“But, as no disease incident to mankind is in its nature more terrible and destructive, so none is more difficult to observe. Its symptoms are scarcely in all respects alike in any two persons, and even vary extremely in the course of an hour in the same subject. The disease, attended in the beginning with symptoms not highly alarming, often ends fatally in a few hours; while the most formidable attacks, by a sudden and unexpected alteration, sometimes terminate happily.
“The first complaints of those seized with this distemper, were, in general, a coldness or shivering; sickness; a vomiting of large quantities of porraceous bile, which often had a very offensive smell; anxiety, or an inexpressible uneasiness about the pit of the stomach; pain in the back or loins; an intense head-ach; uncommon giddiness, and a sudden loss of strength. Some were sensible of a sharp shooting pain darting at intervals into the parotid, axillary or inguinal glands. To these symptoms succeeded a violent fever; in which, while the sick complained of extreme inward heat, their skin, externally to the touch felt little hotter than usual. Sometimes this heat became general and intense; at other times particular parts only were affected; but it seldom continued long in the same degree, having several unequal remissions and exacerbations in a day. In these exacerbations the face became florid, but would often from a deep scarlet change to a livid colour, like that of a person almost strangled, and, again suddenly changing, it would assume a cadaverous paleness. The eyes, soon losing their natural lustre, acquired a kind of muddiness; and the countenance of most of the sick was ghastly and confused beyond description. The pulse the beginning was somewhat quicker and lower, but in other respects varied little from the natural state. Within a few hours it commonly increased in quickness and strength, but seldom remained the some for an hour, nay scarcely many minutes together; incessantly varying, both as to strength and quickness, and without any manifest correspondence with the other febrile symptoms.
“In such as complained of pains darting either into the parotids, the arm-pits, or the groins, a small hard, deep-seated tumour, with external discoloration of the skin, was discovered by the touch in the part, and these were the incipient pestilential buboes.
“The appearances now described were those of the distemper on the first day, till evening, when the sick always suffered a severe exacerbation, in which the heat both internal and external became excessive; and, as they generally were by that time delirious, it was often with difficulty that they would be kept within doors; they were greatly disposed to talk, but faltered so in their speech, that what they said was hardly intelligible, the tongue having shared with the other organs in the general debility. The exacerbation lasted the most part of the night; but the heat, delirium, and inquietude abated towards morning, and a manifest remission took place. Some recovered their senses entirely, some partially, and then complained of intense head-ach, or of pains from the buboes; it was usual in this interval also that those who had carbuncles began to complain of burning pain in those fiery eruptions. The morning remission was commonly of very short duration; the rigours, anxiety and delirium soon returning more violent than before, attended with a strong and frequent subsultus tendinum. These febrile symptoms did not increase regularly as the day advanced; but went away and returned at intervals leaving short but alarming intermissions; for each exacerbation surpassed that which preceded it either in violence or duration. In the evening the pulse could hardly be counted, by reason of its depression and quickness; the patient became comatose, and the respiration was quick, laborious, and interrupted. The buboes which, some hours before, seemed manifestly to advance, often subsided, and sometimes almost entirely disappeared; the carbuncles, mortifying at the top, resembled a great eschar made by a caustic: and at this period also livid or black spots, of various dimensions, often were found scattered universally on the body.
“Under these circumstances, dreadful as they seemed, some hope of recovery still remained; for, though many of the sick died on the third day, several had a favourable crisis on that day, by a profuse sweat; some struggled to the fifth day, a few to the seventh, and, here and there one, even to the eleventh; before any critical alteration took place. Where a copious sweat happened on the third day, if it did not prove perfectly critical, it at least always considerably abated the fever; which, in that case, was generally totally removed by a second, though less profuse sweat, on the fifth: and then besides weakness the chief remains of the disease consisted in the pain of the eruptions.
“Nothing could be predicted with respect to the event of the disease from the manner of its invasion; those who had the most favourable escape having been often in the beginning attacked with as alarming symptoms as others were who died in a few hours. Sometimes the febrile paroxysm, which had set in with such formidable violence, dissolved in a few hours, and left the patient languid indeed, and weak in an extreme degree, but free from other complaints except the pain arising from the bubo, which from that period increasing in size, and advancing favourably to maturation, was, in many cases, ready to open in twelve or fifteen days: the patient all the while, except the first day, walking about as usual. Great numbers happily escaped, not only in the manner just described, but likewise where the buboes never advanced; for these tumours, so far from coming always to maturation in such as recovered, very often discussed without any bad consequence. Carbuncles often began to digest before the termination of the fever in a critical sweat.
“All the infected had buboes, except such as expired suddenly, or survived the first attack a few hours only. Instances of this dreadful kind were more particularly observed in March 1743. The sick were seized in the usual manner; but the head-ach, vomiting, and pain about the præcordia, increasing every moment, proved suddenly mortal, or terminated within a few hours in fatal convulsions.” Dr. Patrick Russel observes, that such instances of sudden death were very rare in the plague of 1760, 1761 and 1762; and in these they happened only in the winter, or early in the spring. In such sudden deaths few had any appearance of buboes; but in general the armpits and groins, or the inside of the arms and thighs, became livid or black, and the rest of the body was covered with confluent petechiæ, livid pustules being here and there interspersed: but all these appearances were more especially observed after death.
In the plague of 1760, vibices as well as livid and black spots were frequently found on the corpse, but not constantly. They were always suspicious in conjunction with other circumstances, but their absence was no proof, though frequently urged as such, that the distemper was not the plague. The vibices sometimes appeared several hours before death, but the livid spots seldom or never.
The tongue in some was quite moist, and continued to be like that of a healthy person throughout the disease; in others, white at first, then yellow; at last black, and covered with a dry, foul scurf or fur. The thirst was generally very great, but never constant; returning at regular intervals, and never appearing to correspond with the danger of the fever. Sometimes it was so little that the patient could not be prevailed upon to drink a sufficient quantity. The appearance of the urine was equally variable, and afforded no certain prognostic; being seldom alike in any two patients in the same stage of the distemper, and varying in the same patient every day. The vomiting commonly ceased after a few hours, excepting where the sick were induced by thirst to load their stomach, in which case it always returned. Sometimes the patients were costive, in others a diarrhœa took place, but in most the discharges were natural. No critical solution by urine or stool seemed ever to take place. A few cases of hæmorrhages from the nose and uterus were observed; and if they happened after the second day, were soon followed by a plentiful sweat, which commonly proved critical; “a circumstance different from what has been usually observed in the plague at other places.
“From the preceding account of the plague it will readily be conceived that nothing can be more difficult than to form any judgment or prognostic of the event of the disease; in which, as it is justly remarked by Morellus, our senses and our reason deceive us, the aphorisms of Hippocrates are erroneous, and even Hippocrates (as I am inclined to think) might have erred in his judgment.”