Part 4 (2/2)
THE Advice to keep at a Distance from the _Sick_, is also to be understood of the _Dead Bodies_; which should be _buried_ at as great a Distance from Dwelling-Houses, as may be; put _deep_ in the Earth; and _covered_ with the exactest Care; but not with _Quick-Lime_ thrown in with them, as has been the Manner abroad: For I cannot but think that _This_, by _Fermenting_ with the putrefying Humours of the Carcases, may give rise to noxious Exhalations from the Ground. They should likewise be _carried out_ in the _Night_, while they are yet fresh and free from _Putrefaction_: Because a Carcase not yet beginning to corrupt, if kept from the Heat of the Day, hardly emits any kind of Steam or Vapour.
AS for those, who must of necessity attend the _Sick_; some farther Directions should be added for their Use. These may be comprehended in two short Precepts. _One_ is, not to _swallow their Spittle_ while they are about the _Sick_, but rather to _spit_ it out: _The other_, not so much as to _draw in their Breath_, when they are very near them. The reason for both these appears from what has been said above concerning the Manner, in which a sound Person receives the Infection. But in case it be too difficult constantly to comply with these _Cautions_, _was.h.i.+ng_ the _Mouth_ frequently with _Vinegar_, and _holding_ to the _Nostrils_ a _Sponge_ wet with the same, may in some measure supply their Place.
THIS is the Sum of what I think most likely to stop the Progress of the _Disease_ in any Place, where it shall have got Admittance. If some few of these Rules refer more particularly to the City of _London_, with small Alteration they may be applied to any other _Place_. It now remains therefore only to lay down some Directions to hinder the Distemper's spreading from _Town_ to _Town_. The best Method for which, where it can be done, (for this is not practicable in very great Cities) is to cast up a _Line_ about the _Town infected_, at a convenient Distance; and by placing a _Guard_, to hinder People's pa.s.sing from it without due Regulation, to other Towns: but not absolutely to forbid any to withdraw themselves, as was done in _France_, according to the usual Practice abroad; which is an unnecessary Severity, not to call it a Cruelty. I think it will be enough, if all, who desire to pa.s.s the _Line_, be permitted to do it, upon Condition they first perform _Quarantaine_ for about twenty Days in _Tents_, or other more convenient _Habitations_. But the greatest care must be taken, that none pa.s.s without conforming themselves to this Order; both by keeping diligent _Watch_, and by _punis.h.i.+ng_, with the utmost Severity, any that shall either have done so, or attempt it. And the better to discover _such_, it will be requisite to oblige all, who travel in any Part of the Country, under the same Penalties, to carry with them _Certificates_ either of their coming from Places not _infected_, or of their pa.s.sing the _Line_ by Permission.
THIS I take to be a more effectual Method to keep the _Infection_ from spreading, than the absolute refusing a Pa.s.sage to People upon any Terms. For when Men are in such imminent Danger of their Lives where they are, many, no doubt, if not otherwise allowed to escape, will use Endeavours to do it secretly, let the Hazard be ever so great. And it can hardly be, but some will succeed in their Attempts; as we see it has often happen'd in _France_, notwithstanding all their Care. But one that gets off thus clandestinely, will be more likely to carry the Distemper with him, than twenty, nay a hundred, that go away under the preceding Restrictions: especially because the _Infection_ of the Place, he flies from, will by this Management be rendered much more intense.
For confining People, and shutting them up together in great Numbers, will make the Distemper rage with augmented Force, even to the increasing it beyond what can be easily imagined: as appears from the Account which the learned _Ga.s.sendus_[93] has given us of a memorable _Plague_, which happened at _Digne_ in _Provence_, where he lived, in the Year 1629. This was so terrible, that in one _Summer_, out of _ten thousand_ Inhabitants, it left but _fifteen hundred_, and of them all but _five_ or _six_ had gone through the _Disease_. And he a.s.signs _this_, as the princ.i.p.al Cause of the great Destruction, that the Citizens were too closely confined, and not suffered so much as to go to their Country-Houses. Whereas in another _Pestilence_, which broke out in the same Place a Year and an half after, more Liberty being allowed, there did not die above _one hundred_ Persons.
FOR these Reasons, I think, to allow People with proper _Cautions_ to remove from an infected Place, is the best Means to suppress the _Contagion_, as well as the most humane Treatment of the present Sufferers: and, under these Limitations, the Method of _investing_ Towns infected, which is certainly the most proper, that can be advised, to keep the Disease from spreading, will be no Inconvenience to the Places _surrounded_. On the contrary, it will rather be useful to them; since the Guard may establish such _Regulations_ for the Safety of those, who shall bring Provisions, as shall remove the Fears, which might otherwise discourage them.
THE securing against all Apprehensions of this Kind, is of so great Importance, that in _Cities_ too large to be invested, as, for Example, this City of _London_, the _Magistrates_ must use all possible Diligence to supply this Defect, not only by setting up _Barriers_ without their City, but by making it in the most particular manner their Care to appoint such _Orders_ to be observed at them, as they shall judge will be most satisfactory to the Country about.
THOUGH Liberty ought to be given to the _People_, yet no sort of _Goods_ must by any means be suffered to be carried over the _Line_, which are made of _Materials_ retentive of _Infection_. For in the present Case, when _Infection_ has seized any Part of a Country, much greater Care ought to be taken, that no _Seeds_ of the _Contagion_ be conveyed about, than when the Distemper is at a great Distance: because a _Bale of Goods_, which shall have imbibed the _Contagious Aura_ when pack'd up in _Turky_, or any remote Parts, when unpack'd here, may chance to meet with so healthful a Temperament of our Air, that it shall not do much hurt. But when the Air of any one of our Towns shall be so corrupted, as to maintain and spread the _Pestilence_ in it, there will be little Reason to believe, that the Air of the rest of the Country is in a much better State.
FOR the same Reason _Quarantaines_ should more strictly be enjoined, when the _Plague_ is in a bordering Kingdom, than when it is more remote.
THE Advice here given with respect to _Goods_, is not only abundantly confirmed from the Proofs, I have given above, that _Goods_ have a Power of spreading _Contagion_ to distant Places; but might be farther ill.u.s.trated by many Instances of ill Effects from the Neglect of this Caution in Times of the _Plague_. I shall mention two, which happen'd among us during the last _Plague_. I have had occasion already to observe, that the _Plague_ was in _Poole_. It was carried to that Place by some _Goods_ contained in a _Pedlar's Pack_. The _Plague_ was likewise at _Eham_ in the Peak of _Derbys.h.i.+re_, being brought thither by means of a Box sent from _London_ to a Taylor in that Village, containing some Materials relating to his Trade. There being several Incidents in this latter Instance, that will not only serve to establish in particular the Precepts I have been giving, in relation to Goods, but likewise all the rest of the Directions, that have been set down, for stopping the Progress of the _Plague_ from one Town to another; I shall finish this Chapter with a particular Relation of what pa.s.sed in that Place. A Servant, who first opened the foresaid _Box_, complaining that the Goods were damp, was ordered to dry them at the Fire; but in doing it, was seized with the _Plague_, and died: the same Misfortune extended itself to all the rest of the Family, except the Taylor's Wife, who alone survived. From hence the Distemper spread about and destroyed in that Village, and the rest of the Parish, though a small one, between two and three hundred Persons. But notwithstanding this so great Violence of the Disease, it was restrained from reaching beyond that Parish by the Care of the Rector; from whose Son, and another worthy Gentleman, I have the Relation. This Clergyman advised, that the _Sick_ should be removed into _Hutts_ or _Barracks_ built upon the _Common_; and procuring by the Interest of the then Earl of _Devons.h.i.+re_, that the People should be well furnished with Provisions, he took effectual Care, that no one should go out of the Parish: and by this means he protected his Neighbours from Infection with compleat Success.
I have now gone through the chief Branches of _Preservation_ against the _Plague_, and shall conclude with some general Directions concerning the _Cure_.
CHAP. III.
_Of the Cure of the Plague._
IT appears, from what has been said in the beginning of this Discourse, that the _Plague_ and the _Small-Pox_ are Diseases, which bear a great Similitude to each other: both being _Contagious Fevers_ from _Africa_, and both attended with certain _Eruptions_. And as the _Eruptions_ or _Pustules_ in the _Small-Pox_ are of two Kinds, which has caused the Distemper to be divided into two Species, the _distinct_ and _confluent_; so we have shewn two Sorts of _Eruptions_ or _Tumors_ likewise to attend the _Plague_. In the first and mildest Kind of the _Small-Pox_ the _Pustules_ rise high above the Surface of the Skin, and contain a digested _Pus_; but in the other, the _Pustules_ lie flat, and are filled with an indigested _Sanies_. The two kinds of critical _Tumors_ in the _Plague_ are yet more different. In the most favourable Case the _Morbific Matter_ is thrown upon some of the softest _Glands_ near the Surface of the Body, as upon the _inguinal_, _axillary_, _parotid_, or _maxillary_ Glands: the first Appearance of which is a small Induration, great Heat, Redness, and sharp Pain near those Glands.
These _Tumors_, if the Patient recover, like the _Pustules_ of the distinct _Small-Pox_, come to a just Suppuration, and thereby discharge the Disease. In worse Cases of the Distemper, either instead of these _Tumors_, or together with them, _Carbuncles_ are raised. The first Appearance of them is a very small indurated _Tumor_, not situate near any of the fore-mention'd Glands, with a dusky Redness, violent Heat, vast Pain, and a blackish _Spot_ in the middle of the _Tumor_. This _Spot_ is the beginning of a _Gangrene_, which spreads itself more and more as the _Tumor_ increases.
BUT, besides the Agreement in these critical Discharges, the two Distempers have yet a more manifest Likeness in those _livid_ and _black Spots_, which are frequent in the _Plague_, and the Signs of speedy Death: for the same are sometimes found to attend the _Small-Pox_ with as fatal a Consequence; nay, I have seen Cases, when almost every _Pustule_ has taken this Appearance. Moreover, in both Diseases, when eminently malignant, Blood is sometimes voided by the Mouth, by Urine, or the like[94]. And we may farther add, that in both Death is usually caused by Mortifications in the _Viscera_. This has constantly been found in the _Plague_ by the Physicians in _France_: and I am convinced, from Accounts I have by me, of the Dissection of a great many, who had died of the _Small-Pox_, that it is the same in that Distemper.
THIS a.n.a.logy 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 _Primae Viae_ 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-Gla.s.s_ 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. c.u.m 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.
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