Chapter XXX: Appendix: N^o I (2)

In despair, and to try to quench the unsufferable heat in my stomach and bowels, I took a pretty large dose of nitre. The oppression and pain increased; in my confusion I took a paper of tartar emetic, which immediately began to operate. From that time, about ten o’clock, till half past two in the afternoon, I know but little of what passed: I was almost all that time either distracted with pain, or in a swoon; and had it not been for the extraordinary care and attention of the commander of the cruiser, who supported me in his arms, and administered such cordials as I, in the short moments of recollection, could call for, I have not a doubt but I must have sunk under this attack. He counted eight times that I fainted, and sometimes an interval of ten minutes before he could perceive any symptoms of returning life. I was chiefly supported by wine, hartshorn, and spirits of lavender. About three o’clock I had recovered my recollection: most copious and continued sweats had carried off the violence of the fever; but faintings and total privation of strength and spirits remained upon me till late in the evening, when I became to all appearance, for a short time, perfectly well. A little strength returned, every symptom of fever vanished, and my feelings were almost the same as if in perfect health. Some circumstances having prevented the Ranger’s carrying me to Bushire, I was taken ashore in the evening. When I was brought to the factory I had an appetite, and ate some chicken broth for supper. Mr. Ross, who had hitherto escaped the fever, administered a potion of laudanum, and, I believe, antimonial wine, on going to rest. I slept pretty well, and awoke refreshed in the morning. I, however, soon became ill, and at noon I had a severe attack, which continued three or four hours, and left me greatly weakened, my skin extremely dry, pulse quick, fluttering and irregular, beating from 100 to 120, with an unquenchable thirst, which no liquids could allay. We had no acids of any kind, which we had great reason to regret.

I did not know till late in the evening that Mr. Abraham, the vice-consul, who for some days past had been ill of the same fever, had determined to embark in the Eagle cruiser next morning for Bushire, as the only chance of saving his life; and a conversation which I overheard to this effect, that as I was so very ill, and no hopes of my recovery, it would be better to leave me to die at Bussorah, made me still more anxious to fly from the place, although I remember well I had not the most distant hope that I could live. I had suffered much at the factory, and in the peevishness of illness I thought (perhaps unjustly) that my living or dying seemed to be a matter of too little consequence to those whom in health I had treated with much kindness and affection.

About ten o’clock, as I was lying in my cot, on a terrace adjoining the stairs from whence the boat was to put off, I was seized with such a fluttering, palpitation, starting, difficulty of utterance from the swelling of my tongue, that I lay in momentary expectation of breathing my last. This was, however, probably the cause of my hearing the preparations for the departure of the boat. About midnight they were leaving the shore. I could not make myself heard, and I was too weak to get up without help. I made several efforts, and at last overset the cot I was lying upon, and brought myself to the floor, from whence I crawled on my hands and knees to the side of the river. Humanity pleaded for me, and I was taken into the boat, in a situation of wretchedness I never can forget. We were, after being several hours on the Euphrates, carried on board the Eagle, opposite to Margil, a country house belonging to the factory, a few miles distant from Bussorah.

12th. The day was uncommonly hot, and my fever came upon me about ten o’clock. The heat was intense. Mr. ----, a young unexperienced Frenchman, gave me tamarind water and cream of tartar, which had not a good effect. I now discerned the first symptom of a cold fit; but it was slight and of short duration. This day, however, I supported the fever rather better than usual, and in the evening had a short intermission, and slept a little during the night. The air on the river was this day cooler and more refreshing than on shore.

13th. About eleven o’clock had a regular cold shivering fit, succeeded by a very severe hot fever, which continued till five in the evening, when I was somewhat relieved by perspiration. This day the agony of the hot fit was inexpressible, with great pain in my loins, and a constant inclination to make water, which came from me in drops like blood. I had a very bad, sleepless night.

14th. By Mr. ----’s advice I took a dose of tartar emetic, which not working, he gave me some ipecacuanha. I brought up a great deal of bile, but the fever increasing, my sufferings under it were greatly increased by the operation of the emetic, which worked powerfully both upwards and downwards. This was a trying day indeed. I can give no idea of what I suffered, which must have been intolerable, attended with intervals of delirium and frequently swooning. About five the fever began to abate a little, and at six Mr. ---- gave me a small dose of decoction of bark, which seemed instantly to cause a return of the fever, heat, thirst, anxiety and pain.

My fellow-sufferer, Mr. Abraham, was in violent agony this day; he cried out repeatedly that a fire was consuming his bowels, and that he was in exquisite torture. The captain of the cruiser had been complaining; he, Mr. Abraham and myself lay in the same cabin. About 4 o’clock in the afternoon, when my pain was excessive, I crawled from my cot, with an intention to drop myself from a port-hole which was under the captain’s bed, into the river. I had nearly accomplished my purpose, when the captain perceived me, and had me carried into my bed. I was not delirious; and, in spite of all my resolution, the agony I suffered this day made me repeatedly scream out. One of our seamen died suddenly, and the blood, I was told, instantly flowed from all parts of his body.

This evening we arrived at Bushire. On our coming to an anchor Mr. Abraham was immediately carried ashore; but I was too ill to be moved, and accordingly followed in the morning with Capt. Sheriff, after a very severe, sleepless night.

The heat was so excessive this day that even the natives we had on board sunk under it, and many of them were struck down with the sun. By noon nobody could keep the deck; and about this time the vessel ran aground on the bar at the mouth of the Euphrates, but fortunately beat over, and got into the gulf. Two more of our people died in the evening; and I should have mentioned that, in sailing down the river, we saw them throwing many dead bodies from the vessels which were at anchor below Bussorah, and many boats crowded with people from the Arabian shore, passing over to Persia.

The Persians at first opposed the landing of our sick, and threatened to burn the ship; but they were prevailed upon by the company’s agent at Bushire, a most worthy man, to permit us to come ashore.

15th. I was so weak that it was with difficulty they could carry me ashore in my cot; my strength was quite gone, and I was helpless as an infant. Some grapes, water-melon and ice had been got for Mr. Abraham: of the latter he had eaten freely; I was much pressed to do the same but was afraid of its increasing my pain, and could hardly be prevailed upon to taste it; I, however, swallowed a little, but by this time my tongue and throat were so swelled that I had difficulty in getting any thing down. About 10 o’clock I was attacked as usual; but I was become so weak, and the fever running higher than usual, that I appeared in the course of this day, more than once, to be in the agonies of death; perspiration gave no relief to the violent pain and oppression I laboured under.

The factory at Bushire is a miserable, wretched mud building, bearing more resemblance to a stable than a human abode: the few rooms, or rather cells, are insufferably hot, even to those in health, and the rest of the building has no cover from the sun. In one of the best of these recesses in the wall Mr. Abraham and I were placed, and on the same bed, as there was not room enough for two: our agonies were great, and our cries dreadful. About 7 o’clock in the evening I perceived my companion in the agonies of death. The company’s agent, Mr. Beaumont, most humanely afforded him every assistance in his power; and when every other person was afraid to come near us, he himself attended, and administered such cordials as he thought might give us relief. Mr. Abraham died in great pain; and, for fear of alarming the inhabitants, or rather commandant or sheik of the town, Mr. Beaumont thought it necessary to conceal his death. It was some time before the dead body could be removed, which had become very putrid, and covered with purple spots. I have been since told that immediately after death a great quantity of blood or bile flowed from him as black as ink, and so highly offensive as to be smelt at some distance from the factory. Past midnight we were both removed to the terrace, but, unfortunately for me, there was only one spot where we could lie, and the smell of the dead body became intolerable; I was, however, cleaned and put into another bed by the humane assistance of Mr. Beaumont, who sat by me, and treated me with uncommon tenderness. I recovered a little, but passed a dreadful night indeed. I shuddered at the agony which I was to feel on the return of the sun, and most anxiously wished for death, as the only relief from pain that I could expect. I was unable at this time to move hand or foot, and at times could not speak. I told Mr. Beaumont that I thought a gentle dose of physic, if it could be got down, might alleviate the racking pain in my breast, stomach, bowels and loins; he accordingly prepared some salts, manna and tamarinds, and gave it to me in the morning.

16th. At eleven o’clock the violence of the fever came on; I grew delirious, swooned, and the symptoms of approaching death, I was afterwards told, grew evident to those around me. My eyes were fixed, my tongue hung from my mouth, and my face grew quite black. I recovered from this fit about twelve o’clock, and felt excruciating pain, and a burning suffocating heat. My stomach and bowels seemed all on fire, my lungs played with the utmost difficulty, and I felt a pain and sensation about my heart which I cannot describe. I was unable to move; my servant lifted me; I fell into a swoon for a few minutes, and, when I came to myself, a great quantity of black putrid bile flowed from me. Relief was instantaneous, and I slept or swooned till about 5 o’clock, when I found myself free from fever, and able to speak, my recollection clear, and my mind perfectly composed, but my body so weak that I had no power of moving, except one of my hands. They gave me some sustenance; I had a little sleep; but about midnight I fell into a situation which I had all the reason to think indicated the immediate approach of death. My tongue cleft to my mouth, my extremities were as cold as ice, and the coldness also appeared to extend up my thigh; my arm was destitute of pulse, nor was the smallest pulsation of the heart perceptible; I never had my recollection clearer, or perhaps so clear, in my life. My servant was lying by my bedside; I was convulsed for some minutes; and, on recovering, I got out the word _boy_. Fortunately for me he was not asleep, and heard me; I then got out the word _wine_; on which he brought me a glass of claret, which, with much difficulty, I got down; I felt myself much revived; I reflected on my situation; and, although I had not the most remote idea of surviving that night, I recollected that I had some fine powdered bark in my trunk, and it occurred to me that, if any thing could be done to preserve my life, it would be that medicine taken in red wine; but, my speech immediately failing me, I could not direct the servant to give it to me. Death seemed approaching; coldness had seized all my limbs; my sight became confused, as I perceived from looking at the stars, which danced before me; and the rattle or noise in my throat was very perceptible to the servant, as he afterwards told me. I fainted and continued in a state of insensibility, I believe, for about an hour. The loud lamentations of the servant, bewailing his own misfortune in losing his master in a country so remote from his own, seemed to recall me to life; I felt as if refreshed with a little sleep, and got out the words _bark and wine_; it was instantly brought, and the man gave me two large tea-spoonfuls in a large glass of claret. The effect was instantaneous, and operated like a charm; the coldness left me, I could speak intelligibly, and could move my hands. I told the servant to give me a tea-spoonful of the bark every hour, in a glass of claret. By 8 in the morning I had taken six doses, and more than half a bottle of claret. I was considerably strengthened, and could converse with Mr. Beaumont, who encouraged me to persevere in the bark, and treated me with uncommon attention. I had been sadly neglected at Bussorah, but this was amply made up to me by the humane and tender attentions of Mr. Beaumont, who was a great predestinarian, and who never shunned danger when he felt it a duty to assist a fellow creature. He waited upon me like a nurse, consoled me under pain and sickness, and, when my fever was at its greatest height, he has often held me in his arms, when I wanted to be removed, or my bed shifted. About this time my legs and thighs became covered with blotches of a dusky brown hue, some of them as broad as the palm of the hand, quite dry, and they itched intolerably. At the same time several little boils broke out in different parts of my body, but there was only one, over my eye, that came to suppuration; the others, and the eruption on my legs and thighs, all disappeared.

I continued the bark till 12 o’clock, and then left it off till 4, when I took another dose. The dreadful fever of the preceding days did not return on this, but I was still extremely ill, had very great difficulty in speaking and breathing; a swelling also in my throat, parched tongue, and unquenchable thirst. I had not the most distant hope of living. I tried to take some broth, but the swelling in my throat prevented my swallowing. I passed a very bad night, with startings, anxiety, and great pain over the kidnies; and what little sleep I got seemed to make me worse; I was fatigued with it, and under the constant dread of suffocation: towards morning my throat grew worse, and my thirst was excessive.

18th. Left off the bark, uncertain what I ought to do--no fever, but the same symptoms as the day before--drank a little chicken broth, which was the only sustenance I had taken for four days before--great oppression and heat in my stomach and bowels. Mr. Beaumont found out an Armenian who professed physic. This man gave me a clyster, which gave me great relief, and a water to drink, famous as a febrifuge among the Persians; I drank of it freely, and found much benefit from it. But the most extraordinary of all the symptoms I experienced was this, that, the third day after the first intermission of my fever, one of my teeth, and one of the nails of my hand, came out without the smallest pain, only a little swelling in the gum; and, on the nail falling off some matter flowed from the end of my finger. I never had the tooth-ach. At this time the boil on my eye suppurated.

From the 18th of June to the 5th of July, being seventeen days, my fever did not return. I recovered strength slowly, and could walk a little, supported by two men. My food was chiefly chicken and veal broth and about a glass and a half of Madeira wine a day. Yet I had many symptoms of disease hanging about me--restless, fatiguing nights--great thirst--bad taste in my mouth: every thing I took seemed bitter and salt--pains in my back, sides and loins and great difficulty in making water. In this time I passed much bile, naturally and by clyster; and I had a purgative from the Armenian, which weakened me greatly.

The springs lifted, as seamen term it, three days before the change. The opinion is universal in those countries, and also in India, particularly Bombay, where intermittents are prevalent, that the change and full of the moon has an effect upon all intermitting diseases, of which afterwards I had many proofs in my own case. To prevent a relapse, I took some decoction of bark, but in too small quantities to answer the purpose.

4th July. My water, from being thick and muddy, became quite clear.

The 5th of July, after dinner, I was taken with a slight hot fit, which continued about two hours, and then went off by copious perspiration; the remaining part of the evening I was entirely free from fever.

6th. I took decoction of bark--no fever.

7th. At 11 o’clock a regular cold and hot fit; the former continued three quarters of an hour, the latter two hours. Although much less severe than my former fever, yet I suffered a good deal from the hot fit. Left off the bark by the advice of the Armenian, who told me that it heated me and made me worse. Much weakened by this day’s illness; nor did the perspiration entirely free me from the fever.

8th. Had a clyster thrown up, and early in the morning took a draught from the Armenian, composed of fine vinegar, sugar, and a country seed infused over night in water.--A slight hot fit, but of short continuance.

9th. The draught of yesterday repeated--at 10 a regular cold and hot fit, rather less violent than the last.

10th. No fever--tolerably well.

11th. Between 8 and 9 in the morning a cold and hot fit, much more severe than the last--great heat, thirst and oppression--much weakened. I now perceived I had got a regular tertian, and determined on the bark, but was prevailed on by the Armenian not to use it, he promising to cure me in a day or two. He gave me water-melon and his infusion of vinegar and seeds.

12th. No fever--find the water-melon to disagree greatly with my stomach.

13th. Had not as yet indulged much hopes of recovery. I felt still, even in those days previous to this last relapse, many alarming symptoms of disease, which made me apprehend I could not recover; and this last attack had again reduced me so low, that it was evident that, unless I could get removed from those scorching climates, a very short time would put an end to my life. Except in the humanity and goodness of Mr. Beaumont, I was without a single comfort or conveniency of life at Bushire. The heat of the weather seemed daily to increase, and the house we were in hardly covered us from the direct rays of the sun. My servant was taken ill, and appeared to be dying: it was with the greatest pleasure, therefore, I received the accounts this day of the Eagle cruiser having arrived last night from Bussorah, on her way to Bombay.

At half past seven o’clock I had a very severe fit; the hot fit was uncommonly violent, and continued about three hours. I was much reduced, and resolved at all events to take the bark in powder, and in large doses, and to dismiss the Armenian. In this I was confirmed by Mr. Puget, who informed me that the few survivors at Bussorah owed their lives entirely to the bark, which had at last been given in very large doses.

14th. I took four doses, or eight tea-spoonfuls, of powdered bark. It purged me, and carried off a great quantity of black putrid bile. This evening I was carried in my cot on board the Eagle, resolved at all events, even if I had been certain of dying in the boat, to leave Bushire, where I had hardly shelter from the sun, and where the heat was so excessive, that Capt. Alderson of the Eagle and two passengers were taken ill from it last night. I got on board very late, yet found myself refreshed from the sea air.

15th. The fever did not return. I continued to take the bark as yesterday, and found myself surprisingly strengthened. I persevered under this course till the 3d of August, when the vessel arrived at Muscat, and I was astonishingly recovered for the shortness of the time.

From the 14th of July to the 3d of August I had taken seven ounces of bark; and as the fever had returned upon me the last day of the springs at the preceding change of the moon, two days before this change I increased my daily dose, and continued in this manner till the 4th, when the springs being over, and perceiving no symptoms of fever remaining, I left off the bark entirely. I had generally taken six tea-spoonfuls every day.

From the 15th of July till my arrival at Muscat, a seaport on the coast of Arabia, my recovery was exceedingly rapid. I had a keen appetite, a pretty good digestion, sound, refreshing sleep, and my daily increase of strength was very perceptible. My diet, till this time, had been generally chicken broth, rice and boiled fowl, light pudding, &c. On leaving off the bark I observed no particular regimen, only abstaining from salted and high-seasoned meats, and confining myself to three or four glasses of Madeira. I found that an infusion of prunes, with a small quantity of cream of tartar, was of much service to me during the course of the bark, as it kept me cool, and my body open. I was sensible, at times, during my recovery, of a slight but troublesome pain under my fifth rib on the right side, especially when I lay on that side; but from feeling and pressing my hand over the region of the liver, and from other circumstances, I had no reason to suspect that my liver was affected; and, as it soon left me, the cause was probably trifling or accidental.

On my leaving Muscat a large boil came upon the hip-bone, the size of a small melon, extending some way up the side, and down the thigh, with a hard basis. After arriving at Bombay, which we did in fourteen days, it broke, and in a few days healed up. I shall only add, that at Bombay I was detained four months before I had an opportunity of proceeding to Europe. In that time I had three returns of my ague, but on taking a few doses of bark it left me. Those attacks happened at the change of the moon. From Bombay to Europe I had three or four slight fits of the ague; the worst on our making the coast of South Guinea, at the settlement of Benguela, where we found the wretched remains of a Portuguese garrison, the survivors of a fatal putrid fever, which, as they told us, raged in those parts for eighteen months before. The last attack I had was the day we made the Rock of Lisbon, since which time I have had no returns of the ague, although, when the wind continues long at east, I am sensible of a tendency to that complaint.

I shall now give a brief account of the fate of my fellow sufferers at Bussorah. This unfortunate party consisted of capt. Sheriff, of the Eagle cruiser; Mr. Brown, a Bengal merchant, carrying goods from India to Aleppo; Mr. Palmer, a gentleman returning with his fortune from Bengal to Europe; Mr. Robson, surgeon to the factory; Mr. Abraham, the vice-consul; Dr. Ross, who had practised many years at Constantinople, some time in Bengal, and was then taking the opportunity of accompanying me across the desert; Mr. Smith, a merchant from India; and an Italian Carmelite, the vicar of Bussorah, who came from Bombay. It is unnecessary to say that the _seca dab_ is a common symptom in the Turkish fever, or, in other words, a strong desire of self-destruction. We had a fatal instance of it in our party. Mr. Brown, the second day of his fever, being left alone, got to his pistols, and, throwing in four or five balls, discharged them into his breast, and was found dead a few minutes afterwards. I believe every one of us at times would have done the same, had we been possessed of the means of accomplishing it. Mr. Robson died the third day of his fever, in great agonies, but perfectly sensible. His was a continued high fever, without any remission. Mr. Palmer died the 4th day, under the same symptoms as the preceding. The Carmelite, the second morning after he was taken ill, had opened a vein in his arm, and bled to death, most probably intentionally. Captain Sheriff was seized with the fever on his return from Bussorah to Bushire. He died the third day, in a manner which is even painful to relate. He was a man of singular strength of constitution, and suffered unusual agonies before he died. His cries were heard all over the factory; he foamed at the mouth, gnashed with his teeth, and tore his arms with his teeth. Those who heard him compared his cries to the bellowing of a mad bull. He was no sooner dead but his body was covered with purple spots, and so offensive that the people could hardly carry it out to be buried. Mr. Sheriff’s was what they call the worst kind of plague.

Mr. --------, formerly mentioned as having escaped the plague at Bussorah by shutting himself up in a mud house, was seized on his voyage to Bussorah with a kind of insanity, imagining that people were conspiring against his life, and that he was capable of overhearing, at a great distance, even a whisper spoken to his disadvantage. He, however, escaped the infection, and returned to England in health.

N^o VII.

_Set of Queries furnished by Doctors_ AIKIN _and_ JEBB; _and by Mr._ HOWARD _put to several foreign Physicians, during his tour; with their Opinions concerning the Plague_.

1. Is the infection of the plague frequently received by the French?

Answer, by _Raymond_, physician at Marseilles: Sometimes it is.----_Demollins_, surgeon do: In the lazaretto some have touched infected bodies and things with impunity. Attributed to the temperament of the body.----_Giovanelli_, physician to the Leghorn lazaretto: The plague cannot be communicated but by very near approach, or touch: air cannot be the vehicle.----_They_, physician to the Malta lazaretto: It may happen that one person may inhabit the same chamber, or even touch an infected person, with impunity; of which I have known instances; but all who approach the atmosphere of an infected body may receive the infection by respiration. Contagion is almost always received before touching or approaching the infected person.----_Morandi_, physician at Venice: Contact is one of the most powerful and dangerous means of communicating the infection; but for the developement of its effects a predisposition in the receiving body is necessary.----_Verdoni_, physician at Trieste: It is most frequently communicated by the touch. It has been given by a flower held and smelt at, first by two persons who remained free; and then by a third, who sickened and died in 24 hours.----_Jew_ physician at Smyrna: The infection is in reality communicated by the touch alone; for all who keep from contact of infected persons or things remain free. To the effect of contact, however, a certain disposition of the air is necessary; for we often see infected persons arrive from other countries, yet the disease does not spread. But what this disposition is can scarcely be conceived. Commonly in this climate, the disease appears at the end of spring, and continues to the middle of summer; with this particularity, that, in cloudy weather, and during the _sirocco_ winds, the attacks are more frequent. Also in the same diathesis of the air some receive the infection, while others exposed to the same dangers escape it. From observation it appears, that cachectic persons, and those of constitutions abounding in acid, do not readily take it. The contagious miasmata may be dormant in the body for some time without doing the least harm, till set in motion by sudden fear, or the excessive heat of a bath.----_Fra. Luigi di Pavia_, prior of the hospital of San Antonio at Smyrna: The plague is communicated by contact, according to all the observations I have been able to make for eighteen years.

2. Does the plague ever rise spontaneously?

_Raymond_: Incontestible experience shows that it only proceeds from contact.----_Demollins_: From all ages the plague has been brought to Marseilles by merchandise or persons beyond sea.----_Giovanelli_: As the disease always appears with the same symptoms, it is not probably spontaneous, but the consequence of a particular contagion.----_They_: Some contagious fevers come of themselves; others proceed from the communication of contagion. The plague is thought to have originated in Egypt, and spread itself from thence.----_Morandi_: Contagious fevers do not arise of themselves, but are always the product of a peculiar poison--_Verdoni_: I know no fever that can properly be called contagious, and doubt if even the plague can be considered as such. My reasons are drawn from the very different manner in which the plague appears in different years, and the different degree in which it spreads. I therefore conclude that contagious fevers come of themselves.----_Jew_ physician: According to the most ancient authorities, the plague has always been brought to Smyrna by contagion, and was never produced here.----_Fra. Luigi_: Ancient and common observation in this city prove that the plague is derived _solely_ from contagion.

3. To what distance is the air infected? How far does actual contact, wearing infected clothes, or touching other things, produce the disease?

_Raymond_: The infected are safely conversed with across a barrier, which separates them only a few paces.----_Demollins_: The air round the patient is infected more or less according to the degree of poison which exhales. Here in the lazaretto they are spoken with across two barriers, a few paces from each other, without fear of contagion. Hence it would appear that the plague is communicated only by the touch, or still more by wearing infected clothes.----_Giovanelli_: If one speaks of an infected person shut up in an unventilated chamber, it may be said that the whole chamber is dangerous; but if one speaks of a patient exposed to the open air, it has been proved that the infection does not extend beyond five geometrical paces from the body. Beyond this distance one is in safety. The actual touch of an infected person or thing is proved to be very dangerous by fatal experience; but to what degree, is not ascertained.----_They_: The infection extends only some paces; and the miasms, at the distance of about ten paces, are so corrected by the air as to lose all their activity. It may be communicated by touching infected things, especially of a porous nature, as cloth, wool, skins, &c.----_Verdoni_: From the moment of infection to the time when nature has entirely dissipated the contagious principle, which usually happens in forty days, there is always a capacity of communicating the infection. The degree of infection is in proportion to the volume of air surrounding the patient; the air being what absorbs, dissipates and communicates the contagious principle. Infected substances communicate the disease for many years, in proportion to the ventilation they have undergone, or of which they are susceptible.----_Jew_ physician: The degree of infection in the air about the sick depends upon the greater or less malignity of the disease, and other circumstances. The air about poor patients is more infectious than about the rich. These things being established, I am of opinion that, in the greatest contagion, we may securely see a patient at the distance of two ells, if the chamber windows be not all shut.----_Fra. Luigi_: The infection is greater or less in proportion to the virulence of the contagion; but I have made no observation as to the distance. The disease is communicated by contact of all infected things, and by close inspiration of the breath of the sick.

4. What are the seasons in which the plague chiefly appears; and what is the interval between the infection and the disease?

_Raymond_: The plague shows itself at all seasons, but less at the two solstices.----_Demollins_: Great ravages may be made in all seasons, but principally in the greatest heats of summer. From the infection to the disease is two or three days.----_Giovanelli_: The plague appears at all times, in the same manner as poisons at all times produce their effects. But observations show that its ravages are greater in hot seasons than in cold; and it seems that summer and the first months of autumn are most to be dreaded. There is no certainty as to the interval between the infection and the disease, as it depends on the particular constitution of the patient.----_They_: Warm, moist seasons contribute to the production of all infectious diseases. The interval from the infection to the seizure is various, according to the virulence of the poison, and the constitution of the patient. Sometimes it acts slowly, sometimes like a stroke of lightning.----_Verdoni_: The spring is the principal season. Generally the disease shows itself at the instant of touch, like an electrical shock. Sometimes a person retains the contagious principle without any sensible effect, and then unknowingly communicates it to a third, in whom, if predisposed to the disease, it becomes active; or, otherwise, it may be communicated to others successively in the same way, till it becomes dissipated and annihilated, as happened at Smyrna in 1783. In bodies predisposed it very rarely conceals itself till the third day.----_Jew_ physician: Answered in the first.----_Fra Luigi_: The plague is most fatal in Smyrna from April to July; and it is constantly observed that great colds and heats much diminish it, and copious dews extinguish it. The infection shows itself in 24 hours, more or less, according to the difference of temperament.

5. What are the first symptoms of plague? Are they not frequently a swelling in the glands of the groin and armpit?

_Raymond_: The plague often conceals itself under the form of an inflammatory, ardent or malignant fever. Tumours of the glands are often its first symptom.----_Demollins_: The first symptoms of the plague vary; but the most common are, buboes in the armpit and groin; parotids and carbuncles in various parts of the body.----_Giovanelli_: The first symptoms are, debility, fever, excessive thirst, followed by great heat; after which carbuncles or buboes appear in the armpits, groin and parotids. The groin is sooner attacked than the armpit.----_They_: Swellings in the armpits and groin are indeed the characteristics of the plague; yet they are not the sole nor the first symptoms, and often are not seen at all; as when the plague disguises itself under the form of other diseases.----_Morandi_: Glandular swellings are properly the symptom of the second stage, and are preceded by those febrile symptoms which are immediately the consequence of receiving the infection; such as pain in the head, drowsiness, great prostration of strength, dryness of the tongue, vomiting, hiccough, tremor, diarrhœa.----_Verdoni_: Its first symptoms are relative to the constitution of the year, and of the body seized, and the place where it was produced, or whence it came. In 1783 all the parts of Natolia were infected; and the disease transported to Smyrna, which is the centre, was extinguished without the loss of a single person. Generally the plague of Constantinople, transported to Smyrna, does little harm. That of Egypt causes havock, as in every country. That of the Thebais is always cruel, and, carried to Lower Egypt, is fatal. The inguinal glands are most generally affected.----_Jew_ physician: The swelling of the glands is seldom the first symptom. Patients are every day seen who, being supposed ill of another disorder, in two, three or more days show glandular swellings, or carbuncles, by which the plague is manifested. On the contrary, many, who from the usual signs are supposed to have the plague, become well in a day or two, without any external swelling. The first symptoms are, horripilation, or actual shivering, nausea or vomiting, loss of strength, and fever. These are common to many diseases; but the pathognomic signs are, a difference in the pulsations of the two sides, with this circumstance, that from the diversity a prognostic arises; it having been observed that if the pulse on the side of the tumour or carbuncle be greater or more frequent, it bodes well; whereas, if it be smaller, it shows greater malignity, and more is to be feared. Further, there is observed among the first symptoms a visible pulsation in the carotids, greatest on the affected side; and also a crystalline vivacity in the eyes, with a kind of contraction or diminution of the eye on the affected side.----_Fra. Luigi_: The most remarkable symptoms of the plague are, turbidness and sparkling of the eyes, the tongue furred with a white mucus, and very red at its tip, frequent biting of the lips, violent pain in the head, and inability to hold it up; a sense of great cold in the loins, vomiting, debility. Swellings of the glands are not among the first symptoms.

6. Is it true that there are two distinct fevers with nearly the same symptoms, one of which is properly termed the plague, and is communicated from a distance by the air, and without contact; while the other, which is properly termed contagion, is only communicated by the touch, or at least by near approach to infected persons or things?

_Morandi_: It is certain, from multiplied observations, that there are two sorts of pestilential fevers, similar in appearance; one of which proceeds from the contamination of the air alone, and is communicable to any distance; the other is produced alone by contact, or near approach. The former of these is properly termed a pestilential fever, the latter a contagious one.----_Verdoni_: The distinction of these fevers is useless; since the same which is communicated by the touch, is that also conveyed by the air to a certain distance, especially in a close place.----_Jew_ physician: That there are two kinds of plague is absolutely to be denied; yet sometimes it happens that persons are attacked with the plague without knowing from whence it came.----_Fra. Luigi_: I hold it for certain that there is only one species of plague, though differing in malignity.

7. What is the method of treatment in the first stage; what in the more advanced periods? What is known concerning bark, snakeroot, opium, wine, pure air, the application of cold water?

_Raymond_: The disease is treated as inflammatory. No specific has been discovered for it.----_Demollins_: At the beginning, bleeding, vomiting, purgatives, diluents, refrigerants and antiseptics are used; afterwards antiseptics and cordials, relatively to the temperament and symptoms----_Giovanelli_: The plague causing always a disposition to inflammation and putrefaction, it is always proper to bleed proportionally to the strength, and to use a cooling regimen, with the vegetable acids. The repeated use of emetics is also proper, both to clean the first passages, and to dispose the virus to pass off by the skin. In the progress it is necessary to favour the evacuation of the virus by that issue which nature seems to point at. Thus either antiphlogistic purgatives are given, if nature points that way, or suppurative plasters are to be applied to any tumours which may appear. Epispastics to the extremities are proper where nature wants rousing. The vitriolic acid in large doses has been found very serviceable in the plague at Moscow, attended with carbuncles. When the inflammation is over, and marks of suppuration appear, the bark, with wine and other cordials, is proper. The surgeon’s assistance is proper in the treatment of boils and anthraces, which last are seldom cured without the actual cautery.----_They_: In the beginning of pestilential fevers bleeding is sometimes proper, and vomits almost always. In their progress frequent subacid and cold drinks, the bark given liberally, and vitriolic acid, have been found powerful remedies when there was a dissolution of the blood----_Morandi_: In the first period, evacuations, according to the particular circumstances of the case, are proper: in the second, bark mixed with wine, and opium as a temporary sedative. Pure air is very necessary; and fire as a corrective, with the burning of antiseptic and aromatic substances.----_Verdoni_: As soon as a Christian finds he has got the plague, he eats caviare, garlic and pork; drinks brandy, vinegar and the like, to raise the buboes. Upon these he applies greasy wool, caviare, honey of roses, dried figs, &c. to bring them to suppuration. The Turks and Arabs drink bezoar in powder with milk, and other sudorifics, in order to expel the virus. They vomit, and possibly a second time. At Cairo they take opium, and cover themselves with mattresses in order to excite sweat; and, though parched with heat and thirst, they drink nothing. They open the immature buboes with a red hot iron. At Constantinople and Smyrna they eat nothing, and drink much water and lemonade. The Jews drink a decoction of citron seeds, lemon or Seville orange peel, and their own urine. They abstain scrupulously from animal food. In 1700 a physician in Smyrna found bleeding very useful. Another, in another year, cured the plague by bleeding, and an antiphlogistic regimen. My brother in Cairo treated it like a biliary fever, with vomits, saponaceous attenuants, and antiphlogistics; and successfully. Some sailors at Constantinople in the frenzy of the plague have thrown themselves into the sea; and it is said that on being taken out of it they have recovered. My opinion upon the whole is, that the treatment ought to be relative to the constitution of the year, and of the patient, by which the nature of the disease itself is greatly altered.----_Jew_ physician: Bleeding in many cases may be serviceable, as I have known patients, who were bled by mistake, recover; and others recovered from a most desperate condition by a spontaneous hemorrhage. On the other hand, persons have been apparently injured by both these circumstances. The difference of effect seems to depend on the state of the blood, whether it be disposed to coagulation or dissolution. In the former, bleeding is useful, in the latter, hurtful. Vomits, according to my experience, have not succeeded; yet I should not hesitate to try ipecacuanha in substance, exhibiting half a scruple at two or three times, in the expectation that in this manner it would not run down. Bark may be useful in dissolutions of the blood; and also small doses of opium, and other medicines prudently administered. In excessive watchfulness I have known relief procured by anointing the temples with ung. populeon. In a case of hiccough the liquor anod. miner. Hoffmanni succeeded with one. The Turks, in the violence of the fever, take handfuls of snow, and apply it all over their bodies, and also eat it; and sometimes throw cold water on their feet. But whether this is of service or not cannot be determined; as these people in other respects pay no regard to rules of diet.----_Fra. Luigi_: They who practise empirically in the plague use none of the recited methods, but only strong sudorifics, and ventilation of the air; and complete the cure by proper treatment of the sores by suppuration.

8. When the plague prevails, do the physicians prescribe to those who have the disorder a more generous, or a more abstemious diet? and do they prescribe any thing to the uninfected?

_Jew_ physician: In times of the plague, many are accustomed to eat no flesh; others, no fish; but I know not whether by the advice of physicians. For myself, I have been in many plague years, but have made no alteration in the management of myself.----_Fra Luigi_: In Smyrna the plague is generally treated with a rigorous diet. They only use rice and vermicelli boiled in water; and sometimes, when the patient is too costive, juices and herbs boiled without seasoning. From time to time they give some acid preserves, and raisins, and, in great heats, some slender lemonade; and a dish of good coffee with a biscuit every day. For drink they only use toast and water; and they follow this abstemious regimen till the fortieth day of the disease is completed, after which they take chicken broth, lamb, and other food of easy digestion.

9. Are convalescents subject to repeated attacks from the same infection?

_Raymond_: Not unless they touch something infected.----_Demollins_: Convalescents are sent to fumigated chambers, and there is no instance of relapse.----_Giovanelli_: No instance of relapse, after being well recovered from the first attack, have come to my knowledge; but they are liable to fall into other disorders, such as consumption, hæmoptoe, &c.----_They_: Convalescents are without doubt liable to a relapse, and authors are full of instances of it. In the plague of Messina M. Cotogno says that a man had successively fourteen buboes, and was cured at last.----_Morandi_: All convalescents may relapse.----_Verdoni_: They have it not twice in the same year----_Jew_ physician: Convalescents are often attacked anew, and die; but this does not usually happen from a fresh infection taken elsewere, but from some remains of their own contagion, excited by intemperance in food, or the venereal act.----_Fra. Luigi_: From irregularities in eating and drinking, bodily fatigues, affections of the mind, especially anger, they are liable to repeated and very dangerous relapses.

10. What is the proportion of deaths, and the usual length of the disease?

_Raymond_: The mortality is different in different seasons and years.----_Demollins_: In the plague of Marseilles in 1720, half the inhabitants perished. The usual length of the disease is that of other acute disorders; but longer when the tumours come to suppurate.----_Giovanelli_: The proportion of deaths is variable and uncertain. As to duration, when the disease is very acute and fatal, the patient generally dies within five days from the first invasion of the fever, or first marks of the plague. When he recovers, no certain termination can be assigned. If the time of healing all the sores be reckoned, it may be to three, four or five months, or more.----_They_: The mortality is very various. Of ten whom I treated in the lazaretto, three died. I have observed that the fever generally runs on to twenty or twenty-one days.----_Morandi_: The bills of mortality in places visited by the plague usually amount to thirty per cent, sometimes to fifty. (He seems to mean of the whole number of inhabitants.)----_Verdoni_: The proportion of deaths varies infinitely. It has been observed that the Jews in Constantinople and Smyrna lose only one third; which is attributed to the care they take of their sick. At Cairo, on the other hand, they are the first attacked and lose more than three fourths. The Turks lose two thirds; other nations a little more or less. Europeans in Cairo lose five sixths. Sometimes it kills immediately; sometimes in twenty-four hours; commonly in three days. When the patient gets over the ninth day there are great hopes of recovery, as the buboes are then suppurated. They may, however, die within the fortieth day, especially if they commit any irregularity, the principal of which is eating flesh, which instantly causes a return of fever, and death. It never passes beyond the fortieth day.----_Jew_ physician: The mortality is various, as also the duration: some in two, three or four days; some hold out six, eight, or more---_Fra. Luigi_: Generally more die than survive; but in our hospital of San Antonio of Smyrna, from the care taken of the sick, the number recovering has, for eighteen years past, exceeded that of the dead.

II. What are the means to prevent the plague, to stop its contagion, and to purify infested places?

_Raymond_: There is no other method of preserving one’s self from the plague, than avoiding the contact of infested things. Goods are purified by exposing them to the open air for forty days; and furniture by a strong fumigation with aromatics and sulphur.---_Demollins_: Here, in the lazaretto, infected goods and furniture are exposed to a current of air for forty days. The air of infested places is purified by burning all sorts of aromatics.----_Giovanelli_: The method of prevention is, to avoid all communication with infected persons or goods. The means of stopping the contagion form a body of police, too extensive to be here mentioned.----_They_: The means of prevention, besides avoiding infected things and persons, are sobriety in living, the use of vinegar internally and externally, and an issue. Infected places are purified by fumigation and ventilation, by scraping the lime from the walls, (which is then thrown into the sea) and whitewashing them anew with lime and sea-water, by washing the floors, windows, doors, &c. first with sea-water, and then with vinegar, taking great care to leave nothing that is infested. The bodies of the dead are buried in a place set apart for that purpose; and their beds and bedding are burned. As to other things not used during the illness, the linen is washed with soap and ley; the woollen clothes are put into sea-water for two days, and then ventilated for twenty days. Those which would be spoiled by water are hung on a line in the air for 40 days, and fumigated from time to time according to their quality----_Morandi_: A fire is to be kept constantly in the sick chamber in all seasons. All fæces, &c. are to be immediately removed. Clean sheets and shirts daily. The healthy must avoid commerce with the infected; must purge gently now and then, smoke tobacco, drink pure wine medicated with wormwood, gentian, zedoary, &c. and avoid fear and other passions, and excess of all kinds.----_Jew_ physician: No means of prevention are used in the Turkish dominions.---_Fra. Luigi_: Fire, water and air are used for stopping the contagion, and purifying places.----_Verdoni_: The best preservatives are supposed to be sprinkling the room with vinegar and perfumes, ventilation and fumigation. The Greeks in Smyrna during lent, when they eat only vegetables, are seldom attacked; while among those who eat flesh the contagion makes great havock. Hence the best means of prevention are to eat moderately, and not at all of animal food; to drink water and vinegar; to sprinkle the chamber with the latter; and use frequent ventilation; to change the clothes, especially the linen, daily; hanging in the air such as has been used, for 15 or 20 days. For suppressing the infection every thing is to be washed that can undergo the operation, and the walls of the chamber to be whitened with lime, but after the 24th of June no further care is taken.

FINIS.

ERRATA.

PAGE. LINE.

20. 23. For ‘destroying three or four thousand,’ read
‘destroying sixteen hundred out of three or four
thousand.’
39. 13. from bottom, for ‘Zabira,’ read ‘Zebire.’
86. 10. for ‘obscured.’ read ‘obscure.’
153. 20. for ‘acid other,’ read ‘acid in the other.’
202. 15. from bottom, after ‘the inhabitants,’ add, ‘Farther
east it does not go.’
280. 7. from bottom, for ‘flattering,’ read ‘fluttering.’
303. 8. from bottom (in a few copies) for ‘gout, fever,’ read
‘gaol-fever.’
309. 10. for ‘safety to,’ read ‘safety of.’
460. 2. from bottom, for ‘fluid,’ read ‘fluids’
480. 12. from bottom, for ‘Black assizes,’ read ‘Black Hole.’
486. 5. for ‘Hansforth,’ read ‘Hansford;’ also in pages 489 &
510.
502. 1. for ‘parcity,’ read ‘paucity.’
513. 1. bottom, for ‘vol. x,’ read ‘vol. iii.’

Spelling inconsistencies include (but are not limited to) the following:

idiosyncracy/idiosyncrasy
occured/occurred
eat/ate
superintendant/superintendent
etherial/ethereal
oxygen/oxygene
syncopy/syncope
alledged/alleged
adviseable/advisable

Corrected misspellings include the following: