An account of the plague which raged at Moscow, in 1771

by Charles de Mertens

To this account which Dr. Mertens has given of the symptoms which the plague at Moscow exhibited, we shall add the descriptions drawn up by two other practitioners (Orræus and Samoïlowitz,) who had great opportunities of observation, and who have been more particular in noticing some of the phenomena than our author.

According to Orræus (Descriptio Pestis, &c.) the plague in Russia appeared under four different forms or varieties. Of these, he terms the first, the period of infection; the second, the slow type; the third, the acute type; and the fourth, the exceedingly acute type.

1. In the period of infection (which is commonly the forerunner of the other forms of the plague) the contagion, less active and virulent, keeps lurking in the body, and produces the following symptoms, viz. sharp, flying pains in the glandular parts (such as the armpit and groins) and in the muscles of the neck and breast; ardor urinæ; drowsiness; an increased secretion of the sebaceous humour, so that the skin is in many parts, and more especially in the hands and face, much more unctuous and glossy than usual; the belly is costive, but when moved, there comes away a great quantity of pulpy slimy fæces; the patients complain of a heaviness of the body (some compare their limbs to a mass of lead), great lassitude and faintings. A swelling, but without much pain, of some gland (in the groin or armpit) together with dark-red or brown spots, denote a higher degree of infection: and a bad taste in the mouth, a viscidity of the saliva, loss of appetite, whiteness and foulness of the tongue, and head-ach, show that the patient is going to be attacked with the plague under one or other of the following types. The above-mentioned symptoms, which continue for a longer or shorter time (in some instances for several days or even weeks) are not accompanied with fever.

2. After the period of infection above described has continued for some time without yielding to medicine, it generally ends in the slow type of the plague, which is characterized by the following symptoms; viz. shiverings, followed by a moderate degree of heat[42], a febrile[43], unequal, for the most part weak, and often intermitting pulse; a constant dull pain in the head (rather, according to the expression of some patients, a heaviness, as if the head was full of lead); urine pale and turbid, but without sediment; tongue foul and moist; very little thirst; depression of spirits; belly costive during the first three or four days, with inflation of the hypochondria and borborygmi, but the abdomen feels soft on pressure; there is frequent nausea and vomiting of a slimy greenish-yellow faburra[44]; petechiæ and other eruptions[45] make their appearance, in some sooner in others later; but in some they are altogether wanting. The rudiments or germs of buboes and carbuncles, which were forming during the period of infection, now gradually increase in size, but without being accompanied with violent pain; and new ones arise in other places; which, if they suppurate on the fifth, sixth, or seventh day, save the life of the patient: on the other hand, if no suppuration takes place, and great debility, diarrhœa, and delirium come on, the disease terminates fatally, not, however, in some cases till after the fourteenth day.

3. In the acute type, the plague is preceded by a much shorter indisposition, sometimes by none at all, suddenly seizing persons in health. It is characterized by the following symptoms: a bitter taste in the mouth, and a viscidity of the saliva; violent head-ach[46]; redness of the eyes[47] and face; a very foul, and sometimes dry tongue; chilliness succeeded by considerable heat; a much fuller, stronger, and quicker pulse than in the slow type of the disorder, as well as more thirst, and deeper coloured urine; costiveness; buboes, and carbuncles come out soon after the attack of fever, or at the same time with it; after these, others come out; frequent vomitings supervene, and a delirium, which is generally of the low kind[48]. If, between the first and fourth day of the attack, the buboes are resolved[49], or they, as well as the carbuncles, come to suppuration, the patient recovers: on the other hand, if no suppuration takes place within that period; if the buboes and carbuncles increase to a great size, and the delirium continues, then the powers of life become exhausted, the pulse sinks, and death is ushered in by hæmorrhages, and a copious exspuition of thin phlegm[50]. Death takes place on the third, fourth, or fifth day; and it often happens, while the corpse is yet warm, that petechiæ and other spots come out. The bodies, after death, appear remarkably pale, soft, somewhat tumid, flexible, and free from fætor.

4. The plague, in its most acute type, attacks in various ways; but in relation to the leading symptoms, it may be reduced to two forms: in the first, a person in perfect health, without any previous marks of infection, is suddenly seized with a short but violent shivering fit, followed by a hot fit, which alternate with each other several times; but the external heat soon goes off, and the skin feels cool. The pulse is hard and very quick, with a most violent headach and intolerable anxiety about the præcordia[51]; a furious delirium generally comes on; the tongue is smooth, exceedingly dry, and after a while becomes livid; the respiration is short and laborious; the eyes, which are more prominent than in the acute plague, are very red and full of ferocity; the face and neck are turgid, at first red and afterwards livid; vomiting seldom comes on spontaneously. Such as are seized with these violent symptoms seldom live more that twenty-four hours. Most of them die apoplectic, or in a state of convulsive suffocation[52]; some, however, expire in a more placid manner. After death the bodies turn livid in those parts where nature had endeavoured to throw out buboes; and dark-coloured spots and vibices appear in different places. In the other mode of attack, the patients are affected with debility from the beginning, which, together with the anxietas præcordiorum, increases every moment; so that unless timely relief be given, death speedily comes on. In these cases, the pulse is very quick, but small, feeble, and at length imperceptible. Sometimes there is a low delirium; but in many instances the patients are sensible to the last. These are all the febrile symptoms that are observable. Rudiments or germs of buboes are seen upon the dead bodies.

Of these two varieties of the plague in its most acute form, the first was observed to take place in persons of a robust constitution and in full health, after making too hearty a meal on food not easily digested, or eating too much fruit, &c. The other variety attacked those who were under the influence of terror, or after immoderate venery, bleeding, &c.

The very acute type of the plague is less frequent than the other types, and often destroys the patient before medical assistance is called in; in so much that he who appeared well yesterday, is to day carried to his grave. In this species of the plague, I never saw perfect carbuncles and exanthemata; but buboes come out quickly after the attack, and are seen considerably elevated and livid in the dead bodies.

Such is the description of symptoms given by Orræus, a diligent and accurate observer. That published by Samoïlowitz[53], although it is not so circumstantial nor so well digested, coincides in all essential points with the above. This last author considers the plague under three different aspects or varieties, which correspond to the three periods of its beginning, its height, and its decline. In the first and last period, carbuncles and confluent petechiæ, or broad maculæ, are very rarely met with; whereas in the middle period, when the disorder rages with the greatest fury, they both occur in one and the same subject, and denote the utmost danger. At this period, (viz. when the plague is at its height) the pestilential particles being more virulent, more volatile, and more subtile, enter the body more readily, act upon it with greater force, and produce a disease which runs its course with greater rapidity than in either of the other two degrees or varieties of the plague.