A Discourse on the Plague by Richard Mead (early readers txt) 📕

This Analogy between the two Diseases, not only shews us, that we cannot expect to cure the Plague any more than the Small-Pox, by Antidotes and Specific Medicines; but will likewise direct us in the Cure of the Distemper, with which we are less acquainted, by the Methods found useful in the other Disease, which is more familiar to us.

In short, as in the Small-Pox, the chief Part of the Management consists in clearing the Primæ Viæ in the beginning; in regulating the Fever; and in promoting the natural Discharges: so in the Plague the same Indications will have Place. The great Difference lies in this, that in the Plague the Fever is often much more acute than in the other Distemper; the Stomach and Bowels are sometimes inflamed; and the Eruptions require external Applications, which to the Pustules of the Small-Pox are not necessary.

When the Fever is very acute, a cool Regimen, commonly so beneficial in the Small-Pox, is here still more necessary. But whenever the Pulse is languid, and the Heat not excessive, moderate Cordials must be used.

The Disposition of the Stomach and Bowels to be inflamed, makes Vomiting not so generally safe in the Plague as in the Small-Pox. The most gentle Emetics ought to be used, none better than Ipecacuanha; and great Caution must be had, that the Stomach or Bowels are not inflamed, when they are administer’d: for if they are, nothing but certain Death can be expected from them: otherwise at the beginning they will be always useful. Therefore upon the first Illness of the Patient it must carefully be considered, whether there appear any Symptoms of an Inflammation having seized these Parts: if there are any Marks of this, all Vomits must be omitted; if not, the Stomach ought to be gently moved.

The Eruptions, whether glandular Tumors, or Carbuncles, must not be left to the Course of Nature, as is done in the Small-Pox; but all Diligence must be used, by external Applications, to bring them to Suppurate. Both these Tumors are to be treated in most respects alike. As soon as either of them appears, fix a Cupping-Glass to it without scarifying; and when that is removed, apply a suppurative Cataplasm, or Plaster of warm Gums.

If the Tumors do not come to Suppuration, which the Carbuncle seldom or never does; but if a thin Ichor or Matter exudes through the Pores; or if the Tumor feel soft to the Touch; or lastly, if it has a black Crust upon it, then it must be opened by Incision, either according to the length of the Tumor, or by a crucial Section. And if there is any Part mortified, as is usually in the Carbuncle, it must be scarified. This being done, it will be necessary to stop the Bleeding, and dry up the Moisture with an actual Cautery, dressing the Wound afterwards with Dossils, and Pledgits spread with the common Digestive made with Terebinth. cum Vitel. Ov. and dip’d in a Mixture of two Parts of warmed Oil of Turpentine, and one Part of Sp. Sal. Ammon. or in Bals. Terebinth. and over all must be put a Cataplasm of Theriac. Lond.

The next Day the Wound ought to be well bathed with a Fomentation made of warm aromatic Plants with Spirit of Wine in it; in order, if possible, to make the Wound digest, by which the Sloughs will separate. After this the Ulcer may be treated as one from an ordinary Abscess.

Farther, in the glandular Tumors, when they suppurate, we ought not to wait, till the Matter has made its way to the outer Skin, but to open it as soon as it is risen to any Bigness: because these Tumors begin deep in the Gland, and often mortify, before the Suppuration has reached the Skin, as the Physicians in France have found upon dissecting many dead Bodies.

This is the Method in which the Plague must be treated in following the natural Course of the Distemper. But the Patient in most Cases runs so great Hazard in this way, notwithstanding the utmost Care, that it would be of the greatest Service to Mankind under this Calamity, if some artificial Discharge for the corrupted Humours could be found out, not liable to so great Hazard, as the natural Way. To this Purpose large Bleeding and profuse Sweating are recommended to us upon some Experience.

Dr. Sydenham tried both these Evacuations with good Success, and has made two very judicious Remarks upon them. The first is, that they ought not to be attempted unless in the Beginning of the Sickness, before the natural Course of the Distemper has long taken Place: because otherwise we can only expect to put all into Confusion without any Advantage. His other Observation is, that we cannot expect any prosperous Event from either of these Evacuations, unless they are very copious: there being no Prospect of surmounting so violent a Malignity without bolder Methods than must be taken in ordinary Cases.

As for Bleeding, by some Accounts from France, I have been informed, that some of the Physicians there have carried this Practice so far, as upon the first Day of the Distemper to begin with bleeding about twelve Ounces, and then to take away four or five Ounces every two Hours after. They pretend to extraordinary Success from this Method, with the Assistance only of cooling Ptisanes, and such like Drinks, which they give plentifully at the same Time. Such profuse Bleeding as this may perhaps not suit with our Constitutions so well as with theirs; for in common Cases they use this Practice much more freely than we: Yet we must draw Blood with a more liberal Hand than in any other Case, if we expect Success from it. I shall excuse myself from defining exactly how large a Quantity of Blood is requisite to be drawn, for want of particular Experience: but I think fit to give this Admonition, that, in so desperate a Case as this, it is more prudent to run some hazard of exceeding, than to let the Patient perish for want of due Evacuation.

As for Sweating, which is the other Method proposed, it ought, no doubt, to be continued without Intermission full twenty-four Hours, as Dr. Sydenham advises. He is so particular in his Directions about it, that I need say little. I shall only add, that Theriaca, and the like solid Medicines, being offensive to the Stomach, are not the most proper Sudorifics. I should rather commend an Infusion in boiling Water of Virginia Snake-Root, or, in want of this, of some other warm Aromatic, with the Addition of about a fourth Part of Aqua Theriacalis, and a proper Quantity of Syrup of Lemons to sweeten it. From which, in Illnesses of the same kind with the Goal Fever, which approaches the nearest to the Pestilence, I have seen very good Effects.

Whether either of these Methods, of Bleeding, or of Sweating, will answer the Purpose intended by them, must be left to a larger Experience to determine; and the Trial ought by no means to be neglected, especially in those Cases, which promise but little Success from the natural Course of the Disease.