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

by Charles de Mertens

4. What are the medicines which have hitherto been administered in the different cases, in what doses, in what stage of the disorder, and with what success? The general result of these observations will determine which is the easiest and most successful method of cure.

5. What is it necessary for the patient to observe when he is taking the remedies, and when he is not; and what sort of regimen is best suited to promote the cure?

6. Lastly, each of you is required to make known, according to his own judgment and experience, what appear to be the best and surest methods by which individuals may escape this terrible scourge, and by which it may be checked, and if possible entirely eradicated; but these methods must be simple and easily put in practice.

My answers to these questions were as follow:

1. That this contagious disorder was propagated by touching the sick or dead bodies; by handling infected goods, such as clothes, furniture, and the like; by the patient’s breath; or by the air of a room, confined and loaded with effluvia from the bodies of the sick; but not at all by the common atmosphere[58]. Hence those who avoid all communication with the sick, and never meddle with infected things, remain free from the plague, although they live in the same territory or in the same town where it is making its ravages; whilst the poor, not shunning communication with the sick, and putting on infected clothes, which they buy cheap or get by inheritance, are continually exposed to the contagion, and are consequently those who are chiefly attacked by the plague[59]. Now, if the cause of the plague existed in the atmosphere, or that it was carried by it in a state of activity from one place to another, it should follow, that all the inhabitants of the same territory, or at least of the same town, rich as well as poor, should be equally attacked by it; but this is not the case. All, therefore, that can be attributed to the atmosphere, with regard to the plague, is, that according to its different temperature, it disposes the human body more or less to receive the contagion; and that according as its temperature is greater or less, it renders the pestilential miasm more or less violent, or even destroys it; which, indeed, seems to have been the opinion of other writers on this subject[60]. We have seen in the preceding narrative, that the cold of winter blunted, and as it were froze the pestilential virus, whilst the heat of summer rendered it more active and volatile; nevertheless, at both these seasons, the atmosphere was as healthy as usual.

2. That it was sometimes difficult to ascertain the existence of the plague on its first appearance; but that afterwards it was attended by certain marks, which distinguish it from every other disease. These characteristic marks are petechiæ, buboes, and carbuncles. When these occur in a disorder which is very rapid in its progress, is accompanied with fever (unless when it destroys suddenly) and is highly contagious, there can be no doubt that such a disorder is the plague[61].

To determine with certainty whether a disorder which prevails in any place is the plague, it must have all the symptoms which I have just described in one or more patients. These symptoms taken singly, do not constitute the plague; for many other disorders are equally rapid in their course; petechiæ appear in common putrid fevers; in some malignant fevers carbuncles are met with; buboes are produced by the venereal disease and scurvy; and some times, though very rarely, a crisis happens in putrid fevers by abscesses forming under the arm-pits; but these abscesses arise later in these cases than they do in the plague, and moreover they are not accompanied with buboes and the other symptoms which characterize the plague. The high degree of contagion by which the disorder is propagated from one person to another, enters necessarily into the definition of the plague; without it there is no plague. In a word, if there is a frequent communication, either by commerce or in consequence of war, with Turkey or Egypt, and some persons, or a great number of persons, are attacked with a disorder which corresponds exactly to the definition above given, it is certain that it is the plague.

3. For the answer to this third question, the reader has only to revert to the description of symptoms in note A of the Addenda. As for the prognosis, it is attended with great uncertainty in cases of the plague. In some instances, an indisposition apparently slight, is quickly followed by death; whilst others who seem to be on the point of death, recover[62]. In general, when the buboes suppurate well, and there is a separation of the eschars from the carbuncles, accompanied with an abatement of the other symptoms, a favourable prognostic may be given.

4. That hitherto medicine had done very little good, the disorder being so rapid in its course as not to allow time for the remedies to act; but that the Peruvian bark and mineral acids, in large doses, ought, in my opinion, to form the basis of the curative treatment.