Part 3

At the close of the year 1771, this dreadful scourge ceased, by the blessing of God, at Moscow, and in every other part of the Russian empire. Besides the three towns before-mentioned, upwards of four hundred villages had been infected.

The weather was intensely cold during the whole of the winter. In order to destroy all remains of the contagion, the doors and windows of the rooms in which there had been any persons ill of the plague, were broken and the rooms were fumigated with the antipestilential powder; the old wooden houses were entirely demolished. The effects of the plague were traced in every part of the city. Even as late as the month of February, 1772, upwards of four hundred dead bodies were discovered, which had been secretly buried the year before in private houses. So powerful is cold in destroying the contagion, that not one of those who were employed in digging up these bodies, and carrying them to the public burying-grounds, became infected.

The total number of persons carried off by the plague amounted, according to the reports transmitted to the Senate and Council of Health, to upwards of seventy thousand; more than twenty-two thousand of this number of deaths happened in the month of September alone. If we add to these, the private and clandestine interments, the whole number of deaths in Moscow will amount to eighty thousand: and reckoning those who died in upwards of four hundred villages, and in the three towns of Tula, Yaroslaw and Kalomna (or Kaluga), it will follow that this plague swept off altogether as many as an hundred thousand persons!

For carrying away and burying the dead, criminals capitally convicted or condemned to hard labour, were at first employed; but afterwards, when these were not sufficient for the purpose, the poor were hired to perform this service. Each was provided with a cloke, gloves, and a mask made of oiled cloth; and they were cautioned never to touch a dead body with their bare hands. But they would not attend to these precautions, believing it to be impossible to be hurt by merely touching the bodies or clothes of the dead, and attributing the effects of the contagion to an inevitable destiny. We lost thousands of these people, who seldom remained well beyond a week. I was informed by the Inspectors of Health, that most of them fell ill about the fourth or fifth day.

The plague, as is generally the case, raged chiefly among the common people; the nobles and better sort of inhabitants escaped the contagion, a few only excepted, who fell victims to their rashness and negligence. The contagion was communicated solely by contact of the sick or infected goods; it was not propagated by the atmosphere, which appeared in no respect vitiated during the whole of the time. When we visited any of the sick we went so near them that frequently there was not more than a foot's distance between them and us; and although we used no other precaution but that of not touching their bodies, clothes, or beds, we escaped infection. When I looked at a patient's tongue, I used to hold before my mouth and nose a pocket-handkerchief moistened with vinegar.

Amid so great a number of deaths, I think there were only three persons of family, a few of the principal citizens, and not more than three hundred foreigners of the common class, who fell victims to the plague; the rest consisted of the lowest order of the Russian inhabitants. The former only purchased what was absolutely necessary for their support, during the time of the pestilence; whereas the latter bought up every thing which was rescued from the flames, and which of course was sold at a very low price; they refused to burn the goods which came to them by inheritance; and, moreover, carried away many things clandestinely, in spite of all we could say or do to the contrary.

Two surgeons died of the plague in the town; and a great number of surgeons-mates and pupils in the hospitals. Dr. Pogaretzky and Mr. Samoïlowitz, first surgeon to the hospital of St. Nicholas, both caught the infection several times; and were cured by critical sweats coming on at the beginning of each attack of the disorder.

The foundling hospital, which contained about a thousand children and four hundred adults (including nurses, servants, masters, and workmen) was kept free from infection by the precautions hereafter mentioned. Only four workmen, and as many soldiers, who had got over the fences in the night time, were seized at different times; but by immediately separating them from the rest of the house, the disorder was prevented from spreading any farther. Thus this building was kept free from the plague, at the time that it raged in all the other houses around it; a proof that the atmosphere, not only during the frost, but even during the great heat of the summer, did not serve as a vehicle for spreading the contagion, which was only propagated by contact of the sick or infected goods.

The young and robust were more liable to become infected than elderly and infirm persons; pregnant women and nurses were not secure from its attacks. Children under four years of age were much less readily infected, but when they were, they exhibited the worst symptoms.

All who were attacked with the plague had more or less fever; though in some it was so slight as to be scarcely perceivable. In a few instances, the patients were seized, from the first, with a furious delirium, accompanied with a high degree of fever; but the greater part were affected with debility, and only complained of oppression about the præcordia, and head-ach.

After taking great pains to ascertain in what manner the plague was introduced into the military hospital, the physician to that institution at length found out that two soldiers had died there in the month of November, 1770, a short time after their arrival from Choczim, where the plague was then raging; and that a Colonel, in whose train they were, had died upon the road. It would seem that the anatomical dissector opened the bodies of these soldiers; and that he caught the plague of them. The persons who waited upon the sick, either became infected by touching the bodies of these soldiers whilst they were living; or by handling their clothes, or their bodies after death. These attendants afterwards spread the contagion among their families.

Thus have we traced the history of the plague which depopulated Moscow in the year 1771, from its first appearance to its final extinction. A plain and faithful statement of facts, even at the risk of being tedious, is what has been aimed at in this narrative; for let it be observed, that it is from simple details of the origin and progress of the plague, as it appears in different places, and of the symptoms and other circumstances with which it is accompanied, and not from the laboured dissertations that have been written upon it by some voluminous authors, that we can hope to acquire an accurate knowledge of the nature of this disorder, to ascertain the manner in which its contagion is propagated, and lastly to discover the best methods of prevention and cure.

ADDENDA.

Symptoms more particularly described.

The symptoms of the plague vary according to the different constitutions of the persons whom it attacks, and the season of the year in which it appears. Sometimes it wears the mask of other diseases; but in general it is ushered in by head-ach, stupor, resembling intoxication, shiverings, depression of spirits, and loss of strength; these are followed by some degree of fever, together with nausea and vomiting. The eyes become red, the countenance melancholy, and the tongue white and foul. In this state of things, the patients are sometimes capable of sitting up, and going about for some hours, or even a day or two. They feel an itching or pain in those parts of the body where buboes and carbuncles are about to appear. During the height of the plague, many of the infected die on the second or third day, before these tumours have time to come out, and with no other external marks except petechiæ or purple spots, which appear a short time before death; in some these spots are altogether wanting. The buboes and carbuncles generally come out on the second or third day, seldom on the fourth.

In some instances, the plague appears under the form of an inflammatory disorder, being accompanied with great heat, thirst, high-coloured urine, flushed cheeks, and violent delirium or phrensy; but in the greater number of cases it assumes the type of a nervous fever, being accompanied with little heat and thirst, and pale and turbid urine; the patients think themselves only slightly indisposed, until a sudden prostration of strength, and the eruption of buboes, carbuncles, petechiæ or vibices, announce to themselves, as well as to those who are about them, the danger they are in. In some few instances, the plague appears under the form of an intermittent fever.--Almost all those who are carried off by this disorder, die before the sixth day; those who get over the seventh day have a good chance of recovery.

The diversity of symptoms above-noticed, has given rise to the opinion that there are three different species of the plague, viz. one which is accompanied with petechiæ, another with carbuncles, and a third with buboes; but the history which we have given, clearly proves, that these are only shades or modifications of one and the same disorder, which is more or less violent under different circumstances and at different seasons. Petechiæ, buboes, and carbuncles often appear at the same time in the same patient, or occur in succession. In the month of July, great numbers of the impested died before the tumours came out, having petechiæ only; whereas in August and September, almost every patient had petechiæ, joined with buboes and carbuncles. After the middle of October, when the contagion was less virulent, although it still produced petechiæ and carbuncles, yet they were neither so malignant nor so frequent. Before this period, scarcely four patients in a hundred recovered; whereas during the latter months of the year, the proportion of recoveries was much greater. Sydenham has made the same observation respecting the plague at London. Nature endeavours to throw off the poison by buboes. Carbuncles and petechiæ are not critical eruptions; they only denote a putrid condition of the humours, and a great degree of acrimony; whence it follows, that in proportion as buboes are more common, and petechiæ and carbuncles more rare, the milder the plague is.

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To this account which Dr. Mertens has given of the symptoms which the plague at Moscow exhibited, we shall add the descriptions drawn up by two other practitioners (Orræus and Samoïlowitz,) who had great opportunities of observation, and who have been more particular in noticing some of the phenomena than our author.

According to Orræus (Descriptio Pestis, &c.) the plague in Russia appeared under four different forms or varieties. Of these, he terms the first, the period of infection; the second, the slow type; the third, the acute type; and the fourth, the exceedingly acute type.

1. In the period of infection (which is commonly the forerunner of the other forms of the plague) the contagion, less active and virulent, keeps lurking in the body, and produces the following symptoms, viz. sharp, flying pains in the glandular parts (such as the armpit and groins) and in the muscles of the neck and breast; ardor urinæ; drowsiness; an increased secretion of the sebaceous humour, so that the skin is in many parts, and more especially in the hands and face, much more unctuous and glossy than usual; the belly is costive, but when moved, there comes away a great quantity of pulpy slimy fæces; the patients complain of a heaviness of the body (some compare their limbs to a mass of lead), great lassitude and faintings. A swelling, but without much pain, of some gland (in the groin or armpit) together with dark-red or brown spots, denote a higher degree of infection: and a bad taste in the mouth, a viscidity of the saliva, loss of appetite, whiteness and foulness of the tongue, and head-ach, show that the patient is going to be attacked with the plague under one or other of the following types. The above-mentioned symptoms, which continue for a longer or shorter time (in some instances for several days or even weeks) are not accompanied with fever.

2. After the period of infection above described has continued for some time without yielding to medicine, it generally ends in the slow type of the plague, which is characterized by the following symptoms; viz. shiverings, followed by a moderate degree of heat, a febrile, unequal, for the most part weak, and often intermitting pulse; a constant dull pain in the head (rather, according to the expression of some patients, a heaviness, as if the head was full of lead); urine pale and turbid, but without sediment; tongue foul and moist; very little thirst; depression of spirits; belly costive during the first three or four days, with inflation of the hypochondria and borborygmi, but the abdomen feels soft on pressure; there is frequent nausea and vomiting of a slimy greenish-yellow faburra; petechiæ and other eruptions make their appearance, in some sooner in others later; but in some they are altogether wanting. The rudiments or germs of buboes and carbuncles, which were forming during the period of infection, now gradually increase in size, but without being accompanied with violent pain; and new ones arise in other places; which, if they suppurate on the fifth, sixth, or seventh day, save the life of the patient: on the other hand, if no suppuration takes place, and great debility, diarrhoea, and delirium come on, the disease terminates fatally, not, however, in some cases till after the fourteenth day.

3. In the acute type, the plague is preceded by a much shorter indisposition, sometimes by none at all, suddenly seizing persons in health. It is characterized by the following symptoms: a bitter taste in the mouth, and a viscidity of the saliva; violent head-ach; redness of the eyes and face; a very foul, and sometimes dry tongue; chilliness succeeded by considerable heat; a much fuller, stronger, and quicker pulse than in the slow type of the disorder, as well as more thirst, and deeper coloured urine; costiveness; buboes, and carbuncles come out soon after the attack of fever, or at the same time with it; after these, others come out; frequent vomitings supervene, and a delirium, which is generally of the low kind. If, between the first and fourth day of the attack, the buboes are resolved, or they, as well as the carbuncles, come to suppuration, the patient recovers: on the other hand, if no suppuration takes place within that period; if the buboes and carbuncles increase to a great size, and the delirium continues, then the powers of life become exhausted, the pulse sinks, and death is ushered in by hæmorrhages, and a copious exspuition of thin phlegm. Death takes place on the third, fourth, or fifth day; and it often happens, while the corpse is yet warm, that petechiæ and other spots come out. The bodies, after death, appear remarkably pale, soft, somewhat tumid, flexible, and free from fætor.

4. The plague, in its most acute type, attacks in various ways; but in relation to the leading symptoms, it may be reduced to two forms: in the first, a person in perfect health, without any previous marks of infection, is suddenly seized with a short but violent shivering fit, followed by a hot fit, which alternate with each other several times; but the external heat soon goes off, and the skin feels cool. The pulse is hard and very quick, with a most violent headach and intolerable anxiety about the præcordia; a furious delirium generally comes on; the tongue is smooth, exceedingly dry, and after a while becomes livid; the respiration is short and laborious; the eyes, which are more prominent than in the acute plague, are very red and full of ferocity; the face and neck are turgid, at first red and afterwards livid; vomiting seldom comes on spontaneously. Such as are seized with these violent symptoms seldom live more that twenty-four hours. Most of them die apoplectic, or in a state of convulsive suffocation; some, however, expire in a more placid manner. After death the bodies turn livid in those parts where nature had endeavoured to throw out buboes; and dark-coloured spots and vibices appear in different places. In the other mode of attack, the patients are affected with debility from the beginning, which, together with the anxietas præcordiorum, increases every moment; so that unless timely relief be given, death speedily comes on. In these cases, the pulse is very quick, but small, feeble, and at length imperceptible. Sometimes there is a low delirium; but in many instances the patients are sensible to the last. These are all the febrile symptoms that are observable. Rudiments or germs of buboes are seen upon the dead bodies.

Of these two varieties of the plague in its most acute form, the first was observed to take place in persons of a robust constitution and in full health, after making too hearty a meal on food not easily digested, or eating too much fruit, &c. The other variety attacked those who were under the influence of terror, or after immoderate venery, bleeding, &c.

The very acute type of the plague is less frequent than the other types, and often destroys the patient before medical assistance is called in; in so much that he who appeared well yesterday, is to day carried to his grave. In this species of the plague, I never saw perfect carbuncles and exanthemata; but buboes come out quickly after the attack, and are seen considerably elevated and livid in the dead bodies.

Such is the description of symptoms given by Orræus, a diligent and accurate observer. That published by Samoïlowitz, although it is not so circumstantial nor so well digested, coincides in all essential points with the above. This last author considers the plague under three different aspects or varieties, which correspond to the three periods of its beginning, its height, and its decline. In the first and last period, carbuncles and confluent petechiæ, or broad maculæ, are very rarely met with; whereas in the middle period, when the disorder rages with the greatest fury, they both occur in one and the same subject, and denote the utmost danger. At this period, (viz. when the plague is at its height) the pestilential particles being more virulent, more volatile, and more subtile, enter the body more readily, act upon it with greater force, and produce a disease which runs its course with greater rapidity than in either of the other two degrees or varieties of the plague.

The symptoms in the first period of the plague are few and moderate; they are for the most part reducible to head-ache, vomiting, and buboes; petechiæ rarely appear, or if they do, they are distinct and very small; carbuncles are hardly ever seen. This degree of the plague terminates favourably by a suppuration of the buboes, often without any assistance from art. It may therefore be termed the mild or benignant form of the plague.