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

by Charles de Mertens

From the preceding history of the plague it appears, that those who are attacked with this disorder are affected with nervous symptoms before the fever comes on, and that the fever itself is of a highly putrid nature, accompanied with marks peculiar to itself, and which distinguish it from all other fevers. The proportion of those in whom the plague appears under the form of an inflammatory fever, is very small: and this happens only in the beginning of the disorder, in plethoric subjects; and that in these instances, from being inflammatory it quickly becomes putrid. Thus there are two sets of symptoms in the plague, viz. those which depend on nervous irritation, and those which depend on the putrid condition of the blood. The first I call the nervous, and the second the putrid state.

In the first, or nervous state, the indication is to promote perspiration by warm acidulated drinks, such as infusions of tea and other herbs mixed with lemon juice or vinegar, camphorated emulsions, camphor julep with vinegar and musk, &c. If ever bleeding is proper, it is at this period, and in plethoric subjects.

In the second, or putrid state, vomits, the Peruvian-bark, and mineral acids are the most promising remedies. The violence and rapidity with which the disease runs its course, require that these medicines should be administered in powerful doses. In the month of September, a woman, aged twenty-four, was seized with head-ache, fever, and vomiting; shortly after, a bubo came out on the right groin, and another under the arm-pit on the same side, of the size of a hazel nut; the next day small petechiæ appeared over the whole body; she was weak and drowsy; the tongue was white and moist; the urine pale; and she complained of head-ache and oppression about the præcordia. After I had made her vomit by giving her twenty grains of ipecacuanha, I ordered her a very strong decoction of Peruvian bark, to a quart of which were added a drachm and a half of the extract of the same bark, a drachm of the acid elixir of vitriol of the London Pharmacopœia, and an ounce of syrup of marshmallow; she took three ounces of this mixture every other hour, and besides this, she also took four times in the day, half a drachm of Peruvian bark in powder. For her common drink, she had a decoction of barley, acidulated with spirit of vitriol. The buboes increased gradually, insomuch that in the space of a few days they were as large as walnuts; they continued in this state, without any signs of suppuration. The patient began to mend regularly, and at the end of a week, she was almost entirely recovered; she was then removed, in spite of all my remonstrances to the contrary, to the hospital, from which she was dismissed a short time afterwards, and came to see me, in perfect health.

By this mode of treatment I am persuaded that those who have the plague in its moderate and slow form, may be rescued from death. This is further confirmed by the cases of three children, one of whom was only a year old, and the two others still younger; each of them had a pestilential bubo in the groin, accompanied with fever and great debility. After they had taken the decoction of Peruvian bark, mixed with the extract, they got better; the buboes ripened and yielded a good pus. Two of these children got quite well; the third was carried off during his convalescence, by convulsions occasioned by the teeth. Although this happened in the month of December, when the disorder, being more mild, allowed many to recover; nevertheless these facts serve to establish the efficacy of the remedy, since the symptoms of the plague are always worse in children than adults, and its good effects were seen in all the three patients at the same time.

But the cure of the plague by the mineral acids and Peruvian bark, is only to be expected when the disease appears under its less violent forms. In a great number of instances (where the disease has been more violent) these remedies have been prescribed, not only without effecting a cure, but even without retarding death for a moment. Various other medicines, such as theriaca (which has been so improperly cried up in the plague) camphor, dulcified spirit of nitre, &c. have in like manner failed; so that we are compelled to acknowledge, that the plague (under its more violent forms) is of such a malignant nature as not to yield to any medicines with which we are yet acquainted, howsoever well adapted they may, à priori, seem to be for getting the better of this disorder. From analogy and the preceding facts, I am inclined to place more reliance upon the Peruvian bark and acids, given in large doses, than upon any other remedy; joining with them, to obviate debility, camphor, elixir of vitriol, wine, and blisters. Some were relieved by gentle emetics, such as ipecacuanha. A surgeon who had brought with him from England a great quantity of James’s Powder, prescribed it to several patients; but I never heard that it answered better than ipecacuanha or other emetics[63]. Purgatives, even of the most gentle sort, were hurtful; they brought on a diarrhœa which it was scarcely possible to check, and which weakened the patients exceedingly. I consider bleeding to be very improper in the plague; nevertheless I would not forbid it entirely, where the disease, in plethoric subjects, assumes an inflammatory form, and is accompanied with phrenitis; which, however, was seldom the case in the plague at Moscow[64].

5. That during the convalescence, wine, malt-liquor, kuas (the small beer of Russia) light vegetable food[65], and above all fresh air, were proper and necessary. The same diet which is suited to putrid fevers is equally suited to the plague. Nothing answers better for raising the drooping spirits and recruiting the strength of the weak and convalescent, than well fermented malt liquor, or wine and water.

6. That as to checking its progress and entirely eradicating the pestilence, that, in the present extended state of the disorder, would be attended with much difficulty; but that whatever tended to lessen the communication between the sick and healthy, and to prevent the latter from coming in contact with infected clothes, furniture, &c. would contribute to this end; and that I hoped the frost would not only weaken the contagion, but in a great measure destroy it.

When physicians of science and probity declare that they are convinced of the existence of the plague in any place, it is incumbent on the magistrates, without paying any regard to the contrary opinions of other practitioners, to take the necessary precautions for preserving the health of the public, by removing, as soon as possible, all infected persons, as well as those who are under suspicion of being infected, out of the town, to a house standing by itself, and to surround the building with guards, in order to cut off all communication. As it is of great importance in the beginning of the plague to suppress it in secret, an infected family may be removed in the night-time, without giving rise to any suspicions concerning the disorder; which if it has, as yet, appeared only in this family, may be thus extinguished, without exciting a general alarm[66]. But when several families have become infected, it is then no longer possible to keep it a secret from the public, since the precautions which it is necessary to employ must make it known. In such a case, the impested, as well as all those who have dwelt under the same roofs with them, must be cut off from all further communication with the rest of the inhabitants. The clothes and furniture belonging to the sick (excepting such things as are of a hard and solid texture, which it will be sufficient to wash with vinegar) must be burnt. The goods that are thrown into the fire must not be touched with the hands, but be taken hold of by tongs and poles furnished with hooks at the end[67]; in the same way, the dead bodies are to be put into the carts, that carry them to the burying-grounds. Persons who may be relied on, should be appointed to see that all these directions are strictly complied with. The relations and friends of the sick should be persuaded to burn the clothes and other effects which they may at different times have received; and the health of such friends and relatives should be well watched by the physicians.