Chapter XV: Section III (9)

This account of the most malignant form of the pestilence differs considerably from that of Dr. Hodges, who seems to think that the _tokens_, as he calls them, very generally were to be found on the bodies of those who died suddenly. He mentions indeed a young man who was suddenly seized with a violent palpitation of the heart, and thus continued till his death, which took place in a few hours. In this case the Doctor supposed that there might be a carbuncle broke out on the heart. Dr. Russel has considered the description of the tokens given by Dr. Hodges, and compared it with that of others called by Diemerbroeck _maculæ mortis_, _spots_ or _tokens_ of _death_; and by this comparison it appears that the former has spoken somewhat indistinctly on the subject, confounding two different kinds of eruptions together. Dr. Hodges, however, as we have already seen (p. 10) asserts, in his _Loimologia_, that the tokens rise from within, and are broadest at their bases, where he also supposes the pestilential poison chiefly to lie. To the same purpose, in his Letter to a Person of Quality he says, “The tokens have their original and rise from within, and afterwards externally show themselves; which is evident, because the basis of them is larger than their outward appearance, and the internal parts are found very often spotted, when there is no discoloration visible on the skin.” Dr. Russel, after quoting Diemerbroeck, makes the following observations: “The author (Diemerbroeck) is diffuse on this subject, and thinks it a mistaken though prevalent notion, that the maculæ are merely superficial in the skin, proceeding from putrefaction, ebullition, &c. in the blood or humours: on the contrary he affirms, they arise from the internal parts, even the periosteum, broad at the base, and tapering to their termination in the skin, being produced by the _extinction_ and _extravasation_ of the vital spirits. Now (says Dr. Russel) this answers exactly to one species of the tokens described by Hodges, which therefore may be reckoned the same with the _maculæ mortis_, and was probably the only one observed at Nimeguen,” &c. On the same subject he quotes a book entitled _Medela Pestis_, in which the author says that by careful dissection the _tokens_ may be traced half-way deep in the flesh, and some, in the muscles of the breast, have been followed by the incision knife even to the bone. By the directions given by authority to the searchers in 1665, they were ordered to look narrowly for these tokens, which were described as “spots arising on the skin, chiefly about the breast and back, but sometimes also in other parts. Their colour is something various, sometimes more reddish, sometimes inclining a little towards a faint blue, and sometimes a brownish mixed with blue; the red ones have often a brownish circle about them, the brownish a reddish.”

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 them _almost 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 that _petechiæ_ and _vibices_ made 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, brown and 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 hardly _knowable_ by 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, the _maculæ magnæ_ of 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 of _tokens_, 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 short while 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 “the mediastinum[101] was 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 time they 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, exclaimed _kulbi! 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 add _eujani kulbi_, my heart pains me; or _naar 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.

[101] The Mediastinum is a membrane by which the cavity of the
breast is longitudinally divided. The tearing of it in any disease
seems altogether unaccountable, unless we suppose an extraordinary
loss of cohesion to have taken place without any mortification. The
pericardium is a membrane surrounding the heart, and in a natural
state contains some water, condensed from vapour after death.

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. Lind in 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 men _felt_ any 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 destroying the 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 called _poisons_, is very remarkable in some things, though in others it totally fails. In the Medical Repository[102] we 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 called _fever_. 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.”

[102] Vol. ii, p. 409.

Our author does not say in what this virulence consists. In the cases of those who die with the _tokens_ upon 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 body suddenly 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 those _tokens_ mentioned 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 been set 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 called _tokens_, 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, notwithstanding the 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 calls _papulæ ardentes_ “burning pimples,” which Dr. Russel supposes to be a modification of carbuncular pustules. Gotwald calls them also _fire-bladders_, and says that they were as broad as a shilling, of an irregular shape, and the skin seemed as if _shrivelled 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 all _burn_ very violently at first, &c.

From all these accounts it seems plain, that in the plague there are partial discharges of heat, from _some_ cause, 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 extraordinary heat 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 mild _pus_ to the pestilential eschar.

In the effects of pestilential contagion we observe, if not a _superiority_, at least a _different mode of action_ from 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 with _thick and black_ blood, 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 the _axilla_ (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 not only 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 the _Mail_ in 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 that _his_ experiments 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 profession _condemned in a manner to death, if punctual in the discharge of their duty_[103] had 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 observed in 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.

[103] This, among innumerable other instances that might be brought,
is a proof of the infectious nature of the plague.

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 of _two thousand seven hundred_ patients, _all_ of 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 the _tokens_, 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 by _electricity_: 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 the true 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 extract of a letter written by a gentleman who resided in that city during the plague in 1743. “It has always been observed, that, after _every_ plague, 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.[104] This 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 an _almost 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 the _quantity_ of heat contained in our bodies is small or inconsiderable; for we have already seen 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,[105] and 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.

[104] Memoires de Societe Medicale, &c.

[105] If we consider the composition of the atmosphere which
surrounds us, we must acknowledge that by far the greater part of
it consists of fire and electric fluid, the latter being properly
the element in a comparatively quiescent state. In deflagrating
dephlogisticated and inflammable air, the mixture has sometimes
shrunk up into a three hundredth part of its bulk; which shows that
of these airs two hundred and ninety-nine parts are fire, the single
remaining part only being earth, water, or some solid matter which we
call the _basis_ of air.

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 an _inflammation_, an _extreme 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 as the 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 the _tokens_ are 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 a _burning 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 may _disbelieve_, he cannot _disprove_. 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 was _fire_. 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 were _immediately_ the 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 no _importation_ supposed, 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 perceive the smallest absurdity, or any thing but what a reasonable man _may_ indeed _must_ believe, 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.