This is what should have been demonstrated

It follows from the comparison of the main monographs of the black disease, that the men who occupied the first rank in the medical practice, all started from the idea, that a violent poison had invaded the blood and the organs. It was therefore necessary to hasten to provoke its elimination; or, failing that, strive to weaken, and if possible, neutralize its activity. The very rational plan which this theory had dictated to them can be summarized in the following prescriptions:

1 o Purify and disinfect the air impregnated with the morbid principle.

2 o Hunt out of the body the poisonous venom, using bleeds and purgations.

3 o observe sobriety and continence, without ever losing a strict life plan.

4 o Keep as much as possible the calm of the body and mind.

5 o Make use of substances deemed capable of neutralizing the harmful agent.

6 o Drop the center of the epidemic.

What could be done with this formula if all the means intended to fulfill the indications had kept their theoretical promises? When one accepts the pathogenic interpretation, the resulting curative method is, in every respect, irreproachable.

When the disease was declared, the doctors intervened without delay; but their ignorance of the nature of evil left them only the worst of treatment symptomatic, too often even forbidden by the speed of death.

As the forces seemed radically destroyed, the most urgent was to restore them by various means, the effects of which did not correspond to the practitioner’s expectations.

If the organism manifested, by the character of the febrile movement, a certain degree of resistance, which was extremely rare, and was observed only in a few plethoric and vigorous subjects, a slight bleeding was attempted. But experience had early learned that a profound adynamy soon took the place of this transient effort of reaction: what was recognized by the pallor of the face, the lowering of the pulse, which became imperceptible, and finally to syncope that their duration was deadly.

According to an old belief, accredited by physicians and very common among the people, the acids enjoyed a general anti-septic property, and consequently had to combat the special venom of the plague. In this view, acidic potions were prescribed by the lemon, the lime, the vinegar, & c. In order to remedy the depressive action of these agents, the use of cordial or stimulating waters was prescribed as corrective.

It goes without saying that the formulas were affected by the indigestible and imaginary polypharmacy of the time. It contains pearls , precious stones, and other similar substances, which a strange association of ideas had brilliant properties. The potable gold had every right not to be forgotten.

Chalin de Vinario boasts a lot of topaz , which according to it is the virtue of drawing venom outside when it is applied to coals. He claims to have made sure of it with the Pope’s ring in which a topaz was enshrined; but I strongly believe that, in his thought, the property of the gemstone should be well enhanced by the moral influence of the pontifical ring.

It appears, however, that in Florence the doctors employed the various substances of which I have just spoken, only as auxiliaries. Their confidence rested mainly on two remedies, one of which is none other than the theriac, that old alexipharmaque who still lives on his old fame. The other, which remained a mystery, passed for a very powerful one, in spite of the incessant denials of Death. I have not been more fortunate than M. Carriere, by searching, in the collections of old formulas, for some indications which could enlighten the nature and the composition of this panacea. It was emphatically called the oil of the Grand Duke against venom! Did this name allude to the brilliant cure of some great personage? Or was it just a well-chosen stamp to strike the imagination and raise the prestige of the new antidote? All that can be said is that he continued to be in great favor throughout the course of the epidemic. We understand this vogue, when we see that by the aid of ten or twelve spoonfuls of this liquid sweetened with syrup, we undertook to cure almost all the patients. Meanwhile, Death “was plugging his ears” and did not slow down his fatal harvest. But hope, revived by popular credulity, sustained the moral force; and this is how the oil of the Grand Duke could indirectly produce some good effects.

What does it take to believe the real properties of this wonderful agent? Would he not have come to us if he had afterwards shown himself worthy of his name? He seems to me probable, that after the first craze, the experience more reassured, has dispelled this new therapeutic illusion, and the famous drug has gone to join in oblivion, so many powers of the same order, whose reign n ‘ did not survive the circumstances that had inaugurated it. The theriac has retained a remnant of esteem which still assures it a place in the practice, and one can not explain why history has kept silence on its rival.

The remedies I have just mentioned were intended to combat the morbid cause, which was supposed to dominate all the symptoms. They were the basis of general treatment, and corresponded to what we now call the specific empirical method. I spared the reader the monotonous review of a host of compositions which had their moment of vogue, and successively replaced each other. Chalin boasts with enthusiasm an alexitere electuary and cordial, of which he attributes the idea to Arnauld de Villeneuve, and which was, he says, very much in honor among the physicians of Paris and Montpellier. The formula of this electuary carries no less than forty-five substances, among which, the inevitable bowl of Armenia, pearls, sapphires, emeralds, etc. It is by his use that Guy de Chauliac thinks he has escaped an attack of the plague of 1361. “I take it,” he says, “like theriac; and I was preserved, God helping . ”

The local treatment also had its indications. It was supposed to promote the maturation and the healing of the buboes, in the cases where they showed themselves.

When they presented a bad aspect, they applied suction cups to extract the poison, which was supposed to be confined; or one sought to destroy it on the spot, scarifying and cauterizing.

The buboes, properly matured, opened to give rise to the puriform matter which they contained, and this festering wound was dressed with Egyptian ointment and theriac; but it was necessary to supervise the use of such an active topic, which could provoke, in the place of application, pains, the repercussions of which were not without danger, in the weakened state in which the patients were.

When the appearance and course of the bubo offered nothing disturbing, it was dressed after its maturation, until the completion of the scar, with a plaster which Rondinelli has preserved the formula. It consisted of plantain juice, lentil flour and black bread crumbs. As a maturative, this topic was well worth another, and filled perfectly the indication. It was commonly called plaster of Arnoglossus , because of the plantain named Arnoglossum , after a vague resemblance of its leaf with the tongue of the lamb .

The convalescence that followed this violent assault was slow and lucky. It was therefore necessary to monitor the subject carefully to prevent a relapse , which was most often fatal. As for recidivism , we are told that it was rare, and almost always had a happy outcome.

The general indication presented itself. It was a question of employing largely the tonics whose action went straight to the restoration of the forces, which it was urgent to remake, after the hard attack which they had undergone.

It can be seen from what precedes, that medicine could render some services; but in what narrow limit! And how much she was below her salutary mission in the too unequal struggle she faced! Are we today more sure of ourselves? Do we have the right to oppose the certainty and excellence of our capabilities, weakness proved too much of those was implementing the art of the XIV th century?

Tributary of a chemistry as strict in its principles, as firm in their applications, the pharmacy broke with these mysterious operations whose black magic seemed to dictate the secrets. She realizes all her acts, simplifies her formulas, avoids the associations of incompatible substances, and leaves in the powder of her archives, those fantastic mixtures which seem the fruit of a sick brain. Why can I not add that the theoretically irreproachable remedies that it puts into our hands have become, with the test, condoms more assured of the big popular diseases, curative agents more able to fight them?

One more word, and I’m done.

Was this explosion of the great epidemic the last, and should it be dated from this period, its definitive extinction? This has always been my opinion, and I am glad to see it shared by Dr. Phillippe, whose authority increases with the depth of his studies. “Impetuous and unbridled,” he says, “the Black Death has traveled the world in the space of three years, and has disappeared after this one invasion .”

Other writers think that she reappeared ten years later. According to Mr. Henri Martin, from the beginning of 1361, she would be declared simultaneously in Paris, Avignon, London and most of France and Germany .

The eminent historian I quote is not a physician; but he can invoke the support of Guy de Chauliac, whose words seem conclusive, at first sight.

“Afterwards, in the sixties and the eighteenth century of Pope Innocent’s sixth pontificate, in retrograding from Germany and the northern parts, the mortality returned to us, and began towards the feast of St. Michael , with bumps, fevers , carbons and anthrax, increasing gradually, and sometimes recovering until the middle of the year sixty-one. Then she lasted so furious even to the three months ensuivans, she left, in many places, that half of the people . ”

Was it a return from the Black Death? Was it not rather Oriental plague, almost always permanently at that time, and which would have previously given way to black death, only to reappear later with redoubled fury? Guy de Chauliac uses the vague word mortality , which does not prejudge anything about the nature of the disease. The pathological analysis still had a long way to go, and there would be no need to be surprised that, under the influence of a disaster which troubled the best-tempered minds, the illustrious author had not thought of to elucidate this question of differential diagnosis.

It has been noticed, however, that he says nothing of the first form, of which the principal and almost inevitably fatal symptom was the spitting of blood, an index of the initial alteration of the lung. This time he limits himself to expressly pointing out the bumps , carbons , anthrax , pathognomonic attributes of the Oriental plague, which he had occasion to know before the Black Death.

It is objected that these cutaneous localizations appear also in the symptomatic procession of the disease of 1348. But they are only in suborder, and we have seen the hemoptoid form carry away the patients during a long phase of the epidemic, without leaving to the buboes and other gangrenous degenerations, the time to occur.

Guy de Chauliac is content to note a distinctive feature that I recall in my turn to be exact. “It differed,” says he, “from the preceding, that in the first, died more of the populace, and in these days, more rich and noble, and infinite children and few women.”

This preference for the rich and those who are called the happy of the century, is found in the history of great plagues. To a certain extent this apparent derogation from their habits may be explained by the temperament of the population, the comparative manners of the various classes of society, the accidental conditions in which the disease has broken forth, & c. As for the epidemic of 1360, whatever its nosological secret, it seems that death, which had almost entirely destroyed, twelve years before, the lower classes, had to fall on the rich classes that had been spared.

M. Carrière does not doubt that the Black Death attacked France and Italy again in 1361. From that moment, it would have preluded to its definitive disappearance in the two countries, by some scattered cases, like the last glimmers of a fire that goes out.

Astruc goes further. According to him, the black plague persisted in France during the year 1373, and had not yet left Europe in 1386 .

When I wrote the history of the pain of ardents, I said that the plague reigned, indeed, in France in 1373. Historians are unanimous on this fact; but they say nothing that adapts to the black plague, with the characters we know it. I believe that Astruc has let himself be taken, like many others, by the generic name of plague, which has given rise to so many nosological confusions, the traces of which have not yet been erased.

In summary, was the illness of 1361 a return from the Black Death or a resumption of the plague of the East? Did the first have two invasions, ten to twelve years old, before joining the extinct diseases in their retreat?

According to the careful comparison of my readings, I maintain, until further clarification, that the lightning invasion of 1348, of which I have just sketched history, is the only one that we must record with certainty, in the annals big popular diseases.

China Rifampicin