6. In case of faintness and uneasiness, a cordial, composed of some of the simple distilled waters, tinctures of saffron and valerian, alkermes, and spirit of vitriol, was used with advantage and great refreshment to the sick. This with plenty of acidulated drinks was the chief prescription for infected children.
Under the above treatment, a sweat often broke out on the second or beginning of the third day; after which the sick were covered up, and the sweat encouraged as long as they could be persuaded to bear it. By this first sweat, especially if it happened on the second day, the patient was never freed from the fever, though greatly relieved. It was therefore necessary to continue the same medicines, in order, by a more plentiful sweat, to procure a perfect crisis. Where the sweat was supposed to be sufficiently copious, and had greatly mitigated the symptoms, a mild cathartic was given in the morning, though some degree of fever still remained; the other medicines not being intermitted during its operation. An anodyne was given in the evening.
In case of an exacerbation of the symptoms or the depression of the buboes, as sometimes happened on the second or third day, it was useful to apply a blister just below the tumour. A blister to the head was useful in cases of coma and debility of the tongue. The natives were exceedingly averse to the use of blisters; but, having observed that some who had been judged past recovery had nevertheless struggled through, apparently from the use of blisters, they at last came into some degree of credit. Cataplasms, composed of garlic, bread and vinegar, were advantageously applied to the soles of the feet. These, as well as blisters, were useful in cases of coma; also emollient laxative clysters. The dose of the alexipharmics was increased, and acidulated drinks, in small quantities at a time, given frequently.
To the buboes it was customary to apply suppurative cataplasms; but, as these could not, where the patient was desirous of walking, be easily kept on, a diachylon gum plaster was substituted, with the addition of few cantharides, or a little euphorbium, if a greater stimulus was judged necessary. In most cases the buboes were left to open of themselves; the natives being afraid of the lancet or caustic, and sometimes operators being wanting. No bad consequence ensued on their being left to open of themselves, nor was any particular treatment necessary. Where they mortified, the treatment was the same as in carbuncles, and though, after the separation of the gangrened parts, the ulcer often remained wide and deep, yet they healed kindly and in a short time.
Sometimes the carbuncles were scarified, but oftener not. The best dressings were pledgits of yellow basilicon, with a small proportion of oil of turpentine, or sometimes tincture of myrrh, with an emollient cataplasm over all.
Dr. Patrick Russel complains that, in Turky, physicians are laid under such restraints, by popular prejudices, that they are sometimes obliged to remain almost passive spectators of the disease. The natives are fond of bleeding, and will at any time let blood in the hot stages, when the febrile symptoms run high. About two thirds of the infected were bled at the arm; but from the rapid progress of the disease, and the quick transition to the low, languid state, few were bled more than once, and that usually within the first forty hours. The time of bleeding was usually the first night, or some time on the second day; but sometimes not till the third. Where the operation was repeated, it was usually on the third, sometimes on the fifth, and even on the sixth; he has even met with instances wherein the patient was three or four times bled, the last being as late as the seventh day. In his own practice he usually advised one bleeding at the beginning, except in the very young, aged, or infirm. On the first day, if not forbid by circumstances, bleeding was ordered by way of precaution; but on the succeeding days it was regulated by the state of the pulse, and other symptoms. Where the infection was slight, and the febrile symptoms moderate, or did not come on till some days after the eruptions, it was wholly omitted. The quantity of blood taken away seldom exceeded eight or ten ounces. Cupping was used by the natives, but never ordered by Dr. Russel. Children were scarified in the legs. He seldom had an opportunity of examining the blood drawn from a vein; but, in such cases as occurred, the general appearance was little different from that of healthy blood; the crassamentum was sometimes of a darkish colour, but never sizy or resolved.
With regard to the propriety or impropriety of bleeding, or at least the success attending it, we can best judge from the histories of cases given by Dr. Russel at the end of his work. Of these there are an hundred and twenty, with some supernumeraries, giving an account of the cases of the attendants, &c. Of these, sixty-five were bled; forty died, and twenty-five recovered.
Of these hundred and twenty cases at large, fifty-seven recovered, as many died, and the event of six was unknown. This would tend to give us some considerable idea of the Doctor’s success; but, when we take into account the time of the year in which these cases were treated, the matter will appear in a quite different light. Twenty-seven took place mostly in the earlier part of the season, and were of consequence more violent than the others; and, of these, twenty-one died, five recovered, and the event of the other case was uncertain. Of the rest only thirty-six died, and fifty-four recovered. Such an excessive disproportion cannot be ascribed to the medical treatment, but to the nature of the disease itself, growing milder as it extended wider. In many of these cases it is not mentioned whether the patients took any medicines or not; nevertheless, as it must always be supposed that a physician would prescribe something for his patient, it must also be supposed that all took medicines, excepting where we are expressly told that they did not. The cases in which he mentions the medicines employed were the following:
1. A young man of 20, suddenly seized, was bled largely; had a vomit of ipecacuanha, which brought off a quantity of bile, but without putting a stop to the natural retchings. Some diaphoretic medicines were given, which did not remain on his stomach, and he did not sweat. These were stopped by a draught of juice of lemons and alkaline salt taken in the act of effervescence. Sinapisms were applied to the feet, and he died the third night at midnight.
2. A widow lady about 40, of a thin, delicate habit, in whom the disease came on gradually, was bled on the third day, and took diaphoretic medicines and acidulated cordials till the 9th. She died on the 11th.