In respect to the carbuncles, it has already been observed, that
they broke out on all parts of the body, the muscular and tendinous
especially. From the size of a silver penny they often spread themselves
speedily to the extent of an inch and half, two inches, nay sometimes
three inches, diameter, frequently penetrating deep into the substance
of the parts they attacked. Their most common time of appearing was on
the second day of the disease. Their progress was very quick, and not
above one half of the sick had them. In such as died, I was told, (for I
saw none of those cases myself) that from the pustule issued a quantity
of ichorous matter; but the black circle remained hard and dry; in the
others the mortification usually stopped on the third day, and in a
day or two more digested, and began to separate round the edges. The
separation of the whole eschar was completed rather sooner than in such
as are made by a caustic.
A few of the sick had pustules, which were filled with well-concocted
matter, without any livid or discoloured circle about them: these,
after a certain time, dried up, and fell off, as it commonly happens in
the distinct small-pox; and as all the patients who had this eruption
recovered, it was considered as a favourable symptom.
To enumerate all the various changes that happened, with the sudden and
unexpected transitions from extreme danger to great safety, would be
tedious, and little instructive. Such, however, were the general outlines
of the distemper, and the most usual symptoms; which though they by no
means furnish one with the necessary helps to form a certain prognostic,
yet some hints may from thence be deduced for establishing a rational,
and perhaps a successful practice.
Upon considering, however, the several circumstances attending this
fatal distemper, the various shapes it assumes, the sudden transitions
from one appearance to another, the precipitate advances to its
height, and the danger which the physician incurs in visiting the
sick, the wonder ceases, that we meet with in authors so various and
contradictory accounts of the proper methods for treating it. Some plead
for evacuations, others decry them with vehemence: if we allow, that
difference of climates, different constitutions of the air in the same
climate, and perhaps some variety even in the plague itself, might lead
practitioners to judge not always alike concerning it; yet it is not so
easy to reconcile the jarring opinions of those who have practised at
the same time, and in the same place, in respect to this essential part
of management: and as in a disease, wherein reason is often perplexed,
and experience itself fallacious, one would chuse to rely much on proper
authority, it is greatly to be lamented, that nature has not been more,
and opinion less, attended to. As the plague has so often visited that
country, one might reasonably have expected among the natives some
vestiges of unbiassed observation, and attempts at least towards a proper
method of cure; but, so far as I have hitherto been able to discover,
no traces of any thing satisfactory are to be met with among them. The
_Turks_ have less faith in medicine for the cure of this disease than
of any other, believing it to be a curse inflicted by God Almighty for
the sins of the people; and as the chief of those who practise physic
are either _Christians_ or _Jews_, and not so strongly prepossessed
with the doctrine of predestination, consequently afraid of catching
the distemper, they rather endeavour to confirm the _Turks_ in their
false notions, lest they should be forced to visit the sick. Hence it
follows, that the greatest part of those who are seized with the plague,
either are left to struggle with the violence of the disorder without
any assistance, or must submit to the direction of the meanest and most
ignorant of mankind. The practice which seems to prevail most generally
amongst them, is to bleed all who apply to them, and in every stage of
the disease; after which they endeavour to promote sweat by a few grains
of bezoar, in the simple distilled water of scorzonera; which is the
medicine they chiefly confide in, such is the slender acquaintance they
have yet acquired in the _materia medica_.
From the most impartial and attentive observation I could make, it
seemed to me, that very plentiful bleeding at the first appearance of
the disease was of great service; but after the first day was always
prejudicial.
Vomiting was also of the utmost consequence at the beginning: warm water
was commonly sufficient to procure it, as the sick had generally a
propensity to this discharge. If a stimulus was required, a small dose
of _ipecacuanha_ or _sal vitrioli_ was all that was necessary for most
patients.
Though purging with the violent cathartics is justly condemned; yet
an emollient glyster, or even a gentle laxative with manna and _crem.
tartar._ when the patient was costive, and the head much affected, was
not only safe, but often of great service; and, when the symptoms were
not violent, I have frequently given a gentle purge of _infus. sennæ,
mann. & crem. tartar._ the second day of the disease with success. It may
appear strange; but it is a fact confirmed to me by many instances, that
a purgative of this kind, given after the critical sweat, was the most
effectual means to bring the buboes to suppuration.
The natural crisis of the disease was always by sweat; and, when the same
evacuation could be procured by art, it was also of service; but there
were two great inconveniences attending attempts of this kind on the
first day. One was, that the common medicines in the usual doses for this
purpose, if they failed of procuring the desired diaphoresis, threw the
patient into a flame, and greatly augmented all the symptoms: the other
inconvenience was, that though we succeeded in raising a sweat, it was
requisite to continue it a much longer time than most of the people in
that country could be persuaded to endure; and, if checked, it was of bad
consequence, either increasing all the symptoms, or, what was often the
case, bringing on a diarrhœa; which though at first it seemed to relieve,
yet generally proved fatal in the end.
The cordial and diaphoretic medicines found to be most efficacious were,
_Rad. contrayerv._ _Valerian. sylvest._ _Croc. Anglic._ _Pulv. contrayerv.
comp. Pharm. Edin._ and _Theriac. Androm._ or _Diascord._ when a diarrhœa
attended. Anodynes also greatly assisted the other medicines in their
operations; but those of the gentler kind, as _syr. diacod._ seemed to
agree better with the sick than opium.
I made an attempt to try the effects of the cortex in this distemper; but
a popular clamour being raised against that medicine, I thought it most
prudent to desist, as I was convinced that my youth, and the short time
I had then resided in the place, would render any efforts I could make
to get the better of it ineffectual. No fair trial was made of the _rad.
serpentar. Virgin._ because few of the natives would take it on account
of its bitterness: for whoever would obtain a ready compliance with his
orders in that country, must as seldom as possible offend their palates
with unpleasant remedies; because whatever may be the consequence to
themselves, they will often chuse to incur distant, though great risks,
rather than submit to present inconveniences. Small doses repeated every
four hours, was the most effectual method of giving these medicines, and
plenty of diluent liquors, acidulated with spirit of vitriol, not only
assisted in promoting a diaphoresis, but was of the utmost consequence in
moderating the fever, which the cordials and diaphoretics were otherwise
apt to increase.
Nitrous medicines in this disease neither were attended with their usual
success in allaying heat, nor could the sick in general bear the common
doses without a sensible increase of languor and dejection, or danger of
bringing on a diarrhœa.
The following method of treating the sick I found the most successful
upon repeated trials.
As soon as the patient was seized, from 10 to 20 ounces of blood,
according to the present condition of the sick, or violence of the
symptoms, were ordered to be taken from the arm. Seldom more than a pound
however was taken from any; that being a quantity greatly exceeding what
they usually lose at once in any disease.
After bleeding, if the nausea was considerable, they were ordered to
drink plentifully of warm water, (which was presently brought up again,
and with it a quantity of bile), and this operation to be repeated
several times. If the nausea was not sufficient, which was but seldom
the case, a small dose of _rad. ipecacuan._ or _sal. vitriol._ was given
to promote the vomiting. It appeared from experience of such consequence
that those evacuations should be made early, that most of my acquaintance
had previous directions to set about them immediately, in case any
person should be infected in their family.
A gentle anodyne was given after vomiting, or, if that did not
settle their stomachs, _Riverius_’s saline draught, with an ounce of
_diacodium_, or 15 drops of _laudanum_.
These evacuations being premised, small doses of the cordial and
diaphoretic medicines, above mentioned, joined with a very small
proportion of _nitr. stibiat._ were given every four hours; and the sick
were encouraged to drink liberally of a decoction of scorzonera roots
and barley, or even of spring water, but always tepid, if they could be
persuaded to drink it so, and acidulated with as much _sp. vitrioli_, as
to make it agreeable. A certain proportion of this spirit, with syrup of
violets, made it more grateful both to the eye and the palate, and was no
small inducement to them to drink the necessary quantity.
In the winter, the sick were ordered to be removed into a larger and more
airy room, than they were accustomed to sleep in at that season; and the
air to be both warmed and corrected by a moderate fire. In the summer,
all the doors and windows were allowed to be opened, excepting that which
was immediately opposite to the patient’s bed; and many of them would
not even bear that restriction, but would have all open in the day time,
and often in the night lay upon the house top. Their covering was the
same as in health.
A moderate cordial of some of the simple waters, with a little _Tinct.
croci_, _Tinct. Valerian_, _sylv. Confect. alkerm._ well acidulated with
_sp. vitrioli_, and commonly sweetened with syrup of white poppies, was
allowed them when faint or uneasy, and they expressed great satisfaction
upon taking this mixture. For children, this alone, with plenty of
acidulated liquors, was what I chiefly used, and with good success.
When the sick could be persuaded to submit to the above regimen, a sweat
often broke out the second or beginning of the third day, when they were
covered up, and the sweat was encouraged so long as they could bear it.
Whether it proceeded from the carelessness of the attendants, in giving
way to the impatience of the sick, and so not encouraging the sweat
so long as it ought to have been, or from the nature of the disease,
I know not, but certain it is, that this first sweat, particularly if
it happened on the second day, though it greatly relieved the patient,
yet did not entirely carry off the fever. A continuance of the same
medicines, in somewhat larger doses, generally enabled nature to throw
off every subsequent exacerbation by a plentiful sweat, till a compleat
crisis was obtained.
When the sweat was sufficient, and had greatly mitigated the symptoms,
notwithstanding some degree of fever still remained, a mild cathartic was
given the next morning, the other medicines were continued during its
operation, and an anodyne was ordered early in the evening.
When an encrease of the symptoms seemed to be the consequence of a sudden
sinking of the buboes, which sometimes happened on the second or third
day, a blister applied just below the bubo was of service.
Upon the first appearance of a coma, or debility in the tongue, a blister
was applied to the head, and to the other usual parts, as necessity
required. Some patients, who had been deemed past recovery, having
struggled through the disease, and apparently by the use of blisters, at
length brought them into credit, and induced the natives to submit, with
less reluctance, to a practice which they would otherwise have abhorred.
Stimulating cataplasms of one part garlic, and two parts crum of bread,
with the addition of a little vinegar, applied to the soles of the feet,
were of great service in this case; and if the patient was costive,
emollient laxative glysters were injected. The dose of the alexipharmics
was encreased, and diluting acidulated liquors given often in small
quantities.
Suppurating cataplasms were sometimes applied to the buboes, but as they
were kept on with difficulty, the _Empl. Diachyl. cum Gum._ was more
generally used; and when a stimulus was required, a few cantharides, or a
little euphorbium was added. In most of the sick, they were left to open
of themselves, on account of the dread the natives have of the lancet
or caustic, and the want sometimes of proper persons to apply them: and
indeed, by what I observed, none suffered from the long delay in opening
them, farther than the usual inconveniences attending other tumors thus
left to themselves; and they never required any method different from the
common to heal them.
When the buboes mortified, they were treated as the carbuncles; and
though, upon the separation of the mortified parts, the ulcers were often
large and deep, yet they healed very soon.
Sometimes the carbuncles were scarified, but oftener not: the dressings
that agreed best with them, were _Ung. Basilic. Flav._ with a small
proportion of _Ol. Terebinthinæ_, and sometimes _Tinct. Myrrh._ applying
over all an emollient cataplasm; and after the indurated black parts were
separated, they soon healed, without any particular accidents.