Such was the form which the plague assumed in the fourteenth century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine, a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs.Now, as every carbuncle, whether it be cutaneous or internal, generates in abundance the matter of contagion which has given rise to it, so, therefore, must the breath of the affected have been poisonous in this plague, and on this account its power of contagion wonderfully increased; wherefore the opinion appears incontrovertible, that owing to the accumulated numbers of the diseased, not only individual chambers and houses, but whole cities were infected, which, moreover, in the Middle Ages, were, with few exceptions, narrowly built, kept in a filthy state, and surrounded with stagnant ditches.Flight was, in consequence, of no avail to the timid; for even though they had sedulously avoided all communication with the diseased and the suspected, yet their clothes were saturated with the pestiferous atmosphere, and every inspiration imparted to them the seeds of the destructive malady, which, in the greater number of cases, germinated with but too much fertility.Add to which, the usual propagation of the plague through clothes, beds, and a thousand other things to which the pestilential poison adheres--a propagation which, from want of caution, must have been infinitely multiplied; and since articles of this kind, removed from the access of air, not only retain the matter of contagion for an indefinite period, but also increase its activity and engender it like a living being, frightful ill-consequences followed for many years after the first fury of the pestilence was past.
The affection of the stomach, often mentioned in vague terms, and occasionally as a vomiting of blood, was doubtless only a subordinate symptom, even if it be admitted that actual hematemesis did occur.For the difficulty of distinguishing a flow of blood from the stomach, from a pulmonic expectoration of that fluid, is, to non-medical men, even in common cases, not inconsiderable.How much greater then must it have been in so terrible a disease, where assistants could not venture to approach the sick without exposing themselves to certain death? Only two medical descriptions of the malady have reached us, the one by the brave Guy de Chauliac, the other by Raymond Chalin de Vinario, a very experienced scholar, who was well versed in the learning of the time.The former takes notice only of fatal coughing of blood; the latter, besides this, notices epistaxis, hematuria, and fluxes of blood from the bowels, as symptoms of such decided and speedy mortality, that those patients in whom they were observed usually died on the same or the following day.
That a vomiting of blood may not, here and there, have taken place, perhaps have been even prevalent in many places, is, from a consideration of the nature of the disease, by no means to be denied; for every putrid decomposition of the fluids begets a tendency to hemorrhages of all kinds.Here, however, it is a question of historical certainty, which, after these doubts, is by no means established.Had not so speedy a death followed the expectoration of blood, we should certainly have received more detailed intelligence respecting other hemorrhages; but the malady had no time to extend its effects further over the extremities of the vessels.After its first fury, however, was spent, the pestilence passed into the usual febrile form of the oriental plague.Internal carbuncular inflammations no longer took place, and hemorrhages became phenomena, no more essential in this than they are in any other febrile disorders.Chalin, who observed not only the great mortality of 1348, and the plague of 1360, but also that of 1373 and 1382, speaks moreover of affections of the throat, and describes the back spots of plague patients more satisfactorily than any of his contemporaries.The former appeared but in few cases, and consisted in carbuncular inflammation of the gullet, with a difficulty of swallowing, even to suffocation, to which, in some instances, was added inflammation of the ceruminous glands of the ears, with tumours, producing great deformity.Such patients, as well as others, were affected with expectoration of blood; but they did not usually die before the sixth, and, sometimes, even as late as the fourteenth day.The same occurrence, it is well known, is not uncommon in other pestilences; as also blisters on the surface of the body, in different places, in the vicinity of which, tumid glands and inflammatory boils, surrounded by discoloured and black streaks, arose, and thus indicated the reception of the poison.These streaked spots were called, by an apt comparison, the girdle, and this appearance was justly considered extremely dangerous.
