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but in the of the skin. - the pustules
vided into two species, the distinct and confluent; so we have shewn two sorts of eruptions or tumours likewise to attend the plague. In the first and mildest kind of the finall-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 tumours 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 tumours, if the patient recover, like the pustules of the distinct small-pox, come to a just fuppuration, and thereby discharge the disease. In worse cases of the distemper, either instead of these tumours, or together with them, carbuncles are raised. The first appearance of them is a very small indurated tumour, not situate near any of the forementioned glands, with a dusky redness, violent heat, vast pain, and a blackish fpot in the middle of the tumour. This spot is the beginning of a gangrene, which spreads itself more and more as the tumour 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 smallpox with as fatal a consequence ; nay, I have seen cases, when almost every pustule has taken this appearance. Moreover, in both diseases, when emi
nenily malignant, blood is sometimes voided by the mouth, by urine, or the like *. 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 fame in that distemper.
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 speci. fic medicines; but will likewise direct us in the curę 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 : fo in the plague the fame in dications 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 arę not necessary, · When the fever is very acute, a cool regimen commonly fo beneficial in the small-pox, is here still inore 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 * Vid. obferv. et reflex. sur la peste de Marseilles, P: 333
inflamed, makes vomiting not fo generally safe in the plague as in the small-pox. The must gentle emeties ought to be used, none better than ipecacuanhạ ; and great caution must be had, that the stomach or bowels are not inflamed, when they are administered : 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 tumours, 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 tumours are to be treated ip 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 tumours do not come to suppuration, which the carbuncle seldom or never does; but if a thin ichor or malter exudes through the pores ; or if the tumour 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 tumour, or by a crucial fection. And if there is any part mortified, as is usual in the carbuncle, it must be scarified. This being done, it will be neceffary to stop the bleeding, and dry up the moisture with an actual cautery, dressing the wound afterwards with
dossils, dossils, and pledgets spread with the common digestive made with terebinth, cum vitel. ov, and dipped in a mixture of two parts of warmed oil of turpentine, and one part of sp. sal. ammon. or in balf, terebinth. and over all must be put a cataplasm of thepiac. 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 poslible, to make the wound digest, by which the foughs will separate. After this the ulcer may be treated as one from an ordinary abscess.
Farther, in the glandular tumours, 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 tu. mours begin deep in the gland, and often mortify, before the fuppuration has reached the skin, as the physicians in France have found upon diffecting 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 fo 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 fo violent a malignity with out bolder methods than must be taken in ordinary cases.
As for bleeding, by fome accounts from France, Í 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 afsistance only of cooling ptisans, 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 fome 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