Many were affected with pains in the _breast_ and _sides_. A difficulty of breathing attended in some, and a _cough_ was universal. Sometimes this cough alternated with a pain in the _head_. Sometimes it preceded this pain, and sometimes it followed it. It was at all times distressing. In some instances, it resembled the chin-cough. One person expired in a fit of coughing, and many persons spat blood in consequence of its violence. I saw several patients in whom the disease affected the trachea chiefly, producing great difficulty of breathing, and, in one case, a suppression of the voice, and I heard of another in which the disease, by falling on the trachea, produced a cynanche trachealis. In most of the cases which terminated fatally, the patients died of pneumonia notha. The _stomach_ was sometimes affected by nausea and vomiting; but this was far from being a universal symptom. I met with four cases in which the whole force of the disease fell upon the _bowels_, and went off in a diarrh[oe]a; but in general the bowels were regular or costive. The _limbs_ were affected with such acute pains as to be mistaken for the rheumatism, or for the break-bone-fever of 1780. The pains were most acute in the back and thighs. _Profuse sweats_ appeared in many over the whole body in the beginning, but without affording any relief. It was in some instances accompanied by erysipelatous, and in four cases which came to my knowledge, it was followed by miliary eruptions. The _pulse_ was sometimes tense and quick, but seldom full. In a great majority of those whom I visited it was quick, weak, and soft. There was no appearance in the urine different from what is common in all fevers. The disease had evident remissions, and the fever seldom continued above three or four days; but the cough, and some other troublesome symptoms, sometimes continued two or three weeks. In a few persons, the fever terminated in a tedious and dangerous typhus. In several pregnant women it produced uterine hæmorrhages and abortions. It affected adults of both sexes alike. A few old people escaped it. It passed by children under eight years old with a few exceptions. Out of five and thirty maniacs in the Pennsylvania hospital, but three were affected by it. No profession or occupation escaped it. The smell of tar and tobacco did not preserve the persons who worked in them from the disease, nor did the use of tobacco, in snuff, smoking, or chewing, afford a security against it.[88] [88] Mr. Howard informs us that the use of tobacco is not a preservative against the plague, as has formerly been supposed; of course that apology for the use of an offensive weed should not be admitted. Even previous and existing diseases did not protect patients from it. It insinuated into sick chambers, and blended itself with every species of chronic complaint.