_The Prognostick Signs of the late Pestilence._
AS that Pestilence which of late made so great Havock amongst Mankind, was
so full of Shiftings and Changes in its Attacks and Progress, that very
little Certainty could be had of its Event; it highly concerns the Credit
and Honour of the Faculty, not too hastily in such Cases to prognosticate
either Recovery or Death: In Order therefore to remove, as much as
possible, such Difficulties for the future, it is with Cheerfulness that I
can leave with Posterity those Observations which I have been able to make
in my daily Attendance upon the Infected, to the utmost Hazard of my Life,
through the Course of this late Sickness.
THE prognostick Signs then regard either the Pestilence it self, as to its
Origin, Heighth, and Declension, or the Recovery or Death of the Patient.
_FROM certain and undoubted Signs, for some time foregoing the manifest
Eruption of the Plague, may its Degrees of Severity be prognosticated._
AS sharp and immoderate Pains apparently denote a pestilential
Constitution, and likewise Tumours breaking out again upon Parts before
affected: For it is a Case that I have often met with, that those who have
had Buboes and Carbuncles in the Sickness well cured, to break out again
afterwards, from some Remains of the pestilential Venom yet lurking in the
Constitution, and not to be conquered.
WHENSOEVER chronick Diseases are changed into acute ones, it may be
concluded that the Infection is not far off; For Valetudinarians are more
sensible of any approaching Disorder than those who are strong and
healthful: And from a natural Cause may it be accounted why infirm
Constitutions can certainly foretel several Changes in the Air, and be
forewarn’d of other external Inconveniencies; and the more virulent any
Infectious _Miasmata_ are, the sooner do they affect such Habits; and it
seems peculiar to the Plague to be preceded by its pernicious _Effluvia_,
like so many Officers seizing the Weak and Helpless first; and such it
tyrannizes over by converting the morbid Humours into its own Nature, in
subtilizing those which are gross, acuating the dull, heating the cold,
changing the natural Ferments, and in short, by inducing opposite
Qualities into the whole Constitution.
MOREOVER, in this Regard we may consider the frequent Mortalities amongst
Cattle, which foregoe an Infection amongst Mankind; for these Creatures
living for the most Part, both Night and Day, in the open Air, not only
are more influenced by it when tainted, but are also hurt by the
infectious Venom which gathers upon the Herbage; as likewise they are more
liable, on other Accounts, to feel its first Approaches, because its
freest Progress is in open Places.
MOREOVER, when there is a general Sadness and Consternation upon the Minds
of the People from no manifest Cause, so that the whole Multitude are pale
and spiritless, who can think but that some general Calamity is at Hand?
AND certainly this will not appear a very difficult Conjecture, and remote
from Reason, when we duly consider the strange Intercourse and Familiarity
which the Spirits maintain with Things very occult, and at a Distance; for
whosoever rightly weighs this Matter, will perceive the Spirits capable of
very subtile Impressions, by Means of their Intercourses with the
Imagination, whereby they are capable of perceiving, though obscurely, any
approaching Evil, and consequently of exciting amongst the Populace a
general Apprehension concerning Futurity, without any miraculous
Influence.
LASTLY, All fore-bodings of any Kind denote the Malignancy of the
approaching Evil, because they are manifestly from the Influence of the
pestilential _Miasmata_; and the further off such Impressions are made,
the greater do they prognosticate the future Calamity will be; because
such Irradiations at a Distance, and propagated through a long Tract of
Air, denote the great Energy and Virulence of their Origin; when therefore
the Pestilence seldom appears without such Fore-warnings, and gradually
diffuses according to the greater or lesser Liberty for the nitro-aerial
Poison to move in, and the first Perceptions of it are so terrible, what
Miseries and Desolations may not be expected from it, when it is arrived
in its full Force?
_A Pestilence that is fierce and deadly in its first Attack, soon ceases._
I call such a Pestilence fierce, that immediately destroys the strongest
Constitutions, and which being every where diffused, seizes all at once;
for the sooner the venomous _Seminium_ is spread and wasted, the sooner
will its Fury be over.
_THE Times of a Pestilence in its Decrease, are in Proportion to the Times
of its Increase._
FOR the infectious Poison does not act precariously, but in a regular and
uniform Manner, as it fully appeared by the Course of the late Sickness
amongst us; (not to mention others at a greater Distance of Place and
Time) but this will be best made appear from the Tables of Mortality
hereunto annexed.
_The Cause of a Pestilence being removed, spent, or extinguished, its
Effects immediately cease._
AS Fire goes out when its Fuel is wanting, or spent, so the pestilential
Virulence continually wants somewhat to keep it up, and no longer than it
is supplied with that necessary _Pabulum_ will it last: Although I
acknowledge that sometimes these fatal Sparks will lie as it were
smothered in their own Ruins, for some Time, and after a certain Interval
break out again into its first Fury, from the original Cause that as yet
hath never been extinguished. And hence perhaps some may be led into an
Error about the Plague’s being co-æval with the World, and its continual
Subsistance in one Place or another, as external Circumstances favour its
Propagation or Hindrance; for the very Increase of the pestilential
_Seminium_, after every Interval of Recess, plainly shews it to take fresh
Root; and upon the total Extirpation of it, I cannot see how the same can
appear again: And this is confirmed by the almost continual Varieties in
different Infections.
WE now come in Course to speak of those Prognosticks, which regard the
Death or Recovery of the infected.
_Every Hemorrhage is bad, but a Flux of the Menses always fatal._
_A Looseness of the Bowels, especially in the Beginning, is commonly a
Sign of Death._
BECAUSE by this Evacuation a _Diaphoresis_ is prevented, the Strength is
wasted, and the Poison is so far thrown upon the Bowels, as sometimes to
induce Sphacelation; the Case if likewise not much better when the _Fæces_
are extreamly fetid, and there is no Relief thereby; or when they are
green, or black, or come away involuntarily, especially when attended with
a _Dysentery_.
_WHERE the Lungs are tender, weak, or distempered, it generally ends ill._
FOR I can hardly remember any one who had bad Lungs that escaped in the
late Sickness; and it was a constant Observation, that Asthmatick Persons,
not only by frequent and hard Inspiration drew in more of the poysonous
Steams than others, but also that the weakned Force of that Organ, gave
Opportunity to them to fix their Lodgment there.
_WHEN Persons grew no better for Sweating, but weaker, and the Distemper
higher, it was judged fatal._
FOR after Nature had made such an Effort to expel the Venom to no Purpose,
all Hopes of Recovery could not but vanish. A great Expence of Spirit, and
a general Decay of Strength, must be the Consequence of such a Wast; and a
Continuance of Sweat likewise brings on a dangerous Colliquatation, or is
a Sign of it; and those hot sharp Sweats, which vesicate the Skin, are
also to be suspected: Moreover, it is very hazardous when cold Sweats come
after such hot ones. But the most certain Fatality of all, is from such
Sweats as have a cadaverous Smell; altho’ there was sometimes a very
disagreeable scented Sweat, with which they recovered, as with it exhaled
the pestilential Venom.
_A Loss of Appetite for a great while, proved most commonly but a
dangerous Prognostick._
IT appears, by what hath been already said, that a Loathing at Stomach was
a certain Sign of Infection; and upon a Continuance of it, it was
necessary that there should ensue a Defect of Nourishment and Strength,
which made a Person much more liable to the worst Influences of the
Distemper, and even to Erosion and Sphacelation of the Stomach.
_DEAFNESS joined with Drowsiness, were Signs the_ Parotides _would soon
appear_.
_WHEN Buboes went in again without due Evacuation, and while bad Symptoms
continued, Matters were generally doubtful, and for the most Part very
dangerous._
I always looked upon my Labours to be defeated, whensoever these Tumours
disappeared of a sudden without any manifest Cause; for it was owing to
the Retreat of the Venom inwards, where it made terrible Mischief, and was
extreamly difficult to be got again to the Surface; yet if Sweats broke
out, that the Patient could well bear, it was not uncommon for them to
return, and bring again Matters into an hopeful State.
_WHENSOEVER these Tumours are discoloured, especially tending to
Blackness, or do not suppurate, or are insensible, it may be pronounced
the Patient will be worse._
_THE more Buboes there are, so that they suppurate, the better._
_CARBUNCLES are always more dangerous than Buboes._
BOTH on Account of their sharper Pain, and greater Difficulty to cure.
_THE smaller the Carbuncles are in Compass, and their Situation remote
from the_ Viscera, _greater Vessels, Tendons, and Nerves, and the fewer
they are in Number, by so much it is the better; and, on the contrary,
when they spread like a Gangrene, and are near the principal Parts, as the
Breast or Belly, and also are numerous, or livid, the Fate of the Patient
may be pronounced desperate._
_THE pestilential_ Tokens, _especially when they are deep, are the sure
and speedy Messengers of Death_.
FOR a general Mortification commonly follows these particular ones:
although there is sometimes (as before observed) some Time given between
one and the other, as for two or three Days.
_A Complication of bad Symptoms, together, precipitates the Patient into
another World._
NAY, sometimes when there are many Symptoms of Recovery, the obstinate
Continuance of one bad is enough to determine the Patient’s Fate.
_FROM the inconstant Appearance of the Urine, there can be no certain
Judgment made._
THE Urine indeed of these Patients is generally not to be distinguished
from that of healthful Persons, although sometimes its Stench is not to be
endured; this a certain Physician found to his Cost, who taking the
Urinal too near, was infected by the Scent, fell ill, and in three Days
died.
_THE Pulse, which in all other Diseases is almost a certain Index, in this
Sickness could not be at all trusted to._
_THOSE who were comatous in the Beginning or Height of the Disease, seldom
escaped._
These Prognosticks I thought my self obliged to take Notice of, by the
Method I proposed to my self herein; but that I have omitted many, is to
be excused by the Difficulty and Difference of Judgment in these Matters;
for such was the delusory Appearance of this Pestilence, that many
Patients were lost when they were thought in a safe Recovery; and when we
thought the Conquest quite obtained, Death run away with the Victory;
whereas others got over it, who were quite given over for lost; much to
the Disreputation of our Art.