whence it is easy to judge that we have here nothing to do but to use successively the Medicines mentioned before. The Observation that we thought fit to insert between the third and fourth Class, and in which it is shown, that several infected Persons perished in a very short Time with Symptoms very moderate, or much less violent than what we generally observe the same Symptoms to be in malignant or common putrid Fevers. This Observation, I say, may instruct us, that this Sort of infected Persons in whom often there only appear a small Weakness, and a very great Consternation, demands as much Care as those in whom the Symptoms are more considerable, and on the least Appearance of their being seized, there ought immediately to be used, besides generous Remedies, every Thing that is proper to sustain their Strength and encourage them.

The Method of treating the Sick of the Fourth Class.

We have nothing here to do, but to cast our Eyes back, on what we have said above, relating to the Accidents that characterise and terminate the Plague, in order to judge that this Method should principally turn on the Manner of treating the Buboes or Carbuncles. The Symptoms, it is true, that appear at the Beginning in the Diseased of this Class, are nearly the same with those that show themselves in the sick Persons of the second Class; so we immediately employ’d the Remedies proper to oppose them, such as are the gentle Emeticks, the diluting Catharticks and Sudorificks of the same sort, according to the Indications that arise, observing however a very exact Regimen. But the Destiny of the Infected, depending principally, as we have remarked already, on the large Emption, and laudable Suppuration of the Buboes and Carbuncles, these Sorts of Tumours have been always the Objects of our chief Care and Attention. And since these Tumours have constantly appeared in the Sick of this fourth Class, and in those of the preceeding, the Method which we are going to propose for their Management, ought to be consider’d, as common to all the Classes.

The Method used in the Treatment of Buboes.

These Tumours were ordinarily situated in the Groin, and often below it, chiefly swelling the lymphatick Glands, placed near the crural Vessels; they appeared also pretty frequently under the Arm-pits, particularly under the pectoral Muscle, as also in the Glands behind and below the Ears, in the Jugular, and under the Chin.

The Buboes with which the Sick of the former Classes were attack’d, often appeared at the Beginning of the Distemper, chiefly in the Groin and Arm-pits, small at first, deep and exceeding painful, that one could scarce touch or handle them, without causing a very uneasy Sensation; these for the most Part made no other Alteration in the Skin, but by swelling it, as they grew bigger, towards the End they became indolent.

In what Time soever of the Distemper these Sorts of Tumours appeared, we attacked them without any Delay, unless there was Reason to presume from other Symptoms that the sick Person was at the Point of Death.

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.

But as the Diseased of the first Classes perish often very suddenly, even at the Time when we apprehend such an Accident the least, we think it not adviseable in this Case to prescribe such Sort of Applications; but we ought immediately to prevent the last Danger, by endeavouring at the opening of the Tumour, and to that End we caused to be applied without Delay, all over the Part a Dressing with the caustick Stone, leaving it there for some Hours, more or less, according to the Depth, Situation, Bulk of the Parts, and the Constitution fat or lean of the Patient; the Escarr being made, it must be opened by Incision, without any Delay, in order to examine the tumified Glands, to dissolve which, there ought to be apply’d Digestives, after they have been a little scarified; or they should be extirpated if they are moveable, and can be removed without an Hemorrhage, which according to our Observations has been always fatal tho’ but moderate. And for this Reason we have thought fit to reject the Method of extirpating these Tumours, which was made use of before we came to this City. The Way of opening them immediately by a Lancet, altho’ more ready than that by Cauteries, appears to us in many Cases insufficient, and less sure, as giving but little Light to view the Part, and leaving very often after it, Abscesses, Fistula’s or Scirrhous Tumours. As to Cupping, Glasses and Blisters, their Effects seem to us slow, useless, and that of the Latter sometimes dangerous; in certain Subjects their Application has been followed by internal Inflamations, especially in the Bladder.

Returning then to our Caustick Stone, the Escarr being formed, and the Incisions made with the Precaution of discovering the tumified Glands, in their whole extent, that no bad Reliques be left behind; the next Thing is to dissolve the Glands by the means of good Digestives, which may be made of equal Parts of Balsom of Arcæus, Ointment of Marsh-Mallows, of Basilicon, adding thereto Turpentine and Oil of St. John’s Wort, which ought to be well mixed, and if there is any remarkable Corruption in the Part, there ought to be joyned with the Turpentine and Oil of St. John’s Wort, the Tinctures of Myrrh, of Aloes, Spirit of Wine camphorated and Sal Armoniack; lastly deterging and cleansing away the Pus and Sanies, whilst it is thick and too corrosive, with Lotions made of Barley Water, Honey of Roses, Camphire; or with vulneraine Decoctions of Scordium, Wormwood, Centaury the less, and Birthwort. And when the Ulcer has been well deterged, and the tumified Glands entirely consumed by Suppuration, there remains nothing but to apply a simple Plaister to bring the Wound to a Cicatrice.

We shall now give in few Words, the Method we used in the Cure of Carbuncles, which in many Circumstances have a near Relation to the preceeding.

The Method used in the treating Carbuncles.

We have observed these sort of Tumours during the whole Course of the Sickness, in a very great number of diseased Persons in all the Classes, though less frequent than the Buboes; remarking also very often in the same Subjects, these two sorts of Emptions.

The Carbuncles present themselves in different Places on the Surface of the Body, especially in the Thighs, Legs, Arms, Breast, Back, but very rarely in the Face, Neck, or Belly.

They appear at first under the Form of a Pustle or Tumour, which is whitish, yellowish, or reddish, Pale in its middle, or inclining to an obscure Red, which becomes insensibly blackish, crustaceous, especially about the Edges; as also variegated with divers Colours; so that, according to that which is predominant, and the Excess or Defect of Sensibility and Elevation, we may give it the Name of a Phlegmonick, Erysipelatous, or