Chapter VI: 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._

These Prognosticks I thought my self obliged to take Notice of, by the Method I proposed to my self herein; but that I have omitted many, is to be excused by the Difficulty and Difference of Judgment in these Matters; for such was the delusory Appearance of this Pestilence, that many Patients were lost when they were thought in a safe Recovery; and when we thought the Conquest quite obtained, Death run away with the Victory; whereas others got over it, who were quite given over for lost; much to the Disreputation of our Art.