The symptoms in the first period of the plague are few and moderate; they are for the most part reducible to head-ache, vomiting, and buboes; petechiæ rarely appear[54], or if they do, they are distinct and very small; carbuncles are hardly ever seen. This degree of the plague terminates favourably by a suppuration of the buboes, often without any assistance from art. It may therefore be termed the mild or benignant form of the plague.
The next degree or variety is that which occurs when the plague is at its height. This is the most terrible form of the disorder. All the symptoms are marked with violence. The head-ache is incessant, and the vomiting recurs frequently; the external characters are numerous; carbuncles appear in various parts of the body; the petechiæ or maculæ are very large and confluent, and often turn to carbuncles a short time before death. This happens in the following manner: two, three, or four large petechiæ run together and form a yellow pustule; sometimes a similar pustule rises upon each petechia; in either case, on opening the pustules, a true carbuncle appears beneath. In some instances the patient is seized from the first with a furious delirium; at other times this delirium or phrenitic state does not supervene until the second, third, or fourth day. If this disorder of the brain continues until the seventh day, there are hopes of recovery; on the other hand, if the delirium ceases on or after the first or second day, and the patient becomes tranquil and feeble, such an alteration is a certain presage of death. If this change took place in the morning, the patients died in the evening; if in the evening, they did not live over the night. At other times torpor came on, and continued through the whole of the disease, so that the patients died without pain, or at least without appearing to suffer any. In some instances, on being asked how they were, the patients replied, “very well,” and called for meat and drink; but soon after they sunk into a deliquium animi, in which they remained motionless, and died.—The pulse was irregular from the beginning. When there was violent head-ache, with high delirium, &c. the pulse was full, hard, strong, and quick; on the other hand, when these symptoms ceased, whether shortly after the attack or after the second or third day, the pulse then became soft, feeble, intermitting, and not to be felt[55]. In many instances the skin was dry and hot, and the patients complained of a burning sensation, both outwardly and inwardly; in others the heat was not so great; in some the skin was yellow; in others it had a pale corpse-like appearance, joined with great flabbiness. The diarrhœa was often accompanied with an incontinence of urine, both which it was sometimes impossible to check; in such cases, these symptoms (occurring together) were the fore-runners of death. The diarrhœa was common to both sexes; but the incontinence of urine was observed in female patients only.
3. The third degree or variety of the plague occurred in the decline of the epidemic. Its symptoms are the same as those which take place in the first type; and, therefore, to avoid repetition, we refer to that[56].
[B].
Questions relative to the Nature, Prevention,
and curative Treatment of the Plague.
The questions proposed by Prince Orlow to the physicians, and surgeons, were
1. In what manner is the contagion, which is making such great ravages in this place, propagated?
2. What are the symptoms which show that a person is infected with this disorder? In what respects does it differ from other malignant fevers, and what symptoms has it in common with them? How is the patient himself to know that he is attacked with this dreadful disorder, so as to be able to apply for help at the very beginning? How are those who are constantly with the sick, to know the disorder, so as to be put upon their guard against taking infection? And, lastly, how is the physician to be certain that it is the disease in question[57], in order that all possible means may be immediately employed to save the life of the patient?
3. Each of you is required to describe accurately the symptoms of this disorder through its whole course and under all its forms, noticing in what order the symptoms succeed each other, more especially what the symptoms are which accompany each crisis, and what those are which denote more or less danger: lastly, in what space of time, in what manner, and with what outward marks this contagious disorder terminates, whether it be in recovery or in death?