PLAGUE is a disease that is epidemic, contagious, and very acute, caused by a subtle poison spread through the air, which penetrates into our bodies and there produces buboes, blisters, [1] rashes, and other most disturbing symptoms.

It is an acute fever that becomes fatal and takes the sick within the first day or two if the vital forces do not promptly expel the poison through the buboes, blisters, flush, and other rashes.

Causes . This point is among the most difficult to treat; every author has written about this subject matter, but we have nothing certain on this point. Endless numbers of conjectures have been advanced: some have insisted on coagulation, others on a general or local infection acting on the humors of our body. But what is most singular is that all are obliged to recognize that the plague acts in a very different way on those in the lands where it arises than on the rest of us.

Plague comes to us from Asia, and for two thousand years all the plagues which have appeared in Europe have been transmitted by the communication of Saracens, Arabs, Moors, or Turks with us, and all plagues here have had no other source.

The Turks seek out the plague in Mecca in their caravans and pilgrimages; they bring it from Egypt also with corrupted grains; and finally it is preserved among them by their strange way of thinking about predestination: persuaded that they cannot escape the order of the Almighty concerning their fate, they take no precautions to prevent the advance of the plague and protect themselves from it; thus they communicate it to their neighbors.

There are four recognized kinds of plagues . First, the bubonic plague , where buboes appear in the armpits and in the groin, or other eruptions over the whole body, like blisters.

Second, the English sweating sickness, sudor anglicus , in which the victim perishes by sweats the first, second, or third day, without buboes or blisters.

The third is without buboes or blisters, but it is accompanied by gangrenous deposits that attack the feet, the hands, and above all the external reproductive parts of men, so that those members detach themselves unaided from the bodies of the infected. This is the plague of Athens which was described by Herodotus and later by Lucretius.

The fourth kind is the best known: it is commonly called the Siamese disease; it comes from the Orient, and we see many infected die of this plague in La Rochelle. In this kind, blood is lost through the pores of the skin as perspiration, and the sick perish.

Thus plague is a particular infection that arises in warm countries, comes to us on vessels carrying merchandise infected in Turkey or in Egypt, where there is plague three or four months of the year because of the flooding of the Nile.

The plague -stricken, or the infected packages unloaded in our ports, cause plague and attract it to us, such as the last plague in Marseille, [2] which was occasioned by a vessel we had taken from the Turks and brought to Marseille. Or else it comes to us by communication of Germany and Hungary with the Ottoman Porte: that is how the Germans brought plague home when returning from the campaigns they had fought in Hungary against the Turks.

In this way plague begins and takes its origin in eastern countries, and we go catch it there. Plague acts on our humors, and we do not know how.

The causes are internal and external, proximate and distant. The internal ones are the vice of parts, corruption of the blood and the other humors. Passions, worries and fear in the soul; bad diet and abuse of unnatural things, either air or foods, or the lack of exercise, contribute a great deal to attracting this disease. The external causes are the southern winds or the lack of wind; an overly mild winter, uneven seasons, violent cold and excessive heat, very dry or very humid air. Epidemic diseases with buboes and phlegmons [3] are more certain forerunners of plague than exhalations and imaginary influences.

Famine too can be counted among the causes, because in that sad conjuncture the same cause that spoils the products of the land and brings shortage must produce plague ; besides, in time of famine one is forced to eat all sorts of unhealthy foods, which form bad blood, and bodies are consequently more disposed to decomposition.

Some attribute plague to earthquakes, because we have often seen malign and deadly diseases succeed these quakes.

The true cause is the reception of putrid air-borne exhalations that come from warm countries and which is aided and fomented by the disposition of our bodies. Their ill effect is particularly perceptible when a warm and humid wind blows, or when they are themselves mixed with corrupt vapors. That is how plague arrives in Egypt after the flooding of the Nile; then the waters, corrupted by excessive heat, let forth pestilential exhalations; the lands, drenched and as if laden with putrefaction, are very unhealthy.

That is how rotting cadavers in large cities during sieges or in armies after battles horribly infect the air; the fetid, volatile exhalations of those cadavers often produce malign diseases, but they do not produce plague without a particular poison that is brought from warm countries and which, mixed with them, gives them a pestilential character.

This ferment can extend so far only by means of the air which serves as its vehicle; for the air, once infected with these exhalations, bears them along and communicates them to many of the bodies which it penetrates; this ferment even remains hidden for long periods in infected bodies, as it did with the most recent plague . That is why we have seen people fall stone dead, and be suddenly stricken with plague at the mere opening of infected packages unloaded from ships that came from the Orient.

Yet these exhalations do not infect the entire mass of the atmosphere; they disperse and flow one way and another, much like smoke; that is why everybody in the same air, which is nonetheless the vehicle of the pestilential ferment, does not catch the plague . It takes a predisposition: that is properly speaking the determining and dispositive cause of plague .

Dispositive cause . Indeed, all bodies are not susceptible to this poison; it affects only those whose fluids and solids are predisposed to receive the infection. If the body does not have this predisposition, it will resist the contagion; thus anything that can preserve our solids and fluids against corruption while the plague prevails should be considered a prophylactic.

Predisposition to corruption is one cause that indeed abets the effect of contagion. For corruption is an inner movement of our humors that tends to destroy the mixture, form, and tissue that change nature. In addition, if the blood slows, that alone suffices to contract this movement of putrefaction; this is what happens in the depression and vice of the upper tract. [4]

This plague poison acts very differently from the one which acts in smallpox, the ague, malign fever, and dysentery. This poison acts on the humors and coagulates them, as appears from the critical eruptions.

That this poison first acts on the nerves appears from symptoms such as headache, weakness, nausea, shivering, external chills with external inflammation inside, the blood then finding resistance on the external parts, rushes to the internal ones.

The proximate cause of plague is therefore the action of the poison on our solids, the development of corruption of the humors and of this poison, and finally its action on the nerves. These actions produce irritation of the nervous sort; that is the source of the corruption. Such is the nature of the pestilential poison that, without this poisonous predisposition, the exhalations have no effect in the body; they remain hidden and quasi dormant there for a long time, and finally they are sweated out and dissipate without producing any damage.

This irritation is a stiffening in the fibers, and a contraction like the one provoked by the passions of the soul, [5] by all irritants, such as those which hot foods, seasonings, and all stimulants are wont to produce. This stiffening is increased by an arousal of the fibers caused by the poison; stimulated, they contract the pestilential disease; for the exhalation then passing into the blood and humors makes the different symptoms of the corruption break out.

Symptoms . The victim is first gripped by a shiver followed by a stirring in his bowels; often he does not feel thirst, although he feels violently hot; sometimes there is little perspiration and extraordinary thirst. The fever is very uneven, but the tongue is dry and black. The urine too is very different, often it is unchanged; in some it is red and burning, in others clear and crude, [6] in some others it is cloudy, and varies often within a single day; now it is in a healthy state, now bloody. Sometimes the diseased is lethargic and delirious, at other times he suffers from an intense headache accompanied by insomnia with bright red eyes and the heart much constricted. Sometimes the pulse is strong, at other times it is weak and rapid, sometimes regular, sometimes irregular, and in certain victims it is intermittent. The diseased is constantly anxious and agitated; jerking and convulsive movements can be seen in the tendons. Vision is clouded, and the afflicted person is tormented by blaring and hissing in his ears. There are some who are felled at the onset of the disease, and others who maintain their strength until death. There are some who have distempered stomachs that respond to no treatment; the stools are sometimes crude and frequent, and like cloudy water. In some victims worms are found; in others hemorrhages through the nose and the mouth, the eyes, the ears, the penis, the womb; others sweat pure blood; some are constantly vomiting; others have nausea and aversions. In most we see heartburn pain and hiccoughs; we see some who have splotches of purplish or violet or black color, sometimes just a few, sometimes in great number, sometimes small, sometimes large and almost perfectly round; sometimes on one part of the body and sometimes on another, often over the whole. There are many who have buboes or blisters on different parts of their body. These are evident and very certain signs of plague , especially when they are accompanied by fever, or come on during a fever.

The diagnosis is made based on the following symptoms:

1. Loss of strength, difficulty breathing, weakness, intermittent and variable pulse.

2. Intestinal symptoms, nausea, vomiting, heartburn, convulsive movements.

Sourness and corruption of bouillons and all nourishment.

3. The urine is cloudy, oily, containing oil gathered into flakes; perspiration is subject to colic, painful, oily and foul-smelling.

4. Buboes in the groin, in the hollows of the parotid glands, lesions on different parts, black, violet, or blue lanyards: the strength of the poison is indicated by these symptoms.

5. Dry gangrene and flaccidness of the members after death; and before death, bloody stools, excretions of blood in stools and perspiration.

6. Finally, the generality and universality of the epidemic, the numerous and too widespread mortality, the violence and the endless number of uncertainties, the unforeseen death that seizes the victims the first, second, or third day, and often almost as soon as they catch it, are evident and diagnostic signs of plague if they are compared to all those we have reported above, and with the causes which we have detailed.

Prognosis . It is all the more disturbing that no one has yet identified either the cause or the remedy for this terrible illness, although we have many very thorough treatises on its cause and the means of treating it. Indeed, it is of all illnesses the cruelest. Everyone trembles at the very mention of this disease; this fright is only too well founded: a thousand times more deadly than war, it kills more people than the sword and gunfire. It is only with horror that one imagines the terrible ravages it causes; it reaps entire families; it spares neither age nor sex: we see old people dying, men in their prime, adults, children in the cradle. Even those who are hidden in their mother’s entrails, though they appear sheltered from its blows, are subject to the same fate; it is even more pernicious for pregnant women, and if the child should reach term, it is less in order to live than to die. The foul air becomes fatal to them; it is even more fatal to those who have a strong and vigorous temperament. The plague destroys intercourse among citizens, communication among relatives; it breaks the strongest ties of family and society; added to so many calamities, men are constantly on the point of falling into despair.

Nevertheless, plague is not always as dangerous as is commonly imagined. The essential thing is not to be frightened in plague -ridden times: death spares those who pay no attention to it, and pursues those who fear it; not all the inhabitants of Marseille died of plague, and fear killed more than contagion did. Plague does not wreak greater havoc among the Turks and other oriental peoples who are accustomed to it than epidemic illnesses do among us, although they take few or no precautions, and this because there are not afraid. Besides, as those who attend the sick are not bothered by it, it seems that it only attacks those who are predisposed catch it.

Treatment of the plague. We can consider plague as threatening and about to seize the victim, or as already present and having infected him. In the first case, he must protect himself, if possible, and in the second, it must be fought to dissipate it and halt its progress. Thus the treatments are prophylactic and turn aside the proximate disease, or they are therapeutic and properly curative, by curing the disease once it is present.

Protective cure. One can protect oneself from plague by distancing oneself from the cause of the plague or by arming oneself against it, which concerns in part the public or the magistrate, and in part individuals.

The magistrate must see to: the cleaning and removal of all excrement and other stinking and corrupted matter, which only foment the pestilential poison and keep it hidden; the cleaning and removal of manure, mud, and garbage from the streets and public squares; the burial of the dead outside the churches in distant places, and to having them covered with lime; the forbidding of all assemblies, whether in open air or in houses; the ordering of fires, having the canon and musketry fired to keep infection away by this means and to cleanse the air with the odor of gunpowder; forbidding trade with cities where the disease prevails, or which are suspect; forbidding absolutely the entrance or use of bad foodstuffs; and finally, the minute plague begins to manifest itself, having the sick separated as soon a possible from people who are well.

The protection of individuals comes down to diet and to surgical and pharmaceutical treatments. Diet controls the use of air and the passions of the soul, which are the two important points in this disease. You avoid infected air by fleeing, or else you cleanse it with fumigations, perfumes, with odors, by bringing them often to your nose to cleanse the air as you breathe; most writers, trusting themselves to no treatment against such a cruel disease, recommend flight as the sole prophylactic by these two verses:

Contentment of mind prevents the effect of fear. Thales of Crete is reputed to have driven out a plague that was wreaking terrible havoc in Lacedaemon [Sparta] by procuring joy for the inhabitants. The physician is useless to those who can take these precautions, but he is necessary to those who cannot take flight and are obliged to remain in the midst of the plague -stricken. We cannot begin to list here all the prophylactic measures against plague ; it would take citing a flood of writers who have written on this subject.

M. Geoffroy wrote a thesis in 1721 in which he raises this problem: whether water is an excellent protection in times of plague . This thesis is translated into French in a book called Les Vertus médicinales de l’eau commune [ The Medicinal Virtues of Common Water ]. [8]

Therapeutic cure . The remedies which are indicated for curing plague when it is present are internal or external. We are going to detail the most vaunted of them, then we will speak of some compositions or some secrets and specific remedies which are highly esteemed.

Internal remedies have received from authors the name of antidote or alexipharmic , but where is the real alexipharmic? It is still unknown and hidden, or rather enveloped in thick darkness. There are however many remedies, simple as well as composite, that have this name.

Simple remedies are the roots of angelica, elecampane, peucedanum ostruthium, carlina, contrayerva, echium, saxifraga, vincetoxicum, zedoaria; the bark and wood of cinnamon, cassia lignea, sandalwood, the wood of balm, the wood of aloe; the leaves of boxwood, scordium, origanum dictamnus, lemon balm, cnicus, achillea millefolium; the flowers of calendula, roses, rosemary, hypericum. The fruits: lemons, oranges, limes, figs, walnuts, juniper berries, piper cubeba, cardamom, cloves, nutmeg, mace, juices and gums; camphor, myrrh, styrax, balm of Gilead; animal parts, flesh of viper, ivory, horns of unicorn, rhinoceros, and deer; volatile salts, their bile; precious fragments; pearls, bolus of bezoar, the stone of porcupine; the buried: Armenian bole, terra sigillata, white sulfur, and antimony.

The composite internal remedies are theriaca andromachi, Strasbourg theriac, Damocrates’ methridate, Francastoro’s diascordium, compounds of alchermes and hyacinth, orvietan, distillates of theriac, theriac vinegar, alexipharmic tinctures and elixirs.

There are a thousand others to which pompous names have been given, but we know for several reasons and from countless observations that all these remedies, instead of doing some good, deceive those who rely on them, often do harm, and lend new strength to the pestilential poison. See Alexipharmic.

The external alexipharmics are those which, applied externally, pass for being good for destroying the poison or purging it from our bodies. There are artificial ones that are purely superstitious; they are full of characters, figures, and signs of the months; they are products of ignorance and superstition that must be rejected by any man with common sense. There are some that are real poisons, like arsenic, realgar, orpiment, toads, spiders: if these things do no harm, they are at the very least useless, as experience has often shown.

What recourse, you will say, is then available? Of all the remedies, following M. Geoffroy’s thesis, none is better and surer than to drink water; water alone can soften the nervous fibers when they are too stiff and taut, destroy the erethism of solids, dilute humors that are too thick, attenuate those that are too crude, temper their sourness, prevent their corruption, and moderate or even totally check the violence of the pestilential poison once it has slipped into our bodies. Besides, there is no reason to fear the least harm from it. This is what the learned author already cited demonstrates in detail, and in a manner that seems to me irrefutable.

Plague can be regarded as a sort of fever, and treated the same way; in that case, the indications of fever will be combined with those of contagion; and moreover if we read the writers who have written after treating plague victims, such as Hildanus, [9] Caldera Heredia, [10] and Thonerus, [11] we will see that cordials that are too hot have killed a number of persons.  [12] Cordials are therefore dangerous and are not the sole nor the true remedy and antidote for plague , no more than for other diseases where great weakness is present.

Celsus [13] says that pestilential diseases require particular attention, since in those cases restricted diet, clysters, and purgation are of no use, but bloodletting is very salutary when strength permits it, especially when the disease is accompanied by the pains of violent fever.

Rivière, [14] and great practitioners after him, recommend bloodletting in small doses; this treatment is strongly contradicted by a great number of practitioners, and moreover it has often met with poor results: there have been victims who died during bloodletting. Nevertheless, one can say that bloodletting indicated by a stiffness, a strength, and power in the pulse, by a temperature and extraordinary thirst, and by the other inflammatory signs, will be done very carefully; and then, to avoid its disadvantages, which are to increase the weakness, one will take care to moderate it, and to check or prevent its ill effects. One will let little blood each time, and repeat it at most once; it can be sustained with cordials.

Celebrated practitioners advise purgation, which is also strongly contested. First, one hesitates to purge in exhaustion and weakness; besides, the buboes and lesions show that the poison is trying to get out, and the public thinks that bloodletting and purgatives cause them to recede. We will only observe, without deciding these questions, that the contamination of the upper tract [15] helps plague along, and that thus the purgatives, by cleaning it, will be very helpful, and will prevent the ravages it attracts; they will flush out the sourness of the upper tract and thereby the pestilence will have less effect.

But the effect of purgatives being to sap strength, to increase heartburn pains, and to send humors from the circumference to the center, should one not expect the return of the buboes, lesions, and exanthems: these latter require the administration of cordials, and the indication of purgatives counterindicates them: it is up to the wise physician to weigh these indications and counterindications in this disturbing perplexity.

Purgatives will be the ordinary emetic, emetic essence, ordinary purgative potions. See Purgative and Potion.

Cordials are simple or composite. The simple ones are all those we have detailed above; the composite ones are the alexipharmic compounds, tinctures, such as tincture of gold mixed with six ounces of scorzonera water, contrayerva syrup, anti-pestilential pills, anti-pestilential sudorifics, alexipharmic sudorific decoctions. See all these articles .

Anti-plague potion . Take plain theriacal water, elderberry water, scabiosa water, two ounces of each; compound of alchermes, one dram; prepared pork bile, half a dram; emetic essence and lilium of Paracelsus, [16] thirty drops of each; contrayerva syrup, three ounces.

This potion will be given by the spoonful every half-hour; in repeated potions the emetic will be eliminated.

Another cordial potion . Take waters of holy thistle, angelica, plain lemon balm, and compounded theriac, one and a half ounces each; tincture of gold and elixir of Paracelsus, one scrupulum; [17] carnation syrup, one and a half ounces: make a potion that can be repeated as needed.

Nourishment must be humidifying, gentle, and slightly tonic and acid; as a beverage, one can prescribe lemonade with contrayerva or some similar syrup. See Contrayerva syrup.

Narcotics . We cannot fail to make an observation on narcotics prepared with opium or white poppies: they are in themselves contrary to the general cause of plague , which is coagulation of the blood, yet there are cases where they can be indicated: then they must be used with all possible caution. See Opium and Narcotics.

This depends on examination by an able physician, as with the entire treatment of plague .

One must conclude from all that has been said about plague , that this disease is totally unknown to us as to its causes and treatment, and that experience alone has taught us its deadly effects only too well.

1. Charbons , in fact blisters caused by anthrax.

2. The last major bubonic plague in Europe arrived in Marseille in July 1720 and killed perhaps 100,000 people in the region by the summer of 1722.

3. A phlegmon is an inflammation of soft tissue, usually caused by infection, which produces pus.

4. Premières voies : “We say that the disease is in the upper tract when it is causes by indigestions and by obstructions in the first vessels or corridors that receive the alimentary juices before they are changed into blood, which requires purgatives and emetics rather than blood-letting” ( Dictionnaire de Trévoux ).

5. Passions de l’âme is an important but somewhat vague psychological category at the time; in 1646 Descartes wrote an important treatise by that name.

6. Crue : “In medicine they say that the humors are crude when the natural warmth is weak, and they lack the preparation which digestion makes them acquire ordinarily” ( Dictionnaire de Trévoux ).

7. ‘These words prevent plague’s infectious pain: / Go quick, fly far, and slow return again’ (Anonymous trans.).

8. That is, it is appended to the translation of an English text with this title by one John Smith: Traité des vertus médicinales de l’eau commune ou l'on fait voir qu'elle previent et guerit un infinite de maladies [...] avec les thèses de Messieurs Hecquet et Geoffroy sur l’eau (Paris: Guillaume Cavelier fils, 1725). Here is a link to the second edition, published in 1726.

9. Wilhelm Fabricius Hildanus (1560–1634), a German surgeon whose treatises are cited many times in the Encyclopédie .

10. Gaspar Caldera de Heredia (1591–1668), whose Tractatus utilis et jucundus de potionum varietate is cited in the article on the medical uses of ice. See Glace.

11. Augustin Thoner, author of Observationum medicalium haud trivialium libri quattuor [...] (1649).

12. Cordials are a category of remedy that is bracing and tonic. They were thought to act, as the name suggests, by strengthening the heart.

13. Aulus Cornelius Celsus, 1 ^st century, an important source on ancient medicine.

14. Roch Le Baillif, sieur de la Rivière (1540–1598), author of a number of books on Paracelsian medicine, including : Traité du remède à la peste, charbon et pleuresie, et du moyen de connaître quel élément les excite, et les hommes qui pour le temps y sont assujettis (Paris, 1580).

15. See note 4.

16. A preparation of antimony: see Venel’s article Lilium.

17. Twenty grains.