It was however observed, that notwithstanding the Disease most frequently was accompanied with Symptoms of pestilential Malignity, yet it sometimes appeared with a much more favourable Aspect; its Progress not being so quick, nor its Symptoms so violent and dangerous, as hath here been described to be the Case in general[[23]]. At its first breaking out in any Place it was commonly the most severe; it then spared no Age or Sex, but swept off Adults together with Infants: By degrees it became less violent, and at length either wholly disappeared, or was of so little Consequence as to be disregarded.
We are directed, by most of the Authors I have seen, to begin the Cure of this Distemper with Evacuations; the chief whereof are Bleeding and Purging; tho' which of the two ought to precede was not a little disputed. Purging was in general preferr'd; and they commonly made use of Manna, Rhubarb, Senna, and Agaric, for this Purpose. Cortesius directs six Ounces of Manna to be given to Adults in a Decoction of Tamarinds. Bleeding, tho' commonly directed at the first, hath been used more sparingly in this, than most other acute Cases[[24]]. Severinus, who was by no means a timid Operator, directs from four to eight Ounces to be taken away; which, considering the common Practice in those Countries, is a very small Quantity[[25]], But it may not be improper here to give a short Sketch of this Author's Practice, as he differs in several Respects from most others.
He orders an antimonial Vomit to be given at the first Attack, and a cooling gently astringent Gargle to be used Night and Day. He then directs a Clyster, takes away some Blood from the Jugular, and gives from xv to xxi Grains of Bezoar Mineral twice a Day; or oftener, as Occasion requires, with thin diluting Liquors, in order to raise and promote a moderate Sweat. He gives five or six Grains of the same Medicine to Children at the Breast, and commends it highly. He scarifies the discolour'd Parts in the Fauces, in order to let out the corrosive Virus; a Practice, which, though it was countenanced by some of the Spaniards, was disliked and condemned by the most eminent Italians. He, as well as Zacutus Lusitanus[[26]], used the Arsenicum album in Gargles in very small Quantities, but with how much Advantage to the Patient is nowhere so fully proved, as to induce one to follow their Example.
Cupping, with Scarification, was universally approved, and commonly practised. Leeches were also applied, by way of Revulsion, to different Parts.
Considerable Benefit was expected from Ligatures made on the Extremities, and from chafing the Limbs with the Hand or a Cloth; also from Cupping without Scarification; apprehending that a Revulsion from the Parts affected was by this means procured; and that some Portion of the morbific Matter, was carried off by the Pores of the Skin.
Some of the Spanish Physicians recommended Vesicatories of Cantharides to be laid on each Side the Neck: The Italians seem not to have been fond of them; and urge it as a Reason against their Use, that the Progress of the Disease was too quick to be relieved by any Discharge they could make.
The internal Medicines they used were such as they deemed Alexipharmics. Armenian Bole, Bezoar both animal and mineral, Pearls, and, according to the Philosophy of those Times, the precious Stones. The Theriaca was excepted against for Children, as Galen had condemned its Use in such young Subjects. But after they had lessened, as they thought, the Plethora by Bleeding, and the Cacochemy, as they stiled it, by a Cathartic; as they found, from Experience, that no Concoction of Humours was to be waited for in this Case[[27]], without laying much Stress upon Internals, they seem chiefly to have applied themselves to Topics; considering the Disease as local, and a peculiar morbid Affection of the Fauces.
In this Part of their Directions they have been more particular; and some of them, in order to point out their Applications with more Propriety, have divided the Course of this Disease into four different Periods[[28]].
The first is the State of Inflammation. In this Repellents were thought necessary; such as Vinegar in Barley-water, Syrup of Roses, Mulberries, and Purslain.
The second, is that wherein the white Sloughs begin to appear, which is a Step towards a gangrenous Colliquation. In this State they order'd mild Abstergents, of which Honey of Roses was esteemed the chief.