The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

CHAP. XII. Of the Plague.

THE Plague may be described after this manner, That it is an Epidemious Disease, contagious, very destructive to Mankind, taking its Rise from a venemous Miasm first received by the Air, afterward propagated by Contagion, which setting upon Men after a hidden and secret manner, causes Extinctions of the Spirits, Coagulations of the Blood, Syderations and Mortifications of it, and of the solid Parts, and brings the Diseased in danger of Life, with an Appearance of Pushes, Bu∣bo's, or Carbuncles, and with the addition of other horrible Symptoms.

There are a great many Signs occurring to us, which fore-shew that the Pestilence will happen in a short time, to wit, if the Year does not keep its Temperament, but has immoderate and very unseasonable excesses of Heat or Cold, Drought or Moisture: if the Measles or Small Pox are every where very rise, if Phlegmons, or Bubo's accom∣pany reigning Fevers; from a preceeding Famines a most certain Pre∣sage is taken of an ensuing Plague; for the like Constitution of the Year which for the most part brings a Dearth of Provisions, by reason of the Corn being blighted, is apt also to produce a Plague; also the evil sort of Dyet, which such as are prest with Hunger make use of, eating all kinds of unwholsome things without choice, disposes their Bodies more readily to receive the Contagion. Moreover Earth-quakes, and fresh-opened Grotto's and Caverns upon the cleaving of the Earth, by reason of the Eruptions of a malignant and venemous Air, have often given Beginnings to Plagues. Again, as there is need of great Dili∣gence in taking a fore-view as it were, from a Watch-Tower, of an imminent Plague, so we ought to be no less sagacious in observing the same as if first arises, and cast its first Darts; for often, being too sollici∣tous, we dread even vulgar Fevers, if haply they end in Death, for this Contagion; and sometimes being too secure, contemning the Pe∣stilence by reason of its Symptoms resembling those of a common Fe∣ver, we find our Dangers but too late: wherefore, for the fuller know∣ledge of this Disease, we shall set down its Signs and Symptoms both common and pathognomick.

Besides the Signs above delivered, which by a certain Demonstra∣tion, a Priori, give a Suspicion of an ensuing Plague; there are others whose concurrence with it plainly shew its Presence in a Body diseas'd: of these some are common to a Plague with a putrid Fever, some are more proper to this Affect; for the Impression of the Plague oftentimes stirs up an Effervescence of the Blood, and has a Fever so

frequently joyn'd with it, that by some, in the Definition of the Plague, the Fever is put as a Genus; wherefore, by reason of the Ebullition of the Blood, and the Injury brought on the Viscera, pre∣sently an Incalescence with a spontaneous Lassitude, a Thirst, a burn∣ing of the Praecordia, Vomitings often violent, a Cardialgia, Gripes in the Bowels, a Roughness or Blackness of the Tongue, a Swooning, and a sudden Fall of the Strength, ensue. Tho vulgar Fevers are of∣tentimes attended with these kinds of Symptoms, yet if at the same time a Plague be rife in the Neighbourhood, and a fear of the same seises the Minds of Men, hence a greater Suspicion of this Evil is gi∣ven; and especially, because, when a Plague reigns, all other Disea∣ses leave their own Nature and pass into that: wherefore, if to the Affects even now mentioned, there be added a Communication of the same Disease to many, and many dye of it, so that it generally becomes mortal and spreads it self; and if besides, Buboes, Carbuncles, Push∣es, or others Marks of a pestiferous Contagion appear, the thing is put without doubt, and we hence proclaim a Pestilence, with no less Confidence, than we do a Fire when we see a Flame burst forth through the Roofs of Houses: but because a mention is here made of Buboes, Carbuncles, and other Symptoms, it remains for us to give briefly the Causes of them, and the ways of their being produc'd; they are these, a Carbuncle, Bubo, Pushes, Wheals, and malignant Pu∣stules.

Concerning these, we say in general, that they are all Products of the Blood, and nervous Juice, struck with a pestiferous Venom, and coagulated by Parts in their Circulation, and variously affected with Purtrefaction; for the Spirits residing in both Liquors, especially in the Blood, are no sooner touched with the breath of a malignant Contagion, but a Coagulation is caused in the remaining Liquor, even as when Milk turns sour, or has an acid Juice mixt with it: wherefore, Portions of it being greatly tainted with Venom, soon grow clotty, and like extravasated Blood, fall into a Corruption with a Blackness; whence presently they stop the Motion of the rest of the Blood in the Heart and Vessels, and coagulate it more by reason of their Ferment. Now whatsoever is gathered together into Clots by Coagulation, un∣less it be presently cast forth, brings Death in a short time, by stop∣ping the Circulation of the Blood; and being driven outward to the Circumference of the Body, is stopt in motion in the narrow Involu∣tions of the Vessels; and either being wholly destitute of Spirit, as tho it were Planet-stricken, it produces black or blew Marks by its Mortification, or by reason of the Salt and Sulphur exalted by the pestilential Ferment, and affecting new things, it grows, into Tumours of various kinds.

A Carbuncle is a fiery Tumour, with very smart and burning Pustules about it, infesting the Diseased with an acute Pain; which arising in

various places indifferently, does not suppurate, but spreading largely round about, burns the Flesh, and at length throws off lobes of it be∣ing corrupted, and leaves a hollow Ulcer, as tho burnt by an Eschro∣tick.

The Generation of Carbuncles seems to be after this manner; when venemous Miasms light on a Blood parch'd with Heat before, its congeal'd Portions are fixed in the Superficies of the Body; and at that place, because the motion of the Blood is a little letted, first a little Tumour is made, which afterward, the malignant Venom pre∣sently spreading it self farther, being increast by little and little, creeps into the Neighbourhood, Suppuration does not follow, because the matter extravasated, and stagnating, is not concoted and digested with a gentle heat, but by reason of the Particles of the Sulphur, grown exorbitant together with the Salt exalted, being heap'd toge∣ther into these Tumours, and by reason of the Stagnation being forth∣with dissolved from mixture, an Adustion is caus'd, as if a Cautery were applied to the part: the pieces and lobes of Flesh, eaten as tho covered with an Eschar, fall away, because the corrosive Venom sticking to the Muscles, does not corrode them only in their Sursace, but through their whole Substance; wherefore, before the whole Flesh is consumed, the Membranes in which it is involved being eaten away, some pieces fall from the rest as tho cut from it: often one, of∣ten more Carbuncles arise; sometimes they are alone, sometimes they have a Bubo accompanying them.

A pestilential Bubo arises only in glandulous parts; toward the bulk of which, not only the Blood congeal'd by the Venom, and car∣ried thither by the Arteries, but also the nervous Juice there heaped together, and to be carried back into the Veins, contribute. Because this Tumour happens from Juices less parch'd, and in a colder part, therefore it partakes of Suppuration; for, the Matter heaped together by degrees when (the vital Spirit departing by reason of Stagnation) it has lost the Form of Blood, through the Particles of the Salt and Sulphur being exhaled, and kept in the Tumor, is converted into a Pus by long Concoction. Now that these Tumours only happen in the Glands, the Reason is, not that the Fewel of the Diseass is con∣veyed to these parts by a certain Appointment of Nature, but as the Particles of the virulent Miasm abound every where in the Blood and nervous Juice, they are heaped together there more readily, as in a common place of Retreat, where both the Blood conveyed to the Extremities of the little Arteries, is with difficulty and not so readily re∣ceived and carried back by the Veins, and withall, where the nutri∣tive Juyce, to be carried back from the Nerves into the Veins, is deposed. That both done about the Glands, it is mani∣fest, both by Experie natomical Experiments; where∣fore, since both Homo Seeds of the pestilential Con∣tagion

met together in these Parts, a seat of Malignity is here made by reason of the Virulency deposed here by both.

Pushes, Wheales, and Purple Spots, in respect of the Venenosity, are of the same Batch with the Tumours even now described; but in these the Products of the Virulency are less in bulk, tho with a greater dan∣ger, by reason of the Seeds of the Venom being more dispersed: small Portions of coagulated Blood sticking in the Skin, make these lesser Phoenomena; wherefore, some of these, rais'd into Bladders, suppu∣rate; others, by reason of a certain Mortification or Syderation of the corrupted Blood, turn into Purple Marks and Spots.

Tho the Plague, by reason of Destruction wherewith it threat∣ens the Diseased, both secretly, and very much on a sudden, scarce affords Place or Time for a Prognostick; and tho by reason of the oc∣cult ways of doing Mischief, this Disease carries all things suspected in it; yet it is manifest, by frequent Observation, that some Signs ap∣pear in the Course of it, from which we are wont to divine a Recove∣ry or Death. The Case is full of Danger if the Contagion suddently passes into an universal Sickness, and makes violent Invasions; if an Haemorrrhagy, or only a small Pain happen in the beginning of the Disease; if the Urine be thick, and troubled, the Pulse unequal and weak; if a Convulsion or Frenzy présently follow; if the Vomitings, or Stools, are livid, black, or very stinking; if the Pushes at first red, afterward turn black and blue; if the Carbuncles are numerous, if the Buboes first arising, disappear; if the Strength be cast down on a sud∣den; if the Countenance looks dismal, or turns black and blue; if with a cold Stiffness of the extream Parts there be a burning of the Viscera, especially if these or most of them happen in a Body very cacochymical, or in an unwholsome Season. On the contrary, the be lighter, and lefs dangerous; if the Disease happens in a sound and robust Body with a Fortitude of Mind; if Remedies are seasonably ad∣ministred before the Disease has seised the whole Mass of the Blood; also, if the Course of the Disease goes on with a constancy of the Strength, a Vigour and Evenness of the Pulse, a Suppuration of Bu∣boes, and a large Discharge of Pus, and with the absence of horrible Symptoms: mean while, tho we may hope here all good, yet it is not free for us to be secure, because sometimes, with a laudable Ap∣pearance of Signs, Ambushes are privily laid for Life; and, as srom a reconciled Enemy, we suffer most severely, when we seem'd to have escap'd his raging Threats.

In the Cures of most Diseases, the chiefest Work is committed to Nature, to whose Failure Physick gives a helping hand: and the Of∣fice and Science of a Physician chiefly consists in this, To wait fit Oc∣casions of giving Aid to her, when she is at a Fault. But the Plague has this peculiar, that the Cure of it is not to be left to Nature, but we

must fight against it always with Remedies taken from Art; nor must we be here sollicitous of a more seasonable, and as it were, a milder Time: but we must get Medicines assoon as may be, and insist on them at all Hours, and almost Minutes. But, because when a Plague reigns there is need of no less care for driving away the Contagion, than that the Contagion receiv'd, be cured: therefore a Physician has a double Task; to wit, both that he take care for the Prevention of this Disease, and for its Cure.

Prophylactick Cautions either regard the Publick, and belong to the Magistrate, or private Persons; by which it is taught what must be done by each Man when a Plague is feared.

The publick care, in a time of the Plague, chiefly consists in these things; That Divine Worship be duely observed; that all Matters maintaining Putrefaction be taken away; that Filth, Dunghils, and all stinking Things, be removed from the Streets, and every occasion of Contagion be most diligently avoided; that Commerce with insect∣ed Places be forbidden; and that a wholsome kind of Diet be con∣stantly kept to by the Citizens; let the Poor, who have not a plen∣ty or choice of Provisions, be fed at publick Charges. If the Plague be already grown rife, let the venemous Force of the Air be corrected as much as may be, which will excellently be purg'd by a frequent burning of sulphureous things: let the insected be separated from such as are sound, and let these keep from their Carkasses or Houshold-stuff Lastly, let skilfull and meet Physicians and Attendants be gotten to sup∣ply the Wants both of those that are in Health, and of the Diseased.

The Rule of a private Prophylaxis is wont to be concluded in these three things; viz. Diet, Pharmacy, and Chirurgery: The Deit regards the six non-natural things, amongst which, those of chiefest Note are the Air, and the Passions of the Mind: as to the rest, the Precept of Hippicrates suffices, viz. that Labour, Meat, Drink, Sleep, and Venus, all keep a mean: let the Pestilential Air either be avoided by remo∣ving into another place, or let it be corrected by sulphureous things duely kindled, or let it be refresh'd in breathing by Fumes and odori∣ferous things frequently help to the Nostrils: As to the Passions of the Mind, Fear and Sadness, whilst a Pestilence reigns, are as a se∣cond Plague; for, by these the seeds of the venemous Contagion, which lye on the Superficies of the Body, as it were in the outmost Margin of the Vortex, are violently drawn inward, and deliver'd to the Heart; wherefore, a cheerful and confident Mind is better than the most exquisite Antidote. I have known many, who were wont to say in the Words of Helmont, That by fortifying the Archeus with Wine and Coufidence, and using no other Alexipharmicks, they past their Time among infected Persons without any injury by Contagion; and those who liv'd otherwise, imbib'd the Seeds of the Pestilence, as tho de∣riv'd from the Stars.

Among Chirurgical Things to be used for Preservation, Blooding, Cauteries, and Amulets, are usually recommended: where there is a Plethora with a great Turgescency of the Blood, or when by a long Usance Persons have accustom'd themselves to be let Blood, opening a Vein agrees with them; for, by how much the less the Blood boyls, and is circulated in the Vessels without trouble, by so much the slower is it infected with the venemous Contagion. Issues made by Cauteries are so much approved of by the Suffrages almost of all Men, for Pre∣servation against the Plague, that their use is Generally receiv'd among the Vulgar; for these constantly drain the assiduous encrease of the excrementitious matter: and if any Miasms of the Pestilence are in∣wardly admitted, they cast them forth by their open passage.

Amulets, hung about the Neck, or worn about the Arm-Wrists, are thought to have a wondersul Force against the Pestilence: of these the most excellent are accounted by some, which consist of Arsenick, Quicksilver, the Powder of Toads, and other venemous Things: that the same do good in some Cases, besides the Observations of Physicians, this Reason seems somewhat to convince; the Effluvia, or atomous Corpuscles which sometimes flowing from certain Bodies, sometimes set∣tling on others, fly about the whole Region of the Air; these being di∣versly figur'd, some of them excellently close with others; but if they jut against Corpuscles of another Form, they enter a Conflict with them, and subvert them; hence the Particles of the pestilent Miasm, which are contrary to our Spirits, excellently agree with those Corpuscles of the Poyson coming to them, and readily close with them: where∣fore Amulets made of Poyson do this; to wit, they gather into them∣selves the Seeds of the Pestilence coming against us, by reason of a Simiiitude of Parts; nay, and by drawing the same from our Body to their Embraces, they in some sort free the Infected from the Malig∣nity.

The Pharmaceutick Prophylaxis has a double Scope; first, That the assiduous Increase of the excrementitious Matter, or Humours, be re∣mov'd by a gentle Furge as often as there is need: secondly, That by Alexipharmicks daily taken, the Spirits and our Bodies be fortified against the Incursion of the Venom: by the former, the Food and Fewel which increase the Putrefaction caused by the Venom, are withdrawn; by the other, the first kindling of the pestiferous Conta∣gion, as it were of a suneral Flame, is hindred: for Alexipharmicks seem to give help against the Contagion of the Pestilence under this two-sold Respect; both because the Mass of Blood, and the Viscera fill'd with the particles of these, also the Spirits being first possest by the same, do not easily admit the Fellowship of the venemous Miasm, and for that the Blood being quick in its Motion by the gentle Instiga∣tion of these Particles, is freed from Coagulation.

So far of Preservation: it remains now for us to treat of the Cure of the Pestilence; the Doctrine whereof is either general, and comprises the Remedies which are taken for this end from Diet, Chirurgery, and Pharmacy; or special, which delivers the use, and cautious con∣cerning the giving of those Remedies, and after what manner we must obviate Symptoms variously emerging.

The Diet comprehends the use of the six non-natural things, tho the chief Care and physical Cautions are concerning the Food; the primary Indications of this have not place together, and at the same time, but ought to be supply'd as occasion requires, now one, now another, and according to the Exigency of Nature. In respect of the Malignity and the Dejection of the Strength, Aliments are required, which greatly refresh the Spirits, and afford a plentiful Nourishment: in respect of the feverish Distemper, a Dyet seems to be required which is thin, cooling, and qualifying of the Blood. Let a Physician take care of both; but let him direct his Remedies rather against the Malignity than against the Fever.

The Aids which belong to Chirurgery are Bleeding, which ought to be used seldom, and with great Caution in this Disease, because the Blood being too much exhausted, and the Vessels falling, a Sweat is not so easily procur'd; the place of this is better supplyed by Cup∣ping-Glasses with a Scarification; for this, and Vesicatories are aptly used for drawing forth the Venom. Moreover, against Buboes, Car∣buncles, and malignant Ulcers produc'd by them, Cataplasms, Fo∣mentations, Plaisters, Liniments, and many other things, to be ap∣ply'd outwardly, are taken from Chirurgery, with which some poy∣sonous things, as Drawers of Venom, are prescribed to be mix'd by some: wherefore, Preparations of Arsenick, viz. its Oyl, and Balsam, are recommended in this Case, as of excellent Use and Efficacy.

Medicines, in order to the Cure of the Plague, are either Evacua∣tives or Alexipharmicks. The Intention of the first is, that the Se∣rous Latex in the Blood, and the excrementitious Humours, which abound in the Viscera, be sent forth; and together with them, a great many Particles of the venemous Miasm every where dispers'd in the Body. Now these things are perform'd by Vomitories and Purges, whose use is rare, and only in the beginning of the Disease; also by Diaphoreticks, which at all times, as long as the Strength is able to bear them, are indicated in the Plague: for these evacuate more fully, and withal from the whole Body, and also by exagitating the Blood, they free it from Congelation, and in regard they move from the Cen∣ter to the Circumference, they drive the venemous Ferments, and al∣so the Corruptions of the Blood and Humours far from the Heart, and repell the Enemy from the Fort: but Vomitories and Purges evacuate less generally, and often by concentrating the malignant Matter, draw it inward, and fix it in the Viscera. Now these Medicines, whether

they work by Purging, or Sweat, ought to be such as have Particles of the same kind with the venemous Miasm, rather than with our Blood or Spirits; for such a Medicine will pass through the various Involutions of our Body with its entire Force, and by reason of the Similitude of both, will certainly lay hold on the virulent matter of the Disease, and through a mutual Adhaesion of Parts, Nature being irritated, will carry it forth with it self: wherefore Medicines, whether Catharticks or Sudorificks, are most recommended, which are pre∣par'd of Mercury, Antimony, Gold, Sulphur, Vitriol, Arsenick, and the like; which, in regard they are not subdued, or overcome by our Heat, become excellent Remedies against the Venom of the Pestilen∣tial Contagion; for, these do not only powerfully evacuate superflu∣ous things, but for as much as they exert, and display on every side in our Body very strong and masterless Particles, they dissipate, and hinder from Maturation, the Ferments of the Venom gliding every way. And since the Remedies themselves, being insuperable by Na∣ture, must of necessity be sent away by the open passages of the Body, they carry forth together with them whatsoever is extraneous and ho∣stile.

As to Alexipharmicks, which are said to resist the Venom of this Disease without a sensible Evacuation, they are for the most part such whose Particles are neither very agreeing with Nature, that they turn to an Aliment, nor are so contrary to it, that they stimulate an Excretion. The same being inwardly taken, and refracted to most minute Parts, they, by their Corpuscles, inspire as it were with a new Ferment, the Blood and Juices flowing in the Vessels and Visce∣ra, and by moving them gently, and keeping them in an even mix∣ture, they free them from Coagulation and Putrefaction: by the same gentle Agitation they dissipate from each other, and hinder from ma∣turation the Particles of the Venom beginning to be gathered thick to∣gether. Lastly, by praeoccupying the Blood and Spirits, they defend them from the Ingressions of the pestilent Character: of these Reme∣dies some Simples are recommended, as Rue, Scordium, &c. but those are esteem'd far better, which are more compounded; wherefore Treacle, Mithridate, and Diascordium, whereof some consist of at least fifty Simples, are accounted Medicines so compleat in all Respects. that it is esteem'd a Crime to omit, in the making of them, ev'n one Plant; the Reason haply is, That many things being put together make a Mass, whose diversifyed Particles, being exalted by a long Digesti∣on, cause a greater Fermentation in our Blood and Humours.

Having thus set down the Remedies with which we ought to be provided for curing the Plague, we should speak next of its method of Cure, to wit, what is to be done in the first place, and what next in order; but that all things are so precipitated in this Disease, that there is no room for Deliberalion, nor will a Physician be frequently

present with the Diseas'd for fear of Contagion: wherefore there is no need here of many Praescripts, or a long Series of Indications. This thing is to be done quick, and must be comprehended in a few words: when therefore a Pestilence reigning, any one is infected with this Disease, God's help being implored, we must presently flye to Re∣medies. If the Plague happens in a Body that is not well purg'd, and prone to Vomit, presently let a Vomitory be taken; the Operation of which being ended, presently Diaphoreticks being giv'n, let a Sweat be procured, and let the same be continued as the Strength will bear; afterward let it be often repeated: moreover, Alexipharmicks must be used almost every moment, till the Venom be wholly sent forth by the eruption of Pushes, Carbuncles, or Buboes; nevertheless, in the mean while, let respective and proper Remedies be oppos'd to the Symptoms chiefly pressing; but especially for the cure of Buboes and Carbuncles, let fit Aids be taken from Chirurgery. The whole stress of the Business relyes on these two chief Intentions, that the pe∣stiferous Venom be by all means expelled from within, outward; and then that the Return of it, being expulsed, be with an equal Di∣ligence prevented.

It is not an easie thing for us, in the Plague, to give Examples and Histories of Persons diseased, with exact Diaries of Symptoms; for these kinds of Sicknesses do not happen every Year, nor when they are rise is it free for every Physician, who minds his own Health, to visit the Sick with a curious Eye, or to stay long with them, that he may diligently observe every Accident, and carefully weigh the Rea∣sons of them; which Task, nevertheless, the Famous Diemerbroch has so accurately performed, that since him, others may lawfully surcease from this Work. When heretofore in this City, viz. Anno 1645. a Plague (tho not exceeding great) was rise, Mr. Henry Sayer, a Physi∣cian very learned, and fortunate in Practise, boldly went to visit all sorts of sick Persons, both poor and rich, many others refusing this Undertaking: he daily gave them Medicines, touching Buboes and virulent Ulcers with his own Hand; and so by a dliligent, tho dange∣rous, means, cured many of the Diseased. To fortifie himself against the Contagion, before he went to infected Houses, he only was wont to drink a good Draught of Generous Wine, and after he had gone his Circuit, to repeat the same Antidote. After that he had taken Care a long time of the Sick in this City, without receiving any Injury, as though he were Plague-free, he was sent for to Wallingford Castle, where this Contagion violently raged, as ā second Aesculapius, to the Governour of that place; and there, in a short space, having dar'd to lye in the same Bed with a certain Officer seised with the Plague, whose Society he very much delighted in, he took the Infection of the same Disease: nor could then those Arts prove of Use to their Ma∣ster, which had been beneficial to all others, not without a mighty

loss in the Art of Physick, did he perish by that Disease. To others seised with the Pestilence, he was wont to order this method of Cure; If he was called before Pushes or Buboes appeared outwardly, for the most part he gave Vomitories, the Praescripts of which were of the Infusion of Crocus Metallorum, sometimes with white Vitriol, and sometimes with Roman; the Vomiting being over, he caused them to be cast into a Sweat, by giving presently Diaphoreticks; and after∣ward, some Intervals being allowed for the restoring of the Strength, he ordered the Sweating to be continued even to the Declination of the Disease: but if he was called to Persons affected after the Tokens appeared, Vomiting being omitted, he insisted only on Sudorificks.