Part 2

As among the workmen of the manufactory, who had been removed from their own houses to a third convent at a distance from the other two, in order to perform quarantine, not one had been attacked with the disorder for the space of two months, they were allowed to return to their respective homes.

We now began to flatter ourselves that the plague had been entirely eradicated by the precautions which had been adopted. Scarcely, however, had we indulged in these fond hopes, when, towards the end of June, some people are taken ill of the same disorder at the hospital of St. Simon, where the quarantine was performed. On the 2nd of July, six people die in one night at a house in the suburb of Preobraginsky; a seventh, who lived with them, absconded[17]. Livid spots, buboes, and carbuncles are found upon the dead bodies. On the following days, many of the common people fall sick in different quarters of the town, and the mortality increases to such a pitch, that the number of deaths, which commonly amounted to about ten or fifteen _per_ day, and which, even during the prevalence of putrid fevers (as was the case for the two last years) did not exceed thirty, amounted at the end of July to as many as two hundred in the space of twenty-four hours. The sick, as well as the dead bodies, exhibited large purple spots and vibices; in many there were carbuncles and buboes. Some died suddenly, or in the space of twenty-four hours, before the buboes and carbuncles had time to come out; but the greatest number died on the third or fourth day.

In the middle of August, the number of deaths amounted daily to four hundred; and at the end of the same month to as many as six hundred. At this time buboes and carbuncles were more frequent than they had been in July. At the beginning of September there were seven hundred deaths in the space of twenty-four hours; in a few days, there were eight hundred deaths within the same number of hours; and a short time after, the deaths amounted to one thousand in a day!

The havoc was still greater during the time of the riots, which began on the 15th of September, in the evening; when an outrageous mob broke open the pest-houses and quarantine-hospitals, renewing all the religious ceremonies which it is customary with them to perform at the bed-side of the sick[18], and digging up the dead bodies and burying them afresh in the city. Agreeably to their ancient custom, the people began again to embrace the dead, despising all manner of precaution, which they declared to be of no avail, as the public calamity (I repeat their own words) was sent by God, to punish them for having neglected their ancient forms of worship. They further insisted, that as it was pre-ordained who should and who should not die, they must await their destiny; therefore, that all endeavours to avoid the contagion were only a trouble to themselves, and an insult to the Divinity, whose wrath was only to be appeased by their refusing all human assistance[19]. _General Yeropkin_, with a small party of soldiers drawn together as speedily as possible, dispersed the mob, and restored tranquillity in a few days, after which every thing was placed on its former footing. This vast concourse and intermixture of the healthy and infected, caused the contagion to spread to such a degree, that at this time the daily number of deaths amounted to one thousand two hundred and upwards!

Moscow, one of the largest cities in Europe, consists of four circles, or inclosures, one within another; the smallest, which occupies the centre, is called Kremmel, and the second, which surrounds it, Kitaya, (or Chinese-Town); they are both inclosed by brick-walls, and the houses within them are built of brick; the third, which is called Bielogorod (or White-Town) is without walls, they having been levelled with the ground; and, lastly, the fourth called Zemlanoïgorod (from Zemla, land or earth, and Gorod, town) is defended by a ditch and rampart of earth[20]. In the two last-named parts of Moscow the houses are, for the most part, constructed of wood. These houses do not stand close together, but are detached with spaces between, and, in general, only one family inhabits each; hence they rarely consist of more than one story, and often of a ground-floor only. The nobles keep a great number of servants; and the common people live crouded together in small wooden houses[21].

In winter time the nobles repair to Moscow, from all parts of the empire, bringing with them a large train of attendants. Great numbers of the common people, who were engaged during the summer in agricultural labour, return to this great city in the winter, to gain subsistence by different employments. This conflux of people makes the town so full, from the month of December to March, that the population, at this season, amounts, according to some computations, to two hundred and fifty thousand; according to others, to three hundred thousand. In the month of March, people begin to go into the country again; hence, during the summer, the number of inhabitants is, at least, one-fourth less than in winter. In 1771 the fear of catching the plague had caused a much greater number to leave the city; so that I do not think that, in the month of August, there were more than one hundred and fifty thousand remaining in the place. An idea may be formed of the destructive nature of this disorder, and the terrible activity of its poison, by reflecting, that of these one hundred and fifty thousand inhabitants, twelve hundred were daily carried off by it, (in the month of September!) The number of deaths kept at this rate for some days, and then diminished to one thousand. As the populace, during the riots, had re-established all the religious ceremonies customary on burying the dead, almost all their priests, deacons, and other ecclesiastics, fell victims to the contagion.

The people, brought to a sense of their duty, partly by the rigorous measures employed against them, and partly by seeing that the public calamity had been aggravated by their disorderly proceedings, now began to implore our assistance. The monasteries and other pest-houses were full; the sick were no longer carried thither; the contagion had spread every where; insomuch that the city itself might be considered as one entire hospital. All, therefore, we could now do, was to exhort every individual to take care of himself; to warn all those who were yet free from the contagion, to avoid, as much as possible, touching with their bare hands any infected person; to direct them to burn the clothes, and every thing else that had been used by those who had been ill of the plague; and, lastly, to keep their rooms clean and well aired.

At this time _Count Gregory Orlow_[22] arrived at Moscow, invested with full powers by the empress. I received an order, in common with the other physicians, to deliver, in writing, my private sentiments on the subject; we were required to turn our attention principally to the most proper measures for destroying the contagion[23]. Having taken the necessary steps to prevent all further popular commotions, the Count selected, from all our papers, what appeared of most moment, and drew up a set of regulations, as well for the treatment of the sick, as for the keeping of those who were yet well, free from infection. He also ordered new hospitals to be immediately built for the reception of the poor seized with the plague[24].

Some months had elapsed since the plague had been carried to many of the villages, as well in the vicinity as at a distance from Moscow. Persons who fled from this city had also carried it with them to Kalomna (Kaluga, according to _Orræus_), Yaroslaw, and Tula. Inspectors of health, attended by physicians and surgeons, were sent to these infected towns and villages.

A Council of Health was formed, composed of _General Yeropkin_ (who was president), of some counsellors of state, and of three physicians, and one surgeon. This council received daily reports from the physicians and police-officers, and took cognizance of every thing which related to the health of the inhabitants. Two physicians, Drs. _Pogaretzky_ and _Meltzer_, being offered a reward of one thousand roubles, undertook, each of them, the care of a pest-hospital; and went thither accordingly.

On the 10th of October the frost set in; from that day the disorder was less fatal, and the contagion became more fixed. The number of sick and dead gradually diminished; and the disorder, which a short time before had terminated on the second or third day, now kept on to the fifth or sixth. Neither those large purple spots, which we have before described, nor carbuncles, were by any means so frequent as they had been; buboes were now almost the only tumours found upon the infected.

The hard frost[25] which prevailed during the two last months of the year, weakened the pestilential virus to such a degree, that those who attended the sick and buried the dead were in much less danger of being infected; and when they were infected, the symptoms were much milder; so that at this period, several persons who had the plague were but slightly indisposed, and walked about though they had buboes upon them.

At the close of the year 1771, this dreadful scourge ceased, by the blessing of God, at Moscow, and in every other part of the Russian empire. Besides the three towns before-mentioned, upwards of four hundred villages had been infected.

The weather was intensely cold during the whole of the winter. In order to destroy all remains of the contagion, the doors and windows of the rooms in which there had been any persons ill of the plague, were broken and the rooms were fumigated with the antipestilential powder[26]; the old wooden houses were entirely demolished. The effects of the plague were traced in every part of the city. Even as late as the month of February, 1772, upwards of four hundred dead bodies were discovered, which had been secretly buried the year before in private houses. So powerful is cold in destroying the contagion, that not one of those who were employed in digging up these bodies, and carrying them to the public burying-grounds, became infected[27].

The total number of persons carried off by the plague amounted, according to the reports transmitted to the Senate and Council of Health, to upwards of seventy thousand; more than twenty-two thousand of this number of deaths happened in the month of September alone[28]. If we add to these, the private and clandestine interments[29], the whole number of deaths in Moscow will amount to eighty thousand[30]: and reckoning those who died in upwards of four hundred villages, and in the three towns of Tula, Yaroslaw and Kalomna (or Kaluga)[31], it will follow that this plague swept off altogether as many as an hundred thousand persons!

For carrying away and burying the dead, criminals capitally convicted or condemned to hard labour, were at first employed; but afterwards, when these were not sufficient for the purpose, the poor were hired to perform this service. Each was provided with a cloke, gloves, and a mask made of oiled cloth; and they were cautioned never to touch a dead body with their bare hands. But they would not attend to these precautions, believing it to be impossible to be hurt by merely touching the bodies or clothes of the dead, and attributing the effects of the contagion to an inevitable destiny. We lost thousands of these people, who seldom remained well beyond a week. I was informed by the Inspectors of Health, that most of them fell ill about the fourth or fifth day.

The plague, as is generally the case, raged chiefly among the common people; the nobles and better sort of inhabitants escaped the contagion, a few only excepted, who fell victims to their rashness and negligence. The contagion was communicated solely by contact of the sick or infected goods; it was not propagated by the atmosphere, which appeared in no respect vitiated during the whole of the time. When we visited any of the sick we[32] went so near them that frequently there was not more than a foot's distance between them and us; and although we used no other precaution but that of not touching their bodies, clothes, or beds, we escaped infection. When I looked at a patient's tongue, I used to hold before my mouth and nose a pocket-handkerchief moistened with vinegar[33].

Amid so great a number of deaths, I think there were only three persons of family, a few of the principal citizens, and not more than three hundred foreigners of the common class, who fell victims to the plague; the rest consisted of the lowest order of the Russian inhabitants. The former only purchased what was absolutely necessary for their support, during the time of the pestilence; whereas the latter bought up every thing which was rescued from the flames, and which of course was sold at a very low price; they refused to burn the goods which came to them by inheritance; and, moreover, carried away many things clandestinely, in spite of all we could say or do to the contrary.

Two surgeons died of the plague in the town; and a great number of surgeons-mates and pupils in the hospitals. Dr. _Pogaretzky_ and Mr. _Samoïlowitz_, first surgeon to the hospital of St. Nicholas, both caught the infection several times; and were cured by critical sweats coming on at the beginning of each attack of the disorder.

The foundling hospital, which contained about a thousand children[34] and four hundred adults (including nurses, servants, masters, and workmen) was kept free from infection by the precautions hereafter mentioned[35]. Only four workmen, and as many soldiers, who had got over the fences in the night time, were seized at different times; but by immediately separating them from the rest of the house, the disorder was prevented from spreading any farther. Thus this building was kept free from the plague, at the time that it raged in all the other houses around it; a proof that the atmosphere, not only during the frost, but even during the great heat of the summer[36], did not serve as a vehicle for spreading the contagion, which was only propagated by contact of the sick or infected goods[37].

The young and robust were more liable to become infected than elderly and infirm persons; pregnant women and nurses were not secure from its attacks. Children under four years of age were much less readily infected, but when they were, they exhibited the worst symptoms.

All who were attacked with the plague had more or less fever; though in some it was so slight as to be scarcely perceivable. In a few instances, the patients were seized, from the first, with a furious delirium, accompanied with a high degree of fever; but the greater part were affected with debility, and only complained of oppression about the præcordia, and head-ach[38].

After taking great pains to ascertain in what manner the plague was introduced into the military hospital, the physician to that institution at length found out that two soldiers had died there in the month of November, 1770, a short time after their arrival from Choczim, where the plague was then raging; and that a Colonel, in whose train they were, had died upon the road. It would seem that the anatomical dissector opened the bodies of these soldiers; and that he caught the plague of them. The persons who waited upon the sick, either became infected by touching the bodies of these soldiers whilst they were living; or by handling their clothes, or their bodies after death. These attendants afterwards spread the contagion among their families.

Thus have we traced the history of the plague which depopulated Moscow in the year 1771, from its first appearance to its final extinction. A plain and faithful statement of facts, even at the risk of being tedious, is what has been aimed at in this narrative; for let it be observed, that it is from simple details of the origin and progress of the plague, as it appears in different places, and of the symptoms and other circumstances with which it is accompanied, and not from the laboured dissertations that have been written upon it by some voluminous authors, that we can hope to acquire an accurate knowledge of the nature of this disorder, to ascertain the manner in which its contagion is propagated, and lastly to discover the best methods of prevention and cure.

ADDENDA.

A.

_Symptoms more particularly described._

The symptoms of the plague vary according to the different constitutions of the persons whom it attacks, and the season of the year in which it appears. Sometimes it wears the mask of other diseases; but in general it is ushered in by head-ach, stupor, resembling intoxication, shiverings, depression of spirits, and loss of strength; these are followed by some degree of fever, together with nausea and vomiting. The eyes become red, the countenance melancholy, and the tongue white and foul. In this state of things, the patients are sometimes capable of sitting up, and going about for some hours, or even a day or two. They feel an itching or pain in those parts of the body where buboes and carbuncles are about to appear. During the height of the plague, many of the infected die on the second or third day, before these tumours have time to come out, and with no other external marks except petechiæ or purple spots, which appear a short time before death; in some these spots are altogether wanting. The buboes and carbuncles generally come out on the second or third day, seldom on the fourth.

In some instances, the plague appears under the form of an inflammatory disorder, being accompanied with great heat, thirst, high-coloured urine, flushed cheeks, and violent delirium or phrensy; but in the greater number of cases it assumes the type of a nervous fever, being accompanied with little heat and thirst, and pale and turbid urine; the patients think themselves only slightly indisposed, until a sudden prostration of strength, and the eruption of buboes, carbuncles, petechiæ or vibices, announce to themselves, as well as to those who are about them, the danger they are in. In some few instances, the plague appears under the form of an intermittent fever.--Almost all those who are carried off by this disorder, die before the sixth day; those who get over the seventh day have a good chance of recovery[39].

The diversity of symptoms above-noticed, has given rise to the opinion that there are three different species of the plague, viz. one which is accompanied with petechiæ, another with carbuncles, and a third with buboes; but the history which we have given, clearly proves, that these are only shades or modifications of one and the same disorder, which is more or less violent under different circumstances and at different seasons. Petechiæ, buboes, and carbuncles often appear at the same time in the same patient, or occur in succession. In the month of July, great numbers of the impested died before the tumours came out, having petechiæ only; whereas in August and September, almost every patient had petechiæ, joined with buboes and carbuncles. After the middle of October, when the contagion was less virulent, although it still produced petechiæ and carbuncles, yet they were neither so malignant nor so frequent. Before this period, scarcely four patients in a hundred recovered; whereas during the latter months of the year, the proportion of recoveries was much greater. _Sydenham_ has made the same observation respecting the plague at London[40]. Nature endeavours to throw off the poison by buboes. Carbuncles and petechiæ are not critical eruptions; they only denote a putrid condition of the humours, and a great degree of acrimony; whence it follows, that in proportion as buboes are more common, and petechiæ and carbuncles more rare, the milder the plague is[41].

* * * * *

To this account which Dr. _Mertens_ has given of the symptoms which the plague at Moscow exhibited, we shall add the descriptions drawn up by two other practitioners (_Orræus_ and _Samoïlowitz_,) who had great opportunities of observation, and who have been more particular in noticing some of the phenomena than our author.

According to _Orræus_ (Descriptio Pestis, &c.) the plague in Russia appeared under four different forms or varieties. Of these, he terms the first, _the period of infection_; the second, _the slow type_; the third, _the acute type_; and the fourth, _the exceedingly acute type_.

1. In _the period of infection_ (which is commonly the forerunner of the other forms of the plague) the contagion, less active and virulent, keeps lurking in the body, and produces the following symptoms, viz. sharp, flying pains in the glandular parts (such as the armpit and groins) and in the muscles of the neck and breast; ardor urinæ; drowsiness; an increased secretion of the sebaceous humour, so that the skin is in many parts, and more especially in the hands and face, much more unctuous and glossy than usual; the belly is costive, but when moved, there comes away a great quantity of pulpy slimy fæces; the patients complain of a heaviness of the body (some compare their limbs to a mass of lead), great lassitude and faintings. A swelling, but without much pain, of some gland (in the groin or armpit) together with dark-red or brown spots, denote a higher degree of infection: and a bad taste in the mouth, a viscidity of the saliva, loss of appetite, whiteness and foulness of the tongue, and head-ach, show that the patient is going to be attacked with the plague under one or other of the following types. The above-mentioned symptoms, which continue for a longer or shorter time (in some instances for several days or even weeks) are not accompanied with fever.

2. After the period of infection above described has continued for some time without yielding to medicine, it generally ends in _the slow type of the plague_, which is characterized by the following symptoms; viz. shiverings, followed by a moderate degree of heat[42], a febrile[43], unequal, for the most part weak, and often intermitting pulse; a constant dull pain in the head (rather, according to the expression of some patients, a heaviness, as if the head was full of lead); urine pale and turbid, but without sediment; tongue foul and moist; very little thirst; depression of spirits; belly costive during the first three or four days, with inflation of the hypochondria and borborygmi, but the abdomen feels soft on pressure; there is frequent nausea and vomiting of a slimy greenish-yellow faburra[44]; petechiæ and other eruptions[45] make their appearance, in some sooner in others later; but in some they are altogether wanting. The rudiments or germs of buboes and carbuncles, which were forming during the period of infection, now gradually increase in size, but without being accompanied with violent pain; and new ones arise in other places; which, if they suppurate on the fifth, sixth, or seventh day, save the life of the patient: on the other hand, if no suppuration takes place, and great debility, diarrhoea, and delirium come on, the disease terminates fatally, not, however, in some cases till after the fourteenth day.