[50] A moderate bleeding from the nose in the beginning of the disease, was, especially in plethoric habits, sometimes salutary; but in most instances it was otherwise. Such as spat up frothy blood, mixed with a great quantity of thin phlegm, though they might not at the time exhibit symptoms of great debility, or appear to be in danger, did, nevertheless, contrary to expectation, die soon afterwards. Hæmorrhages happened more frequently, and proved more fatal to women than to men. An immoderate flow of the menses coming on suddenly and before the stated time, carried off the patient in many instances. When pregnant women were attacked with this type of the plague, they almost always miscarried, and lost their lives by the subsequent hæmorrhage. This was also very generally the case with those who were delivered after having gone their natural time. [51] This anxiety about the præcordia may be regarded as a pathognomonic symptom of the plague in its most acute type. It is so excessive that the patients are at a loss for words capable of expressing it. It does not consist in a violent pain, but in a certain oppressive, suffocating, and altogether intolerable sensation at the pit of the stomach. In this state, they make known their anguish and show the danger they are in by sighs, tears, and lamentations, writhing their bodies in the most violent manner, and, especially when their delirium comes on, falling down upon the ground or floor, and crawling about as long as any muscular power remains. Others who are affected with extreme debility from the first, although they feel the same anguish, are not capable of tossing and writhing themselves about so much. [52] In the same manner as those who die of the catarrhus suffocativus. [53] Memoire sur la Peste, qui en 1771, ravagea l'Empire de Russie, sur tout Moscou, &c. par M. D. Samoïlowitz. A Paris, 1783. [54] This remark respecting the rare occurrence of petechiæ in the beginning of the plague is contrary to the observations of _Mertens_ and _Orræus_. Mr. _Samoïlowitz_ did not see much of the plague at Moscow in the beginning; he was chiefly employed in the care of the pest-hospitals during the height of the disorder. Tr.