Chapter V: 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.

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.