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That a vomiting of blood may not, here and there, have taken place, perhaps have been even prevalent in many places, is, from a consideration of the nature of the disease, by no means to be denied; for every putrid decomposition of the fluids, begets a tendency to hemorrhages of all kinds. Here, however, it is a question of historical certainty, which, after these doubts, is by no means established. Had not so speedy a death followed the expectoration of blood, we should certainly have received more detailed intelligence respecting other hemorrhages; but the malady had no time to extend its effects further over the extremities of the vessels. After its first fury, however, was spent, the pestilence passed into the usual febrile form of the oriental plague. Internal, carbuncular inflammations no longer took place, and hemorrhages became phenomena, no more essential in this than they are in any other febrile disorders. Chalin, who observed not only the great mortality of 1348, and the plague of 1360, but also that of 1373 and 1382, speaks moreover of affections of the throat, and describes the black spots of plague patients more satisfactorily than any of his cotemporaries. The former appeared but in few cases, and consisted in carbuncular inflammation of the gullet, with a difficulty of swallowing, even to suffocation, to which, in some instances, was added inflammation of the ceruminous glands of the ears, with tumours, producing great deformity. Such patients, as well as others, were affected with expectoration of blood; but they did not usually die before the sixth, and sometimes, even so late as the fourteenth day.29 The same occurrence, it is well known, is not uncommon in other pestilences; as also blisters on the surface of the body, in different places, in the vicinity of which, tumid glands and inflammatory boils, surrounded by discoloured and black streaks, arose, and thus indicated the reception of the poison. These streaked spots were called, by an apt comparison, the girdle, and this appearance was justly considered extremely dangerous.30

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