Loimologia: Or, an Historical Account of the Plague in London in 1665 Part 6

BECAUSE by this Evacuation a _Diaph.o.r.esis_ 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 _Faeces_ 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 Appet.i.te 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 p.r.o.nounced 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 Compa.s.s, 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 princ.i.p.al Parts, as the Breast or Belly, and also are numerous, or livid, the Fate of the Patient may be p.r.o.nounced 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.

SECTION VII.

_Concerning the Cure of the late Pestilence._

ALTHOUGH a pestilential Infection is extreamly dangerous, and doubtful as to its Consequences, very few being spared by it, when in its greatest Height, yet we are by no Means to despair in so great a Difficulty, and give up the whole Race of Mankind to Destruction as soon as it comes, but be rather stimulated to greater Endeavours; and, like faithful Ministers of Nature, study all Helps against such common and grievous Calamities.

BUT before we enter upon that Part which seeks a.s.sistance from Medicine, it may be necessary to exhort the infected, that they have due Regard to the Almighty Power, not only in confessing, and seeking Forgiveness for Sin, but in imploring his Blessing upon those Remedies and Means for Recovery which even the most skilful Physician can prescribe.

THE Infected also ought to be admonished that they make their _Wills_, and settle their worldly Affairs, so as to prevent Contention and Law-Suits, least by the Severity of such a Distemper they should chance to be carried off. But this is to be done before they are affected at all in their Understandings by the Disease.

LASTLY, It is likewise to be enjoined the Sick, that they quietly, submissively, and with a chearful Confidence, commit themselves to the Care and Management of their Physicians; And hence appears the Difficulty of that Task to watch over those who are in such imminent Danger; and what variety of Cares lie upon him who undertakes it, and who often falls himself by that Tyrant he is endeavouring to defend others from?

BUT to do Justice to the _Sacred_ Art, in its relieving Mankind in such cruel Diseases, this must eternize the Sons of _Esculapius_, that they seem to be born for the Publick Good, by their Usefulness even in a Pestilence, as well as other more common Calamities of Life; but on this Head I shall forbear saying more, knowing how unworthy I am to give due Honour to so much Worth.

BUT in the Prosecution hereof, as some heretofore have taken a great deal of Pains to no Purpose in finding an _universal specifick_ against the Pestilence, and have imposed many palpable Falsities upon the World under such Pretences; so our modern _Coal-Blowers_ have in like Manner cried up their pernicious Secrets, and wickedly imposed them upon the credulous Populace. Certainly these publick Cheats ought themselves to be deemed pestilential, as their Notions and Practice is abhorrent to all sound Reason: For if the Arguments on both Sides the Question be fairly stated, and one will be convinced, that there never as yet hath been discovered in Nature, the full and absolute Essence of a Pestilence, but that it still remains a Mystery to Mankind; wherefore in this Distemper a Person must proceed, as in all others, by a serious Attention to the manifest Symptoms, and a rational Conformity of the Means of Cure thereunto; and while we hold to this only Rule of Procedure, although the Severity of the Distemper may conquer several, yet many also may be saved.

IT now comes to us to declare what a Physician has to do in this Calamity; as therefore the Disease admits of no Delays, Help must be immediately procured, and the Physician ought to fly to the Patient's Succour, least, by any Omission, the Case should be got beyond Recovery, and a Person be lost for Want of timely a.s.sistance.

WHEN the Physician is come, he ought to address the Patient with Chearfulness, and blame those Fears and melancholy Apprehensions which give many over too much into the Power of the Distemper, by cutting off all Hopes of Recovery.

LASTLY, according to the general Directory of our College beforementioned, the most generous and efficacious Medicines must be contrived with the utmost Care and Deliberation.

IN the first Place then, whether Phlebotomy is to be practiced or not is justly to be questioned; and indeed I should pa.s.s it by here as fatal, but that I know many unskilful and rash Persons, who not only let Blood largely at one Time, but order it likewise to be repeated until the Patient faints.

BUT if the Authority of the Ancients as well as the Experience of the Moderns hath any Weight, and indeed if our own Practice may be regarded, it is highly to be feared, from many Instances, that Bleeding in a genuine Pestilence is not only to be suspected, but charged as pernicious; for we have many times seen the Blood and Life drawn away together; which makes it astonis.h.i.+ng to see the Practisers in such Mischief dare to justifie the fatal Error; what is it that indicates this Evacuation, is it intense Heat; or any Turgescency of the Vessels? Or is it to give Vent to the pestilential Poison to make its escape? Certainly nothing to me seems more absurd; for if the other Symptoms do not remit with the Fever, the Patient will be plunged into the utmost Hazard; for how can the Blood and other Juices be depurated, if the febrile Heat is extinguished? not to say any thing of a Suppression of salutary Breathings hereby, a Perversion of the natural Secretions, and Sinking the Spirits.

THEY also are under as great an Error, who fetch their Reasons for this Practice from the Turgescency of the Vessels; for while inordinate Hurries are excited in the Blood, from disagreeing and heterogeneous Particles striving to extricate themselves from one another, there is made thereby only a seeming Plenitude; what Madness then must it be, in order to remove an imaginary Fulness, to sink the necessary Strength by a rash Effusion of Blood?

AND lastly, the morbifick Poison is not of that kind, as to seek an Escape at the Orifice of a Vein, and run out with the flowing Blood; and which (as before proved) affecting chiefly the Spirits, and residing in other Vessels, makes this Method of Cure in a Pestilence impracticable. I will not however deny but that there may possibly be Circ.u.mstances in malignant and pestilential Fevers, which may justifie Phlebotomy, as when it is done for Revulsion sake, in too great a Flux of the _Menses_: But in a genuine Pestilence, it is not to be meddled with. There is but one, as I can remember, who survived it in the late Sickness; but it is needless to say any more upon a Subject so plain, and therefore I shall pa.s.s to what is of more Consequence.

AS for what concerns the next Means of Remedy, an _Emetick_ may be given in the Infancy of the Disease, where the Stomach is loaded either by over-eating, or by a Crowd of bad Humours, or when there is a Loathing, or a Bitterness in the Mouth; so that any particular Conformation of the Breast and Neck doth not contra-indicate; and amongst these Remedies they are preferrable which plentifully excite Vomiting, without working also downwards.

OF this kind are the _Syr. Diasari Fernelij_, _Syr. Scabios. compos.

Oxymel. Scillit._ and chiefly the _Sal Vitrioli_; but the Antimonial Preparations are not so advisable. The Dose of the _Emetick_ ought to be large enough to Empty the Stomach soon; and the Posset-drink used in the Operation, in order to rince off its Coats all Filthiness, is to be impregnated with _Carduus_, _Scordium_, _Meadow-sweet_, _b.u.t.terbur_, &c.

boiled in it. In my own Practice, I have always found good Service from large Draughts of the Posset-drink above-mentioned, sweetned with _simple Oxymel_, without any other previous _Emetick_ given.

AFTER Vomiting is over, in order to enable the Stomach the better to keep any Alexipharmick Medicines, its Force may be greatly strengthned by adding Stomachicks to the Alexipharmicks: But if a Reaching to vomit prove Symptomatical, _Emeticks_ are by all Means to be avoided; least the Physician (like old Nurses, who are altogether ignorant of the Rules of Practice) should promote that Symptom, which by fruitless Strains waste the Spirits, and sollicit the pestilential Venom into the Stomach from distant Parts; which when fixed there, still irritates into more violent Reachings, that cannot be a.s.swaged by any Remedies.

ALTHOUGH in other Cases a Vomiting may be removed by _Emeticks_, yet in a Pestilence it is dangerous to follow such Practice; because the Malignity, or rather Nitro-saline _Effluvia_, vellicate the Mouth of the Stomach, and so invert its nervous Coats, although empty, as to bring on Convulsions: And some Persons seem to have their Stomachs full, as overloaded with Food, who crave to be freed by Vomiting, which it is by no Means safe to indulge them in, because such a Sensation of Fulness proceeds only from the pestilential Poyson vellicating the Membranes, while the Stomach is it self free from Food, or bad Humours; but what further concerns this Matter, will come to be further considered under the Cure of Symptoms.

MOREOVER, Purges are justly reckoned amongst Medicines of great Efficacy; but whether or no they are to be used in the Case before us, is a Difficulty, and full of Controversy amongst Physicians; and indeed the Varieties in pestilential Diseases, the Differences of Const.i.tutions, the various Complication of Circ.u.mstances, the Uncertainty of Seasons, _&c._ do make it impossible to give any general Rules hereupon; wherefore I shall go no further than what my own Practice hath enabled me to judge concerning it.

A Turgescency or Distemperature of Humours do certainly call for an Evacuation this Way; that is, when the Humours are troublesome more by their Quant.i.ty than any stimulating Quality; when therefore the Const.i.tution is not able to conquer such a Burthen, neither by Digestion nor Expulsion, Catharticks are certainly necessary to help away the Load, and especially if a Person hath been before eating to Excess.

BUT if this Evacuation be delayed till the Juices have received the pestilential Taint, the Humours are then rather to be depurated, then purged away by Catharticks; and it is certainly better to trust to the Strength of Nature, when Things are gone so far, to do the Work her own Way: And whether or no the Blood is too much fused, or (according to some) coagulated, purging Medicines are certainly to be avoided; for in the first Case they further agitate and fuse the Blood, besides the Hazard of breaking open such Vessels as may not without great Difficulty be again closed; the same Medicines are also hurtful in the Blood's Coagulation, because they evacuate only the serous Parts, and leave the Remainder more viscid and tenacious, whereby Obstructions are rendred more perverse and unconquerable, and the stagnant Matter without a Possibility of Dilution, and Rest.i.tution to its pristine State of Fluidity, as also more strongly inclosing the pestilential Poison at the same Time; it is also greatly to be feared, that in so great an Agitation the morbifick Venom may be drawn to the Bowels, and Sphacelation follow thereupon.

THAT Purging may be also practised with Success, the Strength of the Patient is carefully to be consulted, for where the Spirits are low, or deficient, it may not only prove unsafe, but fatal; and where the Bowels are extreamly stimulated by the Cathartick, and the Humours greatly put into Fusion by its rarifying Qualities, they will be apt to pa.s.s off in too large a Profusion.