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the vomiting of bile, which shews an, accumulation of vitiated bile in the gall-bladder, and biliary ducts, and from thence derived into the intestines and stomach'; all of which symptoms I suppose to denote a considerable spasm, and loss of tone, in the extreme vessels on the surface of the body.
5mt, The buboes or carbuncles, which denote an acrimony prevailing in the fluids. And,
Lastly, The petechias, haemorrhagies, and colliquative diarrhoea, which denote a putrescent tendency prevailing to a great degree in the mass of blood.
668. From the consideration of all these symptoms, it appears, that the plague is especially distinguished by a specific contagion, often suddenly producing the most considerable symptoms of debility m the nervous System or moving powers, as well as of a general putrescehcy in the fluids; and it is from the consideration" of these -circumstances as the proximate cause, that I think both the prevention and cure of the plague must be directed.
669; If this disease should revisit the northern parts of Europe, it is probable, that; at the time, there will be-no physician then alive, who, at the first appearance of the disease, can be guided by his former experience, but must be instructed by his study of the writers on this subject, and, by analogy. It is, therefore, I hope allowable for me, upon the same grounds, to offer here my opinion with respect to both the prevention and cure of this disease.
This paragraph was written before I had any notice of the plague of Moscow, anno 1771; but I think it will still apply to the case of Great Bri. tain, and of many other northern states,
Of the prevention of the Plague.
670. With respect to the prevention: as we are firmly persuaded that the disease never arises in the northern parts of Europe, but in consequence of its being imported from some other country; so the first measure necessary, is the magistrate's taking care to prevent the importation: and this may generally be done by due attention to bills of health, and to the proper performance of quarantains.
671. With respect to the latter, we are persuaded, that the quarantain of persons may safely be much less than forty days; and, if this were allowed, the execution of the quarantain would be more exact and certain, as the temptation to break it would be in a great measure removed.
#72. With respect to the quarantain of goods,
it cannot be perfect, unless the suspected goods be unpacked and duly ventilated, as well as the other means employed for correcting the infection they may carry; and, if all this were properly done, it is probable that the time commonly prescribed for the quarantain of goods might also be shortened.
673. A second measure, in the way of prevention, becomes requisite, when an infection has reached and prevailed in any place, to prevent that infection from spreading into other places. This can be done only by preventing the inhabitants, or the goods of any infected place, from going out of it, till they have undergone a proper quarantain.
674. The third measure for prevention, to be employed with great care, is to hinder the infection from spreading among the inhabitants of the place in which it has arisen. The measures necessary for this, are to be directed by the doctrine laid down in 82; and from that doctrine, we infer, that all persons who can avoid any near com-. munication with infected persons or goods, may escape the infection.
675. For avoiding such communication, a great deal may be done by the magistrate; 1, By allowing as many of the inhabitants as are free from the infection, and not necessary to the service of the place, to go out of it; 2, By prohibiting all assemblies, or unnecessary intercourse of the peapie; 3, By taking care that necessary communications be performed without'contact; 4, By making such arrangements and provisions, as may render it easy for the families remaining, to shut themselves up in their own houses; 5, By allowing persons to quit houses in which an infection appears, upon condition that they go into lazarettoes; 6, By ventilating and purifying, or destroying, at the public expence, all infected goods; Lastly, By avoiding hospitals, and providing separate apartments for infected persons.
The execution of these measures will require great authority, and much vigilance and attention, on the part of the magistrate; but it is not our province to enter into any detail on the subject of the public police.
676. The fourth and last part of the business of prevention, respects the conduct of persons necessarily remaining in infected places, especially of
p those obliged to. have some* communication with persons'infected. i
677. Of those obliged to remain in infected places,- but not obliged to have any near communication wiih the sick, they may be preserved from the contagion by avoiding all near communication with other persons, or their goods; and it is probable, that a small distance will answer the pur. pose, if, at the same time, there be no stream of air to carry the effluvia of persons, or goods, to some distance.
678. For those who are necessarily obliged to have a near communication with the sick, it is proper to let them know, that some of the most powerful contagions do not operate, but when the bodies of men exposed to the contagion are in certain circumstances which render them more liable to be affected by it, or when certain causes concur to excite the power of it; and therefore, by avoiding these circumstances and causes, they may often escape infection.
679. The bodies of men are especially liable to be affected by contagions, when they are anywise considerably weakened by want of food, and even by a scanty diet, or one of little nourishment; by intemperance in drinking, which, when the stupor of intoxication is over, leaves the body in a weakened state; by excess in venery ; by great fatigue; or by any considerable evacuation.
680. The causes which, concurring with contagion, render it more certainly active, are cold, fear, and full living.
The several means, therefore, of avoiding or •guarding against the action of cold (94 to 96) are to be carefully studied.