of the
Different Methods that have been used towards the Infected, as they are included in the Five Classes mentioned above.
aving finish’d the preceding Relation the Tenth of November, and applying to the Magistrates to procure Writers to copy a sufficient Number, to satisfie the Desires of all the Persons who have done us the Honour to consult us on this Subject, those Gentlemen replied, that by reason they could not get Transcribers enow, they would willingly take upon themselves the Care of having it printed; so that we have accepted their Offer, being persuaded that it is the shortest and most commodious Expedient to answer to all the Consultations that we receive from all Quarters on this Subject; but having reflected that this same Relation would be of no Use but to Persons of the Faculty who are instructed and experienced in the Knowledge and Cure of Diseases, we have thought proper to add here an Abstract of the different Methods which we have made use of in treating the different Kinds of diseased Persons contained in the five Classes mentioned above; presuming that they may be of Service to the young Physicians and Surgeons that are actually engaged in looking after infected Persons in divers Places of this Province. And we are the more readily determined to give this small Instruction to the Publick; since Mons. Lebret, first President of the Parliament, and Intendant of this Province, a Gentleman zealous for its Preservation, and very active in his Assistance in this time of Calamity, has done us the Honour frequently to ask of us an exact Account of the Treatment of this Malady.
The Method used in treating the Sick of the First Class.
If we afford but the least Attention to the Nature of the Symptoms related in the first Class, that is to say, to the small, unequal, and concentrated Pulse; to the Shiverings; to the universal Chilliness, especially in the extreme Parts, and to the almost continual Sickness at the Stomach; to those Lead-coloured, dismal and cadaverous Faces; it will be very easy to judge, that we have nothing to do in this Case, but to prescribe the most active and generous Cordials; such as are Venice Treacle, Diascordium, the Extract of Juniper Berries, the Lilium; the Confection of Hyacinth, of Alkermes; the Elixirs drawn from Substances that abound the most in a volatile Salt; the Treacle Waters, those of Juniper Berries of Carmes; the volatile Salts of Vipers, of Armoniack, of Hartshorn; the Balms the most spirituous; in one Word, all that is capable to animate, excite and strengthen; augmenting, doubling, and even tripling their ordinary Dose, according as the Case shall be more or less pressing.
All these Remedies, and others of the same Nature, are without doubt very proper to animate and raise the almost extinguished Strength of these poor sick Persons; nevertheless we have with Grief seen almost all of them perish on a sudden, which presently confirmed us in the Opinion generally received, that the Malignity of the pestilential Ferment is of a Force superior to all Remedies; but as we have also seen them succeed in some particular Cases, there is Room to presume, and one is but too much convinced of it by fatal Experience, that the Desertion and Inactivity of the greatest Part of the People who might have given Assistance, that the Want of Nourishment, of Remedies and Attendance, that the fatal Prejudice of being seized by an incurable Distemper, that the Despair of seeing ones self abandoned without any Relief, one is, I say, well convinced that all these Causes have not less contributed than the Violence of the Disease, to the sudden Destruction of so great a Number of the Sick, not only of this first Class, but also of the following; seeing that in Proportion as this mortal Fear of the Contagion is diminished, and that one is mutually assisted, that the Hopes and Courage of the People are returned; that, in one Word, the good Order is re-established in this City by the Authority, Firmness and Vigilance of the Chevalier de Langeron, by the great Care of the Governor, and by the constant and indefatigable Endeavours of the Sheriffs; one has beheld the Progress and Violence of this terrible Scourge to diminish insensibly, and we have been more successful in curing the infected.
Returning then to the Method proposed to treat the sick Persons of this First Class, supposing that by the Remedies mentioned, we were able to revive their dying Forces, and to disengage them from the sad Condition described above, it would remain to examine with Attention the new Changes and Accidents that would arise, which according to our Observations, may be reduced to some of those we have related under the following Classes, and ought by consequence to be treated by some of the Methods which we shall now deliver.
The Method used in treating the Sick of the Second Class.
The Treatment of the Sick of this Second Class has much more employed us than the preceding, in respect to the Multiplicity and Variety of Accidents that offer at the same time several Indications to satisfy.
All these Indications, however, may be reduced to two principal ones, which demand the greater Attention and Prudence, since they are opposite; for we have observed in the same Patient a strange mixture of Tension and Relaxation, of Shivering and Heat, of Agitation and Sinking; insomuch, that we were obliged constantly to endeavour at the expulsion of the noxious Ferments lodged in the primæ Viæ, or dispersed through the whole Mass of Blood, without exasperating them at the same time; or to correct and lessen their Action, without weakening the Patient. We ought, for Example, to vomit or purge without irritating or exhausting; to procure a free Perspiration or Sweating, without too much animating or inflaming; to fortify without augmenting the Heat contrary to Nature; lastly, to dilute and temperate without overcharging or relaxing. And this is what we have endeavoured to execute by the following Method.
Suppose that we were called at the Beginning, and before the Patient was exhausted, we should order immediately a Medicine proper to cleanse the Stomach, that is to say, a gentle Vomit, such as is the Ipecacuanha, in a Dose proportioned to the Age and Temperature of the sick Person, to be taken in a little Broth or common Water; we have seldom used the Emetick Tartar or Vinum Benedictum, for fear of too great Irritations, unless we had to do with very robust and plethorick Bodies, or that some particular Accident seemed to demand them; we promoted the Operation of the Medicine by a large quantity of warm Water, or of Tea, or a Decoction of Carduus Benedictus.
The Effect of this first Medicine being commonly a lessening of the Strength, we endeavoured to fortify, by some gentle Cordial, especially by Venice Treacle and Diascordium, by reason they are proper to prevent or stop an over-working of the Vomit.
To these two Remedies succeed moderate and diluting Catharticks, to cleanse away without irritating the Load of gross Humours which may hinder the Action of the other Medicines, or prevent their free Passage into the Vessels: These Purges are laxative Ptisans, made with Sena and Crystal Mineral, ordered in Phials; the Decoction of Tamarinds, or vulnary Infusions, wherein are dissolved Manna and Sal Prunel; the Diluta-Cassiæ; Syrupus de Chichorco cum Rhab.; to which then succeed the Cordials and gentle Alexipharmacks, for the Reasons given above; that is to say, to fortify, and to stop the Over-purgings, which would infallibly cause some fatal Weakness: And supposing that the Venice Treacle and Diascordium were insufficient to answer this last Indication, we would add sealed Earth, Coral, Bole-Armoniack, which we would render still more efficacious in Cases of Necessity, by the mixture of some Drops of liquid Laudanum, which has been of service in many Cases, not only in stopping the immoderate Evacuations, but even in the want of Sleep, phrenetick Deliria, Hemorrhages, and other Symptoms of the same sort.
The Solar Powder of Hamburgh, the Mineral Kermes, and other Remedies that have been communicated to us with great Commendations, have been also used, both as Emeticks and Catharticks; and have sometimes with success, answered both those Indications: And at the same time, in some certain Cases, we observed they promoted Sweat and Perspiration; but as we have already remarked, they have always seemed to us insufficient to perform the Work of a radical Cure, in a Distemper characterised by divers essential Symptoms.
For what relates to Sudorificks, as soon as we perceive the least Disposition to a free Transpiration or Sweating, in what time soever of the Sickness it happens, we have taken care to make use of them, and that the rather, by reason some infected Persons have escaped by this Method: Nor are we ignorant how this sort of Crisis is recommended as very Salutary by all the Authors that have wrote of the Plague: We have had therefore Recourse to some of the Cordials mentioned above, and particularly the Venice Treacle and Diascordium; to which may be added the Powder of Vipers, Diaphoretick Antimony, Oriental Saffron, Camphire, &c. promoting the Effect of these Medicines by the repeated Draughts of Tea, the vulnerary Infusions of Switzerland, the Waters of Scabious, Carduus Benedictus, Juniper Berries, of Scordium, Rue, Angelica, and others, recommended for pushing from the Center to the Circumference; that is to say, to depurate the Mass of Humours by the way of insensible Perspiration without too much Emotion; observing always, that the Patients are not of a too dry and hot Constitution, or that in forwarding too much this Sort of Crisis, they do not fall into some fatal Weakness.
The great Heats and intolerable Thirst are allayed by a plentiful and repeated drinking of Water, wherein Bread has been macerated, Ptisan of Barley, of Rice, Chicken-Broth, dissolving therein Sal Prunel, or purified Nitre, mixing by intervals a few Drops of Spirit of Sulphur, or of Nitre dulcified, or of Vitriol; as also the Confections of Alkermes, Syrup of Lemons, de Ovo, or any other gentle Cordial, to prevent an Over-charge and Relaxation.
All these Remedies properly made use of, and managed with Prudence, are sufficient to satisfy the divers Indications of this second Class, provided the terrible Prejudice of the Impossibility of a Cure, the Consternation, and the Despair, do not suspend their Action: And we could, if the Time would permit, give several Instances of such, as being supported by their Hopes, Courage, and Firmness, have experienced the good and wholsome Effects thereof: So that Nature being thereby strengthened, comforted, and freed in part, of the noxious Ferment that oppressed her; and above all, being delivered from the Danger of the internal Inflammations, by the means of the external Eruptions, I mean the Carbuncles, Buboes, Parotides, &c. there remains nothing to be done, but to treat methodically these sorts of Tumours, to which we have particularly applied our selves from the beginning of the Distemper to the end; and that with the greater Diligence, by reason, as we have already remarked, the Destiny of the Patient depended almost always on the Success of these sorts of Eruptions, the manner of treating which, we shall give by and by, according their several Varieties.
The Method used in treating the Sick of the Third Class.
It would be altogether needless to enter into the particulars of the Method we used in treating the Patients of this third Class, since the Symptoms they were attack’d with, were the same with those which we have mention’d in the two preceeding Classes; so that they succeeded mutually each other, and the Symptoms related in the second Class, were the Forerunners of those described in the first; whence it is easy to judge that we have here nothing to do but to use successively the Medicines mentioned before. The Observation that we thought fit to insert between the third and fourth Class, and in which it is shown, that several infected Persons perished in a very short Time with Symptoms very moderate, or much less violent than what we generally observe the same Symptoms to be in malignant or common putrid Fevers. This Observation, I say, may instruct us, that this Sort of infected Persons in whom often there only appear a small Weakness, and a very great Consternation, demands as much Care as those in whom the Symptoms are more considerable, and on the least Appearance of their being seized, there ought immediately to be used, besides generous Remedies, every Thing that is proper to sustain their Strength and encourage them.
The Method of treating the Sick of the Fourth Class.
We have nothing here to do, but to cast our Eyes back, on what we have said above, relating to the Accidents that characterise and terminate the Plague, in order to judge that this Method should principally turn on the Manner of treating the Buboes or Carbuncles. The Symptoms, it is true, that appear at the Beginning in the Diseased of this Class, are nearly the same with those that show themselves in the sick Persons of the second Class; so we immediately employ’d the Remedies proper to oppose them, such as are the gentle Emeticks, the diluting Catharticks and Sudorificks of the same sort, according to the Indications that arise, observing however a very exact Regimen. But the Destiny of the Infected, depending principally, as we have remarked already, on the large Emption, and laudable Suppuration of the Buboes and Carbuncles, these Sorts of Tumours have been always the Objects of our chief Care and Attention. And since these Tumours have constantly appeared in the Sick of this fourth Class, and in those of the preceeding, the Method which we are going to propose for their Management, ought to be consider’d, as common to all the Classes.
The Method used in the Treatment of Buboes.
These Tumours were ordinarily situated in the Groin, and often below it, chiefly swelling the lymphatick Glands, placed near the crural Vessels; they appeared also pretty frequently under the Arm-pits, particularly under the pectoral Muscle, as also in the Glands behind and below the Ears, in the Jugular, and under the Chin.
The Buboes with which the Sick of the former Classes were attack’d, often appeared at the Beginning of the Distemper, chiefly in the Groin and Arm-pits, small at first, deep and exceeding painful, that one could scarce touch or handle them, without causing a very uneasy Sensation; these for the most Part made no other Alteration in the Skin, but by swelling it, as they grew bigger, towards the End they became indolent.
In what Time soever of the Distemper these Sorts of Tumours appeared, we attacked them without any Delay, unless there was Reason to presume from other Symptoms that the sick Person was at the Point of Death.
If the Tumour was small, deep, painful, and one had Time to endeavour to mollify it, we began with the Application of emollient and anodyne Cataplasms, and as the Misery and Desertion would not suffer us to have Recourse to choice Drogues, we prepared on the Spot, and applied warm, a Sort of Pultice composed of Crums of Bread, common Water, Oil of Olives, Yolk of an Egg, or a large Onion roasted in the Ashes, which we first hollowed, and filled with Treacle, Soap, Oil of Scorpions or of Olives; using moreover, for Persons of Condition, Cataplasms made with Milk, the Crummy Part of Bread, Yolks of Eggs; or with the Mucilage of emollient Herbs and Roots.
But as the Diseased of the first Classes perish often very suddenly, even at the Time when we apprehend such an Accident the least, we think it not adviseable in this Case to prescribe such Sort of Applications; but we ought immediately to prevent the last Danger, by endeavouring at the opening of the Tumour, and to that End we caused to be applied without Delay, all over the Part a Dressing with the caustick Stone, leaving it there for some Hours, more or less, according to the Depth, Situation, Bulk of the Parts, and the Constitution fat or lean of the Patient; the Escarr being made, it must be opened by Incision, without any Delay, in order to examine the tumified Glands, to dissolve which, there ought to be apply’d Digestives, after they have been a little scarified; or they should be extirpated if they are moveable, and can be removed without an Hemorrhage, which according to our Observations has been always fatal tho’ but moderate. And for this Reason we have thought fit to reject the Method of extirpating these Tumours, which was made use of before we came to this City. The Way of opening them immediately by a Lancet, altho’ more ready than that by Cauteries, appears to us in many Cases insufficient, and less sure, as giving but little Light to view the Part, and leaving very often after it, Abscesses, Fistula’s or Scirrhous Tumours. As to Cupping, Glasses and Blisters, their Effects seem to us slow, useless, and that of the Latter sometimes dangerous; in certain Subjects their Application has been followed by internal Inflamations, especially in the Bladder.
Returning then to our Caustick Stone, the Escarr being formed, and the Incisions made with the Precaution of discovering the tumified Glands, in their whole extent, that no bad Reliques be left behind; the next Thing is to dissolve the Glands by the means of good Digestives, which may be made of equal Parts of Balsom of Arcæus, Ointment of Marsh-Mallows, of Basilicon, adding thereto Turpentine and Oil of St. John’s Wort, which ought to be well mixed, and if there is any remarkable Corruption in the Part, there ought to be joyned with the Turpentine and Oil of St. John’s Wort, the Tinctures of Myrrh, of Aloes, Spirit of Wine camphorated and Sal Armoniack; lastly deterging and cleansing away the Pus and Sanies, whilst it is thick and too corrosive, with Lotions made of Barley Water, Honey of Roses, Camphire; or with vulneraine Decoctions of Scordium, Wormwood, Centaury the less, and Birthwort. And when the Ulcer has been well deterged, and the tumified Glands entirely consumed by Suppuration, there remains nothing but to apply a simple Plaister to bring the Wound to a Cicatrice.
We shall now give in few Words, the Method we used in the Cure of Carbuncles, which in many Circumstances have a near Relation to the preceeding.
The Method used in the treating Carbuncles.
We have observed these sort of Tumours during the whole Course of the Sickness, in a very great number of diseased Persons in all the Classes, though less frequent than the Buboes; remarking also very often in the same Subjects, these two sorts of Emptions.
The Carbuncles present themselves in different Places on the Surface of the Body, especially in the Thighs, Legs, Arms, Breast, Back, but very rarely in the Face, Neck, or Belly.
They appear at first under the Form of a Pustle or Tumour, which is whitish, yellowish, or reddish, Pale in its middle, or inclining to an obscure Red, which becomes insensibly blackish, crustaceous, especially about the Edges; as also variegated with divers Colours; so that, according to that which is predominant, and the Excess or Defect of Sensibility and Elevation, we may give it the Name of a Phlegmonick, Erysipelatous, or gangrened Carbuncle.
We immediately attack all these sorts of Carbuncles by Scarification, making the Incision to the Right and to the Left, in the Middle, and on the Edges, to the Quick; and if the Escarr is Thick and Callous, we take away all the Thickness, and what is Callous, as much as the Situation of the Parts will permit.
We have not thought proper to use here the actual or potential Cauteries which are employed in our Province, in the case of common Carbuncles, because, having made Trial of them at the Beginning, we observed that they caused Inflammations so considerable, that a Gangrene presently ensued, and its Edges became Callous again: The Caustick Stone succeeded not but in small Carbuncles, which heal of themselves, almost without any Help.
After having scarified these Tumours, we applied Pledgets with good Digestives, as in the Case of Buboes, only with this Difference, that we have left out the suppurating Ingredients, using only the Treacle, Balsam of Arcæus, and Oil of Turpentine; and if there is much Corruption, we add the Tinctures of Aloes, of Myrrh and Camphire, &c.
We put over the Pledgets, emollient and anodine, or spirituous and dissolving Cataplasms, as over the Buboes, according to the diversity of Indications. In the Course of the Dressings, the Lotions and Injections are also employed the same as for the Buboes, according to the Exigence of the Case. And, if in the Process of Suppuration, the new Flesh be so sensible, that the Digestives applied cause a very great Pain, as we have seen it often happen, then we substitute in their room Pledgets with Unguentum Nutritum, with very good Success.
The Method relating to the Sick of the Fifth Class.
We believe it will be useless to give every particular of the Method that has been followed, and which is still actually used in the Cure of the diseased of the Fifth Class, wherewith the Hospitals are filled; because they being afflicted with no other Symptom besides the Buboes and Carbuncles ill looked after, or neglected, and by consequence, nothing here offers it self but the Abscesses, Ulcers, Fistula’s, Scirrhus’s, and Callus’s, which Negligence, or an ill Treatment have left behind them; so that there is here nothing farther required, but to put in Use the Method laid down above, or to employ the Means practised in the like Cases, according to the Rules of Art.
We shall remark, in concluding, that all the Methods we have here proposed, are not so general, or constant, as to be without Exceptions, in respect to certain particular Cases, which have fallen under our Observation during this terrible Sickness, and which may furnish Materials for a more exact Account. But what we have already delivered may be sufficient to instruct the young Physicians and Surgeons, that are employed in attending Infected Persons; and at the same time, to let the Publick know what Opinion ought to be had of all those singular Methods, and of those pretended Specificks so cried up by the Populace, and by the Empericks.
F I N I S.
Transcriber’s Notes:
Long “s” has been modernized.