According to Baron Ash, “the plague does not depend upon any constitution of the air, but is communicated only by contact, and they had repeatedly succeeded in suppressing it in different divisions of the army, by the immediate separation of the infected with their attendants, and burning every thing belonging to them, or that they had touched. They found the greatest advantage in keeping the soldiers ignorant of its existence till suppressed; for by this means they preserved their peace of mind, and health of body; and they found an exact military discipline the best preservative against the disease. For the cure of those infected they found the cold regimen, a free circulation of air, vegetable and mineral acids, ipecacuanha, rhubarb and bark, to be the properest remedies. That, to purify the air in hospitals appropriated for their reception, gun-powder was found most efficacious, probably from the commotion given to the air in explosion, over and above its action in common with other fumes. To resist infection, courage and fortitude of mind is necessary, as consternation and terror seem to prepare the body for the reception of the disease.”
Dr. Sydenham seemed to have as great an opinion of bleeding, as the Russian physicians of vomits. Considering the plague as merely inflammatory, he lays the whole strength of the cure upon bleeding, which he greatly prefers to any other remedy. The quantities he took away were very considerable; and he gives an instance of a patient who died from not having enough taken away. He also informs us, that, during the civil wars in England, the plague raged in several places. Being accidentally brought to Dunstar castle in Somersetshire, a surgeon, who had travelled much in foreign parts, applied for leave to give the garrison what assistance he could. This being granted, he bled them, every man as he stood, without distinction, till ready to drop down; the blood was suffered to flow down upon the ground, so that no account could be taken of the quantity. They were then ordered to lie in their tents; and, though no kind of remedy was given after bleeding, every one recovered.[136] Notwithstanding his opinion of bleeding, however, this celebrated physician was obliged to attempt the cure by sweating, which he says he preferred to bleeding on account of its not weakening the patient so much, nor hazarding the reputation of the physician; yet he says it is prejudicial in young people where the powers of life are strong. His improved method therefore was, first to bleed moderately, if no swelling had appeared, by which means a sweat would be more safely and easily raised. The bleeding is to be performed in bed, after which the patient must be covered up with the bed-clothes, and a piece of flanel applied to the forehead. This last expedient, he says, contributes more to the raising of a sweat than one would imagine. If no vomiting ensued, he administered sudorific medicines internally. But, if the stomach cannot retain any thing, he proposes to begin the sweating merely by the weight of the clothes, and now and then throwing part of the sheet over the face. The sweat being thus begun, the vomiting, however violent, generally stops, and the medicines will be retained, so that as plentiful a perspiration as we can desire may be excited. An instance of his success in this way he gives in an apothecary who applied to him in behalf of his brother. A sweat being proposed, the apothecary told him that he had given him several strong sudorifics, all of which had been thrown up; but the Doctor, having first sweated him moderately by the bed-clothes, afterwards gave him a large dose of Venice treacle; which operating powerfully, he recovered from the disease. He advises the sweat to be kept up without intermission for twenty-four hours; a smaller time being insufficient to remove the disease, and a stoppage of the perspiration certainly attended with a return of the bad symptoms. On this occasion he censures Diemerbroeck and others for advising to stop the sweat on every slight occasion. The linen is to be allowed to dry on the patient’s body, he must take all his liquids warm, and continue the use of a diluting fluid. Sage posset drink is what he recommends. Next morning the cure was finished by a purge of senna, tamarinds, &c. Where a swelling appears, he directs to forbear bleeding even in such as are not apt to sweat, least the patient should die suddenly from a return of the morbific matter into the vessels. Bleeding, however, might be used with safety even in this case, provided a sweat was instantly to be raised; and thus he thinks the swelling might be dispersed perhaps with more safety than by waiting for its suppuration.
This may be accounted an epitome of the most approved modern practice in pestilential cases. The Russian physicians above quoted seem to speak with most confidence of their success. They, however, “lay great stress upon distinguishing the plague from the worst kind of malignant fever in hot countries; and it is not without reason, as bad consequences have attended the confounding of them on the breaking out of the plague. I am credibly informed that the great havock made in Moscow was principally owing to this circumstance; for it obtained some time before it was discovered by gentlemen unacquainted with the disease, and before they would acknowledge its existence, although some veteran army practitioners recognised its appearance under one of its forms, and endeavoured to alarm their brethren, but in vain, for a time.”[137]
From this it is natural to conclude, that, when the disease was once fairly discovered and attacked by the powers of medicine, it could not make much resistance; yet Dr. Mertens, speaking of this very plague, says, that owing to the rapidity of the distemper, and many inducements to conceal it, little can be said of remedies in the plague. He divides the distemper into two kinds, the nervous and putrid; the former “comprehending merely that degree of confusion and disturbance given to the nervous system on the first introduction of the miasma, and the latter commencing at the time the miasma begins to operate upon the blood and other fluids by assimilating them to their own putrid nature.” In the nervous state the miasma has sometimes been carried off by sweat, gentle diaphoretics, camphorated emulsions, juleps of camphor and musk. Gentle emetics, particularly ipecacuanha, were found useful; but James’s powder (which was imported from England in great quantity) did not answer any good purpose. In the putrid state, the bark and mineral acids were useful; purgatives were hurtful, blood-letting inadvisable, and scarifying the carbuncles, recommended by almost every writer, attended with no good effect.
Few of the modern travellers who have visited the countries in which the plague is frequent, being versed in medicine, have said much about the cure of it. Mariti only says, that, in the island of Cyprus, infected patients were allowed no other diet than pure water, panada, rice, tea, &c. Some thought to ward off the disease by drinking strong liquors, but these almost always fell victims to it. Whatever their methods were, indeed, they must certainly have been very ineffectual, since the same author informs us that, in the plague of 1759, in many parts of that island there were not a sufficiency of inhabitants left to cultivate the ground.
Diemerbroeck, whose name justly ranks high among those who have written on the plague, trusts mostly to sudorific medicines. Bleeding, according to him, is absolutely to be avoided, as well as purging and vomiting. He directed first that the chambers of the sick should be kept clean, and the air purified three or four times a day by fumigations, and that the sick should take (in the beginning, the first, second, or third day) a sweating draught, and being well covered with blankets plentiful sweats were promoted for two or three hours or more (always having a regard to the patient’s strength.) If the patient did not sweat easily, bags filled with hot, dry sand were applied to the feet, armpits and groin. If the sick were not eased by the first sweat, it was repeated in a few hours; but if, after the second sweat, the fever and other symptoms still increased, it was the worst sign. After ten or twelve hours, and on the following days, they were repeated four or five times as occasion required. Besides this he directed apozems, antidotes, &c. which, as it is most probable they had no effect in removing the disease, it is needless to trouble the reader with.[138]
That a free perspiration is the natural cure of the plague, seems to be allowed by almost all writers of credit. Dr. Russel says, “Of all excretions, that by the skin would seem to be the most materially important in the plague. Where the skin remains perpetually dry, or where short and precipitate sweats are attended with no favourable alteration, danger is always to be apprehended. On the other hand, sweats, at certain periods of the disease, appeared clearly critical in a greater or less degree. They were followed by a manifest alteration for the better, and by their repetition the fever was carried entirely off, or reduced to symptomatic exacerbations, seemingly dependent on the eruptions.” He adds, that he never observed blood exude through the pores, nor did he observe the sweat to be remarkably offensive; or in any degree so remarkable as in some eruptive fevers, particularly in the small-pox before eruption. Dr. Hodges, however, says that in the plague of London sweats were sometimes extremely acrid and fœtid; and that they were met with of various colours, such as purple, green, black, or blood-coloured. Sometimes it was cold, though the patient was tormented with intolerable inward heat and drought; and would continue even after death; but he was of opinion that sweat is the natural crisis of the distemper.
Besides those symptoms of the plague which have been enumerated, there are others, particularly hæmorrhages and convulsions, with which it is sometimes attended. These it has in common with the yellow fever, and therefore are considered in the second part of the work. I now conclude this part with a short retrospect of the principal facts which to me seem to be the result of the investigation. 1. That the plague is of an unknown (I believe it of divine) original. 2. That in the countries on which it first was sent, it still remains, and from them has always been propagated to others, without a single well attested instance to the contrary. 3. That the means by which the distemper usually has been propagated are war and commerce. 4. That the disease differs from all others in having a more violent tendency to inflammation, insomuch that it approaches to actual accension; nay, that the extraordinary instances of spontaneous burning we read of are to be accounted only the highest degree of this disease. 5. That the immediate or proximate cause of the plague is a tendency in the blood and other fluids to discharge upon certain parts the latent heat they contain, in such quantity as to destroy these parts entirely, and to convert them into a kind of coaly substance. 6. That this tendency depends on a certain inexplicable action of the external atmosphere, particularly of the elementary fire contained in it, and of which it principally consists.[139] 7. The approach of a plague cannot be foretold, either from the constitution of the atmosphere, earthquakes, storms, or any other natural phenomena. 8. The plague is an eruptive disease, and it is known to be so by the certain death of all in whom eruptions do not appear; a tendency to eruption being always observed where life remained long enough. 9. The contagion of the plague diffuses itself from a small space all around, lessening in violence the farther it is diffused. In its most concentrated state it hath proved invincible by medicine; in its mild state it requires none;[140] so that in the plague the medical powers are found of less avail than in any other acute distemper. 10. The natural cure of the plague is by perspiration or sweat, and this perhaps is the only evacuation which ought to be kept in view, as having a salutary tendency, by those who attend the sick.[141]
END OF THE FIRST PART.
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