Note 19 — THE GREAT PESTILENCE. CHAPTER I. THE COMMENCEMENT OF THE EPIDEMIC.

The following account of an outbreak of disease somewhat similar to the "Black Death" appeared in the British Medical Journal of 5 November, 1892:—"An official report of the Governor-General of Turkestan, which has recently been published in St. Petersburg, states that that province has been severely visited by an epidemic of 'Black Death,' which followed upon the footsteps of cholera. On September 10 (22) it appeared suddenly at Askabad, and in six days it killed 1,303 persons in a population of 30,000. 'Black Death' has long been known in Western Asia as a scourge more deadly than the cholera or the plague. It comes suddenly, sweeping over a whole district like a pestilential simoon, striking down animals as well as men, and vanishes as suddenly as it came, before there is time to ascertain its nature or its mode of diffusion. The visit here referred to was no exception to this rule. After raging in Askabad for six days the epidemic ceased, leaving no trace of its presence but the corpses of its victims. These putrified so rapidly that no proper post-mortem could be made. The Governor-General gives some details as to the symptoms and course of the disease, which, though interesting as far as they go, do not throw much light on its pathology. The attack begins with rigors of intense severity, the patient shivering literally from head to foot; the rigors occur every five minutes for about an hour. Next an unendurable feeling of heat is complained of; the arteries become tense, and the pulse more and more rapid, while the temperature steadily rises. Unfortunately no thermometric readings or other precise data are given. Neither diarrhœa nor vomiting has been observed. Convulsions alternate with syncopal attacks, and the patients suffer intense pain. Suddenly the extremities become stiff and cold, and in from 10 to 20 minutes the patient sinks into a comatose condition, which speedily ends in death. Immediately after he has ceased to breathe large black bullæ form on the body, and quickly spread over its surface. Decomposition takes place in a few minutes."