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Early modern treatment of the plague focussed on a dual approach: prevention and cure. The former method was undoubtedly the most effective, a fact readily acknowledged by contemporary physicians. Worth’s collection contains a number of works specifically focussing on prevention methods, an issue of contemporary relevance given the outbreak of the plague epidemic at Marseilles during his lifetime.‘When the Disease had spread itself among both Rich and Poor, and raged in the most violent manner, the Pope appointed Cardinal Gastaldi Commissary General of Health, giving him for a time the Power of the whole Sacred College, with full Commission to do whatever he should judge necessary. Hereupon he gave strict Order, that no sick or suspected Persons should stay in their own Houses. The Sick he removed, upon the first Notice, to a Lazaretto in the Island of the Tyber; and all who were in the same Houses with them to other Hospitals just without the City, in order to be sent to the Island, if they should fall sick. At the same time he took diligent care to send away their Goods to an airy Place to be cleansed. He executed these Regulations with so much Strictness, that no Persons of the highest Quality were exempted from this Treatment, which occasioned at first great Complaints against the Cardinal for his Severity; but soon after he had general Thanks: For in two Months time, by this means, he entirely cleared the City of the Pestilence, which had continued in it almost two Years. And it was particularly observed, that whereas before, when once the Disease had got into a House, it seldom ended without seizing the whole Family; in this Management scarce five out of an hundred of the sound Persons removed were infected.’
This quotation, from Worth’s copy of Richard Mead’s, A short discourse concerning pestilential contagion (London, 1722), who in turn is quoting from Cardinal Geronimo Gastaldi’s Tractatus de auertenda et profliganda peste (Bologna, 1684) (a work also collected by Worth), emphases the vital importance of quarantine in the fight against plague. Gastaldi’s policy of strict segregation during the 1656 plague in Rome was the model which Mead later advocated to the British Government when faced with the threat of plague in 1720. This illustration, from Worth’s 1684 edition of Gastaldi’s seminal work on methods of avoiding of the plague, illustrates the principal method of plague prevention in early modern Europe: separation of the sick and quarantine.
Geronimo Gastaldi, Tractatus de auertenda et profliganda peste (Bologna, 1684), title page.
Mead’s work, which by 1722 had run to eight editions, concentrated on prevention: both preventing the Marseilles epidemic from arriving in England and putting forth policies to ensure that if it did manage to infect port towns it would be prevented in spreading inland. As he makes clear, it was a position paper and it acted as the basis for the ensuing Georgian Quarantine Acts, legislation which was politically very contentious but ultimately effective in ensuring that Britain escaped the last great European plague. Worth’s copy of the eighth edition includes a bookmark scrap at the section dealing with what to do should the plague enter the country – surely a sign that plague, for Worth, was no academic topic but one of immediate relevance.
If Mead emphasised the role of the state in prevention of plague, other physicians focussed on what individuals might do when faced with a possible epidemic. They were keen to point out that there were other methods by which the healthy might avoid falling sick with the plague. Older accounts focused on the health regime of the individual in the hope that a strong constitution might withstand the dreaded disease: in particular, sixteenth-century authors condemned excess in all aspects of life, and were keen to emphasis the idea of moderation in all things which had marked medical writing since Hippocrates. Others pointed to specific precautions which might be undertaken to minimise infection, but undoubtedly the principal focus of much of the medical literature dealing with plague lay in the realm of specific treatments for plague once the disease had been caught. Worth’s collection makes it readily apparent that in this genre, old remedies and new cures might stand side-by-side: The unknown physician from Bordeaux, author of Worth’s copy of Lettres sur la peste, ecrites a un medicin de Bordeaux (Bordeaux, 1721), who wrote in response to the outbreak of plague in Marseilles in 1720, was certainly as anxious to recount older remedies as the newest cures.
The detailed listings in such works are encapsulated in Paul Barbette’s ‘Medicaments against the Plague’, which may be found in Worth’s copy of Thesaurus chirurgiæ: the chirurgical & anatomical vvorks of Paul Barbette, M.D., practitioner at Amsterdam (London, 1676):
Barbette also offered suggestions for medicinal compounds but perhaps none was so famous as the 1665 London Plague drink which was still hailed in the English plague literature of 1721 as a useful remedy:‘The following Drink was the Great Medicine by which such Numbers were Cured of, and Preserved from the Infection in London, in the Year 1665. Take 2 Quarts of Canary (if you cannot get Sack, take Claret, or any other Wine: Poor People may make it of Good Beer) put into it of Rue and Sage of each, one good Handful. Boil these together in a Pipkin close covered, ‘till about a Pint is boiled away, then strain it off, and set it over the Fire again, and put into it one Dram of Saffron, One Dram of Long Pepper, Half and Ounc of Ginger, and two good large Nutmegs, all well beaten together. Then let it boil a quarter of an Hour, take it off the Fire, and dissolve in it Mitridate and Venice Treacle of each a full Ounce: and keep it close stopt for Use. This Thing is that Great Secret which the College of Physicians (in their Directions for the Plague, that they published by express Order of the King and Council in the Great Sickness Year 1665,) ordered Persons to make use of, and by which such vast Numbers were Preserved and Recovered.’
Quotation from The Great Bill of Mortality: or, the late dreadful Plague at Marseilles…
Compared with that in London in 1665… (Bristol, 1721).
The market for this type of remedy was a lucrative one. Seventeenth-century authors writing on the plague in France also drew attention to the role played by similar ingredients, not least because the ‘Venice Treacle’ in the above concoction was actually the famous ‘theriac’, a medical term simply referring to a compound which acted against poisons. As Holland (2000) points out, numerous recipes for it existed and the long list of ingredients made it unlikely that laymen and women could concoct it without the help of a physician.
In the view of François Chicoyneau, the pre-eminent French commentator on the plague at Marseilles in 1720, such specific remedies were of doubtful efficacy: ‘the Medicines we have made use of are such, whose Efficacy and manner of Operation, are generally acknowledged by a long Experience, to be adapted to satisfy all the Indications reported above; having moreover not neglected certain pretended Specificks, such as the solar Powder, the mineral Kernes, Elixirs, and other alexiterial Preparations, as have been communicated to us by charitable and well-dispoased Persons; but Experience itself has convinced us, that all these particular Remedies are at the most useful only to remove some certain Accidents, when at the same time they are often noxious in a great many others, and by consequence incapable to cure a Disease characterised by a Number of different essential Symptoms.’ †
Just as he had divided plague patients into five classes exhibiting certain symptoms of plague, so too did he match his suggestions as to treatment to these five groups.
The First Class, by far the most lethal grouping, who had died so quickly that they hadn’t even had time to exhibit the characteristic bubo of bubonic plague, did not respond to any specific treatment: they were ‘not in a Condition to bear Bleeding’ and, as Chicoyneau ruefully admits, ‘Emeticks and Catharticks were equally here useless’. ‘Cordials and Sudorificks were the only Remedies to which we had recourse, which nevertheless could be of no Service, or at the most prolong the last Moments but for few Hours.’
The Second Class were little better off, exhibiting many of the symptoms of the First Class and being likewise difficult to treat because of this: ‘they bore Bleeding no better than those of the First Class’… All Emeticks, if we except Ipecacuanha, were very often more hurtful than useful… The Catharticks that were a little strong and active, were attended with the same Incoveniences… All Cordials and Sudorificks, if they were not soft, gentle and benign, did nothing but promote the Progress of the inward Inflammations.’ In short, no remedies were efficacious but the physicians did notice one crucial development: those patients whose buboes burst had a better chance of surviving. The cure, then, was not in any of the emetic, catharticks or cordials beloved by the physicians, but primarily in their surgical skills.
The Third Class had similar symptoms to those of the first two but had them at different times. Chicoyneau’s practice, therefore, was to vary his methods ‘according to the diversity of Indications, or of the most urgent Symptoms’.
The Fourth Class, so similar in symptomatic outline if not in symptomatic intensity to the Second Class, could, therefore be treated by hastening the eruption of the buboes, while the Fifth Class needed little more than plaisters for painless buboes, the only definite sign of their affliction.
Other writers were not so adverse to bleeding plague patients (though admittedly it depended on the stage of the disease). John Peachey, another physician whose works were collected by Worth, argued that bleeding was appropriate ‘if the Tumor has not yet appear’d’ but it had to be done ‘moderately with respect to the strength and temperament of the sick.’ Paul Barbette disagreed: in his view ‘Blood letting [was] very prejudicial to those that already have the Plague, and dangerous to such that would prevent it’. Far better in his view was the use of ‘Diaphoreticks and Cordials’.
If Chicoyneau concentrated on the various types of plague victim Barbette drew attention to the importance of understanding the fluctuating time-line of the disease: some medicines might be used beneficially at different stages of the infection. Even his beloved cordials might not always produce benefits: ‘Nevertheless, the several disguises of this Disease, and the vanity of the Symptoms which attend it, do require that they should be often changed, since when the Disease is more gentle, those things are not to be used, which would do good service in an acute one.’
The only area where Chicoyneau envisaged making some headway was in the treatment of buboes for he and his team had observed that by lancing the buboes the patient’s chances of survival were enhanced. Here he describes how they did this:‘If the Tumour was small, deep, painful, and one had Time to endeavour to mollify it, we began with the Application of emollient and anodyne Cataplasms, and as the Misery and Desertion would not suffer us to have Recourse to choice Drogues, we prepared on the Spot, and applied warm, a Sort of Pultice composed of Crums of Bread, common Water, Oil of Olives, Yolk of an Egg, or a large Onion roasted in the Ashes, which we first hollowed, and filled with Treacle, Soap, Oil of Scorpions or of Olives; using moreover, for Persons of Condition, Cataplasms made with Milk, the Crummy Part of Bread, Yolks of Eggs; or with the Mucilage of emollient Herbs and Roots.’ †
†All quotations from Chicoyneau are taken from the London 1721 edition: A Succinct Account of the Plague at Marseilles, Its Symptoms, and the Methods and Medicines used for Curing it. Drawn up and presented to the Governor and Magistrates of Marseilles, by M. Chicoyneau, Verney and Soullier… (London, 1721) which is an English translation of Chicoyneau’s Relation touchant les accidens de la peste de Marseille, son prognostic, et sa curation : du 10. decembre 1720 / par messieurs Chicoyneau, Verny & Soulier (Lyon, 1721). Worth had both the 1721 and 1722 Lyon edition of this pamphlet.
*Disclaimer: The Worth Library does not recommend these treatments.