Part 56

It is greatly to be regretted that Galen has given us no description of the dreadful plague which prevailed in his time. It appears that he fled from Rome for fear of infection. He alludes to it, indeed, in several parts of his works, but in very brief terms, only mentioning that it put on the appearance of dysentery; and in one place he strongly commends the celebrated theriac as a most efficacious remedy for the prevention and cure of pestilential disorders; and elsewhere he speaks favorably of the Armenian bole. Of the writers on medicine posterior to him, Oribasius and Aëtius, like our author, give no further information on this important subject than what is contained in the brief extract from the works of Ruffus; and the others, with the exception of Nonnus and Psellus, do not treat of the disease at all, unless in an incidental manner. Nonnus, after briefly stating the causes of the plague, proceeds to lay down the principles for conducting the treatment. He recommends clysters, and, if the stomach be loaded with phlegm, emetics: if there be a fulness of blood, he approves of venesection; and also speaks well of giving diuretics. When symptoms of ardent fever are present, he directs cold drink to be given freely, in order to extinguish the febrile heat. He also recommends apomel, the water of ptisan with the seed of bastard saffron, or Armenian bole, or lapis lazuli. Psellus merely mentions, in very general terms, a few of the common symptoms of the plague. (Opus Medicum.) Actuarius, treating of anthrax, mentions that it sometimes take place in epidemical affections. (Meth. Med. ii, 36.)

Before proceeding to the Arabian authorities, we shall give a brief abstract of Procopius’ description of the dreadful plague which desolated the Roman empire in the reign of Justinian. Its usual precursors were certain delirious fantasies and disturbed dreams, after which the fever made its attack suddenly. The early symptoms, however, were not well marked, for there was neither increased heat nor discoloration of the skin, nor did the patient apprehend danger. Generally on the first or second day, but in a few instances somewhat later, buboes appeared not only in the groin, but also in the armpits and below the ears. Some were affected with deep coma, and others with wild delirium. Some died from sphacelus of the buboes, which, when inspected by the physicians after death, presented the appearance of a coal or carbuncle (anthrax). Some died at the commencement, and others after the lapse of several days. In certain cases the skin was covered over with black phlyctænæ of the size of a lentil, which were usually succeeded by sudden death. Others were unexpectedly cut off by a discharge of blood. To women in the puerperal state it proved particularly fatal. When the buboes came to a proper suppuration, they generally proved a favorable crisis; but when they did not suppurate, they were commonly followed by a wasting of the thigh. One of the common consequences of the fever was an affection of the organs of speech. All the usual prognostics proved fallacious, and the effects of the common remedies were uncertain. In some cases the bath proved beneficial, and in others it had a contrary effect. At one time the amount of deaths in Constantinople ranged from five to ten thousand each day. (De Bello Pers. 22, 23.) This pestilence is described likewise by Agathias (v), and by Evagrius (Hist. Eccles. iv, 29.) It resembled the plague of Avignon, described by Guy of Cauliac.

The symptoms of the plague, as enumerated by Avicenna, are as follows: Heat, and strong inflammation within, but which are not perceived outwardly; respiration large, fetid, and frequent; intense thirst, dryness of the tongue, with nausea and loss of appetite, such as, if not contended against, will prove fatal; enlarged spleen, great anxiety and restlessness, dry cough, prostration of the powers approaching to syncope; delirium, retraction of the hypochondria, insomnolency, with tepid heat of the body. Sometimes there are yellow, whitish, or red eruptions on the skin, which are of short continuance; or else aphthæ and ulcers in the mouth. The pulse is generally frequent, small, and becomes stronger towards night. Occasionally there are dropsical swellings. The discharges from the bowels are bilious, mixed, fetid, unnatural, and sometimes contain black bile; at other times they are frothy and fetid, or unctuous, being produced by melting of the fat. The urine is watery, bilious, and melancholic. There is sometimes vomiting of black, but more frequently of yellow bile. There are often fetid sweats. The disease usually terminates with syncope, coldness of the extremities, lethargy, spasms, and convulsions. Some of the most fatal varieties of the plague are not marked by any striking symptoms, neither the heat, pulse, nor urine being much affected. Fetid breath, as indicating putrefaction about the heart, is a most mortal symptom. The treatment must commence with venesection, if there be a plethora of blood, or with purging, if the body be loaded with other humours. The apartments of the sick are to be cooled, and the air of them corrected: they are to be cooled by cold odoriferous fruits, camphor, rose-water, or, if possible, by introducing a stream of water into them. The fetid air may be corrected by fumigations with camphor, myrtles, quinces, ebony, &c.; by sprinkling the apartments with vinegar and assafœtida, and correcting the putridity with lignum aloes, frankincense, musk, storax, sandarach, mastich, juniper, bays, and the like. (It may be proper to mention that arsenical fumigations are approved of by Muratori, Lind, and Russel, but condemned by Mead.) As a preservative from the plague, he recommends, in particular, exercise and restricted diet. Haly evidently copies his description. (Theor. v, 11.)

Rhases agrees with Hippocrates in stating, that pestilential fevers are distinguished by great heat internally, while the surface of the body is cool. The symptoms, as detailed by him, are vomiting and diarrhœa, pain and distension of the belly, coldness of the extremities, urine showing a tendency to putrefaction, discharge of blood from the nose, heat about the breast, singultus tendinum, blackness of the tongue, bulimia, &c. He particularly states that a black discharge from the bowels is a most fatal symptom. Like Avicenna, he gives directions to perform fumigations with camphor, musk, myrrh, bdellium, frankincense, and the like. He mentions that, during the prevalence of a certain pestilence, it was found that hunters escaped the contagion. Like Avicenna, he approves of bloodletting. See Continens (xxx.) He also recommends cold drink and the cold bath. Calefacients and wine, unless diluted with much cold water, he disapproves of. He, like the other Arabian authorities, joins Galen in speaking favorably of Armenian bole and the theriac. (Ad Mansor. iv, 25.)

The belief that the plague is preceded by extraordinary phenomena in the earth and sky is very ancient. Thucydides concludes his brief account of the last attack of the plague on Athens with the remark, that at that time there were many earthquakes at Athens and other places. (iii, 87.) Manilius says such plagues as that of Athens are commonly prognosticated by comets and other celestial fires. Diodorus Siculus mentions that the Athenian plague was preceded by earthquakes of extraordinary severity. (xii, 59.)

While explaining the symptoms and treatment of the plague, as detailed in the works of the ancient authors, we have purposely omitted to notice its contagious nature, as we wished to give one connected view of the ancient opinions regarding CONTAGION. Before entering upon this disquisition, we think it proper to acknowledge the assistance which we have derived from the writings of Fracastorius, Paulinus, Mead, Marx, Omodei, and Winterbottom, leaving it to the reader to determine, after comparing our humble attempt with their learned labours, whether or not our industry and research have contributed in anywise to throw additional light upon this important subject.

The earlier ancient authors appear to have entertained no suspicions of contagion as a cause of febrile or of other complaints. Homer, as formerly stated, evidently refers the origin of the plague which prevailed in the Grecian army during the siege of Troy to the heat of the sun. The works of the fathers of History and of Medicine have likewise been ransacked in vain, for any traces of the doctrine of contagion. Thucydides, therefore, appears to be the first author (if we except the Mosaic description of leprosy) who makes any positive allusion to the contagious nature of diseases. From his description of the plague of Athens, there can be no doubt that he wishes it to be understood, that the disease was transmitted from one person to another; for he mentions that physicians were more attacked by it than any others, as having most intercourse with the sick; and he afterwards describes the terror which the citizens felt to approach those labouring under the disease, and intimates that it was often contracted by such intercourse. The language of Lucretius, who copies his description, and gives it a poetical form, is still more precise:—

“——nullo cessabant tempore apisci Ex aliis alios avidi contagia morbi.”

(L. 1235.)

And afterwards,

“Qui fuerant autem præsto contagibus ibant.”

(L. 1241.)

Ovid, in like manner, says of the dead bodies:

“Afflatuque nocent et agunt contagia latè.”

(Metam. v, 551.)

And so also, Silius Italicus:

“Et posuere avidæ mortis contagia pestes.”

(Lib. xiv.)

The historians we must dismiss in a few words, with stating that allusions to the infectious nature of certain diseases are to be met with in Livy, Dionysius the Halicarnassian, Diodorus Siculus, Appian, Plutarch, Quintus Curtius, Dio Cassius, Eusebius, Gregory of Nyssa, and Evagrius. Procopius was a non-contagionist.

The philosopher Aristotle, in one of his problems, makes it a question why the plague is the only disease which infects those who approach the sick. (Probl. i.) There is a curious passage in the works of the orator Isocrates, which shows that consumption was reckoned contagious in his days. (Æginet.) The elder Pliny mentions the contagion of the pestilence. (Hist. Nat. xxxiii, 80.)

Virgil mentions the infectious nature of certain diseases of cattle. (Ecl. i, Georg. iii, 464.) The ancient writers on veterinary surgery and agriculture in like manner state that the plague and scabies of cattle are infectious. See Columella (vi, 5); Vegetius (Mulomed. iii, 23.)

The philosopher Marcus Antoninus alludes to the plague as being contagious. (ix, 2.) Chrysostom does the same. (In Joan. Orat. lvii.) The language of Seneca is very precise: “Itaque ut in pestilentiâ cavendum est ne corruptis jam corporibus et morbo flagrantibus assideamus, quia pericula trahemus, afflatuque ipso laborabimus.” (De Tranquil. vii.) To these we may join Isidorus Hispalensis, a much later writer: “Pestilentia est contagium quod quum unum apprehenderit celeriter ad plures transit.” And, in another place: “Pestilentia est morbus latè vagans et contagio suo quæ contigerit interimens.” Alexander Aphrodisiensis intimates that pestilential fevers are contagious, but common fevers not so. (Probl. ii, 42.)

Aretæus appears to be the first medical author who alludes to contagion in unequivocal terms. He says of elephantiasis, that it is as infectious as the plague, being communicated by respiration. Cælius Aurelianus, who was probably nearly contemporary with him, mentions as contagious diseases the plague, incubus, hydrophobia, and elephantiasis. Galen expresses his sentiments on the contagious nature of certain diseases in the following terms: “That a pestilential state of the atmosphere produces fever, is unknown to no one possessed of good understanding; and, also, that it is dangerous to associate with persons having the plague, for there is a risk of catching it, like the itch and ophthalmy. It is dangerous also to live with those labouring under consumption, and, in a word, with all those having a putrid respiration of such a nature as to render the houses in which they lie fetid.” (De Diff. Febr. i, 3.) Aëtius (xiii, 120) and our author (iv, i) state their decided opinion of the infectious nature of the plague and elephantiasis. Oribasius, Alexander, Synesius, Palladius, Actuarius, and all the Latin medical authors, with the exception of Cælius Aurelianus, have omitted to make any allusion to the contagious nature of diseases.

Of the Arabians, Rhases mentions, as diseases “which are transmitted from one person to another,” lepra (elephantiasis?), itch, consumption, and pestilential fever. These, he says, prove infectious, when one is shut up in a narrow house along with those labouring under them, or when one sits in the wind blowing from them. He states afterwards that ophthalmy and malignant pustules are sometimes contagious. (Ad Mansor. iv, 24; see also Contin. xxxiii, 5.) By malignant pustules he means the smallpox. Avicenna and Haly Abbas give the same list of contagious diseases. Avicenna says that smallpox and measles are of all diseases the most contagious. Of the other Arabians, Avenzoar alone, while treating of elephantiasis, alludes to the doctrine of contagion.

Having now done with the ancient authorities, we shall only give further the declaration of the celebrated Boccacio regarding the plague of Florence: “E fu questa pestilenza di maggior forza, percio che essa dagl’ infermi di quella per lo communicare insieme s’avventava a’ sani non altramenti che faccia il fuoco alle cose secche o unte, quando molto gli sono avvicinate.” (Decameron, Introduzione.)

The result of our investigations into the opinions of the ancients on this subject leads us to the conclusion, that all, or at least the most intelligent of the medical authorities, held that the plague is communicated, not by any specific virus, but in consequence of the atmosphere around the sick being contaminated with putrid effluvia. Hence, they maintained that mild fevers (συνηθεῖς) which show no tendency to putrescency are not communicable from one person to another. See Alexander Aphrodisiensis, (l. c.) Fracastorius, in like manner, considered putrefaction as the source of all contagion. (De Contag. i); and nearly the same opinion was maintained by the learned Fernel, Franciscus de Pedemont, Ingrassius, Ficinus, and others. (See Prælect. Mar. 77.) Although Galen several times speaks of a poison being formed in the human body, he means that the animal fluids are so altered as to become deleterious, and does not hold that there is any specific virus transmitted from one person to another. (De Loc. Affect. v, 7, vi, 5; Epidem. iii.)

We may take this opportunity of stating that, after a pretty extensive investigation into the histories of pestilential epidemics, we have come to the conclusion that the plague has almost invariably assumed one or other of the following phases: 1st. That of cholera and dysentery. The plague described by Thucydides, and that of Ingrassias, and many other pestilential epidemics described in ancient and modern times, including the Asiatic cholera of the present age, belong to this class. 2d. That of profuse; and, as they have been termed, syncoptic sweats. The celebrated epidemic of the fifteenth century, now so admirably illustrated by M. Hecker, is the best marked instance which we possess of this form of the disease. M. Hecker, indeed, supposes that the Cardiac disease of the ancients was of a similar nature to the sweating sickness. But it strikes us (although we must admit that we have not had time to consider this point maturely), that the syncoptic fever or cardiac disease of the ancients, was not of a pestilential nature. 3d. The other form is the Glandular plague, which many late authorities would consider as the only form of the disease; but as we think erroneously, since the other types are often mixed up with this in the same epidemic. Thus in the plague of Aleppo, during the years 1760, 1761, and 1762, although the ordinary form of the disease was the glandular, a considerable proportion of the cases assumed the first form which we have noticed. And in the plague of Athens, although it commonly put on the appearance of the first form, it would appear probable, from the obscure allusion to cutaneous eruptions in the description of Thucydides, that a certain proportion of the cases were of the second type. The three forms then would appear to us to be as closely allied to one another as diphtherite, ulcerous sore-throat, and scarlatina are; that is to say, that they are all varieties of one species of disease.

SECT. XXXVII.—ON THE TREATMENT OF THOSE WHO ARE SEIZED WITH SYNCOPE FROM CRUDE HUMOURS.