Dr. Alexander Russel begins with observing that “the discordant opinions of medical writers concerning the method of treating the plague are innumerable. In regard to bleeding and other evacuations, they maintain opinions diametrically opposite; some recommending them as indispensably requisite, others decrying them as invariably pernicious; while both parties, with equal confidence, appeal to experience. But, in a disease wherein reason is often perplexed, and experience itself fallacious, it is greatly to be lamented that nature is not more, and opinion less, consulted.
“No traces of any satisfactory method of cure are to be met with among the natives at Aleppo. The Mahommedans, holding the plague to be a penal curse inflicted by Almighty God on a sinful people, have less faith in the efficacy of medicine in that disease than any other: and, as the chief of those who practise physic are either Christians or Jews, not armed with the doctrine of predestination, and consequently apprehensive of contracting the infection, they (the physicians) endeavour to confirm the vulgar notion of the inutility of their art in the plague, with a prudential view of evading the danger of being forced to visit the sick. Hence the greatest part of the infected are either left to struggle with the disease without any assistance from medicine, or are under the necessity of submitting to the direction of the meanest and most ignorant of mankind.”
The whole practice of the native physicians consists in bleeding, let the stage of the distemper be what it will, and afterwards attempting to raise a sweat with the insignificant remedy of a few grains of bezoar mixed with the distilled water of scorzonera. On the subject of evacuations our author remarks, that bleeding, even very plentifully, was always useful in the beginning, but as constantly prejudicial after the first day. Vomiting was equally useful at the same period; with mere warm water, if that would answer the purpose, but if not, small drops of ipecucuanha or sal vitrioli might be added. Violent cathartics were hurtful, but an emollient clyster or laxative of manna and cream of tartar were not only safe but serviceable. “On the second day of the disease (says the Doctor) where the remissions of the symptoms were tolerably distinct, I have frequently and successfully given an infusion of senna with manna and cream of tartar; and it is a fact confirmed to me by repeated experience, that a purgative of this lenient kind, given after the critical sweat, was the most effectual means of promoting the suppuration of the buboes.
“The natural crisis of the disease was always by the skin. When a copious sweat could be procured by art, it was likewise of service; but the attempt, if made the first day, was attended with two material inconveniences: the first, that the common diaphoretic medicines, if given in the usual dose, if they failed in their operation, threw the patient into a flame, and greatly augmented all their symptoms; the second, that, though they produced the desired effect, it was necessary to keep up the sweat a much longer time than most people of that country could be persuaded to endure; and, if the sweat was prematurely checked by exposure to the air, all the symptoms were either exasperated, or (what was often the case) a diarrhœa was induced, which, though at first it might seem to relieve, yet generally proved fatal in the end.”
Contrayerva and valerian, saffron, the compound powder of contrayerva of the Edinburgh College, are recommended as sudorifics; given in small doses every four hours, with acidulated diluent drinks. These medicines were occasionally joined with anodynes, among which syrup of poppies was reckoned preferable to opium. In cases of diarrhœa, Venice treacle or diascordium were joined with the diaphoretics. Neither bark nor snakeroot could have a fair trial, on account of the prejudices of the people: and on this occasion our author observes, that “the physician who would obtain a ready compliance with his directions, in that country, must as seldom as possible offend the palates of his patients with nauseous remedies; for, whatever may be the consequence, they will often rather choose to incur distant though great risks, than avoid them by submitting to present inconveniences.” Nitrous medicines were found ineligible on various accounts: 1. They did not, as in other diseases, allay heat. 2. The sick could not bear them in ordinary doses without languor and dejection. 3. They were apt to bring on a diarrhœa.—The following is an epitome of our author’s practice:
1. Bleeding from ten to twenty ounces as soon as possible after the seizure. The quantity seldom exceeded sixteen ounces, and even this is greatly above what is taken in any other disease in that country.
2. After bleeding, where the nausea was considerable, the stomach was cleansed with warm water; or, if that failed, with ipecucuanha or salt of vitriol. It was of such importance to have both these evacuations performed early, that our author instructed most of his acquaintance how to act if they should be infected.
3. A gentle anodyne succeeded the vomit. If by it the stomach was not quieted, an ounce of diascordium, or 15 drops of laudanum, were added to the saline draught of Riverius.
4. Small doses of cordial and diaphoretic medicines, with a very small quantity of antimoniated nitre, were exhibited every four hours; the sick were encouraged to drink freely of a decoction of scorzonera roots and barley, or spring water moderately acidulated with spirit of vitriol. A mixture of the acid with syrup of violets was kept ready to be added to plain water. All the drink was given warm if the patient would be prevailed upon to take it so.
5. In the winter the sick were removed into more airy lodgings than those in which they usually slept, and the air of the room was warmed or corrected by a moderate fire. In summer only the windows opposite to the patient’s bed were ordered to be shut; but even this restriction was not universally complied with; many insisting upon setting all the windows open in the day time, and sleeping on the house top at night.