§82 P L A 
tremor of the tongue, are alfo prefent. Dr. Dickfon 
fays, that a trembling biting motion of the lips was a 
common and dangerous fymptom. .He alfo adds, that 
patients are, in a few cafes, quite deaf; and that there is 
often fome difficulty of hearing. 
The tongue very often retains its natural appearance; 
and, where it changes its colour, it becomes only white, 
and remains moift, and never puts on fo thick a fur, 
or affumes fo dark a colour, as in the advanced ltages of 
fome other fevers. The pulfe is generally low, quick, and 
equal; and in the latter ftages it becomes exceedingly 
quick and fmall, efpecially during the exacerbations, fo 
as to be fcarcely perceptible; yet in fome cafes, when the 
difeafe is confiderably protrafifed, and other fymptoms 
denote much diforder, the pulfe varies little from its 
natural ftate. In fafl, the variations of the pulfe are often 
quite incongruous with the other fymptoms. The refpi- 
ration is little difordered, except in the advanced ftage : 
there is no factor of the breath, nor cough ; but there is 
extreme anxiety and oppreffion about the praecordia, 
which produce great inquietude, and, where they come 
on early, always dangerous fymptoms. They are often 
accompanied by a pain and diftreffing fenfe of heat in the 
epigaftrium, probably conneffed with the ftomach, and 
rather increased than relieved by the vomiting. 
The fun&ions of the brain and nerves are particularly 
affe61ed by the attack of the plague; fo that a fudden 
and extreme proftration of ftrength belongs to the difeafe 
under all circumftances, and is, in faft, the moll marked 
chara6feriftic of its fevere and fatal forms; the vital 
principle appearing to be fuddenly as it were extinguiffied, 
or fo enfeebled at once as to be incapable of refilling the 
violence of the diforder. 
Vomiting did not occur at all at Malta, nor in a very 
large proportion of the fick at Aleppo; but, where it 
appeared at the beginning, and continued with ffiort 
intervals, it generally denoted a fatal termination. The 
matter ejected from the ftomach was various; at the 
beginning, it was only the ordinary contents of that 
vifcus; but, after repeated retchings, bile commonly 
followed. Dr. Ruffell did not obferve any fetid difcharges 
from the ftomach ; but a blackiffi liquor fometimes came 
off in the laft ftage of the difeafe. A diarrhoea began 
fometimes on the firft day, but more commonly in the 
"advance of the complaint, and was generally confidered 
as a dangerous fymptom ; but the ftools were lefs offenfive 
than thole in tertian fevers in the fame climate. Some¬ 
times dark-coloured blood was difcharged by ftool, un¬ 
mixed with faeces, and without griping pains. As a 
loofenefs of the bowels was generally detrimental; fo, on 
the other hand, a ftate of coftivenefs was attended with 
no harm or inconvenience. Pain at the Jieart is a very 
conftant fymptom. 
But the peculiar and charafteriftic fymptoms of the 
plague, as before ftated,are the buboes and carbuncles, the 
former being obferved in almoftall thofe patients who are 
not carried off too rapidly to admit of their formation. 
The carbuncles, however, do not occur in more than one- 
third of the cafes of plague, and very rarely exift alone, 
being generally conjoined with buboes. Buboes occur 
in the glands of the groin and arm-pits, and alfo in the 
parotid, maxillary, and cervical, glands; but thofe of the 
groin are molt frequently affefted. 
The inguinal peftilential bubo fometimes appears in 
the fame place as the ordinary venereal tumour, but is 
commonly fituated lower in the thigh. A burning and 
fhooting pain is often felt in the part before any 
fwelling is perceptible by the finger; but, when once dif- 
tinguifhable, the gland is always painful on preffure. In 
the incipient ftate of the bubo, a fmall hard round tumour 
is felt under the finger, moveable under the fkin, foft, and 
of its natural colour; but, as the fwelling increafes, it 
affumes more of an oblong form, becomes lefs moveable, 
and the integuments are thickened and tumid. In fome 
cafes the fwelling is acutely painful, in others obtufely 
G U E. 
fo; and its progrefs is not lefs variable. The ficin is 
feldom inflamed in any degree during the firft week, 
though tenfe and painful; fo that, in the fatal cafes, it 
generally retains the natural colour; indeed, unequivocal 
ligns of the tendency to fuppuration feldom occur till 
the fever abates, and is manifeftly on the decline, as 
about the eighth or ninth day; the external inflammation 
then advances, the fwelling becomes fofter, and breaks 
between the fifteenth and twenty - fecond day, when 
treated limply with poultices. Thofe buboes which do 
not terminate in fuppuration, ufually difperfe gradually, 
and difappear altogether in the fecond month : fome of 
the inguinal tumours, however, remain hard and indoient 
for a longer time. In a very large proportion of thofe 
who are attacked by the plague, the buboes begin to ap¬ 
pear on the firft day of the difeafe ; fometimes they are 
even the very firft fymptom of infection ; and fometimes 
they do not arife until the third day, or even later. 
Sometimes there is a fucceffion of two or three buboes in 
the fame patient. 
The anthrax, or carbuncle, which is not unfrequentiy 
conjoined with the bubo, appears under fome variety of 
form. Dr. Ruffell has defcribed five, Dr. Gotwald (who 
faw the plague at Dantzic) four, and others three, vari¬ 
eties of this peftilential fore. In different inftances, it 
commences in the form of an inflamed puftule, of various 
fize and colour, or of an angry pimple, tubercle, orflight- 
ly-elevated red or livid fpot; and, inftead of fuppurating 
kindly, it becomes black, and forms a gangrenous efchar, 
furrounded by an inflamed and tumid margin. The part 
is affeCted with a pricking and burning pain. Dr. Ban¬ 
croft obferves, that, when carbuncles appear very early, 
they affume a dark-brown or black colour, and remain 
forty-eight hours or more without beingcircumfcribed by 
an inflamed margin ; they generally indicate the greateft 
danger. Moll commonly, however, they appear only in 
the advanced ftages; and, where feveral occur in the 
fame fubjeCf, they generally appear in quick fucceffion. 
They are feated, in different inftances, on every external 
part of the body, even on the fcrotum, and on the eye¬ 
brows; and, when they concur with buboes, they ufually 
appear on the fame fide of the body : fometimes, how¬ 
ever, the carbuncles and buboes appear on the oppofite 
fides. Sympathetic buboes occafionally arife in confe- 
quence of carbuncles ; but they are lefs intenfely painful 
than primary buboes, and difperfe when the carbuncles 
fuppurate kindly. 
'Thirft, the never-failing attendant on febrile difeafes, 
is by no means invariably prefent, even in the word forms 
of the plague. The like remark holds of want of appe¬ 
tite ; this function is not only not impaired, but is aug¬ 
mented to a degree bordering on voracity. 
We (hall not follow Dr. Ruffell through his fix claffes of 
the difeafe; but rather adopt the concife and lefs compli¬ 
cated divifions of fir Brook Faulkner, in his recent De- 
fcription of the Plague at Malta. 
The firft fpecies is, that in which, at the firft attack, the 
energy of the brain and nervous fyftem is greatly im¬ 
paired, indicated by coma, flow drawling, or interrupted 
utterance. In this defcription of the difeafe, the tongue 
is white, but little loaded with fordes, and ufually clean, 
more or lefs, towards the centre and extremity; the anx¬ 
iety is great; caft of countenance pale; ftomach extremely 
irritable, and the ftrength much impaired. Rigors and 
pain in the lower part of the back are among the early 
precurfors of the other fymptoms. This was obferved to 
be the moft fatal fpecies of plague, and prevailed chiefly 
at the commencement of the late difafters. Thofe who 
were thus affeCted died fometimes in the courfe of a few 
hours, and with petechise. 
The next fpecies is, that in which the ftate of the 
brain is the very reverfe of what takes place in the former; 
the fymptoms generally denoting a high degree of excite¬ 
ment : the pain of the head is intenfe ; thirft frequently 
confiderable, though fometimes wanting; the counte¬ 
nance 
