Part 2 — CHAP. III.

Of the Cure of the Plague.

It appears, from what has been said in the beginning of this Discourse, that the Plague and the Small-Pox are Diseases, which bear a great Similitude to each other: both being Contagious Fevers from Africa, and both attended with certain Eruptions. And as the Eruptions or Pustules in the Small-Pox are of two Kinds, which has caused the Distemper to be divided into two Species, the distinct and confluent; so we have shewn two Sorts of Eruptions or Tumors likewise to attend the Plague. In the first and mildest Kind of the Small-Pox the Pustules rise high above the Surface of the Skin, and contain a digested Pus; but in the other, the Pustules lie flat, and are filled with an indigested Sanies. The two kinds of critical Tumors in the Plague are yet more different. In the most favourable Case the Morbific Matter is thrown upon some of the softest Glands near the Surface of the Body, as upon the inguinal, axillary, parotid, or maxillary Glands: the first Appearance of which is a small Induration, great Heat, Redness, and sharp Pain near those Glands. These Tumors, if the Patient recover, like the Pustules of the distinct Small-Pox, come to a just Suppuration, and thereby discharge the Disease. In worse Cases of the Distemper, either instead of these Tumors, or together with them, Carbuncles are raised. The first Appearance of them is a very small indurated Tumor, not situate near any of the fore-mention’d Glands, with a dusky Redness, violent Heat, vast Pain, and a blackish Spot in the middle of the Tumor. This Spot is the beginning of a Gangrene, which spreads itself more and more as the Tumor increases.

But, besides the Agreement in these critical Discharges, the two Distempers have yet a more manifest Likeness in those livid and black Spots, which are frequent in the Plague, and the Signs of speedy Death: for the same are sometimes found to attend the Small-Pox with as fatal a Consequence; nay, I have seen Cases, when almost every Pustule has 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 the Viscera. This has constantly been found in the Plague by the Physicians in France: and I am convinced, from Accounts I have by me, of the Dissection of a great many, who had died of the Small-Pox, that it is the same in that Distemper.

This Analogy between the two Diseases, not only shews us, that we cannot expect to cure the Plague any more than the Small-Pox, by Antidotes and Specific 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.

In short, as in the Small-Pox, the chief Part of the Management consists in clearing the Primæ Viæ in the beginning; in regulating the Fever; and in promoting the natural Discharges: so in the Plague the same Indications will have Place. The great Difference lies in this, that in the Plague the 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 the Pustules of the Small-Pox are not necessary.

When the Fever is very acute, a cool Regimen, commonly so beneficial in the Small-Pox, is here still more necessary. But whenever the Pulse is languid, and the Heat not excessive, moderate Cordials must be used.

The Disposition of the Stomach and Bowels to be inflamed, makes Vomiting not so generally safe in the Plague as in the Small-Pox. The most gentle Emetics ought to be used, none better than Ipecacuanha; 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, all Vomits must be omitted; if not, the Stomach ought to be gently moved.

The Eruptions, whether glandular Tumors, or Carbuncles, must not be left to the Course of Nature, as is done in the Small-Pox; but all Diligence must be used, by external Applications, to bring them to Suppurate. Both these Tumors are to be treated in most respects alike. As soon as either of them appears, fix a Cupping-Glass to it without scarifying; and when that is removed, apply a suppurative Cataplasm, or Plaster of warm Gums.

If the Tumors do not come to Suppuration, which the Carbuncle seldom or never does; but if a thin Ichor or Matter exudes through the Pores; or if the Tumor feel soft to the Touch; or lastly, if it has a black Crust upon it, then it must be opened by Incision, either according to the length of the Tumor, or by a crucial Section. And if there is any Part mortified, as is usually in the Carbuncle, it must be scarified. This being done, it will be necessary to stop the Bleeding, and dry up the Moisture with an actual Cautery, dressing the Wound afterwards with Dossils, and Pledgits spread with the common Digestive made with Terebinth. cum Vitel. Ov. and dip’d in a Mixture of two Parts of warmed Oil of Turpentine, and one Part of Sp. Sal. Ammon. or in Bals. Terebinth. and over all must be put a Cataplasm of Theriac. Lond.

The next Day the Wound ought to be well bathed with a Fomentation made of warm aromatic Plants with Spirit of Wine in it; in order, if possible, to make the Wound digest, by which the Sloughs will separate. After this the Ulcer may be treated as one from an ordinary Abscess.

Farther, in the glandular Tumors, when they suppurate, we ought not to wait, till the Matter has made its way to the outer Skin, but to open it as soon as it is risen to any Bigness: because these Tumors begin deep in the Gland, and often mortify, before the Suppuration has reached the Skin, as the Physicians in France have found upon dissecting many dead Bodies.

This is the Method in which the Plague must 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 Purpose large Bleeding and profuse Sweating are recommended to us upon some Experience.

Dr. Sydenham tried both these Evacuations with good Success, and has made two very judicious Remarks upon them. The first is, that they ought not to be attempted unless in the Beginning of the Sickness, before the natural Course of the Distemper has long taken Place: because otherwise we can only expect to put all into Confusion without any Advantage. His other Observation 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.

As for Bleeding, by some Accounts from France, 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 the Assistance only of cooling Ptisanes, 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.

As for Sweating, which is the other Method proposed, it ought, no doubt, to be continued without Intermission full twenty-four Hours, as Dr. Sydenham advises. He is so particular in his Directions about it, that I need say little. I shall only add, that Theriaca, and the like solid Medicines, being offensive to the Stomach, are not the most proper Sudorifics. I should rather commend an Infusion in boiling Water of Virginia Snake-Root, or, in want of this, of some other warm Aromatic, with the Addition of about a fourth Part of Aqua Theriacalis, and a proper Quantity of Syrup of Lemons to sweeten it. From which, in Illnesses of the same kind with the Goal Fever, which approaches the nearest to the Pestilence, I have seen very good Effects.

Whether either of these Methods, of Bleeding, or of Sweating, 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.

F I N I S.

Footnotes:

[1] See the Dedication.

[2] Vide Huet. De rebus ad eum pertinentibus, pag. 23.

[3] Observations sur la Peste de Marseille, p. 38, 39, 40.

[4] Ibid. p. 113.

[5] Vid. Philos. Transactions N^o. 370.

[6] Le Journal des Sçavans, 1722. pag. 279.

[7] Vid. Dissertation sur la Contagion de la Peste. A Toulouse 1724.

[8] Vid. Mechanical Account of Poisons, pag. 24.

[9] Vid. Philos. Trans. N^o. 372.

[10] Vid. Lettre de Messieurs Le Moine et Bailly.

[11] Astruc, Dissertation sur la Contagion de la Peste. A Toulouse, 1724. 8^o.

[12] Diemerbroek De Peste, p. 120.

[13] In these Words, Where it can be done.

[14] Vid. the Gazettes of the Years 1665. and 1666.

[15] Celsus de Medic. in Praesat. Morbos ad iram deorum immortalium relatos esse, et ab iisdem opem posci solitam.

[16] Libr. De morbo sacro; et libr. De aëre, locis, et aquis.

[17] Observat. et Reflex, touchant la Nature, etc. de la Peste de Marseilles, pag. 47. et suiv.

[18] Journal de la Contagion à Marseilles, pag. 6.

[19] Lib. 2. Ὅτι ἕτερος ἀφ᾿ ἑτέρου, θεραπείας ἀναπιμπλάμενοι, ὥσπερ τὰ πρόβατα ἔθνησκον· καὶ τὸν πλεῖστον φθόρον τοῦτο ἐνεποίει· εἴτε γὰρ μὴ θέλοιεν δεδιότες ἀλλήλοις προσιέναι, ἀπώλλυντο ἔρημοι, καὶ οἰκίαι πολλαὶ ἐκενώθησαν ἀπορίᾳ τοῦ θεραπεύσαντος· εἴτε προσίοιεν, διεφθείροντο, καὶ μάλιστα οἱ ἀρετῆς τι μεταποιούμενοι. The beginning of this Passage, as it here stands, though it is found thus in all the Editions of Thucydides, is certainly faulty, θεραπείας ἀναπιμπλάμενοι being no good Sense. The Sentence I shall presently cite from Aristotle shews that this may be rectified only by removing the Comma after ἑτέρου, and placing it after θεραπείας, for προσαναπίμπλημι in Aristotle absolutely used signifies to infect. With this Correction, the Sense of the Place will be as follows: The People took Infection by their Attendance on each other, dying like Folds of Sheep. And this Effect of the Disease was the principal Cause of the great Mortality: for either the Sick were left destitute, their Friends fearing to approach them, by which means Multitudes of Families perished without Assistance; or they infected those who relieved them, and especially such, whom a Sense of Virtue and Honour obliged most to their Duty.

The Sense here ascribed to the word ἀναπίμπλημι is confirmed yet more fully by a Passage in Livy, where he describes the Infection attending a Plague or Camp Fever, which infested the Armies of the Carthaginians and Romans at the Siege of Syracuse, in such words, as shew him to have had this Passage of Thucydides in view; for he says, aut neglecti desertique, qui incidissent, morerentur; aut assidentes curantesque eadem vi morbi repletos secum traherent. Lib. xxv. c. 26.

[20] L. 6. ℣. 1234.

Et ℣. 1241.

[21] Sect. I. Διὰτί ποτε ὁ λοιμὸς μόνη τῶν νόσων μάλιστα τους πλησιάζοντας τοῖς θεραπευομένοις προσαναπίμπλησι;

[22] Περὶ διαφορᾶς πυρετῶν, βιβ. αʹ.

[23] De Peste, c. iv. annot. 6.

[24] Evagrii Histor. Eccles. l. iv. c. 29.

[25] Gastaldi De avertenda et profliganda Peste, p. 117.

[26] Ibid. p. 118.

[27] Ibid. p. 117.

[28] See Bills of Mortality for the Year 1665.

[29] The Sweating Sickness.

[30] Nat. Hist. l. vii. c. 50.

[31] Histor. l. ii.

[32] Histor. Ecclesiast. l. iv. c. 29.

[33] De Bello Persico, l. ii. c. 22.

[34] Vid. Hodges De Peste.

[35] Vid. Istorie di Matteo Villanni, l. I. c. 2.

[36] Mezeray Hist. de France, Tom. i. p. 798.

[37] Villani, loco citato.

[38] Vid. Huet. Histoire du Commerce des Anciens, p. 88.

[39] Relation Historique de tout ce qui s’est passé à Marseille pendant la derniere Peste.

[40] Vid. Serv. Comment. in Virgil. Æneid, l. iii. ℣. 57.

[41] This was a kind of Expiatory Sacrifice, as the Scape-Goat among the Jews, Levit. xvi. And the Wretches thus devoted to dye for the Sins of the People were called Καθάρματα, Purgations. Vid. Aristophan. in Plut. ver. 454. et in Equit. ver. 1133. et Scholiast. ibid. Suidas adds that when the Sacrificed Person was cast into the Water, these Words were pronounced, Περίψημα ἡμῶν γενοῦ, Be thou our Cleansing. And I observe, by the by, that the Apostle Paul, 1 Corinth. iv. 13. alluding very probably to this wicked Custom, makes use of both these Words, where speaking of himself in the plural number, he says, Ὡς περικαθάρματα τοῦ κόσμου ἐγενήθημεν, πάντων περίψημα; for some of the best MSS. instead of Ως περικαθάρματα, read ὥσπερ, or ὡσπερεὶ καθάρματα; that is, We have been looked upon as Wretches fit only to be Sacrificed for the Public good, and cast out of the World by way of Attonement for the Sins of the whole Society.

[42] Vid. Le Brun Voyage au Levant, c. 38.

[43] Vid. Ludolf. Histor. Æthiop. lib. i. c. 13. et D. August. De civitat. Dei, lib. iii. c. ult.

[44] Vid. Ludolf. Histor. Æthiop. lib. i. c. 5. et Comment.

[45] J. Leo Hist. Afric. lib. i.

[46] Lib. vi. ℣ 1100.

[47] Rhas. et Avicen.

[48] Essay on Poysons, p. 178.

[49] Cicero de Nat. Deor. lib. i. § 36. speaking of these Birds, says: Avertunt Pestem ab Aegypto, cum volucres angues ex vastitate Libyae vento Africo invectas interficiunt atque consumunt; ex quo fit ut illae nec morsu vivae noceant, nec odore mortuae.

[50] Newton’s Optics, Qu. 18 to 24.

[51] Gastaldi, De Peste, p. 116.

[52] Journal de ce qui s’est passé à Marseilles, etc.

[53] Vid. The London Gazette, July 23, 1743.

[54] Kircher, Langius, &c.

[55] Toulon, Traité de la Peste.

[56] Hippocr. Epid. l. iii. That Hippocrates describes here the Constitution of Air accompanying the true Plague, contrary to what some have thought, Galen testifies in his Comment upon this Place, in libr. De Temper. l. i. c. 4. and in lib. De differentiis Febr. lib. i. c. 4.

[57] Vid. Mercurial. Prælect. De Pestilent.

[58] Notitia Eccles. Diniensis.

[59] Histor. lib. lxii.

[60] Sydenham De Peste.

[61] Vid. Caium, De Febr. Ephemer. Britan. and Lord Bacon’s History of Henry VII.

[62] Pag. 162. Edit. Lovan.

[63] Vid. Rondinelli Contagio in Firenze, et Summonte Histor. di Napoli.

[64] Lord Herbert’s History of Henry VIII.

[65] Thuani Histor. lib. 5.

[66] Lord Verulam’s History of Henry VII.

[67] Vide Sydenham, De Peste, An. 1665.

[68] Boccaccio Decameron. Giornat. prim.

[69] De Contagione, l. iii. c. 7.

[70] Observat. l. vi. Schol. ad Observ. 22.

[71] Diemerbroeck, De Peste, l. 1. c. 4.

[72] Memorials presented by the Deputies of the Council of Trade, in France, to the Royal Council, Pag. 44 and 45.

[73] Alex. Benedict. De Peste, cap. 3.

[74] In a Paper of Advice against the Plague, laid before the King and Council by Sir Theod. Mayerne in the Year 1631. MS.

[75] Hodges, De Peste.

[76] Vid. Directions for the Cure of the Plague by the College of Physicians; and Orders by the Lord Mayor and Aldermen of London, published 1665.

[77] Vid. a Journal of the Plague in 1665. by a Citizen. London, 1722.

[78] Discourse upon the Air, by Tho. Cock.

[79] Vid. The shutting up Houses soberly debated, Anno 1665.

[80] Muratori governo della Peste, lib. I. c. 5.

[81] Cardin. Gastaldi, De avertendâ Peste, c. 10.

[82] Journal de ce qui s’est passé à Marseilles, &c. p. 9, 10, 11.

[83] De Pestilent. cap. 21.

[84] Camden. Annal. Regin. Elizab.

[85] Lord Verulam, Natural History, Cent. 10. Num. 194.

[86] Plutarch lib. de Isid. et Osir.

[87] De Peste, c. 22.

[88] Hodges, De Peste, pag. 24.

[89] Journal de la Peste de Marseilles, pag. 19. et Relation Historique de tout ce qui s’est passé à Marseilles pendant la derniere Peste, pag. 77.

[90] Rhazes, De re Medica, lib. 4. c. 24. & Avicenn. Can. Med. lib. 4. c. 1.

[91] Gaudereau Relation des Especes de la Peste que reconnoissent les Orientaux.

[92] Mech. Account of Poisons, Essay III.

[93] Notitia Ecclesiae Diniensis.

[94] Vid. Observ. et Reflex. sur la Peste de Marseilles, p. 333.

Transcriber’s Notes:

Long “s” has been modernized.

Greek ligatures have been expanded to individual letters.

Greek variants for single letters have been modernized.

Other than the corrections noted by hover information, inconsistencies in spelling and hyphenation have been retained from the original.