoni: They have it not twice in the same year——Jewphysician: Convalescents are often attacked anew, and die; but this does not usually happen from a fresh infection taken elsewere, but from some remains of their own contagion, excited by intemperance in food, or the venereal act.——Fra. Luigi: From irregularities in eating and drinking, bodily fatigues, affections of the mind, especially anger, they are liable to repeated and very dangerous relapses.
10. What is the proportion of deaths, and the usual length of the disease?
Raymond: The mortality is different in different seasons and years.——Demollins: In the plague of Marseilles in 1720, half the inhabitants perished. The usual length of the disease is that of other acute disorders; but longer when the tumours come to suppurate.——Giovanelli: The proportion of deaths is variable and uncertain. As to duration, when the disease is very acute and fatal, the patient generally dies within five days from the first invasion of the fever, or first marks of the plague. When he recovers, no certain termination can be assigned. If the time of healing all the sores be reckoned, it may be to three, four or five months, or more.——They: The mortality is very various. Of ten whom I treated in the lazaretto, three died. I have observed that the fever generally runs on to twenty or twenty-one days.——Morandi: The bills of mortality in places visited by the plague usually amount to thirty per cent, sometimes to fifty. (He seems to mean of the whole number of inhabitants.)——Verdoni: The proportion of deathsvaries infinitely. It has been observed that the Jews in Constantinople and Smyrna lose only one third; which is attributed to the care they take of their sick. At Cairo, on the other hand, they are the first attacked and lose more than three fourths. The Turks lose two thirds; other nations a little more or less. Europeans in Cairo lose five sixths. Sometimes it kills immediately; sometimes in twenty-four hours; commonly in three days. When the patient gets over the ninth day there are great hopes of recovery, as the buboes are then suppurated. They may, however, die within the fortieth day, especially if they commit any irregularity, the principal of which is eating flesh, which instantly causes a return of fever, and death. It never passes beyond the fortieth day.——Jewphysician: The mortality is various, as also the duration: some in two, three or four days; some hold out six, eight, or more—-Fra. Luigi: Generally more die than survive; but in our hospital of San Antonio of Smyrna, from the care taken of the sick, the number recovering has, for eighteen years past, exceeded that of the dead.
II. What are the means to prevent the plague, to stop its contagion, and to purify infested places?
Raymond: There is no other method of preserving one’s self from the plague, than avoiding the contact of infested things. Goods are purified by exposing them to the open air for forty days; and furniture by a strong fumigation with aromatics and sulphur.—-Demollins: Here, in the lazaretto, infected goods and furniture are exposed to a current of air for forty days. The air of infested places is purified by burning all sorts of aromatics.——Giovanelli: The method of prevention is, to avoid all communication with infected persons or goods. The means of stopping the contagion form a body of police, too extensive to be here mentioned.——They: The means of prevention, besides avoiding infected things and persons, are sobriety in living, the use of vinegar internally and externally, and an issue. Infected places are purified by fumigation and ventilation, by scraping the lime from the walls, (which is then thrown into the sea) and whitewashing them anew with lime and sea-water, by washing the floors, windows, doors, &c. first with sea-water, and then with vinegar, taking great care to leave nothing that is infested. The bodies of the dead are buried in a place set apart for that purpose; and their beds and bedding are burned. As to other things not used during the illness, the linen is washed with soap and ley; the woollen clothes are put into sea-water for two days, and then ventilated for twenty days. Those which would be spoiled by water are hung on a line in the air for 40 days, and fumigated from time to time according to their quality——Morandi: A fire is to be kept constantly in the sick chamber in all seasons. All fæces, &c. are to be immediately removed. Clean sheets and shirts daily. The healthy must avoid commerce with the infected; must purge gently now and then, smoke tobacco, drink pure wine medicated with wormwood, gentian, zedoary, &c. and avoid fear and other passions, and excess of all kinds.——Jewphysician: No means of prevention are used in the Turkish dominions.—-Fra. Luigi: Fire, water and air are used for stopping the contagion, and purifying places.——Verdoni: The best preservatives are supposed to be sprinkling the room with vinegar and perfumes, ventilation and fumigation. The Greeks in Smyrna during lent, when they eat only vegetables, are seldom attacked; while among those who eat flesh the contagion makes great havock. Hence the best means of prevention are to eat moderately, and not at all of animal food; to drink water and vinegar; to sprinkle the chamber with the latter; and use frequent ventilation; to change the clothes, especially the linen, daily; hanging in the air such as has been used, for 15 or 20 days. For suppressing the infection every thing is to be washed that can undergo the operation, and the walls of the chamber to be whitened with lime, but after the 24th of June no further care is taken.
FINIS.