Symptoms of Plague

Buboes

‘These Tumours were ordinarily situated in the Groin, and often below it, chiefly swelling the lymphatick Glands, placed near the crural Vessels; they appeared also pretty frequently under the Arm-pits, particularly under the pectoral Muscle, as also in the Glands behind and below the Ears, in the Jugular, and under the Chin. The Buboes… often appeared at the Beginning of the Distemper, chiefly in the Groin and Arm-pits, small at first, deep and exceedingly painful, that one could scarce touch or handle them, without causing a very uneasy Sensation; these for the most Part made no alteration in the Skin, but by swelling it, as they grew bigger, towards the End they became indolent’.

Chicoyneau on buboes at Marseilles in 1720

Some buboes were more dangerous than others: Paul Barbette, the seventeenth-century Amsterdam physician whose comments on the causes of plague illustrates contemporary knowledge of the disease, warned that ‘a Bubo behind the Ears, on the Neck, or under the Arm-pits, is more dangerous than that in the Groin’ but that a bubo was less dangerous than a Carbuncle, which arising after a bubo, was a sure sign of death.

Carbuncles

‘We have observed these sort of Tumours during the whole Course of the Sickness, in a very great number of diseased Persons in all the Classes, though less frequently than the Buboes; remarking also very often in the same Subjects, these two sorts of Eruptions.
The Carbuncles present themselves in different Places on the Surface of the Body, especially in the Thighs, Legs, Arms, Breast, Back, but very rarely in the Face, Neck, or Belly.
They appear at first under the Form of a Pustule or Tumour, which is whitish, yellowish, or reddish, Pale in its middle, or inclining to an obscure Red, which becomes insensibly blackish, crustaceous, especially about the Edges; as also variegated with divers Colours; so that, according to that which is predominant, and the Excess or Defect of Sensibility and Elevation, we may give it the Name of a Phlemonick, Erysipelatous, or gangrened Carbuncle.’

Chicoyneau on carbuncles at Marseilles in 1720.

Worth’s collection holds a number of tracts by the renowned French physician, François Chicoyneau, the medical hero of the Plague at Marseilles in 1720. Chicoyneau’s various accounts identified five different types, or classes, of plague victims, each with different symptoms and prognosis. The following is taken from the English translation of one of Worth Chicoyneau tracts, originally printed in French and translated in the same year into English in 1721: A Succinct Account of the Plague at Marseilles, in which he outlines not only the different classes of symptoms, but also the corresponding classes of treatment.

First Class

‘First Class, observed especially in the first Period, and in the greatest Fury of the Distemper, contains such as were afflicted with the Symptoms that we shall here set down, constantly followed by a speedy Death.
These Symptoms were for the most part irregular Shiverings, the Pulse low, soft, slow, quick, unequal, concentrated; a Heaviness in the Head so considerable, that the sick Person could scarce support it, appearing to be seized with a Stupidity and Confusion, like that of a drunken Person; the Sight fixed, dull, wandering, expressing Fearfulness and Despair; the Voice slow, interrupted, complaining; the Tongue almost always white, towards the end dry, reddish, black, rough; the Face pale, Lead-coloured, languishing cadaverous; a frequent Sickness at the Stomach; mortal Inquietudes; a general sinking and Faintness; Distraction of the Mind; dosing, an Inclination to vomit, Vomiting, &c.
The Person thus seized, perished commonly in the Space of some Hours, of a Night, of a Day, or of two or three at farthest, as by Faintness or Extinction; some-times, but more rarely, in convulsive Motions, and a Sort of Trembling; no Eruption, Tumour or Spot appearing without.’

The Second Class

The Second Class had similar symptoms but to these were added a definite sign:

‘But that which deserves to be well observed, and which has always seemed to characterise and distinguish this Disease from all others, is, that almost all had at the Beginning, or in the Progress of this Distemper, very painful Buboes, situated commonly below the Groin, sometimes in the Groin or Arm-pits, or in the Parotide, Maxillar, or jugular Glands; as likewise Carbuncles, especially on the Arms, Legs or Thighs, small, white, livid, black Pustles, dispersed over all the Surface of the Body. It was rare to see any of the disease of this Second Class escape.’

The Third Class

Chicoyneau’s comments on this class remind us of the beguiling and often confusing nature of the disease: it followed no set pattern:

‘The Third Class contains the two preceding; seeing we have attended, during the Course of this terrible Sickness, a great Number of Persons that have been attacked successively with the different Symptoms enumerated in the two former Classes, in such a manner, that the most part of the Signs described in the Second, were commonly the Forerunners of those which we have mentioned in the First; and the appearing of these latter Symptoms denounced an approaching Death.’

Crucially, he reminds us that it might often be difficult to distinguish what was plague from other forms of infectious illness:

‘a very great Number of different Kinds of diseased Persons contained in the preceding, had very moderate Symptoms, whose Force and Malignity appeared to be much less, than in those of the same Accidents daily observed in inflammatory Fevers, or in the most common putrid ones, or in those that are vulgarly called Malignant, if we except the Signs of Fear or Despair, which were Extream, or in the highest Degree.’

The actual identification of plague in the early modern period was a topic fraught with difficulty, for in many cases the people deputised to do the actual diagnosis of death were lay women employed by the parish clerks to act as ‘searchers’. Thus identification of the disease depended on a host of factors: the medical knowledge of the searcher, the willingness of the household to admit to a plague death in their vicinity, the psychologically loaded nature of the term ‘plague’ which could often be used as an umbrella term for any lethal infectious disease.

The Fourth Class

‘The fourth Class contains the Diseased attacked with the same Symptoms with those of the second, but these sorts of Accidents lessened or disappeared the second or third Day of themselves, or in Consequence of the Effects of the internal Remedies, and at the same time in Proportion to the remarkable Eruption of the Buboes and Carbuncles in which the noxious Ferment that was dispersed through the whole Mass, seemed to be collected together; so that the Tumours rising from Day to Day, at length being open, and coming to a Suppuration, the Infected escaped the Danger that threatned them, provided they had some Assistance.’

The Fifth Class

‘This Fifth and Last Class contains all such infected Persons, as without perceiving any Emotion, or there appearing any Trouble or Lesion of their natural Function, have Buboes and Carbuncles, which rise by little and little, and easily turn to Surpuration, becoming sometimes scirrhous, or which is more rare, dissipate insensibly, without leaving any bad Effect behind them; so that without any loss of Strength, and without changing their manner of Living, these infected Persons went about the Streets and publick Places, only using themselves a simple Plaister, or asking of the Physicians and Surgeons such Remedies as are necessary to these sorts of suppurating or scirrhous Tumours.’

*All quotation from Chicoyneau are taken from the 1721 English translation: A Succinct Account of the Plague at Marseilles, Its Symptoms, and the Methods and Medicines used for Curing it. Drawn up and presented to the Governor and Magistrates of Marseilles, by M. Chicoyneau, Verney and Soullier… (London, 1721).