A Breve Description of the Pest

Ane Breve Description of the Pest Dr. Peter M. Worling The plague, known in Scotland as the Pest and sometimes as the Black Death, first occurred in China in the 1330’s. At that time China was a world wide trading Nation and by 1347 ships from Europe arrived in the Black Sea where they linked with the China trade and carried the disease to Sicily and then on to the rest of Europe. There was a mortality rate of between 25 and 40%, which decimated the European population and had far reaching economic influences. The disease reached England in 1348 through the port of Southampton and lasted until 1350. There were further outbreaks in 1361-1362 mostly affecting the young, 1369 when some 13% of the gentry and clergy in England died and also in 1379-1383 and 1389-1393. By the 15 th Century the disease had become endemic with its centre in the middle of Europe and cases continued to occur. Consequently when Gilbert Skeyne published his work there was a considerable amount of knowledge about the appearance and effects of the plague. Gilbert Skeyne was born around 1522 in Aberdeen, Scotland. He was educated at the Grammar School and at Kings College, Aberdeen University, where he gained a Master of Arts Degree. He then went on to study medicine and in 1556 he was appointed Mediciner, that is a Doctor, at the University. It was during his time at the University that he published his treatise on the plague, which was published in 1568. He is known to have published one other work in 1580, “Ane brief description of the qualities and effects of the well of the Woman Hill beside Abirdene”. In 1569 Gilbert married Agnes Lawson the widow of an Edinburgh Burgess and in 1575 he moved to Edinburgh and set up a medical practice in a house in Niddrie Wynd. His practice prospered and he became well known locally. On the 16 th June 1581 he was appointed a physician to King James VI and he was granted a pension of £200 Scots. He died in 1599. His treatise is particularly interesting because it gives us an insight into both the philosophy of medicine, as well as the drugs in use at the time. It is written in Middle Scots and it is the first medical treatise published in Scots. All other medical works were published in Latin and this meant that this work was available to a much wider public. Only one copy of this work is known to exist, held in the National Library of Scotland The treatise is divided into eight chapters: Chapter 1. A description of the Plague 2 The Causes of the Plague 3 Signs 4 The Most Dangerous Places to Be. Chapter 5 Recognition of the Infection 6 Signs of Death 7 Prevention of Plague 8 Cure. Of these the last two chapters are the main sections, giving instructions on how to treat the patient and many prescriptions which he recommends can be used in treatment. While the body of the text is in Scots the prescriptions are in Latin. Europe at that time was strongly influenced by the church and religious belief. It is not surprising that the first cause of the plague is seen as a “scourge and punishment of the most just God, so that heaven which is the admirable instrument of God, blows that contagion upon the face of the Earth.” Gilbert than continues by listing the secondary causes of the plague. “The cause of the plague in a city is the stink and corruption and filth which occupies the common streets and gutters, the great reek of colis(smoke from coal) without the wind to despatch the same , corruption of herbs sic as Cail and growand treis (trees), moist hevie sauer (smell) of lint, hemp, and ledder (leather) stepit (soaked) in water. Ane privat house infectis other of stinkand closetis (toilets) or corrupt carioun (dead animals) therein of near by if the inhabitant’s hes inviseit (visited) other infected townis or drinking corrupt water.” There was consequently a clear understanding that the filthy conditions in which people lived in the cities contributed to ill health and the spread of plague, although they did not know how the infection was spread. In chapter 3 Gilbert describes the physical conditions which are most likely to bring about an epidemic. He believed that these include a wet spring, the eclipse of the sun, meteor showers and following the sickness in poultry. He emphasises the influence of bad weather conditions, but shows in his remarks that, at that time, there was little understanding of how the infection was spread. Gilbert describes in chapter 4, those places where the plague is most likely to occur and those most likely to succumb. The places are those near the sea, situated towards the South and where there is an abundance of standing water, and where dead are buried. As the plague epidemics generally started in Continental Europe and the infection was carried to the ports in the South of England and Scotland before travelling up through England to Scotland, his observation that the disease travelled from the South would be correct. The next two chapters deal with the diagnosis of the plague and the signs of death. He describes the plague symptoms as a high fever, headache, depression, pain in the stomach and the heart, coupled with heavy intakes of breath. He describes the appearance of the swellings, which he calls “BUBONES”, of the lymph glands under the arms, and in the groin and remarks that if a number appear it is considered more deadly, Signs of impending death are given as abdominal cramp and pain, the body being covered with red spots – which turn black, thus the name the Black Death, refusal of food, a black tongue and a dry mouth. He comments that he treats his patients with the help of God who is the only true mediciner for the body and the soul. He ends by explaining that he has of necessity to write his prescriptions in Latin as they cannot be easily translated into the vulgar language. This may make these obscure for the unlearned reader but he can obtain any of these prescriptions form the apothecary prepared with all good faith and diligence, as they are prescribed with benevolence. Chapters 7 and 8 which are the main chapters of the treatise deal with the preservation (prevention) and cure of the plague. He recommends two actions the first is to prepare the body “for purging of the superfluidity or corruption of humours”. Evacuation is recommended before or after anyone has been in a suspect place by drawing blood from the median vein of the right arm taking a quantity that is determined by the strength, temperament, constitution and the age of the patient. He makes the point that man must live in a fresh atmosphere and where there is stink and corruption it must be dealt with by fire and fumigation with aromatic materials. He quotes Hippocrates who lit fires in Athens to combat the plague brought over from Africa and Ethiopia on the prevailing wind. He gives a long list of materials to use in fumigation:- A fire is first made of fir or a similar timber and added to it various herbs such as Aloes, Callamus called Aromaticall, (Calamus rotang – dragons blood)Asarum the scruff of Citroun, Saifroun, (Crocus sativa) Cãnel Cypir, Coste: Galange, (possibly Kaempferia galangal) Caryophillis, (Clove) the tre and Granis of Iuniper, Rosemarie, leavage, (lovage) Balme tre Laure tre, Squináthe calles Iuncus odoratus, Ladanú, myrrhe, minte, Origanum, the root of Valeriane. Pulege, Saige, Sauine, Tamarisce, Rosait, Acorus, (Acurus calamus) Aspic, Basilic, tyme, Calamint, Mariolane, Finkill Hysop or others of such quality as the time shall require such as hot and dry in winter, cold and humid in summer He also says that these ingredients can be used to make compositions in the form of lozenges thick powders candles or “pomis odorative. He gives a number of prescriptions for these, for example: R Yrios Florentine Majoranae Calami aromatici Lapdani Benioni Cpri gariophillorum cuisop drach duas Moschi grana quatuor “Fiat pulvuis gum traganti; quátú sufficere posse artifice videtur; praescripta in massae formam temperet, fomenter deinde pilae suffisimi odoris qui principi pestis causae ex diametro repugnant.” Another prescription he suggests is: R Ros rub Florú violarum et buglos sing drach tres Omnium fandalornm Coralli rubei Spondii opt cuisop drach duas Cinnamoni mastichis Myrrhae recentis Ligni aloes sing drachmam Rad angelicae Cortis citri ana drachmam et semis Camphorae boni granaXII Croci orientalis grana VI “Omnia pulverizentur, facculus ex syndone purpurea ad cordis figuram efformatus, regioni partiú spiritualium applicetur”. He suggests the use of sheets soaked in vinegar as hangings, dipping a sponge in vinegar in which rue has been soaked, and other remedies but he points out that these are not as efficient as the preservative remedies he recommends. There are many other prescriptions recommended in the chapter, some for use in the winter, others in summer. An interesting suggestion is that for those patients that do not know with which disease they are infected should take a drachm of Pill Aggregative followed the next day by a dram of Theriac. However, he says, these days Theriac is not well dispensed and not good and two drachms of the following electuary could be taken instead: R Ros siccaru rad gentianae Squináthi, Trifolii Thuris, sing drachma duas. Sanquinis sicci anseris Haedi Anatis maris et feminae Rutae sylvestris feminis Fenicoli Cumini Anethi Napi sylvestris vel rapi hortensis cuisop drachmem Et feminis------------------------------------------------------------------------------------- Myrrhe Nardi sing drachmas tres Piperis albi et longi: Costi, phu, cinamomi, anisi sing drachmam Benzoi, afari, ámoniaci cuisop drachma et semis Ireos, croci, rhei, gigib, Mistiches sing drach. Semis. Stoecados drach tres Agarici, mari, ana drachma Carpobalsami grana numero viginti “Fiat pulvis tenuissimus ex omnibus”. “Mix with four parts of honey, well mixed and pour into a silver vessel, as a most precious medicine, which not only preserves from the pest but is also good for curing the same and is an antidote for all other poisons or bite of serpent”. A prescription he recommends for older people or those with a humid temperament: R Castorei veri Aristolochia rotundae sing drachma duas Gebtianae drachma Baccharus lauri drach “Ex omnibus fiat pulvus, ane drachma thereof as age and nature of the resauer (patient) requires with wine or some convenient liquid once daily for prevention and twice daily for cure”. The final chapter eight is headed “Cure of the Pest”. Gilbert begins by recommending the patient is given a good fat fowl with two fresh eggs and three ounces of “rosate” honey. This is followed with a dose of the “antidote cordial” (because the venom to the most part draws to the hart). The vital faculties must be carefully observed and the patient should be allowed to rest. If there is deterioration then give the following prescription: R theriace optimae septem ad minus annod Optima venetii tantú, eao legitima cõfictus boli Armenan diarrhodi abbayis sing drac una rheib electi drac semis cinnnamomi opti unciae semis trochiscorú de spodio triu sand loru terrae figillatae et camphorae recentis fin serupulu sacchari ros et bugloss ros enuity --- croci orientalis scrupuli semis “in pulverem quae debent iatricú vertantur, qui in aquis cardui benedicti, scabiosae, buglossae, rosarú et plantaginis sing unc. semis quae tandé colata, per manicam Hippocratis ferantur, fiat antid. capiat infirmus uná , vel tres uncias vt ratio postulat singulis matutinis horis, noctis hora media”. “Within three hours of taking this antidote if any aposteme (lump) appears, affix a “ventose” there, if it does not appear fix the same to the ears, under the oxter (arm pit) and by the secret members. Draw blood from the arm copiously, if the patient can suffer this. If swelling appears on the head, open the cephalic vein on the exterior part of the arm, if between the head nad the secret members Leuer vein on the inner part of the arm, if beneath the secrets the interior vein of the foot called saphena must be opened.” Following bleeding he recommends a number of prescriptions which can be used, for example: R aloes electe unc. duas aristolochiae rot uncia croci drac. semis tormétilae dictani sesquidrachma semisacetose seminis pomtrei ana drac seminis rheib drach duas salisimae spicae sing drachmam cú serapio de acido ori succo “In globú redigátur pro pilulis” “Ane sufficient dose to be taken twice or thrice for prevention or at the beginning of infection”. He recommends that the patient should be kept quiet in a room with a big fire and vinegar and rose water thrown on the fire. He gives a prescription for a hot application for the chest. He recommends that the patient should abstain from sleep the first night but as frequent sickness and fainting will make it difficult to retain the medicine he suggests that the stomach can be settled by giving a prescription which includes olei ros,and myrrh, On the second day he reports that Avicenna gave two ounces of rose water, an ounce of small white wine and bol armen in powder. If the patient retains this he may be safe but if he vomits it is a deadly sign. The third day he is given a drachm of the previous antidote and any swelling, fomented with a decoction of the root of lilies althe, camomile, anete and adiante fixed in a cataplasma of flour and fresh butter. He also discusses the best way to deal with the swellings which he recommends should be opened by a surgeon because of the infections material contained in them. There are many other prescriptions. In only one is aquae vitae mentioned in a prescription to be given to aid recovery after the plague has subsided. From these prescriptions we can get some idea of the more popular treatments. There is an emphasis on the use of Theriac with a multitude of ingredients. Items frequently used are aloes, myrrh, honey, Armenian bole, rosae rubrae (the fresh dried petals of Rosa gallica), oil of roses, cinnamon, camphor, flowers of violets, bugloss, aristolochia, scabious, gentian and vinegar, and many other herbals most of which are familiar to us today. Among the more unusual ingredients he mentions are oil of scorpions and vipers. It is significant that while he recommends purging and bleeding his pharmacopoeia is largely a herbal one and he does not use the more esoteric remedies that have been reported by some other authors at this time. References: Skeyne, G.A. Ane Breve Descriptioun of the Pest; Robert Lekprevik, Edinburgh, 1568. Dr. Peter M. Worling, [email protected]