Title: A Succinct Account of the Plague at Marseilles - Its Symptoms and the Methods and Medicines Used for Curing It
Author: Chicoyneau, Francois, Verney, Soullier
Language: English
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  A SUCCINCT
  ACCOUNT
  OF THE
  PLAGUE
  AT
  _MARSEILLES_,

  Its Symptoms, and the Methods and
  Medicines used for Curing it.


  DRAWN UP

  And presented to the Governor and Magistrates
  of _Marseilles_, by M. _Chicoyneau_, _Verney_
  and _Soullier_, the Physicians who were sent
  thither from _Paris_ by the Duke Regent of
  _France_, to prescribe to the Sick in the Hospitals,
  and other Parts of that Town, during
  the Progress of that Calamity.

  _Translated from the FRENCH by a Physician._


  LONDON:

  Printed for S. Buckley in _Amen-Corner_, and
  D. MIDWINTER at the _Three Crowns_ in St. _Paul_'s
  Church-Yard. M.DCC.XXI.

  (Price Sixpence.)



_The following Relation having been sent to us by Messieurs_ Chicoyneau,
Verney _and_ Soullier, _deputed by the Court for the Relief of our City
afflicted with the Plague: We_ Charles Claude de Andrault de LANGERON,
_Knight and Commander of the Order of St._ John _of_ Jerusalem, _Chief
Commander of the King's Galleys, Field Marshal, and Marshal of his
Majesty's Armies,_ Commandant _in the City of_ Marseilles, _and the
Territories thereof._

Alphonsus de Fortia _Marquis de_ PILLES, _Governing Magistrate, and_
John-Baptiste Estelle, John Baptiste Audimar, John-Peter Moustier, _and_
Balthazar Dieudé, _Sheriffs, Protectors and Defenders of the Privileges,
Franchises and Liberties of this City, Counsellors of the King, and
Lieutenants General of the Police, have thought fit to cause it to be
printed; for having been Eye-witnesses of the Zeal with which these
Gentlemen have exposed themselves for the Service and Relief of our Sick,
as well in the City as in the Hospitals, we are thoroughly persuaded that
their Observations on the Nature of this fatal Malady, and on the Remedies
proper to its Cure, cannot but be very useful to the Inhabitants of divers
Places of this Province that are unfortunately infected._

_At_ Marseilles _this 26 Nov. 1720._



A SHORT RELATION OF THE SYMPTOMS OF THE PLAGUE AT _MARSEILLES_,

Its PROGNOSTICKS and METHOD OF CURE.


To give some Satisfaction to the just Expectations of very many Persons,
as well of this Realm as of foreign Countries, who fearing the dismal
Effects of the Contagion, have done us the Honour to request of us some
Account of the Nature of the Distemper that has depopulated _Marseilles_,
and of the Success of such Remedies as we have employed against it; we
have thought fit to draw up the following Relation, containing in short
what is most essential in this Affair, and which may be sufficient to
intelligent Persons of the Faculty, to direct their Conduct, and help them
in framing a Judgment in the like Case, till we have better Means and a
more convenient Leisure to present to the Publick more exact Particulars
of all that we have observed on this Subject.

All the Diseased that we have seen or attended, in this terrible
Distemper, commonly called the Plague, may be reduced to five principal
Classes; which will take in generally all the Cases that we have observed,
except a few particular ones, which cannot be brought under any general
Rule.


FIRST CLASS.

The First Class, observed especially in the first Period, and in the
greatest Fury of the Distemper, contains such as were afflicted with the
Symptoms that we shall here set down, constantly followed by a speedy
Death.

These Symptoms were for the most part irregular Shiverings, the Pulse low,
soft, slow, quick, unequal, concentrated; a Heaviness in the Head so
considerable, that the sick Person could scarce support it, appearing to
be seized with a Stupidity and Confusion, like that of a drunken Person;
the Sight fixed, dull, wandering, expressing Fearfulness and Despair; the
Voice slow, interrupted, complaining; the Tongue almost always white,
towards the end dry, reddish, black, rough; the Face pale, Lead-coloured,
languishing, cadaverous; a frequent Sickness at the Stomach; mortal
Inquietudes; a general sinking and Faintness; Distraction of the Mind;
dosing, an Inclination to vomit, Vomiting, _&c._

The Persons thus seized, perished commonly in the Space of some Hours, of
a Night, of a Day, or of two or three at farthest, as by Faintness or
Extinction; sometimes, but more rarely, in convulsive Motions, and a Sort
of Trembling; no Eruption, Tumour or Spot appearing without.

It is easy to judge by these Accidents, that the Sick of this kind were
not in a Condition to bear Bleeding; and even such, on whom it was tried,
died a little while after.

Emeticks and Catharticks were equally here useless, and often hurtful, in
exhausting the Patient's Strength, by their fatal over-working.

The Cordials and Sudorificks were the only Remedies to which we had
recourse, which nevertheless could be of no Service, or at the most
prolong the last Moments but for a few Hours.


SECOND CLASS.

The second Class of the Diseased that we attended during the Course of
this fatal Sickness, contains such as at first had the Shiverings, as the
preceding, and the same sort of Stupidity, and heavy Pain in the Head; but
the Shiverings were followed by a Pulse quick, open, and bold, which
nevertheless was lost upon pressing the Artery ever so little. These Sick
felt inwardly a burning Heat, whilst the Heat without was moderate and
temperate; the Thirst was great and inextinguishable; the Tongue white, or
of an obscure red; the Voice hasty, stammering, impetuous; the Eyes
reddish, fixed, sparkling; the Colour of the Face was of a red
sufficiently fresh, and sometimes inclining to livid; the Sickness at the
Stomach was frequent, tho' much less than in those of the preceding Class;
the Respiration was frequent, laborious, or great and rare, without
Coughing or Pain; Loathings; Vomitings, bilious, greenish, blackish,
bloody; the Courses of the Belly of the same Sort, but without any Tension
or Pain; Ravings, or phrenetick Deliria; the Urine frequently natural,
sometimes troubled, blackish, whitish, or bloody; the Sweat, which seldom
smelt badly, and which was far from giving Ease to the Sick, that it
always weakned them; in certain Cases Hemorrhages, which, however
moderate, have been always fatal; a great Decay in the Strength, and above
all, an Apprehension so strong of dying, that these poor Creatures, were
incapable of any Comfort, and looked on themselves, from the first Moment
of their being attacked, as destined to certain Death. But that which
deserves to be well observed, and which has always seemed to characterise
and distinguish this Disease from all others, is, that almost all had at
the Beginning, or in the Progress of this Distemper, very painful Buboes,
situated commonly below the Groin, sometimes in the Groin or Arm-pits, or
in the Parotide, Maxillar, or jugular Glands; as likewise Carbuncles,
especially on the Arms, Legs or Thighs, small, white, livid, black
Pustles, dispersed over all the Surface of the Body.

It was very rare to see any of the diseased of this Second Class escape,
though they supported themselves a little longer than those of the
preceding; they perished almost all with the Marks of a gangren'd
Inflammation, especially in the Brain and Thorax; and that which was most
singular is, that the stronger, fatter, fuller, and more vigorous they
were, the less we had to hope.

As to the Remedies, they bore Bleeding no better than those of the First
Class; at least if they were not blooded at the very first Instant of
their being taken Sick: It was evidently hurtful to 'em; they grew pale,
and fell even in the time of their first Bleeding, or a little while
after, into such Faintings, as could not in most of them be imputed to any
Fear, Repugnance, or Distrust, since they demanded with Earnestness to
have a Vein opened.

All Emeticks, if we except _Ipecacuanha_, were very often more hurtful
than useful; causing such fatal Irritations and Excesses in operating, as
we could neither moderate or stop.

The Catharticks that were a little strong and active, were attended with
the same Inconveniences.

Such as we prescribed in the Form of a laxative Ptisan, as well as
plentiful Draughts, that were diluting, nitrous, cooling, and gently
alexiterial, gave some Relief, but did not hinder the Return of the
Symptoms.

All Cordials and Sudorificks, if they were not soft, gentle and benign,
did nothing but promote the Progress of the inward Inflammations.

In short, if any one escaped, which was very rare, he seem'd to owe his
Cure to the external Eruptions, when they were very much raised; either
solely by the Force of Nature, or by the Assistance of Remedies, as well
internal as external, that determined the Blood to discharge on the
Surface of the Body, the noxious Ferment wherewith it was infected.


THIRD CLASS.

The Third Class contains the two preceding; seeing we have attended,
during the Course of this terrible Sickness, a great Number of Persons
that have been attacked successively with the different Symptoms
enumerated in the two former Classes, in such a manner, that the most part
of the Signs described in the Second, were commonly the Forerunners of
those which we have mentioned in the First; and the appearing of these
latter Symptoms denounced an approaching Death.

In these sorts of Cases we varied our Method according to the diversity of
Indications, or of the most urgent Symptoms; so that without our being
obliged to enter into farther Particulars, a Judgment may be formed of the
Event of this Malady, and of the Success of the Remedies, from what we
before observed on the Subject of the diseased of the two preceding
Classes.

Before we pass on to the Fourth Class, we believe it will not be improper
to observe, that a very great Number of different Kinds of diseased
Persons contained in the preceding, had very moderate Symptoms, whose
Force and Malignity appeared to be much less, than in those of the same
Accidents daily observed in inflammatory Fevers, or in the most common
putrid ones, or in those that are vulgarly called Malignant, if we except
the Signs of Fear or Despair, which were Extream, or in the highest
Degree; insomuch, that of the great Number of infected Persons who have
perished, there were very few, who at the very first Moment of their being
seized, did not imagine themselves lost without Relief, whatever Pains we
took to encourage them: And though many amongst them seemed to us, before
the first Access of the Distemper, to be of a firm and courageous
Disposition of Mind, and resolute under all Events, yet as soon as they
felt the first Strokes, it was easy to know by their Looks, and their
Discourses, that they were convinced that their Sickness was Incurable and
Mortal, even at the Time when neither the Pulse, nor the Tongue, nor the
Disorder in the Head, nor the Colour of the Face, nor the Disposition of
the Mind, nor lastly, the Lesion of any of the other natural Functions
mentioned above, gave any fatal Indication, or before there were any
Grounds to be allarmed.


FOURTH CLASS.

The fourth Class contains the Diseased attacked with the same Symptoms
with those of the second, but these sorts of Accidents lessened or
disappeared the second or third Day of themselves, or in Consequence of
the Effects of the internal Remedies, and at the same time in Proportion
to the remarkable Eruption of the Buboes and Carbuncles in which the
noxious Ferment that was dispersed through the whole Mass, seemed to be
collected together; so that the Tumours rising from Day to Day, at length
being open, and coming to a Suppuration, the Infected escaped the Danger
that threatned them, provided they had some Assistance.

These happy Events have determined us to redouble our Care during the
whole Course of this Sickness, to accelerate, as much as the State of the
Patient will admit, the Eruption, Elevation, Opening, and Suppuration of
the Buboes and Carbuncles, in order to free, as soon as possible, by this
way, the Mass of Blood, from the fatal Ferment that corrupts it; aiding
Nature by a good Regimen, and by such cathartick, cordial, and sudorifick
Medicines, as are proper in the present Condition and Temperature of the
Sick.


FIFTH and LAST CLASS.

This Fifth and Last Class contains all such infected Persons, as without
perceiving any Emotion, or there appearing any Trouble or Lesion of their
natural Function, have Buboes and Carbuncles, which rise by little and
little, and easily turn to Surpuration, becoming sometimes scirrhous, or
which is more rare, dissipate insensibly, without leaving any bad Effect
behind them; so that without any loss of Strength, and without changing
their manner of Living, these infected Persons went about the Streets and
publick Places, only using themselves a simple Plaister, or asking of the
Physicians and Surgeons such Remedies as are necessary to these sorts of
suppurating or scirrhous Tumours.

The Number of the infected contained in the two last Classes, were so
considerable, that one may affirm, without any exaggeration, that more
than fifteen or twenty Thousand Persons were found in these sorts of
Cases; and if the Distemper had not often taken this turn, there would not
have been left in this City the fourth Part of its Inhabitants.

We may very well admit a Sixth Class of such as we have seen perish
without any Forerunner, or other manifest Hurt, than only a decay in
Strength; and who being asked concerning their Condition, answered, that
they were not sensible of any Disorder, which for the most part denoted a
desperate Case, and an approaching Death; but the Number of these were
very small in Comparison of such as made up the preceding Classes.

Besides all these Observations, it has happened that amongst so great a
Number of infected Persons, we have seen many particular Cases, wherein,
contrary to our Expectation, and all the Appearance of Reason, the Sick
have perished or recovered; but we are of Opinion that it would be useless
to relate them here, and to give of them a long and tedious Account;
being moreover persuaded that these Sorts of particular Events can serve
as no sure Rule to form a Prognostick, or how to proceed in the like
Distemper. It is therefore more proper to keep to the Observations we have
made, and that the rather, since they are found conformable to those of
our Collegues who have laboured in concert with us in this so painful and
dangerous Work; and who have always professed to relate what they have
seen and observed themselves, without suffering themselves to be
prejudiced by all the Reports that a vain Credulity, a popular
Superstition, the Boastings of Empericks, and the Greediness of making
Profit by the publick Calamity, have spread through this City.

To conclude, the Medicines we have made use of are such, whose Efficacy
and manner of Operation, are generally acknowledged by a long Experience,
to be adapted to satisfy all the Indications reported above; having
moreover not neglected certain pretended Specificks, such as the solar
Powder, the mineral Kernes, Elixirs, and other alexiterial Preparations,
as have been communicated to us by charitable and well-disposed Persons;
but Experience itself has convinced us, that all these particular Remedies
are at the most useful only to remove some certain Accidents, when at the
same time they are often noxious in a great many others, and by
consequence incapable to cure a Disease characterised by a Number of
different essential Symptoms.



AN ABSTRACT OF THE

_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 _primæ Viæ_, 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-Cassiæ;
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 _Arcæus_, 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 _Arcæus_, 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)





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