Chapter III: Part 3

[46] 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.

[47] 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.

[48] 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.

[49] 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.

[50] 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.

[51] 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.

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

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

[54] 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.

[55] 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.

[56] 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.

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

[58] 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.

[59] 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.

[60] _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.

[61] 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.

[62] See _Chenot_ de Peste, p. 93, and _Russell_'s Aleppo, p. 229 and 235.

[63] 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.

[64] As the author's observations relative to the treatment of the buboes and carbuncles, coincide with those of other writers on this subject, they have been purposely omitted. See _Russell_ on the Plague, Book II. Chap. V. Tr.

[65] Why no animal food? _Orræus_ found broths and soups seasoned with salt and vinegar, and having the fat taken off them, and even boiled meat of a light texture, to be very restorative to the convalescent. Tr.

[66] If there should be any doubts respecting the nature of the disorder on its first appearance, and because, as yet, only a single family happens to be attacked with it; Dr. _Mertens_ proposes that criminals condemned to death should be shut up with the sick, and be made to wear their clothes. Thus in two or three weeks, according as they became infected or not, it would be decided whether the disorder was the plague. But in a free country, like England, neither the removing of a family in the night-time, under the circumstances just mentioned, nor the exposing of criminals to the contagion, are measures which would be deemed justifiable. Indeed, it seems almost impossible to stifle the plague, in any country, in the very beginning, before it has become publicly known and excited a general alarm. Tr.

[67] Those who are employed to burn the goods, should not stand too near the fire, so as to be exposed to the thick smoke which arises from it; and the more effectually to destroy the pestilential particles, it may be useful to throw some gun-powder or nitre into the fire. It is infinitely better to burn the infected goods than to bury them, as some authors recommend; since people may be tempted by avarice to dig them up again.

[68] See _Chenot_ de Peste, p. 208.

[69] _Antrechaux_, Relation de la Peste, p. 65. _Chenot_, de Peste, p. 166.

[70] _Erndtel_ Warsavia physice illustrata, p. 171.

[71] By being distributed in this manner into several houses the sick will be less hurtful to each other; they will breathe a purer air, and recover much sooner. _Mead_ advises the impested to be removed to tents pitched out of the town. (This is not quite accurate. _Mead_'s words are,--"as the advice I have been giving is founded upon this principle, that the best method for stopping infection, is to separate the healthy from the diseased; so in small towns and villages, where it is practicable, if the _sound remove themselves into barracks or the like airy habitations_, it may probably be even more useful, _than to remove the sick_. This method has been found beneficial in France after all others have failed.") Tr. I do not think a better method for stopping the contagion can be suggested; but the season of the year, climate, and other circumstances must often render this measure impracticable; in that case, the doors and windows of the sick-rooms should remain open, and a free circulation of air be constantly kept up. The exposure to the air and wind seems to me to be the principal reason why the plague makes less havoc in armies that are encamped; for although the air or wind has very little power over the poison after it has entered the circulation, nevertheless it carries off the effluvia and dissipates them more quickly; so that the sound are not so readily infected by the sick.

[72] The physicians and surgeons, and all those who are about the sick, should put over their clothes a cloak made of oil-cloth; they should wear gloves and boots made of the same material, which should be frequently washed with vinegar; and they should hold before the mouth and nose, a sponge moistened with vinegar. On other preservatives, see D.

[73] The following is the composition of these fumigating powders, as published by the Council of Health. (See _Orræus_ p. 136, 137.)

_The strong antipestilential powder_ consisted of juniper tops (cut small,) guaiacum shavings, juniper berries, bran, of each 6 lb, nitre 8 lb, sulphur 6 lb, myrrh 2 lb.

_The weaker antipestilential powder_ consisted of the herb abrotanum 6 lb, juniper tops 4 lb, juniper berries 3 lb, nitre 4 lb, sulphur 2-1/2 lb, myrrh 1-1/2 lb.

_The odoriferous antipestilential powder_ consisted of calamus aromaticus 3 lb, frankincense 2 lb, amber 1 lb, storax and dried roses, of each 1/2 lb, myrrh 1 lb, nitre 1 lb 8 oz., sulphur 4 oz.

Of these powders, the first was employed to fumigate the houses and goods of the infected, such as woollens, furs, &c.; the second, for fumigating houses only suspected, and more delicate articles, which would have been spoiled by the first; the last was employed (by way of prevention) in inhabited houses.

(We are now acquainted with a mode of destroying contagion, much more simple and efficacious than that of fumigating with such compound and costly powders as those mentioned in the preceding note; we mean _the vapour extricated from nitre by means of the vitriolic acid_. See an Account of the experiments made on board the Union Hospital-ship, to determine the effect of the nitrous acid in destroying contagion. By James Carmichael Smith, M.D. &c. London, 1796. Tr.)

[74] The author adds, that the smoke from the vegetable substances burnt with them helps to keep the acid vapours longer suspended. We do not see how. Tr.

[75] This asylum of innocence and misfortune holds the first place among all institutions of the same kind in Europe. It was founded by the Empress Catherine the Second. Under the auspices of this Sovereign, and by the great attention of Mr. _de Betzky_, to whom his country owes infinite obligations for the devotion of his time and fortune to the encouragement of the arts and the promotion of undertakings for the public good, this institution had nearly attained to perfection, at the time when this account of it was written.

[76] I caused to be fixed up at the gate near the porter's lodge, two sets of railing, at the distance of twelve feet from each other. The people belonging to the hospital stood at the inner railing, and those who came to see them, at the outer.

[77] There was always a guard of twenty-two men and an inferior officer. After July, I obtained an order not to have them changed.

[78] It was not without great difficulty that we got a house for quarantine, as well on account of obstacles occasioned by the public calamity, as from the scarcity of houses sufficiently roomy. Hence this business was not settled until October. In the mean time, many children continued to be exposed at the hospital-gate. Some of these I put into a wooden house in the vicinity; and Mr. _de Durnowo_ took others of them under his roof. As soon as the above-mentioned quarantine-house was ready to receive them, which was not the case till November, I sent them thither.

[79] In this quarantine-house I also established a small hospital for the reception of pregnant women, and the care of them after their delivery, as long as the plague might continue. Mr. _de Durnowo_ undertook the management of this establishment.

[80] As it was possible for the plague, though it declined in the town, to have been kept up in this quarantine-house by the children that were daily brought there and by the lying-in women; in order to provide against such an event and in compliance with the orders of the Empress, Mr. _de Durnowo_ and myself presented a memoir, containing a detail of the regulations and precautions above-mentioned, to the Committee of Health, who were pleased to signify their approbation thereof.

(Here follows in the original, the letter of approbation from the Committee of Health, which though it is highly flattering to the author, is unimportant to the reader, and is therefore omitted by the Translator.)

[81] In the beginning of the year 1772, I had the remainder of the children who had been received into the quarantine-house, admitted, a few at a time, into the Great Hospital. Their number, including orphans, whose parents had been carried off by the plague, and new-born infants, amounted to one hundred and fifty.

Transcriber's Notes

page viii & ix: the four items listed have been expanded from the original compact paragraph.

page 29: Pogaretsky ==> Pogaretzky

page 44: accompained ==> accompanied

page 75: petechia ==> petechiæ

footnote 5: Samoïlowoitz ==> Samoïlowitz

footnote 27: Pogaretsky ==> Pogaretzky

footnote 33: Russel ==> Russell

footnote 36: Russel ==> Russell

footnote 59: sly ==> fly

footnote 59: hurful ==> hurtful