Part 7

From the author's expressions in this place, the reader might be led to believe that he meant to restrict the communication of infection to contact of the sick and infected goods; but in other parts of his book, he admits the possibility of the contagion being communicated by the breath and other effluvia from the sick. Indeed there can be no doubt that the pestilential particles are (especially in the worst forms of the disease) contained in the moisture perspired through the skin, and in the vapour emitted from the lungs. If not, where was the use of the precaution, which the author adopted in his own person, of holding a handkerchief moistened with vinegar before the mouth and nose on approaching the sick? The conclusion, from all this is, that the sphere of contagion in cases of the plague, extends to a greater distance (several feet at least) than Dr. Mertens imagines. Tr.

For a more particular account of the symptoms, see Addenda, A.

The author did not venture to feel the pulse of those impested patients who were under his own care, lest he should take infection. As the observations communicated to him by others on this head, which he has inserted in his book, coincide with those of Orræus and Samoïlowitz, which we shall afterwards notice, we have omitted them, to avoid repetition. Tr.

It will be sufficient for readers in this country to refer to Sydenham's works, Sect. II. Cap. II. without transcribing the quotation which the author has introduced in this place. Sydenham observes of the London plague (1665), that it was most suddenly mortal in the beginning; whereas the Russian plague was the most rapid in its action when it was at its height. Dr. Mertens reconciles this contrariety of observation, by remarking that the London plague began in the summer, a season the most favourable for its activity. Tr.

The description and treatment of the buboes, carbuncles, and other eruptions, which are to be found in every treatise on the Plague, the translator has purposely omitted, that the pamphlet might not be swelled out to an unnecessary bulk.

Frequently in the progress of the disease there is no heat on the surface of the body; but the burning heat under the axillæ shows that the internal heat is very intense.

A febrile, but not very quick pulse; sometimes almost natural.

The faburra brought up by vomiting, is commonly of a dirty yellow colour, viscid, and sometimes frothy. The quantity thrown up is astonishingly great, much greater than is observed in any other fever.

The petechiæ and other eruptions vary in size and colour. They are mostly small and distinct, but sometimes run together and form broad maculæ, which now and then end in carbuncles. Their colour in many instances is livid or black, in others (when the disease is milder) purplish, in some reddish. In convalescents, they turn first red, then yellow, and afterwards disappear. They are so common in the beginning of the plague, that scarcely any one dies without them; though buboes and carbuncles are not observable. Hence those who have never seen the plague under all its forms are apt to be deceived respecting the nature of the disorder.

The patients complain of this more than of any other symptom. The pain begins in the frontal sinus, and the orbits of the eyes, and afterwards extends to the temples and sides of the head as far as to the back part, and gradually over the whole head; so, however, as to be most violent in the fore part.

The appearance of the eyes in the plague is such as, when once seen, will ever afterwards enable even the commonest observers to recognise the disease. The eyes are unusually prominent, and the vessels of the tunica albuginea are turgid with blood, so as to produce a præternatural redness. They are, moreover, watery, sometimes full of tears (lacrymantes), and have a sparkling fierceness. But in the advanced stage of the disease, when the powers of life become exhausted, the eyes sink in, the redness gradually goes off, and a little while before death they become dull, and appear as if they had a film over them.

Although the delirium is rather higher than it is in the slow type of the plague, yet it is very rarely of the furious kind, in the present type of the disease. The patients are affected with stupor, and lie motionless in a dozing state; or if they awake, they are perpetually stretching out their hands and trying to raise themselves up, as if they wanted to get out of bed. They talk incessantly, but in consequence of the turgid and swollen state of the tongue, their speech is broken and stuttering, like that of drunken people, so as to be scarcely intelligible.

The buboes are dispersed or resolved by critical sweats breaking out on the first day of the attack. Often, at the same time, there is a discharge from the urethra of a white, viscid fluid, resembling pus, similar to what happens in a gleet; but this running is not accompanied with pain, and ceases spontaneously after a few days.

A moderate bleeding from the nose in the beginning of the disease, was, especially in plethoric habits, sometimes salutary; but in most instances it was otherwise. Such as spat up frothy blood, mixed with a great quantity of thin phlegm, though they might not at the time exhibit symptoms of great debility, or appear to be in danger, did, nevertheless, contrary to expectation, die soon afterwards. Hæmorrhages happened more frequently, and proved more fatal to women than to men. An immoderate flow of the menses coming on suddenly and before the stated time, carried off the patient in many instances. When pregnant women were attacked with this type of the plague, they almost always miscarried, and lost their lives by the subsequent hæmorrhage. This was also very generally the case with those who were delivered after having gone their natural time.

This anxiety about the præcordia may be regarded as a pathognomonic symptom of the plague in its most acute type. It is so excessive that the patients are at a loss for words capable of expressing it. It does not consist in a violent pain, but in a certain oppressive, suffocating, and altogether intolerable sensation at the pit of the stomach. In this state, they make known their anguish and show the danger they are in by sighs, tears, and lamentations, writhing their bodies in the most violent manner, and, especially when their delirium comes on, falling down upon the ground or floor, and crawling about as long as any muscular power remains. Others who are affected with extreme debility from the first, although they feel the same anguish, are not capable of tossing and writhing themselves about so much.

In the same manner as those who die of the catarrhus suffocativus.

Memoire sur la Peste, qui en 1771, ravagea l'Empire de Russie, sur tout Moscou, &c. par M. D. Samoïlowitz. A Paris, 1783.

This remark respecting the rare occurrence of petechiæ in the beginning of the plague is contrary to the observations of Mertens and Orræus. Mr. Samoïlowitz did not see much of the plague at Moscow in the beginning; he was chiefly employed in the care of the pest-hospitals during the height of the disorder. Tr.

Feeling the pulse of impested patients with the bare fingers, is always attended with great risk of taking the contagion, which is so readily communicated by contact. This, however, did not deter Mr. Samoïlowitz, from feeling the pulse in all the different forms or varieties of the plague, in the usual manner; though others took the precaution of putting on gloves, or having a leaf of tobacco applied to the patient's wrist before they ventured upon this examination. It is evident that much reliance cannot be placed upon the reports of those who felt the pulse through the intervening substances just mentioned. This and other observers have remarked, that after the pulse was once ascertained in each form or variety of the plague, it became unnecessary to feel it any more. According as the head-ache was either dull or acute, the delirium high or low, &c. the physician could pronounce, without feeling the wrist, upon the state of the pulse. Tr.

If the symptoms in the decline of the plague were precisely the same with those in the beginning, there would be but two types or varieties of the disorder; the 1st, comprehending the phenomena of the plague at its beginning and in its decline; and the 2d, the phenomena which belong to its height. But from the observations of Mertens and others, it appears that although there is a great resemblance between the plague at its decline and in the beginning (viz. that in both cases the symptoms are less violent and less fatal than those which occur in the middle period or at the height of the epidemic) yet there is also a difference between them, the plague in the beginning of its career being accompanied with petechiæ and other spots, as well as buboes; whereas at the decline, scarcely any other external marks, besides buboes, are observed. Tr.

We suppose this query to relate to those physicians who received reports from the surgeons and their assistants, without visiting the sick themselves. Tr.

Although Dr. Mertens maintains (what we believe no physician in these days will be disposed to contradict) that the contagion is not disseminated by the common atmosphere; yet, in other parts of his Treatise, he admits that the air may become infected to a certain distance by a great number of bodies, dead of the plague, lying unburied. Tr.

There are many reasons why the poor must be the chief victims of the plague, whenever it rages in any country; for 1st, They are the persons who are employed to remove or destroy infected goods, to carry away and bury the dead, &c. 2dly, As they live in small, crouded habitations, when any one of them is attacked by the disorder, all the rest of the same family are exposed to the contagion, in consequence of breathing an air tainted by the breath and other effluvia of the sick. 3dly, They are generally destitute of nurses and other necessary attendants, and particularly they cannot have that change of linen, which contributes in a very great degree to carry off the contagion and promote the recovery. 4thly, When the plague is at its height, the number of sick is so great that it becomes impossible for the physicians and surgeons to visit all of them, even once in twenty-four hours, though to be of real service, the visits should be repeated, in every family, twice within that space of time. Lastly, They have not wherewithal to procure themselves the proper food and diet; or, if these are provided for them out of the parochial funds, by the contributions of the wealthy, or by government, they do not strictly adhere to them, but fly to spirituous liquors and other hurtful things. Tr.

Sydenham Oper. Sect. II. Cap. 2. and Van Swieten Comment. Tom. V. § 1407.

We have deemed it sufficient to refer to these authors, without transcribing the passages which Dr. Mertens has introduced. Tr.

The author includes in his definition of the plague the circumstance of the disorder being brought by infected persons or goods from Egypt, or some other province of the Turkish empire; but as this is a circumstance which relates merely to its origin, without serving to mark its properties or pourtray its features, we thought it foreign to a definition, and have accordingly omitted it. Tr.

See Chenot de Peste, p. 93, and Russell's Aleppo, p. 229 and 235.

From the manner in which the author makes mention of James's powder, it appears that it was administered in such large doses as produced vomiting. It should have been given in small quantities, so as to have acted as a diaphoretic, both alone, and in conjunction with opiates. Perhaps, however, it may be objected that this and other antimonials, in small doses, repeated at intervals of three or four hours, are too tardy in their operation for a disease so rapid in its progress? In larger doses they would be apt to purge. Thus there seems to be little encouragement for administering them in any way, in cases of the plague. Tr.