Part 7

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.

SECTION VI.

_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._