PART FIRST. (continued 7)

Along with this muddiness the patient had a peculiar confusion of countenance; the pulse quick and equal, or low and fluttering, but rarely intermittent; the external heat moderately feverish, at other times intense, with irregular flushings, with pain at the heart, or oppressions about the præcordia; burning pain at the pit of the stomach, and incessant inquietude. When to these symptoms were added a faltering in the tongue, loss of speech, while the surface of the body became cold and damp with clammy sweat, death was inevitable. In the evening of the second day all the symptoms became worse; and in the morning the patient appeared to lie quiet more from his strength being exhausted than from any change to the better. When the vomiting had ceased, however, there was frequently such a remission on the third day as gave the attendants great hopes of a favourable event; but these hopes were always fallacious and of short duration. Sometimes where vomiting, looseness or hæmorrhage had preceded, the patient died on the third day: at any rate, none of this class recovered, whether the disease was left to itself, or treated with medicine. The appearance of buboes was of no consequence, for they never came to maturity, and the little advances they made neither accelerated nor retarded the termination of the disease, which happened sometimes on the third, but more frequently on the fifth or sixth day.

The third class of patients were equally unfortunate with the other two. “The difference between the second and third consisted in the absence of vomiting at the beginning, the later accession of coma and other bad symptoms, and a slight tendency to perspiration, which very rarely occurred in the second. . . . From the second or third night the course of symptoms in both classes varied very little, and the termination of the disease was in both the same: it may be added they reigned together through all the periods of the pestilential season, but were most prevalent in its augment; for at its height, and in its decline, they gave place to varieties of the disease less destructive.”

The fourth class was the most numerous of all. Its distinctive marks were, “the continuance of the inflammatory or febrile symptoms with less interruption than in the other, a pulse more constantly sustained, or soon recovering itself when hurried in the exacerbations; the length and vigour of the exacerbations decreasing in the advance of the disease; and, above all, the prevalent tendency to a favourable discharge by the skin, with the critical sweats on the 3d, 5th, or subsequent days. . . . Vomiting was a concomitant in about one fourth of the sick. The fever, for the most part, was very moderate the first night, very rarely accompanied with delirium, and almost never with the comatous disposition. . . . The buboes and carbuncles commonly made their appearance the first day; but it was not unusual to see a successive eruption of these in the course of the disease. . . . The morning sweat, on the third day, in some cases proved completely critical, but more commonly produced only a remission so favourable as to encourage the expectation of a more favourable crisis on the fifth; but, where the patient neither sweat on the third, nor a sensible remission took place on that day, some degree of danger was always to be apprehended. . . . After the sweat on the fifth, the subsequent exacerbations proved slighter and slighter, and the buboes for the most part advancing favourably, little or no fever was left remaining after the beginning of the second week, except perhaps symptomatic heats occasioned by the eruptions.” In this class the patients sometimes appeared only to have a slight attack, and yet at last were seized with mortal symptoms, while others who deemed to be much worse at first yet happily recovered and did well, In general the severe pestilential symptoms did not come on till a considerable time after the attack.

To the fifth class our author refers all cases of slight infection, wherein the more formidable symptoms of pestilence never concurred, and all the infected recovered. “The access here was often attended with so little apparent disorder, that the eruptions gave the first alarm; and the fever which came on afterwards was frequently so slight as not to confine the sick to the house. Others found themselves indisposed for two or three days, but were not sensible of any febrile heat whatever. But in this class the disease did not always invade thus insensibly. The febrile symptoms, especially the first three days, sometimes run pretty high; and the fever afterward, in nocturnal exacerbations particularly, run out to the end of the week or longer: but, as there was no concurrence of alarming symptoms, and the exacerbations, terminating for the most part in sweats, gradually diminished in force after the third or fourth night, it was not difficult in the worst cases to foretel the event at that period, nor necessary in others to defer the decision so long.

“All the infected had buboes or carbuncles, and very often both eruptions concurred in the same subject. Persons not confined by indisposition were often, by the inguinal buboes, prevented from walking abroad. The carbuncles constantly formed the black crust,106 and then suppurated; the buboes in one third of the sick dispersed. The dispersion of the buboes was never observed to be attended with bad consequences, notwithstanding the general neglect of purging in the decline of the disease: indeed very few had recourse to remedies, topical applications excepted, unless perhaps a bleeding at the beginning, where the febrile symptoms ran high. This class was nearly as numerous as the fourth, but began to predominate rather later, and reigned most of all in the decline of the plague in 1762.”

The sixth class must be omitted, as containing dubious, anomalous and extraordinary cases. We shall therefore proceed to consider the accounts of the plague given by other physicians, which, without questioning the accuracy of Dr. Patrick Russel in relating what he has seen, may serve to throw some light on the subject, by relating what others have seen. Dr. Alexander Russel, in his Natural History of Aleppo, gives the following description of it. “The distemper in itself is the most lamentable to which mankind are liable. The torments of heat, thirst and pain frequently unite in some patients; an unspeakable dejection and languor in others; and even those who escape with life do not cease to suffer from painful and putrid ulcers, the painful remains of the disease. The desertion of relations, of friends, and of domestic servants, the want often of the common necessaries of life, and the difficulty of procuring medical assistance, are circumstances likewise which aggravate the miseries of the sick, and contribute greatly to augment the general horror.

“But, as no disease incident to mankind is in its nature more terrible and destructive, so none is more difficult to observe. Its symptoms are scarcely in all respects alike in any two persons, and even vary extremely in the course of an hour in the same subject. The disease, attended in the beginning with symptoms not highly alarming, often ends fatally in a few hours; while the most formidable attacks, by a sudden and unexpected alteration, sometimes terminate happily.

“The first complaints of those seized with this distemper, were, in general, a coldness or shivering; sickness; a vomiting of large quantities of porraceous bile, which often had a very offensive smell; anxiety, or an inexpressible uneasiness about the pit of the stomach; pain in the back or loins; an intense head-ach; uncommon giddiness, and a sudden loss of strength. Some were sensible of a sharp shooting pain darting at intervals into the parotid, axillary or inguinal glands. To these symptoms succeeded a violent fever; in which, while the sick complained of extreme inward heat, their skin, externally to the touch felt little hotter than usual. Sometimes this heat became general and intense; at other times particular parts only were affected; but it seldom continued long in the same degree, having several unequal remissions and exacerbations in a day. In these exacerbations the face became florid, but would often from a deep scarlet change to a livid colour, like that of a person almost strangled, and, again suddenly changing, it would assume a cadaverous paleness. The eyes, soon losing their natural lustre, acquired a kind of muddiness; and the countenance of most of the sick was ghastly and confused beyond description. The pulse the beginning was somewhat quicker and lower, but in other respects varied little from the natural state. Within a few hours it commonly increased in quickness and strength, but seldom remained the some for an hour, nay scarcely many minutes together; incessantly varying, both as to strength and quickness, and without any manifest correspondence with the other febrile symptoms.

“In such as complained of pains darting either into the parotids, the arm-pits, or the groins, a small hard, deep-seated tumour, with external discoloration of the skin, was discovered by the touch in the part, and these were the incipient pestilential buboes.

“The appearances now described were those of the distemper on the first day, till evening, when the sick always suffered a severe exacerbation, in which the heat both internal and external became excessive; and, as they generally were by that time delirious, it was often with difficulty that they would be kept within doors; they were greatly disposed to talk, but faltered so in their speech, that what they said was hardly intelligible, the tongue having shared with the other organs in the general debility. The exacerbation lasted the most part of the night; but the heat, delirium, and inquietude abated towards morning, and a manifest remission took place. Some recovered their senses entirely, some partially, and then complained of intense head-ach, or of pains from the buboes; it was usual in this interval also that those who had carbuncles began to complain of burning pain in those fiery eruptions. The morning remission was commonly of very short duration; the rigours, anxiety and delirium soon returning more violent than before, attended with a strong and frequent subsultus tendinum. These febrile symptoms did not increase regularly as the day advanced; but went away and returned at intervals leaving short but alarming intermissions; for each exacerbation surpassed that which preceded it either in violence or duration. In the evening the pulse could hardly be counted, by reason of its depression and quickness; the patient became comatose, and the respiration was quick, laborious, and interrupted. The buboes which, some hours before, seemed manifestly to advance, often subsided, and sometimes almost entirely disappeared; the carbuncles, mortifying at the top, resembled a great eschar made by a caustic: and at this period also livid or black spots, of various dimensions, often were found scattered universally on the body.

“Under these circumstances, dreadful as they seemed, some hope of recovery still remained; for, though many of the sick died on the third day, several had a favourable crisis on that day, by a profuse sweat; some struggled to the fifth day, a few to the seventh, and, here and there one, even to the eleventh; before any critical alteration took place. Where a copious sweat happened on the third day, if it did not prove perfectly critical, it at least always considerably abated the fever; which, in that case, was generally totally removed by a second, though less profuse sweat, on the fifth: and then besides weakness the chief remains of the disease consisted in the pain of the eruptions.

“Nothing could be predicted with respect to the event of the disease from the manner of its invasion; those who had the most favourable escape having been often in the beginning attacked with as alarming symptoms as others were who died in a few hours. Sometimes the febrile paroxysm, which had set in with such formidable violence, dissolved in a few hours, and left the patient languid indeed, and weak in an extreme degree, but free from other complaints except the pain arising from the bubo, which from that period increasing in size, and advancing favourably to maturation, was, in many cases, ready to open in twelve or fifteen days: the patient all the while, except the first day, walking about as usual. Great numbers happily escaped, not only in the manner just described, but likewise where the buboes never advanced; for these tumours, so far from coming always to maturation in such as recovered, very often discussed without any bad consequence. Carbuncles often began to digest before the termination of the fever in a critical sweat.

“All the infected had buboes, except such as expired suddenly, or survived the first attack a few hours only. Instances of this dreadful kind were more particularly observed in March 1743. The sick were seized in the usual manner; but the head-ach, vomiting, and pain about the præcordia, increasing every moment, proved suddenly mortal, or terminated within a few hours in fatal convulsions.” Dr. Patrick Russel observes, that such instances of sudden death were very rare in the plague of 1760, 1761 and 1762; and in these they happened only in the winter, or early in the spring. In such sudden deaths few had any appearance of buboes; but in general the armpits and groins, or the inside of the arms and thighs, became livid or black, and the rest of the body was covered with confluent petechiæ, livid pustules being here and there interspersed: but all these appearances were more especially observed after death.

In the plague of 1760, vibices as well as livid and black spots were frequently found on the corpse, but not constantly. They were always suspicious in conjunction with other circumstances, but their absence was no proof, though frequently urged as such, that the distemper was not the plague. The vibices sometimes appeared several hours before death, but the livid spots seldom or never.

The tongue in some was quite moist, and continued to be like that of a healthy person throughout the disease; in others, white at first, then yellow; at last black, and covered with a dry, foul scurf or fur. The thirst was generally very great, but never constant; returning at regular intervals, and never appearing to correspond with the danger of the fever. Sometimes it was so little that the patient could not be prevailed upon to drink a sufficient quantity. The appearance of the urine was equally variable, and afforded no certain prognostic; being seldom alike in any two patients in the same stage of the distemper, and varying in the same patient every day. The vomiting commonly ceased after a few hours, excepting where the sick were induced by thirst to load their stomach, in which case it always returned. Sometimes the patients were costive, in others a diarrhœa took place, but in most the discharges were natural. No critical solution by urine or stool seemed ever to take place. A few cases of hæmorrhages from the nose and uterus were observed; and if they happened after the second day, were soon followed by a plentiful sweat, which commonly proved critical; “a circumstance different from what has been usually observed in the plague at other places.

“From the preceding account of the plague it will readily be conceived that nothing can be more difficult than to form any judgment or prognostic of the event of the disease; in which, as it is justly remarked by Morellus, our senses and our reason deceive us, the aphorisms of Hippocrates are erroneous, and even Hippocrates (as I am inclined to think) might have erred in his judgment.”

Innumerable other histories of the distemper might be given, but the following, it is hoped, will be sufficient, along with what has been already detailed, to show that the plague in former ages was the same as at this day. In the terrible plague which broke out in the time of Justinian, the distemper sometimes began with delirium, and the patient instantly despaired of life; but more generally people were surprised by the sudden coming on of a slight fever; so slight that no danger was apprehended either from the state of the pulse or colour of the body. This, however, was quickly followed, sometimes even on the same day, sometimes on the second or third, by buboes or parotids (swellings behind the ear) which when opened were found to contain a black coal, or eschar, of the size of a lentil. If these swellings suppurated kindly, the patient recovered, but if not, a mortification ensued, and death was the consequence, commonly on the fifth day. Black pustules or carbuncles, covering the body, were signs of immediate death, as was likewise a vomiting of blood in weak constitutions; for this terminated in a mortification of the bowels. Pregnant women generally perished, but women were less susceptible of the infection than men; and young persons were in more danger than old. Many, who recovered, lost the use of their speech, and such were not secure from a relapse.

In the last plague at Moscow, the symptoms were various, according to the persons, constitution and the weather; in general, head-ach, giddiness, shivering, loss of strength, slight fever, sickness and vomiting, redness of the eyes, white and foul tongue, with a dejected countenance, buboes and carbuncles appearing on the second or third day, but seldom on the fourth. The buboes were seated chiefly in the glandular parts, the armpits and groin, but sometimes made their appearance in the neck, cheeks, &c. Sometimes these suppurated perfectly, and then they proved beneficial, but not otherwise. Sometimes they suddenly disappeared, after having attained the size of walnuts; and this retrocession was always supposed to be a sign of approaching death. Sometimes they neither showed any sign of inflammation nor were painful, and in such cases afforded no relief. Similar swellings sometimes occured in the parotid glands, but they were never equally beneficial with the buboes. Carbuncles were gangrenous spots on the skin, resembling a burn, with black, livid or red vesicles, bordered with an inflammatory ring, and soon terminating in a hard, black eschar. The anthrax is more prominent, penetrating deeper into the adipose membrane, and attended with more pain and inflammation. The disease was likewise attended with petechiæ similar to those in putrid fevers, but larger; also with vibices, which resembled the mark of a whip, and were considered, as well as the petechiæ, as mortal signs. No distinct account of the pulse could be given; as, after the disease became general, physicians did not choose to feel the pulses of their patients but through a glove or tobacco-leaf. Worms called teretes were frequently discharged both upwards and downwards. Women with child generally suffered abortion, and were carried off by an uterine hæmorrhage.107

According to Sydenham, the plague begins with chilliness and shivering, like the fit of an intermittent, succeeded in a little time by violent vomiting and oppression at the breast, accompanied with its common symptoms. These continue till the disease proves mortal, or the kindly eruption of a bubo or parotis discharges the morbific matter. Sometimes, though rarely, the disease is not preceded by any fever; the purple spots, which denote immediate death, coming out even while persons are abroad about their business. But this hardly ever happens but in the beginning of a very fatal plague, and never while it is on the decline, or in those years in which it is not epidemic. Sometimes swellings appear without having been preceded either by a fever or any other considerable symptom; but he conceives that some slight and obscure shivering always precedes the seizure.

Mariti, in his travels through Cyprus, &c. says that the plague of 1760 began with loss of appetite, pain in the shoulders, head-ach extremely violent, delirium, vomiting, with a most excruciating pain in that part where the tumour by which the plague is characterised, is about to break forth. Death often took place on the third day, and very few lived beyond the thirteenth.

The Abbe’s definition of what he calls the plague, and which seems to be the pestilential bubo of the physicians, is somewhat singular. “The plague (says he) is an oblong tumour, shaped like a pumpkin, which is at first of a flesh colour; but it gradually becomes red, and at length blueish; and this is a sign that the disease is incurable. If it continues red, and a little after inclines to yellow, it is a sign that a suppuration will take place: the swelling is then opened, and the patient is sometimes cured.”

According to our author, the symptoms of the plague do not appear till fifteen days after the infection is received; and this is the reason of a law which subjects to a proof of twenty days every person suspected of being diseased. In this plague it was observed that people of the soundest constitutions were the most subject to it, and the least capable of resisting it. On the other hand, it appeared to spare weak and delicate persons, whose cure, in case of an attack, was much less difficult. A greater number of Moors than of any other nation were attacked by it; and when once they were seized, their case was absolutely desperate. Those who had recovered from the disease were less liable to a second attack, but were not absolutely safe. “I have known some (says our author) who have been ill seven times, and have died of it at last.”

Dr. McBride informs us that in the plague which raged at Marseilles and the adjacent places in 1720, people on their first seizure seemed as if intoxicated with drink; they lost the power of their limbs entirely, and became so dejected that they gave themselves over to despair from the very first attack. Along with the bilious vomitings and purgings which generally took place on the second day, quantities of small worms like ascarides were thrown off. The more plentiful these evacuations were, the more salutary; for those who vomited and purged but little sunk down, oppressed with the disease, and died before the fourth day, covered with livid blotches and petechiæ; those who had the largest evacuations had also the most plentiful eruptions of buboes and parotid abscesses. When these appeared, the patients rose, walked about, and became remarkably hungry; the heat and thirst subsided, but the face continued pale and languid, the pulse hard and frequent. On the sixth, seventh, or eighth day, if the suppuration stopped, and the humours went back, then came on oppression, difficulty of breathing, furious delirium and convulsions, which ended in death. When carbuncles, or biles, with mortified sloughs, appeared in different parts of the body, either alone or accompanied with the glandular swellings, the patients scarcely ever escaped. In great numbers of people tumours appeared without any previous febrile symptom, and, in a few cases, went off by resolution; in others they continued in a schirrous state; but it was best when the tumours came to suppuration.

These are the most remarkable symptoms of this fatal disease, which have been recorded by the physicians of greatest eminence who have written upon the subject. It remains still to give some particular description of the buboes and carbuncles, which are supposed to constitute in a particular manner the characteristic signs of the distemper. Of these the following account, given by Dr. Alexander Russel, seems to be sufficiently clear and explicit.

Only a very few, and such as died suddenly, were exempted from buboes, but only about one half had carbuncles. In the latter plagues their proportion was still smaller; but they seldom appeared earlier than in the months of April or May. In 1742 and 1743, the buboes often appeared on the first commencement of the distemper, sometimes not till twelve hours after; in a few instances not till two or three days; but in 1744 they were sometimes the first symptoms of the disease. The buboes were generally solitary, the inguinal and axillary more frequent than the parotid. “The inguinal bubo for the most part was double; that is, two distinct glands swelled in the same groin. The superior, which in shape somewhat resembled a small cucumber, lay obliquely near the large vessels of the thigh, lower than the venereal buboes are usually found, and it was that which commonly came to suppuration; the inferior was round, and in size much smaller. I once met with a case in which an axillary bubo divided in like manner into two parts, one of which got under the pectoral muscle, the other sunk deeper into the armpit: both grew painful and inflamed, but that in the armpit only suppurated.”

The bubo was at first a small hard tumour, painful but not inflamed externally. These indurated glands were deeply seated, sometimes moveable, at others more or less fixed, but always painful to the touch. Sometimes they would increase to a considerable size in a few hours, with intense pain, then suddenly subside; and these changes would take place several times in twenty-four hours. “An exacerbation of the pestilential symptoms immediately upon the decrease of the bubo, sometimes prompted me to imagine it owing to the retrocession of the tumour; but this did not happen so constantly as to make me think it was so in reality. The buboes, as far as I could learn, never advanced regularly to maturation till such time as a critical sweat had carried off the fever. In ten, twelve, or fifteen days, from the first attack, they commonly suppurated; having been all along attended with the usual symptoms of inflammatory tumours. But I have known them sometimes, nay, frequently, disappear soon after the critical sweat, and discuss completely without any detriment to the patient. At other times, though grown to a pretty large size, the tumour, about the height of the disease, would sink and mortify, without any fatal consequences; for, as soon as the crisis was complete, the mortification stopped, and the gangrened parts separating gradually, left a deep ulcer, which healed without difficulty. I met with no instance of a bubo in which fever did not either precede or follow the eruption.”

On the subject of carbuncles, Dr. Patrick Russel observes, that “there are certainly varieties in them, but perhaps these varieties have been unnecessarily multiplied, from the same eruption having been viewed in different stages of its progress; for all of them sooner or later are covered with a black eschar.” Dr. Alexander Russel describes them as follows: “The carbuncles were commonly protruded the second day of the disease; and though the muscular and tendinous parts were more especially affected, no part whatever could be said to be free of them. The carbuncle at first resembled an angry confluent pock in its inflammatory stage, but was attended with intense, burning pain, and surrounded by a circle of a deep scarlet hue, which soon became livid. By a progress very rapid, it then spread circularly, from the size of a silver penny to an inch and an half, two inches, nay, even three inches, diameter; and the supervening gangrene often penetrated deep into the substance of the parts affected. In such of the sick as recovered, the gangrene usually ceased spreading on the third day; and, a day or two after, signs of suppuration were observed at the edge of the black crust, the separation of which, advancing gradually, was completed rather in less time than that of the eschar in issues made by caustic. In cases where the patient died, I was informed (for I saw none of those cases myself) that a quantity of ichorous matter oozed from beneath the eschar, which remained itself shrivelled and hard, without any favourable signs of separation or digestion.”108

Dr. Alexander Russel also describes another kind of pustule, which he says appeared in a small number of the sick, but which his brother Dr. Patrick had no opportunity of observing in 1760. It had no livid or discoloured circle surrounding it, but was filled with laudable pus; and, when dry, the crust fell off, as in the distinct small-pox. This was looked upon as a favourable symptom, all who had it happening to recover.

We have now detailed, at considerable length, the symptoms of the plague as mentioned by authors of great eminence. To give a detail of all that has been said upon this subject would be impossible; neither indeed can it be thought necessary in the present treatise. Whatever may have been omitted or too slightly mentioned in this section, will naturally be considered when we come to treat of the cure. It now therefore only remains to say, whether the approach of a plague may be known by any visible signs, so that people might in some measure prepare themselves for the ensuing calamity.

Were we in possession of an accurate and authentic history of the world, this question might be very easily decided; but the uncertainty of ancient records, the mutilated state of those which we do possess, the diversity of opinions among mankind, and the unhappy disposition to misrepresent, so common in all ages, render it very difficult to say any thing upon the subject. If the theory hinted at in this section (that plagues arise from some commotion in the electric fluid) can be allowed to have any foundation in nature, then it ought to follow, that the forerunners of pestilence would be some electric phenomena; and, from a perusal of the first and second sections of this work, it will appear that such an opinion is not altogether unfounded.109

The appearance of immense numbers of insects has likewise been accounted a sign of approaching pestilence; but if we suppose their appearance to be a sign, we can scarce imagine their putrefaction to have been a cause, of pestilence. In the east we are informed by Dr. Russel that the inhabitants of Aleppo account the appearance of insects, and even eclipses, as presages of the plague. They suppose also that the stillness of frogs is a sign of pestilence; but the same author informs us that all these signs failed in 1760. Violent earthquakes and famines seem to be more certain signs, though even these are not always to be depended upon; it being evident from historical accounts that pestilence has sometimes preceded, and sometimes followed, earthquake and famine. Mr. Gibbon, however, ascribes to the above-mentioned causes, viz. insects, earthquakes, and even comets, the dreadful plague which took place in the reign of Justinian. At least, all these preceded it; but perhaps the insects were only meant to be accounted the cause of the plague. The cause of the insects must remain in obscurity. According to him, “In a damp but stagnating air, this African fever is generated from the putrefaction of animal substances, and especially from the swarms of locusts, not less destructive to mankind in their death than in their lives.”

This dreadful plague was preceded by comets and most violent earthquakes. A remarkable comet appeared in 536, supposed to be the great one observed by Sir Isaac Newton in 1680. This, we are told by astronomers, revolves round the sun in a period of 575 years; but the failure of astronomical predictions in the return of the expected comets of 1759 and 1789, shew the futility of such calculations. Another comet appeared in 539, and these comets were attended with an extraordinary paleness of the sun. Mr. Gibbon observes, that earthquakes, which he calls a fever of the earth, “raged with uncommon violence during the reign of Justinian. Each year is marked by the repetition of earthquakes of such character, that Constantinople has been shaken above forty days; of such extent, that the shock has been communicated to the whole surface of the globe, or at least of the Roman empire. An impulsive or vibrating motion was felt; enormous chasms were opened, huge and heavy bodies were discharged into the air, the sea alternately advanced and retreated beyond its ordinary bounds, and a mountain was torn from Liburnia, and thrown into the waves, where it protected as a mole the new harbour of Botrys in Phenicia.”

According to Dr. Sydenham the plague at London in 1665 was preceded by a very cold winter; the first continued till spring and went off suddenly towards the end of March. Peripneumonies, pleurisies, quinsies, and other inflammatory disorders, then made their appearance, along with an epidemic fever of a particular kind, which did not yield to the remedies successful in other epidemics. About the middle of the year the plague began, and increased in violence till the autumnal equinox, when it began to abate, and by the ensuing spring was entirely gone. Our author says that the plague seldom rages violently in England but once in thirty or forty years; but since his time, which is upwards of a century, no plague hath appeared. He supposes the plague and other epidemics to depend on some secret constitution of the air, but pretends not to say what that constitution is. But, besides this constitution, he is of opinion that there must be another circumstance, viz. the receiving the effluvia or seminium from an infected person. Thus he supposes that a single infected person is sufficient to poison a whole country; the general mass of atmosphere being infected by the breath of the diseased and the effluvia of the dead bodies. “Thus (says he) the way of propagating this dreadful disease by infection is rendered entirely unnecessary; for though a person be most cautiously removed from the infected, yet the air received in by breathing will of itself be sufficient to infect him, provided his juices be disposed to receive the infection. I much doubt, if the disposition of the air, though it be pestilential, is of itself able to produce the plague; but the plague being always in some place or other, it is conveyed by pestilential particles, or the coming of an infected person from some place where it rages, to an uninfected one, and is not epidemic there, unless the constitution of the air favours it. Otherwise I cannot conceive how it should happen, that, when the plague rages violently in one town in the same climate, a neighbouring one should totally escape it, by strictly forbidding all intercourse with the infected places; an instance of which we had some few years ago when the plague raged with extreme violence in most parts of Italy; and yet the Grand Duke, by his vigilance and prudence, entirely prevented its entering the borders of Tuscany.” As to the nature of the disease, when once produced, Dr. Sydenham is of opinion that it is altogether inflammatory; for which he gives the following reasons: 1. The colour of blood taken away that resembles that in pleuritic and rheumatic disorders. 2. The carbuncles resemble the mark of an actual cautery. 3. The buboes are equally disposed to inflammation with any other tumours that come to suppuration. 4. The season of the year may be adduced in proof of this; for between spring and summer, inflammatory disorders, as pleurisies, quinsies, &c. are common.

Before we put an end to this section, it may now be proper to say a few words by way of apology for the many apparent digressions from the subject which have appeared in it. In the first place, then, the work being intended for general inspection, and not merely for medical readers, it became absolutely necessary to introduce a number of things which for medical readers would have been totally superfluous. It was to be supposed that the book might come into the hands of some who had not read any thing concerning the structure of the body, who had not heard of any of the systems of medicine now prevalent, or the different doctrines they contain. It was impossible to write in an intelligible manner for such people without giving some few hints concerning all these subjects: the same consideration made it necessary to enter pretty largely into the discoveries concerning the composition of the atmosphere and various kinds of elastic fluids, concerning heat, &c. In doing this the writer was under a necessity either to adopt some of the doctrines he took notice of, or to animadvert upon them. If he has ventured freely to give his sentiments, it is not with a view to establish a theory of his own, but to direct the attention of the reader to those natural agents which seem to be at present too much overlooked, principally because they are less accessible to our senses, and of consequence less subject to experiment, than others. If therefore in this treatise it is suggested that the atmosphere acts on the human body by its internal or latent heat, and by its electricity, as well as by its other properties; if the writer is inclined to believe that these are in fact the most powerful parts of it; that we never can act without them, and that in short our life and health are in immediate dependence upon them; I say, that none of all these things are in opposition to any fact hitherto discovered, either of the medical kind or any other. On the other hand, in all ages physicians have sought for some constitution in the air, inexplicable, and perpetually unknown, to which diseases might be ascribed that could not be supposed to originate from any of its ordinary properties. To explore this constitution is as great a desideratum at the present moment as two thousand years ago; and any attempt to investigate it, or a conjecture relating to it, cannot be supposed inconsistent with any thing already discovered and ascertained. There are many things which lead us to think that electricity is very much concerned in diseases, and among the rest we must account the new discovery of Dr. Perkins’s metallic conductors a very notable proof of it. These, when first ushered into the world, were made by many a subject of ridicule; but the evidence in favour of their efficacy, both in America and in various parts of Europe, seems now to be decisive in their favour; and, if they act at all, it is almost impossible to suggest any other principle than that of electricity to which their efficacy can be owing. No doubt it is difficult to draw the line properly betwixt credulity and skepticism, but where credible testimony determines any thing to have actually happened, or where solid reasoning gives room to suppose any thing to be probable, it never can be invalidated by any argument a priori formed against the possibility of such a thing taking place.

In page 128 it is said, that M. Lavoisier, by introducing the new chemical nomenclature, “has entailed the greatest curse upon the science it ever met with.” All apology for this bold assertion is absolutely necessary, and the quotation made from Dr. Ferriar may be deemed inadequate, or perhaps misapplied. In passing this censure on the nomenclature I wrote from experience. The new nomenclature, instead of promoting my improvement in chemistry, hath had a direct contrary tendency. An instance of the inconvenience and ambiguity arising from it is given p. 135, when speaking of Dr. Girtanner’s theory. But a much more remarkable example is to be met with in the review of Dr. Monro’s Chemical Treatise, where we find him censured for the very same ambiguity taken notice of with regard to Dr. Girtanner. “He might have observed (say the reviewers) the distinction between the hydrogen and inflammable air, and between the oxygen and pure air, as well as between the azote and impure air: he has mentioned these as synonimous, whereas they are terms that express bases, or substances in a concrete state (what I have called the condensable part) and the compounds of these substances and heat, when they assume the form of gases or elastic fluids.” (Monthly Rev. for 1790, p. 26.)

That the terms invented by Lavoisier and others have not been received with perfect unanimity by the chemists of the present day, is evident from Dr. Pearson’s “Translation of the New Chemical Nomenclature,” which is not only a translation, but a vindication of it. In the course of his work he quotes the translator of the Chemical Dictionary saying, that, “from the zeal of reforming language, such a number of reformers may arise, that our ears will not be less stunned, nor our understandings less perplexed, than if we were exposed to the clamour of Babel, or the thaw of words of Sir John Mandeville.” To this Dr. Pearson replies, that there is no reason to fear any such bad consequences. “The distinguished superiority of a system produced by a De Guyton, a Lavoisier, or a Bergman, would surely supercede the work of persons of inferior ability.” It is impossible to know the persons here designated, unless the Doctor points them out. If he chooses to call himself one of them, we can have no objection. He certainly has dissented, in one article, from “the system produced by De Guyton, Lavoisier and Bergman,” and this is with regard to the word azote. This is the term announced to us as the most proper for denoting a certain kind of air. But Dr. Pearson determines nitrogen to be more proper. Even this has not given entire satisfaction, for Dr. Mitchell has adopted the word septon in preference to both azote and nitrogen. Thus, instead of the original phrase phlogisticated air, used by Dr. Priestley, we have four; for as long as the works of Dr. Priestley remain, the original term will be used by some, while with others it will be so much disused that perhaps they will not understand it when it happens to occur. Nor are corrections of this kind all that we have to fear. Professor Wiegleb, who has written a System of Chemistry in quarto, has therein changed almost all the nomenclature invented by Lavoisier. Instead of it he gives a nomenclature of his own, in which he makes very much use of the termination cratia, from a Greek word signifying strength; thus, instead of saying the acid of fluor, we are to say fluoricratia. I must confess that to me the perpetual repetition of this termination has a very ridiculous appearance; but the misfortune is, that in the case of nomenclatures we have no choice. We cannot choose one and reject another: good or bad, we must take both; and were an hundred new ones to arise, we must be condemned to learn them all. Nor is even this the worst. Wiegleb’s scholars, for instance, accustomed to the language of their teacher, will be apt to put it into their writings, perhaps without proper explanation; and thus such writings must be unintelligible both to old and new chemists: and thus it will be with as many others as choose to invent new chemical terms.

Were this a proper place for entering into a discussion of Lavoisier’s nomenclature, it might easily be shown that the terms are not more proper than those which preceded them; but no real inconvenience can arise from the propriety or impropriety of a mere name. It is the resemblance of the terms to one another, and the facility with which mistakes may be made, that gives just ground of complaint. Nor is it any just reason to accuse a person of want of judgment or carelessness because he hath mistaken these terms. We see that even Dr. Monro has not attended to every circumstance; and if a man of his experience and accuracy hath been inaccurate in this respect, what is to be expected from others? How easily may the words sulfate, sulfite, sulphuret and sulphure, be mistaken for one another, either in writing or conversation! Yet a mistake of this kind would totally pervert the meaning of the person who used it. The scripture finds fault with those who make people offenders for a word; but here we are in danger of being made offenders for a letter. In short, taking into account the inconveniences arising from this nomenclature itself, the numberless corrections and amendments (no matter whether real or imaginary) to which it may be subjected, and the number of others totally different from it which may arise, I cannot help looking upon the introduction of it into chemistry as an evil of the first magnitude; an evil which cannot be remedied by any art, but must continually become worse and worse.

SECTION IV.

Of the best Methods of Preventing the Plague.

THESE methods may be classed in the following manner: 1. Those most proper for avoiding the infection, supposing the disease to be infectious. 2. The proper mode of resisting or removing those local causes which may give rise to it, or may co-operate with the infectious matter in giving greater force to the disease, should it happen to be introduced; and, 3. The best method of preparing the body for resisting pestilential attacks, should we happen to be so situated that no external method of defence could be used.

With regard to the first of these intentions the flying from places infected has been so universally recommended, and so generally received, that the precept has been made up into the following proverbial Latin distich:

“Hæc tria tabificam tollunt adverbia pestem Mox, longe, tarde, cede, recede, redi.”

These words prevent the plague’s infectious pain, Go quick, fly far, and slow return again.

This maxim hath been put in execution in all ages, but often with so little regard to humanity that it cannot by any means be recommended without very considerable limitation. The reparation of the sick from all promiscous intercourse with the sound, in times of pestilence, seems to be dictated by common sense; but this may be done without killing them, or leaving them to expire in the miserable state to which they are reduced by the disease. Mr. Howard informs us that in some places ships which have the plague on board are chased away and burnt; and instances of cruelty with regard to infested individuals have been formerly mentioned. Dr. Mertens is of opinion that cutting off all the communication between the infected and healthy is the only means of preventing the disease from spreading. The good of this practice was observed in one of the hospitals at Moscow. All the avenues to it were shut up, but one which was strictly guarded, and every suspected article prohibited from entering. Infected clothes and utensils were burned, and the houses where the sick had lived were purified by the fumes of vinegar and gun-powder.

In this mode of prevention it is of the utmost consequence to ascertain the distance to which the contagion extends; in the next place to know whether by means of clothes, cotton or other kinds of merchandise it may be imported from one place to another; and in the third place how long the infection may remain in these kinds of goods; so that people may know when the danger is over. As to the distance, it seems to be generally agreed, that it is but small. Some of the answers to Mr. Howard by the physicians of whom he inquired, have been already related. Of the infection of the plague he speaks in the following manner:

“In my opinion this distemper is not generally to be taken by the touch, any more than the gaol-fever or small-pox; but either by inoculation, or by taking in with the breath the putrid effluvia which hover round the infected body; and which, when admitted, set the whole mass of blood into fermentation, and sometimes so suddenly and violently as to destroy its whole texture, and to produce putrefaction and death in 48 hours. Those effluvia are capable of being carried from one place to another, upon any substance where what is called scent can lodge; as upon wool, cotton, &c. and in the same manner that the smell of tobaco is carried from one place to another.

“The infection in the air does not extend far from the infected object, but lurks chiefly (like that near carrion) to the leeward of it. I am so assured of this, that I have not scrupled going, in the open air, to windward of a person ill of the plague to feel his pulse. The rich are less liable to the plague than the poor, both because they are more careful to avoid infection, and have more large and airy apartments, and because they are more cleanly, and live on better food, and plenty of vegetables; and this I suppose is the reason why Protestants are less liable to this distemper than Catholics during their times of fasting, and likewise why the generality of Europeans are less liable to it than the Greeks, and particularly Jews.

“It is remarkable that, when the corpse is cold of a person dead of the plague, it does not infect the air by any noxious exhalations. This is so much believed in Turky, that the people there are not afraid to handle such corpses. The governor of the French hospital at Smyrna told me, that, in the last dreadful plague there, his house was rendered almost intolerable by an offensive scent; especially if he opened any of those windows which looked towards the great burying-ground, where numbers every day were left unburied; but that it had no effect on the health of himself or family.”

It is likewise a matter of the utmost importance to ascertain the time at which the disease is introduced into any town or district. Dr. Canestrinus, in a treatise on this distemper, published at Saltzburg, complains greatly of the dissensions among physicians concerning the nature of the distemper, owing to which its existence is frequently denied, and thus its ravages are propagated immensely beyond the limits which might otherwise circumscribe them. Of this he gives the following remarkable instance: “In the year 1770 a disease with uncommon symptoms prevailed at Bodrogh in Upper Hungary, which carried off a number of persons in a short time. A physician of the county of Zemplin was sent to inquire into the nature of the malady. He reported that the disease was of a suspicious nature, having a great resemblance to the plague. His report was received by the nobility and health-officers with indignation, as if untrue. Another was sent, who, without hesitation, pronounced the disease an epidemic scurvy. In the mean time the disease, being left to itself, spread wider, and raged with such violence as to carry off seventeen persons in one house. The nature of the disease now becoming apparent, proper measures were taken, and the infected separated from the sound, by which means the disease was confined within a small district.110” With regard to the infection of the disease, or contagion, as it is commonly called, he expresses himself as follows: “The air is not capable of diffusing the contagion to any considerable distance from the infected subject unimpaired in its power, but, like other poisonous matter, it is capable of dilution in the atmosphere, so as to be rendered at length innoxious. The contagion of the plague will be entirely prevented from spreading if all access to, and all intercourse with, the sick be strictly prohibited: whence the following forms a safe and infallible prophylactic of the disease:

“Mox, longe, tarde, cede, recede, redi. Go quick, fly far, and slow return again.”

“No change in the habit takes place previous to the action of the contagion, but the body is from the first equally susceptible of it as of the itch, or any other infectious disease. Whilst the plague ceases in the civilized parts of Europe spontaneously, or by human precautions, its revival is prevented, from the care that is bestowed in purifying or destroying every infected substance. In the east, on the contrary, this precaution is totally neglected; whence it is probable that the disease is not reproduced anew, but that it is perpetuated by the former fomes, as happens with us in the small-pox. The matter producing the ordinary epidemics is widely diffused in the atmosphere, and capable of infecting through a widely extended space. The pestilential poison, on the contrary, is confined to the vicinity of the affected body, and becomes so dilute at the distance of a few paces only as to be incapable of further action. Hence it appears that the plague is much easier avoided than epidemic disorders. The more abundant the contagious matter is, the further probably is the power of its infection carried. This is the reason that the mere separation of the sick and suspected from the healthy is so much more efficacious in destroying it at its commencement than at a later period. To restrain epidemics within bounds is impossible; but with the contagion of the plague, it is certain that it can be confined by art to a narrow spot.”

Of the truth of this last assertion our author gives a remarkable, instance in his own practice about the time that the plague stopped at Bodrogh. Having been sent into Cassovia, along with two other physicians, they were informed by the surgeon of the lazaretto, that an unusual disease had broken out in the district of Zboina, which had suddenly proved fatal to many. On inquiry it was found that it had come from Bodrogh in the following manner: Two young men, returning from the vintage at Tokay, slept a night in an infected house, and stole some clothes belonging to those who had died of the plague. He who carried the clothes died by the way: his father carried home the bundle, kept them unpacked for some weeks, but having at last worn them, he and all his family fell victims to the same disease. The pestilence began to spread, and shewed an appearance of great malignity. Our author did not hesitate to declare its true nature, and in consequence of his declaration all communication was cut off between the adjacent countries and the infected spot, by a cordon of the military. The infected were separated from such as were only suspected, and these last from the sound: three infected houses were destroyed by fire, and other means (to be afterwards related) were used with a view to destroy the contagion itself. Thus the disease was prevented from spreading; and none but such as had been previously suspected were seized.

To the same purpose the Abbe Poiret thinks it an easy matter to extinguish the plague entirely. He was a witness to the ravages of the disease in Barbary, and thinks it the most easily avoided of any distemper; but the misfortune is, that there are many things in their own nature very easily accomplished, which the inattention or perverseness of mankind render utterly impracticable. Such, it is to be feared, is the extinction of the plague by the means just mentioned; for though these means might be enforced in a country district or small town, yet, where the pestilence enters a large and populous city, there are so many modes of concealing its existence, and the unknown intercourse of the sick with the sound must be so frequent, that it seems scarce possible to prevent the malady from spreading.

In London, whether it arose from a neglect of using the precautions for too long a time, or from any other cause, cannot well be known; but the attempts of the magistrates to separate the sick from the sound certainly were not attended with any good consequence. “The consternation (says Dr. Hodges) of those who were thus separated from all society, unless of the infected, was inexpressible, and the dismal apprehensions it laid them under made them but an easier prey to the devouring enemy. And this seclusion was on this account much the more intolerable, because, if a fresh person was seized in the same house but a day before another had finished the quarantine, it was to be performed over again; which occasioned such tedious confinements of sick and well together, as sometimes caused the loss of the whole. Moreover, this shutting up of infected houses made the neighbours fly from theirs, who might otherwise have been a help to them on many accounts; and I verily believe that many who were lost might have been alive, had not the tragical mark upon their doors driven proper assistance from them. And this is confirmed by the examples of other pestilential contagions, which have been observed not to cease until the doors of the sick were set open, and they had the privilege of going abroad.” The Doctor sets forth also the arguments on the other side; but whatever might have been the advantages of a separation of the sick from the healthy, if conducted in a manner less capable of hurting the feelings of humanity, it is evident that in the London plague the methods attempted to prevent the disease at least did no good.

In countries where the plague generally prevails, and the Europeans are united in the opinion that it is necessary to separate themselves from the natives, the method of shutting up is attended with the most salutary effects, as has been attested by almost every traveller who has resided there for any time. Accidents among them are very rare, though not altogether without example. At Alexandria in Egypt, M. Volney tells us, that as soon as the plague makes its appearance the European merchants shut themselves up in their khans and have no communication with the rest of the city. Their provisions are deposited at the gate of the khan, and received there by the porter, who takes them up with iron tongs, and plunges them into a barrel of water provided for the purpose. If it is necessary to speak to any one, they keep at such a distance as to prevent touching with their clothes, or breathing on one another; by which means they preserve themselves from this dreadful calamity, unless by some accidental neglect of these precautions. Some years ago a cat, which passed by one of the terraces into the houses of the French merchants at Cairo, conveyed the plague to two of them, one of whom died. This state of imprisonment continues for three or four months, during which time they have no other amusement than walking in the evening on the terraces, or playing at cards.

The doctrine of predestination, and still more the barbarism of the government, have hitherto prevented the Turks from attempting to guard against this destructive disease: the success, however, of the precautions taken by the French, has of late begun to make some impression upon many of them. The Christians of the country who traffic with the French merchants, would shut themselves up like them; but this cannot be done without permission from the Porte. A lazaretto was some years ago established at Tunis; but the Turkish police is every where so wretched, that little can be hoped for from those establishments, notwithstanding their extreme importance to commerce and the safety to the Mediterranean states. The very last year afforded a proof of this; for as violent a plague as ever was known broke out there. It was brought by vessels coming from Constantinople, the masters of which corrupted the guards, and came into port without performing quarantine. Water carriers have never been attacked by it.

Mariti says, that in the island of Cyprus, and on the continent of Syria, every European, on the slighted appearance of the plague, after taking the necessary precautions, shuts himself up with his family. The Mahometans alone, more intrepid, go abroad as usual, converse with each other, give such assistance to each other as may be necessary, and often fly to the relief of a Christian when deserted by his friends. This arises from their belief in predestination. The Mahometans of Syria, however, less familiarized with this scourge, make use of some precautions, which were augmented in 1760. They published an ordonnance forbidding every vessel attacked by the plague to enter their ports: but their vigilance in this respect was so remiss, that it was not sufficient to prevent the contagion. The governor of Acre checked the progress of this plague, by giving the inhabitants the means of retiring from its ravages; and these means, though absolutely contrary to the dogmas of the Mahometan religion, were eagerly embraced. The Europeans became their models; and the governor, after deriving from them every necessary information, shut himself up, after their example, together with his numerous family. The mufti alone, being the protector of the Mahometan law, cannot imitate a conduct which that law condemns. Instead of shutting himself up in a prudent confinement, he thundered forth against this new method, reproached the governor for his conduct, and, having treated him as an impious person, threatened him with all the vengeance of Heaven. The governor, however, only laughed at this pious folly of the mufti, and sent a detachment of soldiers to impose on him a fine of two hundred and fifty sequins, for having dared to ascribe to him, in matters of religion, an ignorance, from every suspicion of which his age ought to have secured him.

In the time of plague, the proper precautions are, to shut one’s self closely up, and to receive no provisions or other things, except those on which the plague has no influence. The people of Syria, however, in 1760, admitted every kind of provisions without fear, but not without using certain precautions. They did not receive warm bread; flesh of every kind was thoroughly washed, and milk was strained through a linen cloth, in order to free it from the smallest particle of animal hair. All kinds of pulse were soaked in water, and they abstained from peaches, apricots, and other fruits which are covered with a downy rind. Fowls were cooked out of the house, for fear that some small feather might adhere to them. Flowers were altogether proscribed. Letters were opened by the person who brought them; and they were never read until they had been steeped long enough in vinegar to be purified without effacing the writing. Every thing was received into the house by means of a rope of herbage suspended from a window. The governor employed every precaution which he thought likely to guard him from the contagion; and, by shutting himself closely up, he set an example which the rest of the Mahometans did not neglect to follow. Besides this he caused the streets to be cleansed; and carried his vigilance so far as to forbid the caravans which arrived from Damascus, where the plague swept off four or five thousand people every day, to enter the city. He obliged them to submit to a proof of eight days without the walls, and established regulations of the same kind respecting vessels coming from Alexandria or Damietta. One precaution taken in the time of plague is, to prevent cats from entering houses: an open war is therefore declared against these animals; and, wherever they are found, they are knocked on the head with large clubs. This is a cruelty absolutely necessary; for there is no vehicle that will convey the infection with more certainty or rapidity than the hair of cats. Rats and mice multiply in consequence of their destruction; but there is no instance of their ever having propagated the plague. This disease, when it attacks men, spares quadrupeds and birds. The furs of the one, and the feathers of the other, however, attract and communicate the infection. People ought particularly to keep from goats and sheep; from horses and oxen little is to be apprehended.

All these precautions were sometimes ineffectual. The French at Acre, who there, as well as throughout Syria, are collected into one quarter, used every precaution that could be thought of, yet, on the 30th of March, 1760, five of them were infected. They belonged to the hospital of the Holy Land, and the monks were instantly ordered to shut themselves up. They did so; and eight of them died, one only escaping.

Mr. Howard likewise gives particular accounts of the precautions used in several different countries through which he travelled. In Malta two kinds of quarantine are performed; one for ships with clean bills, the other for those with foul. The former lasts 18 days.111 The crews and passengers are allowed to buy provisions, and converse by means of enclosures with stone posts and palisadoes. A letter received from a Turkish ship was taken by a pair of iron tongs, dipped in vinegar, put into a case, and laid for about a quarter of an hour on a wire grate under which straw and perfumes had been burnt; after which the letter was taken out and opened by one of the directors. In this island ships with foul bills must perform quarantine eighty days; but, at the end of forty, may change their station. The different kinds of goods are separated and placed in proper order under cover. The cottons are taken out of the bags containing them, and placed on rows of piles on boards, laid on stone pillars about 18 inches from the floors; and, in repacking them they are flung over a man who gets into the bags, and treads down the cotton; the consequence must be the exposing him to great danger, should any infection remain.

Mr. Howard took a voyage to Venice in a ship with a foul bill, on purpose to know every thing relative to the performance of quarantine. “A messenger (says he) came in a gondola to conduct me to the new lazaretto. I was placed, with my baggage, in a boat fastened by a cord ten feet long to another boat in which were six rowers. When I came near the landing place the cord was loosed, and my boat was pushed with a pole on the shore, where I was met by the person appointed to be my guard. Soon after unloading the boat, the sub-prior came and showed me my lodging; a very dirty room, full of vermin, and without table, chair or bed. That day and the next morning I employed a person to wash my room; but this did not remove the offensiveness of it, or prevent that constant head-ach which I had been used to feel in visiting other lazarettos and some of the hospitals in Turky. My guard sent a report of my health to the office, and, on the representation of our consul, I was removed to the old lazaretto. Having brought a letter to the prior from the Venetian ambassador at Constantinople, I hoped now to have had a comfortable lodging. But I was not so happy. The apartment, consisting of an upper and lower room, was no less disagreeable and offensive than the former. I preferred lying in the lower room, on a brick floor, where I was almost surrounded by water. After six days, however, the prior removed me to an apartment in some respects better, and consisting of four rooms. Here I had a pleasant view; but the rooms were without furniture, very dirty, and no less offensive than the sick wards of the worst hospital. The walls of my chamber, not having been cleaned perhaps for half a century, were saturated with infection. I got them washed repeatedly with boiling water, to remove the offensive smell, but without any effect. My appetite failed, and I concluded I was in danger of the slow hospital fever. I proposed whitewashing my room with lime slaked in boiling water, but was opposed by strong prejudices. I got this, however, done one morning through the assistance of the British consul, who supplied me with a quarter of a bushel of fresh lime for that purpose. The consequence was, that my room was immediately rendered so sweet and fresh, that I was able to drink tea in it in the afternoon, and to lie in it the following night. On the next day the walls were dry, as well as sweet, and in a few days I recovered my appetite. This room was lime-whited in November, and in a very rainy season. In the following March, in complaining to the under sheriffs in Newgate of their inattention to the clause which orders this in the act of parliament for securing the health of prisoners, their excuse was, that they were afraid of dampness.”

An health-office was established at Venice in 1448, in the midst of a very destructive pestilence. The old and new lazarettos are both built on little islands, surrounded not only by canals, but high walls. They have only a ground floor, and one over it, and are divided and subdivided into a great number of apartments, each having an open court in front, with plats of grass, which is not suffered to grow too high; nor are any trees suffered to grow within this district, or a good way from it. The internal government is managed by a prior, who must not be related to the magistracy nor any of its ministers. He must have no interest nor concern in shipping nor in trade. He must see all the gates and doors of the apartments locked every evening by sunset; he takes the keys into his possession, and suffers them not to be opened before sunrise; and, in case of any suspicion of infection, the gates must be kept constantly locked, and opened only for necessary occurrences in presence of the prior. He must not suffer dogs, cats, &c. to lodge in the lazaretto. He must neither buy nor sell, nor suffer others to do so, within the lazaretto. No fishing boats or other small craft to come within a certain distance, or keep communication with those performing quarantine. Provisions are received by poles seven or eight feet long, and the money dipped in vinegar and salt water before it is received. The prior and his substitute must carefully avoid touching either goods or passengers in quarantine, and for this purpose they keep a cane to make those who approach them keep their proper distance; but if by an unfortunate accident they should be contaminated, they must perform quarantine. Any person maliciously touching them is liable to punishment.

Ships are strictly forbid to use any ropes but such as are tarred. Wool, silk, cotton-wool, woollen and linen clothes, and furs especially, are accounted the most dangerous goods. Animals with long hair are subject to full quarantine; but short haired ones purged by swimming ashore; feathered animals, by sprinkling with vinegar till wet.

The celebrated Dr. Mead, though an enemy to the cruel mode of abandoning the sick, or treating them with any kind of harshness, was perfectly sensible of the necessity of using every precaution for preventing pestilential contagion from being imported. In his opinion it is not sufficient that ships should perform quarantine, “the only use of this being to observe whether any die among them. For infection may be preserved so long in clothes among which it is once lodged, that as much, nay, more of it, if sickness continues in the ship, may be brought on shore than at the beginning of the forty days, unless a new quarantine be begun every time any person dies; which might not end but with the destruction of the whole ship’s crew.” He is therefore of opinion that lazarettos ought to be established on small islands near the sea-coast; and in this Mr. Howard agrees with him. The latter recommends the lazaretto at Leghorn as the best in Europe. Dr. Mead also very much insists on the utility of destroying the clothes of the sick, because, says he, they harbour the very essence of the contagion. He quotes in favour of this opinion what Boccacio says he saw at Florence in 1348; viz. that two hogs, finding in the streets the rags which had been thrown out from off a poor man dead of the disease, after snuffling upon them, and tearing them with their teeth, fell into convulsions, and died in two hours. This is one of the things which Dr. Moseley looks upon to be incredible. It is indeed very marvellous, and seems to be contradicted by M. Deidier’s account of the dog at Marseilles who swallowed with impunity the filthy pus and pestilential matter adhering to the dressings of plague sores: but, when a person of credit informs us that he saw any thing, we scarce know how to contradict him. The evidence of pestilential contagion adhering to clothes, does not depend on such accounts. That lately quoted from Dr. Canestrinus is decisive on the subject; and he informs us that one of the methods used by himself to stop the plague in Zboina, above mentioned, was, the burning of the clothes of infected persons. He says that the pestilential contagion resembles that of the small-pox, in being of a fixed nature; and that all who studiously avoided communication with the sick, or with whatever fomes might carry the contagion, escaped it altogether. “That the contagion of the plague (says he) may lie dormant for a considerable time, and be carried to a great distance by the medium of packages, &c. and again revive with its former violence, is proved by various circumstances. Chenot relates, in his treatise on the plague which raged in Transylvania, that the infection was revived a whole year after it had disappeared; and other similar instances are adduced.” If this revival happened from infected clothes or soft goods, it shows them to be dangerous in the extreme; but of this we have not any direct proof, neither indeed is such a belief quite consistent with what takes place in all plagues, viz. that the clothes of the infected are worn by the sound, without producing any reinfection. In the great plague at London, for instance, where an hundred thousand probably perished, and a much greater number must have been infected, we cannot suppose that all the clothes belonging to such an immense multitude were burned, or never made use of again. It is of necessity therefore that we suppose the pestilential contagion to become effete, and to lose its virulence, after some time; and this seems to be very much hastened by exposure to the atmosphere. The doing of this, however, by obliging people to put their naked arms into bales of suspected goods, has such an appearance of cruelty, that Dr. Mead has proposed to judge of the presence or absence of infection by allowing little birds to fly about among them; “because (says he) it has been observed, in times of the plague, that the country has been forsaken by the birds; and those kept in houses have many of them died.” But, though he says this upon very great authority, no less than that of Diemerbroeck, yet we can by no means look upon the fact to be absolutely determined. Dr. Russel indeed says that the desertion of the birds is looked upon by the Turks to be the sign of an approaching plague; but this failed in 1760. Thucydides says that birds of prey deserted the territory of Athens during the great plague in his time; and he supposes them to have been poisoned by feeding upon the bodies of such as died of the disease. It is possible that such food might be disagreeable to them, but no proof is brought of any of them having been actually poisoned by it. As for birds kept in houses, it is possible that in a time of general calamity they might have been neglected, and died for want of proper food, &c. Dr. Mead also quotes an instance which cannot be credited in a consistency with undoubted testimonies that pestilential contagion does not extend but for a very little way. Upon opening an infected bale of wool in the field near Cairo, “two Turks employed in the work were immediately killed, and some birds which happened to fly over the place dropped down dead.” Such accounts have arisen from a supposition that the whole mass of atmosphere was violently infected; but this would be totally inconsistent with the life of any human creature, and we may well put down this, as that of pestilential infection arising from cities like a cloud, as merely chimerical.112 It is too well known that pestilential contagion, instead of soaring in the air, keeps very near the ground.

We now come to the second mode of prevention, viz. removing these local causes which, in the opinion of some, may produce a plague in any country, and, in that of others, may increase or set in action the contagion previously existing. These causes have been enumerated by the late Dr. Smith,113 in a Dissertation on the pestilential Diseases which at different times appeared in the Athenian, Carthaginian and Roman armies, in the neighbourhood of Syracuse. They are, 1. The climate and season. 2. The situation of the armies; and, 3. Their condition. The climate of the island of Sicily in general he observes is extremely pleasant at some seasons of the year; in the neighbourhood of Syracuse particularly storms are so infrequent during the former part of the year, that the sun is never obscured for a whole day. Even in the month of January, however, the weather is warm, and as the season advances the heat becomes insupportable. In autumn it is rendered somewhat unpleasant and unhealthy by the frequent rains and chillness of the evenings. But, in particular places, during the hottest season, nothing can exceed its unhealthiness. According to Barichten, “the least stagnant water is sufficient, in the heats of summer, to poison the atmosphere: its effects on the countenances of the poor people who live in its vicinity are evident; and a stranger who travels through the island in this season ought to avoid ever passing a night near them.” De Non says, that “as soon as the sun enters the Lion, this country becomes the house of death: fevers of the most malignant kind seize on the imprudent or unfortunate wretch that spends a night near them (ponds and marshes) and few escape with life when attacked by so virulent a disorder.”

To the poisonous effluvia of these marshes the Doctor attributes, in an especial manner, the plagues which took place in the armies. In the second year of the Peloponnesian war, the Athenian army was encamped, as we are told by Thucydides, “upon marshy and unwholesome ground;” and that such kind of encampments will produce diseases in an army is well known. In the time of Dionysius, when the Carthaginian army under Imilco suffered so dreadfully, or rather was totally destroyed, his camp was situated on an eminence between two morasses, the heat at that time being excessive. Hannibal, the predecessor of Imilco, had also lost great part of his army by a plague, though he had been encamped in a healthy situation; but, in order to raise a wall which should overlook the city, he had taken the materials of the tombs found in the common burial place, the city at that time containing two hundred thousand inhabitants. “From the uncovering and disturbing of so many dead bodies (says our author) arose a terrible pestilence, which carried off immense numbers of the Carthaginians, and amongst the rest the general himself.” To the unhealthy situation of the armies also the Doctor ascribes the plague which took place in the Roman and Carthaginian camps in the time of the second punic war; and the Carthaginians suffered most, by reason of their being nearer to the marshes. The state of mind, the cleanliness of the person, &c. also must be taken into account; and our author shows that neither of these could be supposed favourable to the Carthaginians.

That personal cleanliness, and breathing pure air, should contribute to the health of individuals, or to any number of them collected into camps or cities, seems to be agreeable to reason and common sense; nevertheless we find that this has been denied, and even Dr. Canestrinus says that “in the plague of Lyons and Marseilles it was observed, that the most populous parts of these cities, where the streets were narrow and filthy, suffered less from the disease than those which were more airy and clean. At the time of the plague in London in the time of Charles II, the physicians advised that all the privies should be opened and exposed; the fetid odour from which having pervaded the city, the plague was stopped! Is it from this cause (the author asks) that the plague has seldomer visited Spain, the towns of which are intolerably offensive from their want of cleanliness?”114

This certainly seems a very strange doctrine, nevertheless the fact that Spain is but little subject to the plague seems undeniable, and as it is no less certain that the towns are excessively filthy, it would seem that cleanliness is not effectual in preventing it. But, however agreeable the smell of human excrements may be to the Spaniards, or to the English physicians in former times, it seems to be less so at present. “I am persuaded (says Dr. Ferriar) that mischief frequently arises from a practice common in narrow back streets of leaving the vaults of privies open. I have often observed that fevers prevail most in houses exposed to the effluvia of dunghills in such situations.” In Spain the opinion seems to have been but lately eradicated; for some years ago, an order having been issued by government that the streets of Madrid should be kept somewhat cleaner, the people were so much exasperated at being threatened with the loss of the savoury odour, that a rebellion had almost ensued, and the physicians declared the smell of human excrements to be the most wholesome thing in the world.115

That the confinement of human effluvia, along with heat and want of water, will produce a malignant fever, is certain from the example of the unfortunate people confined in the Black Hole at Calcutta. In this case the distemper seems to justify the opinion that plague may be artificially produced, perhaps more than any other upon record; for Dr. Ferriar informs us that it was attended with eruptions resembling those of the true plague. In this case, however, the confinement was beyond example in any situation which can be supposed incident to a city or camp. There is no country in the world where the inhabitants are equally numerous with those of the empire of China, its population at present being estimated by Sir George Staunton at three hundred and thirty-three millions, a number equal to one third of the supposed inhabitants of the whole globe; of consequence the cities must be immensely crowded with inhabitants; yet it remains free from plagues. Human effluvia therefore, in the most populous state in which mankind can exist in society, are not able to taint the atmosphere of a country or city. The following is Dr. Clark’s account of that celebrated empire: “The whole empire of China is represented to be extremely delightful; the soil rich, the air pure, and the industry of the inhabitants astonishing. As it produces every luxury and necessary of life, it is justly esteemed one of the most fertile countries in the world. As the Chinese prohibit emigration, and seldom or never engage in war, their country is extremely populous. Every river maintains a proportion of inhabitants adequate to the land, whose families live continually in boats, without having any other place of residence. Their number of people lays them under the necessity of carrying industry to the greatest height; for otherwise their country, fertile as it naturally is, would be insufficient to maintain the inhabitants. Every inch of land is cultivated; no forests nor woods, nor even a single tree, is suffered to obstruct the labours of the husbandman. Canals are cut every where to water the fields, and marshes are manured for the cultivation of rice. By these means health and plenty are, in a great measure, the portion of its inhabitants through all the seasons of the year. The only terrible and fatal diseases to which they seem to be subject are the small-pox and leprosy.”

But, though our author determines in general that the air of China is pure, this cannot apply to every part of it without exception. On the contrary he describes in the following manner Wampoa, a village about fourteen or sixteen miles below the city of Canton, on Canton river: “It is the usual station of all European ships in this river. On one side the land is low, marshy, and covered with water, forming swamps fit only for the cultivation of rice. The extent of these swamps is considerable; the tide rises high, and overflows great part of them; but the intersection of the rivers renders them more pure than they would otherwise be; and consequently the air is much healthier than one could expect from the unfavourable aspect.”

In like manner Canton city he says “is built on a very extensive plain, and is large and populous. Here the government allow the English, Dutch, French, Danes and Swedes separate factories on the banks of the river. The city, though paved, is very wet in rainy weather; and the water makes its way under the factories of the different nations every tide. The houses are built with bricks; the apartments are in general small, and not very lofty, and the ground stories are very damp. When the business of the season is over, the supercargoes remove to Macao, a Portuguese island, subject to the Chinese government. The city of Macao is situated on a rising ground; the whole island is dry, rocky and barren; it is, however, plentifully supplied with provisions by the Chinese; and, though the air is very sultry, yet it is tolerably healthy.”

From the preceding account it is plain, that the causes which operate in the production of plagues and epidemic diseases in other countries, though they exist in China, do not act there with equal efficacy. At Wampoa the marshes in the neighbourhood must, in the hot season, emit noxious effluvia as well as any where else, and there can be no certainty that the overflowing of the tide is sufficient to put a stop to their malignant influence. At Canton the water penetrates below the floors of the houses, and we have seen from Dr Fordyce117 that in other countries the sprinkling of a floor with clean water, and the encampment of an army upon ground where water was found at a small depth below the surface, were sufficient to produce fevers; yet here it is not so. In this city also the inhabitants are numerous, and the apartments small; so that neither the perspiration of multitudes, nor the moist exhalations from water stagnating in the streets, nay, under the houses themselves, are able to produce the diseases in question. Again, at Macao the sultry heat of the air has as little effect as the rest.

Lastly, in Pekin, the capital, the population and the crowd are immense. According to Sir George Staunton,118 the city is about one third larger than London; but, as he supposes119 it to contain three millions of inhabitants, the population must be twice and a third-part as great as that of London in proportion to its bulk. “The low houses of Pekin (says he) seem scarcely sufficient for so vast a population; but very little room is occupied by a Chinese family, at least by the middling and lower classes of life. In their houses there are no superfluous apartments. A Chinese dwelling is generally surrounded by a wall six or seven feet high. Within this enclosure, a whole family of three generations, with all their respective wives and children, will frequently be found. One small room is made to serve for the individuals of each branch of the family, sleeping in different beds, divided only by mats hanging from the ceiling. One common room is used for eating.”

Where diseases are prevalent, circumstances of the kind just mentioned would certainly be urged as evident causes of them; but in China we see that something disarms such causes of their power. People, however, seldom want a salvo for any thing. “The crowds of people, at Pekin (says our author) do not prevent it from being healthy. The Chinese indeed live much in the open air, increasing or diminishing the quantity of their apparel according to the weather. The atmosphere is dry, and does not engender putrid diseases; and excesses productive of them are seldom committed.” But, if the dry air at Pekin contributes to the health of the people, why does not the moist air of Canton produce diseases? Besides, in this empire there are multitudes of people who live entirely upon the water, in a kind of houses constructed upon junks, employed in carrying grain from place to place, or for other purposes.120 Sir George Staunton computes the number of inhabitants on a branch of a single river to be no less than an hundred thousand. What then must they be throughout the whole empire! Yet these people, though continually exposed to moisture, as well as to an almost inconceivably crowded situation, are yet no more subject to epidemics than others. Our author does not specify the excesses which produce disorders. Intemperance in drinking no doubt is one of them; but Dr. Patrick Russel expressly says, that he never saw an instance of the plague being brought on by intemperance.

Lastly, with regard to living in the open air, Mr. McLean has ascribed to the vicissitudes of this element the principal if not the only cause of epidemics. “A fact worthy of notice (says he) is, that aged persons and children are both seldomer and less severely attacked by epidemics and pestilential disorders than the young and middle aged, and women seldomer and less severely than men. Now, if contagion was the source of these diseases, the case would be exactly reversed. Old people, women and children, being more in the way of contagion, would be more frequently and more severely attacked. But the young and middle aged, being more exposed to the vicissitudes of the atmosphere, the principal source of those diseases, they are consequently more severely attacked. It has been a puzzling question to solve why old people and children are less exposed to plague, &c. but the solution will be no longer difficult if it should be proved that these diseases are always produced by certain states or vicissitudes of the atmosphere, together with the application of other powers co-operating in the production of indirect debility.” In the country we speak of, however, this solution fails in a manner almost as evident as can be imagined. “The removal of the embassy, (says Sir George Staunton) was a disappointment to several persons belonging to it, who had made arrangements for passing the winter at Pekin. Judging of its temperature by the latitude of the place, a few minutes under 40° north, they were not aware of the violent effect of the great range of high Tartarian mountains, covered perpetually with snow, upon that capital, where the average degree of the thermometer is under twenty in the night during the winter months, and even in the day time is considerably below the freezing point. The usual inhabitants were guarded against cold, not only by habit, but by an increase of clothing in proportion to its intenseness, consisting of furs, woollen clothes and quilted cottons. They are not accustomed to the presence of fire. They have no chimneys, except to kitchens in great hotels. Fires, on which Englishmen chiefly depend against suffering by the sharpness of the atmosphere, could not well answer that purpose in houses which are so constructed as to admit the external air almost on every side. Stoves are, however, common in large buildings. These stoves are situated frequently under the platforms on which the inhabitants sit in the day time, and rest at night. The worst weather experienced in that capital might be considered as mild by the Tartars, coming from a climate still more rude; but other foreigners are said to feel themselves less comfortable at Pekin in the winter than in the summer, though the heat is then raised to the opposite extreme. In both they seem to require a seasoning. Several individuals of the embassy fell ill during their stay; and all did not recover. The human frame seems calculated for the hottest rather than the coldest atmosphere, and to exist at the equator rather than the pole.”

Here we are involved in difficulties much greater than before. It appears that even the fine climate of China is healthful only to its own inhabitants. They can bear the vicissitudes of the air, which Europeans cannot. The prevention of plagues or mortal diseases then must consist in some mode of living by which people can accommodate themselves to the country which they inhabit, and without which every other precaution will be ineffectual. The diseases with which the attendants of the ambassador were seized could not be owing to any slovenliness or dirtiness in their lodgings or food, or to want of apparel; nor were they more exposed to the inclemencies of the air than others; only they were in a strange country, where that inexplicable constitution of the elements acted upon them in a manner different from what it did on the natives, and, while it was friendly to the latter, proved pernicious to the former. But there was a time when even China was as unhealthy as other countries; for the great plague in 1346 began in the northern part of it. We have seen, in a former section, that this was preceded by the most dreadful and violent wars throughout the whole Asiatic continent. Since the cessation of these violent wars the Chinese have staid at home, and applied themselves to the arts of peace, particularly to agriculture, which they have carried, we may say, to its utmost perfection. This seems therefore to be the true method of removing all those local causes which produce epidemics, or at least of preventing them from doing hurt; and, without attention to the natural duties and occupations of man, it is to be feared that all artificial modes of prevention will be found not only precarious but ineffectual.

Dr. Smith in the dissertation above mentioned observes, that “it may be doubted whether any moral cause would be sufficient to protect, for a long period, an unaccustomed resident in a marshy situation from the usual consequences.” This is no doubt very probable but, from the example of Lord Macartney’s attendants in China, it appears equally probable that it makes little difference whether the country be marshy or not. Dr. Lind has many excellent observations upon the subject of unhealthy countries, and gives particular directions for strangers how to act, when obliged to expose themselves to the inclemencies of the weather; but none of these being effectual in preventing the access of the true pestilence, we must still adhere to the old Latin adage already quoted, p. 302. Flight seems to be the most effectual method. To avoid migrations to those countries where it usually rages, and, if it were possible to persuade the inhabitants of such countries, to imitate the example of Chinese industry, instead of allowing the greater part of the territories they possess to lie waste, would in all probability gradually lessen both the frequency and violence of this terrible disease. Migrations of large bodies of people, especially for the purposes of war, are greatly to be dreaded. If a few Englishmen, possessed of every thing necessary, could not keep their health at Pekin, what must have been the probable consequence of landing an army of an hundred thousand, with a view to conquest? Or what could we expect if the Chinese were to “pour forth by millions” into other countries in order to conquer them? Dr. Lind takes notice that even of the first Portuguese adventurers to Africa, such as escaped the first sickness continued afterwards to enjoy good health. He likewise observes that many who left Britain, after being seasoned to the countries to which they went, chose rather to remain abroad for life, than to run a new risk by going back to their own country. It is not therefore so much the greater unhealthiness of the country to which we go, as the change, which is to be dreaded. If therefore great bodies of men will employ themselves in constant rambling from one country to another, no wonder that diseases break out among them, unknown, either in the countries they have left, or those to which they go.