Part 8
These Prognosticks I thought my self obliged to take Notice of, by the Method I proposed to my self herein; but that I have omitted many, is to be excused by the Difficulty and Difference of Judgment in these Matters; for such was the delusory Appearance of this Pestilence, that many Patients were lost when they were thought in a safe Recovery; and when we thought the Conquest quite obtained, Death run away with the Victory; whereas others got over it, who were quite given over for lost; much to the Disreputation of our Art.
SECTION VII.
_Concerning the Cure of the late Pestilence._
ALTHOUGH a pestilential Infection is extreamly dangerous, and doubtful as to its Consequences, very few being spared by it, when in its greatest Height, yet we are by no Means to despair in so great a Difficulty, and give up the whole Race of Mankind to Destruction as soon as it comes, but be rather stimulated to greater Endeavours; and, like faithful Ministers of Nature, study all Helps against such common and grievous Calamities.
BUT before we enter upon that Part which seeks Assistance from Medicine, it may be necessary to exhort the infected, that they have due Regard to the Almighty Power, not only in confessing, and seeking Forgiveness for Sin, but in imploring his Blessing upon those Remedies and Means for Recovery which even the most skilful Physician can prescribe.
THE Infected also ought to be admonished that they make their _Wills_, and settle their worldly Affairs, so as to prevent Contention and Law-Suits, least by the Severity of such a Distemper they should chance to be carried off. But this is to be done before they are affected at all in their Understandings by the Disease.
LASTLY, It is likewise to be enjoined the Sick, that they quietly, submissively, and with a chearful Confidence, commit themselves to the Care and Management of their Physicians; And hence appears the Difficulty of that Task to watch over those who are in such imminent Danger; and what variety of Cares lie upon him who undertakes it, and who often falls himself by that Tyrant he is endeavouring to defend others from?
BUT to do Justice to the _Sacred_ Art, in its relieving Mankind in such cruel Diseases, this must eternize the Sons of _Esculapius_, that they seem to be born for the Publick Good, by their Usefulness even in a Pestilence, as well as other more common Calamities of Life; but on this Head I shall forbear saying more, knowing how unworthy I am to give due Honour to so much Worth.
BUT in the Prosecution hereof, as some heretofore have taken a great deal of Pains to no Purpose in finding an _universal specifick_ against the Pestilence, and have imposed many palpable Falsities upon the World under such Pretences; so our modern _Coal-Blowers_ have in like Manner cried up their pernicious Secrets, and wickedly imposed them upon the credulous Populace. Certainly these publick Cheats ought themselves to be deemed pestilential, as their Notions and Practice is abhorrent to all sound Reason: For if the Arguments on both Sides the Question be fairly stated, and one will be convinced, that there never as yet hath been discovered in Nature, the full and absolute Essence of a Pestilence, but that it still remains a Mystery to Mankind; wherefore in this Distemper a Person must proceed, as in all others, by a serious Attention to the manifest Symptoms, and a rational Conformity of the Means of Cure thereunto; and while we hold to this only Rule of Procedure, although the Severity of the Distemper may conquer several, yet many also may be saved.
IT now comes to us to declare what a Physician has to do in this Calamity; as therefore the Disease admits of no Delays, Help must be immediately procured, and the Physician ought to fly to the Patient’s Succour, least, by any Omission, the Case should be got beyond Recovery, and a Person be lost for Want of timely Assistance.
WHEN the Physician is come, he ought to address the Patient with Chearfulness, and blame those Fears and melancholy Apprehensions which give many over too much into the Power of the Distemper, by cutting off all Hopes of Recovery.
LASTLY, according to the general Directory of our College beforementioned, the most generous and efficacious Medicines must be contrived with the utmost Care and Deliberation.
IN the first Place then, whether Phlebotomy is to be practiced or not is justly to be questioned; and indeed I should pass it by here as fatal, but that I know many unskilful and rash Persons, who not only let Blood largely at one Time, but order it likewise to be repeated until the Patient faints.
BUT if the Authority of the Ancients as well as the Experience of the Moderns hath any Weight, and indeed if our own Practice may be regarded, it is highly to be feared, from many Instances, that Bleeding in a genuine Pestilence is not only to be suspected, but charged as pernicious; for we have many times seen the Blood and Life drawn away together; which makes it astonishing to see the Practisers in such Mischief dare to justifie the fatal Error; what is it that indicates this Evacuation, is it intense Heat; or any Turgescency of the Vessels? Or is it to give Vent to the pestilential Poison to make its escape? Certainly nothing to me seems more absurd; for if the other Symptoms do not remit with the Fever, the Patient will be plunged into the utmost Hazard; for how can the Blood and other Juices be depurated, if the febrile Heat is extinguished? not to say any thing of a Suppression of salutary Breathings hereby, a Perversion of the natural Secretions, and Sinking the Spirits.
THEY also are under as great an Error, who fetch their Reasons for this Practice from the Turgescency of the Vessels; for while inordinate Hurries are excited in the Blood, from disagreeing and heterogeneous Particles striving to extricate themselves from one another, there is made thereby only a seeming Plenitude; what Madness then must it be, in order to remove an imaginary Fulness, to sink the necessary Strength by a rash Effusion of Blood?
AND lastly, the morbifick Poison is not of that kind, as to seek an Escape at the Orifice of a Vein, and run out with the flowing Blood; and which (as before proved) affecting chiefly the Spirits, and residing in other Vessels, makes this Method of Cure in a Pestilence impracticable. I will not however deny but that there may possibly be Circumstances in malignant and pestilential Fevers, which may justifie Phlebotomy, as when it is done for Revulsion sake, in too great a Flux of the _Menses_: But in a genuine Pestilence, it is not to be meddled with. There is but one, as I can remember, who survived it in the late Sickness; but it is needless to say any more upon a Subject so plain, and therefore I shall pass to what is of more Consequence.
AS for what concerns the next Means of Remedy, an _Emetick_ may be given in the Infancy of the Disease, where the Stomach is loaded either by over-eating, or by a Crowd of bad Humours, or when there is a Loathing, or a Bitterness in the Mouth; so that any particular Conformation of the Breast and Neck doth not contra-indicate; and amongst these Remedies they are preferrable which plentifully excite Vomiting, without working also downwards.
OF this kind are the _Syr. Diasari Fernelij_, _Syr. Scabios. compos. Oxymel. Scillit._ and chiefly the _Sal Vitrioli_; but the Antimonial Preparations are not so advisable. The Dose of the _Emetick_ ought to be large enough to Empty the Stomach soon; and the Posset-drink used in the Operation, in order to rince off its Coats all Filthiness, is to be impregnated with _Carduus_, _Scordium_, _Meadow-sweet_, _Butterbur_, &c. boiled in it. In my own Practice, I have always found good Service from large Draughts of the Posset-drink above-mentioned, sweetned with _simple Oxymel_, without any other previous _Emetick_ given.
AFTER Vomiting is over, in order to enable the Stomach the better to keep any Alexipharmick Medicines, its Force may be greatly strengthned by adding Stomachicks to the Alexipharmicks: But if a Reaching to vomit prove Symptomatical, _Emeticks_ are by all Means to be avoided; least the Physician (like old Nurses, who are altogether ignorant of the Rules of Practice) should promote that Symptom, which by fruitless Strains waste the Spirits, and sollicit the pestilential Venom into the Stomach from distant Parts; which when fixed there, still irritates into more violent Reachings, that cannot be asswaged by any Remedies.
ALTHOUGH in other Cases a Vomiting may be removed by _Emeticks_, yet in a Pestilence it is dangerous to follow such Practice; because the Malignity, or rather Nitro-saline _Effluvia_, vellicate the Mouth of the Stomach, and so invert its nervous Coats, although empty, as to bring on Convulsions: And some Persons seem to have their Stomachs full, as overloaded with Food, who crave to be freed by Vomiting, which it is by no Means safe to indulge them in, because such a Sensation of Fulness proceeds only from the pestilential Poyson vellicating the Membranes, while the Stomach is it self free from Food, or bad Humours; but what further concerns this Matter, will come to be further considered under the Cure of Symptoms.
MOREOVER, Purges are justly reckoned amongst Medicines of great Efficacy; but whether or no they are to be used in the Case before us, is a Difficulty, and full of Controversy amongst Physicians; and indeed the Varieties in pestilential Diseases, the Differences of Constitutions, the various Complication of Circumstances, the Uncertainty of Seasons, _&c._ do make it impossible to give any general Rules hereupon; wherefore I shall go no further than what my own Practice hath enabled me to judge concerning it.
A Turgescency or Distemperature of Humours do certainly call for an Evacuation this Way; that is, when the Humours are troublesome more by their Quantity than any stimulating Quality; when therefore the Constitution is not able to conquer such a Burthen, neither by Digestion nor Expulsion, Catharticks are certainly necessary to help away the Load, and especially if a Person hath been before eating to Excess.
BUT if this Evacuation be delayed till the Juices have received the pestilential Taint, the Humours are then rather to be depurated, then purged away by Catharticks; and it is certainly better to trust to the Strength of Nature, when Things are gone so far, to do the Work her own Way: And whether or no the Blood is too much fused, or (according to some) coagulated, purging Medicines are certainly to be avoided; for in the first Case they further agitate and fuse the Blood, besides the Hazard of breaking open such Vessels as may not without great Difficulty be again closed; the same Medicines are also hurtful in the Blood’s Coagulation, because they evacuate only the serous Parts, and leave the Remainder more viscid and tenacious, whereby Obstructions are rendred more perverse and unconquerable, and the stagnant Matter without a Possibility of Dilution, and Restitution to its pristine State of Fluidity, as also more strongly inclosing the pestilential Poison at the same Time; it is also greatly to be feared, that in so great an Agitation the morbifick Venom may be drawn to the Bowels, and Sphacelation follow thereupon.
THAT Purging may be also practised with Success, the Strength of the Patient is carefully to be consulted, for where the Spirits are low, or deficient, it may not only prove unsafe, but fatal; and where the Bowels are extreamly stimulated by the Cathartick, and the Humours greatly put into Fusion by its rarifying Qualities, they will be apt to pass off in too large a Profusion.
WHAT can a Person likewise expect to do with a Cathartick, in Disorders of the Spirits? It certainly appears to me more likely to purge away all the Humours of the Body, than re-kindle the Spirits that are oppressed, cloudy, and almost extinct, by such Means; and further, as the Subtilty of the pestilential Poison inclines it rather to escape by the superficial Pores, than the larger Emunctories, this Method is contrary to that natural Tendency, calling it back again from the Circumference to the Center; I cannot imagine what they propose, who even repeat in these Cases their purging Medicines, until they bring both intolerable Pains, and Gripings into the Bowels, and Sphacelations, as beforementioned.
BUT if after all Considerations any Person thinks it proper to purge, it ought to be certainly done in the Beginning of the Infection, and with somewhat that operates speedily; and to which Purpose those in Liquid Forms answer best, as for Example:
℞ _Aq. Angelicæ simpl. Tartarizatæ +℥ ij.+ Syr. de spinâ Cervinâ +℥ j.+ Elix. proprietatis Crollii vel Antipestilentialis +℈ j.+ & interdum +ʒ [ss.]+ +dissolve+ salis absynthii gr. +viij.+ M. S. Fiat haustus horâ commodâ, & typo remittendo dandus._
A Solution also of _Pil. Ruffi_ from ʒ [ss.] to ʒ j. may be made in _Marigold Water_, by those who like that better. They who please likewise may use the following:
℞ _Extract. Pilularum Ruffi +ʒ ij.+ resin zalapii +℈ j.+ trochisc. de rhabarb. +ʒ j.+ gum. ammoniaci in aceto scillit. soluti +ʒ j.+ salis Tartari, absynthii +ana+ gr. +viij.+ cum tinct. Theriacali q. s. fiat massa, è cujus +ʒ j.+ conglobentur pilulæ +vij.+, vel +viij.+ Dos. in constitutione athleticâ ad +℈ ij.+ prout medico visum fuerit varianda._
IN a Disease that will admit of no Delay, it is best to evacuate but little, yet that not slowly; so that the morbid Humours may be expelled at the first Seizure, before they have received the pestilential Taint, and before its Virulence hath reached to the whole Mass of Fluids: For it is certain that no Digestion is to be expected in this Case, and therefore can there be no Room for _Alterants_ or _Digestives_: But when the Body is very costive, I judge it most convenient and safe to do this with Suppositories.
BUT all Authors and practical Physicians agree in this, to throw out the pestilential Malignity as soon as possible; which is expeditiously and surprizingly done by _Alexipharmicks_; and to these, as soon as the Belly is loosned, Recourse must speedily be had, as to a sacred Refuge: And there is such Plenty of Remedies of this kind, that Nature seems to have had more than an ordinary Indulgence and Forecast, in providing against this destructive Enemy of Mankind; nor hath the medicinal Art been likewise wanting in supplying us with many Preparations of _Simples_, that are powerful against so grievous a Destroyer. But in this great Choice it behoves us to select those which are most efficacious; for this Distemper, which is certainly the most tyrannical of any that besets a humane Body, may be sometimes conquered in its Infancy, which when got to a Head, is not to be managed by the greatest Efforts of humane Skill.
AMONGST the Simples of the three Kingdoms, to begin with the Vegetable, _Virginian Snake Root_, when fresh and fragrant, is the most efficacious; insomuch indeed that I have often admired, that such great Vertue should reside in such minute Fibres, having a Tast very pungent, and a quick aromatick Scent, and discovering somewhat wonderful and almost supernatural; so that it deservedly is accounted the most efficacious and generous _Diaphoretick_ and _Alexipharmick_ for expelling the pestilential Poison. Its Dose, finely powdered, is from _gr._ iv. or vi. to ℈ ij. in any proper Vehicle, due Regard being had to the Strength and Age of the Patient.
THE next Place is justly given to the _Contrayerva-Root_, from which also a compound Medicine, which I shall hereafter describe, is admirably contrived: The Dose of this in fine Powder is from ℈ i. to ʒ i. in _Angelica_, or _Scordium_ Water, or in Wine, _&c._
THERE are other Roots likewise which daily Experience hath taught us to be very good for the same Purposes; and with which, as Occasion requires, many valuable Compounds are formed, in order to effect that with a united Force which they could not do singly; in this Class are the Roots of _Angelica_, _Scorzonera_, _Butterbur_, _Masterwort_, _Tormentil_, _Zedoary_, _Garlick_, _Elicampane_, _Valerian_, _Birthwort_, _Gentian_, _Bittany_, and many others, which any Person that loves Variety may find in proper Authors.
BUT even Gratitude obliges me not to omit saying somewhat of _Ginger_, which I have prescribed both in the Root powdered, and candied, many Times with great Success, for it is very powerful both to raise a breathing Sweat, and defend the Spirits against the Pestilential Impression.
FROM these Roots may be made Extracts, either with Spirit of Wine or Vinegar; for it is agreed by all, that the more subtil Particles collected together, and divested of their grosser and unprofitable Parts, become more efficacious in Medicinal Cases.
THE Leaves of Vegetables most used in Practice, are _Scordium_, _Rue_, _Sage_, _Veronica_, _Dragon_, the _lesser Centaury_, _Scabious_, _Pimpinel_, _Marygolds_ and _Baum_, and from which, on Occasion, are several _Formulæ_ contrived.
GOOD Vehicles to wash down and facilitate the taking more efficacious Medicines, are made of the Waters distilled from those Herbs while they are fresh and fragrant (having not yet lost their volatile Salt;) for those which are commonly kept for Ornament in the Shops are insipid, and of little or no Worth.
A _Clyssus_ also of the same Herbs is preferrable to the Waters, made after this Manner, let a Quantity of Water be drawn from the green and succulent Plant, and the Juice be expressed from another Parcel of the same Herb, and depurated by standing; let then both be evaporated to the Consistence of _Honey_, and from it a Tincture drawn with some more distilled Water and a little Spirit of Wine, which is again by Evaporation to be reduced into an Extract; also from the dryed Plant draw its essential Oil, and from the _Residium_ after Distillation the Salt. Of the Extract take ʒ iv. of the _Salt_ ℥ [ss.], and of the _Oil_ 50 drops, and mix them together, where let them lie to incorporate more intimately with one another. The inspissated Juices likewise of these Ingredients are of good Effect, and in the Winter, Decoctions may conveniently be made of them for the same medical Purposes; and further, that the Remedies in this Case may be yet the more efficacious, they may be joined with _Alkaline-Salts_ dissolved in a proper _Menstruum_: For by this Means the Tone of the Stomach will be strengthened, Putrefaction will be prevented, the nitro-saline _Effluvia_ will be resisted, or at least precipitated, and a _Diaphoresis_ promoted.
SOME Berries are also of great Use in Practice; as the Powder of _Ivy-Berries_ given to the Quantity of one Dram in two Parts of _Elder Vinegar_, and One Part of _White-Wine_; the Spirit likewise drawn from _Elder-Berries_ would do the same in a Dose of ℥ iij. or ℥ iv. the Spirit of _Juniper Berries_ given to ℥ i. a Spirit drawn from green _Walnuts_, with _Treacle-Water_, as also from the Seeds of _Carduus_, _Citrons_, &c. had likewise their due Recommendations in powerfully promoting Sweat.
BUT I know nothing amongst the _Simples_ that hath so obtained, for Ages together, as the _Oriental Bezoar_, and which still hath so great a Name; yet without having any Inclination to contradict a received Opinion, I have been so confirmed by a Multitude of Trials, that the Truth will speak for it self, which manifestly denies its Virtues to be at all equivalent to its Value: And I have really given it in Powder many times to 40 or 50 Grains, without any manner of Effect; and I dare affirm that the _Bezoar_ with which I made these Trials was genuine.
THE Powder also of an _Unicorn_’s Horn, so much cried up for an Antidote, never answered any good Expectations, although I had several Dozes of it given me by a Merchant, on purpose to try its Virtues: But that which would cure Pidgeons, Fowls, Cats and Dogs, from Arsenical Poisons, as the worthy Gentleman assured me that did, had yet no Efficacy against the pestilential Virulence: Yet if it was not controverted to this very Day, whether or no there is such an Animal in Being as an _Unicorn_; and it should moreover be granted that the Horn hath these stupendious Virtues; the Price of it would make it purchaseable only by the Rich; whereas in this dreadful Calamity the Populace were chiefly infected; and therefore cheap and common Medicines should be contrived for them by the Physicians; in the Number of which, first occur the _Troches_ of _Vipers_, given to the Quantity of ℈ iv. in compound _Scordium Water_, or the volatile _Salt_ of _Vipers_ given to ʒ [ss.] in the same Vehicle. A very worthy Person sent us from _New-England_ some Troches made of the Flesh of a _Rattle-Snake_, from which I found more Success amongst the Sick, than those we commonly have here.
THE _Powder of Toads_ was likewise prodigiously extolled by every Body; but I found more Success in _Spirits of Hartshorn_, given from ℈ ij. to ʒ i. in _Plague-water_.
A Youth was seized with a great Difficulty of Breathing, and the Arteries hardly beat, and, in short, all Things seem’d to bespeak him in his last Moments; I prescribed him ʒ i. of the forementioned Spirits in ℥ iij. of _compound Scordium Water_; but the Symptoms continuing obstinate, I again repeated the same in three Hours Time with Addition of ℈ i. more; and five Blisters were also forthwith applied, after which in about half an Hour, he began to move his Limbs, and recollect himself, as if risen from the Dead: but at last when all Things were hopeful, there appeared a Discolouration upon one of his Legs, where a Blister had been raised, with a Loss of Sense very near to a Sphacelation; upon this the affected Part was deeply scarified and then fomented, which, with a Repetition of the same Draught twice in a Day, by the Blessing of Heaven, again restored every Thing into a hopeful Way. For this Spirit is of such a fiery Nature, that it immediately disperses through the whole Body; and on Account of its great Volatility, helps to encounter with, and correct the saline, malignant Quality of the Pestilence: But I need say no more than that it is the most powerful _Diaphoretick_ that can be given in any Disease whatsoever.
WHENSOEVER Things are brought to Extremity, some have Recourse to Mineral Preparations, in Order to drive out the Pestilence by mere Force; amongst which the chief are _Mineral Bezoar_, _Sulphur Auratum_, and _Aurum Vitæ_, &c. the Preparations of which are to be met with in chymical Writers.
I am fearful indeed of being too prolix in the Enumeration of Remedies under this Class; although I am very sensible that some _Simples_ prudently chosen may singly encounter a Pestilence with Success, as well as some other Diseases: But because this Evil is usually attended with so many Complications, the Contrivances to oppose it should also, in the Opinion of some, be equally and proportionably complicated; and all Forces drawn up in Battle against it with full Front, in Order to be equal to the Encounter. To this Purpose some of the Sons of _Esculapius_ have invented manifold Compositions; and some of them so prolix, as if they intended a Sacrifice of an _Hecatomb_ to appease the Severity of this tyrannical Destroyer.
IT would be entirely foreign to our Business here, to extract all the Medicines which some Writers abound with for this End; and it is our Business here only to take Notice of those which were made Use of with Success in the late Sickness; and in this Performance both Gratitude and Duty oblige me to begin with such as were ordered by the _College_, amongst which first occurs their _Plague-water_.