On the subject of tokens Dr. Hodges further observes, that they differed also in their degrees of hardness, some being easily penetrated with a needle or penknife, while others, more callous or horny, were penetrated with more difficulty. They so strongly resembled warts, that they could scarce be distinguished from them; and Dr. Hodges himself was often obliged to have recourse to a needle for this purpose. They seemed hard to the touch, not unlike kernels under the skin, the superfices being smooth. “When I essayed to prove some of them (says he) I found themalmost impenetrable.” Another very remarkable circumstance relative to them was, that they were often quite insensible, and this distinguished them from the carbuncle, which is always very painful. Hodges also remarks, that a quick sensibility in the skin was always a good sign, and those that went no farther than the skin would sometimes slough off.
Along with these tokens we can scarce doubt thatpetechiæandvibicesmade their appearance. The former, even in the inferior degrees of the distemper, were dangerous, the latter always fatal, never appearing till the patient is within a few hours of death, sometimes indeed not till death has taken place. Of the petechiæ Dr. Russel says, that for the most part they predicted death, but not without exception. Such as he observed were round, somewhat smaller than a recent flea-bite. They were distinct, few in number, and scattered irregularly about the breast and mastoid muscles. When they did not appear till the approach of death, they were from the first livid, or very dusky; but if they appeared early, they were of a less deep colour, changing afterwards to livid. Hodges speaks of them as deeper coloured than the spots of malignant fever, not fixed in any particular spot, sometimes few, but commonly very numerous; the colour sometimes red or purple, sometimes yellow, and sometimes livid or black. From Gotwald, Russel quotes a description of these spots, which he divides into four species. 1. Reddish, like flea-bites, soon growing brown or black; appearing on all parts of the body except the face. 2. In the form of lentils, spreading like the former all over the body; ruddy at first, but in 24 hours growing dark or ash-coloured. 3. Large brown spots, scattered here and there, sometimes intermixed with the lentil kind. 4. Not unlike the measles, spreading all over the body, rising afterwards in small blisters without any matter, vanishing about the fifth day. Russel also takes notice of a species of petechiæ which were very numerous, confluent, and of a dark red or dusky colour and irregular figure. These were sometimes remarked in the interstices of the former. Such instances occurred but rarely.
The vibices were much larger than the petechiæ. Gotwald says that they covered the face as high as the nose, and from thence spread to the forehead, disfiguring the patient in a frightful manner. They did not appear till a short time before death. Often they appeared unexpectedly, shooting up like lightning from the breast to the face, in spots of various colours, blue, green, brownand yellow. Diemerbroeck describes them as oblong spots of a livid or black colour, like strokes drawn with a pen; sometimes they were larger, the biggest resembling the strokes of a whip. Russel takes notice of a kind of marbled appearance which took place at the height of the disease, or a few hours before death; the colours being a faint blue, and darkish red, both more or less obscure at times, but never bright. It was not permanent, vanishing in one place, without leaving any trace, and returning at short intervals. “The skin in various places was sometimes deformed by narrow streaks of reddish purple, or livid colour. When such took possession of the face they gave a frightful appearance to the countenance, and frequently made such an alteration in the features, and so completely disguised the patient, as to render him hardlyknowableby his acquaintance. A streak nearly of the same kind was sometimes observed darting from the edges of the buboes and carbuncles. The vibices or weals were much longer and broader, and more exactly resembled the marks left in the fleshy parts by blows or stripes; they were found chiefly on the thighs, buttock, and back, and made their appearance several hours before death, in some cases, but in others not till after. Large blue or purple spots, themaculæ magnæof authors, were sometimes observed with or without the vibices, a little while before the patient expired, but most commonly were discovered only on the corpse. Their figure in general was round, sometimes irregular.”
Whether all these mortal signs appeared on such as died very suddenly of plagues, and were by the English writers confounded under the general name oftokens, cannot certainly be determined. Dr. Russel saw none who died within the twenty-four hours, and few who died within thirty hours, so that we cannot from him expect any particular account of the situation of those who died suddenly. In general, however, he says, that “in the most destructive forms of the plague, the vital principle seems to be suddenly, as it were, extinguished, or else enfeebled to a degree capable only for a shortwhile to resist the violence of the disease; in the subordinate forms, the vital and animal functions, variously affected, are carried on in a defective, disorderly manner, and denote more or less danger accordingly.” It seems probable therefore that in those who are suddenly killed, the same effects take place in a short time which are observed to take place after a longer space in those who die gradually, buboes only excepted, which require for their formation a longer time than is allowed to the patient to live. Internal mortifications, or rather eschars, are therefore to be suspected, and dissections have evinced that this was really the case; but besides these there was an appearance observed in the plague at Marseilles which is not taken notice of by former physicians; viz. a preternatural enlargement of the heart. M. Deidier on that occasion communicated an account of nine dissections, but of these only one had died without eruptions. This was a woman of 40 years of age, who lived till the third day. In her “themediastinum101was torn towards the upper part; the pericardium of a livid colour; the heart larger than in its natural state, by the swelling of its ventricles; full of thick, black blood. The liver was also very large, and of a livid colour, with a carbuncular pustule on the side of the gall-bladder, which was filled with very black bile.” In others who had eruptions, and who of consequence we must suppose to have lived longer, the enlargement of the heart was still more remarkable. In one who lived eleven days, the heart was of double the bigness, having scarce any blood in the ventricles, whose cavities were filled each with a large polypus, that on the right side having dilated the auricle to the breadth of four inches. The liver also was larger than ordinary, and the gall-bladder full of a black and green bile. The appearances were much the same in all the rest, but, as the timethey sustained the disease is not mentioned, we cannot determine whether the enlargement of the heart took place at the very first, or was only an adventitious symptom after the fever had come on. Dr. Russel takes notice that such patients as he attended complained greatly of their heart. “A sense of oppression about the præcordia (says he) which the sick were at a loss to describe, was, in one degree or other, a constant attendant on the plague, except in very slight cases of infection; and where it came on early, or persisted in a high degree, was always a dangerous symptom. The sick showed how severely they suffered by their perpetually changing their posture, in hopes of relief; but, when asked where their pain lay, they either answered hastily they could not tell, or, with a fixed, wild look, exclaimedkulbi! kulbi!(my heart! my heart!) This anxiety increasing as the disease advanced, terminated at length in mortal inquietude, the patient, for many hours, in the last stages, incessantly writhing his body and limbs as if in agony. Though pain at the heart was often conjoined with the symptom just mentioned, and by the sick seemingly blended together, it appeared to be different, and to exist separately. They often exclaimed as in the other, my heart! my heart! pointing also towards the scrobiculum cordis, but then would addeujani kulbi, my heart pains me; ornaar fi kulbi, my heart is on fire.” This last pain the Doctor supposes might have its seat in the upper orifice of the stomach; the extreme anxiety may be accounted for from the enlargement of the heart; but as neither of these symptoms took place in such as died in a very short time, we must be apt to consider this enlargement not as any primary and essential symptom of the disease, but as one which takes place when the vital powers are able to oppose for some considerable time the cause of the disease.
In his account of the origin of the plague, Dr. Russel takes notice of the opinion that, at the communication of the infection, the sick were sometimes sensible of having received it. This has been observed by Dr. Lindin malignant fevers; it has also been observed in plagues, as we have seen from Dr. Hodges, Verdoni, and others; but Russel says he never saw any instance of this. He owns, however, that he has seen instances of the disease quickly succeeding a panic fear of being infested. “In cases (says he) where the disease was not discovered to be the plague, till upon the eruption of buboes after two or three days, I have known several persons who had, till then, without the least suspicion, frequented the sick, struck suddenly with a panic, and imagine themselves ill. They felt shooting pains in their groins, confusion in the head, and a loathing. Though in some these complaints were merely imaginary, and soon vanished, in others they proved real; the symptoms increasing, and being followed by eruptions. In such cases I suspected the latent infection to have been excited by terror.”
In the instance formerly quoted from Dr. Guthrie at Petersburg, we have a notable example of this sudden seizure by a stroke. His information was derived from the physician-general of the Russian army. This gentleman assured him, that “he had seen men, in apparent good health, instantaneously drop down, as if shot by a musket ball, by the sudden action of the pestiferous miasma, and upon duty again in 24 hours, perfectly recovered by the operation of a strong vomit.” Whether or not these menfeltany stroke at the instant of their falling we are not told: possibly it might be only a syncope very common in the plague, which took place at the very first invasion. Russel informs us, that “the sudden loss of strength, and disturbance of the functions attributed to the brain and heart, are reckoned, in a particular manner, symptoms of the plague. In their highest degree they distinguish the most fatal forms of the disease; and, under different modifications, adhere to all its varieties. . . . The early appearance of faintness was very remarkable in the plague,” &c.
Thus we see that the plague attacks without fever in two different modes; one, by attacking and destroyingthe solid parts of the body, the other, without any disorganization of the body, attacking the vital principle itself, or rather the blood, from which this principle is derived, so that a temporary suspension of all the functions ensues. The analogy between the cause of pestilence and those visible substances calledpoisons, is very remarkable in some things, though in others it totally fails. In the MedicalRepository102we have a dissertation upon this analogy by Dr. Edward Miller. He observes, that this analogy has been generally overlooked, chiefly on account of the invisible nature of the aerial poison, and the suddenness of death from poisons, more frequently than from pestilential diseases. This he accounts for from the largeness of the dose of poisons compared with that of contagion; “but (says he) by diminishing the quantity to an appropriate amount, these noxious substances (the poisons) may be made to exhibit the course, duration, and nearly all the phenomena, of what is called a malignant fever. But, above all, the attention of physicians has been diverted from this analogy between miasmata and poisons, by the febrile part of the character which generally belongs to pestilential diseases, and which, in common apprehension, is constantly connected with them. Yet these diseases are by no means universally accompanied with what is strictly calledfever. There is often a degree of virulence in the Asiatic plague, in the yellow fever, and in all the other forms of pestilential and malignant diseases, which altogether transcends the process of fever, and extinguishes life in a more summary manner. In the worst cases both of poison and pestilence, the febrile part of the symptoms excites little attention.”
Our author does not say in what this virulence consists. In the cases of those who die with thetokensupon them, the cause is plainly within the body; the destroying power acting with greatest efficacy below the skin in the soft substance of the flesh. Where the patient is suddenly seized in the manner described by Dr. Guthrie, the cause seems to be something foreign to the bodysuddenly inhaled, the effects being similar to those of fixed air when drawn in by the breath, and of consequence easily expelled by a vigorous action of the powers of the system. Guthrie observes, that, in such cases, it seems “as if the contagious matter existed in a very loose state in the first passages at the beginning of the disease.”
In the production of thosetokensmentioned by Dr. Hodges, we know that there must have existed in the body a certain cause capable of totally destroying the parts, and reducing them to an hard eschar, similar to that produced by fire or by a caustic. As we are unacquainted with any thing capable of producing this effect but fire, we can attribute the origin of these tokens to nothing else but the emission of the latent heat of both the solids and fluids which compose these parts, and their consequent transmutation into an hard, and as it were charred, substance. That such an emission of latent heat does in some cases take place is evident from the production of a great quantity of sensible heat when certain substances are mixed together. Thus, upon mixing together oil of vitriol, oil of turpentine and strong spirit of nitre, the whole mixture will take fire and burn violently, though two of the ingredients, viz. oil of vitriol and spirit of nitre, are by themselves incapable of being inflamed. In like manner if strong spirit of nitre be poured upon oil of cloves or sassafras, the mixture will burst out into a violent flame. Water poured upon quick lime occasions great heat, and seems in great part to be converted into a solid substance; for only a small part evaporates, and the slaked lime falls into a powder to appearance perfectly dry, and from which the moisture cannot be expelled without a very violent fire. In this case Dr. Black is of opinion that the heat comes from the water, which, as we have already seen, contains a great quantity of it in a latent state. But, according to his experiments, the emission of 135 degrees of heat is sufficient to reduce water to a state of solidity; and the heat of lime when slaking is so much superior to this, that ships have frequently beenset on fire by it. We must therefore either say that water in certain circumstances can part with much more than 135 degrees, or that the lime itself emits part of the heat it contains. This last indeed seems to be the more probable supposition of the two; for though fluids contain more heat in proportion to their bulk than solid bodies, we have no reason to suppose that the latter contain none at all: on the contrary the experiments formerly mentioned, especially those made by Count Rumford, show that they are furnished with an almost unlimited quantity.
The cause of the most violent kind of plague then we must suppose to be something received into the body, which in a certain time, probably sooner or later according to the strength of the contagion, disposes to an irregular emission of its heat, which coming by a kind of explosions, or, as Dr. Hodges calls them,blasts, produce those eschars which have been calledtokens, and seem to be no other than partial combustions, by which the parts affected are reduced to a state of charcoal, or nearly so.
In assigning this cause for the most deadly kind of plague, we must naturally ask the question, how can all this take place without any pain? for of those who died in this manner, many felt neither pain nor uneasiness till within a few moments of death. This can only be accounted for by the sudden and perfect destruction of the parts, which did not allow time for any sensation of pain to take place; and indeed in the application of caustic for an issue, the patient often feels but little pain. It is impossible to avoid perceiving a very strong connexion between this kind of plague and the dreadful cases of spontaneous combustion related p.182–186. In the case of the priest indeed the fire seems to have come from without, though even this cannot be ascertained beyond a doubt; but in those who were absolutely consumed to ashes, it seems equally probable that it may have arisen from within; and as none of the unfortunate persons seem to have made any noise or struggle, the priest alone excepted, it seems probable that the first attack had deprived them of all sensation, and that, notwithstandingthe terrible ideas with which such extraordinary occurrences must have inspired those who saw them, the sufferers may have died without feeling any pain. The priest seems to have felt nothing after the first stroke.
Should this cause be admitted (indeed whether it is admitted or not) we see that it is in vain to attempt to solve the phenomena of pestilence by the doctrine of stimuli, excitement or debility. There is no degree of stimulus, fire exepted, which can convert part of the body into an hard eschar, neither can it be done by any degree of debility or exhaustion. Besides, the irregular manner in which these eschars are scattered up and down, shows that the cause has not acted from a regular diffusion all over the body, but in a number of insulated spots, between which the connexion can by no means be traced. In all pestilential eruptions indeed the action of fire seems to be very perceptible. Gotwald mentions his having observed in two patients what he callspapulæ ardentes“burning pimples,” which Dr. Russel supposes to be a modification of carbuncular pustules. Gotwald calls them alsofire-bladders, and says that they were as broad as a shilling, of an irregular shape, and the skin seemed as ifshrivelled with fire. The carbuncle itself approaches much to the nature of the eschar, and is attended with violent heat in the adjacent parts. Gotwald, who gives an account of the plague at Dantzic, distinguishes the carbuncle into four kinds, (to be afterwards described.) Of these he says in general, that they allburnvery violently at first, &c.
From all these accounts it seems plain, that in the plague there are partial discharges of heat, fromsomecause, upon various parts of the body; and that, in many instances, this heat destroys the texture of the parts entirely. When this is done instantaneosly the patient feels no pain, but if more gradually, the pain is excessive, as in the case of buboes and carbuncles; which the Journalist of the plague year in London informs us were attended with such horrid pain as to make the patients cry out in a lamentable manner. This extraordinaryheat must either come from without or within, and we have all the reason in the world to believe that it comes from within. Mr. Hunter, in his Treatise on the Blood, informs us that in a local inflammation there is always an increase of heat in the inflamed part. Should this heat arise, as it probably does, from an emission of part of the latent heat, we may conclude, that such a quantity might be emitted, as entirely to change the texture of the parts. Thus mortifications or destructions of those parts may ensue, of all kinds, from the mildpusto the pestilential eschar.
In the effects of pestilential contagion we observe, if not asuperiority, at least adifferent mode of actionfrom what takes place in poisons. All these seem to act by dissolving the blood, or infecting it in such a manner that it supplies no sufficient quantity of animal spirits; of consequence, the creature soon faints and dies. In the plague, the blood does not appear to be much affected, nevertheless it emits, in various places, certain explosions which convert the parts into an eschar. Poisons always seem to produce the petechiæ or purple spots which sometimes appear in the plague. In Dr. Miller’s Treatise, already quoted, we find, among the symptoms occasioned by arsenic, “red or dark spots appearing on the skin, and rapid putrefaction, which renders speedy interment necessary.” Herein it differs from the plague, for the bodies of such as die of that distemper are not more liable to speedy putrefaction than others. Of the vegetable poisons he also observes, that, “after death, sometimes before, livid spots are observed on the body, the appearance of the blood is dark and dissolved, and putrefaction speedily takes place.” Of animal poisons—“The bite of the poisonous serpents is generally followed by tumour, and livid colour of the part bitten, extravasation of dark coloured blood into the adjacent cellular membrane, nausea and vomiting, sudden prostration of strength, paralysis of the limbs, convulsions, yellowness of the skin, hæmorrhages, &c. Livid appearances of the body, a dark coloured and dissolved state of the blood, and a rapid putrefaction, are observed after death.”
From all these accounts, however, it is plain, that, whatever may be the analogy between the action of poisons and malignant fevers, they do not in any manner operate like the contagion of the true pestilence. Of this the constant effect is to produce buboes, carbuncles, and other eruptions, resembling much more the effects of fire than any thing else; or, if the patient is cut off without the appearance of these, similar effects are observed on the internal and vital parts. Dr. Miller’s conclusion seems therefore liable to exception; in which he says, “that only the lighter cases of pestilence are unlike the effects of poison, but that, in proportion to the degree of malignity, the resemblance grows stronger.” It doth not appear that any poison hath produced one of the characteristic symptoms of the true plague, or any thing but what is common to animals dying of various diseases, the red spots on the skin only excepted.
In the eighth volume of the Philosophical Transactions abridged by Martyn, we have an account of a number of experiments by M. Deidier and others, made upon dogs into whose veins he injected, or poured into wounds made in the miserable animals, the bile of people dead of the plague at Marseilles. “The consequence was, that they became melancholy, drowsy, and without caring to eat. All of them died in three or four days, with the essential marks of the true plague, declared by buboes, carbuncles, and gangrenous inflammations in the viscera, in the same manner as in the human carcases from whence the bile was taken.”
The poisonous bile affected the creatures differently according to the vicinity of the place of injection to the heart. In the jugular vein it killed them in twenty-four hours, injected in the quantity of a drachm to two ounces of water. In this short time were brought on gangrenous inflammations, the heart was stuffed withthick and blackblood, the liver was swelled, and the gall-bladder full of green bile. This shows a very essential difference between the action of the pestilential poison and that of others; the former, in some parts of the body at least, coagulates the blood; the latter, in all parts, dissolves it.
In the crural vein (the vein of the leg) the effects were less violent. In about an hour they became heavy. In the former case they instantly became drowsy. In the second experiment they contracted such a loathing for food, that they would neither eat nor drink any thing after the injection was made. On the third day there appeared considerable tumours under theaxilla(the fore leg I suppose) and on their thighs, about three inches from the wound. The wound itself turned to a gangrene, and the creatures died usually on the fourth day.
In another experiment the animal had convulsive motions all over immediately after the injection, followed by a lethargy. Next day a carbuncle appeared on the great pectoral muscle on the right side. On the third, a bubo appeared on the thigh, and the same day the dog died. From the time of the injection he had neither eat nor drank. On dissection the fore part of the breast under the teguments was found entirely gangrened, the inward parts and viscera full of black clotted blood, the outward surface of the lungs was all purple, the heart was swelled as big again as usual, and the four cavities were full of black clotted blood. The bile of this dog, injected into the crural vein of another, produced similar symptoms, only the latter eat a little boiled meat, which he vomited up again in two hours. He died the third day, with the same symptoms of the plague as the others.
The bile of people who died of ordinary malignant fevers was much less powerful. A quantity (not mentioned how much, but probably a drachm) mixed with four ounces of warm water, was partly injected into the jugular vein of a dog, and a compress soaked in the rest of the liquor applied to the wound. He appeared heavy and sleepy, and would neither eat nor drink till the third day, when he did both willingly. On the fourth day the compress fell off, the wound was found to be diminished one half, and healed by degrees, the dog recovering perfectly. In another experiment with the bile of a patient who had died of a malignant fever, the dog notonly had about a drachm of it put into a wound in his thigh, but was made to swallow some of it; notwithstanding which he was not seized with any distemper, and the wound healed in fifteen days. This bile was as black as ink, in great quantity, and very thick. In the other subjects it was of a deep green. In another experiment, with the same bile applied on a compress, the dog likewise escaped without any apparent disorder; but in a third, the animal died in twenty-three hours, though at first he had shown no sign of being affected, only that he seemed to be thirsty, and drank with greediness. On opening him his heart was found still to beat with violence, and, after the beating ceased, no blood was to be found in it, either in the auricles or ventricles. “This liquor, crowded together in the great vessels, appeared of a lively red, and very fluid, without any of those concretions that we constantly observed in those who died of the plague. Here appeared neither external nor internal marks of the plague.” The bile of a person who had died of an erysipelas, injected into the crural vein of a dog, produced no bad effect. A dog was killed by half a drachm of Hungarian or blue vitriol injected into the jugular vein. He died in universal convulsions: the heart was full of grumous blood, reduced to a kind of thick pap, but without any clots. The bile, applied to two wounds in another dog, produced no bad effect.
From other experiments it appeared that even the pestilential poison itself, taken into the stomach of dogs, did not produce any deleterious effects. “A dog of the Hospital of theMailin Marseilles, who followed the surgeons when they went to dress the sick, used greedily to swallow the corrupted glands, and the dressings charged with pus which they used to take off the plague sores: he licked up the blood that he found spilt on the ground in the infirmary; and this he did for three months, being always gay, brisk, well, full of play, and familiar with all comers.” The health and briskness of this unfortunate dog proved his ruin, by making him the subject of philosophical experiment.A drachm of the pestiferous bile injected into the crural vein, killed him in four days. He had a considerable hæmorrhage from the wound the night before he died, and he had also a disagreeable smell both while living and after he was dead. Two other dogs, which had swallowed a quantity of pestiferous bile, became heavy and melancholy, refused their food, and showed other signs of disorder; but all these went off in a short time, and no signs of the distemper appeared.
These experiments induced M. Deidier to suppose that the contagion of the plague lay only in the bile; but the following experiment shows that the blood was equally infected, and capable of communicating the disease, and that of the most malignant species. It was made by M. Couzier, physician to the infirmary at Alais, and in the Philosophical Transactions we have the following account: “I took a quantity of blood from a person dead of the plague, and mixed it with warm water, which mixture I attempted to inject into the crural vein of a dog, but the end of the syringe being too large to enter the vein, the experiment did not succeed. This made me resolve to try to lay some of the same infected blood upon the wound. This I accordingly did, and covered it with a dressing, which the dog got off in the night. I found the next morning that the dog had licked the wound, and that he refused his food. Towards night he began to bemoan himself, and gave signs of an approaching death. The next morning I found him dead, the wound being considerably swelled and gangrened, and the edges round the swelling were likewise gangrened.
“Upon opening the body, we found the liver something larger than usual, with spots of a livid purple, as in the bodies of persons dead of the plague. In the stomach was found a quantity of black coagulated blood, of the size of a hen’s egg. This in all likelihood was what he had swallowed upon licking the wound. The heart was very large, with a black grumous blood in the ventricles, and the auricles were turned blackish and gangrenous.”
This last experiment naturally brings to remembrance those of Dr. Home at Edinburgh, in which he inoculated the measles by means of the blood of patients ill of that disorder. From the accounts he has given in his treatise entitled Medical Facts and Observations, we can have little doubt thathisexperiments succeeded, however others may have failed. One thing, however, is very obvious, viz. that if we mean to communicate a disease by means of the blood, we must use a much greater quantity than if we make the experiment with the matter of an abscess. The case of contagious diseases seems to be the same as in fermenting liquors. With a small quantity of yeast we can easily induce fermentation in any proper liquor, but, if we skim off the yeast, and use only the pure fermenting liquor, we must use a much greater quantity; and to inattention to this circumstance we may with probability ascribe the difficulty which Dr. Home himself met with in introducing the disease, and the total want of success in others. In M. Couzier’s experiment a considerable quantity must have been used, as he says that in the dog’s stomach it equalled the size of an hen’s egg. A much smaller quantity of matter taken from a pestilential abscess is capable of producing the disease in a human body, as is evident from the case formerly quoted of that gentleman who inoculated himself for the plague, and of which Dr. Guthrie gives the following account: “This was Mathias Degio, one of the surgeons of the hospital at Bucharest, a building appropriated to the cure of the plague in the Russian army. He, perceiving the gentlemen of his professioncondemned in a manner to death, if punctual in the discharge of their duty103had the resolution to inoculate himself for the plague, in the full confidence of its efficacy, and ever afterwards found himself invulnerable, whilst his companions around him were falling victims to its fury. He produced the disease by inserting, with the point of a lancet, under the epidermis of his arm, matter from a pestiferous abscess, and followed the cold regimen observedin the small-pox, as he had imitated its mode of inoculation. On the fourth day of the puncture the fever declared itself, and he, being perfectly devoid of fear, got through the disease without feeling more inconvenience than if it had been that which he imitated. He drank freely of cold water, with vinegar, or a little wine, and kept generally out of doors. This beverage was the only thing that had the appearance of medicine,” &c.
From a careful attention to all these histories, it is plain that the plague is naturally an eruptive disease, as, in all the animals in which it was artificially brought on, eruptions took place, provided the life of the creature was sufficiently prolonged to allow them to come out. Dr. Russel says, that, from his diary, he noted down the cases oftwo thousand seven hundredpatients,allof whom had eruptions of one kind or other. In this it agrees with the small-pox, which Dr. Mead justly considers as an inferior kind of plague. In the latter, however, the eruptions seem to resemble those called by Dr. Hodges thetokens, only that the cause which produces them is less violent in its nature; but why the eruptions of the small-pox should be in distinct pustules, and not one continued boil all over the body, is undoubtedly inexplicable on any theory whatever. The same is true of the plague. No man can explain why the tokens, for instance, instead of being collected into one great eschar, are dispersed into small distinct pieces; or why, instead of buboes in the groin and armpit, or instead of carbuncles in different parts of the body, there should not be a single one equivalent in bulk and power to them all. This appears similar to the phenomena of rain, hail or snow, which fall in distinct drops, fluid or congealed, or in flakes, instead of being equally diffused all over the spot on which they fall. In the latter case we say that the phenomenon is occasioned byelectricity: we may say the same, if we please, of the small-pox and plague, with equal emolument.
From the accounts we have just now quoted, it appears that there is between malignant fevers and thetrue pestilence a very essential difference; the latter tending to thicken the blood, the former to make it thinner. In this respect therefore the poisons seem to resemble malignant fevers very considerably; for M. Fontana observed that by mixing animal poisons with blood drawn from a vein, it was prevented from coagulating. In the instance above related where a dog died in consequence of bile injected into his veins from one who died of a malignant fever, the blood was found extremely fluid. In some who died of the hospital fever, Sir John Pringle informs us, that suppurations had taken place in the brain; but in the true plague the tendency to mortification always prevailed above every thing.
Lastly, that the plague proceeds from too great a quantity of heat, either emitted from the body itself, or some how introduced into it, seems to be pretty plain from the effect it has of augmenting the venereal appetite to an almost inconceivable degree. This was taken notice of in the plague of Marseilles, and indeed in many others. Russel quotes two remarkable passages to this purpose; one in a plague at Genoa, the other in Messina. “Amidst so many dreadful fears and terrors, amid so many fetid and putrefying bodies, amid the shrieks, the sighs and the groans of the sick, what would you have expected? That the people, struck with dread and horror, remained sad, modest and quiet. You are mistaken. They sung, played on instruments, danced, intrigued, and Genoa never was seen so shameless, debauched, and disorderly. I have said before, that God in this plague gathered in a harvest for heaven; but it seemed to be also a vintage for the lascivious of of the earth. If not so, how came so many marriages to be celebrated in the Lazaretto of Consolation, and that so many women, without shedding a tear for the death of their husbands, immediately entered into new engagements? One day, in particular, five marriages were performed, four of the bridegrooms being buriers of the dead, and dressing themselves and their brides in clothes stripped off from the bodies of the deceased.” On the plague of Medina he quotes the following extractof a letter written by a gentleman who resided in that city during the plague in 1743. “It has always been observed, that, aftereveryplague, those who recover are addicted in an extraordinary degree to lewdness and incontinence, which was surprisingly visible at Messina, and carried to such a degree of frenzy and bestiality, that many were known to violate the bodies of dead virgins!”
That an extraordinary propensity to venery may be produced by introducing into the body a quantity of heat, admits now of a kind of demonstration from a fact mentioned by M. le Roy concerning phosphorus.104This substance is exceedingly apt to take fire on the application of a small degree of heat, and even by slight friction. It is now introduced into the materia medica, and is found to be a very powerful medicine, though dangerous on account of its inflammability, the heat and air contained in the human stomach being sometimes sufficient to set it on fire. The taking such a substance into the body therefore seems not much different from taking actual fire into it; and indeed M. le Roy mentions the case of a woman who had taken only a single grain, and who he says had been recovered,by it, from a putrid fever, but died suddenly from some imprudence. In this woman the whole substance of the body was found luminous upon dissection, and the hands of the operator continued luminous even after being washed. M. le Roy, having taken three grains of this fiery substance, found himself extremely incommoded by it for some hours, and was obliged to drink great quantities of very cold water. Next day he found his muscular powers amazingly increased, and had analmost insupportable venereal irritation. This we see was the consequence of throwing into the body a quantity of heat from without; but if the body itself emits that heat which it invisibly contains, the effects must be the same as though an extraneous quantity had been thrown into it. Neither are we to imagine that thequantityof heat contained in our bodies is small or inconsiderable; for we have alreadyseen that heat consists in the efflux from any substance, of an invisible and most subtile fluid, in all directions. When this flux is gentle, the heat is moderate, but in proportion to the activity of the discharge, the temperature becomes hotter and hotter, and if very violent, the cohesion of the parts is dissolved entirely, and the substance is said to be on fire. There is required therefore only some cause to begin the emission of this fluid; for as soon as this begins, the immense quantity with which we are surrounded, will supply more in abundance,105and continue so to do, as long as the original cause subsists, or until the substance can no longer bear the power which operates upon it.
From this view of the causes of the plague, and from the facts which have been laid down concerning it, we cannot help perceiving a very strong similarity between the plagues mentioned in the Old Testament and those which still exist in the world. In one of the passages formerly quoted it is called aninflammation, anextreme burning; and from the testimonies of different authors above quoted, it is plain that the disease still deserves the name bestowed upon it in the sacred writings. From the account given of its proximate cause, it is plain that plagues of all degrees of intensity may take place, from absolute accension of the body, and its reduction to ashes, to the mildest state of the disease, in which the patient is not confined to his bed; and all this from the single principle of emission of heat from the body itself. It likewise appears that there may be either in the body itself, or in the element which surrounds it, such a constitution as will dispose that element which is the natural and immediate preserver of our life, suddenly to attack and destroy it, of which the case of the Italian priest is a most remarkable instance. In other cases, such asthe Italian lady, and the woman at Coventry, the body itself seems to have given out its heat, though this could not be done without a concurrence of the surrounding ethereal fluid. In a stage still lower, the body is partially consumed, or rather partly charred into a kind of cinder, as where thetokensare produced; and when the cause acts with still less violence, a fever is produced. In the Old Testament we find these different kinds of plagues very distinctly mentioned. In some cases the offenders died by actual fire, which either struck them from without, or was kindled within their bodies. In others, they seem to have died by that very deadly kind of plague of which we have already said so much, which kills in a few hours. This was probably the plague which destroyed the army of Sennacherib, and this in the tenth chapter of Isaiah is by some thought to have been prophesied of under the title of aburning like the burning of a fire.
Of these things I the rather take notice, as I perceive, in a late oration, not only the doctrine of the plague being propagated by contagion severely ridiculed, but the scripture itself treated in a most indecent and scandalous manner. “In the earliest ages of the world (says he) when ignorance and superstition led men to attribute all extraordinary phenomena to the direct agency of supernatural beings, pestilence was supposed to be immediately imported from heaven. This is the opinion which appears to have prevailed among the ancient Hebrews, and may be ranked at the head of the catalogue of absurdities on this subject. The dominion of prejudice over the minds of that ignorant and obstinate people appears in this instance particularly striking. Such was the depth of their blind bigotry in favour of the healthfulness of the globe they inhabited, that they would seem to have considered it as even superior to that of the celestial regions. Hence, unwilling to believe that their favourite earth could give origin to an evil so dreadful as the pestilence, they imported the seeds of this calamity from the more unhealthful climate of heaven!!”
In this extraordinary paragraph we find the matter so much misrepresented, that every vestige of truth is swallowed up in it. The Hebrews believed that they were under the immediate inspection and government of the Deity; a doctrine which, however our author maydisbelieve, he cannotdisprove. But, notwithstanding this immediate inspection and government, the Deity never did bring upon them any plague but by the intervention of natural causes. The agents which he had originally created were sufficiently able to execute his purposes. The Creator never employed any power but what already existed in the world, and the power that he generally did employ wasfire. This agent he directed to exert its force in such degrees as he pleased, and against whom he pleased. It is a mistake to think that miracles wereimmediatelythe effects of supernatural power. They were all accomplished by the very powers which exist in the world at this moment, only these powers were by the Creator at particular times directed to act in a manner that they would not have done had they been left to the mechanism of their own nature. When we read therefore of people being consumed by fire from the Lord, there was neither importation of fire from heaven nor any where else; the element exerted its power on these particular persons, either by lightning proceeding from the cloud which represented the Deity, or their bodies threw out the latent heat which they contained, and consumed of themselves. That in cases of this kind there was noimportationsupposed, is evident from an expression used about bringing water from the rock. It is not said that the water fell from the stars, or came down with the tail of a comet, but that the rock gave out the water which it previously contained. At the present day the same powers exist, and sometimes produce the same effects that they did in former times, with this difference, that now, having no intelligent agent to interfere with their natural mode of action, they exert their force indiscriminately, and as the mechanism of their nature happens to be stimulated, they destroy every thing promiscuously before them. In all this I cannot perceivethe smallest absurdity, or any thing but what a reasonable manmayindeedmustbelieve, if he makes use of his reason. As to the causes which Dr. Caldwell so much insists upon, viz. filth and corruption, it is extremely probable that (while the Israelites were in the wilderness) these had no existence. By their law they were enjoined such frequent ablutions, that their bodies must always have been perfectly clean. Human excrements were not allowed to lie above ground. The offals and dung of their sacrifices were carried to a distance, and they were expressly told, that they must not allow of any uncleanness in their camp, lest God should turn away from them and abhor them. Add to all this the great heat and dryness of the desert in which they wandered, which would quickly parch up and carry off the moisture from any dead carcases or putrefying matters that might be allowed to remain notwithstanding the injunctions to the contrary. Indeed if we consider the dryness of the climate where these people were, and that they were constantly attended by a large stream of water, it is difficult to conceive any situation upon earth more healthy than that of the Jews in the wilderness. If plagues therefore came upon them, it is difficult to say how they could have happened according to the ordinary course of nature; and, if not according to this, it must have been by an alteration of it, or by miracle.
The plague, as has already mentioned, in its very severe state appears most commonly in the beginning of an epidemic season, and is neither very common nor very infectious. The most common mode in which it invades the patient is with the symptoms of a malignant fever; and of cases of this kind Dr. Russel has made up his five classes of patients, the first or deadly kind having been already described. In his second class, the next in malignity to the fatal kind, the disease made its attack with a slight shivering, succeeded by fever with giddiness, vomiting, head-ach, and sometimes looseness. In the night the fever increased, the thirst was excessive, and the patient, harassed by the vomiting, &c. passed a very unquiet night, frequently with delirium or coma.Towards morning the fever abated, the sick recovered their senses if delirium had taken place, but if coma, it continued through the day, and the remissions were less. Throughout the first day, and part of the second, the pulse was full and strong, but on the second it began to alter, and some of the characteristic signs of the disease to appear. The principal of these was a certain muddiness in the eyes, which sometimes took place even on the first day. This is by our author accounted a symptom very difficult to be described, and, though he recounts the descriptions given by several authors, none are found adequate to the real appearance. “It resembled (says he) somewhat the dull, fixed eye observable in the last stage of malignant fevers; but the dullness was different, muddiness and lustre being strangely blended together. It continued with little alteration in the remissions, and even where the patient appeared sensible and composed it did not increase in the febrile exacerbations, but the eyes acquired a redness that added wildness to the look, which abating or going off in the remissions, the muddiness remained behind. It was this which contributed chiefly in composing that confusion of countenance which I shall not attempt to describe, but which enabled me to pronounce with tolerable certainty whether the disease was or was not the plague, though not independently of other symptoms. When this muddiness disappeared or abated, it was constantly a favourable sign. After a critical sign it often disappeared suddenly, but where there was a succession of sweats, or where no visible crisis happened, its disappearance was slow and gradual.”
Along with this muddiness the patient had a peculiar confusion of countenance; the pulse quick and equal, or low and fluttering, but rarely intermittent; the external heat moderately feverish, at other times intense, with irregular flushings, with pain at the heart, or oppressions about the præcordia; burning pain at the pit of the stomach, and incessant inquietude. When to these symptoms were added a faltering in the tongue, loss of speech, while the surface of the body becamecold and damp with clammy sweat, death was inevitable. In the evening of the second day all the symptoms became worse; and in the morning the patient appeared to lie quiet more from his strength being exhausted than from any change to the better. When the vomiting had ceased, however, there was frequently such a remission on the third day as gave the attendants great hopes of a favourable event; but these hopes were always fallacious and of short duration. Sometimes where vomiting, looseness or hæmorrhage had preceded, the patient died on the third day: at any rate, none of this class recovered, whether the disease was left to itself, or treated with medicine. The appearance of buboes was of no consequence, for they never came to maturity, and the little advances they made neither accelerated nor retarded the termination of the disease, which happened sometimes on the third, but more frequently on the fifth or sixth day.
The third class of patients were equally unfortunate with the other two. “The difference between the second and third consisted in the absence of vomiting at the beginning, the later accession of coma and other bad symptoms, and a slight tendency to perspiration, which very rarely occurred in the second. . . . From the second or third night the course of symptoms in both classes varied very little, and the termination of the disease was in both the same: it may be added they reigned together through all the periods of the pestilential season, but were most prevalent in its augment; for at its height, and in its decline, they gave place to varieties of the disease less destructive.”
The fourth class was the most numerous of all. Its distinctive marks were, “the continuance of the inflammatory or febrile symptoms with less interruption than in the other, a pulse more constantly sustained, or soon recovering itself when hurried in the exacerbations; the length and vigour of the exacerbations decreasing in the advance of the disease; and, above all, the prevalent tendency to a favourable discharge by the skin, with the critical sweats on the 3d, 5th, or subsequentdays. . . . Vomiting was a concomitant in about one fourth of the sick. The fever, for the most part, was very moderate the first night, very rarely accompanied with delirium, and almost never with the comatous disposition. . . . The buboes and carbuncles commonly made their appearance the first day; but it was not unusual to see a successive eruption of these in the course of the disease. . . . The morning sweat, on the third day, in some cases proved completely critical, but more commonly produced only a remission so favourable as to encourage the expectation of a more favourable crisis on the fifth; but, where the patient neither sweat on the third, nor a sensible remission took place on that day, some degree of danger was always to be apprehended. . . . After the sweat on the fifth, the subsequent exacerbations proved slighter and slighter, and the buboes for the most part advancing favourably, little or no fever was left remaining after the beginning of the second week, except perhaps symptomatic heats occasioned by the eruptions.” In this class the patients sometimes appeared only to have a slight attack, and yet at last were seized with mortal symptoms, while others who deemed to be much worse at first yet happily recovered and did well, In general the severe pestilential symptoms did not come on till a considerable time after the attack.
To the fifth class our author refers all cases of slight infection, wherein the more formidable symptoms of pestilence never concurred, andallthe infected recovered. “The access here was often attended with so little apparent disorder, that the eruptions gave the first alarm; and the fever which came on afterwards was frequently so slight as not to confine the sick to the house. Others found themselves indisposed for two or three days, but were not sensible of any febrile heat whatever. But in this class the disease did not always invade thus insensibly. The febrile symptoms, especially the first three days, sometimes run pretty high; and the fever afterward, in nocturnal exacerbations particularly, run out to the end of the week or longer: but, asthere was no concurrence of alarming symptoms, and the exacerbations, terminating for the most part in sweats, gradually diminished in force after the third or fourth night, it was not difficult in the worst cases to foretel the event at that period, nor necessary in others to defer the decision so long.
“Allthe infected had buboes or carbuncles, and very often both eruptions concurred in the same subject. Persons not confined by indisposition were often, by the inguinal buboes, prevented from walking abroad. The carbuncles constantly formed theblack crust,106and then suppurated; the buboes in one third of the sick dispersed. The dispersion of the buboes was never observed to be attended with bad consequences, notwithstanding the general neglect of purging in the decline of the disease: indeed very few had recourse to remedies, topical applications excepted, unless perhaps a bleeding at the beginning, where the febrile symptoms ran high. This class wasnearly as numerousas the fourth, but began to predominate rather later, and reigned most of all in the decline of the plague in 1762.”
The sixth class must be omitted, as containing dubious, anomalous and extraordinary cases. We shall therefore proceed to consider the accounts of the plague given by other physicians, which, without questioning the accuracy of Dr. Patrick Russel in relating whathehas seen, may serve to throw some light on the subject, by relating whatothershave seen. Dr. Alexander Russel, in his Natural History of Aleppo, gives the following description of it. “The distemper in itself is the most lamentable to which mankind are liable. The torments of heat, thirst and pain frequently unite in some patients; an unspeakable dejection and languor in others; and even those who escape with life do not cease to suffer from painful and putrid ulcers, the painful remains of the disease. The desertion of relations, of friends, and of domestic servants, the wantoften of the common necessaries of life, and the difficulty of procuring medical assistance, are circumstances likewise which aggravate the miseries of the sick, and contribute greatly to augment the general horror.
“But, as no disease incident to mankind is in its nature more terrible and destructive, so none is more difficult to observe. Its symptoms are scarcely in all respects alike in any two persons, and even vary extremely in the course of an hour in the same subject. The disease, attended in the beginning with symptoms not highly alarming, often ends fatally in a few hours; while the most formidable attacks, by a sudden and unexpected alteration, sometimes terminate happily.
“The first complaints of those seized with this distemper, were, in general, a coldness or shivering; sickness; a vomiting of large quantities of porraceous bile, which often had a very offensive smell; anxiety, or an inexpressible uneasiness about the pit of the stomach; pain in the back or loins; an intense head-ach; uncommon giddiness, and a sudden loss of strength. Some were sensible of a sharp shooting pain darting at intervals into the parotid, axillary or inguinal glands. To these symptoms succeeded a violent fever; in which, while the sick complained of extreme inward heat, their skin, externally to the touch felt little hotter than usual. Sometimes this heat became general and intense; at other times particular parts only were affected; but it seldom continued long in the same degree, having several unequal remissions and exacerbations in a day. In these exacerbations the face became florid, but would often from a deep scarlet change to a livid colour, like that of a person almost strangled, and, again suddenly changing, it would assume a cadaverous paleness. The eyes, soon losing their natural lustre, acquired a kind of muddiness; and the countenance of most of the sick was ghastly and confused beyond description. The pulse the beginning was somewhat quicker and lower, but in other respects varied little from the natural state. Within a few hours it commonly increased in quickness and strength, butseldom remained the some for an hour, nay scarcely many minutes together; incessantly varying, both as to strength and quickness, and without any manifest correspondence with the other febrile symptoms.
“In such as complained of pains darting either into the parotids, the arm-pits, or the groins, a small hard, deep-seated tumour, with external discoloration of the skin, was discovered by the touch in the part, and these were the incipient pestilential buboes.
“The appearances now described were those of the distemper on the first day, till evening, when the sick always suffered a severe exacerbation, in which the heat both internal and external became excessive; and, as they generally were by that time delirious, it was often with difficulty that they would be kept within doors; they were greatly disposed to talk, but faltered so in their speech, that what they said was hardly intelligible, the tongue having shared with the other organs in the general debility. The exacerbation lasted the most part of the night; but the heat, delirium, and inquietude abated towards morning, and a manifest remission took place. Some recovered their senses entirely, some partially, and then complained of intense head-ach, or of pains from the buboes; it was usual in this interval also that those who had carbuncles began to complain ofburningpain in thosefieryeruptions. The morning remission was commonly of very short duration; the rigours, anxiety and delirium soon returning more violent than before, attended with a strong and frequent subsultus tendinum. These febrile symptoms did not increase regularly as the day advanced; but went away and returned at intervals leaving short but alarming intermissions; for each exacerbation surpassed that which preceded it either in violence or duration. In the evening the pulse could hardly be counted, by reason of its depression and quickness; the patient became comatose, and the respiration was quick, laborious, and interrupted. The buboes which, some hours before, seemed manifestly to advance, often subsided, and sometimes almostentirely disappeared; the carbuncles, mortifying at the top, resembled agreat eschar made by a caustic: and at this period also livid or black spots, of various dimensions, often were found scattered universally on the body.
“Under these circumstances, dreadful as they seemed, some hope of recovery still remained; for, though many of the sick died on the third day, several had a favourable crisis on that day, by a profuse sweat; some struggled to the fifth day, a few to the seventh, and, here and there one, even to the eleventh; before any critical alteration took place. Where a copious sweat happened on the third day, if it did not prove perfectly critical, it at least always considerably abated the fever; which, in that case, was generally totally removed by a second, though less profuse sweat, on the fifth: and then besides weakness the chief remains of the disease consisted in the pain of the eruptions.
“Nothing could be predicted with respect to the event of the disease from the manner of its invasion; those who had the most favourable escape having been often in the beginning attacked with as alarming symptoms as others were who died in a few hours. Sometimes the febrile paroxysm, which had set in with such formidable violence, dissolved in a few hours, and left the patient languid indeed, and weak in an extreme degree, but free from other complaints except the pain arising from the bubo, which from that period increasing in size, and advancing favourably to maturation, was, in many cases, ready to open in twelve or fifteen days: the patient all the while, except the first day, walking about as usual. Great numbers happily escaped, not only in the manner just described, but likewise where the buboes never advanced; for these tumours, so far from coming always to maturation in such as recovered, very often discussed without any bad consequence. Carbuncles often began to digest before the termination of the fever in a critical sweat.
“All the infected had buboes, except such as expired suddenly, or survived the first attack a few hours only. Instances of this dreadful kind were more particularly observed in March 1743. The sick were seized in the usual manner; but the head-ach, vomiting, and pain about the præcordia, increasing every moment, proved suddenly mortal, or terminated within a few hours in fatal convulsions.” Dr. Patrick Russel observes, that such instances of sudden death were very rare in the plague of 1760, 1761 and 1762; and in these they happened only in the winter, or early in the spring. In such sudden deaths few had any appearance of buboes; but in general the armpits and groins, or the inside of the arms and thighs, became livid or black, and the rest of the body was covered with confluent petechiæ, livid pustules being here and there interspersed: but all these appearances were more especially observed after death.
In the plague of 1760, vibices as well as livid and black spots were frequently found on the corpse, but not constantly. They were always suspicious in conjunction with other circumstances, but their absence was no proof, though frequently urged as such, that the distemper was not the plague. The vibices sometimes appeared several hours before death, but the livid spots seldom or never.
The tongue in some was quite moist, and continued to be like that of a healthy person throughout the disease; in others, white at first, then yellow; at last black, and covered with a dry, foul scurf or fur. The thirst was generally very great, but never constant; returning at regular intervals, and never appearing to correspond with the danger of the fever. Sometimes it was so little that the patient could not be prevailed upon to drink a sufficient quantity. The appearance of the urine was equally variable, and afforded no certain prognostic; being seldom alike in any two patients in the same stage of the distemper, and varying in the same patient every day. The vomiting commonly ceased after a few hours, excepting where the sick were induced by thirst to load their stomach, in which case italways returned. Sometimes the patients were costive, in others a diarrhœa took place, but in most the discharges were natural. No critical solution by urine or stool seemed ever to take place. A few cases of hæmorrhages from the nose and uterus were observed; and if they happened after the second day, were soon followed by a plentiful sweat, which commonly proved critical; “a circumstance different from what has been usually observed in the plague at other places.
“From the preceding account of the plague it will readily be conceived that nothing can be more difficult than to form any judgment or prognostic of the event of the disease; in which, as it is justly remarked by Morellus, our senses and our reason deceive us, the aphorisms of Hippocrates are erroneous, and even Hippocrates (as I am inclined to think) might have erred in his judgment.”
Innumerable other histories of the distemper might be given, but the following, it is hoped, will be sufficient, along with what has been already detailed, to show that the plague in former ages was the same as at this day. In the terrible plague which broke out in the time of Justinian, the distemper sometimes began with delirium, and the patient instantly despaired of life; but more generally people were surprised by the sudden coming on of a slight fever; so slight that no danger was apprehended either from the state of the pulse or colour of the body. This, however, was quickly followed, sometimes even on the same day, sometimes on the second or third, by buboes or parotids (swellings behind the ear) which when opened were found to contain a blackcoal, oreschar, of the size of a lentil. If these swellings suppurated kindly, the patient recovered, but if not, a mortification ensued, and death was the consequence, commonly on the fifth day. Black pustules or carbuncles, covering the body, were signs of immediate death, as was likewise a vomiting of blood in weak constitutions; for this terminated in a mortification of the bowels. Pregnant women generally perished, but women were less susceptible of the infection than men;and young persons were in more danger than old. Many, who recovered, lost the use of their speech, and such were not secure from a relapse.
In the last plague at Moscow, the symptoms were various, according to the persons, constitution and the weather; in general, head-ach, giddiness, shivering, loss of strength, slight fever, sickness and vomiting, redness of the eyes, white and foul tongue, with a dejected countenance, buboes and carbuncles appearing on the second or third day, but seldom on the fourth. The buboes were seated chiefly in the glandular parts, the armpits and groin, but sometimes made their appearance in the neck, cheeks, &c. Sometimes these suppurated perfectly, and then they proved beneficial, but not otherwise. Sometimes they suddenly disappeared, after having attained the size of walnuts; and this retrocession was always supposed to be a sign of approaching death. Sometimes they neither showed any sign of inflammation nor were painful, and in such cases afforded no relief. Similar swellings sometimes occured in the parotid glands, but they were never equally beneficial with the buboes.Carbuncleswere gangrenous spots on the skin, resembling a burn, with black, livid or red vesicles, bordered with an inflammatory ring, and soon terminating in a hard, black eschar. Theanthraxis more prominent, penetrating deeper into the adipose membrane, and attended with more pain and inflammation. The disease was likewise attended with petechiæ similar to those in putrid fevers, but larger; also with vibices, which resembled the mark of a whip, and were considered, as well as the petechiæ, as mortal signs. No distinct account of the pulse could be given; as, after the disease became general, physicians did not choose to feel the pulses of their patients but through a glove or tobacco-leaf. Worms calledtereteswere frequently discharged both upwards and downwards. Women with child generally suffered abortion, and were carried off by an uterine hæmorrhage.107
According to Sydenham, the plague begins with chilliness and shivering, like the fit of an intermittent, succeeded in a little time by violent vomiting and oppression at the breast, accompanied with its common symptoms. These continue till the disease proves mortal, or the kindly eruption of a bubo or parotis discharges the morbific matter. Sometimes, though rarely, the disease is not preceded by any fever; the purple spots, which denote immediate death, coming out even while persons are abroad about their business. But this hardly ever happens but in the beginning of a very fatal plague, and never while it is on the decline, or in those years in which it is not epidemic. Sometimes swellings appear without having been preceded either by a fever or any other considerable symptom; but he conceives that some slight and obscure shivering always precedes the seizure.
Mariti, in his travels through Cyprus, &c. says that the plague of 1760 began with loss of appetite, pain in the shoulders, head-ach extremely violent, delirium, vomiting, with a most excruciating pain in that part where the tumour by which the plague is characterised, is about to break forth. Death often took place on the third day, and very few lived beyond the thirteenth.
The Abbe’s definition of what he calls the plague, and which seems to be thepestilential buboof the physicians, is somewhat singular. “The plague (says he) is an oblong tumour, shaped like a pumpkin, which is at first of a flesh colour; but it gradually becomes red, and at length blueish; and this is a sign that the disease is incurable. If it continues red, and a little after inclines to yellow, it is a sign that a suppuration will take place: the swelling is then opened, and the patient is sometimes cured.”
According to our author, the symptoms of the plague do not appear till fifteen days after the infection is received; and this is the reason of a law which subjects to a proof of twenty days every person suspected of being diseased. In this plague it was observed that people of the soundest constitutions were the most subject to it,and the least capable of resisting it. On the other hand, it appeared to spare weak and delicate persons, whose cure, in case of an attack, was much less difficult. A greater number of Moors than of any other nation were attacked by it; and when once they were seized, their case was absolutely desperate. Those who had recovered from the disease were less liable to a second attack, but were not absolutely safe. “I have known some (says our author) who have been ill seven times, and have died of it at last.”
Dr. McBride informs us that in the plague which raged at Marseilles and the adjacent places in 1720, people on their first seizure seemed as if intoxicated with drink; they lost the power of their limbs entirely, and became so dejected that they gave themselves over to despair from the very first attack. Along with the bilious vomitings and purgings which generally took place on the second day, quantities of small worms like ascarides were thrown off. The more plentiful these evacuations were, the more salutary; for those who vomited and purged but little sunk down, oppressed with the disease, and died before the fourth day, covered with livid blotches and petechiæ; those who had the largest evacuations had also the most plentiful eruptions of buboes and parotid abscesses. When these appeared, the patients rose, walked about, and became remarkably hungry; the heat and thirst subsided, but the face continued pale and languid, the pulse hard and frequent. On the sixth, seventh, or eighth day, if the suppuration stopped, and the humours went back, then came on oppression, difficulty of breathing, furious delirium and convulsions, which ended in death. When carbuncles, or biles, with mortified sloughs, appeared in different parts of the body, either alone or accompanied with the glandular swellings, the patients scarcely ever escaped. In great numbers of people tumours appeared without any previous febrile symptom, and, in a few cases, went off by resolution; in others they continued in a schirrous state; but it was best when the tumours came to suppuration.
These are the most remarkable symptoms of this fatal disease, which have been recorded by the physicians of greatest eminence who have written upon the subject. It remains still to give some particular description of the buboes and carbuncles, which are supposed to constitute in a particular manner the characteristic signs of the distemper. Of these the following account, given by Dr. Alexander Russel, seems to be sufficiently clear and explicit.
Only a very few, and such as died suddenly, were exempted from buboes, but only about one half had carbuncles. In the latter plagues their proportion was still smaller; but they seldom appeared earlier than in the months of April or May. In 1742 and 1743, the buboes often appeared on the first commencement of the distemper, sometimes not till twelve hours after; in a few instances not till two or three days; but in 1744 they were sometimes the first symptoms of the disease. The buboes were generally solitary, the inguinal and axillary more frequent than the parotid. “The inguinal bubo for the most part was double; that is, two distinct glands swelled in the same groin. The superior, which in shape somewhat resembled a small cucumber, lay obliquely near the large vessels of the thigh, lower than the venereal buboes are usually found, and it was that which commonly came to suppuration; the inferior was round, and in size much smaller. I once met with a case in which an axillary bubo divided in like manner into two parts, one of which got under the pectoral muscle, the other sunk deeper into the armpit: both grew painful and inflamed, but that in the armpit only suppurated.”
The bubo was at first a small hard tumour, painful but not inflamed externally. These indurated glands were deeply seated, sometimes moveable, at others more or less fixed, but always painful to the touch. Sometimes they would increase to a considerable size in a few hours, with intense pain, then suddenly subside; and these changes would take place several times in twenty-four hours. “An exacerbation of the pestilential symptomsimmediately upon the decrease of the bubo, sometimes prompted me to imagine it owing to the retrocession of the tumour; but this did not happen so constantly as to make me think it was so in reality. The buboes, as far as I could learn, never advanced regularly to maturation till such time as a critical sweat had carried off the fever. In ten, twelve, or fifteen days, from the first attack, they commonly suppurated; having been all along attended with the usual symptoms of inflammatory tumours. But I have known them sometimes, nay, frequently, disappear soon after the critical sweat, and discuss completely without any detriment to the patient. At other times, though grown to a pretty large size, the tumour, about the height of the disease, would sink and mortify, without any fatal consequences; for, as soon as the crisis was complete, the mortification stopped, and the gangrened parts separating gradually, left a deep ulcer, which healed without difficulty. I met with no instance of a bubo in which fever did not either precede or follow the eruption.”