SECTION V.
Of the Cure of the Plague.
FROMwhat has already been laid down in a former section concerning the nature of this distemper, it appears, in its worst and most deadly form, to consist in the sudden breaking forth of a kind of hard mortifications, or rather eschars, like those made by fire, in different parts of the body. When these happen to fallupon any of the vital parts, it is evident that no cure can be applied. When such eschars discover themselves in abundance on the external parts, it is likewise observed that the patient certainly dies; whether from the same taking place inwardly, or from nature not being able to bear the loss of substance, and to separate so many deep eschars, is uncertain: but this kind, which attacks without fever, has always been reckoned absolutely incurable. When the tendency to internal mortification is less, and the fiery blasts, if we may so call them, approach the surface, so that buboes or carbuncles begin to appear, there is then some hope that the patient may recover. Even here, however, the case must be considered as very doubtful, and we have seen that in Dr. Russel’s three first classes of patients not one recovered; nevertheless, as we are not always able to distinguish with certainty whether the patient is altogether beyond the power of medicine or not, excepting where thetokensformerly mentioned appear, this kind only is here distinguished by the name of thefatalor inevitably mortal kind of plague. In all cases, where there is time allowed, medicine ought to be employed; but, as in other diseases, different theories have bred such a contradiction of opinions, that it is with no small difficulty we can judge which has anyprobabilityof success. In this uncertainty, however, we must look upon those who have recently had an opportunity of seeing the disease as superior not only to those who have onlyreadof it, but even to the most celebrated ancient physicians who have written upon the subject. Those who have had the best and latest opportunities of seeing the distemper are Drs. Alexander and Patrick Russel at Aleppo, and the physicians to the Russian army when the plague raged in it in 1770, &c.
Dr. Alexander Russel begins with observing that “the discordant opinions of medical writers concerning the method of treating the plague are innumerable. In regard to bleeding and other evacuations, they maintain opinions diametrically opposite; some recommending them as indispensably requisite, others decryingthem as invariably pernicious; while both parties, with equal confidence, appeal to experience. But, in a disease wherein reason is often perplexed, and experience itself fallacious, it is greatly to be lamented that nature is not more, and opinion less, consulted.
“No traces of any satisfactory method of cure are to be met with among the natives at Aleppo. The Mahommedans, holding the plague to be a penal curse inflicted by Almighty God on a sinful people, have less faith in the efficacy of medicine in that disease than any other: and, as the chief of those who practise physic are either Christians or Jews, not armed with the doctrine of predestination, and consequently apprehensive of contracting the infection, they (the physicians) endeavour to confirm the vulgar notion of the inutility of their art in the plague, with a prudential view of evading the danger of being forced to visit the sick. Hence the greatest part of the infected are either left to struggle with the disease without any assistance from medicine, or are under the necessity of submitting to the direction of the meanest and most ignorant of mankind.”
The whole practice of the native physicians consists in bleeding, let the stage of the distemper be what it will, and afterwards attempting to raise a sweat with the insignificant remedy of a few grains of bezoar mixed with the distilled water of scorzonera. On the subject of evacuations our author remarks, that bleeding, even very plentifully, was always useful in the beginning, but as constantly prejudicial after the first day. Vomiting was equally useful at the same period; with mere warm water, if that would answer the purpose, but if not, small drops of ipecucuanha or sal vitrioli might be added. Violent cathartics were hurtful, but an emollient clyster or laxative of manna and cream of tartar were not only safe but serviceable. “On the second day of the disease (says the Doctor) where the remissions of the symptoms were tolerably distinct, I have frequently and successfully given an infusion of senna with manna and cream of tartar; and it is a fact confirmed tome by repeated experience, that a purgative of this lenient kind, given after the critical sweat, was the most effectual means of promoting the suppuration of the buboes.
“The natural crisis of the disease was always by the skin. When a copious sweat could be procured by art, it was likewise of service; but the attempt, if made the first day, was attended with two material inconveniences: the first, that the common diaphoretic medicines, if given in the usual dose, if they failed in their operation, threw the patient into a flame, and greatly augmented all their symptoms; the second, that, though they produced the desired effect, it was necessary to keep up the sweat a much longer time than most people of that country could be persuaded to endure; and, if the sweat was prematurely checked by exposure to the air, all the symptoms were either exasperated, or (what was often the case) a diarrhœa was induced, which, though at first it might seem to relieve, yet generally proved fatal in the end.”
Contrayerva and valerian, saffron, the compound powder of contrayerva of the Edinburgh College, are recommended as sudorifics; given in small doses every four hours, with acidulated diluent drinks. These medicines were occasionally joined with anodynes, among which syrup of poppies was reckoned preferable to opium. In cases of diarrhœa, Venice treacle or diascordium were joined with the diaphoretics. Neither bark nor snakeroot could have a fair trial, on account of the prejudices of the people: and on this occasion our author observes, that “the physician who would obtain a ready compliance with his directions, in that country, must as seldom as possible offend the palates of his patients with nauseous remedies; for, whatever may be the consequence, they will often rather choose to incur distant though great risks, than avoid them by submitting to present inconveniences.” Nitrous medicines were found ineligible on various accounts: 1. They did not, as in other diseases, allay heat. 2. Thesick could not bear them in ordinary doses without languor and dejection. 3. They were apt to bring on a diarrhœa.—The following is an epitome of our author’s practice:
1. Bleeding from ten to twenty ounces as soon as possible after the seizure. The quantity seldom exceeded sixteen ounces, and even this is greatly above what is taken in any other disease in that country.
2. After bleeding, where the nausea was considerable, the stomach was cleansed with warm water; or, if that failed, with ipecucuanha or salt of vitriol. It was of such importance to have both these evacuations performed early, that our author instructed most of his acquaintance how to act if they should be infected.
3. A gentle anodyne succeeded the vomit. If by it the stomach was not quieted, an ounce of diascordium, or 15 drops of laudanum, were added to the saline draught of Riverius.
4. Small doses of cordial and diaphoretic medicines, with a very small quantity of antimoniated nitre, were exhibited every four hours; the sick were encouraged to drink freely of a decoction of scorzonera roots and barley, or spring water moderately acidulated with spirit of vitriol. A mixture of the acid with syrup of violets was kept ready to be added to plain water. All the drink was given warm if the patient would be prevailed upon to take it so.
5. In the winter the sick were removed into more airy lodgings than those in which they usually slept, and the air of the room was warmed or corrected by a moderate fire. In summer only the windows opposite to the patient’s bed were ordered to be shut; but even this restriction was not universally complied with; many insisting upon setting all the windows open in the day time, and sleeping on the house top at night.
6. In case of faintness and uneasiness, a cordial, composed of some of the simple distilled waters, tinctures of saffron and valerian, alkermes, and spirit of vitriol, was used with advantage and great refreshment to the sick. This with plenty of acidulated drinks was the chief prescription for infected children.
Under the above treatment, a sweat often broke out on the second or beginning of the third day; after which the sick were covered up, and the sweat encouraged as long as they could be persuaded to bear it. By this first sweat, especially if it happened on the second day, the patient was never freed from the fever, though greatly relieved. It was therefore necessary to continue the same medicines, in order, by a more plentiful sweat, to procure a perfect crisis. Where the sweat was supposed to be sufficiently copious, and had greatly mitigated the symptoms, a mild cathartic was given in the morning, though some degree of fever still remained; the other medicines not being intermitted during its operation. An anodyne was given in the evening.
In case of an exacerbation of the symptoms or the depression of the buboes, as sometimes happened on the second or third day, it was useful to apply a blister just below the tumour. A blister to the head was useful in cases of coma and debility of the tongue. The natives were exceedingly averse to the use of blisters; but, having observed that some who had been judged past recovery had nevertheless struggled through, apparently from the use of blisters, they at last came into some degree of credit. Cataplasms, composed of garlic, bread and vinegar, were advantageously applied to the soles of the feet. These, as well as blisters, were useful in cases of coma; also emollient laxative clysters. The dose of the alexipharmics was increased, and acidulated drinks, in small quantities at a time, given frequently.
To the buboes it was customary to apply suppurative cataplasms; but, as these could not, where the patient was desirous of walking, be easily kept on, a diachylon gum plaster was substituted, with the addition of few cantharides, or a little euphorbium, if a greater stimulus was judged necessary. In most cases the buboes were left to open of themselves; the natives being afraid of the lancet or caustic, and sometimes operators being wanting. No bad consequence ensued on their being left to open of themselves, nor was any particular treatment necessary. Where they mortified, the treatmentwas the same as in carbuncles, and though, after the separation of the gangrened parts, the ulcer often remained wide and deep, yet they healed kindly and in a short time.
Sometimes the carbuncles were scarified, but oftener not. The best dressings were pledgits of yellow basilicon, with a small proportion of oil of turpentine, or sometimes tincture of myrrh, with an emollient cataplasm over all.
Dr. Patrick Russel complains that, in Turky, physicians are laid under such restraints, by popular prejudices, that they are sometimes obliged to remain almost passive spectators of the disease. The natives are fond of bleeding, and will at any time let blood in the hot stages, when the febrile symptoms run high. About two thirds of the infected were bled at the arm; but from the rapid progress of the disease, and the quick transition to the low, languid state, few were bled more than once, and that usually within the first forty hours. The time of bleeding was usually the first night, or some time on the second day; but sometimes not till the third. Where the operation was repeated, it was usually on the third, sometimes on the fifth, and even on the sixth; he has even met with instances wherein the patient was three or four times bled, the last being as late as the seventh day. In his own practice he usually advised one bleeding at the beginning, except in the very young, aged, or infirm. On the first day, if not forbid by circumstances, bleeding was ordered by way of precaution; but on the succeeding days it was regulated by the state of the pulse, and other symptoms. Where the infection was slight, and the febrile symptoms moderate, or did not come on till some days after the eruptions, it was wholly omitted. The quantity of blood taken away seldom exceeded eight or ten ounces. Cupping was used by the natives, but never ordered by Dr. Russel. Children were scarified in the legs. He seldom had an opportunity of examining the blood drawn from a vein; but, in such cases as occurred, the general appearance was little different from that of healthy blood; the crassamentumwas sometimes of a darkish colour, but never sizy or resolved.
With regard to the propriety or impropriety of bleeding, or at least the success attending it, we can best judge from the histories of cases given by Dr. Russel at the end of his work. Of these there are an hundred and twenty, with some supernumeraries, giving an account of the cases of the attendants, &c. Of these, sixty-five were bled; forty died, and twenty-five recovered.
Of these hundred and twenty cases at large, fifty-seven recovered, as many died, and the event of six was unknown. This would tend to give us some considerable idea of the Doctor’s success; but, when we take into account the time of the year in which these cases were treated, the matter will appear in a quite different light. Twenty-seven took place mostly in the earlier part of the season, and were of consequence more violent than the others; and, of these, twenty-one died, five recovered, and the event of the other case was uncertain. Of the rest only thirty-six died, and fifty-four recovered. Such an excessive disproportion cannot be ascribed to the medical treatment, but to the nature of the disease itself, growing milder as it extended wider. In many of these cases it is not mentioned whether the patients took any medicines or not; nevertheless, as it must always be supposed that a physician would prescribe something for his patient, it must also be supposed that all took medicines, excepting where we are expressly told that they did not. The cases in which he mentions the medicines employed were the following:
1. A young man of 20, suddenly seized, was bled largely; had a vomit of ipecacuanha, which brought off a quantity of bile, but without putting a stop to the natural retchings. Some diaphoretic medicines were given, which did not remain on his stomach, and he did not sweat. These were stopped by a draught of juice of lemons and alkaline salt taken in the act of effervescence. Sinapisms were applied to the feet, and he died the third night at midnight.
2. A widow lady about 40, of a thin, delicate habit, in whom the disease came on gradually, was bled on the third day, and took diaphoretic medicines and acidulated cordials till the 9th. She died on the 11th.
3. A Jewish rabbi, between 30 and 40, of a thin, spare habit, was bled on the 2d day, and died early on the morning of the 4th.
4. A Jewish boy, between seven and eight years old, of a pale, unhealthy complexion, was repeatedly purged, and had suppurative cataplasms applied to the buboes without effect. He recovered slowly. Dr. Russel was not called till the seventh day of the disease, and we are not informed when the purgatives were administered.
5. A Jewish lad of 14, healthy and florid, was visited on the third day. He had already been scarified in the legs, and bleeding was ordered; but, as he became faint, only a small tea-cupful could be taken away. The blood, after two hours, was found to have a soft and loose texture, somewhat blackish on the surface; but the quantity of serum was not greater than usual. It had appeared of a blackish colour at first. He had a vomit, draughts with spiritus mindereri; afterwards a diaphoretic mixture and acidulated cordial, and sinapisms to the feet. On the seventh day he sweated copiously, and was much relieved, but soon relapsed. On the 10th he sweated early in the morning, and had a temporary relief, but soon became worse than ever. On the eleventh he had three stools of black blood. One of these, kept for the Doctor’s inspection, consisted of about three tea-cupfuls, without any fœtor; the others were “inconsiderably small.” Some tincture of bark was now added to his usual mixture. On the 15th he had a purging potion which operated five times, had an opiate at night, and tincture of bark with elixir of vitriol was ordered twice a day. Next day he was quite free of fever, and quickly recovered.
6. A Jew of a thin, spare habit, who took no medicines, died on the sixth day. His wife, of a delicate frame, and six months gone with child, was bled in the arm, had “proper drinks” directed for her, broughtforth a child in the agonies of death, and expired on the sixth day. They were extremely poor, and Dr. Russel says of the house they inhabited, that it “was one of those miserable dwellings which he had always considered as one of the receptacles of contagion.” It did not, however, appear to be so; for, though there were other six in the family, only one of them was infected, who died in ten days.
7. A youth of a delicate constitution, a French native of Aleppo, was visited on the morning of the third day. He had a carbuncle on his neck, which had been mistaken for an ordinary inflammation, and a physician who had previously visited him applied a galbanum plaster, ordering also some nitrous medicines; but the plaster giving much pain, it was changed for a common poultice. Live pigeons were applied to the feet. On the fourth he had a diaphoretic medicine, and his drinks were acidulated with spirit of vitriol. The symptoms increasing, sinapisms were applied to the feet, but without effect. Cataplasms of garlic were applied next night; he had two copious black stools, not very fœtid, and two bilious ones in the morning of the sixth. By these stools he was greatly weakened, and was ordered a cordial with diascordium. He had another stool, and became much worse. Cataplasms were applied without effect, and he died on the seventh day. This patient had a great number of eruptions; but, though six people attended him constantly, none of them were infected.
8. A Jewish girl of nine years old, of a delicate frame, and sprightly disposition, was visited on the 4th day. The usual regimen and medicines were ordered, but she could not be prevailed on to take any thing besides an acidulated cordial. Palm-oil was externally applied to a carbuncle near the corner of the mouth, about an inch long, and the third of an inch broad. This seemed to ease the pain, but did not prevent it from spreading. The face was also strangely disfigured by three or four streaks of a pale red colour, shooting up on each side from the cheeks towards the temples. The gangrenespread rapidly, and she died on the evening of the tenth day.
9. A stout, healthy Armenian youth, about 20, was visited on the first day, and took a vomit of ipecacuanha, which brought up a good deal of bile. An anodyne was given at night, but without effect. He took no medicines afterwards but an acidulated cordial. On the third he eat a quantity of cherries, and drank some iced water. He died on the fourth. Here the infection spread violently, only one out of six in the same house escaping the disease. Three died.
10. An Armenian woman in the seventh month of her pregnancy. She was bled the first day, had afterwards diaphoretic boluses, but did not sweat. On the third day she was delivered of a dead child, and seemed much better, but died at night. After death the body was entirely covered with purple marks.
11. A boy was bled and had an alexipharmic mixture the first day. A diarrhœa came on, and diascordium was added to the mixture without success. He died the third night. The infection was violent, only one in the house escaping.
12. A Jew of middle age and gross habit of body was bled on the second day. He was visited on the fifth, had diaphoretic powders, and sinapisms were ordered without success. He died on the 6th.
13. A Christian youth of 17, taken suddenly, was visited on the second day. A cataplasm was applied to the groin; he had a vomit of ipecacuan, and a diaphoretic draught with nitre and diascordium at night, but did not sweat. Next day he had acidulated drinks, a mixture with sweet spirit of nitre, and a small proportion of nitre itself. On the fourth, he had two stools, of a reddish colour like blood, after which he became much worse. In the night he had two other stools, which seemed to lower him. Throughout the day a larger portion of nitre had been added to his mixture, and three tea-cupfuls of blood were taken away, without the Doctor’s knowledge, by cupping. On the fifth the nitre was omitted; he was ordered an astringent cordial,but it was not given; however, the diaphoretic medicines were continued, and he had three loose stools, which sunk him greatly. Next day he seemed past recovery; lying motionless, insensible, his breathing quick, laborious and interrupted; the skin not cold, but the feverish heat gone, and his countenance ghastly. From this lethargic state the women attempted frequently to rouse him, by applying vinegar to his nostrils, calling him loudly by his name, and such like means, by which they sometimes succeeded; but, though he opened his eyes, and gave signs of sense, he could not be prevailed on to drink; and he remained silent. He would then, for some time, writhe his body as in mortal agony, and again relapse into lethargy. This dreadful paroxysm, however, began to wear off about noon; and at night he was less disturbed than usual. On the seventh day he was manifestly better; he had a looseness, with gripes, for which the white decoction was ordered; and he had tincture of bark thrice in twenty-four hours. On the sixteenth day the fever was entirely gone. The Doctor observes that this patient sweated much less than was usual with those who recovered.
14. A Christian boy about 17 was visited on the 4th day, having taken some absorbent powders on the 2d from another physician. The family would allow no other medicines to be given, except a few grains of bezoar, and he died next day.
15. An Italian, a man about 40, of a gross habit of body, and addicted to drinking, but who, finding himself somewhat indisposed, had for two or three days lived temperately, was visited on the second day of his illness, had a diaphoretic mixture, and a laxative medicine, without relief. In the night between the 5th and 6th he had some retchings to vomit. Next day he complained of a pain at the pit of the stomach, had a vomit of ipecacuanha, which brought off a considerable quantity of bile by vomit and stool, but without any apparent relief. He had two fœtid stools, and was ordered a cordial with volatiles. On the 7th his pulse was exceedingly sunk, and his extremities had been as cold as ice,but with very little alteration in the eyes or countenance. The patient did not know that these parts had lost their heat; and, notwithstanding this change, the sensation still remained in them. He died on the afternoon of the 8th day. This patient had no eruptions.
16. A Christian merchant about 50, of an atrabilious habit, and subject to the hæmorrhoids, on being taken ill drank immoderately of cold water. He was visited next day. In the afternoon about ten ounces of blood were taken away, and, as his pulse rose after the operation, he lost, by Dr. Russel’s order, six ounces more. Three ounces were afterwards taken away by cupping, and about as much more was accidentally lost by the loosening of the bandage of the arm; so that about 24 ounces were taken away in all. Next day he got a few drops of Carmelite water, a kind of spiritous cordial, which he vomited, had a blister and sinapisms applied, and died between 10 and 11 at night. He had no eruptions.
17. An Armenian youth was visited on the morning of the third day, was bled, and had a saline draught every four or five hours. On the fifth he was removed into a more airy chamber, and had Huxham’s tincture of the bark. He died on the ninth day.
18. A young lady of French extraction, of a thin, slender make, was visited on the morning of the second day. On the third she had diaphoretic powders, and lost a few ounces of blood by cupping, without the Doctor’s knowledge; she had a diaphoretic mixture, and died on the sixth day.
From these accounts it is easy to see, that, in violent cases of the plague, medicine can do little or nothing. Such cases generally occur in the earlier months of the season, though they may take place, and do take place in great numbers, at any time. In the beginning of the season the patients are almost all attacked in this violent manner, and very seldom recover, whether they take medicines or not. It being then an established fact, that as the epidemic season advances the disease grows milder, and many more continue to recover ofthemselves than did so at first, we are naturally led to suppose that a multitude of those who recovered after taking the medicines would have done the same without them. Little therefore needs be said of the immense number of prescriptions found in authors who have written upon the plague, as it may generally be supposed that at certain times these would have been ineffectual, and at others they were useless.—The following is an epitome of Dr. Patrick Russel’s practice:
1. Bleeding as early as possible, seldom repeated, except where manifestly indicated by circumstances.
2. Vomiting, if spontaneous, was encouraged by warm water. If the patient was affected by nausea, vomiting was provoked by warm water or camomile tea, assisted by a feather. If a bitter taste in the mouth was complained of, ten or fifteen grains of ipecacuanha were given. The times of remission were laid hold of for those remedies.
3. Where spontaneous vomiting continued too long, a saline mixture was given, sometimes with opiates and external applications.
4. The stomach being settled, mild sudorifics were given in small doses, every five or six hours. In the beginning, nitre was joined with contrayerva, but where it occasioned loose stools, was left off. Spiritus mindereri and saline mixture were also given as sudorifics.
5. In case of diarrhœa, dilution was first prescribed and then the white decoction. Laxative medicines were seldom admitted by the friends of the patient. Diascordium and opiates were used in cases of obstinate diarrhœa.
6. In the advance of the distemper it was found more eligible to give the sudorifics at shorter intervals, when occasion required, than to augment the dose, which was apt to occasion disgust, and a rejection of medicine entirely; consequences which also attended an attempt to heighten the power of the medicines themselves. The general design was to make their operation coincide with the periodical determination to the skin naturally occurring in the disease.
7. The sudorifics exhibited having but small power by themselves, it was found necessary to assist them by dilution, as well as in every other method which could be attempted. If the patient was not naturally inclined to drink, he was encouraged to it by offering agreeable liquids, either hot or cold at the person’s option.
8. The diet was the same as in other acute distempers. No animal food stronger than chicken broth was allowed; the rest confided of farinacea and leguminous vegetables. “It was certainly necessary (says our author) to a certain degree, to support nature by proper food; but to force it upon a nauseating stomach seems to have been irrationally recommended; and, where attempted, which the over care of the nurses frequently did, usually excited vomiting. I sometimes wished to give wine, but a religious bar lay in the way of Mahommedans, and a prejudice against it, in all fevers, rendered it equally inadmissible among the Christians and Jews.”
9. For oppression at the præcordia, mild cordials, acidulated drinks and cool air were found useful. Throughout the disease access of cool air to the chamber was constantly allowed, and, where the chamber itself was not sufficiently airy, the bed was removed to the house top. Towards the height of the exacerbations, however, when there happened to be the least appearance of moisture on the skin, the sick were kept moderately covered up from the chin downward.
10. After the height, and through the decline of the disease, the bark in substance, or Huxham’s tincture, were given instead of the ordinary sudorifics.
In the plague which took place in the Russian army, the greatest confidence seems to have been put in vomits. The disease commonly began with a dull pain in the head, resembling that produced by the fumes of charcoal, accompanied with shivering, universal weakness, &c.135On the first appearance of these a vomit was given, working it off with acid drinks. “If the nausea and bitter taste in the mouth was not removed bythe first, they gave a second, and sometimes a third or fourth; nay, they sometimes, if the symptoms were very urgent, gave two or three in the space of twelve hours, as there is no time to be lost in this disease; for they did not find this species of evacuation subject to the same inconvenience with purges, which a man in the plague is unable to support; nay, they are even dangerous, though he bears brisk vomits, and a repetition of them, when the nature of the case requires it.
“The stomach being thus cleansed, they gave every morning a powder composed of twenty grains of rhubarb, mixed with as much flower of brimstone, and three grains of ipecacuanha, exhibiting also, every hour, five grains of pure nitre mixed with two grains of camphor; and, if costive, a laxative clyster was given every evening, composed of decoction of camomile, wine vinegar, with or without soap, according to circumstances.
“The head, temples and buboes were frequently washed with warm vinegar, and the last urged to suppuration with emollient cataplasms; but, in case they were found to baffle all attempts to bring them forward, they were then scarified or extirpated, and the patient ordered to drink plentifully oflime-water. Bark was given after evacuation, joined to the flower of brimstone in the proportion of one ounce of the former to a drachm of the latter, divided into sixteen powders, and taken in twenty-four hours. When delirium came on, blisters were applied to the legs and arms, and camphor given largely. Vegetable and mineral acids were given indiscriminately; but they found the vegetable kind sometimes remain on the stomach when the other was thrown up; and of the latter they preferred the vitriolic. Acidulated drinks were given in quantity through the whole disease, and the food consisted of acidulated water-gruel, and fruit when they could procure any. The air of the room was kept charged with acetous vapours, as much as possible, and it was remarked, that, while the bitter taste remained, there was little hope of the disease abating.”
According to Baron Ash, “the plague does not depend upon any constitution of the air, but is communicated only by contact, and they had repeatedly succeeded in suppressing it in different divisions of the army, by the immediate separation of the infected with their attendants, and burning every thing belonging to them, or that they had touched. They found the greatest advantage in keeping the soldiers ignorant of its existence till suppressed; for by this means they preserved their peace of mind, and health of body; and they found an exact military discipline the best preservative against the disease. For the cure of those infected they found the cold regimen, a free circulation of air, vegetable and mineral acids, ipecacuanha, rhubarb and bark, to be the properest remedies. That, to purify the air in hospitals appropriated for their reception, gun-powder was found most efficacious, probably from the commotion given to the air in explosion, over and above its action in common with other fumes. To resist infection, courage and fortitude of mind is necessary, as consternation and terror seem to prepare the body for the reception of the disease.”
Dr. Sydenham seemed to have as great an opinion of bleeding, as the Russian physicians of vomits. Considering the plague as merely inflammatory, he lays the whole strength of the cure upon bleeding, which he greatly prefers to any other remedy. The quantities he took away were very considerable; and he gives an instance of a patient who died from not having enough taken away. He also informs us, that, during the civil wars in England, the plague raged in several places. Being accidentally brought to Dunstar castle in Somersetshire, a surgeon, who had travelled much in foreign parts, applied for leave to give the garrison what assistance he could. This being granted, he bled them, every man as he stood, without distinction, till ready to drop down; the blood was suffered to flow down upon the ground, so that no account could be taken of the quantity. They were then ordered to lie in their tents;and, though no kind of remedy was given after bleeding, every one recovered.136Notwithstanding his opinion of bleeding, however, this celebrated physician was obliged to attempt the cure by sweating, which he says he preferred to bleeding on account of its not weakening the patient so much, nor hazarding the reputation of the physician; yet he says it is prejudicial in young people where the powers of life are strong. His improved method therefore was, first to bleed moderately, if no swelling had appeared, by which means a sweat would be more safely and easily raised. The bleeding is to be performed in bed, after which the patient must be covered up with the bed-clothes, and a piece of flanel applied to the forehead. This last expedient, he says, contributes more to the raising of a sweat than one would imagine. If no vomiting ensued, he administered sudorific medicines internally. But, if the stomach cannot retain any thing, he proposes to begin the sweating merely by the weight of the clothes, and now and then throwing part of the sheet over the face. The sweat being thus begun, the vomiting, however violent, generally stops, and the medicines will be retained, so that as plentiful a perspiration as we can desire may be excited. An instance of his success in this way he gives in an apothecary who applied to him in behalf of his brother. A sweat being proposed, the apothecary told him that he had given him several strong sudorifics, all of which had been thrown up; but the Doctor, having first sweated him moderately by the bed-clothes, afterwards gave him a large dose of Venice treacle; which operating powerfully, he recovered from the disease. He advises the sweat to be kept up without intermission for twenty-four hours; a smaller time being insufficientto remove the disease, and a stoppage of the perspiration certainly attended with a return of the bad symptoms. On this occasion he censures Diemerbroeck and others for advising to stop the sweat on every slight occasion. The linen is to be allowed to dry on the patient’s body, he must take all his liquids warm, and continue the use of a diluting fluid. Sage posset drink is what he recommends. Next morning the cure was finished by a purge of senna, tamarinds, &c. Where a swelling appears, he directs to forbear bleeding even in such as are not apt to sweat, least the patient should die suddenly from a return of the morbific matter into the vessels. Bleeding, however, might be used with safety even in this case, provided a sweat was instantly to be raised; and thus he thinks the swelling might be dispersed perhaps with more safety than by waiting for its suppuration.
This may be accounted an epitome of the most approved modern practice in pestilential cases. The Russian physicians above quoted seem to speak with most confidence of their success. They, however, “lay great stress upon distinguishing the plague from the worst kind of malignant fever in hot countries; and it is not without reason, as bad consequences have attended the confounding of them on the breaking out of the plague. I am credibly informed that the great havock made in Moscow was principally owing to this circumstance; for it obtained some time before it was discovered by gentlemen unacquainted with the disease, and before they would acknowledge its existence, although some veteran army practitioners recognised its appearance under one of its forms, and endeavoured to alarm their brethren, but in vain, for a time.”137
From this it is natural to conclude, that, when the disease was once fairly discovered and attacked by the powers of medicine, it could not make much resistance; yet Dr. Mertens, speaking of this very plague, says, that owing to the rapidity of the distemper, and many inducementsto conceal it,little can be said of remediesin the plague. He divides the distemper into two kinds, the nervous and putrid; the former “comprehending merely that degree of confusion and disturbance given to the nervous system on the first introduction of the miasma, and the latter commencing at the time the miasma begins to operate upon the blood and other fluids by assimilating them to their own putrid nature.” In the nervous state the miasma has sometimes been carried off by sweat, gentle diaphoretics, camphorated emulsions, juleps of camphor and musk. Gentle emetics, particularly ipecacuanha, were found useful; but James’s powder (which was imported from England in great quantity) did not answer any good purpose. In the putrid state, the bark and mineral acids were useful; purgatives were hurtful, blood-letting inadvisable, and scarifying the carbuncles, recommended by almost every writer, attended with no good effect.
Few of the modern travellers who have visited the countries in which the plague is frequent, being versed in medicine, have said much about the cure of it. Mariti only says, that, in the island of Cyprus, infected patients were allowed no other diet than pure water, panada, rice, tea, &c. Some thought to ward off the disease by drinking strong liquors, but thesealmost alwaysfell victims to it. Whatever their methods were, indeed, they must certainly have been very ineffectual, since the same author informs us that, in the plague of 1759, in many parts of that island there were not a sufficiency of inhabitants left to cultivate the ground.
Diemerbroeck, whose name justly ranks high among those who have written on the plague, trusts mostly to sudorific medicines. Bleeding, according to him, is absolutely to be avoided, as well as purging and vomiting. He directed first that the chambers of the sick should be kept clean, and the air purified three or four times a day by fumigations, and that the sick should take (in the beginning, the first, second, or third day) asweating draught, and being well covered with blanketsplentiful sweats were promoted for two or three hours or more (always having a regard to the patient’s strength.) If the patient did not sweat easily, bags filled with hot, dry sand were applied to the feet, armpits and groin. If the sick were not eased by the first sweat, it was repeated in a few hours; but if, after the second sweat, the fever and other symptoms still increased, it was the worst sign. After ten or twelve hours, and on the following days, they were repeated four or five times as occasion required. Besides this he directed apozems, antidotes, &c. which, as it is most probable they had no effect in removing the disease, it is needless to trouble the reader with.138
That a free perspiration is the natural cure of the plague, seems to be allowed by almost all writers of credit. Dr. Russel says, “Of all excretions,thatby the skin would seem to be the most materially important in the plague. Where the skin remains perpetually dry, or where short and precipitate sweats are attended with no favourable alteration, danger is always to be apprehended. On the other hand, sweats, at certainperiods of the disease, appeared clearly critical in a greater or less degree. They were followed by a manifest alteration for the better, and by their repetition the fever was carried entirely off, or reduced to symptomatic exacerbations, seemingly dependent on the eruptions.” He adds, that he never observed blood exude through the pores, nor did he observe the sweat to be remarkably offensive; or in any degree so remarkable as in some eruptive fevers, particularly in the small-pox before eruption. Dr. Hodges, however, says that in the plague of London sweats were sometimes extremely acrid and fœtid; and that they were met with of various colours, such as purple, green, black, or blood-coloured. Sometimes it was cold, though the patient was tormented with intolerable inward heat and drought; and would continue even after death; but he was of opinion that sweat is the natural crisis of the distemper.
Besides those symptoms of the plague which have been enumerated, there are others, particularly hæmorrhages and convulsions, with which it is sometimes attended. These it has in common with the yellow fever, and therefore are considered in the second part of the work. I now conclude this part with a short retrospect of the principal facts which to me seem to be the result of the investigation. 1. That the plague is of an unknown (I believe it ofdivine) original. 2. That in the countries on which it first was sent, it still remains, and from them has always been propagated to others, without a single well attested instance to the contrary. 3. That the means by which the distemper usually has been propagated arewarandcommerce. 4. That the disease differs from all others in having a more violent tendency to inflammation, insomuch that it approaches to actual accension; nay, that the extraordinary instances of spontaneous burning we read of are to be accounted only the highest degree of this disease. 5. That the immediate or proximate cause of the plague is a tendency in the blood and other fluids to discharge upon certain parts the latent heat they contain, in such quantity as to destroythese parts entirely, and to convert them into a kind of coaly substance. 6. That this tendency depends on a certain inexplicable action of the external atmosphere, particularly of the elementary fire contained in it, and of which it principally consists.1397. The approach of a plague cannot be foretold, either from the constitution of the atmosphere, earthquakes, storms, or any other natural phenomena. 8. The plague is an eruptive disease, and it is known to be so by thecertain deathof all in whom eruptions do not appear; a tendency to eruption beingalwaysobserved where life remained long enough. 9. The contagion of the plague diffuses itself from a small space all around, lessening in violence the farther it is diffused. In its most concentrated state it hath proved invincible by medicine; in its mild state it requires none;140so that in the plague the medical powers are found of less avail than in any other acute distemper. 10. The natural cure of the plague is by perspiration or sweat, and this perhaps is the only evacuation which ought to be kept in view, as having a salutary tendency, by those who attend the sick.141
END OF THE FIRST PART.
A
TREATISE
ON THE
Plague and Yellow Fever.