All the facts mentioned in the notes are taken from old journals or letters written at the times they happened.
It is the common opinion of the inhabitants of Aleppo, that they are visited with the plague about once in ten years, and that it is brought thither from some neighbouring city, where it first makes its appearance, as Antab, Urfa, &c. to the northward, or Damascus to the southward; from which last place it is generally alledged that the worst plagues have been brought; though some assert that those which have come from the northward have raged with the greatest violence.
With respect to the intervals between the returns of the plague, though that of 1742 is an exception, yet the common opinion seems in some measure to be founded on experience[493]. And it seems a fact pretty well attested, that it never rages at Aleppo without having first visited some of the above mentioned places; though the first appearance of all is, from what I have been able to learn, always in some town on the coast of Syria[494]. If it first shews itself in Sidon, Byroot, or Tripoly, Damascus is usually the channel through which it comes to Aleppo; but if in Scanderoon or Byass, then it commonly passes by way of Antab, Killis, Urfa, &c.
During the winter this disease is constantly moderate; as the spring advances it grows more violent, it comes to its height in June, decreases greatly in July, and certainly disappears in August; and this seems to be the constant course of the plague at Aleppo: so that none are ever seized with it in the months of September and October, even in such extraordinary instances as when it has made its appearance for three years successively, as it did in 1742, 1743, and 1744[495].
A considerable difference is observable, both as to the mortality and number of the infected, in different years; but it does not appear that it has ever raged in this country with the violence that it has often done in Europe.
Extreme heat seems to check the progress of the distemper; for though, during the few first hot days, the mortality, as well as the number of those newly infected, encreased, yet a few days longer continuance of that weather greatly diminished the number of the sick. Add to this, that the season wherein it always ceases at Aleppo, is that in which the heats are the most excessive.
Though the natives, as well as several authors, have a notion that the moon has some influence over this distemper, yet experience no ways favoured this opinion in the late plague at Aleppo.
Having the distemper once, does not prevent a second seizure, numbers of people being alive when I left Aleppo, who have had it twice or oftener; and I have even seen instances of the same person’s having had the disease three several times in the same season.
It is no wonder that the very name of plague among us should strike terror whenever it is mentioned; for, besides the numerous and terrible distresses of the whole body of the people during the rage of a pestilence, and the scenes of death and misery which are continually before our eyes, the distemper itself is the most lamentable to which mankind are liable. The torments of heat, thirst, and pain, frequently unite in some patients; an unspeakable languor and dejection in others; the loathsome remains of the distemper in the painful and putrid ulcers, even in those who escape; the desertion of friends and attendants; the want of common necessaries, and medical assistance, are all of them circumstances which aggravate the miseries of the sick, and contribute not a little towards augmenting the general horror.
And as there is no disease incident to mankind that is in its nature more terrible and destructive, so there is none more difficult to describe. Its symptoms are scarcely in all respects alike in any two persons; nay, they even vary extremely in an hour in the same subject. The disease begins often with the most flattering appearances, and ends fatally in a few hours. Some complain of a pain at their heart, are seized with a vomiting and giddiness, and die in a few minutes; while the most alarming attacks sometimes end speedily in health and security.
In general, however, a coldness or shivering, with sickness, vomiting large quantities of porraceous bile, often of a very offensive smell, pain in the back or loins, an intense headach, uncommon giddiness, and a sudden loss of strength, were the first complaints of those who were seized with this distemper; and these were usually attended with great uneasiness or anxiety about the pit of the stomach, and a sharp, shooting pain darting into the parotid, axillary, or inguinal glands.
These symptoms were soon succeeded by a violent fever; in which, while the patients complained of extreme inward heat, their skin felt but little hotter than usual. Sometimes this heat soon became general and intense, at other times particular parts only were affected therewith; and it seldom continued many hours together alike, but remitted and returned with considerable, but unequal force several times in a day. The face, in these exacerbations, became florid, and was often changed from a deep scarlet to a livid colour, resembling that of a person almost strangled. These appearances again would suddenly give place to a cadaverous paleness. The eyes soon lost their lustre, and acquired a kind of muddiness; and the countenance of the greatest part of the sick was ghastly, and confused beyond description.
The pulse, at the first seizure, was very little different from its natural state, only somewhat more quick and low. In a few hours it commonly encreased in quickness and strength; but these seldom continued in the same way an hour together, nay, scarce many minutes, but varied without any manifest correspondence with the other febrile symptoms, both as to strength and quickness, incessantly.
In those who complained of pains, either darting into the parotids, the armpits, or groins, a small, painful, hard, deep-seated tumor was discovered by the touch in the part, without any manifest discoloration of the skin. Such were the first beginnings of the pestilential buboes.
This was the common appearance of the distemper the first day of the disease; and those who had the most favourable escape were often attacked at first with as alarming symptoms as those who died in a few hours; for sometimes this febrile paroxysm dissolved in a few hours, and left the patient indeed languid, and weakened to an extreme degree, but free from other complaints, except the pain of the tumor above mentioned; which in many encreased from this time, both in size, tension, and pain, during about twelve or fifteen days, when it commonly suppurated, the patient, all the time, the first day excepted, walking about as usual.
But though many thus escaped, yet several who were seized in this manner, especially in the month of March 1743, suddenly dropped down dead, or at least lived but a few hours; the headach, vomiting, and pain about the præcordia, encreasing every moment to such a degree as to occasion immediate death, or fatal convulsions. Few of those who died in this manner had any appearance of such indurated tumors, though generally the armpits, groins, or internal parts of the arms and thighs, were livid or black, and the whole body was covered with confluent petechiæ, interspersed with livid pustules, especially after death.
Those who survived the first attack of the distemper, which was by much the greatest part of the sick, in the evening had a very considerable encrease of every symptom. The heat became excessive, both internally and externally; and as the sick were by this time for the most part delirious, it was often with difficulty they could be kept within doors. They were disposed to talk a great deal, but faultered so much in their speech as scarcely to be understood; the tongue having also shared in the debility that was evident in every other part of the body.
In this state they continued during most part of the night; towards morning the violence of the heat, inquietude, and delirium, abated; a manifest remission succeeded; some recovered their senses entirely, some in great part, and then complained much of intense headach, or pain of the buboes, which last would often increase suddenly, and decrease as quickly, in the space of a few hours. About one half of the sick about this time had an additional complaint of a painful pustule, like an angry, confluent pock, surrounded by a circle of a deep scarlet tinge, which soon became livid, and was attended with an intense burning pain; from which circumstance, as well as from its fiery aspect, it has probably obtained the name of carbuncle.
These pustules broke out indiscriminately on all parts of the body, and increased from the size of a large pock to the extent of an inch and a half diameter, sometimes, though rarely, to three inches.
The remission of the feverish symptoms was commonly but of very short continuance, the rigors, anxiety, and delirium soon returning with greater violence, with a frequent and strong subsultus tendinum. These symptoms, however, did not proceed with a regular increase during the day; but the rigors and heats coming and going by turns, formed short, but alarming intermissions, each paroxysm surpassing the former either in violence or duration; till, in the evening, the pulse was scarcely to be counted by reason of its depression and quickness. The patient grew comatose, with a quick, laborious, and interrupted respiration.
The buboes, which some hours before seemed manifestly to increase, now often subsided, and almost disappeared, and the livid circle about the carbuncle became black, resembling a large eschar made by a caustic; and livid or black spots, of different dimensions, about this time often appeared dispersed over the whole body.
Under these circumstances, dreadful as they seemed, some hope of recovery still remained; for though many died on the third day, yet several had a favourable crisis by a profuse sweat: some struggled under these difficulties to the fifth day, a few to the seventh, and here and there one even to the eleventh, before any critical alteration appeared.
If the disease was not wholly carried off by a copious sweat on the third day, it was always considerably abated, and was in general totally removed by a second, though less profuse one, by the fifth; so that no symptoms of the disease were then left, weakness excepted, and the pain proceeding from the buboes and carbuncles. And it may here be remarked, that all who were attacked had buboes; though, even in many that recovered, they discussed without any manner of bad consequences: but the carbuncles did not appear on above one half of the sick, and often begun to digest before the critical sweat happened.
It is evident, from the account already given, that nothing could be more difficult than to form a judgment about the event of this disease, or be more just than what Morellus[496] observes on a similar occasion. This author, after reciting several circumstances proving the irregularity of its type, concludes, “That, in respect to the plague, even our senses and reason deceive us, the aphorisms of Hippocrates are erroneous; and Hippocrates himself, was he present, would likewise be mistaken.”
The tongue was in some quite moist, and in all respects like that of a person in health through the whole course of the distemper; in others it was at first white, but soon became yellow, black, and covered with a dry, rough scurf or fur. Some had no thirst at all, and could scarcely be prevailed upon to take liquids in sufficient quantities. But the generality of the sick were extremely thirsty, and drank with great eagerness whatever they had given them, especially at particular times; for the intenseness of their thirst had irregular intervals, and did not continue alike through the progress of the distemper, nor often correspond with the violence of the fever.
In most patients the vomiting ceased after the first few hours, excepting when they overloaded their stomachs during this excess of thirst; at which times the vomiting returned.
The urine was as little to be depended on as a sign as any other circumstance, being scarce alike at the same time of the disease in any two persons; and its appearance varied no less in the same patient every day. In general, however, it was somewhat of a deeper yellow than usual in a person in health, and without sediment.
Some had a diarrhœa during all the time, others were costive; in most the discharges were natural. The distemper, however, seemed never to admit of a critical solution by either stool or urine. Some few had hæmorrhages from the nose or uterus: and if these happened after the second day, a plentiful sweat, which was most commonly critical, soon followed; a circumstance different from what usually has happened in the plague at other places.
In the years 1742 and 1743, the buboes often appeared as soon as the patients were taken ill, in some not till twelve hours after, and in a few not till after two or three days: but, in 1744, some perceived the buboes a day or two before they had any other symptom of the disease. And during all the time the plague raged at Aleppo, none of the sick were without them, except such who died suddenly. In general, the sick had but one, and they were more common in the axillary or inguinal glands than in the parotids. Some few had even two or three, which were not confined to one side of the body. Their first appearance, as hath been mentioned, was like a small indurated gland; deeply seated; in some they were fixed but more frequently moveable, and most commonly painful to the touch. They would often, increase considerably in a few hours with intense pain, and would as suddenly subside; and these changes would frequently succeed each other several times in twenty-four hours. Sometimes an exacerbation immediately following the decrease of the bubo, would prompt one to imagine this decrease to have been the cause; but this was not so constantly the case as to induce me to think it was so in reality.
The buboes, so far as I could learn, never advanced towards a regular maturation, till a critical sweat had carried off the fever. In ten, twelve, or fifteen days from the first attack, they commonly suppurated with the usual attendants of heat and pain. Sometimes, nay frequently, I have known them to disappear soon after the critical sweat, and discuss without any detriment to the patient. At other times, when grown pretty large, about the height of the disease, they sunk, and mortified without being attended with fatal consequences: for as soon as the crisis was compleat, the mortification stopped, and the eschar separated gradually, leaving a large deep ulcer, which healed without difficulty by the usual methods.
The inguinal buboes were seldom single, there being generally two, and in the same groin. The superior was the largest, of a long figure, somewhat resembling a cucumber, lying obliquely, but lower than where the venereal buboes appear, and it was this which commonly came to suppuration. Once I met with a case where an axillary bubo divided into two; one part getting under the pectoral muscle, the other sinking deeper into the armpit: both of them grew painful and inflamed; but that in the armpit only suppurated.
I met with no instance of a bubo not followed or preceded by the fever.
In respect to the carbuncles, it has already been observed, that they broke out on all parts of the body, the muscular and tendinous especially. From the size of a silver penny they often spread themselves speedily to the extent of an inch and half, two inches, nay sometimes three inches, diameter, frequently penetrating deep into the substance of the parts they attacked. Their most common time of appearing was on the second day of the disease. Their progress was very quick, and not above one half of the sick had them. In such as died, I was told, (for I saw none of those cases myself) that from the pustule issued a quantity of ichorous matter; but the black circle remained hard and dry; in the others the mortification usually stopped on the third day, and in a day or two more digested, and began to separate round the edges. The separation of the whole eschar was completed rather sooner than in such as are made by a caustic.
A few of the sick had pustules, which were filled with well-concocted matter, without any livid or discoloured circle about them: these, after a certain time, dried up, and fell off, as it commonly happens in the distinct small-pox; and as all the patients who had this eruption recovered, it was considered as a favourable symptom.
To enumerate all the various changes that happened, with the sudden and unexpected transitions from extreme danger to great safety, would be tedious, and little instructive. Such, however, were the general outlines of the distemper, and the most usual symptoms; which though they by no means furnish one with the necessary helps to form a certain prognostic, yet some hints may from thence be deduced for establishing a rational, and perhaps a successful practice.
Upon considering, however, the several circumstances attending this fatal distemper, the various shapes it assumes, the sudden transitions from one appearance to another, the precipitate advances to its height, and the danger which the physician incurs in visiting the sick, the wonder ceases, that we meet with in authors so various and contradictory accounts of the proper methods for treating it. Some plead for evacuations, others decry them with vehemence: if we allow, that difference of climates, different constitutions of the air in the same climate, and perhaps some variety even in the plague itself, might lead practitioners to judge not always alike concerning it; yet it is not so easy to reconcile the jarring opinions of those who have practised at the same time, and in the same place, in respect to this essential part of management: and as in a disease, wherein reason is often perplexed, and experience itself fallacious, one would chuse to rely much on proper authority, it is greatly to be lamented, that nature has not been more, and opinion less, attended to. As the plague has so often visited that country, one might reasonably have expected among the natives some vestiges of unbiassed observation, and attempts at least towards a proper method of cure; but, so far as I have hitherto been able to discover, no traces of any thing satisfactory are to be met with among them. The Turks have less faith in medicine for the cure of this disease than of any other, believing it to be a curse inflicted by God Almighty for the sins of the people; and as the chief of those who practise physic are either Christians or Jews, and not so strongly prepossessed with the doctrine of predestination, consequently afraid of catching the distemper, they rather endeavour to confirm the Turks in their false notions, lest they should be forced to visit the sick. Hence it follows, that the greatest part of those who are seized with the plague, either are left to struggle with the violence of the disorder without any assistance, or must submit to the direction of the meanest and most ignorant of mankind. The practice which seems to prevail most generally amongst them, is to bleed all who apply to them, and in every stage of the disease; after which they endeavour to promote sweat by a few grains of bezoar, in the simple distilled water of scorzonera; which is the medicine they chiefly confide in, such is the slender acquaintance they have yet acquired in the materia medica.
From the most impartial and attentive observation I could make, it seemed to me, that very plentiful bleeding at the first appearance of the disease was of great service; but after the first day was always prejudicial.
Vomiting was also of the utmost consequence at the beginning: warm water was commonly sufficient to procure it, as the sick had generally a propensity to this discharge. If a stimulus was required, a small dose of ipecacuanha or sal vitrioli was all that was necessary for most patients.
Though purging with the violent cathartics is justly condemned; yet an emollient glyster, or even a gentle laxative with manna and crem. tartar. when the patient was costive, and the head much affected, was not only safe, but often of great service; and, when the symptoms were not violent, I have frequently given a gentle purge of infus. sennæ, mann. & crem. tartar. the second day of the disease with success. It may appear strange; but it is a fact confirmed to me by many instances, that a purgative of this kind, given after the critical sweat, was the most effectual means to bring the buboes to suppuration.
The natural crisis of the disease was always by sweat; and, when the same evacuation could be procured by art, it was also of service; but there were two great inconveniences attending attempts of this kind on the first day. One was, that the common medicines in the usual doses for this purpose, if they failed of procuring the desired diaphoresis, threw the patient into a flame, and greatly augmented all the symptoms: the other inconvenience was, that though we succeeded in raising a sweat, it was requisite to continue it a much longer time than most of the people in that country could be persuaded to endure; and, if checked, it was of bad consequence, either increasing all the symptoms, or, what was often the case, bringing on a diarrhœa; which though at first it seemed to relieve, yet generally proved fatal in the end.
The cordial and diaphoretic medicines found to be most efficacious were, Rad. contrayerv. Valerian. sylvest. Croc. Anglic. Pulv. contrayerv. comp. Pharm. Edin. and Theriac. Androm. or Diascord. when a diarrhœa attended. Anodynes also greatly assisted the other medicines in their operations; but those of the gentler kind, as syr. diacod. seemed to agree better with the sick than opium.
I made an attempt to try the effects of the cortex in this distemper; but a popular clamour being raised against that medicine, I thought it most prudent to desist, as I was convinced that my youth, and the short time I had then resided in the place, would render any efforts I could make to get the better of it ineffectual. No fair trial was made of the rad. serpentar. Virgin. because few of the natives would take it on account of its bitterness: for whoever would obtain a ready compliance with his orders in that country, must as seldom as possible offend their palates with unpleasant remedies; because whatever may be the consequence to themselves, they will often chuse to incur distant, though great risks, rather than submit to present inconveniences. Small doses repeated every four hours, was the most effectual method of giving these medicines, and plenty of diluent liquors, acidulated with spirit of vitriol, not only assisted in promoting a diaphoresis, but was of the utmost consequence in moderating the fever, which the cordials and diaphoretics were otherwise apt to increase.
Nitrous medicines in this disease neither were attended with their usual success in allaying heat, nor could the sick in general bear the common doses without a sensible increase of languor and dejection, or danger of bringing on a diarrhœa.
The following method of treating the sick I found the most successful upon repeated trials.
As soon as the patient was seized, from 10 to 20 ounces of blood, according to the present condition of the sick, or violence of the symptoms, were ordered to be taken from the arm. Seldom more than a pound however was taken from any; that being a quantity greatly exceeding what they usually lose at once in any disease.
After bleeding, if the nausea was considerable, they were ordered to drink plentifully of warm water, (which was presently brought up again, and with it a quantity of bile), and this operation to be repeated several times. If the nausea was not sufficient, which was but seldom the case, a small dose of rad. ipecacuan. or sal. vitriol. was given to promote the vomiting. It appeared from experience of such consequence that those evacuations should be made early, that most of my acquaintance had previous directions to set about them immediately, in case any person should be infected in their family.
A gentle anodyne was given after vomiting, or, if that did not settle their stomachs, Riverius’s saline draught, with an ounce of diacodium, or 15 drops of laudanum.
These evacuations being premised, small doses of the cordial and diaphoretic medicines, above mentioned, joined with a very small proportion of nitr. stibiat. were given every four hours; and the sick were encouraged to drink liberally of a decoction of scorzonera roots and barley, or even of spring water, but always tepid, if they could be persuaded to drink it so, and acidulated with as much sp. vitrioli, as to make it agreeable. A certain proportion of this spirit, with syrup of violets, made it more grateful both to the eye and the palate, and was no small inducement to them to drink the necessary quantity.
In the winter, the sick were ordered to be removed into a larger and more airy room, than they were accustomed to sleep in at that season; and the air to be both warmed and corrected by a moderate fire. In the summer, all the doors and windows were allowed to be opened, excepting that which was immediately opposite to the patient’s bed; and many of them would not even bear that restriction, but would have all open in the day time, and often in the night lay upon the house top. Their covering was the same as in health.
A moderate cordial of some of the simple waters, with a little Tinct. croci, Tinct. Valerian, sylv. Confect. alkerm. well acidulated with sp. vitrioli, and commonly sweetened with syrup of white poppies, was allowed them when faint or uneasy, and they expressed great satisfaction upon taking this mixture. For children, this alone, with plenty of acidulated liquors, was what I chiefly used, and with good success.
When the sick could be persuaded to submit to the above regimen, a sweat often broke out the second or beginning of the third day, when they were covered up, and the sweat was encouraged so long as they could bear it.
Whether it proceeded from the carelessness of the attendants, in giving way to the impatience of the sick, and so not encouraging the sweat so long as it ought to have been, or from the nature of the disease, I know not, but certain it is, that this first sweat, particularly if it happened on the second day, though it greatly relieved the patient, yet did not entirely carry off the fever. A continuance of the same medicines, in somewhat larger doses, generally enabled nature to throw off every subsequent exacerbation by a plentiful sweat, till a compleat crisis was obtained.
When the sweat was sufficient, and had greatly mitigated the symptoms, notwithstanding some degree of fever still remained, a mild cathartic was given the next morning, the other medicines were continued during its operation, and an anodyne was ordered early in the evening.
When an encrease of the symptoms seemed to be the consequence of a sudden sinking of the buboes, which sometimes happened on the second or third day, a blister applied just below the bubo was of service.
Upon the first appearance of a coma, or debility in the tongue, a blister was applied to the head, and to the other usual parts, as necessity required. Some patients, who had been deemed past recovery, having struggled through the disease, and apparently by the use of blisters, at length brought them into credit, and induced the natives to submit, with less reluctance, to a practice which they would otherwise have abhorred. Stimulating cataplasms of one part garlic, and two parts crum of bread, with the addition of a little vinegar, applied to the soles of the feet, were of great service in this case; and if the patient was costive, emollient laxative glysters were injected. The dose of the alexipharmics was encreased, and diluting acidulated liquors given often in small quantities.
Suppurating cataplasms were sometimes applied to the buboes, but as they were kept on with difficulty, the Empl. Diachyl. cum Gum. was more generally used; and when a stimulus was required, a few cantharides, or a little euphorbium was added. In most of the sick, they were left to open of themselves, on account of the dread the natives have of the lancet or caustic, and the want sometimes of proper persons to apply them: and indeed, by what I observed, none suffered from the long delay in opening them, farther than the usual inconveniences attending other tumors thus left to themselves; and they never required any method different from the common to heal them.
When the buboes mortified, they were treated as the carbuncles; and though, upon the separation of the mortified parts, the ulcers were often large and deep, yet they healed very soon.
Sometimes the carbuncles were scarified, but oftener not: the dressings that agreed best with them, were Ung. Basilic. Flav. with a small proportion of Ol. Terebinthinæ, and sometimes Tinct. Myrrh. applying over all an emollient cataplasm; and after the indurated black parts were separated, they soon healed, without any particular accidents.
Next to the protection of Divine Providence, the means that the Europeans at Aleppo depend upon for their preservation during the time of the plague, are either retiring from the city, or shutting up at home, in such a manner as effectually to prevent all communication with either persons or goods capable of conveying the infection. The first method was formerly the common practice of the English, when the nature of their business was such as allowed them to retire early in the season, and their number so considerable, that they encamped upon the Bylan mountains, without any danger from the Curds[497]: so that, by keeping the person employed to go to the village to market at a proper distance, and using the necessary precautions in receiving provisions, &c. if the plague should be there, they were quite secure, and had at the same time an opportunity of amusing themselves by riding, shooting, and other country-recreations, and enjoying the cool air and verdure among those mountains; a pleasure at other times surpassing most others in that warm climate, though now barely sufficient to allay the melancholy reflexions so natural on this occasion. At present, however, as the nature of their business is such as prevents their retiring early, their number small, and the Curds more troublesome than heretofore, so that they cannot well encamp upon the mountains, a retirement from the place is attended with considerable inconveniences; for it is next to impossible, when the season is advanced, but one or other of the servants who must unavoidably be hired to carry baggage, &c. on the road, (for all sorts of necessaries must be carried along with one in this country, even provisions and bedding) either has the distemper in his own family, or at best has daily intercourse with numbers in that condition. And though, by carrying tents, the danger of sleeping in an infected village may be avoided; yet it may nevertheless happen to be at the very place where the retirement has been intended, it being, I believe, very rare that it rages at Aleppo without likewise affecting most other places within a few days journey round it, and full as rare that the people will confess its being amongst them.
Shutting up at home is attended with none of these inconveniences, and, when conducted in the proper manner, its salutary effects are found by experience to be such, that persons in this situation remain without danger in the middle of a city where the plague rages with the greatest violence; a circumstance so evident, that all the Christians and Jews who can afford it follow the example of the Franks in this respect. And though the Turks cannot, on account of their religion, do it avowedly[498]; yet such of them as have been any ways conversant with the Europeans, and are not mere bigots, either keep at home, on pretence of being indisposed, or retire to some garden for change of air, if their affairs will not admit of their going abroad to some distant place, where they imagine the disease does not reach. A journey to Mecca, on pretence of devotion, is their most common expedient.
It having been mentioned, that the Europeans are not so subject to the epidemic diseases of that country as the natives, it is necessary to inform the reader, that experience confirms their being liable to the plague, some of them having generally been infected when the distemper raged in the place, either before they shut up, or after they came abroad. It may also be proper to add, that their servants, who are natives, and are a much greater number than the Europeans, enjoy the same benefit from shutting up.
While the number of the sick is inconsiderable, as is commonly the case during the winter, the Europeans content themselves with using the following precautions, viz. to have no more intercourse with the natives than what they are necessarily obliged to by their business; to keep their servants at home, if possible, which however is not easily accomplished; not to make use of a common barber, if it can be avoided; and to carefully enquire concerning the health of those who wash their linen, chusing for that office such as are not employed by the natives. This does not however prevent their visiting each other, and enjoying their usual recreations abroad in the country.
During this time it is usual for the natives to make use of all the arguments in their power to persuade the Europeans, that either the whole of the reports concerning the distemper are false, or, when this cannot be accomplished, that the little which had appeared is now quite over; which last pretence, however untrue, or indeed vain to hope for, many are willing to be deceived by, till either some European, their dependants, or others under their immediate inspection, being infected, causes a general consternation, and occasions their shutting up with all expedition. Such of the Franks as act with the most prudence not only use the precautions already mentioned, but also make the proper dispositions for shutting up, so as to be ready to do it upon the first visible increase of the distemper, which they look upon as unavoidable in the spring, and lay their account with being confined till July. The progress of the disease is so quick, that the difference between such as shut up early, and those that brave it out to the last, is seldom more than a few days.
As it would be disagreeable for a single person to be confined by himself, they generally divide into small parties, and shut up in such houses as are most spacious and convenient. It is an advantage to be in one that has no communication, by way of the terrace, with any other; for though when the distemper is not frequent, going over the house-top to visit such other of their friends as are also shut up, is sometimes practised, yet, when the plague rages much, it is reckoned safest not to trust to any one, lest they should be guilty of irregularities; and when such communications are open, it is impossible to be sure of keeping the servants in order. Provision is made, as has been already mentioned, for a confinement till July; for, after the doors are once shut, nothing is admitted but letters, and what is absolutely necessary for the table, and these too with the precautions which shall be mentioned. One thing, though it may seem trifling, conduces not a little to their ease, and that is, to have one person that can shave; for a long beard is extremely disagreeable in hot weather. Cats, being great ramblers, are looked upon as dangerous animals at such times; and therefore the Europeans either confine theirs at home, or send them to be taken care of by some of their dependants, in a distant part of the city; and no quarter is shewn to any strange cats that shall happen to be seen within their bounds, but such are immediately shot, and thrown into the street by the help of a pair of tongs.
This disposition being made, and the distemper so far advanced that it is thought imprudent to go abroad any longer, the street-door is locked, and, for the greater security, sealed up; and, if there are any windows, or passages of any kind below stairs, through which the servants might possibly receive any thing from without, they are secured also; even the small hole cut in the door through which the water, for the service of the family is conveyed, has a lock and key, so that it is never opened, but when the Sacka (or water-carrier) comes, and then usually one of the Europeans attends; for these water-carriers, being of the same race with the servants, are the most likely to bring them such things as they may desire. A window above stairs is next allotted, through which the necessary provisions, &c. are to be received; and such an one is usually chose as looks into the most private part of the Khane, or street, to avoid drawing together a concourse of idle passengers, which the novelty of the sight would naturally do: but the more this window is exposed to the eyes of the family within, the better it is for preventing irregularities from servants. The necessary apparatus for this window, consists of a rope, which, with the addition of a few yards of an iron chain, and a hook to the lower end, reaches within two or three feet of the ground; an iron or copper pail, which is hung on the hook of the chain, and let down for conveying things to or from a person below, whom they hire on purpose, and is all day in waiting to bring the necessary provisions, carry messages, &c. A quantity of vinegar, a pail of water, a long reed split at one end for conveying letters, and some brimstone to smoke them with, as also a pair of tongs for taking out the provisions. Meat, poultry (which last must be well picked) and every thing else that will allow of it, is dipped in water, mixed with a small proportion of vinegar, and hung up some little time before it is touched. Bread, which will admit of nothing of that nature, is exposed to the air for some hours before it is handled; and letters or other papers, are sprinkled with vinegar and smoked with sulphur; for which purpose, if it was a more general practice to have a box so contrived, as to impregnate the papers more throughly with the fumes of that mineral, it might perhaps be more safe. Some few, in place of sulphur, smoke their letters with the following, which is what is commonly used in the Lazaretto at Malta[499].
The impatience under confinement, with the melancholy occasion of it, the apprehension that some of the company may have received the infection, though it may not as yet have appeared, the singing before the corps in the day, and the shrieking of the women for the dead, both day and night, all contribute to make the first week’s confinement very disagreeable. Custom, however, soon renders those things so familiar, as to lose much of their force; and the company falling into various ways of amusing themselves, in a very little time, though they cannot help feeling for the unhappy sufferers, yet the only uneasiness most people express, on their own account, is from a want of liberty to go abroad; this want, they endeavour to supply by an evening’s walk upon the house-top, from whence as many of the European houses are but at a small distance from each other, they enjoy the conversation of some of their friends, though too far off for secrecy.
Though the shutting up of the Europeans and many Christians, as also the retirement of some Turks, as has been already mentioned, in a great measure puts a stop to trade while the distemper rages violently, yet the markets are all open, and as great plenty of provisions, and every thing else to be had as at any other time: the streets too, though not so much crouded, yet are still pretty full of people; the generality of the Turks visit the sick, and attend their funerals, in the same manner as at other times; and though the Christians and Jews do not, except on very emergent occasions, visit their sick friends, and very few besides a priest, and those who carry the bier, attend the funerals, yet there is no want of servants and relations, to do the necessary offices about the sick, the same as if it was any common distemper.
As soon as the number of the sick begins to decline, the same causes that prevented some from shutting up early, together with a natural desire that all have for liberty, generally induces several to get abroad too soon. The difference between the first and the last, in opening as in shutting up, seldom exceeds a few days; and yet this, however, makes a very considerable one in the risk, for both the increase and decrease of the distemper, are very sudden.
The first step upon opening, is usually to ride abroad; and though it is at a season wherein there is not the least verdure, except in the gardens, yet, after so long a confinement, the sight of the open country affords no small pleasure. Care is taken, while the gentlemen are abroad, to prevent the servants in the family from having intercourse with any body; and, after the doors are opened, the same precautions are used for a week or two, as before shutting up.
The above precautions, are all that the Europeans commonly practise; but by myself, and such of the natives, who being obliged to be amongst the sick, asked my advice, the following rules were observed, which, though nothing new, I have taken the liberty to insert; as they have hitherto proved successful, and many of them may be useful to the Europeans, while their business obliges them to go abroad: to this, however, it is but justice to add, that the trials were not many, and that there were some few persons who were equally in the way of the disease, without being infected, though they used no precautions at all. The rules laid down were these:
Never to go abroad in the morning fasting.
To avoid, as much as possible, all excesses, violent passions, or large evacuations, but not to live more abstemiously, either with regard to eating or drinking, than usual: perhaps one or two glasses of good wine more than customary, might rather be beneficial than otherwise; and a plentiful use of acid liquors, such as a very weak sour punch in the summer, is not only agreeable but useful.
While in the sick person’s chamber, passing a corpse, or near any thing infected, not to swallow the saliva, and to breathe, in the natural way through a handkerchief or spunge, wetted either with plain vinegar, or such as had rue infused in it.
When examining the pulse, and other circumstances that require being very nigh the sick, to hold the breath as much as possible, and, as soon as retired from the chamber, to wash the mouth, face, and hands with vinegar.
Upon returning home, to put on other cloaths, and expose such as had been wore to the air; perhaps it might also be of service to smoke them with sulphur, but this was not practised. At such times also, it is proper once more to wash the mouth, face, and hands with vinegar.
As to medicine, a large dose of the extract of the bark, with a draught of wine and water, well acidulated with elixir of vitriol, taken twice a day, were all that were used. For such as can take the bark in a liquid form, a strong decoction of it may answer the purpose as effectually.
A Cutaneous disease, thought by some to be peculiar to this place, has acquired the name of Il mal d’Aleppo, or Aleppo evil, among the Europeans. The natives call it Habt il senne, or Botch of a year, from the supposed time of its duration. In Turkish, Haleb Choban, or the Aleppo ulcer. This disease is not, however, peculiar to this place, being almost as common at Antab, and all the other villages on the banks of the rivers Sejour and Coick, as at this place; which favours the opinion of its being occasioned by the water.
The natives reckon but two species of this disorder, and distinguish them by the names of male and female; but there is a third kind of cutaneous distemper, which, though it is commonly ascribed to the bite or sting of a common millepedes, or wood-louse, seems to me to be altogether of the same nature, though milder in degree.
What they call the male distemper, makes its appearance in the form of a small, red, hard tubercle or pimple, which commonly passes some weeks unregarded, as it gives no manner of uneasiness: afterwards it begins to encrease, and usually comes to the size of an English sixpence, which, after some months, begins to be scurfy on the top; by degrees the little matter that oozes out of it, forms into a thick crusty scab; which, unless it is picked off, or otherwise disturbed, remains upon it till the parts underneath being healed, it falls off, and leaves but a very small mark. The whole of its duration is seldom above eight months.
What is called the female species begins like the former; but after a month or two it becomes somewhat painful, encreases often to double the extent of the male, discharges a good deal of the ichorous matter from under the scab, and by degrees comes to have the appearance of an indigested scorbutic ulcer, with a livid circle round it; but seems to be no deeper than the tunica cellulosa. In this condition it remains for several months, and is in general about a year from its first appearance before it is cured: but this is not a thing certain, many getting well some months sooner, while others remain several months longer. After it is cicatrised, it leaves an ugly scar, which remains thro’ life, and for many months has a livid colour. When they are not irritated, they seldom give much pain.
The third kind of Mal, which they call the pinch of a millepedes, begins like the two others, but seldom grows larger than about twice the size of a large pin’s head, and never changes its appearance, remaining a small tubercle for many months, without any pain, after which, it usually throws off a few scurfy scales and disappears; but some remain a much longer time.
It affects the natives when they are children, and generally appears in the face, though they also have some on their extremities; for most of them have two, three, or sometimes more, it being rare that they have but one. In strangers, it commonly appears some months after their arrival; and they have them not so frequently on the face as the natives: very few escape having them, but they seldom affect the same person above once; dogs and cats are as subject to the disease as men; it commonly breaks out upon the nose of these creatures.
In respect to the cure, like the tooth-ach, or ague with us, every one pretends to an infallible remedy for them; but the many beautiful faces, daily impaired by the disease, are too evident proofs of their ill success: and in truth, from what I have observed, it is infinitely better to apply nothing, than any of the numberless medicines they make use of.
Of several applications that I made trial of upon myself and some others, I found the mercurial plaister the most efficacious; the prescription was the same as the Emplastrum commune cum mercurio, with a smaller proportion of mercury, and a little larger of Bals. sulphur.
If this was applied at the beginning, it often prevented their making any farther progress; if they had begun to run, it hindered them from increasing so much as they would otherwise have done, and generally cured them before their usual time. This is to be understood of that called the female; for the male, as well as the third kind, seldom require any medicinal application.
The reader, it is hoped, is now no longer a stranger to most of the particulars relating to Aleppo; but I cannot conclude these sheets, without rendering justice to their natural patrons, the gentlemen of the British factory there, who still maintain that excellent character, for which they have been long celebrated, of mitigating the inconveniences that necessarily attend their residence in that city, by the perfect harmony in which they live, and improving every circumstance of advantage by the same social quality, of which, having been so long witness, and in which being so much a partaker, I make no doubt, the public will receive with candor, this testimony which gratitude requires.