Chapter VI: Part II (2)

Through the winter the plague had been frequent in _Antab_, _Kilis_, _Azass_, and most of the villages among the mountains _Amanus_; to which places, according to the best information we could get, it had been brought from _Bias_[489], where it had raged the summer before.

The _Chinganas_, who came as usual from these parts, about the middle of _April_, to be hired for reaping corn, brought it with them to _Aleppo_. To these, and a few others in the out-parts of the town, it was confined for some time; and it was not till the 18th of _May_, that we had any notice of it, when, upon strict enquiry, it was found that there had been some seized with the distemper in the city. In a few days, it encreased pretty much among the _Jews_ (who suffered greatly in proportion to their small number this season) and came to be more general through the city and suburbs, where it continued, though in a limited degree, till the beginning of _July_, when the extream heat of the weather put a considerable check to it: some, however, were daily carried off by the disease till near the end of this month, when it entirely ceased. The _Europeans_ shut up[490] this year the beginning of _June_, and continued so about a month.

About the middle of _July_, diarrhœas and dysenteries became very frequent. The discharges at first were bilious, and the gripes violent. A very high fever was a constant attendant often with petechiæ, and other malignant symptoms: plentiful bleeding was always necessary at the beginning; after which an ipecacuan vomit, with a few doses of rhubarb (found most effectual when a few grains of calomel were added) prepared the way for anodynes and gentle astringents: these, with soft mucilaginous aliment, in most instances, compleated the cure; but in several, from a promising appearance, it proved suddenly mortal: this was likewise the case with some in intermitting fevers that were now epidemic, and continued with the dysentery all the autumn. This unexpected fatality happened at times, to such as were not shut up, in all acute diseases during the time of the plague; but buboes, or other signs of that distemper, were seen but seldom[491].

About the beginning of _September_, the small-pox made their appearance, especially amongst children; but being of a mild distinct kind, very little assistance was required from medicine. In _October_ this disease became more frequent; and much the greater part that were seized, had the confluent sort, attended with hæmorrhages, petechiæ, phlyctanæ, and other the worst of symptoms. Convulsions (always violent) on their first seizure, indicated that the pock would flux, and prove fatal. In this confluent kind the eruptions were often discovered on the extremities as soon as the child was observed to be out of order, and never were later in appearing than the end of the second day. These patients generally died on the beginning of the eleventh, reckoning from the first attack, when the distemper was left to nature, as is commonly the case in this country; or, if they survived, yet many of them were afterwards harrassed with corrosive ulcers, carious bones, hard tumors on the glandular parts, difficult either to discuss or bring to suppuration, coughs, and fluxes; which last soon put an end to their miseries. By degrees this great malignancy seemed to wear off; so that by _December_ the disease became mild and favourable, and most of the sick recovered.

The _Jews_ were the most severely afflicted by this sort of small-pox.

Bleeding, bathing the extremities in warm water, with a plentiful use of diluting, antiphlogistic medicines, if used at the beginning, often prevented fatal consequences. Purging in the secondary fever, or after the decline of the disease, is never practised here by the natives; from the neglect of which, perhaps, the dreadful symptoms above enumerated were more frequent; though they often happened when all possible means had been used to prevent them.

Inoculation is only practised here among the Christians, and is not yet general even among them. However, it appears to gain ground daily, though their injudicious method of proceeding in it seems to lay this practice under several disadvantages. They do not either prepare the body beforehand, or consider the habit of the child to be inoculated, or the nature of the pock, or other diseases of the party from whom they receive infection, but carry the child to be inoculated into the chamber of the sick; where an old woman opening one of the pustles with a needle, takes a little of the matter upon its point; with this needle she pricks many times the fleshly part of the child’s hand, between the first joint of the thumb and the same joint of the fore-finger, taking up a little more matter upon the point of the needle after every two or three punctures; then putting a bit of cotton on the part, it is tied up, and the operation finished.

About the middle of _November_ the plague began to shew itself again in the suburbs called _Bankusa_[492], and that neighbourhood; and before _Christmas_ it was found to be in some parts of the city, though it made little or no progress.

A few pleurisies and rheumatisms began to make their appearance in _December_.

_A. D._ MDCCXLIII.

In _January_, the small-pox, which were now for the most part distinct, abated considerably, and by the end of _February_ they quite disappeared.

The pleurises and rheumatisms grew more common in _January_, and continued through the greatest part of _February_. They were commonly accompanied with headach, thirst, and other febrile symptoms. The pulse was low, quick, and hard; the urine not so high-coloured as usual in those inflammatory fevers, but without sediment. The blood was sizey. The pains of the rheumatics were not generally very acute, though fixed, and more especially in the knees, which soon swelled considerably, and were often subject to great weakness long after the pain and fever were removed.

In both diseases the method of cure was the same. They could not for the most part bear such large and repeated bleeding as is usual in those inflammatory cases at other times; but, by moderate bleeding, twice, or at most thrice, cooling purges, emollient fomentations to the parts in pain, a plentiful use of antiphlogistic and saponaceous diluters, with volatiles added towards the decline of the disease, they speedily recovered.

During the winter, a continual fever, much like that of the preceding spring, affected several; but the pain in the right hypochonder did not so commonly attend it.

During the course of the spring, intermittents were common; but they had nothing in them particular.

The plague which had continued in the suburbs during all the month of _January_, though hitherto it had made but little progress, now began to spread among the _Jews_ in the city, and seized many of the Christians in the month of _February_; though, as it was then diminished at _Bankusa_, it might more properly be said to have changed its quarters, than to have augmented its forces.

About the beginning of _March_, some _Jews_ and _Turks_, who were known to the _Europeans_, dying suddenly, they began to be alarmed. However, whether from a cessation of the distemper, or from great industry used in concealing it, together with the natural credulity of mankind in what they wish to be true, cannot easily be determined; but certain it is, that we then heard no more of it, and most people flattered themselves with hopes that it was entirely ceased: but, on the 20th of _March_, we were credibly informed, that two _Jews_ were dead in the same house, and that several other persons of different sects were dead or infected, which raised a fresh alarm amongst us; and, in truth, the increase became soon too visible, particularly among the _Armenians_, who suffered in a very extraordinary manner during the whole continuance of the distemper.

Hitherto the greatest part of the infected were women and children, and mostly in the suburbs; but, about the beginning of _April_, there was a manifest encrease of the burials in the city, and several were seized in the _Khanes_, where the _Europeans_ live, so that most of them shut up the 11th of that month.

It continued encreasing gradually in all parts, and among all sorts of people during the month of _April_, but continued its ravages in _May_ with much more violence, and arrived at its greatest height, according to the reports we received, about the last of that month, when the number of burials was every day apparently great. But as we had no account that could be depended upon, it is not possible to ascertain the precise number. Our list of the Christians was however tolerably exact; and, notwithstanding many of them were gone out of the city, and the rest who could afford it were shut up, though not in the most regular way, their burials amounted from 20 to 30, and sometimes 34 a-day. Hence it is evident, that the number of _Turks_ must have been very considerable; though, according to the informations of those who remember former plagues in this place, the mortality attending this was but very moderate.

About the beginning of _June_ the distemper decreased pretty much amongst the _Turks_, according to the accounts brought to us, though the number of Christian burials (of which we were informed with more certainty) diminished but little. From the 13th to the 17th, it again encreased, particularly among the _Turks_, though not to the height it was at about the end of _May_. On the 18th it began again to decline, and continued decreasing with a surprising rapidity, some small interruptions excepted, till the end of the month, by which time the burials were reduced to a very few. However, they kept at that stand the greatest part of _July_; nor could the city be said to be quite exempt from the infection till about the middle of _August_, though it was so much abated that most of the _Europeans_ got abroad about the 18th of _July_.

About the beginning of _August_, intermittent fevers became frequent, and were at their height in _September_; after which they abated, but did not entirely cease till the close of the year.

For a few days after their commencement, they often resembled continual fevers, with violent and irregular symptoms, not unlike those of the plague; but, after bleeding and vomiting, or, what was most commonly practised, purging, with a plentiful use of nitrous medicines, they formed into tertians, double tertians, or quotidians, and were speedily and safely cured by the use of the bark. It was remarkable in those fevers, that they affected many more of the _Europeans_ than epidemics in this country commonly do.

Diarrhœas were also frequent throughout the autumn, and till the end of _December_, but without any thing particular in their symptoms.

From the middle of _November_ till the end of the year, we now and then heard of a person dying of the plague; but these instances were very rare, hardly more than two of whom we could be certain that they had the distemper.

_A. D._ MDCCXLIV.

A few pleurisies and peripneumonies occurred during the months of _January_ and _February_; but these were not either frequent or violent, yielding, and that very quickly, to the common methods.

About the middle of _February_ the chincough broke out among the children. It was often attended with a smart fever, and pain in the side. Copious bleeding was necessary, cooling purges, with pectoral and antiphlogistic medicines, and, towards the decline of the fever, blisters, which were most effectual when applied to the part affected: but it was not often that the parents would consent to this application, having in general a great aversion to blistering on any account. Notwithstanding this treatment, the fever, and often the pain, remained fourteen days, and the cough for two or three weeks after; but the force of it was much diminished, and the intervals between the fits long. This disease ceased by the end of _March_.

At this time also an inflammatory fever, without affecting any particular part, was frequent amongst children; which bleeding, purging, and nitrous medicines, with the testacea, commonly carried off in a few days.

For want of bleeding, the above mentioned diseases proved fatal to many, this operation being scarce ever performed upon children by the physicians of this country. They content themselves with making a few slight scarifications on the top of the ears, or on the calves of the legs; from whence they seldom procure more than a few drops of blood.

The plague, which began to appear in _November_, made very little progress during the months of _January_ and _February_. In _March_ it became a little more apparent, and proceeded exactly in the same course as the year before, ceasing entirely about the middle of _August_. The number of the infected were but few; so that the _English_ nation did not shut up at all, and some of the _French_ only towards the middle of _May_.

In the preceding years, I prescribed for the sick chiefly from the accounts I had from a person I employed to visit them; for though, notwithstanding all my precautions, I was often deceived by false representations, and employed to visit some of the infected before we shut up, yet I avoided it to the utmost of my power; but this year, the fears of infection being (like that of all other dangers to which one has been long exposed) much wore off, I attended the sick of the plague in common with those under other diseases.

Intermittents made their appearance about the middle of _March_, and continued till the beginning of _May_. Those who had laboured under this disease in the autumn, were now the most subject to it.

As the greatest part were regular, formed tertians, a vomit or purge, with the use of the cortex, was all that was necessary to cure them; and the same medicine, with the warm bitters, and elixir of vitriol, were continued for some time after, to prevent a relapse.

In _June_, _July_, _August_, and part of _September_, a malignant fever was common, attended with much the same symptoms as the plague, excepting buboes and carbuncles. The vomiting, with which it began, lasted for several days, and the fever continued at least till the fourteenth, but often longer; some few after the fourteenth had regular intermissions.

The method of cure was much the same as that of the plague, only that they bore a second bleeding, and nitrous medicines, better than I usually found they did in that distemper. When the fever intermitted, the bark was given with success.

From _June_ till _December_, intermittent fevers of various forms were very frequent. They did not put on the appearance of continual fevers in the beginning, like those of the last year; but, if they were not timely stopped by the bark after the fourth paroxysm, (_viz._ the seventh day) there was no remission; but the fever became continual, remaining at least till the fourteenth day, but more frequently till the twenty-first, if it did not prove fatal before, which was often the case while the warm weather continued.

A few diarrhœas occurred between the end of _August_ and the beginning of _January_. In _November_ and _December_ some pleurisies and quinsies appeared; but neither of these diseases had any thing in them different from those of other seasons.

_A. D._ MDCCXLV.

We had no disease that could be called epidemic, excepting the spring-intermittents, which began early (_January_), and continued till the beginning of _May_. They indeed were more frequent than usual.

The summer-fevers among the young children begun in _June_, and were generally accompanied with a diarrhœa, but had nothing unusual.

Intermittents also made their appearance this year in _June_, and were numerous till _December_; but though they were very liable to return, they were not of a bad kind.

A few dysenteries were to be met with in the autumn, but scarce so many as to entitle the disease epidemic.

In _September_, the small-pox appeared among the children. The few that were first seized had a mild, distinct pock; but by the middle of _October_ they became very common, and the generality of the sick had a bad confluent kind, which proved fatal to many on the eleventh day from their seizure; but of such as were treated after _Sydenham_’s method, very few died. The most part of those that recovered had inflammatory tumors on the elbows, which always suppurated, and proved tedious in their cure; but, if timely opened, the bone was seldom affected.

_A. D._ MDCCXLVI.

The small-pox, which had raged violently in _November_ and _December_, became milder in _January_, as also less frequent, and by the beginning of _February_ entirely disappeared.

In _January_ and _February_ several had inflammatory fevers, which were commonly cured in a few days by bleeding, cooling purges, and a plentiful use of nitrous medicines.

In _June_, a putrid fever, with petechiæ, began, and continued during the months of _July_ and _August_; but the number of the sick was but small. It however seldom proved fatal, but commonly terminated happily by a critical sweat on the eleventh day, or at the furthest on the fourteenth.

This autumn was most remarkably free from intermittents; none were seen before _September_, and they totally disappeared by _November_. The remainder of the year was very healthy.

_A. D._ MDCCXLVII.

As the last year ended, so this begun, free from any disease that had the appearance of an epidemic. A few diarrhœas occurred during _January_ and _February_, in _April_ peripneumonies affected several, and now and then through all these months intermittents appeared: but none of these diseases were either frequent or dangerous; so that this season might be esteemed one of the most healthy.

In _May_ a putrid fever broke out, and was very frequent through the whole of the summer, and to the end of _October_; after which, though it became less common, yet it now and then shewed itself till the end of _January_ 1748.

This fever began with a shivering and vomiting, which were soon succeeded by violent headachs, pains over the whole body, and an evident loss of strength, though the pulse was full and hard for the first four days. The tongue was first white, then became brown, hard, and dry. Most of the sick became delirious on the fifth day, and towards the end of the disease comatose. The heat was violent, both internally and externally, with regular exacerbations in the evenings, preceded by flushing in the cheeks. Purple spots, about the size of a flea-bite, generally broke out over the whole body about the fifth day, and the fever most commonly ended by a plentiful sweat, either on the seventh or by the ninth; sometimes indeed it continued to the eleventh. At its first appearance, the fourteenth day was usually critical. Signs from the urine were very fallacious. However, in proportion to the number of the sick, and violence of the symptoms, this fever was not very mortal.

The method found most effectual in treating the sick, was to bleed plentifully on the first days of the disease; once to discharge the contents of the primæ viæ, with a gentle laxative, which was the more necessary, as the generality of the sick voided quantities of worms; to give nitrous medicines in small doses often repeated, with the plentiful use of the _spir. vitrioli_, and cooling glysters _pro re nata_. Towards the end of the disease, warmer medicines were added as the state of the pulse seemed to indicate; and blisters, when the sick could be prevailed upon to admit them, were of great service.

In _September_ and _October_ several were seized with a fever that seemed different from that before described, and which indeed proved fatal to more than one half of those who were afflicted with it.

The first attack of this fever was by a slight shivering and nausea, sometimes a vomiting. These were not succeeded by any violent heat, but by an excessive languor, and most exquisite pains over the whole body. The head either did not ache at all, or but very little. Several times in a day, however, they complained of a lancinating pain, which, as they expressed it, run through their head; and as it came suddenly, it as suddenly went off again; and, though they had no great pain, they complained of a giddiness, and constant noise in their ears, like the rushing of water. From the very beginning they laboured under great dejection of spirits; and their eyes appeared muddy, with a particular ghastly look, much like to that of a person in the plague. The tongue was moist; and, like one in health, for several hours they seemed to be without thirst, or other uneasiness, and then would suddenly complain of a violent internal heat, and drink great quantities of liquor greedily, though neither their pulse nor tongue were altered, nor any external heat to be observed.

The urine was of a straw-colour, without cloud or sediment, till the sixth day, when there appeared in it a small cloud suspended about half-way; and this appearance it had in those who died, as well as in those who recovered. They slept very little, or not at all, during the whole course of the disease. The pulse from the beginning to the end was but very little quicker than natural; about the fifth day it sunk, and about twelve hours before death was not to be felt. The sick were scarcely ever delirious, and never comatose, continuing entirely sensible till they expired, which was commonly on the seventh day of the disease. Those who recovered had a crisis by a plentiful sweat on the ninth. None of the sick had any petechiæ.

The blood that was drawn on the first day was like that of a person in health; but, after the third day, it was of the colour of coffee-grounds, appearing quite thin as it run out of the vein, and, when cold, was bluish on the top, and but very loosely coagulated.

This fever did not appear any way infectious; for I observed no instance wherein two persons had it in the same family, nor where any of the sick could be supposed to have caught it from another affected with the disease: and indeed the whole number of the sick that came within my knowledge did not amount to above thirty, twelve of whom were my own patients, and out of these I lost four. The others seemed to owe their recovery to a pretty large bleeding, and an ipecacuan vomit at the beginning of the disease, small and repeated doses of _pulv. contrayervæ comp._ with a few grains of _nitr. stibiat._ gentle anodynes, with moderate acidulated cordials _pro re nata_, and an emollient refrigerating glyster every evening. Towards the fifth day, a warmer regimen was necessary, with blisters applied to the back, legs, and arms, according as the sinking of the pulse seemed to require.

Plenty of barley-water, acidulated with spirit of vitriol, was allowed for the patient’s drink; and panada, rice-gruel, and roasted apples, for food; though, to such as would not be contented with this diet without the addition of butter, which is the method of this country, I chose rather to allow weak chicken-broth, with crum of bread, or a little rice, boiled in it.

The autumnal intermittents were this year but few; nor did any other diseases besides those already mentioned appear so frequently as to claim the title of epidemics.

From the year 1748 to 1751, I was prevented from taking notes in the manner that was necessary to furnish an account of the epidemics of those years, by a constant engagement in the duties of my profession, together with an almost daily attendance on the _Bashaw_; which however furnished me with an opportunity of seeing more of the manners of the people than I should otherwise have done, and was fully recompensed by the large presents, and other public marks of his favour, which he was pleased to confer on me. In general, however, the first three years were healthy, if we except the measles and small-pox, which were sometimes in this period very frequent. The measles first made their appearance in the spring of 1749, and finished in the spring of 1750. As this disease had not visited _Aleppo_ for several years, it affected numbers of adults, as well as children; so that it was no uncommon thing to see the father, mother, children, and servants, all sick of the measles together. No description of the disease could be more exact than that which _Sydenham_ gives us of 1670, nor any method of cure more effectual, none having died that were treated after his manner, though it proved fatal to many of those who were treated after the manner of the country; which is, to keep them extremely warm, and on the ninth day to take the sick out of the hot room, in which they have been kept, to the bagnio; without which they imagine that the sick would fall into an incurable diarrhœa: whereas in the small-pox, which one would imagine is a disease that should require more washing, they don’t allow them to go to the bagnio till after the fortieth day.

The small-pox made their appearance about the middle of _August_ 1750, and were at first of a bad confluent kind: however, they became more mild by the middle of _November_, and disappeared early in the spring.

The harvest of the year 1750 proved bad; so that a want of corn began to be felt early in the winter, and the poor were much distressed for want of bread. The new _bashaw_ embraced this opportunity to bring in large quantities of wheat from his own granaries at _Hamah_, where it had been hoarded up for several years; by which means it was very much damaged, and the bread made of it was extremely black and musty: however, it was all that the poor had to eat till the coming in of the new grain.

About the beginning of _June_ 1751, a most fatal dysentery made its appearance, and continued till the middle of _November_; and possibly proceeded as much from the bad bread, as the epidemic constitution of the air, though both causes perhaps concurred in producing it.

_A. D._ MDCCLII.

The first part of the year was very healthy; but, about the vernal equinox, a continual fever began, which attacked a great many people of all ranks, and continued with violence till near the end of _July_; after which the number of the sick diminished greatly, and by the middle of _September_ this fever quite disappeared.

It began in the usual way, by a slight shivering, and often with a nausea; to which succeeded heat, thirst, headach, and pain in the loins. The head was much confused from the first seizure, and a remarkable stupidity appeared in the patient’s look. The tongue became immediately white, soon after brown, and often, towards the end of the disease, was covered with a black crust. The pulse was quick, but seldom hard or full, and continued in a more equal state than I ever observed in any other fever in this country, few or none of the sick having any remission or exacerbations, the heat and other symptoms continuing almost uniformly at one regular standard from the beginning to the end, if the patient’s strength was not exhausted by unseasonable evacuations and improper management. On the ninth or eleventh day most of the sick had an hæmorrhage from the nose, which in some seemed to mitigate the symptoms, though many grew worse upon it; in others it had no manifest effect, either good or bad. The crisis was almost always by a plentiful sweat; but this happened to none at the first appearance of this disease before the fourteenth, and to the greater part on the seventeenth.

Towards the end of _May_, the hæmorrhage commonly happened on the seventh day, and a copious discharge by sweat on the eleventh; which, though it very much relieved, yet was not a perfect crisis, the fever never quite leaving them till the fourteenth. Many of the sick now had petechiæ.

As the hot weather advanced, so likewise these discharges came on earlier in the disease; so that by the latter end of _June_ almost all had the hæmorrhages, the fifth or seventh, and on this last the sweats likewise. And what is very remarkable is, that from about this time till the epidemic ceased, though the sick had been duly purged after the fever, and the utmost care taken in respect to the non-naturals; yet none of them escaped a relapse, which seized them in the same way as the preceding fever, only the heat was much more intense. The second day they were taken with violent pains in the hypochonders, bilious vomitings, and often purging, which left them the third day; a smart fever remaining till the fifth, with many remissions and exacerbations, when a critical sweat put an end to it; I mean in such as had recovered of the preceding fever on the seventh day; but such as had grown better on the fourteenth, did not recover of the relapse before the eleventh.

Several of the sick had the fever so slightly, that they were able to walk abroad; but, notwithstanding this mildness of the symptoms, the disease continued the same number of days as in the others.

Though this fever was not in its own nature very dangerous, yet it proved fatal to many, particularly in the months of _April_ and _May_, when the number of the sick was very great, and the fever was of long continuance. The increase of its mortality was probably owing to bleeding and purging, which were often used by the natives towards the eleventh day of the disease, and to which they were prompted by the spontaneous hæmorrhages, and an impatience under the long duration of the fever; but it seldom happened that any evacuations were used after the eighth day, without manifest detriment to the sick, either by retarding their recovery, or sinking them irretrievably.

Of several hundreds that were treated after the following method, only two died. As soon as the person was taken ill, he was blooded pretty largely; next day he took a laxative potion of _infus. sennæ limon._ and manna, and in the evening of that day a gentle anodyne. If he was strong and plethoric, the bleeding was repeated the third day; but, after this, blood was seldom, if ever, taken. Nitrous medicines, with a small proportion of _pulv. contrayerv. composit._ were given every six hours, and the last encreased or diminished according as the pulse seemed to require; and towards the end of the disease, or when the pulse was low, the _pulv. contrayerv. comp. Phar. Edin._ was substituted in its stead. A glyster of milk, pulp of cassia fistula, or sugar, and a little oil, was injected every evening till the eleventh, if the head was much confused, and the body costive, which was generally the case in the first months; though afterwards, when the disease became more acute, most of the sick had several stools every day.

When petechiæ appeared, and the heat was intense, with great languor, moderate cordials, acidulated with _spir. vitrioli_, together with the above mentioned powders, were repeated as necessity required.

The second day after the crisis, they were purged with the same potion as at the beginning, and it was repeated at proper intervals, once or twice: when a tendency to relapses became so general, a decoction of the cortex, with a small proportion of _elixir vitrioli_, was given to prevent them, and often with success.

In these relapses, though the symptoms seemed violent, they were seldom or never blooded. When the vomiting came on, the sick were ordered to drink quantities of warm water, to wash the stomach; glysters were occasionally injected, and the medicines before mentioned exhibited.

The patient’s drink was a ptisan, in common use here, made of barley, grass-roots, and a few injubs, sometimes acidulated with lemon-juice; their food, weak chicken-broth, with a little rice, or crum of bread, boiled in it, and now and then a roasted apple.

From the beginning of the summer till the end of _September_, the chincough was frequent among the children; but though it was very violent, it much sooner gave way to medicines than I ever knew it; for by once bleeding, (which was generally with leeches) a few purges, and a weak solution of gum ammoniac in water, with a small proportion of _acet. scillitic. & tinct. castor._ they either soon recovered, or the cough grew much less frequent and violent, and went off entirely in about a fortnight more.

This year the fever usually attending young children was more frequent than in others.

Scarcely one intermittent was to be met with this autumn; and the place was exceeding healthy till the middle of _November_, when a fever became very frequent (chiefly among children three years old and upwards) with a swelling in one or both parotids, the maxillary glands, and sometimes over the whole face.

Bleeding, with a gentle purgative once or twice repeated, and a low diet, generally cured those that had it the most violently in five or six days, and such as had it slightly recovered without any assistance in about the same time; and though this fever continued to affect great numbers all the year, and till about the middle of _January_ 1753, I did not hear of any to whom it proved fatal.

_A. D._ MDCCLIII.

With this year commenced a continual fever, which was chiefly confined to adults, and to the northern suburbs of the city, where the Christians mostly inhabit.

The disease began with a shivering and nausea, but the patient seldom vomited. The heat was intense during the first two or three days, the pulse strong and frequent: the sick did not so much complain of pain, as of great confusion in their head, and noise in their ears, acute pains in their back, legs, and arms; which last they could scarcely bear to move. The tongue was at first white, afterwards yellow, and towards the height of the disease generally black. From the beginning their aspect was stupid, and by the sixth day they became delirious; from the seventh to the ninth petechiæ appeared over the whole body, not round, as usual, but in irregular figures. The pulse by this time began to sink, and they were often comatose; from the ninth to the eleventh, a moderate sweat sometimes broke out, or they had a few loose stools, which seemed to relieve, and for the present to abate the symptoms; yet the fever always continued till the seventeenth day, when it began to decline gradually, and went off without any remarkable evacuation. When the head was much affected, the urine was pale as water, without any sediment; in some it was of a blackish cast, like a weak tincture of steel. On the eleventh day it commonly let fall a white sediment in those who recovered; and indeed all who were treated in the method mentioned for the continual fever of last year (with the addition of sinapisms to the soles of the feet, for they are much averse to blisters) recovered.

Those who were bled to any considerable quantity after the seventh day generally died on the ninth or the eleventh.

This fever continued to prevail till the beginning of _February_, when the very cold weather we had at that time put a check to it; so that, from the beginning to the 20th, I saw but two persons who had any appearance of it. These, besides the above mentioned symptoms, had an acute pain in the right hypochonder affecting their breathing, and bore larger bleeding than could be endured without great injury in the preceding constitution, and the blood was sizey. Both these patients had a crisis of the fever by a large hæmorrhage from the right nostril on the seventh day, and very nearly about the same hour in which they were first seized. In one of them the hæmorrhage was accompanied by a diarrhœa, and about a fortnight after he had a regular tertian.

In _January_ several old people had apoplexies, though few proved mortal: they commonly ended in hemiplegias, which in several, though much advanced in years, gave way to medicine.

About the 20th of _February_, the continual fever above mentioned, which had almost totally ceased upon the setting in of cold weather, again made its appearance, and with additional force. Almost all now had petechiæ, which were round, very small, and of a purple colour. These, after the twelfth or thirteenth day, disappeared, without any manifest alteration in the disease. The urine during the first three or four days was of an orange colour, and towards the seventh let fall a copious white sediment; after that it became clear and pale as water till the eleventh or twelfth; when, though it still retained the same appearance whilst warm, when cold it let fall a sediment like fine flour, and continued thus till the end of the disease, which always happened on the seventeenth.

Many of the sick in the fever, both of this and the last year, voided many worms of the round kind, and towards the height of the disease almost all were deaf, which last was a good sign; and it may here be remarked, that these two symptoms are almost common to all fevers in _Aleppo_.

About the middle of _April_ near one fourth of the people were seized with violent coughs, which did not either last long with those attacked, or in the compass of a few days continued to spread any farther.

The _Jews_, who had hitherto kept pretty clear of the fever, though it was now very common in the city, began to feel its effects severely very soon after their feast, about the middle of _April_.

In _May_ several of the sick had a critical sweat on the seventh day, preceded in some by an hæmorrhage from the nose; but all who had this hæmorrhage, in about five or six days after, had a return of the fever, which was more violent than at the first attack, and continued five days. In several those relapses were accompanied with peripneumonic symptoms, and required bleeding.

Children had hitherto escaped this disease; but in this month (_May_) a considerable number of them, from nine years old and upwards, were seized with it. The symptoms and duration were much the same as in adults; only their most frequent complaint was of pains in the belly, and they voided worms either by vomiting or stool, chiefly of the round kind.

The number of the sick was much diminished by the beginning of _June_, and the fever quite disappeared before _July_.

The method pursued in the cure of the fever of last year was attended with the same success in this; and evacuations after the seventh day, as in the preceding, so likewise in the present, were always prejudicial, and often fatal.

The summer-fever, commonly incident to young children in this country, began this year in _June_, and continued through the summer as customary.

In _July_ a very few were seized with mild dysenteries, others with intermittents, chiefly quartans; but neither of these distempers were so frequent as to be termed epidemic.

The ophthalmias, which, according to custom, were epidemic in _September_, had this particular from other years, that the inflammation was chiefly external in the palpebræ.

Both this and last year furunculi were frequent on different parts of the body, but more especially the fingers; in _November_, and part of _December_, they often broke out in the armpits, but without any other disorder.

A very few had pleurisies in _December_, and several died suddenly of apoplexies about this time.

It should have been before observed, that the continual fever of this year, particularly after the month of _February_, seldom affected one person in a house, without going through two thirds of the family; but it was rare to find two sick together, one being generally a few days recovered before the other was taken ill.

CHAP. IV.

Of the PLAGUE.

SECT. I.

_Of the PLAGUE in General._

All the facts mentioned in the notes are taken from old
journals or letters written at the times they happened.

It is the common opinion of the inhabitants of _Aleppo_, that they are visited with the plague about once in ten years, and that it is brought thither from some neighbouring city, where it first makes its appearance, as _Antab_, _Urfa_, _&c._ to the northward, or _Damascus_ to the southward; from which last place it is generally alledged that the worst plagues have been brought; though some assert that those which have come from the northward have raged with the greatest violence.

With respect to the intervals between the returns of the plague, though that of 1742 is an exception, yet the common opinion seems in some measure to be founded on experience[493]. And it seems a fact pretty well attested, that it never rages at _Aleppo_ without having first visited some of the above mentioned places; though the first appearance of all is, from what I have been able to learn, always in some town on the coast of _Syria_[494]. If it first shews itself in _Sidon_, _Byroot_, or _Tripoly_, _Damascus_ is usually the channel through which it comes to _Aleppo_; but if in _Scanderoon_ or _Byass_, then it commonly passes by way of _Antab_, _Killis_, _Urfa_, &c.

During the winter this disease is constantly moderate; as the spring advances it grows more violent, it comes to its height in _June_, decreases greatly in _July_, and certainly disappears in _August_; and this seems to be the constant course of the plague at _Aleppo_: so that none are ever seized with it in the months of _September_ and _October_, even in such extraordinary instances as when it has made its appearance for three years successively, as it did in 1742, 1743, and 1744[495].

A considerable difference is observable, both as to the mortality and number of the infected, in different years; but it does not appear that it has ever raged in this country with the violence that it has often done in _Europe_.

Extreme heat seems to check the progress of the distemper; for though, during the few first hot days, the mortality, as well as the number of those newly infected, encreased, yet a few days longer continuance of that weather greatly diminished the number of the sick. Add to this, that the season wherein it always ceases at _Aleppo_, is that in which the heats are the most excessive.

Though the natives, as well as several authors, have a notion that the moon has some influence over this distemper, yet experience no ways favoured this opinion in the late plague at _Aleppo_.

Having the distemper once, does not prevent a second seizure, numbers of people being alive when I left _Aleppo_, who have had it twice or oftener; and I have even seen instances of the same person’s having had the disease three several times in the same season.

SECT. II.

_Of the Plague, as it appeared in ~Aleppo~, in 1742, 1743, and 1744._

It is no wonder that the very name of _plague_ among us should strike terror whenever it is mentioned; for, besides the numerous and terrible distresses of the whole body of the people during the rage of a pestilence, and the scenes of death and misery which are continually before our eyes, the distemper itself is the most lamentable to which mankind are liable. The torments of heat, thirst, and pain, frequently unite in some patients; an unspeakable languor and dejection in others; the loathsome remains of the distemper in the painful and putrid ulcers, even in those who escape; the desertion of friends and attendants; the want of common necessaries, and medical assistance, are all of them circumstances which aggravate the miseries of the sick, and contribute not a little towards augmenting the general horror.

And as there is no disease incident to mankind that is in its nature more terrible and destructive, so there is none more difficult to describe. Its symptoms are scarcely in all respects alike in any two persons; nay, they even vary extremely in an hour in the same subject. The disease begins often with the most flattering appearances, and ends fatally in a few hours. Some complain of a pain at their heart, are seized with a vomiting and giddiness, and die in a few minutes; while the most alarming attacks sometimes end speedily in health and security.

In general, however, a coldness or shivering, with sickness, vomiting large quantities of porraceous bile, often of a very offensive smell, pain in the back or loins, an intense headach, uncommon giddiness, and a sudden loss of strength, were the first complaints of those who were seized with this distemper; and these were usually attended with great uneasiness or anxiety about the pit of the stomach, and a sharp, shooting pain darting into the parotid, axillary, or inguinal glands.

These symptoms were soon succeeded by a violent fever; in which, while the patients complained of extreme inward heat, their skin felt but little hotter than usual. Sometimes this heat soon became general and intense, at other times particular parts only were affected therewith; and it seldom continued many hours together alike, but remitted and returned with considerable, but unequal force several times in a day. The face, in these exacerbations, became florid, and was often changed from a deep scarlet to a livid colour, resembling that of a person almost strangled. These appearances again would suddenly give place to a cadaverous paleness. The eyes soon lost their lustre, and acquired a kind of muddiness; and the countenance of the greatest part of the sick was ghastly, and confused beyond description.

The pulse, at the first seizure, was very little different from its natural state, only somewhat more quick and low. In a few hours it commonly encreased in quickness and strength; but these seldom continued in the same way an hour together, nay, scarce many minutes, but varied without any manifest correspondence with the other febrile symptoms, both as to strength and quickness, incessantly.

In those who complained of pains, either darting into the parotids, the armpits, or groins, a small, painful, hard, deep-seated tumor was discovered by the touch in the part, without any manifest discoloration of the skin. Such were the first beginnings of the pestilential _buboes_.

This was the common appearance of the distemper the first day of the disease; and those who had the most favourable escape were often attacked at first with as alarming symptoms as those who died in a few hours; for sometimes this febrile paroxysm dissolved in a few hours, and left the patient indeed languid, and weakened to an extreme degree, but free from other complaints, except the pain of the tumor above mentioned; which in many encreased from this time, both in size, tension, and pain, during about twelve or fifteen days, when it commonly suppurated, the patient, all the time, the first day excepted, walking about as usual.

But though many thus escaped, yet several who were seized in this manner, especially in the month of _March_ 1743, suddenly dropped down dead, or at least lived but a few hours; the headach, vomiting, and pain about the præcordia, encreasing every moment to such a degree as to occasion immediate death, or fatal convulsions. Few of those who died in this manner had any appearance of such indurated tumors, though generally the armpits, groins, or internal parts of the arms and thighs, were livid or black, and the whole body was covered with confluent petechiæ, interspersed with livid pustules, especially after death.

Those who survived the first attack of the distemper, which was by much the greatest part of the sick, in the evening had a very considerable encrease of every symptom. The heat became excessive, both internally and externally; and as the sick were by this time for the most part delirious, it was often with difficulty they could be kept within doors. They were disposed to talk a great deal, but faultered so much in their speech as scarcely to be understood; the tongue having also shared in the debility that was evident in every other part of the body.

In this state they continued during most part of the night; towards morning the violence of the heat, inquietude, and delirium, abated; a manifest remission succeeded; some recovered their senses entirely, some in great part, and then complained much of intense headach, or pain of the buboes, which last would often increase suddenly, and decrease as quickly, in the space of a few hours. About one half of the sick about this time had an additional complaint of a painful pustule, like an angry, confluent pock, surrounded by a circle of a deep scarlet tinge, which soon became livid, and was attended with an intense burning pain; from which circumstance, as well as from its fiery aspect, it has probably obtained the name of _carbuncle_.

These pustules broke out indiscriminately on all parts of the body, and increased from the size of a large pock to the extent of an inch and a half diameter, sometimes, though rarely, to three inches.

The remission of the feverish symptoms was commonly but of very short continuance, the rigors, anxiety, and delirium soon returning with greater violence, with a frequent and strong _subsultus tendinum_. These symptoms, however, did not proceed with a regular increase during the day; but the rigors and heats coming and going by turns, formed short, but alarming intermissions, each paroxysm surpassing the former either in violence or duration; till, in the evening, the pulse was scarcely to be counted by reason of its depression and quickness. The patient grew comatose, with a quick, laborious, and interrupted respiration.

The buboes, which some hours before seemed manifestly to increase, now often subsided, and almost disappeared, and the livid circle about the carbuncle became black, resembling a large eschar made by a caustic; and livid or black spots, of different dimensions, about this time often appeared dispersed over the whole body.

Under these circumstances, dreadful as they seemed, some hope of recovery still remained; for though many died on the third day, yet several had a favourable crisis by a profuse sweat: some struggled under these difficulties to the fifth day, a few to the seventh, and here and there one even to the eleventh, before any critical alteration appeared.

If the disease was not wholly carried off by a copious sweat on the third day, it was always considerably abated, and was in general totally removed by a second, though less profuse one, by the fifth; so that no symptoms of the disease were then left, weakness excepted, and the pain proceeding from the buboes and carbuncles. And it may here be remarked, that all who were attacked had buboes; though, even in many that recovered, they discussed without any manner of bad consequences: but the carbuncles did not appear on above one half of the sick, and often begun to digest before the critical sweat happened.

It is evident, from the account already given, that nothing could be more difficult than to form a judgment about the event of this disease, or be more just than what _Morellus_[496] observes on a similar occasion. This author, after reciting several circumstances proving the irregularity of its type, concludes, “That, in respect to the plague, even our senses and reason deceive us, the aphorisms of _Hippocrates_ are erroneous; and _Hippocrates_ himself, was he present, would likewise be mistaken.”

The tongue was in some quite moist, and in all respects like that of a person in health through the whole course of the distemper; in others it was at first white, but soon became yellow, black, and covered with a dry, rough scurf or fur. Some had no thirst at all, and could scarcely be prevailed upon to take liquids in sufficient quantities. But the generality of the sick were extremely thirsty, and drank with great eagerness whatever they had given them, especially at particular times; for the intenseness of their thirst had irregular intervals, and did not continue alike through the progress of the distemper, nor often correspond with the violence of the fever.

In most patients the vomiting ceased after the first few hours, excepting when they overloaded their stomachs during this excess of thirst; at which times the vomiting returned.

The urine was as little to be depended on as a sign as any other circumstance, being scarce alike at the same time of the disease in any two persons; and its appearance varied no less in the same patient every day. In general, however, it was somewhat of a deeper yellow than usual in a person in health, and without sediment.

Some had a diarrhœa during all the time, others were costive; in most the discharges were natural. The distemper, however, seemed never to admit of a critical solution by either stool or urine. Some few had hæmorrhages from the nose or uterus: and if these happened after the second day, a plentiful sweat, which was most commonly critical, soon followed; a circumstance different from what usually has happened in the plague at other places.