_Of the Plague, as it appeared in ~Aleppo~, in 1742, 1743, and 1744._
It is no wonder that the very name of _plague_ among us should strike
terror whenever it is mentioned; for, besides the numerous and terrible
distresses of the whole body of the people during the rage of a
pestilence, and the scenes of death and misery which are continually
before our eyes, the distemper itself is the most lamentable to which
mankind are liable. The torments of heat, thirst, and pain, frequently
unite in some patients; an unspeakable languor and dejection in others;
the loathsome remains of the distemper in the painful and putrid ulcers,
even in those who escape; the desertion of friends and attendants; the
want of common necessaries, and medical assistance, are all of them
circumstances which aggravate the miseries of the sick, and contribute
not a little towards augmenting the general horror.
And as there is no disease incident to mankind that is in its nature more
terrible and destructive, so there is none more difficult to describe.
Its symptoms are scarcely in all respects alike in any two persons; nay,
they even vary extremely in an hour in the same subject. The disease
begins often with the most flattering appearances, and ends fatally in
a few hours. Some complain of a pain at their heart, are seized with a
vomiting and giddiness, and die in a few minutes; while the most alarming
attacks sometimes end speedily in health and security.
In general, however, a coldness or shivering, with sickness, vomiting
large quantities of porraceous bile, often of a very offensive smell,
pain in the back or loins, an intense headach, uncommon giddiness, and
a sudden loss of strength, were the first complaints of those who were
seized with this distemper; and these were usually attended with great
uneasiness or anxiety about the pit of the stomach, and a sharp, shooting
pain darting into the parotid, axillary, or inguinal glands.
These symptoms were soon succeeded by a violent fever; in which, while
the patients complained of extreme inward heat, their skin felt but
little hotter than usual. Sometimes this heat soon became general and
intense, at other times particular parts only were affected therewith;
and it seldom continued many hours together alike, but remitted and
returned with considerable, but unequal force several times in a day.
The face, in these exacerbations, became florid, and was often changed
from a deep scarlet to a livid colour, resembling that of a person
almost strangled. These appearances again would suddenly give place to a
cadaverous paleness. The eyes soon lost their lustre, and acquired a kind
of muddiness; and the countenance of the greatest part of the sick was
ghastly, and confused beyond description.
The pulse, at the first seizure, was very little different from its
natural state, only somewhat more quick and low. In a few hours it
commonly encreased in quickness and strength; but these seldom continued
in the same way an hour together, nay, scarce many minutes, but varied
without any manifest correspondence with the other febrile symptoms, both
as to strength and quickness, incessantly.
In those who complained of pains, either darting into the parotids,
the armpits, or groins, a small, painful, hard, deep-seated tumor was
discovered by the touch in the part, without any manifest discoloration
of the skin. Such were the first beginnings of the pestilential _buboes_.
This was the common appearance of the distemper the first day of the
disease; and those who had the most favourable escape were often attacked
at first with as alarming symptoms as those who died in a few hours; for
sometimes this febrile paroxysm dissolved in a few hours, and left the
patient indeed languid, and weakened to an extreme degree, but free from
other complaints, except the pain of the tumor above mentioned; which in
many encreased from this time, both in size, tension, and pain, during
about twelve or fifteen days, when it commonly suppurated, the patient,
all the time, the first day excepted, walking about as usual.
But though many thus escaped, yet several who were seized in this manner,
especially in the month of _March_ 1743, suddenly dropped down dead, or
at least lived but a few hours; the headach, vomiting, and pain about
the præcordia, encreasing every moment to such a degree as to occasion
immediate death, or fatal convulsions. Few of those who died in this
manner had any appearance of such indurated tumors, though generally
the armpits, groins, or internal parts of the arms and thighs, were
livid or black, and the whole body was covered with confluent petechiæ,
interspersed with livid pustules, especially after death.
Those who survived the first attack of the distemper, which was by much
the greatest part of the sick, in the evening had a very considerable
encrease of every symptom. The heat became excessive, both internally
and externally; and as the sick were by this time for the most part
delirious, it was often with difficulty they could be kept within doors.
They were disposed to talk a great deal, but faultered so much in their
speech as scarcely to be understood; the tongue having also shared in the
debility that was evident in every other part of the body.
In this state they continued during most part of the night; towards
morning the violence of the heat, inquietude, and delirium, abated; a
manifest remission succeeded; some recovered their senses entirely, some
in great part, and then complained much of intense headach, or pain of
the buboes, which last would often increase suddenly, and decrease as
quickly, in the space of a few hours. About one half of the sick about
this time had an additional complaint of a painful pustule, like an
angry, confluent pock, surrounded by a circle of a deep scarlet tinge,
which soon became livid, and was attended with an intense burning pain;
from which circumstance, as well as from its fiery aspect, it has
probably obtained the name of _carbuncle_.
These pustules broke out indiscriminately on all parts of the body, and
increased from the size of a large pock to the extent of an inch and a
half diameter, sometimes, though rarely, to three inches.
The remission of the feverish symptoms was commonly but of very short
continuance, the rigors, anxiety, and delirium soon returning with
greater violence, with a frequent and strong _subsultus tendinum_. These
symptoms, however, did not proceed with a regular increase during the
day; but the rigors and heats coming and going by turns, formed short,
but alarming intermissions, each paroxysm surpassing the former either
in violence or duration; till, in the evening, the pulse was scarcely to
be counted by reason of its depression and quickness. The patient grew
comatose, with a quick, laborious, and interrupted respiration.
The buboes, which some hours before seemed manifestly to increase, now
often subsided, and almost disappeared, and the livid circle about the
carbuncle became black, resembling a large eschar made by a caustic; and
livid or black spots, of different dimensions, about this time often
appeared dispersed over the whole body.
Under these circumstances, dreadful as they seemed, some hope of recovery
still remained; for though many died on the third day, yet several had
a favourable crisis by a profuse sweat: some struggled under these
difficulties to the fifth day, a few to the seventh, and here and there
one even to the eleventh, before any critical alteration appeared.
If the disease was not wholly carried off by a copious sweat on the
third day, it was always considerably abated, and was in general totally
removed by a second, though less profuse one, by the fifth; so that no
symptoms of the disease were then left, weakness excepted, and the pain
proceeding from the buboes and carbuncles. And it may here be remarked,
that all who were attacked had buboes; though, even in many that
recovered, they discussed without any manner of bad consequences: but the
carbuncles did not appear on above one half of the sick, and often begun
to digest before the critical sweat happened.
It is evident, from the account already given, that nothing could be more
difficult than to form a judgment about the event of this disease, or be
more just than what _Morellus_[496] observes on a similar occasion. This
author, after reciting several circumstances proving the irregularity of
its type, concludes, “That, in respect to the plague, even our senses
and reason deceive us, the aphorisms of _Hippocrates_ are erroneous; and
_Hippocrates_ himself, was he present, would likewise be mistaken.”
The tongue was in some quite moist, and in all respects like that of a
person in health through the whole course of the distemper; in others
it was at first white, but soon became yellow, black, and covered
with a dry, rough scurf or fur. Some had no thirst at all, and could
scarcely be prevailed upon to take liquids in sufficient quantities.
But the generality of the sick were extremely thirsty, and drank with
great eagerness whatever they had given them, especially at particular
times; for the intenseness of their thirst had irregular intervals, and
did not continue alike through the progress of the distemper, nor often
correspond with the violence of the fever.
In most patients the vomiting ceased after the first few hours, excepting
when they overloaded their stomachs during this excess of thirst; at
which times the vomiting returned.
The urine was as little to be depended on as a sign as any other
circumstance, being scarce alike at the same time of the disease in any
two persons; and its appearance varied no less in the same patient every
day. In general, however, it was somewhat of a deeper yellow than usual
in a person in health, and without sediment.
Some had a diarrhœa during all the time, others were costive; in most the
discharges were natural. The distemper, however, seemed never to admit of
a critical solution by either stool or urine. Some few had hæmorrhages
from the nose or uterus: and if these happened after the second day,
a plentiful sweat, which was most commonly critical, soon followed; a
circumstance different from what usually has happened in the plague at
other places.
In the years 1742 and 1743, the buboes often appeared as soon as the
patients were taken ill, in some not till twelve hours after, and in a
few not till after two or three days: but, in 1744, some perceived the
buboes a day or two before they had any other symptom of the disease. And
during all the time the plague raged at _Aleppo_, none of the sick were
without them, except such who died suddenly. In general, the sick had but
one, and they were more common in the axillary or inguinal glands than
in the parotids. Some few had even two or three, which were not confined
to one side of the body. Their first appearance, as hath been mentioned,
was like a small indurated gland; deeply seated; in some they were fixed
but more frequently moveable, and most commonly painful to the touch.
They would often, increase considerably in a few hours with intense
pain, and would as suddenly subside; and these changes would frequently
succeed each other several times in twenty-four hours. Sometimes an
exacerbation immediately following the decrease of the bubo, would prompt
one to imagine this decrease to have been the cause; but this was not so
constantly the case as to induce me to think it was so in reality.
The buboes, so far as I could learn, never advanced towards a regular
maturation, till a critical sweat had carried off the fever. In ten,
twelve, or fifteen days from the first attack, they commonly suppurated
with the usual attendants of heat and pain. Sometimes, nay frequently, I
have known them to disappear soon after the critical sweat, and discuss
without any detriment to the patient. At other times, when grown pretty
large, about the height of the disease, they sunk, and mortified without
being attended with fatal consequences: for as soon as the crisis was
compleat, the mortification stopped, and the eschar separated gradually,
leaving a large deep ulcer, which healed without difficulty by the usual
methods.
The inguinal buboes were seldom single, there being generally two, and in
the same groin. The superior was the largest, of a long figure, somewhat
resembling a cucumber, lying obliquely, but lower than where the venereal
buboes appear, and it was this which commonly came to suppuration. Once I
met with a case where an axillary bubo divided into two; one part getting
under the pectoral muscle, the other sinking deeper into the armpit:
both of them grew painful and inflamed; but that in the armpit only
suppurated.