Innumerable other histories of the distemper might be given, but the following, it is hoped, will be sufficient, along with what has been already detailed, to show that the plague in former ages was the same as at this day. In the terrible plague which broke out in the time of Justinian, the distemper sometimes began with delirium, and the patient instantly despaired of life; but more generally people were surprised by the sudden coming on of a slight fever; so slight that no danger was apprehended either from the state of the pulse or colour of the body. This, however, was quickly followed, sometimes even on the same day, sometimes on the second or third, by buboes or parotids (swellings behind the ear) which when opened were found to contain a black coal, or eschar, of the size of a lentil. If these swellings suppurated kindly, the patient recovered, but if not, a mortification ensued, and death was the consequence, commonly on the fifth day. Black pustules or carbuncles, covering the body, were signs of immediate death, as was likewise a vomiting of blood in weak constitutions; for this terminated in a mortification of the bowels. Pregnant women generally perished, but women were less susceptible of the infection than men; and young persons were in more danger than old. Many, who recovered, lost the use of their speech, and such were not secure from a relapse.
In the last plague at Moscow, the symptoms were various, according to the persons, constitution and the weather; in general, head-ach, giddiness, shivering, loss of strength, slight fever, sickness and vomiting, redness of the eyes, white and foul tongue, with a dejected countenance, buboes and carbuncles appearing on the second or third day, but seldom on the fourth. The buboes were seated chiefly in the glandular parts, the armpits and groin, but sometimes made their appearance in the neck, cheeks, &c. Sometimes these suppurated perfectly, and then they proved beneficial, but not otherwise. Sometimes they suddenly disappeared, after having attained the size of walnuts; and this retrocession was always supposed to be a sign of approaching death. Sometimes they neither showed any sign of inflammation nor were painful, and in such cases afforded no relief. Similar swellings sometimes occured in the parotid glands, but they were never equally beneficial with the buboes. Carbuncles were gangrenous spots on the skin, resembling a burn, with black, livid or red vesicles, bordered with an inflammatory ring, and soon terminating in a hard, black eschar. The anthrax is more prominent, penetrating deeper into the adipose membrane, and attended with more pain and inflammation. The disease was likewise attended with petechiæ similar to those in putrid fevers, but larger; also with vibices, which resembled the mark of a whip, and were considered, as well as the petechiæ, as mortal signs. No distinct account of the pulse could be given; as, after the disease became general, physicians did not choose to feel the pulses of their patients but through a glove or tobacco-leaf. Worms called teretes were frequently discharged both upwards and downwards. Women with child generally suffered abortion, and were carried off by an uterine hæmorrhage.[107]
According to Sydenham, the plague begins with chilliness and shivering, like the fit of an intermittent, succeeded in a little time by violent vomiting and oppression at the breast, accompanied with its common symptoms. These continue till the disease proves mortal, or the kindly eruption of a bubo or parotis discharges the morbific matter. Sometimes, though rarely, the disease is not preceded by any fever; the purple spots, which denote immediate death, coming out even while persons are abroad about their business. But this hardly ever happens but in the beginning of a very fatal plague, and never while it is on the decline, or in those years in which it is not epidemic. Sometimes swellings appear without having been preceded either by a fever or any other considerable symptom; but he conceives that some slight and obscure shivering always precedes the seizure.
Mariti, in his travels through Cyprus, &c. says that the plague of 1760 began with loss of appetite, pain in the shoulders, head-ach extremely violent, delirium, vomiting, with a most excruciating pain in that part where the tumour by which the plague is characterised, is about to break forth. Death often took place on the third day, and very few lived beyond the thirteenth.
The Abbe’s definition of what he calls the plague, and which seems to be the pestilential bubo of the physicians, is somewhat singular. “The plague (says he) is an oblong tumour, shaped like a pumpkin, which is at first of a flesh colour; but it gradually becomes red, and at length blueish; and this is a sign that the disease is incurable. If it continues red, and a little after inclines to yellow, it is a sign that a suppuration will take place: the swelling is then opened, and the patient is sometimes cured.”
According to our author, the symptoms of the plague do not appear till fifteen days after the infection is received; and this is the reason of a law which subjects to a proof of twenty days every person suspected of being diseased. In this plague it was observed that people of the soundest constitutions were the most subject to it, and the least capable of resisting it. On the other hand, it appeared to spare weak and delicate persons, whose cure, in case of an attack, was much less difficult. A greater number of Moors than of any other nation were attacked by it; and when once they were seized, their case was absolutely desperate. Those who had recovered from the disease were less liable to a second attack, but were not absolutely safe. “I have known some (says our author) who have been ill seven times, and have died of it at last.”
Dr. McBride informs us that in the plague which raged at Marseilles and the adjacent places in 1720, people on their first seizure seemed as if intoxicated with drink; they lost the power of their limbs entirely, and became so dejected that they gave themselves over to despair from the very first attack. Along with the bilious vomitings and purgings which generally took place on the second day, quantities of small worms like ascarides were thrown off. The more plentiful these evacuations were, the more salutary; for those who vomited and purged but little sunk down, oppressed with the disease, and died before the fourth day, covered with livid blotches and petechiæ; those who had the largest evacuations had also the most plentiful eruptions of buboes and parotid abscesses. When these appeared, the patients rose, walked about, and became remarkably hungry; the heat and thirst subsided, but the face continued pale and languid, the pulse hard and frequent. On the sixth, seventh, or eighth day, if the suppuration stopped, and the humours went back, then came on oppression, difficulty of breathing, furious delirium and convulsions, which ended in death. When carbuncles, or biles, with mortified sloughs, appeared in different parts of the body, either alone or accompanied with the glandular swellings, the patients scarcely ever escaped. In great numbers of people tumours appeared without any previous febrile symptom, and, in a few cases, went off by resolution; in others they continued in a schirrous state; but it was best when the tumours came to suppuration.
These are the most remarkable symptoms of this fatal disease, which have been recorded by the physicians of greatest eminence who have written upon the subject. It remains still to give some particular description of the buboes and carbuncles, which are supposed to constitute in a particular manner the characteristic signs of the distemper. Of these the following account, given by Dr. Alexander Russel, seems to be sufficiently clear and explicit.
Only a very few, and such as died suddenly, were exempted from buboes, but only about one half had carbuncles. In the latter plagues their proportion was still smaller; but they seldom appeared earlier than in the months of April or May. In 1742 and 1743, the buboes often appeared on the first commencement of the distemper, sometimes not till twelve hours after; in a few instances not till two or three days; but in 1744 they were sometimes the first symptoms of the disease. The buboes were generally solitary, the inguinal and axillary more frequent than the parotid. “The inguinal bubo for the most part was double; that is, two distinct glands swelled in the same groin. The superior, which in shape somewhat resembled a small cucumber, lay obliquely near the large vessels of the thigh, lower than the venereal buboes are usually found, and it was that which commonly came to suppuration; the inferior was round, and in size much smaller. I once met with a case in which an axillary bubo divided in like manner into two parts, one of which got under the pectoral muscle, the other sunk deeper into the armpit: both grew painful and inflamed, but that in the armpit only suppurated.”
The bubo was at first a small hard tumour, painful but not inflamed externally. These indurated glands were deeply seated, sometimes moveable, at others more or less fixed, but always painful to the touch. Sometimes they would increase to a considerable size in a few hours, with intense pain, then suddenly subside; and these changes would take place several times in twenty-four hours. “An exacerbation of the pestilential symptoms immediately upon the decrease of the bubo, sometimes prompted me to imagine it owing to the retrocession of the tumour; but this did not happen so constantly as to make me think it was so in reality. The buboes, as far as I could learn, never advanced regularly to maturation till such time as a critical sweat had carried off the fever. In ten, twelve, or fifteen days, from the first attack, they commonly suppurated; having been all along attended with the usual symptoms of inflammatory tumours. But I have known them sometimes, nay, frequently, disappear soon after the critical sweat, and discuss completely without any detriment to the patient. At other times, though grown to a pretty large size, the tumour, about the height of the disease, would sink and mortify, without any fatal consequences; for, as soon as the crisis was complete, the mortification stopped, and the gangrened parts separating gradually, left a deep ulcer, which healed without difficulty. I met with no instance of a bubo in which fever did not either precede or follow the eruption.”