_Of the Epidemical Diseases, from the beginning of 1742 to the end of
1747, and of the Years 1752 and 1753._
_A. D._ MDCCXLII.
This year was very healthy, till about the beginning of _March_; when
an acute fever, attended with a pain in the right hypochonder, became
very frequent, both among adults and children, though few of those were
seized with it who were under ten years old. Copious bleeding, emollient
glysters, cooling purges, with antiphlogistic medicines internally, and
emollient fomentations to the part affected, generally relieved the
symptoms, and brought the fever to a favourable crisis on the seventh or
ninth day in adults by a plentiful sweat, and in children most commonly
by a diarrhœa.
In some these evacuations only carried off the pain, and brought the
fever to a regular intermission; when it was soon and safely cured by
the cortex; though, if any errors were committed in the use of the
non-naturals, the patients were very subject to relapses.
But when evacuations were not used in due time, the disease often proved
fatal, or at best the fever was protracted to thirty, and even forty
days, and some few of the sick died hectic.
Though the above mentioned fever did not quite disappear till the autumn;
yet, after the beginning of _June_, it affected so few, that it could
scarcely be called epidemical.
Inflammatory quinsies were also frequent at this time; but they were not
violent, and quickly yielded to the common methods.
Through the winter the plague had been frequent in _Antab_, _Kilis_,
_Azass_, and most of the villages among the mountains _Amanus_; to which
places, according to the best information we could get, it had been
brought from _Bias_[489], where it had raged the summer before.
The _Chinganas_, who came as usual from these parts, about the middle
of _April_, to be hired for reaping corn, brought it with them to
_Aleppo_. To these, and a few others in the out-parts of the town, it
was confined for some time; and it was not till the 18th of _May_, that
we had any notice of it, when, upon strict enquiry, it was found that
there had been some seized with the distemper in the city. In a few
days, it encreased pretty much among the _Jews_ (who suffered greatly in
proportion to their small number this season) and came to be more general
through the city and suburbs, where it continued, though in a limited
degree, till the beginning of _July_, when the extream heat of the
weather put a considerable check to it: some, however, were daily carried
off by the disease till near the end of this month, when it entirely
ceased. The _Europeans_ shut up[490] this year the beginning of _June_,
and continued so about a month.
About the middle of _July_, diarrhœas and dysenteries became very
frequent. The discharges at first were bilious, and the gripes violent.
A very high fever was a constant attendant often with petechiæ, and
other malignant symptoms: plentiful bleeding was always necessary at
the beginning; after which an ipecacuan vomit, with a few doses of
rhubarb (found most effectual when a few grains of calomel were added)
prepared the way for anodynes and gentle astringents: these, with soft
mucilaginous aliment, in most instances, compleated the cure; but
in several, from a promising appearance, it proved suddenly mortal:
this was likewise the case with some in intermitting fevers that were
now epidemic, and continued with the dysentery all the autumn. This
unexpected fatality happened at times, to such as were not shut up, in
all acute diseases during the time of the plague; but buboes, or other
signs of that distemper, were seen but seldom[491].
About the beginning of _September_, the small-pox made their appearance,
especially amongst children; but being of a mild distinct kind, very
little assistance was required from medicine. In _October_ this disease
became more frequent; and much the greater part that were seized, had
the confluent sort, attended with hæmorrhages, petechiæ, phlyctanæ, and
other the worst of symptoms. Convulsions (always violent) on their first
seizure, indicated that the pock would flux, and prove fatal. In this
confluent kind the eruptions were often discovered on the extremities as
soon as the child was observed to be out of order, and never were later
in appearing than the end of the second day. These patients generally
died on the beginning of the eleventh, reckoning from the first attack,
when the distemper was left to nature, as is commonly the case in this
country; or, if they survived, yet many of them were afterwards harrassed
with corrosive ulcers, carious bones, hard tumors on the glandular
parts, difficult either to discuss or bring to suppuration, coughs, and
fluxes; which last soon put an end to their miseries. By degrees this
great malignancy seemed to wear off; so that by _December_ the disease
became mild and favourable, and most of the sick recovered.
The _Jews_ were the most severely afflicted by this sort of small-pox.
Bleeding, bathing the extremities in warm water, with a plentiful use
of diluting, antiphlogistic medicines, if used at the beginning, often
prevented fatal consequences. Purging in the secondary fever, or after
the decline of the disease, is never practised here by the natives; from
the neglect of which, perhaps, the dreadful symptoms above enumerated
were more frequent; though they often happened when all possible means
had been used to prevent them.
Inoculation is only practised here among the Christians, and is not
yet general even among them. However, it appears to gain ground daily,
though their injudicious method of proceeding in it seems to lay this
practice under several disadvantages. They do not either prepare the
body beforehand, or consider the habit of the child to be inoculated,
or the nature of the pock, or other diseases of the party from whom
they receive infection, but carry the child to be inoculated into the
chamber of the sick; where an old woman opening one of the pustles with a
needle, takes a little of the matter upon its point; with this needle she
pricks many times the fleshly part of the child’s hand, between the first
joint of the thumb and the same joint of the fore-finger, taking up a
little more matter upon the point of the needle after every two or three
punctures; then putting a bit of cotton on the part, it is tied up, and
the operation finished.
About the middle of _November_ the plague began to shew itself again in
the suburbs called _Bankusa_[492], and that neighbourhood; and before
_Christmas_ it was found to be in some parts of the city, though it made
little or no progress.
A few pleurisies and rheumatisms began to make their appearance in
_December_.
_A. D._ MDCCXLIII.
In _January_, the small-pox, which were now for the most part distinct,
abated considerably, and by the end of _February_ they quite disappeared.
The pleurises and rheumatisms grew more common in _January_, and
continued through the greatest part of _February_. They were commonly
accompanied with headach, thirst, and other febrile symptoms. The pulse
was low, quick, and hard; the urine not so high-coloured as usual in
those inflammatory fevers, but without sediment. The blood was sizey.
The pains of the rheumatics were not generally very acute, though fixed,
and more especially in the knees, which soon swelled considerably, and
were often subject to great weakness long after the pain and fever were
removed.
In both diseases the method of cure was the same. They could not for the
most part bear such large and repeated bleeding as is usual in those
inflammatory cases at other times; but, by moderate bleeding, twice,
or at most thrice, cooling purges, emollient fomentations to the parts
in pain, a plentiful use of antiphlogistic and saponaceous diluters,
with volatiles added towards the decline of the disease, they speedily
recovered.
During the winter, a continual fever, much like that of the preceding
spring, affected several; but the pain in the right hypochonder did not
so commonly attend it.
During the course of the spring, intermittents were common; but they had
nothing in them particular.
The plague which had continued in the suburbs during all the month of
_January_, though hitherto it had made but little progress, now began to
spread among the _Jews_ in the city, and seized many of the Christians in
the month of _February_; though, as it was then diminished at _Bankusa_,
it might more properly be said to have changed its quarters, than to have
augmented its forces.
About the beginning of _March_, some _Jews_ and _Turks_, who were known
to the _Europeans_, dying suddenly, they began to be alarmed. However,
whether from a cessation of the distemper, or from great industry used
in concealing it, together with the natural credulity of mankind in what
they wish to be true, cannot easily be determined; but certain it is,
that we then heard no more of it, and most people flattered themselves
with hopes that it was entirely ceased: but, on the 20th of _March_, we
were credibly informed, that two _Jews_ were dead in the same house, and
that several other persons of different sects were dead or infected,
which raised a fresh alarm amongst us; and, in truth, the increase became
soon too visible, particularly among the _Armenians_, who suffered in a
very extraordinary manner during the whole continuance of the distemper.
Hitherto the greatest part of the infected were women and children, and
mostly in the suburbs; but, about the beginning of _April_, there was a
manifest encrease of the burials in the city, and several were seized in
the _Khanes_, where the _Europeans_ live, so that most of them shut up
the 11th of that month.
It continued encreasing gradually in all parts, and among all sorts of
people during the month of _April_, but continued its ravages in _May_
with much more violence, and arrived at its greatest height, according to
the reports we received, about the last of that month, when the number
of burials was every day apparently great. But as we had no account that
could be depended upon, it is not possible to ascertain the precise
number. Our list of the Christians was however tolerably exact; and,
notwithstanding many of them were gone out of the city, and the rest
who could afford it were shut up, though not in the most regular way,
their burials amounted from 20 to 30, and sometimes 34 a-day. Hence it
is evident, that the number of _Turks_ must have been very considerable;
though, according to the informations of those who remember former
plagues in this place, the mortality attending this was but very moderate.
About the beginning of _June_ the distemper decreased pretty much amongst
the _Turks_, according to the accounts brought to us, though the number
of Christian burials (of which we were informed with more certainty)
diminished but little. From the 13th to the 17th, it again encreased,
particularly among the _Turks_, though not to the height it was at about
the end of _May_. On the 18th it began again to decline, and continued
decreasing with a surprising rapidity, some small interruptions excepted,
till the end of the month, by which time the burials were reduced to a
very few. However, they kept at that stand the greatest part of _July_;
nor could the city be said to be quite exempt from the infection till
about the middle of _August_, though it was so much abated that most of
the _Europeans_ got abroad about the 18th of _July_.
About the beginning of _August_, intermittent fevers became frequent, and
were at their height in _September_; after which they abated, but did not
entirely cease till the close of the year.
For a few days after their commencement, they often resembled continual
fevers, with violent and irregular symptoms, not unlike those of the
plague; but, after bleeding and vomiting, or, what was most commonly
practised, purging, with a plentiful use of nitrous medicines, they
formed into tertians, double tertians, or quotidians, and were speedily
and safely cured by the use of the bark. It was remarkable in those
fevers, that they affected many more of the _Europeans_ than epidemics in
this country commonly do.
Diarrhœas were also frequent throughout the autumn, and till the end of
_December_, but without any thing particular in their symptoms.
From the middle of _November_ till the end of the year, we now and then
heard of a person dying of the plague; but these instances were very
rare, hardly more than two of whom we could be certain that they had the
distemper.
_A. D._ MDCCXLIV.
A few pleurisies and peripneumonies occurred during the months of
_January_ and _February_; but these were not either frequent or violent,
yielding, and that very quickly, to the common methods.
About the middle of _February_ the chincough broke out among the
children. It was often attended with a smart fever, and pain in the
side. Copious bleeding was necessary, cooling purges, with pectoral
and antiphlogistic medicines, and, towards the decline of the fever,
blisters, which were most effectual when applied to the part affected:
but it was not often that the parents would consent to this application,
having in general a great aversion to blistering on any account.
Notwithstanding this treatment, the fever, and often the pain, remained
fourteen days, and the cough for two or three weeks after; but the force
of it was much diminished, and the intervals between the fits long. This
disease ceased by the end of _March_.
At this time also an inflammatory fever, without affecting any particular
part, was frequent amongst children; which bleeding, purging, and nitrous
medicines, with the testacea, commonly carried off in a few days.
For want of bleeding, the above mentioned diseases proved fatal to
many, this operation being scarce ever performed upon children by the
physicians of this country. They content themselves with making a few
slight scarifications on the top of the ears, or on the calves of the
legs; from whence they seldom procure more than a few drops of blood.
The plague, which began to appear in _November_, made very little
progress during the months of _January_ and _February_. In _March_ it
became a little more apparent, and proceeded exactly in the same course
as the year before, ceasing entirely about the middle of _August_. The
number of the infected were but few; so that the _English_ nation did not
shut up at all, and some of the _French_ only towards the middle of _May_.
In the preceding years, I prescribed for the sick chiefly from the
accounts I had from a person I employed to visit them; for though,
notwithstanding all my precautions, I was often deceived by false
representations, and employed to visit some of the infected before we
shut up, yet I avoided it to the utmost of my power; but this year, the
fears of infection being (like that of all other dangers to which one has
been long exposed) much wore off, I attended the sick of the plague in
common with those under other diseases.
Intermittents made their appearance about the middle of _March_, and
continued till the beginning of _May_. Those who had laboured under this
disease in the autumn, were now the most subject to it.
As the greatest part were regular, formed tertians, a vomit or purge,
with the use of the cortex, was all that was necessary to cure them; and
the same medicine, with the warm bitters, and elixir of vitriol, were
continued for some time after, to prevent a relapse.
In _June_, _July_, _August_, and part of _September_, a malignant
fever was common, attended with much the same symptoms as the plague,
excepting buboes and carbuncles. The vomiting, with which it began,
lasted for several days, and the fever continued at least till the
fourteenth, but often longer; some few after the fourteenth had regular
intermissions.
The method of cure was much the same as that of the plague, only that
they bore a second bleeding, and nitrous medicines, better than I usually
found they did in that distemper. When the fever intermitted, the bark
was given with success.
From _June_ till _December_, intermittent fevers of various forms were
very frequent. They did not put on the appearance of continual fevers in
the beginning, like those of the last year; but, if they were not timely
stopped by the bark after the fourth paroxysm, (_viz._ the seventh day)
there was no remission; but the fever became continual, remaining at
least till the fourteenth day, but more frequently till the twenty-first,
if it did not prove fatal before, which was often the case while the warm
weather continued.
A few diarrhœas occurred between the end of _August_ and the beginning
of _January_. In _November_ and _December_ some pleurisies and quinsies
appeared; but neither of these diseases had any thing in them different
from those of other seasons.
_A. D._ MDCCXLV.
We had no disease that could be called epidemic, excepting the
spring-intermittents, which began early (_January_), and continued till
the beginning of _May_. They indeed were more frequent than usual.
The summer-fevers among the young children begun in _June_, and were
generally accompanied with a diarrhœa, but had nothing unusual.
Intermittents also made their appearance this year in _June_, and were
numerous till _December_; but though they were very liable to return,
they were not of a bad kind.
A few dysenteries were to be met with in the autumn, but scarce so many
as to entitle the disease epidemic.
In _September_, the small-pox appeared among the children. The few
that were first seized had a mild, distinct pock; but by the middle of
_October_ they became very common, and the generality of the sick had a
bad confluent kind, which proved fatal to many on the eleventh day from
their seizure; but of such as were treated after _Sydenham_’s method,
very few died. The most part of those that recovered had inflammatory
tumors on the elbows, which always suppurated, and proved tedious in
their cure; but, if timely opened, the bone was seldom affected.
_A. D._ MDCCXLVI.
The small-pox, which had raged violently in _November_ and _December_,
became milder in _January_, as also less frequent, and by the beginning
of _February_ entirely disappeared.
In _January_ and _February_ several had inflammatory fevers, which were
commonly cured in a few days by bleeding, cooling purges, and a plentiful
use of nitrous medicines.
In _June_, a putrid fever, with petechiæ, began, and continued during the
months of _July_ and _August_; but the number of the sick was but small.
It however seldom proved fatal, but commonly terminated happily by a
critical sweat on the eleventh day, or at the furthest on the fourteenth.
This autumn was most remarkably free from intermittents; none were seen
before _September_, and they totally disappeared by _November_. The
remainder of the year was very healthy.
_A. D._ MDCCXLVII.
As the last year ended, so this begun, free from any disease that had
the appearance of an epidemic. A few diarrhœas occurred during _January_
and _February_, in _April_ peripneumonies affected several, and now and
then through all these months intermittents appeared: but none of these
diseases were either frequent or dangerous; so that this season might be
esteemed one of the most healthy.
In _May_ a putrid fever broke out, and was very frequent through the
whole of the summer, and to the end of _October_; after which, though it
became less common, yet it now and then shewed itself till the end of
_January_ 1748.
This fever began with a shivering and vomiting, which were soon succeeded
by violent headachs, pains over the whole body, and an evident loss of
strength, though the pulse was full and hard for the first four days.
The tongue was first white, then became brown, hard, and dry. Most of
the sick became delirious on the fifth day, and towards the end of the
disease comatose. The heat was violent, both internally and externally,
with regular exacerbations in the evenings, preceded by flushing in the
cheeks. Purple spots, about the size of a flea-bite, generally broke
out over the whole body about the fifth day, and the fever most commonly
ended by a plentiful sweat, either on the seventh or by the ninth;
sometimes indeed it continued to the eleventh. At its first appearance,
the fourteenth day was usually critical. Signs from the urine were
very fallacious. However, in proportion to the number of the sick, and
violence of the symptoms, this fever was not very mortal.
The method found most effectual in treating the sick, was to bleed
plentifully on the first days of the disease; once to discharge the
contents of the primæ viæ, with a gentle laxative, which was the more
necessary, as the generality of the sick voided quantities of worms; to
give nitrous medicines in small doses often repeated, with the plentiful
use of the _spir. vitrioli_, and cooling glysters _pro re nata_. Towards
the end of the disease, warmer medicines were added as the state of the
pulse seemed to indicate; and blisters, when the sick could be prevailed
upon to admit them, were of great service.
In _September_ and _October_ several were seized with a fever that seemed
different from that before described, and which indeed proved fatal to
more than one half of those who were afflicted with it.
The first attack of this fever was by a slight shivering and nausea,
sometimes a vomiting. These were not succeeded by any violent heat, but
by an excessive languor, and most exquisite pains over the whole body.
The head either did not ache at all, or but very little. Several times
in a day, however, they complained of a lancinating pain, which, as
they expressed it, run through their head; and as it came suddenly, it
as suddenly went off again; and, though they had no great pain, they
complained of a giddiness, and constant noise in their ears, like the
rushing of water. From the very beginning they laboured under great
dejection of spirits; and their eyes appeared muddy, with a particular
ghastly look, much like to that of a person in the plague. The tongue
was moist; and, like one in health, for several hours they seemed to be
without thirst, or other uneasiness, and then would suddenly complain of
a violent internal heat, and drink great quantities of liquor greedily,
though neither their pulse nor tongue were altered, nor any external heat
to be observed.
The urine was of a straw-colour, without cloud or sediment, till the
sixth day, when there appeared in it a small cloud suspended about
half-way; and this appearance it had in those who died, as well as in
those who recovered. They slept very little, or not at all, during the
whole course of the disease. The pulse from the beginning to the end
was but very little quicker than natural; about the fifth day it sunk,
and about twelve hours before death was not to be felt. The sick were
scarcely ever delirious, and never comatose, continuing entirely sensible
till they expired, which was commonly on the seventh day of the disease.
Those who recovered had a crisis by a plentiful sweat on the ninth. None
of the sick had any petechiæ.
The blood that was drawn on the first day was like that of a person in
health; but, after the third day, it was of the colour of coffee-grounds,
appearing quite thin as it run out of the vein, and, when cold, was
bluish on the top, and but very loosely coagulated.
This fever did not appear any way infectious; for I observed no instance
wherein two persons had it in the same family, nor where any of the
sick could be supposed to have caught it from another affected with
the disease: and indeed the whole number of the sick that came within
my knowledge did not amount to above thirty, twelve of whom were my
own patients, and out of these I lost four. The others seemed to owe
their recovery to a pretty large bleeding, and an ipecacuan vomit
at the beginning of the disease, small and repeated doses of _pulv.
contrayervæ comp._ with a few grains of _nitr. stibiat._ gentle anodynes,
with moderate acidulated cordials _pro re nata_, and an emollient
refrigerating glyster every evening. Towards the fifth day, a warmer
regimen was necessary, with blisters applied to the back, legs, and arms,
according as the sinking of the pulse seemed to require.
Plenty of barley-water, acidulated with spirit of vitriol, was allowed
for the patient’s drink; and panada, rice-gruel, and roasted apples, for
food; though, to such as would not be contented with this diet without
the addition of butter, which is the method of this country, I chose
rather to allow weak chicken-broth, with crum of bread, or a little rice,
boiled in it.
The autumnal intermittents were this year but few; nor did any other
diseases besides those already mentioned appear so frequently as to claim
the title of epidemics.
From the year 1748 to 1751, I was prevented from taking notes in the
manner that was necessary to furnish an account of the epidemics of those
years, by a constant engagement in the duties of my profession, together
with an almost daily attendance on the _Bashaw_; which however furnished
me with an opportunity of seeing more of the manners of the people than
I should otherwise have done, and was fully recompensed by the large
presents, and other public marks of his favour, which he was pleased to
confer on me. In general, however, the first three years were healthy,
if we except the measles and small-pox, which were sometimes in this
period very frequent. The measles first made their appearance in the
spring of 1749, and finished in the spring of 1750. As this disease had
not visited _Aleppo_ for several years, it affected numbers of adults,
as well as children; so that it was no uncommon thing to see the father,
mother, children, and servants, all sick of the measles together. No
description of the disease could be more exact than that which _Sydenham_
gives us of 1670, nor any method of cure more effectual, none having died
that were treated after his manner, though it proved fatal to many of
those who were treated after the manner of the country; which is, to keep
them extremely warm, and on the ninth day to take the sick out of the hot
room, in which they have been kept, to the bagnio; without which they
imagine that the sick would fall into an incurable diarrhœa: whereas in
the small-pox, which one would imagine is a disease that should require
more washing, they don’t allow them to go to the bagnio till after the
fortieth day.
The small-pox made their appearance about the middle of _August_ 1750,
and were at first of a bad confluent kind: however, they became more mild
by the middle of _November_, and disappeared early in the spring.
The harvest of the year 1750 proved bad; so that a want of corn began to
be felt early in the winter, and the poor were much distressed for want
of bread. The new _bashaw_ embraced this opportunity to bring in large
quantities of wheat from his own granaries at _Hamah_, where it had been
hoarded up for several years; by which means it was very much damaged,
and the bread made of it was extremely black and musty: however, it was
all that the poor had to eat till the coming in of the new grain.
About the beginning of _June_ 1751, a most fatal dysentery made its
appearance, and continued till the middle of _November_; and possibly
proceeded as much from the bad bread, as the epidemic constitution of the
air, though both causes perhaps concurred in producing it.
_A. D._ MDCCLII.
The first part of the year was very healthy; but, about the vernal
equinox, a continual fever began, which attacked a great many people of
all ranks, and continued with violence till near the end of _July_; after
which the number of the sick diminished greatly, and by the middle of
_September_ this fever quite disappeared.
It began in the usual way, by a slight shivering, and often with a
nausea; to which succeeded heat, thirst, headach, and pain in the loins.
The head was much confused from the first seizure, and a remarkable
stupidity appeared in the patient’s look. The tongue became immediately
white, soon after brown, and often, towards the end of the disease,
was covered with a black crust. The pulse was quick, but seldom hard
or full, and continued in a more equal state than I ever observed in
any other fever in this country, few or none of the sick having any
remission or exacerbations, the heat and other symptoms continuing almost
uniformly at one regular standard from the beginning to the end, if the
patient’s strength was not exhausted by unseasonable evacuations and
improper management. On the ninth or eleventh day most of the sick had an
hæmorrhage from the nose, which in some seemed to mitigate the symptoms,
though many grew worse upon it; in others it had no manifest effect,
either good or bad. The crisis was almost always by a plentiful sweat;
but this happened to none at the first appearance of this disease before
the fourteenth, and to the greater part on the seventeenth.
Towards the end of _May_, the hæmorrhage commonly happened on the seventh
day, and a copious discharge by sweat on the eleventh; which, though it
very much relieved, yet was not a perfect crisis, the fever never quite
leaving them till the fourteenth. Many of the sick now had petechiæ.
As the hot weather advanced, so likewise these discharges came on
earlier in the disease; so that by the latter end of _June_ almost all
had the hæmorrhages, the fifth or seventh, and on this last the sweats
likewise. And what is very remarkable is, that from about this time till
the epidemic ceased, though the sick had been duly purged after the
fever, and the utmost care taken in respect to the non-naturals; yet
none of them escaped a relapse, which seized them in the same way as the
preceding fever, only the heat was much more intense. The second day they
were taken with violent pains in the hypochonders, bilious vomitings, and
often purging, which left them the third day; a smart fever remaining
till the fifth, with many remissions and exacerbations, when a critical
sweat put an end to it; I mean in such as had recovered of the preceding
fever on the seventh day; but such as had grown better on the fourteenth,
did not recover of the relapse before the eleventh.
Several of the sick had the fever so slightly, that they were able to
walk abroad; but, notwithstanding this mildness of the symptoms, the
disease continued the same number of days as in the others.
Though this fever was not in its own nature very dangerous, yet it
proved fatal to many, particularly in the months of _April_ and _May_,
when the number of the sick was very great, and the fever was of long
continuance. The increase of its mortality was probably owing to bleeding
and purging, which were often used by the natives towards the eleventh
day of the disease, and to which they were prompted by the spontaneous
hæmorrhages, and an impatience under the long duration of the fever;
but it seldom happened that any evacuations were used after the eighth
day, without manifest detriment to the sick, either by retarding their
recovery, or sinking them irretrievably.
Of several hundreds that were treated after the following method, only
two died. As soon as the person was taken ill, he was blooded pretty
largely; next day he took a laxative potion of _infus. sennæ limon._
and manna, and in the evening of that day a gentle anodyne. If he was
strong and plethoric, the bleeding was repeated the third day; but, after
this, blood was seldom, if ever, taken. Nitrous medicines, with a small
proportion of _pulv. contrayerv. composit._ were given every six hours,
and the last encreased or diminished according as the pulse seemed to
require; and towards the end of the disease, or when the pulse was low,
the _pulv. contrayerv. comp. Phar. Edin._ was substituted in its stead. A
glyster of milk, pulp of cassia fistula, or sugar, and a little oil, was
injected every evening till the eleventh, if the head was much confused,
and the body costive, which was generally the case in the first months;
though afterwards, when the disease became more acute, most of the sick
had several stools every day.
When petechiæ appeared, and the heat was intense, with great languor,
moderate cordials, acidulated with _spir. vitrioli_, together with the
above mentioned powders, were repeated as necessity required.
The second day after the crisis, they were purged with the same potion as
at the beginning, and it was repeated at proper intervals, once or twice:
when a tendency to relapses became so general, a decoction of the cortex,
with a small proportion of _elixir vitrioli_, was given to prevent them,
and often with success.
In these relapses, though the symptoms seemed violent, they were seldom
or never blooded. When the vomiting came on, the sick were ordered to
drink quantities of warm water, to wash the stomach; glysters were
occasionally injected, and the medicines before mentioned exhibited.
The patient’s drink was a ptisan, in common use here, made of barley,
grass-roots, and a few injubs, sometimes acidulated with lemon-juice;
their food, weak chicken-broth, with a little rice, or crum of bread,
boiled in it, and now and then a roasted apple.
From the beginning of the summer till the end of _September_, the
chincough was frequent among the children; but though it was very
violent, it much sooner gave way to medicines than I ever knew it; for
by once bleeding, (which was generally with leeches) a few purges, and a
weak solution of gum ammoniac in water, with a small proportion of _acet.
scillitic. & tinct. castor._ they either soon recovered, or the cough
grew much less frequent and violent, and went off entirely in about a
fortnight more.
This year the fever usually attending young children was more frequent
than in others.
Scarcely one intermittent was to be met with this autumn; and the place
was exceeding healthy till the middle of _November_, when a fever became
very frequent (chiefly among children three years old and upwards) with
a swelling in one or both parotids, the maxillary glands, and sometimes
over the whole face.
Bleeding, with a gentle purgative once or twice repeated, and a low diet,
generally cured those that had it the most violently in five or six days,
and such as had it slightly recovered without any assistance in about the
same time; and though this fever continued to affect great numbers all
the year, and till about the middle of _January_ 1753, I did not hear of
any to whom it proved fatal.
_A. D._ MDCCLIII.
With this year commenced a continual fever, which was chiefly confined
to adults, and to the northern suburbs of the city, where the Christians
mostly inhabit.
The disease began with a shivering and nausea, but the patient seldom
vomited. The heat was intense during the first two or three days, the
pulse strong and frequent: the sick did not so much complain of pain, as
of great confusion in their head, and noise in their ears, acute pains
in their back, legs, and arms; which last they could scarcely bear to
move. The tongue was at first white, afterwards yellow, and towards the
height of the disease generally black. From the beginning their aspect
was stupid, and by the sixth day they became delirious; from the seventh
to the ninth petechiæ appeared over the whole body, not round, as usual,
but in irregular figures. The pulse by this time began to sink, and they
were often comatose; from the ninth to the eleventh, a moderate sweat
sometimes broke out, or they had a few loose stools, which seemed to
relieve, and for the present to abate the symptoms; yet the fever always
continued till the seventeenth day, when it began to decline gradually,
and went off without any remarkable evacuation. When the head was much
affected, the urine was pale as water, without any sediment; in some it
was of a blackish cast, like a weak tincture of steel. On the eleventh
day it commonly let fall a white sediment in those who recovered; and
indeed all who were treated in the method mentioned for the continual
fever of last year (with the addition of sinapisms to the soles of the
feet, for they are much averse to blisters) recovered.
Those who were bled to any considerable quantity after the seventh day
generally died on the ninth or the eleventh.
This fever continued to prevail till the beginning of _February_,
when the very cold weather we had at that time put a check to it; so
that, from the beginning to the 20th, I saw but two persons who had
any appearance of it. These, besides the above mentioned symptoms, had
an acute pain in the right hypochonder affecting their breathing, and
bore larger bleeding than could be endured without great injury in the
preceding constitution, and the blood was sizey. Both these patients had
a crisis of the fever by a large hæmorrhage from the right nostril on the
seventh day, and very nearly about the same hour in which they were first
seized. In one of them the hæmorrhage was accompanied by a diarrhœa, and
about a fortnight after he had a regular tertian.
In _January_ several old people had apoplexies, though few proved mortal:
they commonly ended in hemiplegias, which in several, though much
advanced in years, gave way to medicine.
About the 20th of _February_, the continual fever above mentioned, which
had almost totally ceased upon the setting in of cold weather, again made
its appearance, and with additional force. Almost all now had petechiæ,
which were round, very small, and of a purple colour. These, after the
twelfth or thirteenth day, disappeared, without any manifest alteration
in the disease. The urine during the first three or four days was of an
orange colour, and towards the seventh let fall a copious white sediment;
after that it became clear and pale as water till the eleventh or
twelfth; when, though it still retained the same appearance whilst warm,
when cold it let fall a sediment like fine flour, and continued thus till
the end of the disease, which always happened on the seventeenth.
Many of the sick in the fever, both of this and the last year, voided
many worms of the round kind, and towards the height of the disease
almost all were deaf, which last was a good sign; and it may here be
remarked, that these two symptoms are almost common to all fevers in
_Aleppo_.
About the middle of _April_ near one fourth of the people were seized
with violent coughs, which did not either last long with those attacked,
or in the compass of a few days continued to spread any farther.
The _Jews_, who had hitherto kept pretty clear of the fever, though it
was now very common in the city, began to feel its effects severely very
soon after their feast, about the middle of _April_.
In _May_ several of the sick had a critical sweat on the seventh day,
preceded in some by an hæmorrhage from the nose; but all who had this
hæmorrhage, in about five or six days after, had a return of the fever,
which was more violent than at the first attack, and continued five days.
In several those relapses were accompanied with peripneumonic symptoms,
and required bleeding.
Children had hitherto escaped this disease; but in this month (_May_) a
considerable number of them, from nine years old and upwards, were seized
with it. The symptoms and duration were much the same as in adults; only
their most frequent complaint was of pains in the belly, and they voided
worms either by vomiting or stool, chiefly of the round kind.
The number of the sick was much diminished by the beginning of _June_,
and the fever quite disappeared before _July_.
The method pursued in the cure of the fever of last year was attended
with the same success in this; and evacuations after the seventh day, as
in the preceding, so likewise in the present, were always prejudicial,
and often fatal.
The summer-fever, commonly incident to young children in this country,
began this year in _June_, and continued through the summer as customary.
In _July_ a very few were seized with mild dysenteries, others with
intermittents, chiefly quartans; but neither of these distempers were so
frequent as to be termed epidemic.
The ophthalmias, which, according to custom, were epidemic in
_September_, had this particular from other years, that the inflammation
was chiefly external in the palpebræ.
Both this and last year furunculi were frequent on different parts of
the body, but more especially the fingers; in _November_, and part of
_December_, they often broke out in the armpits, but without any other
disorder.
A very few had pleurisies in _December_, and several died suddenly of
apoplexies about this time.
It should have been before observed, that the continual fever of this
year, particularly after the month of _February_, seldom affected one
person in a house, without going through two thirds of the family; but
it was rare to find two sick together, one being generally a few days
recovered before the other was taken ill.