Charles de Mertens

“ Histories of the Plague, exhibiting the modifications it undergoes in different climates, must at all times and in all places be acceptable, if not to the public at large, at least to that class of persons who make the art of medicine their study and employ: But, to a country situated like our own, histories of this terrible disorder occurring in the northern parts of Europe are more particularly interesting, by holding up to our view a picture of what it probably would be, whenever it should visit us again. ”

“ 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. ”

“ When physicians of science and probity declare that they are convinced of the existence of the plague in any place, it is incumbent on the magistrates, without paying any regard to the contrary opinions of other practitioners, to take the necessary precautions for preserving the health of the public, by removing, as soon as possible, all infected persons, as well as those who are under suspicion of being infected, out of the town, to a house standing by itself, and to surround the building with guards, in order to cut off all communication. ”

“ 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. ”

“ If you drag from their houses the fathers of families, mothers, and children, and thrust them into hospitals, you rob them of the only consolation which is left them, you heap misery upon misery, and plunge them into despair, from which it is impossible for them to recover. ”

“ Not only those among the poor who are ill of the plague, but those also who are suspected of having the contagion, should be fed and maintained at the public expence; humanity, as well as the safety of the rest of the inhabitants, requires that this should be done. ”

“ In spite of all our efforts to the contrary, every kind of precaution was neglected in the city; it was only at the military-hospital that, by order of the Empress, the means of prevention were still observed; in consequence whereof the plague was entirely suppressed there, after twenty-four persons had been seized with it, only two of whom recovered [10] . Six weeks after the death of the last of them, all their clothes, beds, &c. together with the house, to which they had been removed, and which was built of wood, were burnt. The hospital was opened again at the end of February. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The high degree of contagion by which the disorder is propagated from one person to another, enters necessarily into the definition of the plague; without it there is no plague. In a word, if there is a frequent communication, either by commerce or in consequence of war, with Turkey or Egypt, and some persons, or a great number of persons, are attacked with a disorder which corresponds exactly to the definition above given, it is certain that it is the plague.
3. For the answer to this third question, the reader has only to revert to the description of symptoms in note A of the Addenda. ”

“ And no [v] one who is acquainted with the nature of that contagion can deny the possibility of its importation from America into this country, either now or hereafter, by infected persons or infected merchandise. On the other hand, are we not threatened with a similar danger from the East? In executing the hostile operations which are going forwards in the Mediterranean, it seems scarcely possible for our fleets and armies to keep clear of contagion. No nation was ever long engaged in a war with the Turks, without taking the plague. ”

“ We wished that what had passed on this subject should not transpire; but the rumour of the plague having broke out at Kiow, some months before, had produced such an effect upon the minds of the public, that the precautions which were adopted, with regard to the military-hospital, threw the whole city into the greatest alarm. All attempts to dissipate the fears of the inhabitants were fruitless. ”

“ To determine with certainty whether a disorder which prevails in any place is the plague, it must have all the symptoms which I have just described in one or more patients. These symptoms taken singly, do not constitute the plague; for many other disorders are equally rapid in their course; petechiæ appear in common putrid fevers; in some malignant fevers carbuncles are met [85] with; buboes are produced by the venereal disease and scurvy; and some times, though very rarely, a crisis happens in putrid fevers by abscesses forming under the arm-pits ”

“ We now began to flatter ourselves that the plague had been entirely eradicated by the precautions which had been adopted. Scarcely, however, had we indulged in these fond hopes, when, towards the end of June, some people are taken ill of the same disorder at the hospital of St. Simon, where the quarantine was performed. On the 2nd of July, six people die in one night at a house in the suburb of Preobraginsky; a seventh, who lived with them, absconded [17] . Livid spots, buboes, and carbuncles are found upon the dead bodies. ”

“ The common practice of carrying camphor in the pocket or sewed in the lining of the clothes, has nothing to recommend it. In like manner the smoking of tobacco, though it has been so strongly recommended by Diemerbroeck and others, is by no means a certain protection against the contagion. The Turks, says Dr. Mertens, are continually smoking their pipes; and yet great numbers of them are swept off by the plague every year. ”

“ 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 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. ”

“ 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. ”

“ They have a particular taste in their mouths, which soon turns to a bitter; at the same time they have an ardor urinæ. To these succeed chilly and hot fits, and, lastly, all the symptoms which characterize the plague. The disease sometimes terminates favourably by perspiration, before the appearance of exanthemata, buboes, or carbuncles. The contagion is sometimes more rapid and more violent in its action; in that case the infected are suddenly seized after making a hearty meal, after a fit of anger, or too much bodily motion, with head-ach, 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 [43] 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. ”

“ While the plague was raging at Moscow, many Russian gentlemen and foreigners had [115] recourse to the smoking of tobacco, as an infallible preservative. Those who were accustomed to the pipe, smoked oftener, whilst others gradually brought themselves to bear it, until they saw some among the foreigners of the lower class carried off by the plague, in spite of the use of this remedy. ”

“ 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 [39] 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 ”

“ 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. ”

“ The pulse is hard and very quick, with a most violent headach and intolerable anxiety about the præcordia [51] ; 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 spontane [71] ously. Such as are seized with these violent symptoms seldom live more that twenty-four hours. ”

“ 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 ”

“ Under such circumstances, we should only aggravate the evil, by compelling the sick to conceal their illness. Besides, it is impossible to find buildings sufficiently large and convenient for such a vast number of patients. Nevertheless, every exertion must be made to stop the progress of this terrible disorder, which propagates itself by contagion, in every direction. ”

“ It is well known that the carcases of all animals in a state of corruption fill the surrounding atmosphere with effluvia that are accompanied with an intolerable stench, and that these effluvia, though they do not produce the plague, are nevertheless the cause of putrid, malignant fevers. ”

“ This Board or Committee should divide the town into quarters or districts, in each of which they should appoint a physician to visit the sick; they should enjoin the inhabitants to apprize them whenever any individual in a family is taken ill; and they should order that no person be buried until the corpse shall have been examined by one of the faculty, and a note be given certifying the disorder of which the person died. If there should not be a sufficient number of physicians, the surgeons may be employed in this business. ”

“ At Moscow we employed [111] with success a powder, called antipestilential, of which sulphur and nitre formed the basis; some bran and other vegetable substances, such as abrotanum, juniper-berries, &c. together with certain resins, were added; but in my opinion these resins are totally useless, and only increase the expence [73] . The acid [112] vapours let loose on burning nitre and sulphur together, remain a long time suspended in the air [74] . ”