Plague and pestilence in literature and art

by Sir Raymond Henry Payne Crawfurd

‘Some vampire bloated with blood like a blister.’

The image must be that of a vampire, so bloated with blood, that its body seems actually enveloped in it, simulating a blood-blister.

Aristotle applies the term to the bite of a shrew-mouse, which would presumably produce a solid local swelling, and not a blister. Procopius uses φλύκταινα for the black cutaneous lesions of Oriental plague, known nowadays as pustules: he says, too, that they were of the size of a lentil, but does not mention terminal ulceration. Procopius is so precise in his medical terminology, that it is improbable he borrowed the term from Thucydides without appreciating its exact significance: far more likely he adopted it from the medical terminology of his day.

There is something to be said for appropriating the terms used by Thucydides to the pustular lesions of Oriental plague. Many writers, ancient as well as modern, have described the so-called pustules as commencing in some cases as blisters and terminating in eroding ulcers. But, on the other hand, we know nothing of epidemics of plague without a considerable proportion of bubonic cases, while we do know from the narrative of Procopius that plague has maintained its characters unchanged for 1,500 years. In an epidemic of plague, in which death did not supervene till the seventh or ninth day the presence of buboes would be the outstanding feature of the disease, and Thucydides does not even mention them.

Assuming that typhus fever also has maintained its characters unchanged, and that the external manifestations of the Athenian pestilence were not of the exceptional type we have alluded to, but of the type habitually associated with the disease, can it reasonably be contended that the terms φλύκταινα and ἕλκη are applicable to these?

Murchison says that ‘according to its colour, the eruption may be said to pass through three stages, viz. 1, Pale dirty pink or florid; 2, reddish brown or rusty; 3, livid or petechial’. In the first stage, it is generally admitted that except on careful observation, and in a good light, the faint diffuse maculae (spots) are apt to escape detection, so that the impression is of a general suffusion of the skin—what in fact Thucydides terms ὑπέρυθρον.

In the second stage, the deeper coloration of the spots throws them into relief as individual lesions against the paler background of general suffusion of the skin. Can it be that this is indicated by the vague term φλύκταινα? Be it remembered that Thucydides was a layman, describing, as he says, the lesions of a hitherto unknown disease. Every physician is well aware of the restricted terminology that the laity possess for the description of multifarious lesions. Medicine itself is not exempt from the same confusion, for when physicians glibly speak of the subcutaneous haemorrhages of typhus as petechiae they forget that the word throws back to petigo (a scab).

There remains then for the third stage of the eruption—the haemorrhagic stage—the term ἕλκος, a generic term applicable to almost any lesion, and having no philological affinity to the Latin ulcus, and the English ‘ulcer’, with which medical usage has confused it.

Reviewing, then, all the facts, it cannot be held that the description of the eruption, as given by Thucydides, is sufficient to negative a diagnosis of typhus fever, which disease is otherwise depicted to the life in all else that he says of its clinical course and characters.

Thucydides was so impressed with the intensity of the internal fever, that he expected certainly to find a corresponding temperature of the body surface: hence his surprise is obvious at finding it not excessively hot. For all that, sufferers were ready to cast off every shred of clothing, till they were naked, and longed to throw themselves into cold water. Some did actually plunge into cisterns, but no amount of water sufficed to slake their thirst. Procopius mentions this same fierce longing to fling themselves into water among the plague victims of Byzantium, but raving delirium of this kind is far more characteristic of typhus than of plague. Curschmann depicts the fierce medley of wild ravings, mingled with frantic efforts at self-destruction, which give an unmistakable character to a ward of typhus patients. Murchison, quoting from Bancroft, says: ‘Some leaving their beds would beat their keepers or nurses and drive them from their presence: others, like madmen, would run about the streets, markets, lanes, and other places: and some again would leap headlong into deep waters.’ Intolerable restlessness and insomnia fill up the cup of misery to overflowing. Curschmann confirms the observation of Thucydides, that typhus cadavers exhibit very little emaciation, but this does not help to differentiate typhus from other acute fevers of equally brief duration.