17. The HÆMORRHAGIC state; known by fluxes of blood from various parts of the body.
18. The CONVULSIVE or SPASMODIC state. Convulsions are frequently attendant on the malignant state of fever.
19. The CUTANEOUS state; attended with various eruptions on the skin, particularly petechiæ.
These include the most remarkable varieties described by physicians as different species. From the subsequent account of the symptoms of the plague, it will appear that this single distemper monopolises, as it were, the symptoms, at least the most dangerous and terrible, belonging to them all. Those nosologists therefore who suppose the states of fever above described to be different species, instead of saying that the plague belongs to one kind of fever, ought to say that it is a complication of a great many different kinds. But here a question arises: Do all the varieties of fever just now described, or do all the other fevers described by different authors, include all the different modes by which the plague makes its attack? If so, then we know that the plague really partakes of the nature of fever, or may be accounted the highest degree of it. This is the opinion of Dr. Rush; for in his 4th vol. p. 153, he considers the different inflammatory states of fever, according to their strength, in the following order. 1. The plague. 2. The yellow fever. 3. The natural small pox. 4. The malignant sore throat, &c. To this I can have but one objection, and to me it appears insuperable; viz. that the plague frequently destroys without any symptom of fever; and, if so, we must certainly account it a distemper of another kind. To decide this matter, let us compare the symptoms of the most violent fever with what happens in times of violent pestilence. We can scarce imagine a fever more powerful than that which destroys in five minutes, and the following is the description of it from Dr. Fordyce. “When the first attack of fever has been fatal, it has been classed among sudden deaths, and all of these have been very erroneously called apoplexy, or syncopy (fainting.). . . . When the attack is fatal, it sometimes kills in five minutes, sometimes it requires half an hour, seldom longer than that time. While the patient is yet sensible, violent head-ach with a great sense of a chilliness takes place, the extremities become very cold, and perfectly insensible; there is great prostration of strength, so that the patient is incapable of supporting himself in an erect posture; he becomes pale, his skin is of a dirty brown, and he is soon insensible to external objects; the eyes are half-open, and the cornea somewhat contracted. If the patient goes off very soon, the pulse is diminished, and at last lost, without any frequency taking place, but if it be longer before he dies, the pulse becomes excessively small and frequent; all the appearances of life gradually subside, and the patient is carried off. Of this the author has seen instances, sometimes at the first attack, oftener in the returns of the disease, although very few.”
This no doubt is very terrible, and no plague whatever can exceed it. Indeed, when death is the termination, it signifies little what the disease is called. But the question is not whether fever or plague is the most dreadful, but whether they are the same. Now, from the above description, it is plain that fever never kills without some warning. In the present instance, head-ach and chilliness give a certain, though short, warning of the ensuing catastrophe; but, in violent plagues, Dr. Sydenham informs us, that people have been suddenly destroyed as if by lightning. Dr. Guthrie assures us that in the last plague at Moscow he has seen soldiers drop down suddenly as if they had been struck by lightning, or by a musket ball; yet some of these recovered by bleeding and proper management; but it is certainly not unreasonable to suppose that many, who were not thus taken care of, perished. Dr. Hodges speaks of the contagion of the plague in the most energetic terms. He says, “it is so rare, subtile, volatile and fine, that it insinuates into, and resides in, the very pores and interstices of the aerial particles. It is said to be of a poisonous nature also, from its similitude to the nature of a poison, so that they seem to differ in degree only; for the deadly quality of a pestilence vastly exceeds either the arsenical minerals, the most poisonous animals or insects, or the killing vegetables; nay, the pestilence seems to be a composition of all the other poisons together, as well as in its fatal efficacies to excel them. . . . The contagion of the plague is more active than lightning, and in the twinkling of an eye carries to a distance putrefaction, mortification and death. As for the manner whereby it kills, its approaches are generally so secret, that persons seized with it seem to be fallen into an ambuscade or a snare, of which there seems to be no suspicion. . . . In the plague of 1665, as in many others, people frequently died without any symptoms of horror, thirst, or concomitant fever. A woman, who was the only one left alive of a family, and in her own opinion in perfect health, perceived upon her breast the pestilential spots, which she looked upon to be the fatal tokens; and in a very short space died, without feeling any other disorder, or forerunner of death. . . . A youth of a good constitution, after he had found himself suddenly marked with the tokens, believed at first that they were not the genuine marks, because he found himself so well; yet he was dead in less than four hours, as his physician had prognosticated. A fever, however, did for the most part show itself, and was always of the worst kind. Sometimes it seemed to resemble a quoridian, sometimes a tertian; there never was a total cessation, but every exacerbation was worse than before.” In like manner the author of the Journal of the Plague Year informs us that many, supposing themselves, and supposed by others, to be in good health, would suddenly find themselves seized with great sickness, crawl to a bench, and instantly expire. “Many (says Dr. Hodges) in the middle of their employ, with their friends and other engagements, would suddenly fall into profound, and often deadly sleeps.”
It is needless to multiply examples: the above are sufficient to show that the plague, when in its most violent state, kills suddenly and imperceptibly, and that like the bite of a vampire,[60] without producing any sensible disorder. In a state somewhat inferior, it excites the most malignant fevers; in one still inferior it produces fevers of a milder nature, and so on until we find it so mild, that those infected with it are not even confined to their bed. In all this inquiry, however, we find the secrecy and invisibility of the pestilence, so often mentioned in scripture, still confirmed. Other distempers may “waste openly at noon-day,” but this always “walks in darkness.”
In one of the inferior stages of this distemper the body is affected with those eruptions named buboes and carbuncles. Dr. Patrick Russel, in his treatise on the plague at Aleppo, divides the symptoms of the distemper into six classes. In the first there were no eruptions, and all the patients of this class died. In the second, and all the rest, there were buboes and carbuncles. But, in the latter of these especially, it is worthy of remark, that they appear neither as a suppuration, nor as a common mortification, but like the eschar formed by a caustic, which can scarcely be cut by a knife. This appearance is not to be met with in any other disease. In many there are mortifications of various parts of the body, but all these are soft, and seemingly corruptions of the flesh. When a person dies of any ordinary distemper, the flesh soon corrupts and dissolves, but there is no example of its turning to a hard eschar like that made by a hot iron, or the caustic with which issues are made. This shews not merely a cessation of life, but the operation of some very active power in the body, like fire, tending to destroy the texture of it entirely, and to reduce it to a cinder. This power seems also to operate internally in the fleshy parts; for when the bodies of those were opened who died with the tokens, as they are called by Dr. Hodges, upon them, the mortification was always found much larger inwardly than it appeared to be on the outside. The tokens themselves are by Dr. Hodges called “minute distinct biasts, which had their origin from within, and rose up in little pyramidal protuberances, sometimes as small as pins’ heads, at others as large as a silver penny; having the pestilential poison chiefly collected at their bases,” &c.
That the plague was by the ancients reckoned a disease of a nature different from all others, appears from Galen, as quoted by Deusingius. “What is called the pestilence is most properly remarked by Galen not to be a genus of any known disease. For whatever diseases and symptoms are associated with the plague, truly and properly so called, the same are wont to be called pestilential diseases; of which indeed there are an innumerable multitude, and these not always nor every where the same.”[61]
In like manner Diemerbroeck, as quoted by Allen, gives his opinion, that “The plague is something different from a fever, and a fever is only a symptom of it, as I have very often observed; and therefore some very ill define the plague by a fever, since a fever does not essentially belong to it. . . . A pestilential fever, the companion of the plague, is not occasioned by a pestilential venom, but by the mediation of putrefaction; that is, it is not produced because the humours are infected with the pestilent venom, but because the heart, being irritated, overwhelmed and much weakened by the pestilent venom, can neither duly digest and rarefy, nor govern and sufficiently discharge the infected humours; which for this reason putrefy and acquire a preternatural heat, and so excite a fever; which by reason of the foresaid secondary cause, is different and distinct from the plague, and a symptom of it. This is confirmed both by the maxims and authority of the ancients and moderns, as well as by practice, and evident examples.”
Thus it appears, both by fair reasoning by induction from facts, and from the authority of the greatest physicians, that the plague is certainly a disease by itself, and entirely distinct from all others. Hence it follows, that, though we could investigate the causes of fever in their utmost extent, we might still be ignorant of the true plague. That nothing, however, may be omitted, let us now consider what physicians have advanced on this subject, and what progress they have made in ascertaining the sources from whence so many direful calamities are derived.