PESTILENCE. The terms pestilence and plague are used with much laxity in our A. V. The latter, however, which generally represents the Hebrew 11), is by far the wider term, as we read of ' plagues of leprosy,' of hail,' and of many other visitations. Pestilence is employed to de note a deadly epidemic, and is the word by which nn (Sept. Odvaros, and occasionally XotL6s) is translated. In our time, however, both these terms are nearly synonymous ; but plague is, by medical writers at least, restricted to mean the glandular plague of the East. There is indeed no description of any pestilence in the Bible, which would enable us to form an adequate idea of its specific character. Severe epidemics are the com mon accompaniments of dense crowding in cities, and of famine ; and we accordingly often find them mentioned in connection (Lev. xxvi. 25 ; Jer. xiv. 12 ; xxix. IS ; Matt. xxiv. 7 ; Luke xxi. ii). But there is no better argument for believing that ' pestilence ' in these instances means the glandular plague, than the fact of its being at pre sent a prevalent epidemic of the East. It is also remarkable that the Mosaic law, which contains such strict rules for the seclusion of lepers, should have allowed a disease to pass unnoticed, which is above all others the most deadly, and, at the same time, the most easily checked by sanatory regula tions of the same kind.* The destruction of Sen nacherib's army (2 Kings xix. 35) has also been ascribed to the plague. But—not to insist on the circumstance that this awfully sudden annihilation of 185,00o men is not ascribed to any disease, but to the agency of an angel (since such passages as 2 Sam. xxiv. 15, 16, weaken this objection ; and even Josephus understood the cause to be a pestil ence, Antiq. x. 1. 5)—it is impossible that such a mortality could have been produced, in one night, by a disease which spread itself by contagion, like the Oriental plague ; and the same remark applies, though in a less degree, to the three days' pesti lence in the reign of David (2 Sam. xxiv. 13). Those who entertain the common opinion about the means by which the destruction of Senna cherib's army was effected, regard the illness of Hezekiah (2 Kings xx. I-1 s) as connected, both as to time and cause, with that event ; and consider his `boil' especially to afford direct evidence that he suffered from the plague. The boil would have certainly been a most characteristic symptom, if we had the least indication that his disease was pesti lential ; but we have no evidence whatever that any epidemic prevailed at that time at Jerusalem.
The glandular plague, like the small-pox, is an eruptive fever, and is the most virulent and most contagious disease with which we are acquainted. The eruption consists of buboes, carbuncles, and petechix. Buboes are inflamed and swollen glands ; and the glands so affected are generally those of the groin, axilla, neck, and the parotid glands. More frequently there are two, three, or even four, such tumours. They sometimes subside of themselves ; or, what is more commonly the case, they suppurate : and as this process seldom commences before the disease has taken a favour able turn, it is regarded as the cause, but more correctly as a sign, of approaching recovery. A carbuncle is an inflammation of the skin, giving rise to a hard tumour, with pustules or vesicles upon it. It resembles a common boil, but differs from it in this important respect. The carbuncle becomes gangrenous throughout its whole extent, so that when the eschar separates a large deep ulcer is left. Under the term petechix are in cluded evanescent spots and streaks of various hues, from a pale blue to a deep purple, which give a marbled appearance to the skin. When
such livid streaks occur in the face, they disfigure the countenance so much that a patient can hardly be recognised by his friends. The disease varies so considerably in its symptoms and course, that it is impossible to give one description that will suit even the majority of cases. Sometimes the eruption does not appear at all, and even the general symptoms are not of that violence to lead an ignorant person to suspect the least danger. The patient is suddenly attacked with a loss of strength, a sense of confusion, weight in the head, oppression at the heart, and extreme dejection of spirits. Such cases sometimes terminate fatally within twenty-four hours, and occasionally on the second or third day. Generally, however, the patient is attacked with shivering or coldness, which is soon followed by fever, giddiness, pain in the head, occasionally also by vomiting. Buboes and carbuncles in most cases make their appearance on the first day ; and successive erup tions of them are not unusually observed during the course of the disease. There is a peculiar and characteristic muddiness of the eye, which has been described by Dr. Russell as a muddiness and lustre strangely blended together. The fever remits every morning, and increases during the day and night. The vomiting then increases ; the tumours become painful ; and the patient wanders, and is inclined to stupor. On the morn ing of the third day, in favourable cases, a sweat breaks out, which produces great relief, and some times even proves critical. The exacerbation on the fourth day is more severe than on the preced ing ones, and continues intense until it is terminated by the sweat on the morning of the fifth day, which leaves the patient weak, but in every respect re lieved. After this, the exacerbations become slighter and slighter ; and the buboes advancing favourably to suppuration, little or no fever remains after the beginning of the second week. In other cases, again, the symptoms are far more urgent. Besides vomiting, giddiness, and headache, there is also diarrhoea at the outbreak of the fever. During the night the patient becomes delirious or comatose. The pulse is full and strong; and though the tongue is not dry, the thirst is excessive. The fever abates somewhat on the succeeding morning, but the pulse is frequent, the skin hot and dry, and the patient dejected. As the second day advances, the vomiting and diarrhoea become urgent, the eyes are muddy, expression of counte nance confused, the pulse quick, and sometimes low and fluttering, external beat moderately feverish, or occasionally intense in irregular flush ings. There is pain at the heart, burning pain at the pit of the stomach, and incessant restlessness. When to these symptoms are joined faltering of the tongue, or loss of speech, and the surface of the body becomes cold or covered with clammy sweats, death is inevitable, although it may still be at some distance. When the patient has been much weakened by the vomiting, diarrhoea, or hmor rhage, the third day proves fatal ; but more com monly the disease is prolonged two or three days longer. In this form of plague, buboes appear on the second or third day, and sometimes later ; but whether they advance towards suppuration or not, they seem to have no effect in hastening or retard ing the termination of the disease. Lastly, in some cases, the eruption of buboes and carbuncles constitutes the principal symptom of the disease ; and patients are so little indisposed, that they are able to go about the streets, or attend to their usual avocations, if not prevented by the inflam mation of inguinal tumours.