Putrefaction occurs speedily after death ; the limbs re main flexible, hxmorrhages take place, and petechix or vibices appear. On dissection, the gall-bladder has been found distended with greenish-black bile, the inside of the intestines and stomach have been covered with a yellow mucus, and the conglobate glands indurated. But dis sections, for obvious reasons, have not been numerous.
It has been asked, whether the buboes and other erup tions are a favourable effort of nature ; and, of course, what their treatment ought to be. It is commonly thought that their disappearance is a bad sign ; yet there are many instances of recovery under these circumstances. The plague has sometimes a crisis at three, five, or seven days, marked by the urine and perspiration ; but it does not appear that the eruptions are ever critical. Nothing is known of the proximate cause of this disease, more than that of fever, and we will not waste upon this sub ject what, after all, are nothing but words.
It is very important to be able to distinguish this dis ease with certainty, even in the slightest cases, and on the first attack ; as it is in these that its progress is most dangerous. Unfortunately the first symptoms are often very equivocal ; but, in the Levant, where physicians are always on the watch for it, the slightest marks of debility, sickness, or pain of the head, are carefully watched. In our own country, these would naturally pass for common fever, should the presence of the plague not be suspected. Many imaginary signs, peculiar to this disease, are talked of in the Levant, particularly among the Turks; but European physicians consider them as unmeaning. The presence of buboes, or petechix and carbuncles, leave no doubt :' but in all cases the physician must be guided by many circumstances united, and by such collateral con siderations as may be derived from the presence or pro bability of this contagion.
Prognosis in the Plague.
The disease may be divided into three periods, its rise, vigour, and declension. It is in the first stage that cures are chiefly effected, and often, it is likely, by the hand of nature, even when medicines have gained the credit. All general attacks of the disease are most fatal to people during the times when there are most sick. During its decline at Marseilles, about one half recovered, but during its more general prevalence, not more than one third were saved. It does not prevent the occurrence of the usual remittents and other diseases of a country, and, by careless persons, these have sometimes been con founded with it.
In individual cases, the prognostic depends on the violence of the symptoms. At Marseilles, the favourable cases were attended only slight shivering at the time of the attack, pain in the epigastrium, nausea, vomit ing, headach, and vertigo, with a moderate fever that ter minated in five or six days, by sweat or alvine dejections, but without hoboes or eruptions. But even in some of these, there were buboes that suppurated quickly, or of which the suppuration was protracted without inconve nience for twenty or thirty clays, or which were resolved and disappeared.
In the next class, besides the symptoms above enume rated, there were pains about the region of the heart, great prostration of strength, fainting, oppression, coma, delirium, phrenzy, hxmorrhages, and diarrhza, with bu boes that suppurated with difficulty, carbuncles, pustules, and petechix. But even in these cases, if the patients survived four days, about one quarter of them recovered. In the last and most severe cases, the patients were sud denly attacked with violence, as already remarked, and generally died in a few hours, from one even to twenty lour, although the pulse was but slightly or not at all af fected. These patients complained of little but debility, but were always known by their peculiar physiognomy already described.
In Egypt, in the French army, those who had a slight fever, with delirium and buboes, almost always recovered ; the delirium abating on the fifth day, and the fever dis appearing on the seventh, was attended with a consider able proportion of recoveries. In the more severe cases, where there was much delirium and fever, with carbun cles, buboes, and petechix, very few recovered, and death took place between the third and fifth days. In the Le vant, it is esteemed a good sign if there are many buboes ; and even thirteen have been known ; but when there are buboes and carbuncles together, the cases are esteemed nearly hopeless. A firm hard buboe is esteemed favour able ; a flaccid or soft one the contrary ; particularly if it is attended with convulsions, hiccup, cardialgia, diarrhoea, or swcatings. It is farther said, that a bright red inflam mation in all these tumours is a fatal sign, and that a vio let colour is favourable.