From this view of the causes of the plague, and from the facts which have been laid down concerning it, we cannot help perceiving a very strong similarity between the plagues mentioned in the Old Testament and those which still exist in the world. In one of the passages formerly quoted it is called an inflammation, an extreme burning; and from the testimonies of different authors above quoted, it is plain that the disease still deserves the name bestowed upon it in the sacred writings. From the account given of its proximate cause, it is plain that plagues of all degrees of intensity may take place, from absolute accension of the body, and its reduction to ashes, to the mildest state of the disease, in which the patient is not confined to his bed; and all this from the single principle of emission of heat from the body itself. It likewise appears that there may be either in the body itself, or in the element which surrounds it, such a constitution as will dispose that element which is the natural and immediate preserver of our life, suddenly to attack and destroy it, of which the case of the Italian priest is a most remarkable instance. In other cases, such as the Italian lady, and the woman at Coventry, the body itself seems to have given out its heat, though this could not be done without a concurrence of the surrounding ethereal fluid. In a stage still lower, the body is partially consumed, or rather partly charred into a kind of cinder, as where the tokens are produced; and when the cause acts with still less violence, a fever is produced. In the Old Testament we find these different kinds of plagues very distinctly mentioned. In some cases the offenders died by actual fire, which either struck them from without, or was kindled within their bodies. In others, they seem to have died by that very deadly kind of plague of which we have already said so much, which kills in a few hours. This was probably the plague which destroyed the army of Sennacherib, and this in the tenth chapter of Isaiah is by some thought to have been prophesied of under the title of a burning like the burning of a fire.
Of these things I the rather take notice, as I perceive, in a late oration, not only the doctrine of the plague being propagated by contagion severely ridiculed, but the scripture itself treated in a most indecent and scandalous manner. “In the earliest ages of the world (says he) when ignorance and superstition led men to attribute all extraordinary phenomena to the direct agency of supernatural beings, pestilence was supposed to be immediately imported from heaven. This is the opinion which appears to have prevailed among the ancient Hebrews, and may be ranked at the head of the catalogue of absurdities on this subject. The dominion of prejudice over the minds of that ignorant and obstinate people appears in this instance particularly striking. Such was the depth of their blind bigotry in favour of the healthfulness of the globe they inhabited, that they would seem to have considered it as even superior to that of the celestial regions. Hence, unwilling to believe that their favourite earth could give origin to an evil so dreadful as the pestilence, they imported the seeds of this calamity from the more unhealthful climate of heaven!!”
In this extraordinary paragraph we find the matter so much misrepresented, that every vestige of truth is swallowed up in it. The Hebrews believed that they were under the immediate inspection and government of the Deity; a doctrine which, however our author may disbelieve, he cannot disprove. But, notwithstanding this immediate inspection and government, the Deity never did bring upon them any plague but by the intervention of natural causes. The agents which he had originally created were sufficiently able to execute his purposes. The Creator never employed any power but what already existed in the world, and the power that he generally did employ was fire. This agent he directed to exert its force in such degrees as he pleased, and against whom he pleased. It is a mistake to think that miracles were immediately the effects of supernatural power. They were all accomplished by the very powers which exist in the world at this moment, only these powers were by the Creator at particular times directed to act in a manner that they would not have done had they been left to the mechanism of their own nature. When we read therefore of people being consumed by fire from the Lord, there was neither importation of fire from heaven nor any where else; the element exerted its power on these particular persons, either by lightning proceeding from the cloud which represented the Deity, or their bodies threw out the latent heat which they contained, and consumed of themselves. That in cases of this kind there was no importation supposed, is evident from an expression used about bringing water from the rock. It is not said that the water fell from the stars, or came down with the tail of a comet, but that the rock gave out the water which it previously contained. At the present day the same powers exist, and sometimes produce the same effects that they did in former times, with this difference, that now, having no intelligent agent to interfere with their natural mode of action, they exert their force indiscriminately, and as the mechanism of their nature happens to be stimulated, they destroy every thing promiscuously before them. In all this I cannot perceive the smallest absurdity, or any thing but what a reasonable man may indeed must believe, if he makes use of his reason. As to the causes which Dr. Caldwell so much insists upon, viz. filth and corruption, it is extremely probable that (while the Israelites were in the wilderness) these had no existence. By their law they were enjoined such frequent ablutions, that their bodies must always have been perfectly clean. Human excrements were not allowed to lie above ground. The offals and dung of their sacrifices were carried to a distance, and they were expressly told, that they must not allow of any uncleanness in their camp, lest God should turn away from them and abhor them. Add to all this the great heat and dryness of the desert in which they wandered, which would quickly parch up and carry off the moisture from any dead carcases or putrefying matters that might be allowed to remain notwithstanding the injunctions to the contrary. Indeed if we consider the dryness of the climate where these people were, and that they were constantly attended by a large stream of water, it is difficult to conceive any situation upon earth more healthy than that of the Jews in the wilderness. If plagues therefore came upon them, it is difficult to say how they could have happened according to the ordinary course of nature; and, if not according to this, it must have been by an alteration of it, or by miracle.
The plague, as has already mentioned, in its very severe state appears most commonly in the beginning of an epidemic season, and is neither very common nor very infectious. The most common mode in which it invades the patient is with the symptoms of a malignant fever; and of cases of this kind Dr. Russel has made up his five classes of patients, the first or deadly kind having been already described. In his second class, the next in malignity to the fatal kind, the disease made its attack with a slight shivering, succeeded by fever with giddiness, vomiting, head-ach, and sometimes looseness. In the night the fever increased, the thirst was excessive, and the patient, harassed by the vomiting, &c. passed a very unquiet night, frequently with delirium or coma. Towards morning the fever abated, the sick recovered their senses if delirium had taken place, but if coma, it continued through the day, and the remissions were less. Throughout the first day, and part of the second, the pulse was full and strong, but on the second it began to alter, and some of the characteristic signs of the disease to appear. The principal of these was a certain muddiness in the eyes, which sometimes took place even on the first day. This is by our author accounted a symptom very difficult to be described, and, though he recounts the descriptions given by several authors, none are found adequate to the real appearance. “It resembled (says he) somewhat the dull, fixed eye observable in the last stage of malignant fevers; but the dullness was different, muddiness and lustre being strangely blended together. It continued with little alteration in the remissions, and even where the patient appeared sensible and composed it did not increase in the febrile exacerbations, but the eyes acquired a redness that added wildness to the look, which abating or going off in the remissions, the muddiness remained behind. It was this which contributed chiefly in composing that confusion of countenance which I shall not attempt to describe, but which enabled me to pronounce with tolerable certainty whether the disease was or was not the plague, though not independently of other symptoms. When this muddiness disappeared or abated, it was constantly a favourable sign. After a critical sign it often disappeared suddenly, but where there was a succession of sweats, or where no visible crisis happened, its disappearance was slow and gradual.”
Along with this muddiness the patient had a peculiar confusion of countenance; the pulse quick and equal, or low and fluttering, but rarely intermittent; the external heat moderately feverish, at other times intense, with irregular flushings, with pain at the heart, or oppressions about the præcordia; burning pain at the pit of the stomach, and incessant inquietude. When to these symptoms were added a faltering in the tongue, loss of speech, while the surface of the body became cold and damp with clammy sweat, death was inevitable. In the evening of the second day all the symptoms became worse; and in the morning the patient appeared to lie quiet more from his strength being exhausted than from any change to the better. When the vomiting had ceased, however, there was frequently such a remission on the third day as gave the attendants great hopes of a favourable event; but these hopes were always fallacious and of short duration. Sometimes where vomiting, looseness or hæmorrhage had preceded, the patient died on the third day: at any rate, none of this class recovered, whether the disease was left to itself, or treated with medicine. The appearance of buboes was of no consequence, for they never came to maturity, and the little advances they made neither accelerated nor retarded the termination of the disease, which happened sometimes on the third, but more frequently on the fifth or sixth day.
The third class of patients were equally unfortunate with the other two. “The difference between the second and third consisted in the absence of vomiting at the beginning, the later accession of coma and other bad symptoms, and a slight tendency to perspiration, which very rarely occurred in the second. . . . From the second or third night the course of symptoms in both classes varied very little, and the termination of the disease was in both the same: it may be added they reigned together through all the periods of the pestilential season, but were most prevalent in its augment; for at its height, and in its decline, they gave place to varieties of the disease less destructive.”
The fourth class was the most numerous of all. Its distinctive marks were, “the continuance of the inflammatory or febrile symptoms with less interruption than in the other, a pulse more constantly sustained, or soon recovering itself when hurried in the exacerbations; the length and vigour of the exacerbations decreasing in the advance of the disease; and, above all, the prevalent tendency to a favourable discharge by the skin, with the critical sweats on the 3d, 5th, or subsequent days. . . . Vomiting was a concomitant in about one fourth of the sick. The fever, for the most part, was very moderate the first night, very rarely accompanied with delirium, and almost never with the comatous disposition. . . . The buboes and carbuncles commonly made their appearance the first day; but it was not unusual to see a successive eruption of these in the course of the disease. . . . The morning sweat, on the third day, in some cases proved completely critical, but more commonly produced only a remission so favourable as to encourage the expectation of a more favourable crisis on the fifth; but, where the patient neither sweat on the third, nor a sensible remission took place on that day, some degree of danger was always to be apprehended. . . . After the sweat on the fifth, the subsequent exacerbations proved slighter and slighter, and the buboes for the most part advancing favourably, little or no fever was left remaining after the beginning of the second week, except perhaps symptomatic heats occasioned by the eruptions.” In this class the patients sometimes appeared only to have a slight attack, and yet at last were seized with mortal symptoms, while others who deemed to be much worse at first yet happily recovered and did well, In general the severe pestilential symptoms did not come on till a considerable time after the attack.
To the fifth class our author refers all cases of slight infection, wherein the more formidable symptoms of pestilence never concurred, and all the infected recovered. “The access here was often attended with so little apparent disorder, that the eruptions gave the first alarm; and the fever which came on afterwards was frequently so slight as not to confine the sick to the house. Others found themselves indisposed for two or three days, but were not sensible of any febrile heat whatever. But in this class the disease did not always invade thus insensibly. The febrile symptoms, especially the first three days, sometimes run pretty high; and the fever afterward, in nocturnal exacerbations particularly, run out to the end of the week or longer: but, as there was no concurrence of alarming symptoms, and the exacerbations, terminating for the most part in sweats, gradually diminished in force after the third or fourth night, it was not difficult in the worst cases to foretel the event at that period, nor necessary in others to defer the decision so long.
“All the infected had buboes or carbuncles, and very often both eruptions concurred in the same subject. Persons not confined by indisposition were often, by the inguinal buboes, prevented from walking abroad. The carbuncles constantly formed the black crust,[106] and then suppurated; the buboes in one third of the sick dispersed. The dispersion of the buboes was never observed to be attended with bad consequences, notwithstanding the general neglect of purging in the decline of the disease: indeed very few had recourse to remedies, topical applications excepted, unless perhaps a bleeding at the beginning, where the febrile symptoms ran high. This class was nearly as numerous as the fourth, but began to predominate rather later, and reigned most of all in the decline of the plague in 1762.”
The sixth class must be omitted, as containing dubious, anomalous and extraordinary cases. We shall therefore proceed to consider the accounts of the plague given by other physicians, which, without questioning the accuracy of Dr. Patrick Russel in relating what he has seen, may serve to throw some light on the subject, by relating what others have seen. Dr. Alexander Russel, in his Natural History of Aleppo, gives the following description of it. “The distemper in itself is the most lamentable to which mankind are liable. The torments of heat, thirst and pain frequently unite in some patients; an unspeakable dejection and languor in others; and even those who escape with life do not cease to suffer from painful and putrid ulcers, the painful remains of the disease. The desertion of relations, of friends, and of domestic servants, the want often of the common necessaries of life, and the difficulty of procuring medical assistance, are circumstances likewise which aggravate the miseries of the sick, and contribute greatly to augment the general horror.