Chapter XVI: Section III (10)

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 became cold 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 subsequent days.... 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, and _all_ the 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, as there 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.

“_All_ the 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 the _black crust_,[106] and 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 was _nearly as numerous_ as the fourth, but began to predominate rather later, and reigned most of all in the decline of the plague in 1762.”

[106] This is in favour of what has already been observed, that
the pestilential eruptions in _all_ cases showed a tendency to
mortification.

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 what _he_ has seen, may serve to throw some light on the subject, by relating what _others_ have 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 want often 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, but seldom 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 of _burning_ pain in those _fiery_ eruptions. 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 almost entirely disappeared; the carbuncles, mortifying at the top, resembled a _great 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 it always 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 black _coal_, or _eschar_, 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. _Carbuncles_ were 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. The _anthrax_ is 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 called _teretes_ were frequently discharged both upwards and downwards. Women with child generally suffered abortion, and were carried off by an uterine hæmorrhage.[107]

[107] Bonetus relates, that in 1676 in a malignant fever at Borgo di
Safia, the patients discharged live worms by the mouth, and adds that
they were sooner killed by wine than any thing.

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 the _pestilential bubo_ of 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 symptoms immediately 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.”

On the subject of carbuncles, Dr. Patrick Russel observes, that “there are certainly varieties in them, but perhaps these varieties have been unnecessarily multiplied, from the same eruption having been viewed in different stages of its progress; for all of them sooner or later are covered with a black eschar.” Dr. Alexander Russel describes them as follows: “The carbuncles were commonly protruded the second day of the disease; and though the muscular and tendinous parts were more especially affected, no part whatever could be said to be free of them. The carbuncle at first resembled an angry confluent pock in its inflammatory stage, but was attended with intense, burning pain, and surrounded by a circle of a deep scarlet hue, which soon became livid. By a progress very rapid, it then spread circularly, from the size of a silver penny to an inch and an half, two inches, nay, even three inches, diameter; and the supervening gangrene often penetrated deep into the substance of the parts affected. In such of the sick as recovered, the gangrene usually ceased spreading on the third day; and, a day or two after, signs of suppuration were observed at the edge of the black crust, the separation of which, advancing gradually, was completed rather in less time than that of the eschar in issues made by caustic. In cases where the patient died, I was informed (for I saw none of those cases myself) that a quantity of ichorous matter oozed from beneath the eschar, which remained itself shrivelled and hard, without any favourable signs of separation or digestion.”[108]

[108] Dr. Gotwald, formerly quoted, describes four varieties
of carbuncles, the differences between which seem to be pretty
distinctly marked. 1. “One kind rises pretty high, is of a dark
brown colour, the cuticle appearing as if it were burnt, and it is
surrounded with a lead-coloured circle. In the beginning it is no
bigger than a pea, but, if not prevented, soon grows to the size
of a crown piece; inwardly it is moister than the rest, and may be
more easily separated. Its seat is generally in the fleshy parts,
as on the shoulders, neck, hips, arms and legs. 2. The second lie a
little deeper, and do not rise so high; the eschar in the middle is
entirely dark and ash-coloured, full of small chops, as if it would
burst by too great dryness: it has a strong lead-coloured circle,
behind which the sound flesh looks red and shining. It eats into
the flesh round about it, and takes deep root: it generally fixes
in the most fleshy parts, as the buttocks, calves, &c. 3. The third
is not very large at first; it appears like a blood swelling, not
so dark as the former, with a wrinkled skin; as it increases, small
blisters arise in the middle, and form an eschar, in little clusters,
which, as an ingenious physician observed, were small carbuncles.
They commonly are situated in membranous and tendinous parts about
the knees, toes, and behind the ears, &c. 4. The fourth is the most
curious, as Purman, in his treatise on the plague, has well observed.
Sitonius calls them pale, livid, ulcerous papulae: they appear with a
high, yellowish blister, which seems full of corruption: the circle
round it is first red, then of an ash colour: the blister soon
falls, and, with the carbuncle, appears scarce so big as a pepper
corn, continually eating deeper and wider. They are seated upon the
cartilaginous or gristly parts. Gotwald found them near the pit of
the stomach, upon the cartilago ensiformis and short ribs. All the
four take root and burn very violently at first, but the two former
most of all.”

Dr. Alexander Russel also describes another kind of pustule, which he says appeared in a small number of the sick, but which his brother Dr. Patrick had no opportunity of observing in 1760. It had no livid or discoloured circle surrounding it, but was filled with laudable pus; and, when dry, the crust fell off, as in the distinct small-pox. This was looked upon as a favourable symptom, all who had it happening to recover.

We have now detailed, at considerable length, the symptoms of the plague as mentioned by authors of great eminence. To give a detail of _all_ that has been said upon this subject would be impossible; neither indeed can it be thought necessary in the present treatise. Whatever may have been omitted or too slightly mentioned in this section, will naturally be considered when we come to treat of the cure. It now therefore only remains to say, whether the approach of a plague may be known by any visible signs, so that people might in some measure prepare themselves for the ensuing calamity.

Were we in possession of an accurate and authentic history of the world, this question might be very easily decided; but the uncertainty of ancient records, the mutilated state of those which we do possess, the diversity of opinions among mankind, and the unhappy disposition to _misrepresent_, so common in all ages, render it very difficult to say any thing upon the subject. If the theory hinted at in this section (that plagues arise from some commotion in the electric fluid) can be allowed to have any foundation in nature, then it ought to follow, that the forerunners of pestilence would be some electric phenomena; and, from a perusal of the first and second sections of this work, it will appear that such an opinion is not altogether unfounded.[109]

[109] See p. p. 61, 62.

The appearance of immense numbers of insects has likewise been accounted a sign of approaching pestilence; but if we suppose their appearance to be a _sign_, we can scarce imagine their putrefaction to have been a _cause_, of pestilence. In the east we are informed by Dr. Russel that the inhabitants of Aleppo account the appearance of insects, and even _eclipses_, as presages of the plague. They suppose also that the stillness of frogs is a sign of pestilence; but the same author informs us that all these signs failed in 1760. Violent earthquakes and famines seem to be more certain signs, though even these are not always to be depended upon; it being evident from historical accounts that pestilence has sometimes preceded, and sometimes followed, earthquake and famine. Mr. Gibbon, however, ascribes to the above-mentioned causes, viz. insects, earthquakes, and even _comets_, the dreadful plague which took place in the reign of Justinian. At least, all these preceded it; but perhaps the _insects_ were only meant to be accounted the cause of the plague. The cause of the _insects_ must remain in obscurity. According to him, “In a damp but stagnating air, this African fever is generated from the putrefaction of animal substances, and especially from the swarms of locusts, not less destructive to mankind in their death than in their lives.”

This dreadful plague was preceded by comets and most violent earthquakes. A remarkable comet appeared in 536, supposed to be the great one observed by Sir Isaac Newton in 1680. This, we are told by astronomers, revolves round the sun in a period of 575 years; but the failure of astronomical predictions in the return of the expected comets of 1759 and 1789, shew the futility of such calculations. Another comet appeared in 539, and these comets were attended with an extraordinary paleness of the sun. Mr. Gibbon observes, that earthquakes, which he calls a fever of the earth, “raged with uncommon violence during the reign of Justinian. Each year is marked by the repetition of earthquakes of such character, that Constantinople has been shaken above forty days; of such extent, that the shock has been communicated to the whole surface of the globe, or at least of the Roman empire. An impulsive or vibrating motion was felt; enormous chasms were opened, huge and heavy bodies were discharged into the air, the sea alternately advanced and retreated beyond its ordinary bounds, and a mountain was torn from Liburnia, and thrown into the waves, where it protected as a mole the new harbour of Botrys in Phenicia.”

According to Dr. Sydenham the plague at London in 1665 was preceded by a very cold winter; the first continued till spring and went off suddenly towards the end of March. Peripneumonies, pleurisies, quinsies, and other inflammatory disorders, then made their appearance, along with an epidemic fever of a particular kind, which did not yield to the remedies successful in other epidemics. About the middle of the year the plague began, and increased in violence till the autumnal equinox, when it began to abate, and by the ensuing spring was entirely gone. Our author says that the plague seldom rages violently in England but once in thirty or forty years; but since his time, which is upwards of a century, no plague hath appeared. He supposes the plague and other epidemics to depend on some secret constitution of the air, but pretends not to say what that constitution is. But, besides this constitution, he is of opinion that there must be another circumstance, viz. the receiving the effluvia or seminium from an infected person. Thus he supposes that a single infected person is sufficient to poison a whole country; the general mass of atmosphere being infected by the breath of the diseased and the effluvia of the dead bodies. “Thus (says he) the way of propagating this dreadful disease by infection is rendered entirely unnecessary; for though a person be most cautiously removed from the infected, yet the air received in by breathing will of itself be sufficient to infect him, provided his juices be disposed to receive the infection. I much doubt, if the disposition of the air, though it be pestilential, is of itself able to produce the plague; but the plague being always in some place or other, it is conveyed by pestilential particles, or the coming of an infected person from some place where it rages, to an uninfected one, and is not epidemic there, unless the constitution of the air favours it. Otherwise I cannot conceive how it should happen, that, when the plague rages violently in one town in the same climate, a neighbouring one should totally escape it, by strictly forbidding all intercourse with the infected places; an instance of which we had some few years ago when the plague raged with extreme violence in most parts of Italy; and yet the Grand Duke, by his vigilance and prudence, entirely prevented its entering the borders of Tuscany.” As to the nature of the disease, when once produced, Dr. Sydenham is of opinion that it is altogether inflammatory; for which he gives the following reasons: 1. The colour of blood taken away that resembles that in pleuritic and rheumatic disorders. 2. The carbuncles resemble the mark of _an actual cautery_. 3. The buboes are equally disposed to inflammation with any other tumours that come to suppuration. 4. The season of the year may be adduced in proof of this; for between spring and summer, inflammatory disorders, as pleurisies, quinsies, &c. are common.

Before we put an end to this section, it may now be proper to say a few words by way of apology for the many apparent digressions from the subject which have appeared in it. In the first place, then, the work being intended for general inspection, and not merely for medical readers, it became absolutely necessary to introduce a number of things which for medical readers would have been totally superfluous. It was to be supposed that the book might come into the hands of some who had not read any thing concerning the structure of the body, who had not heard of any of the systems of medicine now prevalent, or the different doctrines they contain. It was impossible to write in an intelligible manner for such people without giving some few hints concerning all these subjects: the same consideration made it necessary to enter pretty largely into the discoveries concerning the composition of the atmosphere and various kinds of elastic fluids, concerning heat, &c. In doing this the writer was under a necessity either to adopt some of the doctrines he took notice of, or to animadvert upon them. If he has ventured freely to give his sentiments, it is not with a view to establish a theory of his own, but to direct the attention of the reader to those natural agents which seem to be at present too much overlooked, principally because they are less accessible to our senses, and of consequence less subject to experiment, than others. If therefore in this treatise it is suggested that the atmosphere acts on the human body by its internal or latent heat, and by its electricity, as well as by its other properties; if the writer is inclined to believe that these are in fact the most powerful parts of it; that we never can act without them, and that in short our life and health are in immediate dependence upon them; I say, that none of all these things are in opposition to any fact hitherto discovered, either of the medical kind or any other. On the other hand, in all ages physicians have sought for some constitution in the air, inexplicable, and perpetually unknown, to which diseases might be ascribed that could not be supposed to originate from any of its ordinary properties. To explore this constitution is as great a desideratum at the present moment as two thousand years ago; and any attempt to investigate it, or a conjecture relating to it, cannot be supposed inconsistent with any thing already discovered and ascertained. There are many things which lead us to think that electricity is very much concerned in diseases, and among the rest we must account the new discovery of Dr. Perkins’s metallic conductors a very notable proof of it. These, when first ushered into the world, were made by many a subject of ridicule; but the evidence in favour of their efficacy, both in America and in various parts of Europe, seems now to be decisive in their favour; and, if they act at all, it is almost impossible to suggest any other principle than that of electricity to which their efficacy can be owing. No doubt it is difficult to draw the line properly betwixt credulity and skepticism, but where credible testimony determines any thing to have actually happened, or where solid reasoning gives room to suppose any thing to be probable, it never can be invalidated by any argument _a priori_ formed against the _possibility_ of such a thing taking place.

In page 128 it is said, that M. Lavoisier, by introducing the new chemical nomenclature, “has entailed the greatest curse upon the science it ever met with.” All apology for this bold assertion is absolutely necessary, and the quotation made from Dr. Ferriar may be deemed inadequate, or perhaps misapplied. In passing this censure on the nomenclature I wrote from experience. The new nomenclature, instead of promoting _my_ improvement in chemistry, hath had a direct contrary tendency. An instance of the inconvenience and ambiguity arising from it is given p. 135, when speaking of Dr. Girtanner’s theory. But a much more remarkable example is to be met with in the review of Dr. Monro’s Chemical Treatise, where we find him censured for the very same ambiguity taken notice of with regard to Dr. Girtanner. “He might have observed (say the reviewers) the distinction between the hydrogen and inflammable air, and between the oxygen and pure air, as well as between the azote and impure air: he has mentioned these as synonimous, whereas they are terms that express bases, or substances in a concrete state (what I have called the condensable part) and the compounds of these substances and heat, when they assume the form of gases or elastic fluids.” (Monthly Rev. for 1790, p. 26.)

That the terms invented by Lavoisier and others have not been received with perfect unanimity by the chemists of the present day, is evident from Dr. Pearson’s “Translation of the New Chemical Nomenclature,” which is not only a _translation_, but a _vindication_ of it. In the course of his work he quotes the translator of the Chemical Dictionary saying, that, “from the zeal of reforming language, such a number of reformers may arise, that our ears will not be less stunned, nor our understandings less perplexed, than if we were exposed to the clamour of Babel, or the _thaw of words_ of Sir John Mandeville.” To this Dr. Pearson replies, that there is no reason to fear any such bad consequences. “The distinguished superiority of a system produced by a _De Guyton_, a _Lavoisier_, or a _Bergman_, would surely supercede the work of persons of _inferior ability_.” It is impossible to know the persons here designated, unless the Doctor points them out. If he chooses to call _himself_ one of them, we can have no objection. He certainly has dissented, in one article, from “the system produced by De Guyton, Lavoisier and Bergman,” and this is with regard to the word _azote_. This is the term announced to us as the most proper for denoting a certain kind of air. But Dr. Pearson determines _nitrogen_ to be more proper. Even this has not given entire satisfaction, for Dr. Mitchell has adopted the word _septon_ in preference to both _azote_ and _nitrogen_. Thus, instead of the original phrase _phlogisticated air_, used by Dr. Priestley, we have four; for as long as the works of Dr. Priestley remain, the original term will be used by some, while with others it will be so much disused that perhaps they will not understand it when it happens to occur. Nor are corrections of this kind all that we have to fear. Professor Wiegleb, who has written a System of Chemistry in quarto, has therein changed almost all the nomenclature invented by Lavoisier. Instead of it he gives a nomenclature of his own, in which he makes very much use of the termination _cratia_, from a Greek word signifying strength; thus, instead of saying the _acid of fluor_, we are to say _fluoricratia_. I must confess that to me the perpetual repetition of this termination has a very ridiculous appearance; but the misfortune is, that in the case of nomenclatures we have no choice. We cannot choose one and reject another: good or bad, we must take both; and were an hundred new ones to arise, we must be condemned to learn them all. Nor is even this the worst. Wiegleb’s scholars, for instance, accustomed to the language of their teacher, will be apt to put it into their writings, perhaps without proper explanation; and thus such writings must be unintelligible both to old and new chemists: and thus it will be with as many others as choose to invent new chemical terms.

Were this a proper place for entering into a discussion of Lavoisier’s nomenclature, it might easily be shown that the terms are not more proper than those which preceded them; but no real inconvenience can arise from the propriety or impropriety of a mere name. It is the _resemblance_ of the terms to one another, and the facility with which mistakes may be made, that gives just ground of complaint. Nor is it any just reason to accuse a person of want of judgment or carelessness because he hath mistaken these terms. We see that even Dr. Monro has not attended to every circumstance; and if a man of his experience and accuracy hath been inaccurate in this respect, what is to be expected from others? How easily may the words _sulfate_, _sulfite_, _sulphuret_ and _sulphure_, be mistaken for one another, either in writing or conversation! Yet a mistake of this kind would totally pervert the meaning of the person who used it. The scripture finds fault with those who make people offenders for a _word_; but here we are in danger of being made offenders for a _letter_. In short, taking into account the inconveniences arising from this nomenclature itself, the numberless corrections and amendments (no matter whether real or imaginary) to which it may be subjected, and the number of others totally different from it which may arise, I cannot help looking upon the introduction of it into chemistry as an evil of the first magnitude; an evil which cannot be remedied by any art, but must continually become worse and worse.