_Of the manifest Signs of the late Pestilence._
IT is altogether foreign to my Design here, to enumerate all the
Appearances that belong to a pestilential Constitution, because a great
deal may be ascribed to Phantasie and Conjecture, as the Influence of
Comets, and the Conjunctions of Planets, with others of like Nature: For
what strange Notions have been broached concerning this Contagion, which
was imported to us from Abroad? Are the Tails of Comets always armed with
pestilential Arrows? Or is the Air the more impure and unhealthful? Had we
any Famine before the last Sickness? Or had we portentious Swarms of
Insects like Clouds over us? No, just the contrary, as we before observed;
all Things from Nature were promising and serene, and this Destroyer
invaded us on a sudden from strange Countries; it is therefore of more
Advantage to our Design here, to take all its concomitant Signs from its
manifest Effects.
AND indeed there are not many peculiar to a pestilential Fever, as that is
chiefly a Collection, or an Epitome of all other Fevers together, which in
such a Confederacy are not therefore without a tedious Work to be
enumerated in all their Affections; I shall therefore satisfie my self
with describing such only which are most obvious to common Observation,
and are met with in most infected Persons: And these for Method Sake I
shall distribute into two Classes.
_FIRST_, The manifest Signs of Infection.
_SECONDLY_, The Appearances after Infection.
BUT hereunto I think it necessary to premise, that a Pestilence puts on
sometimes one, and at others another Appearance, and sometimes even
contrary ones, according to the Constitution or Age of the Patient, the
Season of the Year, present or preceding Distempers, a faulty Way of
Living, and the different Means of Communication, both with Respect to
Virulence and Degree.
THE Symptoms of the first Class are Horror, Vomiting, Delirium, Dizziness,
Head-ach, and Stupefaction.
OF the second, a Fever, Watching, Palpitation of the Heart, Bleeding at
Nose, and a great Heat about the _Precordia_.
THE Signs more peculiar to a Pestilence, are those Pustules which the
common People call _Blains_, Buboes, Carbuncles, Spots, and those Marks
called _Tokens_; of all which distinctly.
I do not know indeed throughout the whole Compass of Nature, (as before it
hath been frequently hinted) any Thing so subtile as the pestilential
Poison, and what will penetrate the Body with so much Swiftness and
Secrecy, insomuch that it is not perceived sometimes till long after its
Entrance; what therefore is commonly said of its sensible Attack, and that
the infected feel its first Insult as from a sudden Blow, is more the
Effect of a deluded Imagination and Conjecture, than any solid Judgment;
as the Populace are apt enough to frame strange Conceits out of their own
Heads, and what hath long obtained amongst them is very difficult to
erace.
WHEN therefore such a kind of People hath received the Notion, as was
common in the late Sickness, concerning the forementioned Manner of
Infection, it is no great Wonder that others likewise in general go into
the Error, and take it for granted that this unmerciful Destroyer makes
its Seizure in this violent Way, and therefrom wait for it as for a hidden
Stroke.
ALTHOUGH I am not insensible, that some may have thus perceived its first
Impression, upon taking in ungrateful and filthy Smells; for the
pestilential _Seminium_, (as before observed) when it incorporates with
other Bodies that are gross, fat, and viscid, may strike the Organs of
Sensation very manifestly at its first Entrance.
AFTER the pestilential _Miasmata_ have thus seized a Person, and the
Spirits are overcome, the whole Mass of Blood, and other animal Juices,
partake of the Disorder; from whence proceed Struggles not to be born, and
a Train of Symptoms, of which quaking or shuddering is the chief, all of a
sudden, without any manifest Cause.
THIS Symptome owes its Origin to the Conflict of Nature with the infused
Malignity, whose Efforts of Resistance excite a Sense of Cold from the
pestilential _Seminium_; after the same Manner as Nitre put upon the
Tongue excites the same Sensation; it is also to be suspected that this
Rigor may be owing to a Quality in the poysonous _Effluvia_ of
extinguishing the native Heat: And the Spasmodick Affections of the
Nerves proceed from salt, sharp, malignant, and heterogeneous Particles
rushing into the sensible Fibres, and vellicating them into involuntary
Motions and Twitchings.
THE greatest Part indeed of the Infected perceived this Horror, but some
of them more vehemently than others; but of the immediate Impression upon
the Spirit there is no Room to doubt, nor of a consequent Degeneration of
the whole Mass of Blood; although I am sensible that the Subtilty of the
pestilential Taint took Place sooner or later, according to the different
Degrees of Strength and Texture in the Body to resist it.
IT is certain that the fine and exquisite Contexture of the nervous
System, and the Agreement and Consent of one Part with another, as well as
the extraordinary Perfection of the Animal Spirits, set as Guards over
such sensible Parts, could not but be affected with the Apprehensions of
Mischief, and shake and tremble, and use their Efforts to throw off the
Danger; and indeed I take it further to be probable, that the pestilential
Poison might be shook by such Means out of the Nerves into the Muscles,
and there cause Tention, Trembling, Vellication, Yawning, Stretching, and
all those other Concomitants of putrid and malignant Fevers.
THE Duration also of this Shuddering was as uncertain as its Degree, for
it went off sometimes sooner, and at others later; sometimes in half an
Hour, and at others, not till four or five Hours; which Difference I
conjecture owing to the Quantity and Intenseness of the Malignity, as to
the greater or lesser Struggles of Nature to resist it.
AS soon as this Horror could be said to terminate, for the most commonly a
Nauseousness and Reaching succeeded, from whence there was such an
excessive Loathing of Food, that even the Mention of it was irksome; a
certain and infallible Sign of Seizure.
BESIDES the Nauseousness and Loathing, some were followed by grievous
Vomitings, occasioned by the poisonous Quality of the Pestilence
irritating and subverting the Stomach; for that, by Means of its nervous
Coats, being endowed with an exquisite Sense, endeavours to throw off any
Thing offensive and corrosive with the utmost Efforts, and prevent the
saline, pestilential Venom, if possible, from taking Place; insomuch that
nothing is more certain, than that the Stomach, by this fine Contrivance
of Nature, is ready also to throw off any other Thing disagreeable to it,
as well as the Poison we are here speaking of.
SOME endure hereby such a vehement and continued Irritation, that cannot
be asswaged by any Remedies, how often soever repeated, and sometimes the
Reaching continues after the Strength of the Patient is too far spent to
throw any Thing up, whereby the Symptoms aggravate, and the pestilential
Venom takes deeper Root in the Constitution.
AFTER the principal Load of Humours at the Stomach are thrown up, a very
frothy Bile, fermenting like Yest, follows, that in its Colour is
greenish, and sometimes so fetid, that a Person cannot endure the Room
without holding his Nose, such is the prodigious Putrefaction and
Malignity in some of these Cases.
BUT where the Use of Medicines, otherwise effectual to stop the most
obstinate Vomiting, proves ineffectual, and there follows a great Thirst
and Heat, it gives strong Suspicion of Carbuncles in the Stomach, and
immediate Death, so that the infected as it were vomit up their Souls,
which (if we believe _Helmont_) have their Residence there; but this will
be further spoke of in the Prognosticks.
BUT before I proceed any further, the Health of my Country, and the
Concern of Posterity, oblige me to take Notice of the pernicious Practice
of Empiricks of all Orders, with whom it was a Custom to give Emeticks;
for certainly many were destroyed by this Practice, the convulsive
Reachings to vomit being carried beyond a Possibility to bear it. And
truly the best Deliberation and Thought I was able to take in such
Exigencies, where I happened to be called, was but of little Effect, and
after Administration of the best Medicines that the Rules of Physick could
invent, Things generally grew worse; which made it appear as impossible to
rectifie a rash and fatal Error in the Conduct of a violent Disease, as
in the Management of a military Engagement; but of this we shall have
Occasion to say more hereafter.
YET to satisfie any inquisitive Person how this primary Affection of the
Stomach does arise, and through what Passages the pestilential Poison
makes its Entrance, it is to be observed, that nothing is more plain than
that the pestilential _Miasmata_ not only enter at the larger Passages,
but also through the Pores of the Skin, even to the whole nervous System,
from whence they are communicated to all other Parts; for this is peculiar
to the Nerves, that they not only convey the first Impression to the
Stomach by its general Consent with all Parts, but also when that is after
any Manner whatsoever affected, they communicate it to the whole Frame, as
in the taking a Vomit.
SOMETIMES the pestilential _Aura_ is mixed with the Food, and swallowed
therewith, which after some Delay in the Stomach being digested and
dissolved, lets out the imprisoned Venom to vellicate the Fibres into
Reachings and convulsive Motions: And to put this altogether out of
Dispute, I have often observed Persons immediately to fall sick from a
State of perfect Health after eating, and to throw up their Food, in other
Respects good and wholsome, as somewhat corrupted and poisonous.
VOMITING also may be promoted by Scents, as well those which are fetid, as
such as are contrary, by some particular Antipathy to the Nature and
Constitution of the Patient; and this I conjecture happens from the
Harmony and Consent of the Organs of Smelling with the Coats of the
Stomach, insomuch that the Stomach immediately perceives any Thing that
ungratefully strikes the Nose, and rises up against it. In the mean Time I
would however transiently make this one Remark, that as in many Cases the
Administration of Emeticks was pernicious, whether or no Evacuation of the
first Putrefaction at Stomach, might not be much better encouraged upwards
by Scents; as, on the contrary, the Reachings at Stomach are sometimes
allayed by like Means, as by the Smell of Vinegar, _&c._ I do confess,
that this is a Practice I cannot attest the Success of by Experience, yet
it is not unworthy a rational Physician to attempt it.
ALL the Sick likewise quickly after Seizure grew delirious, running wildly
about the Streets, if they were not confined by Force; when some tired
with Rambling, on Increase of the Distemper, would fall down, ignorant of
their Condition, or where they were; and lastly, to repeat what hath been
already remarked, that sad Calamity seemed to have complicated in its
Production every Thing of a poisonous and a destroying Nature.
MANY were seized with a _Vertigo_, which, without any Motion of external
Objects, made them believe their Heads to turn round: Without doubt the
Brain grievously suffered from the pestilential Taint, not only because
the Spirits used to be clouded, but that all Things were done as if in
Sleep, which might arise from the inflammatory, caustick, and narcotick
Nature of the Venom, and the Texture and Consent of the Vessels with the
various Dispositions of the Fluids. This vertiginous Disposition also in
my Opinion might sometimes arise from the inordinate and anomolous
Motions of the Spirits.
A great many likewise much complained of the Head-ach, which was so
vehement, as if the Parts would have flown asunder; a Complaint the most
intolerable of all, because it continued without any Remission or
Intervals; the Enemy never retreating of it self, and only to be
vanquished by the Efforts of the Constitution, and apposite Medicines.
Indeed nothing was more plain, than that the _Meninges_ were stimulated by
the saline _Spicula_ of the Contagion; and from the Inflammation of the
Brain, and its Sphacelation in those who died, there is a strong Suspicion
that this cruel, shooting Pain continued to the last.
IN this Class of Symptoms, Stupefaction is also to be ranked; because from
the Moment of Seizure many were taken with a _Coma_, and slept as if they
were dozed with an Opiate; many in the middle of their Employ, with their
Friends in Conversation, or other Engagements, (as was before taken notice
of) would suddenly, without any Reluctance, fall into profound, and often
deadly Sleeps.
BUT by what Means this Venom does exert its narcotick Qualities, is not
with me so ready to be accounted for; that is to say, whether it be from
its original _Seminium_? Or from Its affinity and Complication with the
Scurvy? Or from its predominant Malignity, and Antipathy? Or from an
Obstruction of Circulation, or Coagulation, or Extravasation of Blood? Or
lastly, from some particular Impression made upon the Origin of the
Nerves? For this is a Difficulty reserved for another _Hippocrates_. In
the mean while it is by all confessed, that by such Stupefaction or
Sleeping, the pestilential Venom becomes not only more deeply rooted, but
also more cruelly affects the nervous System, and greatly weakens it.
THE first and most considerable Symptom of the second Class, is a Fever,
which (as was before said) was a constant Attendant upon the last
Pestilence; although indeed the Infection seemed to kill some before the
Blood and other Juices could rise into Fermentation; wherefore it may be
taken for granted, that most Persons were accompanied with a Fever. But
this Fever indeed was in some very low and concealed, though in others it
appeared openly; and he must be but little acquainted in physical
Practice, who hath not frequently observed, that in malignant Fevers their
Beginnings are hardly discernable, being accompanied with no Heat, no
Inequality of Pulse, and no Thirst, although secretly indicated by some
other lurking Symptoms; and the Manner in which such Patients expire,
demonstrates, that they could not be altogether free of a Fever. There are
many Circumstances indeed which make it thus difficult in the Accession to
discern its Approaches, as a Want of Turgescency of Blood in the Veins and
Arteries, through Defect of Room for such Commotion and Depuration, or
because the Blood is so thin, crude, and degenerate, that it cannot but
with Difficulty ferment and grow hot; or because the pestilential
_Miasmata_ seem at their first Insinuation so friendly to the
Constitution, as to stir up no remarkable Alteration in the Blood; or from
its cold and styptick Quality, retarding or suppressing such an
Agitation.
WHEREFORE no Body should conjecture, that there is no Fever at all, where
its manifest Symptoms do not immediately appear; but it most commonly
happened otherwise during the late Contagion, for that discovered Signs
apparent enough of its Presence, such as extream Inquietude, a most
intense Heat outwardly, attended with unquenchable Thirst within, Dryness,
Blackness of the Tongue, intolerable Heat of the _Præcordia_, and all
other usual Concomitants of a Fever’s Accession.
AS to the Fever’s Exacerbations and Remissions, it appeared by constant
Experience, that sometimes they were erratick and changeable, and at
others continued, without any Intervals; and it was also customary to meet
with some that wholly remitted for 8, 10, or 12 Hours. The Alternations
likewise of Heat and Cold were very various, and with some would change
several Times in one Hour, and with others the Periods would be at much
greater Distances; so also the recurring Accessions were sometimes milder,
and at others more severe. Those who with great Difficulty went through
the first Paroxysm, could bear the second with Ease, as being much
milder; whereas again the third or fourth Accession would be with
intolerable Vehemence and Fury: And at other Times the first Fit would be
gentle, and the subsequent very severe and intense; and truly such was the
Uncertainty and Disguise of this insidious Enemy, that nothing could be
prognosticated of its Attacks or Cruelty.
BUT to come at some tolerable Notion of the Reason for such Uncertainty;
it is to be enquired,
_FIRST_, What Cause can be assigned for such an uncertain Return of the
Paroxysms? And,
_SECONDLY_, What Reason can be given for the unequal Exacerbations when
the Fits do recur?
CAN any one doubt what Tumults and Disorders may be excited in the Blood,
and other animal Juices, by that saline _Seminium_ of a Pestilence, which
we have already described? The Uncertainty then of such Disorders must
regard either the morbifick Venom, or the Nature and Motion of the Fluids
upon which it operates: The morbifick Venom, in Proportion to its Energy,
and Disagreement in Figure, irritates Nature, always ready in her own
Preservation to expel the Enemy; but when her Exertions are slow, or
imperfect, or quite languid, such a Depuration is not obtained; but upon a
Remission of the Conflict, there is Space given for interval; and this
indeed happens, when the Nature and peculiar Figures of the noxious
Particles are such, as may in the first Struggle be broke and subdued, but
after some Truce insinuates its Virulence further into the Habit, and
imprints upon every Part the true Characteristicks of a fatal Pestilence.
BUT to subdue and throw out the Enemy, the Spirits are at continual
Strife, although their Efforts are not always successful; to dispatch this
Matter therefore in one Word, as the Assimulation and perfect Mixture of
the heterogeneous Particles procures a Motion regular and conformable to
the Blood, so from an Inequality and disproportionate Mixture, arises an
irregular Circulation and Fermentation, so that the Reason for that
Uncertainty in these Fevers, and their irregular Returns and
Exacerbations, is to be fought for in the Fluids and their circulating
Vessels, and not from any Corruption, or Degree of Putrefaction, according
to the Opinion of the Ancients.
AND as for my own Part, I can affirm, that I never could in any one single
Instance amongst the infected, find the least Impressions of Corruption in
the Blood; and this even those Empiricks, though unwillingly, confess,
who, to the vast Detriment of the Sick, let them Blood upon such a Notion;
none of them having been ever able to discover any Signs of Corruption in
their Blood, which as conscious of it self blushed for their fatal
Mistake, and in this Distemper commonly appeared more florid than at other
Times.
THAT the Times of the Paroxysms should be uncertain, I take owing to the
Inability of the Constitution to struggle with the pestilential Venom; for
as every Fever is accounted regular, where all its Changes are uniform and
distinct, by Reason of the managable and ductile Disposition of the
morbifick Matter; so, on the contrary, where the pestilential _Miasmata_
uncertainly exert themselves, and excite new Commotions, either by the
Obstinacy or Asperity of their Parts not yielding to Comminution, there a
Fever returns with inconstant and unexpected Exacerbations: But to hasten
to the subsequent Symptoms.
ALTHOUGH some (as before said) were buried in Sleep, yet others suffered
by a very different Extream, and kept continually waking, insomuch that
frequent Repetitions of the most efficacious Opiates could not procure the
least Composure; in which Case, it is my Opinion, that the Membranes of
the Brain are pricked and vellicated by poisonous _Spicula_; besides which
also those soft, dewy Moistures upon the Brain, necessary for its
Relaxation to sleep, are dissipated and exhaled by the burning Heat of the
Fever; so that the Spirits are, as it were, set on Fire, and Inflammations
raised, not to be again extinguished, and frequently likewise
Sphacelations of the Brain.
BUT the most remarkable Symptoms of this Class, is the Palpitation of the
Heart, the Ancients conjectur’d that Pestilential _Aura_ to have a
specifick Contrariety to the Nature of that Organ; and it must be
confessed that in the late Sickness this Complaint was very grievous; but
yet I cannot see how this Venom should more particularly be pointed
against the Heart than any other of the _Viscera_, unless in Consideration
to the greater Importance of its Office in the OEconomy.
As soon as the subtile Poison of a Contagion hath insinuated it self into
the Mass of Blood, either through the Pores of the Skin, or other more
open Passages, there is no doubt, but it imprints upon it very malignant
Qualities, which, according to the necessary Laws of Circulation, must
arrive at the Heart it self, and affect it with Uneasiness, so that its
Palpitation is nothing else than its Struggles to throw off what is
Offensive; and it is no wonder to me this happens, because the Heart is
composed of such a Contexture of Fibres; for as the Pestilential Venom
hath somewhat in it of a saline Nature, and what is acrid, it very
naturally stimulates the nervous Parts, and gives to this Organ even
convulsive Motions; but of this matter every one hath leave to judge for
himself.
BUT how vehemently the Heart may beat on this Occasion, appears very
manifest from a remarkable Instance; I was sent for to a Youth of about
fourteen Years of Age, who had continued free of the Infection, after his
Mother and the rest of the Family had been visited by it, when all on a
sudden he was seized with such a Palpitation at Heart, That I and several
others could hear it at some considerable Distance, and it continued so to
do till he died, which was soon after; many Medicines being given without
any manner of Success: But in so extraordinary a Case as this, I am apt to
conjecture it rather owing to a Pestilential Carbuncle seizing the Heart
it self, than from the Vellication and _Stimulus_ only of pungent
Particles passing through it.
BUT to go on in the Enumeration of Symptoms, Sweat deserves mention,
because sometimes it breaks out in such Profusion as if the whole
Constitution was dissolved, and with a vast Loss of Spirits and Strength,
to the imminent Danger of the Patient, by such a Dissipation of Spirits,
such a Colliquation of the Balsam of Life, and an Extinction of the
natural Heat. And indeed I know nothing that more powerfully attenuates
the Humours, and more suddenly puts all the animal Juices into Fusion, so
as to run them through the Pores of the Skin, and the pestilential
nitro-aereal Poyson; and by whose colliquative Quality even the fleshy
Parts are dissolved and exhaled in vapour.
THESE Sweats also of the Infected are not only profuse, but also variously
coloured; in some of a citron Hue, in others Purple, in some green or
black, and in others like Blood; which I take to be from the various
Dispositions of the morbifick Venom, to give different Tinctures to the
Humours: And by this Means some experienced Nurses could prognosticate the
Event of the Distemper from the Colour of the Cloaths or Linen tinged with
the Sweat.
THE Sweat of some would be so fetid and intolerable, from a kind of
Empyreumatick Disposition, possibly, of the Juices, that no one could
endure his Nose within the Stench; sometimes it was sharp, and in a Manner
caustick; and hence it was easy to judge from what Origin the Pestilence
derived its Qualities, _viz._ From a sharp and burning _Ichor_, that would
even excoriate the Parts, and sometimes vesicate them, as if scalding
Water had been poured upon them.
SOMETIMES cold Sweats would break out, while the Heat raged inwardly, and
excited unquenchable Drought. Some continued in a Profusion of Sweat until
Life it self exhaled with it, while others had short Intervals of Truce
and Cessation; nay, some at the same time sweat on one Side, while the
other was quite parched with Dryness.
BUT the Benefit of this Evacuation, when it was regular, either natural or
by Art, was so manifest, that all the Infected that recovered were
sensible of it, and greatly rejoyced at its good Effects; for those
pestilential Particles, which eluded the Power of all other Means,
immediately upon a Sweat, as at a common Signal, made their Escape with
the transpiring Steam; but whensoever Diaphoreticks could not conquer the
Coagulation, Viscidity, or Obstinacy of the pestilential Poyson, it
always went very bad, being commonly followed by a Symptomatical Sweat,
and a fatal Separation of the animal Fluids.
YET the Energy of the pestilential Contagion not only freely discovered
its self in these Profusions amongst the Living, who (as already observed)
were dissolved as in an _Helodes_ and a _Typhodes_, but commonly the very
Carcases when dead, would weep out, as it were, the morbid Ferment, both
through the cutaneous Pores, and the common lachrymal Ducts of the Eyes.
THERE is no Occasion to say much concerning Hemorrhages at Nose; this
Symptom happening much more often from the Colliquative Nature of the
Poison, and its Erosion of the Vessels, than from a Plethora; as is
evident more from the ichorous Colour of the Blood than its continual
Distillation from those Vessels.
Were it not here that we study all possible Brevity, many other Symptoms
might be enumerated which commonly attended this pestilential Fever, as
Heat of the _Præcordia_, Hiccup, Gripings, _&c._ all which I at present
pass by, and close the whole with such as are more peculiar to it,
particularly those poisonous Vesications commonly called _Blains_.
THESE Vesications used commonly to rise with an exquisite and shooting
Pain, containing a serous Humour or _Ichor_, for the most part of a
Yellowish or Straw Colour, and encompassed with a variegated Circle,
generally Reddish.
THESE Pustules broke out in many Parts of the Body; and as their Station
was various, so their Number was also uncertain; in some they were few, in
others many, and a Woman I once met with covered all over with them; as to
their Bigness, they were also uncertain; for some were as a small Pea,
while others increased to the Magnitude of a Nutmeg.
THE included Matter (near perhaps to the Nature of Urine) was altogether
incapable of Suppuration, as it was saline and almost caustick; for very
soon after its Eruption it would corrode its Vesicle, and burst out, of a
Colour yellowish, livid, or black. Moreover, the surrounding Circle was
not always of the same Appearance, although at first coming out it was
continually inflamed.
BUT this is highly observable, that sometimes these Vesicles broke out
without any other previous Indications of Infection, and, as I imagine,
from the expeditious Separation of the pestilential Venom, and the sudden
Conquest of the Distemper by a strong Constitution: But whensoever the
Pain and Heat of the Part was so aggravated, that no proper Applications
would asswage it, there was commonly Danger of a Mortification from so
great a Concourse of pestilential Particles together; and once I remember
a Vesicle to change into a Carbuncle, from the continued Accession to it
of fresh morbifick Poison.
WE come now in Course to speak of Buboes, which were hard and painful
Tumours, with Inflammation and Gathering upon the Glands, behind the Ears,
Arm-Pits, or Groin.
THESE Tumors immediately upon Seizure are found so hard, that they will
not at all give Way to the Touch. In some these were moveable, and in
others fixed; but after some Time this great Tension remitted; and it was
common to prognosticate the Event of the Distemper from their sudden or
slow Increase, and from their genuine or untoward Suppuration, as also
from the Degrees of Virulence in their Contents.
THE Groans and unfeigned Tears of the Sick too plainly expressed the
Aggravations of their Miseries, and some seemed even to drown their Sense
of Pain with their Complainings; and this Intenseness of Pain cannot be a
Wonder to any, who duly consider either the Nature of the pestilential
Venom, or the Constitution of the Glands. I have already so largely
discoursed of the Virulence and corrosive Qualities of the pestilential
Poison, that no more need here be said about it; and whosoever examines
the Glands will find, that from the great Distention of the Vessels, in
this Case, the Buboes must chiefly owe their Rise to a Correspondence
between the Nerves and Lymphaticks, and the Juices they contain.
MANY Persons of publick Note have elegantly given the Anatomy and Use of
the Glands; it is therefore sufficient for my Purpose here to shew, how
from an Obstruction of those Juices, which flow through the larger Nerves,
particularly of the Arms and Thighs, and their subservient Vessels, and
their Impregnation with heterogeneous and poisonous Particles, Buboes do
arise.
IF any one makes it a Doubt, why these Tumors should rather come in the
above-mentioned Places, rather than on the _parotide_ Glands, let such
consider, that it is owing to the Magnitude and Capacity of the Nerves and
Vessels constituting the Glands of those Parts; as also that their
different Dispositions to Suppuration does proceed from the same Cause.
BUT that this Affair may more fully appear, it is to be discovered from
what Source that Matter flows, which degenerates into Matter, and
discharges from a Buboe in so great Plenty.
IN the Prosecution of this Enquiry, it shall not be without a Colour, at
least, of Reason, that I shall dissent from an Opinion both of Ancients
and Moderns, about the Blood alone being immediately changed into Matter;
for I rather think it to proceed from other Juices; and this I shall
endeavour to support by the following Arguments.
AND first of all, notwithstanding the Blood which runs in the Arteries and
Veins does sometimes, though very seldom, appear whitish; it then happens
from too great a Mixture either of nutritious Juice, or of a degenerate
Chyle, that will not easily change, and take its red Colour; but it never
passes into Matter, because the necessary Conditions of Circulation will
not admit of so much Rest as is requisite thereunto; besides, even the
extravasated Blood will not easily undergoe such an Alteration: For when
any Vessels, and chiefly the Capillaries, are so obstructed by Contusions,
or any other Means, that the neighbouring Parts swell, every Physician and
Surgeon too, I hope, knows that discutient Medicines and Cataplasms will
restore the former Motion and Fluxility to the Blood, ease the Pain, and
dissipate the Tumour.
IF the Blood be too fluid in the Arteries, it is apt to occasion
_Anareusms_, and in the capillary Veins an _Ecchymosis_; but nothing is
more commonly observed in Practice, that upon a Recovery of the Blood’s
due Constitution and Circulation, the obstructed Matter in an _Ecchymosis_
will dissipate through the Pores of the Skin, or be absorbed by the
refluent Blood: But when the Blood happens to be too grumous and stagnate,
a Fever immediately arises, unless it be prevented by Evacuation; and in
such a Disorder every one knows that there is most Danger of a _Schirrus_,
or a Mortification.
AND as it hath been already observed that Blood could not be drawn from
the infected by Phlebotomy, without Loss of Strength, if not of Life,
whereas the greater Quantities of _Pus_ were obtained by Suppuration of
their Buboes, the Patient was so much the better for it; it seems
consonant to Reason, that if _Pus_ was generated immediately from the
Blood, the Strength would as much decay upon its Loss, as upon Phlebotomy:
But I have always found it, (as many Times already observed) that how
little soever the Quantity of Blood drawn away was, and although done at
several Times, yet it proved of more Prejudice to the Patient than an
hundred times as much Matter drawn from a Buboe; and that the whole
remaining Mass was not able to recruit the Loss sustained thereby.
IF they who espouse a contrary Opinion, should suggest that Blood may be
drawn from a Tumour imperfectly suppurated, and from thence conclude, that
its Origin was from the Arterial and Venal Fluids; it may be readily
answered, that on opening a fresh Tumour, a bloody _Ichor_ will flow out,
because in the Operation some Blood-Vessels will be cut; whereas when the
Tumour is in Maturation, the Quantity of Humour there collected obstructs
the Blood from flowing to it through its proper Vessels; and which Humour,
altho’ in it self at first more thin and crude, yet by the Heat of its
neighbouring Parts, and its own natural Disposition, it will afterwards
thicken, and change into a white Colour of a laudable Consistence.
_THIRDLY_, To the foregoing it may be added, that so far as the Blood
partakes of a saline Quality, by so much the less will it be disposed to
change into Matter; for the same Reason that Sea-Water cannot be boiled
into a Gelly; for Salt adds to the Fluxility of Fluids, and thereby
prevents Incrassation, unless in those Instances where they of themselves
chrystallize, by Means of an Incapacity of the _Menstruum_ to keep them in
Solution, which is foreign to the Case before us.
LASTLY, Nothing is more known in Nature, than that Blood, by what Means
soever extravasated, if it cannot get back again into the Vessels, will,
after some Stagnation, run for the most Part into Grume; so that when a
Fluctuation requires opening, little else than a coagulated Blood flows
out: And if any one please to receive the Blood from an opened Vein into a
warm Porringer, and afterwards place it in a luted Vessel upon a Sand
Heat, as near as possible equal to that which is natural, he will find all
Labour lost in endeavouring to produce thereby any Appearances of _Pus_ in
it, either from its Colour, Smell, or any other of its requisite
Properties.
WHY then may we not conclude with some others of great Note, that _Pus_ is
generated immediately from the nutritious Juice, not in the Arteries and
Veins, but in other Vessels; in which Juice all the requisite Properties
are to be found, as a Disposition to grow thick, without Smell, white,
light, and of a smooth Consistence; and I take it to be very probable,
that the _Pus_ is made from hence by the Assistance of the natural Heat,
and the Conveyance of it by the forementioned Vessels into the Glands
whereinto they are complicated, and not by any Means from the Venal Blood,
and much less from the Arterial.
BUT least I should seem to digress too far; the _Sanies_ thrown out by a
Buboe is very different, sometimes thin and ichorous, at others thicker
and more laudable, as in Abscesses that are not malignant; in Respect of
its Smell, it is sometimes so extreamly fetid, as not to be endured by the
Nose; but always the more plentifully it discharges, the better does the
Patient fare afterwards: Nature finds a Vent this open Way to disengage
her self from a pernicious Enemy.
THE Number of Buboes was uncertain, sometimes one only appeared, at
others, which was most commonly, two broke out at once; nay, there were
met with Instances wherein all the Glands capable of it were tumified.
Many Buboes at a Time infallibly demonstrated the Aggravation, and
Dispersion of the virulent Taint; and on the contrary, but few shewed the
Poison to be not so prevalent, more contracted, and brought to a narrower
Compass for Expulsion.
The Places, and Manner of their Eruption was very uncertain, sometimes one
would appear in the right _Axilla_, and another on the contrary Side of
the Groin; these Tumours would likewise sometimes last but a Day, and
again insensibly vanish, that is, always when profuse Sweat arose; but
whensoever they were drawn in again by any Mismanagement or Casualty, they
would appear and vanish again many Times, and be very difficult afterwards
to be fixed; and sometimes when they could be brought to Suppuration, and
a plentiful Discharge, they would renew again, as we shall hereafter have
further Occasion to observe.
THE _Parotides_ borrow their Names from the Glands affected, which grow
behind the Ears; but these Tumours are not to be distinguished from others
but by their Situation, and therefore require not any particular
Description here, so that amongst many Instances I shall give but one to
discover their Nature; In a certain Youth there arose a _Parotis_ on each
Side, behind the Ears, which after Suppuration and Incision, let out great
Quantities of _Pus_, and were afterwards by a Surgeon healed up; but the
musculous Flesh was at this Time so wasted, as to discover a Sight as
pleasant as strange, _viz._ the external jugular Veins, with the Arteries
under them, the recurrent Nerves, the Tendons, the OEsophagus, and in
short all the Vessels quite bare and untouched; but upon the Patient’s
Recovery all filled up as before with new Flesh.
A Conjecture of _Diemebrooeck_ comes here in our Way to examine; he will
have it that Buboes are produced from an Ebullition of a saline and an
acid Humour meeting together, like a Mixture of Salt of Tartar and Spirit
of Vitriol: But whence can such a vast Coagulation arise? Indeed I do not
deny but that a Tumult and Bustle may be occasioned by the Concourse of
such Principles, as also that from such a Colluctation some saline
Particles may be precipitated; and it must further be allowed, that a Part
will inflate and swell while such Fermentation continues; but yet I cannot
apprehend how _Pus_ can be generated by such Means; for by an Effusion of
such a Mixture the _Serum_ would be more changed into a _Lixivium_, than a
purulent Matter; after the Conflict likewise is over, the Tumour would
immediately subside and vanish; but, on the contrary, Buboes daily and
gradually come to their Height of Suppuration: But I shall not detain the
Reader on this Head any longer, but proceed to a Description of a
Carbuncle.
A Carbuncle then is a small Eruption, whose Contents are soon discharged,
after which it appears in a crusty Tubercle about the Bigness of a Millet
Seed, gradually spreading, and encompassed with a very red and fiery
Circle; arising first of all from an ichorous Humour, afterwards with
great Pain and Heat, from a lixivious and caustick Poison.
THAT I may dispatch as much as possible in a few Words, it now lies before
me to describe the common Method of its Eruption; in the Beginning is a
sharp pricking Pain upon the Part affected, which in a little Time grows
very hot, and then lifts up the Cuticle into a Blister, containing a thin
_Ichor_; but after the Vesicle is by rubbing or any other Accident broke,
and the contained Fluid by Heat dissipated, its caustick Quality leaves an
_Eschar_ behind, which crusts over, in some sooner, and in others later;
its Extension is various, sometimes more broad, and at others more
contracted; nor is its Colour more certain; in the greatest Degree of
Inflammation it is extreamly red, but for the most Part it is dusky, very
often livid, and sometimes, from the peculiar Virulence of the
pestilential Poison, even quite black.
BUT as there is a Quality in the pestilential Venom not yielding even to
an actual Cautery, and from which in the Production of Carbuncles
_Eschars_ are generated, I take it to be of Consequence to know how such a
sharp, burning, and caustick Humour comes to be bred in an humane Body;
and by what Contrivance of Nature it comes to be thus separated and thrown
out?
AND in an Affair of this Difficulty, I expect to be candidly set right by
any one who thinks me mistaken. The whole Tribe of Diseases an humane
Constitution is subject to, does undeniably prove that our Bodies are
capable of producing many venomous Taints, even equal to any Thing in the
Air or the Earth; nay, the Histories of Physick give many Instances of
poisonous Insects and Animals bred within us; and no one can be ignorant,
that besides the Disposition of corrupted Humours within us to generate
such Creatures, that their _Semina_ are often brought to us from without:
And this is very manifest in a _private_ Pestilence, (if that Term may be
allowed me) where, without any Help from external Contagion, not only a
poisonous _Seminium_ may be generated, but Carbuncles also may break out;
that is, from the peculiar caustick Quality of saline Particles in the
Body.
WHEREFORE if this can be done in a _private_ Pestilence, what may we not
expect from a Pestilence that is the Consequence of an Epidemick Cause;
for the additional Assistance of a more powerful saline Principle from
without, cannot but greatly actuate the animal Juices, and induce a
compound Malignity abundantly sufficient for the Production of
pestilential Carbuncles.
THE more aggravated therefore the saline Qualities of this foreign saline
Principles shall be, and in Proportion to the Quantities of it insinuated
into the animal Fluids, the Carbuncles will break out more or fewer,
sooner or later; although as long as the pestilential Poison flows in
Company with other Fluids within the Vessels, it seems more mild, because
then diluted, than when separated and thrown upon the Skin by the natural
Excretory Powers. And this Expulsion of it seems much to be assisted by
the common Tendency of serous Particles towards the Surface, and the
Congress of nitro-aereal Particles therewith; but nothing however is more
manifest than that when the pestilential Poison hath got to the Surface,
it exercises its Virulence upon all the Parts it touches, and leaves cruel
Marks of its Triumph behind; the same as which likewise obtains not only
from an epidemick Pestilence, but upon drinking any poisonous Draughts.
BUT it concerns us here to remove one Mistake; For it is laid down by
_Diemebrooeck_, in Opposition to the common Opinion, that a Carbuncle is
nothing else but an actual Gangrene; for if any Credit may be given to our
Experience, which we look upon to be as well founded as that of this great
Man, I do not remember any Carbuncles (unless where there hath some
manifest Error been committed in external Applications, or the Virulence
of the Pestilence hath been greater than ordinary) to have tended more to
a Sphacelation, than any other Consequences of the pestilential Poison.
And were there not innumerable Testimonies to the Truth of this, many
Arguments might be alledged in its Vindication; for while there is a free
Influx of vital Spirits, and other natural Fluids, into the Part affected;
while the native Heat is preserved from Suffocation, and Putrefaction is
prevented, what Person can imagine there to be any particular Disposition
to Mortification in a single Carbuncle? And the more especially when the
Spirits are so far from being intercepted by the Carbuncle’s Eruption,
that they flow more plentifully to the Part; when the native Heat is so
far from being suffocated; that by its Assistance a salutary Separation is
made; and lastly, when the Part affected is so far from Putrefaction, and
rendered more humid than before, that these saline Particles of an
escharotick Quality, rather prevent Mortification, and by drying the Part
make it rather more able to resist such a Change: And according to the
best of my Remembrance, I never did meet with a Carbuncle that mortified,
unless from the Mismanagement or Carelesness of Surgeons, or when the
highest Degree of Virulence in the pestilential Poison had not occasioned
an immediate Sphacelation.
NO Part of an humane Body was free from the Eruption of the Carbuncles;
And I shall not exceed the Truth if I affirm that I have met with them at
one time or other in all Places. But this Matter will yet appear more
fully beyond Contradiction, when I shall have brought a few select
Instances out of a great Multitude, to put it quite out of Dispute.
A Girl of about 12 Years of Age, felt a grievous Pain about her Breast,
where quickly after the Appearance of a Pimple, there broke out a
Carbuncle; the _Eschar_ at last came off, and the Ulcer discharging some
Matter plentifully; after about twenty Days she was reckoned to be very
well, had not a Surgeon too rashly dressed her with the _red drying
Ointment_, in order to cicatrize it; for upon that the Pestilence appeared
again, and killed her in about three Days, undoubtedly from a Return of
the Venom inwards before it was all discharged.
ANOTHER Case, almost beyond Belief, were it not attested by many
Eye-Witnesses, was of a Woman, who immediately after Delivery had a
Carbuncle appear upon her Breasts, when the Infant sucked all the Time
without Harm, and the Woman, through the Favour of the Season, and exact
Care in all Respects, recovered. I was also another time called to a Man
of advanced Years, whose whole Thigh and Hip was over-run with a
Carbuncle, but the Vesication was made by such an ichorous _Serum_, that I
strongly suspected a Mortification; I complained of being called so late,
but however ordered a deep Scarification, and other Means suitable,
whereupon there grew some Hopes of Separation, but for Want of inward
Strength and Spirits, the Patient died; whereas another of a more vigorous
Habit, was recovered in the same Case, for no other Reason, but that there
was Strength enough to carry him through it. Moreover, I once met with a
Buboe and Carbuncle together in the Groin of a Boy, not above two Finger’s
Breadth of each other; but by due Means, both medicinal and chirurgical,
the Lad got well from both his Ails together.
A certain Merchant had a Carbuncle upon his Arm, a little below the
Elbow, but what was most unhappy was, that at the Beginning he was so
Impatient of the Pain, that he applyed a Cooling Cataplasm to it of his
own ordering, for suddenly thereupon it changed into a Gangrene, to
obviate which, Scarrification was immediately had recourse to, in the
Execution of which, the Surgeon inadvertently cut a large Vein, which
caused such a Flux of Blood, as could not be stopped by either actual
Cautery, or any other Means; whereupon followed such a Sinking of his
Spirits, that the unfortunate Gentleman died in three Hours time.
LASTLY, A Carbuncle appeared on the Finger of a young Woman, to eradicate
which, we took all imaginable Care; and all Things at first seemed to
answer our Wishes; but the Uncertainty of humane Expectations! for the
Patient with her old Nurse Supping plentifully upon _French_ Beans, that
very Night the Distemper returned; and although she vomited as much as her
Strength would bear, by the Provocation of an Emetick given her, after
which were used the most Cordial Remedies, and the most warm
Alexipharmicks, early in the Morning, a fresh Carbuncle came in the Place
of the old one; she was delirious all that Day, and in the Evening she
expired. After the Bearers came that Night to bury her, and talked of
fetching away the old Woman next, as a Person dead, the poor Wretch, as
awakened from Sleep, cried out, she was not dead; but she disappointed not
their Agreement, and died time enough to be carried away the same Night to
the burying Place.
I might easily imploy a Volume in a Recital of all the particular
Circumstances of these Carbuncles; but however, before I dismiss this
Subject, I cannot omit that the pestilential Venom was in a very great
Manner communicable from one Carbuncle to another; or to speak perhaps
more properly, the saline Virulence of a Carbuncle would generate another
wheresoever it lodged.
THE Number of Carbuncles was undeterminate, sometimes two, three, four, or
more, would come out at once, the pestilential Venom being diffused to
many Parts at the same Time; but the rest we shall leave to that Section
concerning the Cure of Carbuncles; we shall here therefore subjoin
somewhat concerning pestilential Spots, called _Petechiæ_.
THE _Petechiæ_ then are little Spots upon the Skin, not easily
distinguishable from a Flea-Bite; though this Difference may be observed,
in a Flea-Bite there may be seen a Puncture in the middle, where the
little Creature had struck in its Teeth, and round it an Inflammation,
with a little extravasated Blood: But these Spots are more uniform in
their Colour, more fixed, and difficult to be removed, whereas upon any
Pressure with the Finger a Flea-Bite gives Way, except in the central
Puncture. Furthermore the pestilential _Petechiæ_ are to be distinguished
from the Spots of a malignant Fever, as they are deeper coloured; and
likewise to be known (as before observed) from Scurvy Spots, which are
much broader, and not always exactly round; although these are likewise
sometimes intermixed with the pestilential ones, and by Means of the
aforementioned Affinities between them, hardly in some Cases to be
distinguished.
TO this it may be added, that the pestilential _Petechiæ_ do not always
fix in the same Parts, and sometimes they disappear, after a short Stay
in one Place, and immediately rise in others: And indeed there is no Part
altogether exempted from them, although they chiefly come out in the Neck,
Breast, and Back; whereas those of the Scurvy come mostly in the extream
Parts. The Reason of this in the former Case may probably be from the
Proximity of the larger Vessels, and the Largeness of the Pores about the
Trunk of the Body; and in the Scurvy, the Legs particularly are most
spotted, from the Tendency and Precipitation of the saline Particles
downwards.
THE Spots were sometimes few, but most commonly very numerous; in some
they were so thick, as to cover in a manner the whole Skin. I saw a little
Girl that was all over full with them, but upon a large Sweat arising,
they all disappeared, and she recovered; yet sometimes the Distemper was
so delusory, that these Spots would arise, and disappear, and come out
again, for several Times; that is, when Nature gave its utmost Efforts to
expel the Poison, they might be seen upon the Surface; but when the
Spirits languished, or upon any external Cold, they would go in again.
I might here conveniently observe, that this Eruption was almost always
symptomatical, and very rarely critical; the Colour of them was not always
the same, sometimes they were red, or purple, at others yellow, and
sometimes livid or black, according to the Nature and Energy of the
morbifick Venom, and its Complication with other Contingencies; and hence
we naturally pass to the essential Characteristicks of a Pestilence.
THE genuine pestilential Characters, by the common People amongst us
called _Tokens_, as the Pledges or Fore-warnings of Death, are nothing
else than minute and distinct _Blasts_, which have their Origin from
within, and rise up with a little pyramidal Protuberance, having the
pestilential Poison chiefly collected at their Bases, and, according to
the accustomed Dispersion of such Agents, gradually tainting the
neighbouring Parts, and reaching to the Surface, as the Configuration of
Vessels and Pores are disposed to favour their Spreading.
MOREOVER these Blasts were derivable from external Causes, as from the
Injuries of Air, where the pestilential _Miasmata_ were pent up and
condensed, and by that Means their Virulence increased to that Degree,
that Life it self was immediately extinguished, upon coming within their
Reach. Nay, some were so suddenly marked with these fatal Characters, that
they did not before find themselves in any other Respect out of Order;
which is a Circumstance so well known, that there is little need to
confirm it by particular Instances, however, for the Reader’s
Satisfaction, I shall recollect one or two Facts of this Kind.
I was called to a Girl the first Day of her Seizure, who breathed without
any Difficulty, her Warmth was moderate and natural, her Inwards free from
glowing and Pain, and her Pulse not unequal or irregular; but, on the
contrary, all Things genuine and well, as if she had ailed nothing; and
indeed I was rather inclined to think she counterfeited being sick, than
really to be out of Order, until examining her Breast, I found the certain
Characters of Death imprinted in many Places; and in that following Night
she died, before she her self, or any Person about her, could discern her
otherwise out of Order.
Some time after I visited a Widow of Sixty Years of Age, whom I met with
at Dinner, where she had eat heartily of Mutton, and filled besides her
Stomach with Broth; after I had enquired into several Particulars relating
to her Health, she affirmed her self to have never been better in her
Life, but upon feeling her Pulse, I perceived it to intermit, and upon
examining her Breast, I found an Abundance of Tokens, which proved too
true a Prognostick, that even after so good a Dinner she would by the
Evening be in another World.
AS to the Eruption of these fatal Characters, I judged them to be rather
the Effects of the pestilential corrosive Salt, than of any Putrefaction
of the Humours; for this Poison wanting room for Exhalation through the
Pores of the Skin, collected in Quantities upon the Surface, and for want
of Spirits to strive therewith, imprinted these Marks thereupon.
FURTHERMORE these external Parts not only grew dry from the Acrimony of
this Venom, but were also very liable to Sphacelation by an Extinction of
the vital Spirits; but enough of this, because it would be but adding
Light to the Noon-day Sun, to endeavour to confirm it by more Testimonies.
THESE _Tokens_ did differ in Regard to their Colour and Hardness; of their
Colour we shall speak hereafter: Their Hardness I used to try with a
Needle or Penknife, to see whether the Sense and Life was perished or not;
in which Trials I found a great deal of Difference, as some would be
penetrated with very little Trouble, when others were even callous and
horny, and difficult to be penetrated. The Origin of these I conjecture to
be from the nervous Juice, or some gelatinous Substance evaporated into a
gummy Consistence, not unlike those horny Excrescencies from the Bones;
their Colour and Affinity in many Respects with Wharts is also
remarkable.
AND here I cannot pass by an Instance worth Observation, of a Girl who
came to my House full of Sadness and Consternation, already even to sink
down; upon Examination she told me that she had broke out from an House
where she was shut up with a Nurse, all the rest of the Family being dead,
to shew me the certain Forerunner of Death upon her, saying she had the
_Tokens_ upon her Leg; but I soon found a Mistake that might have been
fatal to her, for it was only a Whart, which neither she nor the Nurse had
ever taken Notice of before; she was soon undeceiv’d, and by my
Encouragement shook off all her Fear; returning Home chearful to take
those Medicines which were directed to carry off the Disorders upon her,
and sweating her plentifully removed all Suspicion of the Contagion: But I
really believe, that had not her Mind been soon made easie, by what was
said to her, she would have died merely by the Force of her Imagination;
as such a Dread extreamly aggravates the least Complaints.
BUT some of these _Tokens_ were not only so like in Appearance to Wharts,
that they deceived this young Girl, for sometimes even the Surgeons
mistook them; and I was beholden to the Management beforementioned of
pricking through them to be satisfied sometimes my self, as well as to
know the Degrees of Malignity in the Venom of the true _Tokens_; where I
found quickly a Sensibility, I took it for a good Sign, and those which
went no further than the Skin, would oftentimes slough off; whereas when
they went deeper, they were deemed dangerous, especially when the Part
lost its Feeling, and threatned Sphacelation. There were likewise some
found so extreamly comatous, that the whole Body was deprived of Sense;
insomuch that if any Limb, or Part clear of the _Tokens_, was tried by
Puncture, or Incision, there would be no more felt than upon the deadly
Marks themselves; notwithstanding which Insensibility of Body, some
Faculties of the Mind would return and be perceived even till Death.
THE _Viscera_ also, as well as the external Parts, would sometimes be
marked with these Characters, nay, sometimes it appeared, that the Inwards
were affected, when nothing of the _Tokens_ were seen externally.
THE Magnitude of the _Tokens_ were various, sometimes as small as a Pin’s
Head, and at others larger, and as broad as a Silver Peny; there were
indeed Instances of many running into one, but this was but seldom in the
late Sickness.
LASTLY, Some were depressed, and others prominent, and some did not appear
till the infected Person was dead; so that it did not suffice to kill, but
also to leave Marks of its Triumph; but some of the crafty Nurses would
put the dead Body immediately into wet Cloaths, whereby they stopped the
further Fermentation of the Juices, and restrained such Eruption, in Order
to elude the Magistrates Notice and Power, to shut up the Houses.
BUT how much soever these deep Marks were the sure Fore-warnings of Death,
yet sometimes they would be out from the fourth Day before, and remain all
that while as terrible Admonitions both to the Sick and others.