_Different Methods that have been used towards the Infected, as they
are included in the_ FIVE CLASSES _mentioned above_.
Having finish'd the preceding Relation the Tenth of _November_, and
applying to the Magistrates to procure Writers to copy a sufficient
Number, to satisfie the Desires of all the Persons who have done us the
Honour to consult us on this Subject, those Gentlemen replied, that by
reason they could not get Transcribers enow, they would willingly take
upon themselves the Care of having it printed; so that we have accepted
their Offer, being persuaded that it is the shortest and most commodious
Expedient to answer to all the Consultations that we receive from all
Quarters on this Subject; but having reflected that this same Relation
would be of no Use but to Persons of the Faculty who are instructed and
experienced in the Knowledge and Cure of Diseases, we have thought proper
to add here an Abstract of the different Methods which we have made use of
in treating the different Kinds of diseased Persons contained in the five
Classes mentioned above; presuming that they may be of Service to the
young Physicians and Surgeons that are actually engaged in looking after
infected Persons in divers Places of this Province. And we are the more
readily determined to give this small Instruction to the Publick; since
Mons. LEBRET, first President of the Parliament, and Intendant of this
Province, a Gentleman zealous for its Preservation, and very active in his
Assistance in this time of Calamity, has done us the Honour frequently to
ask of us an exact Account of the Treatment of this Malady.
_The Method used in treating the Sick of the First Class._
If we afford but the least Attention to the Nature of the Symptoms related
in the first Class, that is to say, to the small, unequal, and
concentrated Pulse; to the Shiverings; to the universal Chilliness,
especially in the extreme Parts, and to the almost continual Sickness at
the Stomach; to those Lead-coloured, dismal and cadaverous Faces; it will
be very easy to judge, that we have nothing to do in this Case, but to
prescribe the most active and generous Cordials; such as are _Venice_
Treacle, Diascordium, the Extract of Juniper Berries, the _Lilium_; the
Confection of Hyacinth, of Alkermes; the Elixirs drawn from Substances
that abound the most in a volatile Salt; the Treacle Waters, those of
Juniper Berries of Carmes; the volatile Salts of Vipers, of Armoniack, of
Hartshorn; the Balms the most spirituous; in one Word, all that is capable
to animate, excite and strengthen; augmenting, doubling, and even tripling
their ordinary Dose, according as the Case shall be more or less pressing.
All these Remedies, and others of the same Nature, are without doubt very
proper to animate and raise the almost extinguished Strength of these poor
sick Persons; nevertheless we have with Grief seen almost all of them
perish on a sudden, which presently confirmed us in the Opinion generally
received, that the Malignity of the pestilential Ferment is of a Force
superior to all Remedies; but as we have also seen them succeed in some
particular Cases, there is Room to presume, and one is but too much
convinced of it by fatal Experience, that the Desertion and Inactivity of
the greatest Part of the People who might have given Assistance, that the
Want of Nourishment, of Remedies and Attendance, that the fatal Prejudice
of being seized by an incurable Distemper, that the Despair of seeing ones
self abandoned without any Relief, one is, I say, well convinced that all
these Causes have not less contributed than the Violence of the Disease,
to the sudden Destruction of so great a Number of the Sick, not only of
this first Class, but also of the following; seeing that in Proportion as
this mortal Fear of the Contagion is diminished, and that one is mutually
assisted, that the Hopes and Courage of the People are returned; that, in
one Word, the good Order is re-established in this City by the Authority,
Firmness and Vigilance of the Chevalier _de_ LANGERON, by the great Care
of the Governor, and by the constant and indefatigable Endeavours of the
Sheriffs; one has beheld the Progress and Violence of this terrible
_Scourge_ to diminish insensibly, and we have been more successful in
curing the infected.
Returning then to the Method proposed to treat the sick Persons of this
First Class, supposing that by the Remedies mentioned, we were able to
revive their dying Forces, and to disengage them from the sad Condition
described above, it would remain to examine with Attention the new Changes
and Accidents that would arise, which according to our Observations, may
be reduced to some of those we have related under the following Classes,
and ought by consequence to be treated by some of the Methods which we
shall now deliver.
_The Method used in treating the Sick of the Second Class._
The Treatment of the Sick of this Second Class has much more employed us
than the preceding, in respect to the Multiplicity and Variety of
Accidents that offer at the same time several Indications to satisfy.
All these Indications, however, may be reduced to two principal ones,
which demand the greater Attention and Prudence, since they are opposite;
for we have observed in the same Patient a strange mixture of Tension and
Relaxation, of Shivering and Heat, of Agitation and Sinking; insomuch,
that we were obliged constantly to endeavour at the expulsion of the
noxious Ferments lodged in the _primae Viae_, or dispersed through the
whole Mass of Blood, without exasperating them at the same time; or to
correct and lessen their Action, without weakening the Patient. We ought,
for Example, to vomit or purge without irritating or exhausting; to
procure a free Perspiration or Sweating, without too much animating or
inflaming; to fortify without augmenting the Heat contrary to Nature;
lastly, to dilute and temperate without overcharging or relaxing. And this
is what we have endeavoured to execute by the following Method.
Suppose that we were called at the Beginning, and before the Patient was
exhausted, we should order immediately a Medicine proper to cleanse the
Stomach, that is to say, a gentle Vomit, such as is the _Ipecacuanha_, in
a Dose proportioned to the Age and Temperature of the sick Person, to be
taken in a little Broth or common Water; we have seldom used the Emetick
Tartar or _Vinum Benedictum_, for fear of too great Irritations, unless we
had to do with very robust and plethorick Bodies, or that some particular
Accident seemed to demand them; we promoted the Operation of the Medicine
by a large quantity of warm Water, or of _Tea_, or a Decoction of _Carduus
Benedictus_.
The Effect of this first Medicine being commonly a lessening of the
Strength, we endeavoured to fortify, by some gentle Cordial, especially by
_Venice_ Treacle and Diascordium, by reason they are proper to prevent or
stop an over-working of the Vomit.
To these two Remedies succeed moderate and diluting Catharticks, to
cleanse away without irritating the Load of gross Humours which may hinder
the Action of the other Medicines, or prevent their free Passage into the
Vessels: These Purges are laxative Ptisans, made with Sena and Crystal
Mineral, ordered in Phials; the Decoction of Tamarinds, or vulnary
Infusions, wherein are dissolved Manna and Sal Prunel; the Diluta-Cassiae;
Syrupus de Chichorco cum Rhab.; to which then succeed the Cordials and
gentle Alexipharmacks, for the Reasons given above; that is to say, to
fortify, and to stop the Over-purgings, which would infallibly cause some
fatal Weakness: And supposing that the _Venice_ Treacle and Diascordium
were insufficient to answer this last Indication, we would add sealed
Earth, Coral, Bole-Armoniack, which we would render still more efficacious
in Cases of Necessity, by the mixture of some Drops of liquid Laudanum,
which has been of service in many Cases, not only in stopping the
immoderate Evacuations, but even in the want of Sleep, phrenetick Deliria,
Hemorrhages, and other Symptoms of the same sort.
The Solar Powder of _Hamburgh_, the Mineral Kermes, and other Remedies
that have been communicated to us with great Commendations, have been also
used, both as Emeticks and Catharticks; and have sometimes with success,
answered both those Indications: And at the same time, in some certain
Cases, we observed they promoted Sweat and Perspiration; but as we have
already remarked, they have always seemed to us insufficient to perform
the Work of a radical Cure, in a Distemper characterised by divers
essential Symptoms.
For what relates to Sudorificks, as soon as we perceive the least
Disposition to a free Transpiration or Sweating, in what time soever of
the Sickness it happens, we have taken care to make use of them, and that
the rather, by reason some infected Persons have escaped by this Method:
Nor are we ignorant how this sort of Crisis is recommended as very
Salutary by all the Authors that have wrote of the Plague: We have had
therefore Recourse to some of the Cordials mentioned above, and
particularly the _Venice_ Treacle and Diascordium; to which may be added
the Powder of Vipers, Diaphoretick Antimony, Oriental Saffron, Camphire,
_&c._ promoting the Effect of these Medicines by the repeated Draughts of
Tea, the vulnerary Infusions of _Switzerland_, the Waters of Scabious,
_Carduus Benedictus_, Juniper Berries, of Scordium, Rue, Angelica, and
others, recommended for pushing from the Center to the Circumference; that
is to say, to depurate the Mass of Humours by the way of insensible
Perspiration without too much Emotion; observing always, that the Patients
are not of a too dry and hot Constitution, or that in forwarding too much
this Sort of Crisis, they do not fall into some fatal Weakness.
The great Heats and intolerable Thirst are allayed by a plentiful and
repeated drinking of Water, wherein Bread has been macerated, Ptisan of
Barley, of Rice, Chicken-Broth, dissolving therein Sal Prunel, or purified
Nitre, mixing by intervals a few Drops of Spirit of Sulphur, or of Nitre
dulcified, or of Vitriol; as also the Confections of Alkermes, Syrup of
Lemons, _de Ovo_, or any other gentle Cordial, to prevent an Over-charge
and Relaxation.
All these Remedies properly made use of, and managed with Prudence, are
sufficient to satisfy the divers Indications of this second Class,
provided the terrible Prejudice of the Impossibility of a Cure, the
Consternation, and the Despair, do not suspend their Action: And we could,
if the Time would permit, give several Instances of such, as being
supported by their Hopes, Courage, and Firmness, have experienced the good
and wholsome Effects thereof: So that Nature being thereby strengthened,
comforted, and freed in part, of the noxious Ferment that oppressed her;
and above all, being delivered from the Danger of the internal
Inflammations, by the means of the external Eruptions, I mean the
Carbuncles, Buboes, Parotides, _&c._ there remains nothing to be done, but
to treat methodically these sorts of Tumours, to which we have
particularly applied our selves from the beginning of the Distemper to the
end; and that with the greater Diligence, by reason, as we have already
remarked, the Destiny of the Patient depended almost always on the Success
of these sorts of Eruptions, the manner of treating which, we shall give
by and by, according their several Varieties.
_The Method used in treating the Sick of the_ THIRD CLASS.
It would be altogether needless to enter into the particulars of the
Method we used in treating the Patients of this third Class, since the
Symptoms they were attack'd with, were the same with those which we have
mention'd in the two preceeding Classes; so that they succeeded mutually
each other, and the Symptoms related in the second Class, were the
Forerunners of those described in the first; whence it is easy to judge
that we have here nothing to do but to use successively the Medicines
mentioned before. The Observation that we thought fit to insert between
the third and fourth Class, and in which it is shown, that several
infected Persons perished in a very short Time with Symptoms very
moderate, or much less violent than what we generally observe the same
Symptoms to be in malignant or common putrid Fevers. This Observation, I
say, may instruct us, that this Sort of infected Persons in whom often
there only appear a small Weakness, and a very great Consternation,
demands as much Care as those in whom the Symptoms are more considerable,
and on the least Appearance of their being seized, there ought immediately
to be used, besides generous Remedies, every Thing that is proper to
sustain their Strength and encourage them.
_The Method of treating the Sick of the_ FOURTH CLASS.
We have nothing here to do, but to cast our Eyes back, on what we have
said above, relating to the Accidents that characterise and terminate the
Plague, in order to judge that this Method should principally turn on the
Manner of treating the Buboes or Carbuncles. The Symptoms, it is true,
that appear at the Beginning in the Diseased of this Class, are nearly the
same with those that show themselves in the sick Persons of the second
Class; so we immediately employ'd the Remedies proper to oppose them, such
as are the gentle Emeticks, the diluting Catharticks and Sudorificks of
the same sort, according to the Indications that arise, observing however
a very exact Regimen. But the Destiny of the Infected, depending
principally, as we have remarked already, on the large Emption, and
laudable Suppuration of the Buboes and Carbuncles, these Sorts of Tumours
have been always the Objects of our chief Care and Attention. And since
these Tumours have constantly appeared in the Sick of this fourth Class,
and in those of the preceeding, the Method which we are going to propose
for their Management, ought to be consider'd, as common to all the
Classes.
_The Method used in the Treatment of Buboes._
These Tumours were ordinarily situated in the Groin, and often below it,
chiefly swelling the lymphatick Glands, placed near the crural Vessels;
they appeared also pretty frequently under the Arm-pits, particularly
under the pectoral Muscle, as also in the Glands behind and below the
Ears, in the Jugular, and under the Chin.
The Buboes with which the Sick of the former Classes were attack'd, often
appeared at the Beginning of the Distemper, chiefly in the Groin and
Arm-pits, small at first, deep and exceeding painful, that one could
scarce touch or handle them, without causing a very uneasy Sensation;
these for the most Part made no other Alteration in the Skin, but by
swelling it, as they grew bigger, towards the End they became indolent.
In what Time soever of the Distemper these Sorts of Tumours appeared, we
attacked them without any Delay, unless there was Reason to presume from
other Symptoms that the sick Person was at the Point of Death.
If the Tumour was small, deep, painful, and one had Time to endeavour to
mollify it, we began with the Application of emollient and anodyne
Cataplasms, and as the Misery and Desertion would not suffer us to have
Recourse to choice Drogues, we prepared on the Spot, and applied warm, a
Sort of Pultice composed of Crums of Bread, common Water, Oil of Olives,
Yolk of an Egg, or a large Onion roasted in the Ashes, which we first
hollowed, and filled with Treacle, Soap, Oil of Scorpions or of Olives;
using moreover, for Persons of Condition, Cataplasms made with Milk, the
Crummy Part of Bread, Yolks of Eggs; or with the Mucilage of emollient
Herbs and Roots.
But as the Diseased of the first Classes perish often very suddenly, even
at the Time when we apprehend such an Accident the least, we think it not
adviseable in this Case to prescribe such Sort of Applications; but we
ought immediately to prevent the last Danger, by endeavouring at the
opening of the Tumour, and to that End we caused to be applied without
Delay, all over the Part a Dressing with the caustick Stone, leaving it
there for some Hours, more or less, according to the Depth, Situation,
Bulk of the Parts, and the Constitution fat or lean of the Patient; the
Escarr being made, it must be opened by Incision, without any Delay, in
order to examine the tumified Glands, to dissolve which, there ought to be
apply'd Digestives, after they have been a little scarified; or they
should be extirpated if they are moveable, and can be removed without an
Hemorrhage, which according to our Observations has been always fatal tho'
but moderate. And for this Reason we have thought fit to reject the Method
of extirpating these Tumours, which was made use of before we came to this
City. The Way of opening them immediately by a Lancet, altho' more ready
than that by Cauteries, appears to us in many Cases insufficient, and less
sure, as giving but little Light to view the Part, and leaving very often
after it, Abscesses, Fistula's or Scirrhous Tumours. As to Cupping,
Glasses and Blisters, their Effects seem to us slow, useless, and that of
the Latter sometimes dangerous; in certain Subjects their Application has
been followed by internal Inflamations, especially in the Bladder.
Returning then to our Caustick Stone, the Escarr being formed, and the
Incisions made with the Precaution of discovering the tumified Glands, in
their whole extent, that no bad Reliques be left behind; the next Thing is
to dissolve the Glands by the means of good Digestives, which may be made
of equal Parts of Balsom of _Arcaeus_, Ointment of Marsh-Mallows, of
Basilicon, adding thereto Turpentine and Oil of St. _John's_ Wort, which
ought to be well mixed, and if there is any remarkable Corruption in the
Part, there ought to be joyned with the Turpentine and Oil of St. _John's_
Wort, the Tinctures of Myrrh, of Aloes, Spirit of Wine camphorated and Sal
Armoniack; lastly deterging and cleansing away the Pus and _Sanies_,
whilst it is thick and too corrosive, with Lotions made of Barley Water,
Honey of Roses, Camphire; or with vulneraine Decoctions of Scordium,
Wormwood, Centaury the less, and Birthwort. And when the Ulcer has been
well deterged, and the tumified Glands entirely consumed by Suppuration,
there remains nothing but to apply a simple Plaister to bring the Wound to
a Cicatrice.
We shall now give in few Words, the Method we used in the Cure of
Carbuncles, which in many Circumstances have a near Relation to the
preceeding.
_The Method used in the treating Carbuncles._
We have observed these sort of Tumours during the whole Course of the
Sickness, in a very great number of diseased Persons in all the Classes,
though less frequent than the Buboes; remarking also very often in the
same Subjects, these two sorts of Emptions.
The Carbuncles present themselves in different Places on the Surface of
the Body, especially in the Thighs, Legs, Arms, Breast, Back, but very
rarely in the Face, Neck, or Belly.
They appear at first under the Form of a Pustle or Tumour, which is
whitish, yellowish, or reddish, Pale in its middle, or inclining to an
obscure Red, which becomes insensibly blackish, crustaceous, especially
about the Edges; as also variegated with divers Colours; so that,
according to that which is predominant, and the Excess or Defect of
Sensibility and Elevation, we may give it the Name of a Phlegmonick,
Erysipelatous, or gangrened Carbuncle.
We immediately attack all these sorts of Carbuncles by Scarification,
making the Incision to the Right and to the Left, in the Middle, and on
the Edges, to the Quick; and if the Escarr is Thick and Callous, we take
away all the Thickness, and what is Callous, as much as the Situation of
the Parts will permit.
We have not thought proper to use here the actual or potential Cauteries
which are employed in our Province, in the case of common Carbuncles,
because, having made Trial of them at the Beginning, we observed that they
caused Inflammations so considerable, that a Gangrene presently ensued,
and its Edges became Callous again: The Caustick Stone succeeded not but
in small Carbuncles, which heal of themselves, almost without any Help.
After having scarified these Tumours, we applied Pledgets with good
Digestives, as in the Case of Buboes, only with this Difference, that we
have left out the suppurating Ingredients, using only the Treacle, Balsam
of _Arcaeus_, and Oil of Turpentine; and if there is much Corruption, we
add the Tinctures of Aloes, of Myrrh and Camphire, _&c._
We put over the Pledgets, emollient and anodine, or spirituous and
dissolving Cataplasms, as over the Buboes, according to the diversity of
Indications. In the Course of the Dressings, the Lotions and Injections
are also employed the same as for the Buboes, according to the Exigence of
the Case. And, if in the Process of Suppuration, the new Flesh be so
sensible, that the Digestives applied cause a very great Pain, as we have
seen it often happen, then we substitute in their room Pledgets with
Unguentum Nutritum, with very good Success.
_The Method relating to the Sick of the_ FIFTH CLASS.
We believe it will be useless to give every particular of the Method that
has been followed, and which is still actually used in the Cure of the
diseased of the Fifth Class, wherewith the Hospitals are filled; because
they being afflicted with no other Symptom besides the Buboes and
Carbuncles ill looked after, or neglected, and by consequence, nothing
here offers it self but the Abscesses, Ulcers, Fistula's, Scirrhus's, and
Callus's, which Negligence, or an ill Treatment have left behind them; so
that there is here nothing farther required, but to put in Use the Method
laid down above, or to employ the Means practised in the like Cases,
according to the Rules of Art.
We shall remark, in concluding, that all the Methods we have here
proposed, are not so general, or constant, as to be without Exceptions, in
respect to certain particular Cases, which have fallen under our
Observation during this terrible Sickness, and which may furnish Materials
for a more exact Account. But what we have already delivered may be
sufficient to instruct the young Physicians and Surgeons, that are
employed in attending Infected Persons; and at the same time, to let the
Publick know what Opinion ought to be had of all those singular Methods,
and of those pretended Specificks so cried up by the Populace, and by the
Empericks.
_FINIS._
Transcriber's Notes:
Long "s" has been modernized.
The following misprints have been corrected:
"MARSELLIES" corrected to "MARSEILLES" (page 5)
"funish" corrected to "furnish" (page 38)