Book II PESTILENT FEVERS 91

contagious; this is the most important indication. But since
it is not always possible to observe it, we must watch for other
indications. Nearly all these fevers have one thing in common,
namely that in the initial stage everything seems quite peace—
ful, so much so that the patient is hardly thought to have fever,
though nevertheless he has contracted the plague and it is
latent in him. 'The pulse and urine give evidence of this, but
only such evidence as might elude all but the expert. Further—
more, as the disease runs its course, though it waxes normally,
still the whole fever per se seems gentle and mild, the heat
of the body is not burning to the touch, while within the body
it is felt to be lingering rather than acute. In fact when patients
are asked whether they have fever, they declare they have not,
but they say that all the same they feel a sort of malaise. '"The
patient lies flat on his back, the back feels as though it had been
beaten, the respiration is slower than normal, the pulse not ir—
regular, not quicker than normal, but rather oppressed, as
though it hardly ventured to beat. 'These, then, are the symp—
toms that appear in the earlier stages of the disease. When
you see them, look out for others who are suffering from fevers,
and when you see that many are dying from a similar malady,
then you may well fear that the patient whom you are attend—
ing has pestilent fever. Moreover, from day to day, more de—
finite symptoms will show themselves; either spots will appear
on the skin or abscesses in the region of the so called emunctories
(nostrils etc.); the eyes become red and unsteady, the breath
is charged with a peculiar sort of stench, and by this symptom
alone experts often diagnose a pestilent fever; often the patient
talks much, and sometimes incoherently, his head feels heavy
and he at times suffers from insomnia, at times sleeps too heavily.
"TThe abdomen is distended, the evacuations are liquid, corrupt,
very different in form from the normal faeces and humors, and
have a very offensive smell. The urine is like that of cattle,
or like pomegranate wine, either thin and raw, or clouded and
red; though sometimes it is like that of healthy persons. 'The
tongue is foul, and all the bodily powers decline and wane.
"The following are bad signs: continual delirium, retention of
the urine, nose—bleeding that brings no relief, considerable
evacuation of the bowels, whether spontaneous at first or
produced by a mild laxative, the appearance of spots and
abscesses, and presently their sudden subsidence.