HENCE it comes strongly to be conjectured, how the pestilential Seminium comes to be hid so secretly in the Porosities of the Air, so as to be conveyed from one Country to another, and to travel unperceived into very distant Regions. Further, as this Medium is more still, it is so much the more capable to receive the pestilential Infection; whereupon Places that are close, confined, and dark, as Prisons, and Houses in Vallies, are much more liable to Contagion, than Situations upon Eminencies, where the Air is frequently agitated by Winds; for the malignant Effluvia cannot so well fix in an Air so tumultuously hurried about; and they are likewise rendred less hurtful by a continual Mixture of fresh Air with them.
THIRDLY, A suitable Disposition of the Subject is very necessary for the Reception of the pestilential Taint; and this Disposition respects either some Fitness in the Pores of the Body, or a long Accumulation of distempered Humours. The more open the Pores are, and the wider, by so much the more easily will the Infection penetrate into the Body; and the more constringed they are, the better Security is there against it, insomuch that hardly by any other Means can it enter.
A Turgescency of bad Humours greatly facilitates the Plague’s Admission into any Person, whether such a morbid Constitution arises from the Suppression of usual Evacuations, or from an erroneous Use of the Non-naturals; and most of all, a Load of bad Humours from an Excess or a Surfeit, leaves so great a Similitude to the pestilential Poison, as greatly to encourage its Admission. But besides these Dispositions of the Subject, it is much to the Purpose to suggest this following Observation, that the Plague is sometimes so much hereditary, and influenced by a seminal Taint, that in a common Contagion it shall much exert it self in some in the same Manner upon Children, as their Parents, as in the Small-Pox, and other Affections of like Nature.
FOURTHLY, It is necessary that there should be a continual Lodgment of the pestilential Poison; for if the noxious Steams were blown away as soon as received, there would be but little Mischief done; but those which meet with any glutinous Matter, and a certain Lentor from the Viscidity of the Humours, with which they lie entangled, until they are carried through the larger Vessels with the Blood, begin to fuse and taint all the animal Juices; and thus the pestiferous Miasmata having got Possession, are able to subvert the whole Machine, and bring all into Confusion, without requiring any long Stay to execute their pernicious Effects; for as soon as they once find a viscid and tenacious Substance, they eagerly join with it, and are but with great Difficulty to be extricated. Yet notwithstanding it is generally thus, I have sometimes found Instances of a longer Stay of the pestilential Poison before its Exertion, where the Symptoms of Infection have not appeared until a fit Time of Maturity for Eruption into Action, and for the Confirmation of which several Instances might be produced were it controverted; I have known many go into the Country after Intercourses with the infected, and keep well for a Month or two, when the Enemy that has lay hid so long, rushed out of its Fastnesses, and by its Fury sufficiently compensated its foregoing Delays; and this Eruption sooner might very probably have been hindred, partly by the Viscosity of the Humours entangling the pestilential Miasmata, and partly from an over-powerful balsamick Quality, natural to a good Blood, and to a Plenty and Vigour of animal Spirit; but as I would not be tedious upon Things so very obvious, this shall suffice concerning a Contagion.
BESIDES the Causes already recited, there may be others also worth Consideration, viz. the eating corrupted, or rotten Flesh; and it is not at all foreign to our Purpose here to take Notice, that on the Year before the late pestilential Sickness, there was a great Mortality amongst the Cattel, from a very wet Autumn, whereby their Carcases were sold amongst the ordinary People at a very mean Price; and a great deal of putrid Humours in all likelihood produced from thence: And this, in the Opinion of many, was the Source of our last Calamities; and many knowing Persons ascribe the Pestilence to this Origin, as the morbid Disposition which such a Feeding must needs subject the People, could not but facilitate both the Infection and Progress of that fatal Destroyer.
TO this I do not deny, but that the common People, who fed upon such a Diet even to Gluttony, might treasure up Matter enough for so deadly an Impression, and with which the Plague might naturally enough go into a Co-operation; but such Provision, although very much corrupt, and liable thereby to excite Symptoms like to those in a Pestilence; yet they were not in Plenty enough to supply the whole Market, and therefore a Cause so private and particular, could not be supposed to extend to so universal an Effect.
HENCE it is further manifest, that a corrupt Diet can do no more in giving a pestilential Impression, than a good one can in removing it; and therefore, not to dwell too long upon this Matter, it is my Opinion that such a Way of Living may raise the Humours to a Degree of Putrefaction, as brings Fevers very malignant, and causes epidemical Diseases, but not a true Pestilence.
AND the Conjecture that a Sickness amongst Cattle is transferable to the humane Species, hath not yet appeared on any good Foundation; but to remove this Difficulty, no one doubts but that a Plague amongst Cattle, from some common Cause, as a Corruption of the aerial Nitre, and which differs from a Plague amongst Men but in Degree, may also be transmitted to the humane Species; that is, a feebler Degree of Poison, and a milder Aura, may taint the Herbage, than that which is sufficient to destroy the firmer Constitution of Animals; besides which, from the Diversity in the Pores of Brutes, and their different Constitutions, and the Fortitude in the Spirit of a Man, I cannot be induced to believe that the Pestilence amongst Cattle from a private Cause, can ever obtain any Dominion over Mankind. These Stories therefore have no Weight with me, that a certain Leech, upon opening an Horse, that with a great many others had died of some common Distemper, in Order to know what it was, and finding certain pestilential Tokens upon his Inwards, both the Master and the Family soon died of the Infection; which yet went no further than that Family, but expired with them.
DURING the late Plague likewise at London, a Citizen travelling into the Country, found his Horse of a sudden to tire and fall down, whereupon he opened his Mouth to find out if possible the Cause of so sudden a Change; when the good Man, upon Receipt of the Horse’s Breath upon him, immediately grew sick, and died in two Days Time.
BUT these and the like Instances certainly tend to prove no more than that there may be Constitutions and malignant Steams, which, by agitating the Mass of Humours, may excite putrid and irregular Orgasms, wherein the Juices and Animal Fluids, according to the Quantity and Prevalency of the Distemperature, and the Variety of the infused Taint, with the Diversity of Putrefaction, goes into Corruption; but the forementioned Transplantation of the Plague does not happen but where there is a suitable Predisposition of Humours to admit it, as its Cause is not general.
MOREOVER, although the Intemperature of the Year, sudden Change of Air, Suppression of usual Evacuation, Diminution of Perspiration, Drunkenness, Venery, and Passions of the Mind, especially Anger and Fear, are justly reckoned amongst the remote Causes of a Pestilence; yet they regard rather the Invasion of it, than its Origin; but of this we shall say more hereafter. As to the above-mentioned Passions, it is almost incredible how some, at the Height of the Infection, would from a very slight Cause kindle into the utmost Rage, and rave at one another like meer Scolds, until Death parted their Contentions.
NOR does Fear or Sorrow less prepare the Way for the Infection, by deadning the Fancy and Memory, by Suffocating the Spirits, Suppressing the natural Heat, breaking the Constitution, and Promoting Malignity: We have manifold Instances of this kind in Readiness; but if, as some do, we should be prolix in the Enumeration of Things that want not Proof, the Reader would be quite tired with needless Stories.
BUT now it may be convenient to add a few Remarks concerning the Translation of a Pestilence from an hot Country to a cold one; for according to the different Effects of Heat and Cold, the one attenuating and rarefying, the other condensing and constipating, the pestilential Venom is strangely altered, insomuch that in a Thing so obvious, there does not require much to be said: Every Thing of this kind prodigiously spreads in hot Climates, as being more subtile than even the Air it self; tho’ the same in the Northern Countries is more restrained, and confined in Fastnesses it cannot escape from; and from hence the Reason is very obvious why there is so much Difference between the Diseases of different Climates, which would be too tedious for us here to go into.
TO come nearer therefore to our Business; the same Affections that in an hot Country heat the Blood and other Juices, so as in a great Measure to put them into Fusion, when translated into the contrary Extream may give contrary Properties to the same Fluids, and è contra; and this might be demonstrated by innumerable Experiments, were there any Doubt about it.
IT being then granted, that this Plague first was brought from Africa, or Asia, to Holland, and from thence into Britain, every one may easily conjecture, how much Alteration it must undergo in such a Travel, from a hot and dry Climate into a moist and cold one, not so much in its own Nature, as from the Vehicle of Air which conveyed it, and thereby producing different Degrees of Infection, and Series of Symptoms: But this Variation would be most discernable in the Complication of the pestilential Seminium, with the particular Diseases of each Country, and those which are as it were peculiar to them: This in our Case is very well worth Notice, for in Holland, where the Scurvy extreamly reigns, and therefore, for Reasons before given, most liable to a pestilential Infection, it obtained only as a more aggravated Scurvy, as shall hereafter be further remarked.
AS for that Opinion of the famous Kircher, about animated Worms, I must confess I never could come at any such Discovery with the Help of the best Glasses, nor ever found the same discovered by any other; but perhaps in our cloudy Island we are not so sharp-sighted as in the serene Air of Italy; and with Submission to so great a Name, it seems to me very disconsonant to Reason, that such a pestilential Seminium, which is both of a nitrous and poisonous Nature, should produce a living Creature.
AS in putrid Fevers, so in a Pestilence, Malignity is a Destroyer of Insects, and frightens them away as it were alive, so far is it from giving Birth to them; indeed in some malignant Ulcers and Cancers, and in the Blood of some People, sometimes animalcula are found; which is rather to be looked upon as the Effect of some Fault in the nutritious Juice, than the Produce of any Poison; and therefore they are not to be accounted amongst the Causes of a Pestilence.
IN Order to put an End to the Controversies about the Seat of a Pestilence, which have from Antiquity even to this Day been warmly maintained, many Authors putting the Heart for the Principle of Life and Death, some the Brain, and others the Stomach, Lungs, or Liver: It will be necessary here to discover the immediate Residence of the pestilential Seminium. Since therefore the above-mentioned Aura, according to Hypothesis, is very subtile and spirituous, for that Reason there must necessarily be some conformable Property in the Matter which is fit to receive it; as therefore there is not in the whole humane Machine any Subject more apposite, and capable of its Union, than the animal Spirits, we must fix its Residence there. But because I am sensible what Objections this Opinion lies open to, with some Persons, who may not conceive how an immediate Infection of the Spirits is communicable to the Viscera, and all Parts of the Body, it will be necessary to go thro’ this Matter in a very particular Manner, by enquiring;
FIRST, What are the Spirits concerning which we are here speaking?
SECONDLY, What is that Disposition of Spirits which makes them fit to receive the pestilential Impression? And,
THIRDLY, After what Manner the vitiated Spirits can affect the whole Body with Disorders?
TO this Purpose we must know, that the Spirits are the most thin and subtile Particles of the Aliment and other Juices, raised to the utmost Perfection and Volatility by the innate Heat, and the nitro-aerial Spirit, to serve in the Operations of the Mind, and all the Purposes of the animal OEconomy.
THE Matter whence the Spirits are generated is the Chyle, and their Restauration, Confirmation, and Vigour, from the Recruits of Food, as is their Languor, Prostration, and utter Extinction from the Want of it; so that howsoever they were first generated in the original, they owe their Conservation and Vitality to the Nourishment continually brought in; and although in a State of perfect Health they are never changed by that, yet they continually act upon that after various Ways, bringing it from a crude, recrementicious State, into a noble Juice, or rich spiritual Balsam, retaining its ideal Character: And hence it comes about, that although there is a daily Waste of Spirits, there is no Want, because Nature is continually, while Things are in Health, making more; insomuch that after a due Constitution of Spirits is obtained, they of themselves are the main Efficients in making more, as one Light is kindled by another, and as the Blood it self is the chief Instrument in Sanguification, or making more Blood.
IT is a Matter indeed of much more Difficulty to determine, how Particles from a gross Origin, should be raised to so great Volatility and Fineness; but this is very certain, that when they are elaborated in the most perfect Manner, they exceed even the Light and Activity of the Sun-Beams; and the brighter and more active they are, the better do they perform their Offices in the OEconomy, as from their Efficiency is procured a State of Health and Vigour both in Body and Mind.
IT is of no great Moment to enquire, what Quantity of Spirit is necessary for the Conservation and Support of an humane Body, so that we do but know they partake of the Source from whence they are generated, insomuch that they are more or less perfect, according to the greater or lesser Degree of Purity in their productive Juices.
BUT I must here acknowledge my self diffident in that Opinion of the Spirits being prepared of a different Nature for particular Parts, for according to the Influences of the Mind, and the Contiguity, Rectitude, or Consent of the Vessels, they are by a voluntary Act determined the same into this or that Limb or Part: Which is manifest enough in the Prick of a Needle, or a venomous Bite, from the great Affluence of Spirits to that Part; I have therefore no Notion of a continued Emanation of Spirits, but that on such Occasions they are called, by the Sensation upon the affected Part, from the nervous Origin where they are elaborated.
SECONDLY, It sometimes happens that the Spirits degenerate from their native Purity, as also at others that they prove abortive, in not arriving to their utmost Maturity, whereby they lie more open to foreign Impressions of Distemperature.
BUT when the juices, or common Promptuary from whence the Spirits are generated, is not uniform, genuine, and perfect in kind, it is impossible that Spirits should be made from it in any tolerable Perfection; for one may as well pretend to wash a Brick, or draw clear Water from a foul Spring, as expect pure and natural Spirits from a corrupt and vitiated Chyle; although even when the Chyle is in right Order, there may various Errors happen in the Generation of Spirits, as from too great an Heat agitating the Blood in a preternatural Manner, or from an imperfect or unequal Separation of Particles, or from too much Cold causing an Intermixture of Crudities; and again, although the Spirits are duly elaborated, yet they may run into irregular Motions, and be the Occasion of many Disorders: But what is most to the Purpose, they may sometimes also receive a Taint from external Impressions.
AND this Aptitude, or Propensity of the Spirits to receive a pestilential Taint, is manifest from their fiery, or rather saline Nature, for on Account of that Subtilty which they acquire thereby, do they more naturally attract the contagious Aura, than Bodies more gross and heavy: For as these Spirits, as before observed, are nitrous, and inflammable, by their Similitude to a pestilential Aura, they not only are fitted to receive, but even attract it, and provoke it into Union; as the Snuff of a Candle just blown out, if it is not too far off, will by an Affinity of Qualities be soon rekindled by another lighted one at some Distance; and how much soever the poisonous Qualities of the pestilential Effluvia may be destructive of the animal Spirits, yet there is nothing more certain, than that their Taint is very easily impressed upon them.
AFTER the pestilential Poison is thus received by the Spirits, it is impossible to express the fatal Consequences, and the cruel Havock that is made in the whole OEconomy; for the same Instruments which before were aery, lucid, and like the Rays of the Sun, immediately become vapid, dark, and useless, neither able to invigorate the Constitution, nor defend it against the Contagion.
THIRDLY, Having briefly passed over these Matters, it remains that we shew by what Steps the humane Frame comes to be disordered by this pestilential Invasion; and in Order to this, I know not a more fatal Circumstance in Nature than to have the very Guards and tutelary Preservers of Life, turn, as it were, Deserters and Betrayers. For there is nothing more manifest, than that the whole Compage, and its several Parts, run into Decay as soon as the pestilential Taint takes Place; for immediately upon the first Seizure, the whole Effort of Nature, as at Rome when Hannibal was at their Gates, is recollected against the Enemy, as sensible that all is at Stake, but being unequal to the Conflict, they retreat, and are taken Prisoners, leaving the whole Body defenceless. Hence the Infection runs through all the Blood, whereby the Heart and Lungs are principal Sufferers. Hence such a Corruption of the nutritive Fluids, that the whole nervous System is disturbed, the burning Heat of the Pancreas produces the most extream Sickness, and hence follows such a Depravation of the whole Machine, that all the vital Faculties cease to act, and Death closes the fatal Scene.
BUT I do not at all see how such a noble Part as the Heart, should be first affected by any particular specifick Quality in the Poison of a Plague, to affect that more than any other; as if it was so frightful, as some would have it, to attack the Principles of Life at once; for the Heart seems at first to be affected chiefly from the Multiplicity of Vessels, and the great Crowd of Circulation that Way, giving Opportunity for the Venom sooner to arrive thither; concerning which we shall have Occasion to say more under that Head of Symptoms.
UPON the strong, presumptive Proofs therefore that the pestilential Poison chiefly resides in the Spirits, we cannot but much admire at the Weakness of those, who expect to detect its Nature and Cause from what they can find on the Dissection of morbid Bodies, and such like Circumstances: For a very noted Person, and one of exquisite Skill in Anatomy, although he himself at last fell in the general Calamity, affirmed, that the Seat of the last Pestilence was in the extream Angles of the Plexus Choroides, towards the Cerebellum, because he had found a small Vesicle there; others have observed the Lungs to have been marked with the Tokens of Infection; others report the Heart to have been tumefied, and burnt as it were, to a Coal; whereas it is plain, that these Parts are only so many Fields of Battle, where the Spirits and the Infection contend it with each other; Nor will any one, who rightly considers these Things, wonder, that such Marks of Devastation should every where be left by so cruel an Enemy.
THEREFORE, although it should be granted that the most obvious and open Tokens of a Pestilence are from a spiritual and an invisible Cause, and whose Effects may perhaps sometimes be laid open to Sight, yet I have no Intention to discourage anatomical Dissections as a needless Trouble, for by such Light, Medicine is recovered from the Reproach of Conjecture; but when Bodies are opened which have been destroyed by such subtile Agents as here spoke of, there is no Confidence to be given from thence to the Nature of the Disease; and those who have been most knowing in the Nature, Use, and Disorders of the Spirits, very well can direct how to recover those Disorders, and avoid future Inconveniencies by immediate Application thereunto.
AND Lastly, to conclude this Doctrine concerning the Spirits Infection, this irrefragable Argument may be produced from the Intention of Cure; for I have experienced by more than a thousand Instances, that the more cardiack and alexipharmick Medicines are subtile and spirituous, the more certainly do they encounter the pestilential Poison with Success; whereas, on the contrary, those Medicines which are coarser and slower of Exertion, do little or no Good. But this we refer to the curative Part hereafter in another Section.
AS the Pestilence is the most powerful of all other Distempers, so it also claims a particular Privilege of joining with all others; so that it does not more excel in its own Contrariety and Antipathy to Nature, than it asserts a Prerogative over all those various Evils which the humane Frame is subjected to, and draws them into its Assistance in exercising its cruel Power over Mankind.
THIS Assertion might be supported by a Multitude of Instances, if it were not for taking up too much of the Reader’s Time; for which Reason we shall only take Notice, that amongst all those Distempers which are thus inclined to join their Forces with this most powerful Enemy, some seem to have a more particular Fitness for such a Union, from a common Affinity in the Nature of their Infection, and the Energy of their Poison.
ONE of the First of this Class is the venereal Disease, with which the pestilential Venom does in a very familiar Manner unite it self. At the first breaking out indeed of the last Sickness it was given out by common Fame, that those who were previously infected with any foul Distemper, as the Pox in particular, would be secured thereby against the pestilential Taint; but wicked and impious was the Consequence of such a Suggestion; for many were hereby encouraged to seek the most lascivious and filthy Prostitutions, on purpose to be secur’d by one previous Infection against another: But besides the poisonous Quality peculiar to this nasty Disease, besides that Expence of Spirit in the procuring it, and besides a lost Force of the Constitution thereby, the greatest Aggravation to this Misfortune was, that the very Taint which was to defend against another, had it in its Nature to be more forcibly attracted by it; so that the rash Adventurer was soon brought to a bitter Repentance for his Experiment, by sinking immediately under the pestilential Contagion at its first Stroke; and it was common to find, by a very easy Transition, the venereal Buboes changed into pestilential Carbuncles, except in a few Instances where Nature found out an uncommon Artifice against these united Powers, by endeavouring an Ejectment of their joint Malignities by Salivation, whereby sometimes the Patient was brought into some Chance for his Life, both the Poisons being in a great Measure cast off together that way.
BUT here it may not be improper to admonish the young Physicians not to be too forward Imitators of Nature in such a Circumstance; unless they will run the same Hazard with a certain Empirick, who crouded his Powders upon the Sick that raised an untimely spitting, and brought a great many into a dangerous Condition, which by a regular Practice might have been, tho’ with Difficulty, saved.
Yet to set this whole Affair in a clear Light, there is great Reason to suspect that in many Cases Mercury had for some time remained in the Body, which, like a Snake in the Grass, being raised by the Pestilential Infection, flew up into a Salivation; for the febrile Heat, assisted with Medicines also of an hot Nature, throw up the Mercury, which had long lain quiet, like a Sublimation; which should be a Caution, not only to young Physicians, but those of more standing in Practice, not to be so buisy with mercurial Medicines, to Children as well as grown Persons, as they are too much apt to be; least besides the Inconveniencies already mentioned they cause malignant Ulcers, and Rotenness upon the Bones, as it is too commonly observed to be done in irregular Practice, to the irreparable Detriment of the Patients.
I am not however ignorant that sometimes the Pestilential Venom may tumifie the salival Glands without any other Assistance, and occasion Ulcers in the Mouth as with Mercury; for it is a common Case in many malignant Fevers.
BUT it is so clear a Matter that the Pestilential and venereal Poysons may intimately join together by their Affinity with one another, to the great Detriment of Mankind, as to want no further Proofs to confirm it; nor does their Opinion at all obviate ours, who place the venereal Poyson in Humidity, and that of a Pestilence in Dryness, as long as the Symptoms and Affections of both discover one common Principle, that is, somewhat saline; but yet if this should not be granted, they are naturally enough joined together by their known Malignity and Destruction to human Nature.
BUT the Affinity between a Pestilence and a Scurvy is not a slight, and a supposititious Conjecture, but strengthened and confirmed by a plain Union between them, whereby they attack like confederate Troops; and both confess the same Origin, viz. a saline Principle; as is most remarkably obvious in their eager Coalition, whether we consider the forementioned Transplantation of the like Plague from Turky to Holland, where their Alliance was first formed; Or whether we reflect upon them both as Distempers equally epidemical, which when joined make such cruel Havock among the human Species; as neighbouring Flames catch together from a like Affinity of Parts, and burn with united Fury.
FOR although there is a great Difference in Salts of different Kinds, yet there is a common Property amongst them all, that when joined together they cannot hardly by any Means possibly be afterwards separated, for which Reason when these two Enemies of Mankind were joined, the complicated Evil was at first customarily distinguished by the outlandish Scurvy, which by a confederate Power had increased its Malignity to so great a Degree. But to give some apparent Facts, which irrefragably prove the natural Union between these two Origins of Mischief, it may be proper to recite some Symptoms common to them both, and first of all those Spots which were their certain Characteristicks.
THE Spots of those in the Plague were sometimes so numerous, as to cover all the Body, of which we shall say more hereafter; and if we consider the Appearances and Conditions of the Spots in both, we shall find a very great Agreement; the pestilential Spots sometimes break out broad, at other Times more contracted, just in the same Manner as it happens in a Scurvy; and as to their Duration, sometimes they are longer out than at others in both; now also suddenly appear, and then again as suddenly turn in, and sometimes remain out for two or three Days together; and their Likeness in all Respects is frequently so great, that amongst the ignorant Nurses and Empiricks, sometimes the fatal Tokens of a Pestilence have been mistaken only for Scurvy Spots: As to their Colour in a Plague, as well as in a Scurvy, they are sometimes florid, resembling fresh Flea-Bites, and at others dusky and livid; and I met with them in a certain Youth resembling Violet Flowers painted all over the Body; and in some I have seen them almost quite black, which are with great Difficulty to be distinguished from the true pestilential Tokens.
THERE are other Symptoms also that denote the Agreement herein, such as large Stools, of a saline and fetid Nature, and which are with great Difficulty restrained by the most powerful Medicines; but if such a Flux continues, it threatens irretrievable Injuries, as Corrosion, Inflammation, and sometimes even Sphacelation of the Bowels, with intolerable Gripings, and sometimes Loss of Blood: Furthermore, the Agreement that there is between the Ulcers and Tumours of both evidently demonstrate the Affinity of both their Origins, as will hereafter more fully appear in that Part about the Cure.
THE Pestilence likewise shews its Affinity with the Scurvy, by leaving behind it a scorbutick Habit, even where a Person was not given to it in the least before; and it is not indeed at all strange, that after such Disorders, and Corruption of the animal Juices, and such an Exhalation or Suffocation of subtile and spirituous Particles, an Habit should be confirmed, that can be removed but by the most generous Remedies, and the most powerful Antiscorbuticks.
IT remains now briefly to enquire, whether a Pestilence coming upon another Disease, in any Instances proves of Service; and this I shall dispatch in two Histories of Cases, one in a Consumption, and the other in the King’s-Evil.
A Girl of fifteen Years of Age was so emaciated, that she had left little besides Skin and Bones, and taking no Nourishment for 14 Days together, she was given over as gone, but being called to the same House, to see her Mother, and two others who had the Infection, and recovered, the same Distemper seized that Creature almost half-dead before, whom also I then attended; but she who just before lay as expiring, seemed animated by the feverish Heat, began to move her Limbs, and with the Help of Alexipharmick Medicines, although before speechless, began to complain of painful Swellings about her; but those Buboes, which I suppose would otherwise have broke out, for Want of Matter to raise them, were dissipated by Transpiration; so that she recovered, and in about two Weeks also manifestly lost her former Distemper, and gathered Flesh and Strength.
ANOTHER Maid of about 16 Years of Age had been so scrophulous from her Childhood, as to have many indurated Glands remain after all possible Means had been used to dissipate them. She at last was seized with the Contagion, and pestilential Buboes rose upon the strumous Glands, which suppurated, and let out a great Quantity of Filth; and upon her Recovery from thence, her former Distemper was quite lost.
SOME gouty Persons likewise, and others accustomed to very obstinate Complaints, were, by a lucky Conjunction with this Infection, quite restored: and indeed most who were rightly managed in the Plague, and perfectly recovered of it, were afterwards, in many Respects, better in their Health than before; so that this terrible Enemy, as it was commonly fatal, so it also sometimes proved a Remedy. And thus much for the Complication of the Pestilence with other Distempers. We shall now proceed to its Symptoms.
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.