Strong robust persons die in a greater proportion than the feeble, the women, and the children : menstruation in women is also said to terminate the plague favourably. In the celebrated plague of Morocco in 1808, the young, strong, and healthy, were first attacked ; then women and children; and lastly valetudinarians and aged persons. This is similar to what happens in ordinary contagious fevers.
It has been a frequent, and is an important question, whether the same individual is subject to the plague more than once.
The opinions differ, unfortunately, on this subject. In Alarseilles, it is said that the convalescents, who, with this expectation, were employed to attend the sick, all re lapsed and died. The same happened in the French army in Egypt, according to the reports of their physicians. On this view, inoculation, which has been proposed as a means of diminishing the violence of the d€ease, must be Jseless.
But Mr. Tully, our latest writer on this subject, who was employed with the British army in Malta, and in the Ionian islands, in this department, maintains an opinion directly the reverse, as far as his own experience is con cerned. At Corfu, twelve persons, who had had the dis ease at different periods, were employed by him in the hospitals and lazarettos, and they all escaped ; as did four soldiers, who were employed as orderlies in the same situation. Among the expurgators in the lazarettos, there were also many persons who had had the plague many years before, in Smyrna and at other places. These all escaped infection ; and indeed such was their own confidence in their immunity, that they made use of no precaution. Mr. Tully concludes by remarking, that he never wit nessed a single relapse, nor any instance where a person took the plague a second time. Some irregular febrile symptoms were indeed observed during the period of convalescence, but in no case was it any thing like a re lapse.
It is admitted that, in any febrile attack, ancient pesti lential buboes have become painful and inflamed. These affections seem often to have been mistaken for attacks of the plague, and have probably given rise to the opinion of its return when it has not been present. In this state at present remain the notions of physicians on this part of the subject.
Treatment of the Plague.
That this disease does sometimes terminate by the as sistance of nature alone, gives ground to hope that medi cal treatment may really be of use. The two chief errors hitherto seem to have been, that a specific against the plague might be found, and that, being a highly putres cent disorder, it was to be treated by cordials and stimu lants. Others, again, finding the symptoms variable, have been content to attack these as they arose, without adopt ing any fixed principles of cure. The treatment, in short, has been chiefly of an empirical nature.
In the plague which appeared in the French army at Jaffa, bark, famarinds, coffee, and camphor in large doses, were among the remedies employed, but without success, as were sudorifics, emetics, and blisters. Bleeding was
thought to be of advantage when the season was coldest. At Damietta, the same means were all resorted to with as little success, though it was thought that blisters were useful. From these reports, bleeding and blisters appear to be the only remedies that have been attended with any advantage.
In the plague of Vicenza, in 1576, Massaria found that bleeding was of great use, and that purgatives were inju rious. Laxatives alone were admissible. in a subsequent plague in Italy, in the following autumn, advantages were also derived from bleeding, by Septa!, a Milanese physi cian. Pct this practice had not the same success at Rome at the same time ; and Fallopius relates, that out of a thou sand persons bled by one physician, only two were saved. The same uncertainty has appeared in the current prac tice of the Levant ; the Greek physicians having some times found bleeding advantageous, and, in other cases, quite ineffectual.
Whether these differences are to be attributed to the climate or the season, is uncertain ; but it is probable that, from some cause or other, the condition of the disease varied on those different occasions. Clear indications for this practice seem to lie in the circumstances of a youthful and plethoric habit, a strong pulse, violent headach, and oppressed respiration. This practice is also indicated if there have been previously suppressed hemorrhages or other evacuations, and if the season is cold, as in winter and spring. But without the presence of these symptoms, it is probably an inefficacious or dangerous remedy.
When the stomach or intestines are loaded, emetics or laxatives seem to be indicated, according to the circum stances. In small-pox and in fevers, this practice is alike useful ; but unless these symptoms were present, it does not seem safe to adopt it in the plague. That the stomach is not necessarily affected in this disease, is certain ; since, even when buboes are present, the patients have been sometimes known to preserve their appetite. As diarr hoea is a dangerous symptom, it seems judicious to avoid any thing which may bring it on.
The slighter cases seem best abandoned to nature ; sup plying the patient only with light aliment and the ordinary drinks in fevers. When the nervous system seems much affected, or the vital forces are much depressed, with faint ings, violent delirium, or convulsions, and when the erup tions do not appear, or there arc only petichix, it becomes a question, whether the common cordials and alexiphar macs are really advantageous or not. It seems safest at present to regulate our practice on these occasions by that usual in the typhus.
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