As this Management is necessary with Respect to the Poor and meaner Sort of People; so the Rich, who have Conveniences, may, instead of being carried to Lazaretto’s, be obliged to go to their Country-Houses: provided that Care be always taken to keep the Sound separated from the Infected. And at the same Time all the Inhabitants who are yet well, should be permitted, nay encouraged to leave the Town, which, the thinner it is, will be the more healthy.
No manner of Compassion and Care should be wanting to the Diseased; to whom, when lodged in clean and airy Habitations, there would, with due Cautions, be no great Danger in giving Attendance. All Expences should be paid by the Publick, and no Charges ought to be thought great, which are counterbalanced with the saving a Nation from the greatest of Calamities. Nor does it seem to me at all unreasonable, that a Reward should be given to the Person, that makes the first Discovery of Infection in any Place: since it is undeniable, that the making known the Evil to those, who are provided with proper Methods against it, is the first and main Step towards the overcoming it.
Although the Methods taken in other Countries, as well as in our own, have generally been different from what we have here recommended; yet there are not wanting some Instances of extraordinary Success attending these Measures, whenever they have happened to be put in Practice.
The Magistrates of the City of Ferrara in Italy in the Year 1630, when all the Country round about them was infected with the Plague, observing the ill Success of the Conduct of their Neighbours, who, for Fear of losing their Commerce, did all they could to conceal the Disease, by keeping the Sick in their Houses, resolved, whenever occasion should require, to take a different Method. Accordingly, as soon as they received Information, that one had died in their City of the Pestilence, they immediately removed the whole Family he belonged to into a Lazaretto, where all, being seven in Number, likewise died. But though the Disease was thus malignant, it went no farther, being suppressed at once by this Method. Within the Space of a Year the same Case returned seven or eight Times, and this Management as often put a Stop to it. The Example of this City was afterwards followed more than once by some other Towns in the same Territory with so good Success, that it was thought expedient, for the common Good, to publish in the Memoirs of the People of Ferrara this Declaration: That the only Remedy against the Plague is to make the most early Discovery of it, that is possible, and thus to extinguish it in the very Beginning[80].
No less remarkable than this Occurrence at Ferrara, is what happened at Rome in the Plague, I have taken Notice of before, in the Year 1657. When the Disease had spread itself among both Rich and Poor, and raged in the most violent Manner; the Pope appointed Cardinal Gastaldi, to be Commissary General of Health, giving him for a Time the Power of the whole Sacred College, with full Commission to do whatever he should judge necessary. Hereupon he gave strict Orders, that no sick or suspected Persons should stay in their own Houses. The Sick he removed, upon the first Notice, to a Lazaretto in the Island of the Tyber; and all who were in the same Houses with them to other Hospitals just without the City, in order to be sent to the Island, if they should fall sick. At the same Time he took diligent Care to send away their Goods to an airy Place to be cleansed. He executed these Regulations with so much Strictness, that no Persons of the highest Quality were exempted from this Treatment; which occasioned at first great Complaints against the Cardinal for his Severity; but soon after he had general Thanks: for in two Months Time, by this means, he entirely cleared the City of the Pestilence, which had continued in it almost two Years. And it was particularly observed, that whereas before, when once the Disease had got into a House, it seldom ended without seizing the whole Family; in this Management scarce five out of an hundred of the sound Persons removed were infected[81].
I cannot but take Notice, that the Plague was stopp’d at Marseilles a full Fortnight by the same Measures, and probably might have been wholly extinguished, had not new Force been given it by the unseasonable Confidence of the Inhabitants upon this Intermission: which, we are informed, was so great, that they would not believe the Pestilence had been at all among them, and publickly upbraided the Physicians and Surgeons for frighting them causlesly[82]. At this Time, no doubt, they must have neglected the Cautions necessary for their Security so much, as to leave us no room to be surprized, that the Disease should after this break out again with too great Violence to be a second Time overcome.
But, besides these Examples in foreign Countries, we have one Instance of the same Nature nearer Home. When the Plague was last here in England, upon its first Entrance into Poole in Dorsetshire, the Magistrates immediately suppress’d it, by removing the Sick into Pest-Houses, without the Town, as is well remember’d there to this Time. A very remarkable Occurrence has greatly contributed towards preserving all the Circumstances of this Transaction in Memory. They found some Difficulty in procuring any one to attend upon the Sick after their Removal: which obliged the Town to engage a young Woman, then under Sentence of Death, in that Service, on a Promise to use their Interest for obtaining her Pardon. The young Woman escaped the Disease, but neglecting to solicite the Corporation for the Accomplishment of their Engagement with her, three or four Months after she was barbarously hanged by the Mayor upon a Quarrel between them.
I would have it here observed, that as the Advice I have been giving is founded upon this Principle, that the best Method for stopping Infection, is to separate the Healthy from the Diseased; so in small Towns and Villages, where it is practicable, if the Sound remove themselves into Barracks, or the like airy Habitations, it may probably be even more useful, than to remove the Sick. This Method has been found beneficial in France after all others have failed. But the Success of this proves the Method of Removing the Sick, where this other cannot be practised, to be the most proper of any.
When the sick Families are gone, all the Goods of the Houses, in which they were, should be buried deep under Ground. This I prefer to burning them: because, especially in a close Place, some infectious Particles may possibly be dispersed by the Smoak through the Neighbourhood; according to what Mercurialis relates, that the Plague in Venice was augmented by burning a large Quantity of infected Goods in the City[83]. A learned Physician of my Acquaintance lately communicated to me the Relation of a Case, (given to him by an Apothecary, who was at the Place when the Thing happened) very proper to be here mentioned. The Story is this. At Shipston, a little Town upon the River Stour in Worcestershire, a poor Vagabond was seen walking in the Streets with the Small-Pox upon him. The People frightened took Care to have him carried to a little House, seated upon a Hill, at some Distance from the Town, providing him with Necessaries. In a few Days the Man died. They ordered him to be buried deep in the Ground, and the House with his Cloaths to be burnt. The Wind, being pretty high, blew the Smoak upon the Houses on one Side of the Town: In that Part, a few Days after, eight Persons were seized with the Small-Pox. So dangerous is Heat in all Kinds of pestilential Distempers, and so diffusive of Contagion. And moreover the Houses themselves may likewise be demolished or pulled down, if that can conveniently be done; that is, if they are remote enough from others: otherwise it may suffice to have them thoroughly cleansed, and then plastered up. And after this, all possible Care ought still to be taken to remove whatever Causes are found to breed and promote Contagion. In order to this, the Overseers of the Poor (who might be assisted herein by other Officers) should visit the Dwellings of all the meaner Sort of the Inhabitants; and where they find them stifled up too close and nasty, should lessen their Number by sending some into better Lodgings, and should take Care, by all Manner of Provision and Encouragement, to make them more cleanly and sweet.
No good Work carries its own Reward with it so much as this kind of Charity: and therefore, be the Expence what it will, it must never be thought unreasonable. For nothing approaches so near to the first Original of the Plague, as Air pent up, loaded with Damps, and corrupted with the Filthiness, that proceeds from Animal Bodies.
Our common Prisons afford us an Instance of something like this, where very few escape what they call the Goal Fever, which is always attended with a Degree of Malignity in Proportion to the Closeness and Stench of the Place: and it would certainly very well become the Wisdom of the Government, as well with regard to the Health of the Town, as in Compassion to the Prisoners, to take Care, that all Houses of Confinement should be kept as airy and clean, as is consistent with the Use, to which they are designed.
The Black Assise at Oxford, held in the Castle there in the Year 1577, will never be forgot[84]; at which the Judges, Gentry, and almost all that were present, to the Number of three hundred, were killed by a poisonous Steam, thought by some to have broken forth from the Earth; but by a noble and great Philosopher[85] more justly supposed to have been brought by the Prisoners out of the Goal into Court; it being observed, that they alone were not injured by it.
At the same Time, that this Care is taken of Houses, the proper Officers should be strictly charged to see that the Streets be washed and kept clean from Filth, Carrion, and all manner of Nusances; which should be carried away in the Night Time: nor should the Laystalls be suffered to be too near the City. Beggers and idle Persons should be taken up, and such miserable Objects, as are neither fit for the common Hospitals, nor Work-Houses, should be provided for in an Hospital of Incurables.
Orders indeed of this Kind are necessary to be observed at all Times, especially in populous Cities; and therefore I am sorry to take Notice, that in these of London and Westminster there is no good Police established in these Respects: for want of which the Citizens and Gentry are every Day annoyed more ways than one.
If these early Precautions, we have mentioned, prove successful, there will be no need of any Methods for Correcting the Air, Purifying Houses, or of Rules for preserving particular Persons from Infection: to all which, if the Plague get head, so that the Sick are too many to be removed (as they will be when the Disease has raged for a considerable Time) Regard must be had.
As to the first: Fire has been almost universally recommended for this Purpose, both by the Ancients and Moderns; who have advised to make frequent and numerous Fires in the Towns infected. This Precept, I think, is almost entirely founded upon a Tradition, that Hippocrates put a stop to a Plague in Greece by this means. But it is to be observed, that there is no mention made of any Thing like it in the Works of Hippocrates. The best Authority we have for it, is the Testimony of Galen, though it is also mentioned by other Authors. Galen, recommending Theriaca against the Pestilence, has thought fit, it seems, to compare it to Fire; and, upon this Conceit, relates, that Hippocrates cured a Plague, which came from Æthiopia into Greece, by purifying the Air with Fires; into which were thrown sweet-scented Herbs, and Flowers, together with Ointments of the finest Flavour. It is remarkable, that among the Epistles ascribed to Hippocrates, which, though not genuine, yet are older than Galen, there is a Decree said to be made by the Athenians in Honour of this Father of Physicians, which, making mention of the Service he had done his Country in a Plague, says only, that he sent his Scholars into several Parts, with proper Instructions to cure the Disease. By which it should seem, that this Story of the Fires was hardly or not at all known at the Time, when these Letters were compiled. And Soranus may yet more confirm us, that it was framed long after the Death of Hippocrates: for Soranus only says in general, that Hippocrates foretold the coming of the Pestilence, and took care of the Cities of Greece; without any mention of having used this particular Expedient. Plutarch indeed speaks of a Practice like this as commonly approved among Physicians, which he makes use of to illustrate a certain Custom of the Egyptians: of whom he says, that they purify the Air by the Fumes of Resin and Myrrh, as Physicians correct the Foulness, and attenuate the Thickness thereof in Times of Pestilence, by burning Sweet-Woods, Juniper, Cypress[86] &c.
This I take to be the Sum of what can be learned from Antiquity in Relation to this Point; from whence we may see, that Writers have concluded a little too hastily for the use of common Fires in this Case, upon the Authority and Example of Hippocrates, though we should allow the Fact as related by Galen: when it will not from thence appear that Hippocrates himself relied upon them; since he thought it necessary to take in the Assistance of aromatic Fumes. But as this Fact is not grounded upon sufficient Authority, so it is needless to insist long upon it. The Passage I have brought from Plutarch will better explain what was the Sentiment of those Physicians who approved the Practice. It seems they expected from thence to dispel the Thickness and Foulness of the Air. And no doubt but such evil Dispositions of the Air, as proceed from Damps, Exhalations, and the like, may be corrected even by common Fires, and the Predisposition of it from these Causes to receive Infection sometimes removed. But I think this Method, if it be necessary, should be put in Practice before the coming of the Pestilence. For when the Distemper is actually begun, and rages, since it is known to spread and increased by the Heat of the Summer, and on the contrary checked by the Cold in Winter; undoubtedly, whatever increases that Heat, will so far add Force to the Disease: as Mercurialis takes notice, that Smiths, and all those who worked at the Fire were most severely used in the Plague at Venice in his Time[87]. Whether the Service Fires may do by correcting any other ill Qualities of the Air, will counterbalance the Inconvenience upon this Account, Experience only can determine: and the fatal Success of the Trials made here in the last Plague, is more than sufficient to discourage any farther Attempts of this Nature. For Fires being ordered in all the Streets for three Days together, there died in one Night following no less than four thousand (if we may believe Dr. Hodges:) whereas in any single Week before or after, never twice that Number were carried off[88]. And we find that upon making the same Experiment in the last Plague at Marseilles, the Contagion was every Day spread more and more thro’ the City with increas’d Rage and Violence[89].
What has been said of Fires, is likewise to be understood of Firing of Guns, which some have too rashly advised. The proper Correction of the Air would be to make it fresh and cool: Accordingly the Arabians[90], who were best acquainted with the Nature of Pestilences, advise People to keep themselves as airy as possible, and to chuse Dwellings exposed to the Wind, situate high, and refreshed with running Waters.
As for Houses, the first Care ought to be to keep them clean: for as Nastiness is a great Source of Infection, so Cleanliness is the greatest Preservative; which shews us the true Reason, why the Poor are most obnoxious to Contagious Diseases. It is remarked of the Persians, that though their Country is surrounded every Year with the Plague, they seldom or never suffer any Thing by it themselves: and it is likewise known, that they are the most cleanly People of any in the World, and that many among them make it a great Part of their Religion to remove Filthiness and Nusances of every Kind from all Places about their Cities and Dwellings[91].
Besides this, the Arabians advise the keeping Houses cool, as another Method of their Purification, and therefore, to answer this End more fully, they directed to strew them with cooling Herbs, as Roses, Violets, Water-Lilies, &c. and to be washed with Water and Vinegar: than all which, especially the last, nothing more proper can be proposed. I think it not improper likewise to fume Houses with Vinegar, either alone or together with Nitre, by throwing it upon a hot Iron or Tile; though this be directly contrary to what modern Authors mostly advise, which is to make Fumes with hot things, as Benzoin, Frankincense, Storax, &c. from which I see no reason to expect any Virtue to destroy the Matter of Infection, or to keep particular Places from a Disposition to receive it; which are the only things here to be aimed at. The Smoak of Sulphur, perhaps, as it abounds with an acid Spirit, which is found by Experience to be very penetrating, and to have a great Power to repress Fermentations, may promise some Service this way.
As hot Fumes appear to be generally useless, so the Steams of Poisonous Minerals ought to be reckoned dangerous: and therefore I cannot but dissuade the use of all Fumigations with Mercury or Arsenic. Much less would I advise, as some have done, the wearing Arsenic upon the Pit of the Stomach as an Amulet: since this Practice has been often attended with very ill Consequences, and is not grounded upon any good Authority, but probably derived from an Error in mistaking the Arabian Word Darsini, which signifies Cinnamon, for the Latin de Arsenico, as I have formerly shewn[92].
The next thing after the Purifying of Houses, is to consider by what Means particular Persons may best defend themselves against Contagion: for the certain doing of which, it would be necessary to put the Humours of the Body into such a State, as not to be alterable by the Matter of Infection. But since this is no more to be hoped for, than a Specific Preservative from the Small-Pox; the most that can be done, will be to keep the Body in such Order, that it may suffer as little as possible. The first Step towards which, is to maintain a good State of Health, in which we are always least liable to suffer by any external Injuries; and not to weaken the Body by Evacuations. The next is, to guard against all Dejection of Spirits, and immoderate Passions: for these we daily observe do expose Persons to the more common Contagion of the Small-Pox. These Ends will be best answered by living with Temperance upon a good generous Diet, and by avoiding Fastings, Watchings, extreme Weariness, &c. Another Defence is, to use whatever Means are proper to keep the Blood from Inflaming. This, if it does not secure from contracting Infection, will at least make the Effects of it less violent. The most proper Means for this, according to the Advice of the Arabian Physicians, is the repeated Use of acid Fruits, as Pomegranates, Sevil Oranges, Lemons, Tart Apples, &c. But above all, of Wine Vinegar in small Quantities, rendered grateful to the Stomach by the Infusion of some such Ingredients as Gentian Root, Galangal, Zedoary, Juniper Berries, &c. Which Medicines by correcting the Vinegar, and taking off some ill Effects it might otherwise have upon the Stomach, will be of good Use: but these, and all other hot aromatic Drugs, though much recommended by Authors, if used alone, are most likely to do hurt by over-heating the Blood.
I cannot but recommend likewise the Use of Issues. The properest Place for them I take to be the inside of the Thigh a little above the Knee. Besides, the smoaking Tobacco, much applauded by some, since it may be put in Practice without any great Inconvenience, need not, I think, be neglected.
But since none of these Methods promise any certain Protection; as leaving the Place infected is the surest Preservative, so the next to it is to avoid, as much as may be, the near Approach to the Sick, or to such as have but lately recovered. For the greater Security herein, it will be adviseable to avoid all Crouds of People. Nay, it should be the Care of the Magistrate to prohibit all unnecessary Assemblies: and likewise to oblige all, who get over the Disease, to confine themselves for some time, before they appear abroad.
The Advice to keep at a Distance from the Sick, is also to be understood of the Dead Bodies; which should be buried at as great a Distance from Dwelling-Houses, as may be; put deep in the Earth; and covered with the exactest Care; but not with Quick-Lime thrown in with them, as has been the Manner abroad: For I cannot but think that This, by Fermenting with the putrefying Humours of the Carcases, may give rise to noxious Exhalations from the Ground. They should likewise be carried out in the Night, while they are yet fresh and free from Putrefaction: Because a Carcase not yet beginning to corrupt, if kept from the Heat of the Day, hardly emits any kind of Steam or Vapour.
As for those, who must of necessity attend the Sick; some farther Directions should be added for their Use. These may be comprehended in two short Precepts. One is, not to swallow their Spittle while they are about the Sick, but rather to spit it out: The other, not so much as to draw in their Breath, when they are very near them. The reason for both these appears from what has been said above concerning the Manner, in which a sound Person receives the Infection. But in case it be too difficult constantly to comply with these Cautions, washing the Mouth frequently with Vinegar, and holding to the Nostrils a Sponge wet with the same, may in some measure supply their Place.
This is the Sum of what I think most likely to stop the Progress of the Disease in any Place, where it shall have got Admittance. If some few of these Rules refer more particularly to the City of London, with small Alteration they may be applied to any other Place. It now remains therefore only to lay down some Directions to hinder the Distemper’s spreading from Town to Town. The best Method for which, where it can be done, (for this is not practicable in very great Cities) is to cast up a Line about the Town infected, at a convenient Distance; and by placing a Guard, to hinder People’s passing from it without due Regulation, to other Towns: but not absolutely to forbid any to withdraw themselves, as was done in France, according to the usual Practice abroad; which is an unnecessary Severity, not to call it a Cruelty. I think it will be enough, if all, who desire to pass the Line, be permitted to do it, upon Condition they first perform Quarantaine for about twenty Days in Tents, or other more convenient Habitations. But the greatest care must be taken, that none pass without conforming themselves to this Order; both by keeping diligent Watch, and by punishing, with the utmost Severity, any that shall either have done so, or attempt it. And the better to discover such, it will be requisite to oblige all, who travel in any Part of the Country, under the same Penalties, to carry with them Certificates either of their coming from Places not infected, or of their passing the Line by Permission.
This I take to be a more effectual Method to keep the Infection from spreading, than the absolute refusing a Passage to People upon any Terms. For when Men are in such imminent Danger of their Lives where they are, many, no doubt, if not otherwise allowed to escape, will use Endeavours to do it secretly, let the Hazard be ever so great. And it can hardly be, but some will succeed in their Attempts; as we see it has often happen’d in France, notwithstanding all their Care. But one that gets off thus clandestinely, will be more likely to carry the Distemper with him, than twenty, nay a hundred, that go away under the preceding Restrictions: especially because the Infection of the Place, he flies from, will by this Management be rendered much more intense. For confining People, and shutting them up together in great Numbers, will make the Distemper rage with augmented Force, even to the increasing it beyond what can be easily imagined: as appears from the Account which the learned Gassendus[93] has given us of a memorable Plague, which happened at Digne in Provence, where he lived, in the Year 1629. This was so terrible, that in one Summer, out of ten thousand Inhabitants, it left but fifteen hundred, and of them all but five or six had gone through the Disease. And he assigns this, as the principal Cause of the great Destruction, that the Citizens were too closely confined, and not suffered so much as to go to their Country-Houses. Whereas in another Pestilence, which broke out in the same Place a Year and an half after, more Liberty being allowed, there did not die above one hundred Persons.
For these Reasons, I think, to allow People with proper Cautions to remove from an infected Place, is the best Means to suppress the Contagion, as well as the most humane Treatment of the present Sufferers: and, under these Limitations, the Method of investing Towns infected, which is certainly the most proper, that can be advised, to keep the Disease from spreading, will be no Inconvenience to the Places surrounded. On the contrary, it will rather be useful to them; since the Guard may establish such Regulations for the Safety of those, who shall bring Provisions, as shall remove the Fears, which might otherwise discourage them.
The securing against all Apprehensions of this Kind, is of so great Importance, that in Cities too large to be invested, as, for Example, this City of London, the Magistrates must use all possible Diligence to supply this Defect, not only by setting up Barriers without their City, but by making it in the most particular manner their Care to appoint such Orders to be observed at them, as they shall judge will be most satisfactory to the Country about.
Though Liberty ought to be given to the People, yet no sort of Goods must by any means be suffered to be carried over the Line, which are made of Materials retentive of Infection. For in the present Case, when Infection has seized any Part of a Country, much greater Care ought to be taken, that no Seeds of the Contagion be conveyed about, than when the Distemper is at a great Distance: because a Bale of Goods, which shall have imbibed the Contagious Aura when pack’d up in Turky, or any remote Parts, when unpack’d here, may chance to meet with so healthful a Temperament of our Air, that it shall not do much hurt. But when the Air of any one of our Towns shall be so corrupted, as to maintain and spread the Pestilence in it, there will be little Reason to believe, that the Air of the rest of the Country is in a much better State.
For the same Reason Quarantaines should more strictly be enjoined, when the Plague is in a bordering Kingdom, than when it is more remote.
The Advice here given with respect to Goods, is not only abundantly confirmed from the Proofs, I have given above, that Goods have a Power of spreading Contagion to distant Places; but might be farther illustrated by many Instances of ill Effects from the Neglect of this Caution in Times of the Plague. I shall mention two, which happen’d among us during the last Plague. I have had occasion already to observe, that the Plague was in Poole. It was carried to that Place by some Goods contained in a Pedlar’s Pack. The Plague was likewise at Eham in the Peak of Derbyshire, being brought thither by means of a Box sent from London to a Taylor in that Village, containing some Materials relating to his Trade. There being several Incidents in this latter Instance, that will not only serve to establish in particular the Precepts I have been giving, in relation to Goods, but likewise all the rest of the Directions, that have been set down, for stopping the Progress of the Plague from one Town to another; I shall finish this Chapter with a particular Relation of what passed in that Place. A Servant, who first opened the foresaid Box, complaining that the Goods were damp, was ordered to dry them at the Fire; but in doing it, was seized with the Plague, and died: the same Misfortune extended itself to all the rest of the Family, except the Taylor’s Wife, who alone survived. From hence the Distemper spread about and destroyed in that Village, and the rest of the Parish, though a small one, between two and three hundred Persons. But notwithstanding this so great Violence of the Disease, it was restrained from reaching beyond that Parish by the Care of the Rector; from whose Son, and another worthy Gentleman, I have the Relation. This Clergyman advised, that the Sick should be removed into Hutts or Barracks built upon the Common; and procuring by the Interest of the then Earl of Devonshire, that the People should be well furnished with Provisions, he took effectual Care, that no one should go out of the Parish: and by this means he protected his Neighbours from Infection with compleat Success.
I have now gone through the chief Branches of Preservation against the Plague, and shall conclude with some general Directions concerning the Cure.
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.