PART FIRST. (continued 8)

We come now to the third mode of prevention, viz. that of destroying the infection after it has begun to exist. This is varied according to the nature of those things which we suppose to be infected. The general notion of infection taking place in the atmosphere has been already spoken of; but the uncertainty of this hypothesis, and the apparent impossibility of altering a constitution of the atmosphere, must certainly leave very little room for hope in this case. It hath, however, been attempted by various methods. Hippocrates adopted the opinion that all diseases were produced by the air, and from him it was borrowed by Lucretius, as we are informed by the annotator on Creech’s Translation of that author. “In his book de Flatibus (of winds) says the annotator, after a long narration of the effects that the air produces, he at length falls on the subject of diseases, all of which he affirms to be bred and generated in the bodies of animals by means of the air. First (says he) I will begin with the most common fevorous disease, which accompanies, in a manner, all diseases whatever. For there are two sorts of fevers, one that is promiscuous, and common to all, and is called the plague; the other, by reason of unhealthful diet, is peculiar only to such as use that diet; but of both these kinds of fevers the air is the sole author and cause, for the common fever or plague happens alike to all, because they all breathe the same air; and it is certain that the like air, being alike mingled in like bodies, must beget like fevers.” In consequence of his theory, this great physician advised to have recourse to fire as a purifier of air in times of pestilence. But experience doth not warrant the success of this method; neither indeed can we suppose that it could be successful, unless people were able to kindle such fires as would absorb the whole atmosphere of a country. This method was tried in London without the least success; nay, seemingly with bad effect; for, the very night the fires were lighted, more than four thousand people died; and, a few days after, an end was put to the experiment by such violent rains as extinguished all the fires at once.

The burning of infected clothes has already been taken notice of; but though this must certainly prevent any new infection from arising from these clothes, it will not prove that the infection may not evaporate during the time of burning, and, being volatilized even beyond its natural pitch, by the heat, may do mischief at a greater distance than could have happened had they been let alone. The instance, formerly quoted from Dr. Huxham, of the small-pox being disseminated by the smoke of burning infected clothes, if not a proof, affords at least a strong presumption, of the danger of such a practice. The only way of perfectly ensuring safety in such a case would be to burn them by the sea-side, when the wind blows from the shore. Were the smoke allowed to pass over land, and great piles burnt at once, it is impossible to say how far the contagion might be carried.121

Another mode of purification is by exposing suspected goods to heat, to the vapour of vinegar, &c. fumigating with gun-powder, sulphur, &c. and on this principle various powders of fumigation have been invented; some of which are said to have been very successful in Russia; and the composition of one is given by Dr. Alexander Russel in his Natural History of Aleppo; but all these are undervalued by Dr. Guthrie,122 who calls the practice of fumigation or smoaking, an “inadequate and ineffectual ceremony.” Dr. Mitchel, also discommends them, saying that they are advised “without any proof that these destroy pestilential matter, and while, at the same time, it is certain that they diminish more or less the wholesomeness of the atmosphere with which they are mingled.”123 Of late the vapours of pure nitrous acid (the nitric, according to the new nomenclature) has been recommended, with the boldest appeal to experience; but the consideration of this naturally belongs to the second part of this work, where we shall have occasion also to consider the theory of the septic acid. In the mean time we must go on with some farther account of the different modes of fumigation.

“There is no better corrective (says Allen from Diemerbroeck124) of a pestilential air, than fire; as much experience has taught us. Hippocrates subdued and extinguished that famous plague, which came amongst the Grecians from Ethiopia; for he commanded great fires to be kindled throughout the whole city, especially in the night time, to purge away the pollutions of the air. It is believed that a fire made with juniper-wood or ash, tends much to correct the venomous corruptions of the air. The kindling of sulphur and gun-powder purify the air, and drive away its corruptions; so does the burning of amber, pitch, frankincense, &c. so do the fumes of vinegar raised with red-hot irons, or bricks.” According to Etmuller, “Hippocrates drove away that famous plague in Greece by the use of sulphur; the fumes of it are very much commended to correct the air, and make drink more wholesome; it prevents all manner of corruptions and alterations, as well as the putridinous alteration of the blood. In a great degree of malignity, the shirt and clothes may be impregnated with the fume of sulphur.”

Here we have accounts of a disease, called that famous plague, driven away by two different methods; and, to complete our dilemma, Dr. Canestrinus tells us that the plague at Athens is said to have been staid “by sprinkling the streets with wine.” What an expensive remedy, when the odour of privies was afterwards found to answer as well! “Whilst the plague was raging at Oczakow, an earthquake125 happened on the very day that it began to decline. In this case did any vapour issue from the earth destructive of the pestilential contagion? or did former noxious exhalations cease in consequence of the convulsion of the earth?126 Sorbait relates, that, in the time of the vintage in the neighbourhood of Moselle, the plague ceased like a miracle, while the must was in a fermenting state. At Vienna likewise it was observed that, during and at the close of the vintage, the disease manifestly declined; which may have been owing to the great quantity of fixed air in the atmosphere.”

To this our author adds, that “places adjoining to spice-shops have generally remained free from infection; and, in the plague of London, all those employed in shipbuilding escaped the disease. Smiths also and cooks remained uninfected.” M. Volney tells us that, in Egypt, water-carriers are exempted; and Baldwin, that oilmen are in the same happy predicament; while on the other hand Allen quotes Boerhaave saying, that “Forestus, Diemerbroeck, the French, English, and Germans, observed, that all dealers in soap, washers, and all who by their business used soap, nay, who only wore shirts washed with soap, presently died of the plague.”

From so many and so discordant opinions, the only conclusion we can draw is, that, when once a pestilence has invaded a country, there is not any possibility of operating upon the contagion in such a manner as to destroy it. If the plague ceases, it must do so naturally, and we cannot accelerate this cessation. This is entirely conformable to the opinion of Dr. Patrick Russel. Speaking of the decline of the plague at Marseilles, and the vigorous exertions of the magistrates to put a stop to it, he says, “The causes now enumerated might no doubt have some effect, but a more powerful and general cause had begun long before to restrain the havock of the pestilence, which had declined visibly in the month of September, and in those of October, November and December declined with a rapidity not ascribable to the exertions of the most vigorous police. This cause is generally supposed to be some change in the constitution of the air; but which has hitherto been defined with no better success than that peculiar state of the atmosphere which, in conjunction with contagion, is absolutely necessary to render the plague epidemical.”

Dr. Russel takes notice of the methods of extinguishing contagion already mentioned, by kindling fires, &c. and disapproves of them. We shall not therefore spend more time in considering whether or not there is any probability of eradicating or mitigating the violence of a plague when once it is introduced. However this may be impracticable in so large a space, it seems that it certainly may be done in smaller spaces, ships for instance; or, if not with the true plague, at least with malignant and infectious fevers. Dr. Trotter, in his Medicina Nautica, has laid down methods for accomplishing this, and expresses the highest confidence in their success. He adopts the doctrine of contagion, of which he gives the same definition that in this treatise is given of infection, viz. “Something propagated from diseased bodies, or from substances that have been in contact with them, producing a similar disease in other persons127—the propagation of contagion, as well as its reception into the healthy body. A more aggravated degree of malignity will generate a greater quantity of infection, and, as it may be confined in a larger or smaller space, it will be less or more noxious. A fever may be called malignant, when, with the symptoms of debility, there is a cadaverous smell arising from the body, an unusual fœtor of the breath, stools, and other excretions, the tongue black and parched, the eye dusky or yellow, the countenance bloated and dejected, and the skin sallow. In approaching a sick bed of this kind, a person not much accustomed to such visits will be very liable to receive the infection; and the unpleasant smell will be much sooner perceived than by the physician or other attendants. We conclude that a malignant typhus is more apt to generate contagion, because slight cases are found not to extend to others, even though no mode of precaution has been used. The disease itself is incapable of generating infection, till after a certain period; but this period is uncertain: it seems to depend on the nature of the symptoms, whether they are mild or malignant. We are assured of this fact, from a timely separation having prevented the farther progress; and by this means ALONE, I apprehend, we eradicate contagion in SHIPS, or ANY WHERE ELSE. In the small-pox128 the disease seems incapable of infecting another person before the second or third day of the eruption. With the measles it is otherwise. The disease may be propagated at the most early stage of the eruption; and, if I was to be allowed to conjecture on the subject, I would say, that the contagion is the offspring of the catarrh (the cough and hoarseness resembling a cold) which accompanies the measles.

“Substances imbued with the exhalations from infected bodies, if not exposed to the air, have their powers of communicating the disease increased; or, in other words, the infection from fomites (infected cotton, clothes, &c.) is said to become more virulent than it was when first separated from the body.

“I am of opinion, with others, that the exhalations or excretions of the sick are the vehicles of contagion. It is these which impregnate the atmosphere with noxious matter: they affect in like manner bed-clothes, or apparel, and every thing that can imbibe them, when in contact with the diseased body. When bed-clothes, or body-linen, but particularly silk or woolen cloth, have been exposed to these exhalations, and then heaped together for a length of time, the noxious effluvia are, as it were, multiplied, and will more certainly infect others than they did at first. The bales of goods which brought the plague to Marseilles, and affected the people that opened them so suddenly, had their virulence increased by not being duly ventilated. When the jail-fever was brought into court by the prisoners at Oxford assizes, and more lately at the Old Bailey, the fever was propagated from the clothing of the prisoners; no doubt, from being confined in impure, ill-aired cells, this infection became more virulent. The highly concentrated state of contagion, in the bales of goods, could only have been brought to that degree of virulence from the closeness of the package: it cannot be supposed that human beings could have put them together otherwise. The nurses of hospitals know well, as Dr. Lind tells us, that there is most danger of catching a fever when they pile heaps of bed-clothes or body-linen together for a few days, before it is carried to the wash-house. The washer-women at Haslar have also told me the same thing. They know when a dangerous fever is in the hospital by the bad smell of the clothes: this makes them air them abroad, till the smell is gone, and then they can wash them with safety. But, if it happened, from the hurry, that this could not be done, or if it was neglected by design, many of them were seized with the sickness. The porters and people employed in cleaning and fumigating the blankets and beds at Haslar are well acquainted with this fact, and they measure the danger by the badness of the smell. This ought to instruct every body to stand to windward of these infected substances when they are opened; as the current of air would then carry it the other way. In one of the courts of justice, the people who stood between the prisoners and a window, into which the wind blew, escaped the infection, while those on the other side were sufferers.

“In the summer of 1793, while the Orestes brig, commanded by Lord Augustus Fitzroy, lay at Plymouth, she was anchored very near and to leeward of an army transport, which had on board a very malignant fever among the soldiers. While the soldiers were moved on deck, to go on shore to the hospital, the crew of the Orestes, from curiosity, walked on deck to look at them. Such was the concentrated state of the contagion among the clothing and bedding of these troops, on bringing them from below, that eighteen people belonging to the brig were quickly seized with the same fever, the infection of which had been conveyed by the current of wind. It did not, however, extend much farther in the Orestes, from the attention of her commander. But this ought to be a caution for ships to keep clear of those that have fevers on board, as a virulent CONTAGION may be conveyed to a considerable distance.

“Dr. Lind is inclined to think that washing the bed-linen in hot water, even when first shifted, is attended with much risk; and that the noxious matter may be volatilized by the heat of the water, and affect the woman. For this purpose he has recourse to his favourite process, of fumigation, to insure the washer-woman. The heat of his fumigating furnace would no doubt dry the linen, and exhale any moisture; but our practice in the Charon (the hospital ship) was, to plunge everything as it came from the bed into a tub of hot water kept ready on purpose. The linen was washed and dried immediately after. We had in that hospital many malignant cases of typhus, and some deaths, yet no infection was ever spread there.”

Our author next proceeds to inquire into the cause of this excessive concentration of the infectious matter in fomites, or clothes, bed-clothes, bale-goods, &c. The most plausible reason, he says, that could for some time be assigned for this, “was, the generation of animalcula; the cotton or woollen clothing was said to serve as a nest for the corpuscles to multiply; and thus the contagion was thought to increase seven fold.” This theory had an effect on the practice of physicians, both as to the prevention and cure of fevers supposed to proceed from thence. Our author looks upon the hypothesis to be chimerical, because none of these animalcules have ever been made visible by the best microscopes. But there is no necessity for supposing the animalcules to be invisible to the naked eye. They may creep on the ground, or fly in the air, without being observed by us. Mr. Baker’s discovery of the insect which not only poisoned eleven hundred thousand times its bulk of water, but infected a much greater bulk of air, with its effluvia,129 shows that such a thing may be possible; and in dubious matters bare possibility ought always to produce inquiry. If the perspiration of human bodies when confined becomes noxious, why may not that of a multitude of insects be so too? There is no necessity for supposing that an insect must be swallowed, or inhaled by the breath, before it can do hurt. What Dr. Trotter says of the variolous contagion emitted from the human body will apply equally to insects. “What has been called the insensible perspiration (says he) which arises from the surface and the lungs, we have a right to believe carries with it in solution a portion of the variolous matter which charges the atmosphere with the contagion of small-pox, even in such quantities as to impregnate the clothing of attendants and visitors; by which means it has been frequently carried to families and villages many miles distant from its source.” The smallness of size of insects can be little objection here. A skunk is but a small animal, yet it spreads its odour farther than an hundred diseased human bodies could propagate the plague.130

On this subject, however, we may remark, that though the nurses and attendants on hospitals measure the degree of infection by the smell, yet people are by no means safe in approaching patients about whom no smell can be perceived. We have already seen, from Dr. Fordyce, that what may be called the pure infection of fevers is not perceptible by any of our senses; and there are examples of very offensive smells issuing from diseased bodies without any contagion ensuing. Dr. Trotter tells us, that “a patient in typhus was sent from the Venerable to the hospital ship, with a fœtor about him, that exceeded any thing of the kind that ever came within the Doctor’s knowledge. After being washed and shifted, it still continued, and was perceived at a considerable distance. He died in a few days, yet nobody was infected from him, either in his own ship, or in our hospital. There was probably some peculiarity of constitution here.” In M. Deidier’s experiments, above related, the dog which eat the dressings of the plague sores, after being infected with the disease, emitted a very disagreeable odour, but we do not find that the odour was in any way infectious. In the Encycloped. Britan, art. Med. Hydrophobia, we find an account of an hydrophobic patient (and a patient who recovered) in whom the blood drawn from a vein was as black as ink, and stunk abominably, yet this stench was attended with no bad consequence. There is therefore no essential connexion between offensive smells and contagion; yet, as they are sometimes united, the absence of the smell ought not to encourage us rashly to go into suspicious places, neither ought the presence of it to deter us from venturing where we have otherwise good reason to do so.

Having given up the doctrine of animalcula, the Doctor goes on to explain the doctrine of concentrated contagion in a manner very similar to that given in this treatise, viz. from the decomposition of some kind of gas. “The fœtor of the breath (says he) perspirable matter, &c. evidently demonstrate that they differ from the healthy state. The smell, to our senses, comes very near what is called sulphurated-hydrogenous gas. Some of the fluids within the body would seem to be in some degree in a state of actual decomposition; unless we can suppose the mucous glands of the lungs secreting a fluid that taints the expired air in this manner. The decomposition of the fat, which sometimes disappears very suddenly in fevers, may give some ground for the supposition that a large portion of these exhalations are composed of hydrogenous gas. But, whether we can go thus far or not, what is separated from the body, it is plain, is more disposed to decomposition than when the body is in health. Now this process will still go on, whether exposed to the atmosphere or not, with this difference, that, by exposing substances which have imbibed the exhalations of the diseased to a free air, the noxious gases will be dissipated as quickly as they are evolved; while, on the other hand, by laying the clothes in a heap, packing them firm in a chest, or making up cloth into small bales, the gases are concentrated into a small space; and woe to the man who first inspires them. . . . Now this does not hold out an idea that the powers of contagion are multiplied, as by generation; for that would be to say, that these gases are themselves what we call the matter of infection. I would only go so far as to assert that they are the vehicles of it, till more certain experience shall determine farther.”

With respect to fumigations with nitrous acid, our author repeatedly declares that he has no confidence in them; nay, he brings instances where they seemed to have bad effects. But as the dispute about fumigation has no connexion with the true plague, nitrous acid having never been used as a preventive for it, we shall defer any farther consideration of it to the second part of this treatise, to which it naturally belongs.

We come now to the fourth and last mode of prevention, viz. a consideration of those means by which an individual, without separating himself from society, and who is daily obliged to have communication with the sick, may yet secure himself against infection. Here the means recommended are extremely various, and some of them so opposite, that we can scarce avoid suspecting them all. The misfortune is, that though a person should go, without fear, among the sick, though he should constantly take a medicine, and should never have the distemper, yet we cannot say whether the medicine did preserve him or not. Were it possible to know the particular constitution of the body which disposed some to resist the attack of the disease, attempts might be made to bring the constitutions of others to the same standard, but unfortunately our ignorance here is so great, that any attempt to alter the constitution of the body has generally proved unfortunate even in other diseases. Dr. Lind informs us, that the first Portuguese adventurers in Africa, having observed, that “such as had the good fortune to escape a fit of sickness or death, soon after their arrival, enjoyed afterwards a pretty good state of health, thence concluded, that the blood of such persons had been entirely changed by the diet of the country. Upon this erroneous principle they adopted a most fatal method of seasoning people to these unhealthy climates. They, by small quantities, frequently repeated, took away as much blood as they supposed to be contained in the body, and thus they reduced the patient to a state of extreme weakness.” From its being observed that people of delicate constitutions are less liable to the plague than others, such a mistake probably has also been made with regard to this distemper, but with equally bad success. Allen tells us from Diemerbroeck, “Phlebotomy, though mightily cried up by many of the ancient and modern physicians, yet we reject it altogether, as very dangerous and detrimental; for it appeared by experience that those who made use of it for prevention’s sake were seized with the plague soon after bleeding, wherefore we forbad it to all.” This may seem surprising, as we find bleeding so much recommended by Sydenham as a remedy; but by others it is equally reprobated; nay, Dr. Hodges tells us that he never knew but one who recovered from the disease after the use of it. Issues seem more likely, if not to prevent, at least to render the disease more mild if it should attack. They are recommended by Diemerbroeck, and Russel speaks of them as, “by some authors, represented as almost infallible.” He cannot, however, recommend them from his own experience, having never seen them opened for the purpose of preventing the plague; and he justly observes, that when habitual on any other account, they may perhaps lose their effect in this. “Multitudes (says he) of both sexes at Aleppo had issues in their arms, it being there a very common remedy in a variety of chronic disorders: but, notwithstanding those outlets, numbers perished; and I did not remark that those who had them were in any degree less liable than others to be infected.”

Tobacco has been recommended as an excellent preservative, particularly by Diemerbroeck, who writes with a kind of enthusiasm in its favour. “Being called (said he) to visit a patient afflicted with the plague, as soon as I entered his chamber I felt a most offensive smell of excrements (for he had a diarrhœa) with which I was greatly affected. Leaving the house after a very short visit, I instantly found myself seized with giddiness, nausea, and uneasiness at the heart; so that I had no doubt of my having caught the pestilential contagion. Laying aside all business, therefore, I immediately returned home, and smoked five or six pipes of the best tobacco; by the use of which all the above-mentioned symptoms so totally vanished, that I felt not the least uneasiness any more. Then, being again desirous to go abroad and visit other sick people, I took a drachm of theriaca, and from thence-forward was in perfect health. The same thing happened to me three or four times during the time of this pestilence; and without loss of time, according to the quantity of infection I supposed that I had taken in, I had recourse to the more plentiful use of tobacco, by which my health was restored. I always looked upon tobacco to be an excellent preventive remedy, and its smoke I have sometimes found useful to myself even in an incipient attack of the disease.131” He then proceeds to inform us of a report that in a violent plague at London all the dealers in tobacco were exempted. At Nimeguen, however, they were not so fortunate; yet of the family of the principal tobacco merchant (Thomas Peters, an Englishman) which was very large, none were infected, excepting only one servant maid, and she quickly recovered.

On this remedy Dr. Russel makes the same remark as on the issues. “The custom of smoking (says he), is universal among both men and women at Aleppo. This too, from its being habitually practised, might perhaps lose part of its prophylactic virtue: at the same time those who use it as a preservative must always be supposed in some degree accustomed to it, otherwise the violence of its operation on most persons, on their first beginning to smoke, might prove hurtful. It should further be observed, that the tobacco commonly used in Syria is much milder than the American, and that the oriental smokers seldom or never spit.”

It hath been observed that the plague is stopped either by great heat or great cold, but more readily by the former than the latter. “It has generally been supposed (says Dr. Canestrinus) that the cold of winter was destructive of contagious matter; but various instances of the contrary may be collected. The plague in Transylvania continued through the very severe frost in 1709. On the contrary it has been found, that excessive heat has extinguished, or at least diminished, pestilential diseases. During the plague at Aleppo the weather was unusually hot in the beginning of July, and it was remarked that the disease declined considerably; and in general Dr. Russel observed, that the plague ceased at the hottest season of the year. The plague at Ockzacow, which raged in the years 1738 and 1739, began in the month of April, and continued with violence till July, when it declined considerably, and entirely ceased in the month of September; in February of the year following it re-appeared, and totally ceased in July.”

From these facts we might be led to suppose that a warm regimen, or occasionally exposing the body to great heat, might be advantageously used by way of prevention; but Dr. Russel justly observes, that the human frame, “could it support such an application of fire and smoke as is necessary to expel or destroy contagion from infected substances, would probably receive little benefit from it, if infected; nor could those in health sustain, without prejudice, the heat and dense smoke which is probably required for the perfect extinction of the infectious effluvia floating in the confined atmosphere of a morbid body.” He is of opinion, however, that some kinds of fumigations may be of use, and he mentions some of these, but says that the perfumes ordered by the college are perhaps as proper as any, though their forms might be rendered more simple. Heat alone can scarce be thought very proper for prevention, and, when the disease is once begun, is said to be detrimental. Dr. Guthrie quotes Baron Ash saying, that “in heated rooms the disease is ungovernable: it is only in free air that it is to be treated.” But of late a discovery has been made of a surprising power in heated oil of removing this disease, insomuch that, if we can believe what has been published of it, we must suppose it to be little less than a specific. So great indeed has been the confidence put in this method, that, by order of the Academy of Sciences at Lisbon, it has been translated into Arabic, French and Portuguese.132 “The method was first proposed by George Baldwin esq. agent for his Britannic Majesty, and consul-general at Alexandria. He communicated his method to Lewis de Pavia, chaplain and agent to St. Anthony’s Hospital at Smyrna; who, after five years experience, pronounces it to be the most effectual remedy hitherto made use of in the hospital of which he has had the management for twenty-seven years. Immediately after a person is perceived to be infected with the plague, he must be taken into a close room; and, over a brazier of hot coals, with a clean sponge, dipped in warm olive oil, his body must be very briskly rubbed all over; for the purpose of producing a profuse sweat. During the friction, sugar and juniper berries must be burned in the fire, which raise a dense and hot smoke, that contributes to the effect. The friction ought not to be continued more than four minutes, and a pint of oil is enough to be used at each time. In general the first rubbing is attended by a very copious perspiration; but, should it fail of this effect, the operation may be repeated, first wiping the body with a warm, dry cloth; and, in order to promote perspiration still farther, the patient may take any warm sudorific drink, such as elder-flower water, tea, &c. It is not necessary to touch the eyes; and other tender parts of the body must be touched gently. Every possible precaution must be made use of to prevent the patient from taking cold, nor must the linen be changed till the perspiration has entirely subsided. The operation should be repeated once a day, until evident symptoms of recovery begin to appear. If there are already tumours on the body, they should be gently and more frequently rubbed, till they appear to be in a state of suppuration, when they may be dressed with the usual plasters. The operation ought to be begun on the first appearance of the symptoms of disease; if neglected till the nerves and the mass of blood are affected, or a diarrhœa has commenced, little hopes can be entertained of a cure; but still the patient should not be despaired of, as, by an assiduous application of the means proposed, some few have recovered, even after diarrhœa had commenced. During the first four or five days the patient must observe a very abstemious diet; the author allows only a small quantity of vermicelli, simply boiled in water. Nor must any thing be taken for thirty or forty days, except very light food, as, he says, an indigestion in any state of the disorder might be dangerous. He does not allow the use of wine till forty days. There is no instance of the person rubbing a patient having taken the infection. He should previously anoint himself all over with oil, and must avoid receiving the infected person’s breath into his mouth or nostrils. The precaution to be used in all circumstances is that of carefully anointing the body, and living upon light and easily digestible food. Mr. Baldwin observes, that among upwards of a million of people carried off by the plague in Upper and Lower Egypt, in the space of four years, he could not discover a single oilman, or dealer in oil.” Lisbon, July, 1797. By Royal Permission.

With regard to diet, and the use of spiritous liquors, opinions, as may well be imagined, have been very discordant. Allen quotes Diemerbroeck advising poor people to take two or three spoonfuls of the best white wine vinegar every morning, which he looked upon to be one of the best preservatives: he recommends also the frequent application to the nostrils of a spunge dipped in treacle vinegar. With regard to himself he says that his principal care was to avoid uneasy passions of the mind; and that when he found himself any way disturbed by these, he cheered his heart by three or four glasses of wine: his common drink was beer, and also white wine, small, or moderately strong, which sometimes he drank to cheerfulness, but never to drunkenness. Dr. Patrick Russel also says, that “a glass of generous wine, or any other cordial more agreeable to the choice, may be taken before dinner, in case of languor, or oppression at the stomach, from fatigue, fœtor, or apprehension. I found a rummer of old hock very agreeable on such occasions.” Allen goes on to inform us from Diemerbroeck, that, “as to diet, it is advisable in a pestilential disposition to use temperance, which very much contributes to the preservation of health; but all sudden changes are dangerous; wherefore it is most dangerous suddenly to alter the usual rule of diet. It is very ill in the plague to go abroad with an empty stomach: hog’s flesh is looked upon to be very pernicious: all sweet things are to be avoided: wine moderately made use of is good, but the abuse of it very dangerous.—Mercurialis testifies, that among the Patavians and Venetians, most of the tipplers died, who thought to drive out the plague with strong wines.” Mr. Howard informs us, that a person in high station at Constantinople, attributed his recovery entirely to the use of green tea, others to brandy. He also mentions a Mr. Hare, master of a merchant vessel at Senegal, who, during the prevalence of a malignant fever there, was very much exposed to the infection, and who out of humanity waited upon a negro, whom nobody would go near. He took no medicines, neither did he taste either spiritous or fermented liquors, and was the only European that entirely escaped the contagion.133

These accounts seem to evince that little or nothing is to be expected from a change of diet. This is an attempt to change the constitution of the body, and cannot be expected to succeed any more than bleeding. There is a certain quantity, and a certain species, both of food and drink, different in different persons, necessary to preserve health, and those who require both in larger quantity or better quality than others, are no more to be charged with intemperance than those who are supported by the smallest quantity of the coarsest fare. In times of danger, therefore, those who have been accustomed to spiritous liquors ought not to give them over; neither ought those to begin the use of them who have not used them before. From the account formerly given of the structure of the human body, it appears to be furnished with an apparatus for exhaling or throwing out a perspirable matter as well as for inhaling or taking in one equally subtile. How far the skin may be able to inhale or rather imbibe surrounding effluvia, may be doubted; but with the lungs there cannot be any doubt; and the effluvia taken into them must unquestionably affect the blood, and of consequence the vital principle, almost without any medium. To deprive the body of its due portion of nourishment therefore is to throw a temptation in its way (if I may use the expression) to absorb any thing; and the same effect must ensue from any other mode of debilitating it, either by intemperance, terror, or the like; and hence to visit infected places while under any such debility must be very imprudent. Dr. Russel agrees that it is a general and rational precept, never to go abroad fasting. For those who cannot easily bear fatigue without eating between breakfast and dinner, some light food may be proper, at an intermediate hour, in order to avoid going into the chambers of the sick with an empty stomach in the forenoon. “In such circumstances (says he) after a long and fatiguing morning, I have often found myself disagreeably affected in my latter visits, and have been sensible of slight giddiness, and of the appetite flagging at dinner, as if something lay on the stomach. I have known others much more strongly affected in this manner, and consequently much more alarmed. In such cases much no doubt may depend on the fancy; but in those times the power of the imagination requires management. So intimately is it connected with the accidental state of the body, that the same risk, from which a man shrinks in a state of languor and fatigue, he will encounter undauntedly after a temperate meal: the strange, unusual sensations, which amount almost to a persuasion of having caught the infection, will often, like the phantoms of a vision, vanish after a few glasses of wine.134 Whether any slight degree of real infection can be thus dissipated, I shall not take upon me to determine; it is sufficient for the present purpose to indicate the means of restraining those alarming sensations which, when aggravated by imagination, are apt to depress the spirits, and, according to the general opinion, to reduce the human body to that relaxed, inhaling state peculiarly susceptible of contagion.”

As to other modes of precaution, the Doctor advises that such as are about the sick “should guard the mouth and nostrils with vinegar, avoid drawing in the breath while close to the bed side, or swallowing their spittle while in the infected chamber. Before they approach the bed in order to examine the eruptions, the bed-clothes ought to be removed, to give time for the dispersion of a confined steam which immediately discovers itself to the senses; and it will be advisable to dip the hands in vinegar before examining the parts. On coming out of the chamber it will also be proper to rinse the mouth, and wash the hands, with vinegar, plain or camphorated.” He advises also to fumigate the clothes with nitre, sulphur, and juniper berries, burnt on a red-hot iron.

“Upon returning home it may be advisable to shift clothes immediately, hanging those taken off upon lines in a small chamber, to be again smoked, and afterwards aired. The mouth and hands ought once more to be well washed, and the hair might be fumigated with a little nitre and sulphur, by means of a pipe, so as not to incommode the lungs.”

One other mode of prevention, not of the disease, but of incurring danger from it, is inoculation. This is greatly recommended by Baron Ash above mentioned, and not only for the plague among the human species, but for that among cattle, which frequently destroys great numbers of those necessary animals. The case of Mathias Degio related p. 272, shows the practicability and the safety of it. The only solid objection that can be made to it is, that those who have once had the plague are not secure from having it a second time, or oftener. Yet, if we consider the extreme fatality of the disease when it attacks in the natural way, and that the number of those who have the plague only once is much greater than of those who relapse, this practice will certainly be found to merit consideration, and, unless some objection to it be discovered greater than any that has yet appeared, seems likely to be advantageous to the human race in general.

SECTION V.

Of the Cure of the Plague.

FROM what 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 fall upon 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 the tokens formerly mentioned appear, this kind only is here distinguished by the name of the fatal or 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 any probability of 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 only read of 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 decrying them 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 to me 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. The sick 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 treatment was 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 crassamentum was 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, brought forth 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 gangrene spread 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 of themselves 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.135 On 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 by the 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 of lime-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.136 Notwithstanding 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 insufficient to 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 inducements to conceal it, little can be said of remedies in 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 these almost always fell 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) a sweating draught, and being well covered with blankets plentiful 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, that by 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 certain periods 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 of divine) 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 are war and commerce. 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 destroy these 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.139 7. 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 the certain death of all in whom eruptions do not appear; a tendency to eruption being always observed 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;140 so 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.