vided into two fpecies, the diftinct and confluent ; fo we have fhewn two forts of eruptions or tumours likewife to attend the plague. In the firft and mildeft kind of the finall-pox the puftules rife high above the furface of the fkin, and contain a digefted pus: but in the other, the puftules lie flat, and are filled with an indigefted fanies. The two kinds of critical tumours in the plague are yet more different. In the most favourable cafe the morbific matter is thrown upon fome of the fofteft glands near the furface 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 puftules of the diftinct fmall-pox, come to a juft fuppuration, and thereby discharge the disease. In worfe cafes of the diftemper, either inftead of these tumours, or together with them, carbuncles are raised. The first appearance of them is a very finall indurated tumour, not fituate near any of the forementioned glands, with a dufky rednefs, violent heat, vaft pain, and a blackish fpot in the middle of the tumour. This fpot is the beginning of a gangrene, which fpreads itself more and more as the tumour increases.

But, befides the agreement in thefe critical discharges, the two diftempers have yet a more manifeft likeness in thofe livid and black fpots, which are frequent in the plague, and the figns of fpeedy death : for the fame are fometimes found to attend the fmallpox with as fatal a confequence; nay, I have feen cafes, when almost every puftule has taken this appearance. Moreover, in both difeafes, when emi

far

nently malignant, blood is fometimes voided by the mouth, by urine, or the like. And we may ther add, that in both death is ufually caused by mortifications in the vifcera. This has conftantly been found in the plague by the physicians in France; and I am convinced, from accounts I have by me, of the diffection of a great many who had died of the fmall pox, that it is the fame in that distemper.

This analogy between the two difcafes, not only fhews us, that we cannot expect to cure the plague any more than the small-pox, by antidotes and fpecific medicines; but will likewife direct us in the cure of the distemper, with which we are lefs acquainted, by the methods found ufeful in the other disease, which is more familiar to us.

In short, as in the small-pox, the chief part of the management confifts in clearing the primæ viæ in the beginning; in regulating the fever; and in promoting the natural discharges: fo in the plague the fame 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 diftemper; the ftomach and bowels are fometimes inflamed; and the eruptions require external applications, which to the puftules of the finall-pox are not neceffary.

When the fever is very acute, a cool regimen commonly fo beneficial in the fmall-pox, is here still more neceffary. But whenever the pulfe is languid, and the heat not exceffive, moderate cordials must be ufed.

The difpofition of the ftomach and bowels, to be

* Vid. obferv. et reflex. fur la pefte de Marfeilles,

P: 333

inflamed,

inflamed, makes vomiting not fo generally fafe in the plague as in the fmall-pox. The most gentle emetics ought to be ufed, none better than ipecacuanha; and great caution must be had, that the ftomach 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 firft illnefs of the patient it must carefully be confidered, whether there appear any fymptoms of an inflammation having feized thefe parts: if there are any marks of this, all vomits must be omitted; if not, the ftomach ought to be gently moved.

The eruptions, whether glandular tumours, or carbuncles, muft 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 fuppurate. Both these tumours are to be treated in most respects alike. As foon as either of them appears, fix a cupping-glafs to it without fcarifying; and when that is removed, apply a fuppurative cataplafin, or plafter of warm gums.

If the tumours do not come to fuppuration, which the carbuncle feldom or never does; but if a thin ichor or matter exudes through the pores; or if the tumour feel foft to the touch; or laftly, if it has a black cruft upon it, then it must be opened by incifion, either according to the length of the tumour, or by a crucial fection. And if there is any part mortified, as is ufual in the carbuncle, it must be fcarified. This being done, it will be neceffary to ftop the bleeding, and dry up the moisture with an actual cautery, dreffing the wound afterwards with doffils,

doffils, and pledgets fpread with the common digeftive made with terebinth. cum vitel. ov. and dipped in a mixture of two parts of warmed oil of turpentine, and one part of fp. fal. ammon. or in balf. terebinth. and over all must be put a cataplasm of thefiac. Lond.

The next day the wound ought to be well bathed with a fomentation made of warm aromatic plants, with fpirit of wine in it; in order, if poffible, to make the wound digeft, by which the floughs will feparate. After this the ulcer may be treated as one from an ordinary abfcefs.

Farther, in the glandular tumours, when they fuppurate, we ought not to wait, till the matter has made its way to the outer fkin, but to open it as foon as it is rifen to any bignefs: because thefe tumours begin deep in the gland, and often mortify, before the fuppuration has reached the fkin, as the phyficians in France have found upon diffecting many dead bodies.

This is the method in which the plague must be treated in following the natural courfe of the diftemper. But the patient in most cafes runs fo great hazard in this way, notwithstanding the utmost care, that it would be of the greatest service to mankind under this calamity, if fome artificial difcharge for the corrupted humours could be found out, not liable to fo great hazard, as the natural way. To this purpose large bleeding and profufe fweating are recommended to us upon fome experience.

Dr Sydenham tried both thefe evacuations with good fuccefs, and has made two very judicious remarks upon them. The firft is, that they ought

not

not to be attempted unlefs in the beginning of the fickness, before the natural courfe of the diftemper has long taken place because otherwise we can only expect to put all into confufion without any advantage. His other obfervation is, that we cannot expect any profperous event from either of thefe evacuations, unless they are very copious; there being no profpect of furmounting fo violent a malignity without bolder methods than must be taken in ordinary cafes.

As for bleeding, by fome accounts from France, I have been informed, that fome of the phyficians there have carried this practice fo far, as, upon the first day of the diftemper, to begin with bleeding about twelve ounces, and then to take away four or five ounces every two hours after. They pretend to extraordinary fuccefs from this method, with the affiftance only of cooling ptifans, and fuch like drinks, which they give plentifully at the fame time. Such profufe bleeding as this may perhaps not fuit with our conftitutions fo well as with theirs; for in common cafes they use this practice much more freely than we : yet we must draw blood with a more liberal hand than in any other cafe, if we expect fuccefs from it. I fhall excufe myself from defining exactly how large a quantity of blood is requifite to be drawn, for want of particular experience: but I think fit to give this admonition, that, in fo defperate a cafe as this, it is more prudent to run fome hazard of exceeding, than to let the patient perifh for want of due evacuation.

As for fweating, which is the other method propofed, it ought, no doubt, to be continued without intermiffion full twenty-four hours, as Dr Sydenham

advises.