Part 5

THERE are other Symptoms also that denote the Agreement herein, such as large Stools, of a saline and fetid Nature, and which are with great Difficulty restrained by the most powerful Medicines; but if such a Flux continues, it threatens irretrievable Injuries, as Corrosion, Inflammation, and sometimes even Sphacelation of the Bowels, with intolerable Gripings, and sometimes Loss of Blood: Furthermore, the Agreement that there is between the Ulcers and Tumours of both evidently demonstrate the Affinity of both their Origins, as will hereafter more fully appear in that Part about the Cure.

THE Pestilence likewise shews its Affinity with the Scurvy, by leaving behind it a scorbutick Habit, even where a Person was not given to it in the least before; and it is not indeed at all strange, that after such Disorders, and Corruption of the animal Juices, and such an Exhalation or Suffocation of subtile and spirituous Particles, an Habit should be confirmed, that can be removed but by the most generous Remedies, and the most powerful Antiscorbuticks.

IT remains now briefly to enquire, whether a Pestilence coming upon another Disease, in any Instances proves of Service; and this I shall dispatch in two Histories of Cases, one in a Consumption, and the other in the _King’s-Evil_.

A Girl of fifteen Years of Age was so emaciated, that she had left little besides Skin and Bones, and taking no Nourishment for 14 Days together, she was given over as gone, but being called to the same House, to see her Mother, and two others who had the Infection, and recovered, the same Distemper seized that Creature almost half-dead before, whom also I then attended; but she who just before lay as expiring, seemed animated by the feverish Heat, began to move her Limbs, and with the Help of Alexipharmick Medicines, although before speechless, began to complain of painful Swellings about her; but those Buboes, which I suppose would otherwise have broke out, for Want of Matter to raise them, were dissipated by Transpiration; so that she recovered, and in about two Weeks also manifestly lost her former Distemper, and gathered Flesh and Strength.

ANOTHER Maid of about 16 Years of Age had been so scrophulous from her Childhood, as to have many indurated Glands remain after all possible Means had been used to dissipate them. She at last was seized with the Contagion, and pestilential Buboes rose upon the strumous Glands, which suppurated, and let out a great Quantity of Filth; and upon her Recovery from thence, her former Distemper was quite lost.

SOME gouty Persons likewise, and others accustomed to very obstinate Complaints, were, by a lucky Conjunction with this Infection, quite restored: and indeed most who were rightly managed in the Plague, and perfectly recovered of it, were afterwards, in many Respects, better in their Health than before; so that this terrible Enemy, as it was commonly fatal, so it also sometimes proved a Remedy. And thus much for the Complication of the Pestilence with other Distempers. We shall now proceed to its Symptoms.

SECTION V.

_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.