4. What are the seasons in which the plague chiefly appears; and what is the interval between the infection and the disease?
Raymond: The plague shows itself at all seasons, but less at the two solstices.——Demollins: Great ravages may be made in all seasons, but principally in the greatest heats of summer. From the infection to the disease is two or three days.——Giovanelli: The plague appears at all times, in the same manner as poisons at all times produce their effects. But observations show that its ravages are greater in hot seasons than in cold; and it seems that summer and the first months of autumn are most to be dreaded. There is no certainty as to the interval between the infection and the disease, as it depends on the particular constitution of the patient.——They: Warm, moist seasons contribute to the production of all infectious diseases. The interval from the infection to the seizure is various, according to the virulence of the poison, and the constitution of the patient. Sometimes it acts slowly, sometimes like a stroke of lightning.——Verdoni: The spring is the principal season. Generally the disease shows itself at the instant of touch, like an electrical shock. Sometimes a person retains the contagious principle without any sensible effect, and then unknowingly communicates it to a third, in whom, if predisposed to the disease, it becomes active; or, otherwise, it may be communicated to others successively in the same way, till it becomes dissipated and annihilated, as happened at Smyrna in 1783. In bodies predisposed it very rarely conceals itself till the third day.——Jew physician: Answered in the first.——Fra Luigi: The plague is most fatal in Smyrna from April to July; and it is constantly observed that great colds and heats much diminish it, and copious dews extinguish it. The infection shows itself in 24 hours, more or less, according to the difference of temperament.
5. What are the first symptoms of plague? Are they not frequently a swelling in the glands of the groin and armpit?
Raymond: The plague often conceals itself under the form of an inflammatory, ardent or malignant fever. Tumours of the glands are often its first symptom.——Demollins: The first symptoms of the plague vary; but the most common are, buboes in the armpit and groin; parotids and carbuncles in various parts of the body.——Giovanelli: The first symptoms are, debility, fever, excessive thirst, followed by great heat; after which carbuncles or buboes appear in the armpits, groin and parotids. The groin is sooner attacked than the armpit.——They: Swellings in the armpits and groin are indeed the characteristics of the plague; yet they are not the sole nor the first symptoms, and often are not seen at all; as when the plague disguises itself under the form of other diseases.——Morandi: Glandular swellings are properly the symptom of the second stage, and are preceded by those febrile symptoms which are immediately the consequence of receiving the infection; such as pain in the head, drowsiness, great prostration of strength, dryness of the tongue, vomiting, hiccough, tremor, diarrhœa.——Verdoni: Its first symptoms are relative to the constitution of the year, and of the body seized, and the place where it was produced, or whence it came. In 1783 all the parts of Natolia were infected; and the disease transported to Smyrna, which is the centre, was extinguished without the loss of a single person. Generally the plague of Constantinople, transported to Smyrna, does little harm. That of Egypt causes havock, as in every country. That of the Thebais is always cruel, and, carried to Lower Egypt, is fatal. The inguinal glands are most generally affected.——Jew physician: The swelling of the glands is seldom the first symptom. Patients are every day seen who, being supposed ill of another disorder, in two, three or more days show glandular swellings, or carbuncles, by which the plague is manifested. On the contrary, many, who from the usual signs are supposed to have the plague, become well in a day or two, without any external swelling. The first symptoms are, horripilation, or actual shivering, nausea or vomiting, loss of strength, and fever. These are common to many diseases; but the pathognomic signs are, a difference in the pulsations of the two sides, with this circumstance, that from the diversity a prognostic arises; it having been observed that if the pulse on the side of the tumour or carbuncle be greater or more frequent, it bodes well; whereas, if it be smaller, it shows greater malignity, and more is to be feared. Further, there is observed among the first symptoms a visible pulsation in the carotids, greatest on the affected side; and also a crystalline vivacity in the eyes, with a kind of contraction or diminution of the eye on the affected side.——Fra. Luigi: The most remarkable symptoms of the plague are, turbidness and sparkling of the eyes, the tongue furred with a white mucus, and very red at its tip, frequent biting of the lips, violent pain in the head, and inability to hold it up; a sense of great cold in the loins, vomiting, debility. Swellings of the glands are not among the first symptoms.
6. Is it true that there are two distinct fevers with nearly the same symptoms, one of which is properly termed the plague, and is communicated from a distance by the air, and without contact; while the other, which is properly termed contagion, is only communicated by the touch, or at least by near approach to infected persons or things?
Morandi: It is certain, from multiplied observations, that there are two sorts of pestilential fevers, similar in appearance; one of which proceeds from the contamination of the air alone, and is communicable to any distance; the other is produced alone by contact, or near approach. The former of these is properly termed a pestilential fever, the latter a contagious one.——Verdoni: The distinction of these fevers is useless; since the same which is communicated by the touch, is that also conveyed by the air to a certain distance, especially in a close place.——Jew physician: That there are two kinds of plague is absolutely to be denied; yet sometimes it happens that persons are attacked with the plague without knowing from whence it came.——Fra. Luigi: I hold it for certain that there is only one species of plague, though differing in malignity.
7. What is the method of treatment in the first stage; what in the more advanced periods? What is known concerning bark, snakeroot, opium, wine, pure air, the application of cold water?
Raymond: The disease is treated as inflammatory. No specific has been discovered for it.——Demollins: At the beginning, bleeding, vomiting, purgatives, diluents, refrigerants and antiseptics are used; afterwards antiseptics and cordials, relatively to the temperament and symptoms——Giovanelli: The plague causing always a disposition to inflammation and putrefaction, it is always proper to bleed proportionally to the strength, and to use a cooling regimen, with the vegetable acids. The repeated use of emetics is also proper, both to clean the first passages, and to dispose the virus to pass off by the skin. In the progress it is necessary to favour the evacuation of the virus by that issue which nature seems to point at. Thus either antiphlogistic purgatives are given, if nature points that way, or suppurative plasters are to be applied to any tumours which may appear. Epispastics to the extremities are proper where nature wants rousing. The vitriolic acid in large doses has been found very serviceable in the plague at Moscow, attended with carbuncles. When the inflammation is over, and marks of suppuration appear, the bark, with wine and other cordials, is proper. The surgeon’s assistance is proper in the treatment of boils and anthraces, which last are seldom cured without the actual cautery.——They: In the beginning of pestilential fevers bleeding is sometimes proper, and vomits almost always. In their progress frequent subacid and cold drinks, the bark given liberally, and vitriolic acid, have been found powerful remedies when there was a dissolution of the blood——Morandi: In the first period, evacuations, according to the particular circumstances of the case, are proper: in the second, bark mixed with wine, and opium as a temporary sedative. Pure air is very necessary; and fire as a corrective, with the burning of antiseptic and aromatic substances.——Verdoni: As soon as a Christian finds he has got the plague, he eats caviare, garlic and pork; drinks brandy, vinegar and the like, to raise the buboes. Upon these he applies greasy wool, caviare, honey of roses, dried figs, &c. to bring them to suppuration. The Turks and Arabs drink bezoar in powder with milk, and other sudorifics, in order to expel the virus. They vomit, and possibly a second time. At Cairo they take opium, and cover themselves with mattresses in order to excite sweat; and, though parched with heat and thirst, they drink nothing. They open the immature buboes with a red hot iron. At Constantinople and Smyrna they eat nothing, and drink much water and lemonade. The Jews drink a decoction of citron seeds, lemon or Seville orange peel, and their own urine. They abstain scrupulously from animal food. In 1700 a physician in Smyrna found bleeding very useful. Another, in another year, cured the plague by bleeding, and an antiphlogistic regimen. My brother in Cairo treated it like a biliary fever, with vomits, saponaceous attenuants, and antiphlogistics; and successfully. Some sailors at Constantinople in the frenzy of the plague have thrown themselves into the sea; and it is said that on being taken out of it they have recovered. My opinion upon the whole is, that the treatment ought to be relative to the constitution of the year, and of the patient, by which the nature of the disease itself is greatly altered.——Jew physician: Bleeding in many cases may be serviceable, as I have known patients, who were bled by mistake, recover; and others recovered from a most desperate condition by a spontaneous hemorrhage. On the other hand, persons have been apparently injured by both these circumstances. The difference of effect seems to depend on the state of the blood, whether it be disposed to coagulation or dissolution. In the former, bleeding is useful, in the latter, hurtful. Vomits, according to my experience, have not succeeded; yet I should not hesitate to try ipecacuanha in substance, exhibiting half a scruple at two or three times, in the expectation that in this manner it would not run down. Bark may be useful in dissolutions of the blood; and also small doses of opium, and other medicines prudently administered. In excessive watchfulness I have known relief procured by anointing the temples with ung. populeon. In a case of hiccough the liquor anod. miner. Hoffmanni succeeded with one. The Turks, in the violence of the fever, take handfuls of snow, and apply it all over their bodies, and also eat it; and sometimes throw cold water on their feet. But whether this is of service or not cannot be determined; as these people in other respects pay no regard to rules of diet.——Fra. Luigi: They who practise empirically in the plague use none of the recited methods, but only strong sudorifics, and ventilation of the air; and complete the cure by proper treatment of the sores by suppuration.
8. When the plague prevails, do the physicians prescribe to those who have the disorder a more generous, or a more abstemious diet? and do they prescribe any thing to the uninfected?
Jew physician: In times of the plague, many are accustomed to eat no flesh; others, no fish; but I know not whether by the advice of physicians. For myself, I have been in many plague years, but have made no alteration in the management of myself.——Fra Luigi: In Smyrna the plague is generally treated with a rigorous diet. They only use rice and vermicelli boiled in water; and sometimes, when the patient is too costive, juices and herbs boiled without seasoning. From time to time they give some acid preserves, and raisins, and, in great heats, some slender lemonade; and a dish of good coffee with a biscuit every day. For drink they only use toast and water; and they follow this abstemious regimen till the fortieth day of the disease is completed, after which they take chicken broth, lamb, and other food of easy digestion.