Part 6

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.