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Finally, in Russia the plague appeared two years later than in Southern Europe; yet here again, with the same symptoms as elsewhere. Russian contemporaries have recorded that it began with rigor, heat, and darting pain in the shoulders and back; that it was accompanied by spitting of blood, and terminated fatally in two, or at most, three days. It is not till the year 1360, that we find buboes mentioned as occurring in the neck, in the axillæ and in the groins, which are stated to have broken out when the spitting of blood had continued some time. According to the experience of Western Europe, however, it cannot be assumed that these symptoms did not appear at an earlier period.25

Thus much, from authentic sources, on the nature of the Black Death. The descriptions which have been communicated contain, with a few unimportant exceptions, all the symptoms of the oriental plague which have been observed in more modern times. No doubt can obtain on this point. The facts are placed clearly before our eyes. We must, however, bear in mind, that this violent disease does not always appear in the same form, and that while the essence of the poison which it produces, and which is separated so abundantly from the body of the patient, remains unchanged, it is proteiform in its varieties, from the almost imperceptible vesicle, unaccompanied by fever, which exists for some time before it extends its poison inwardly, and then excites fever and buboes, to the fatal form in which carbuncular inflammations fall upon the most important viscera.