This explains Dekker’s statement in 1603 that some had buboes repeatedly, and that one person had eighteen sores. Dr Thomson himself had buboes thrice. Hodges, also, knew of many cases fatal at the third seizure, the later attacks being not relapses but new infections; some even fell at the fifth or sixth time, being before well recovered. In one of the earlier London plagues, that of 1563, Jones saw a case of a woman near Temple Bar that ended fatally at the third attack, the buboes having suppurated twice, but not at the third time. Boghurst goes on:
Of evil omen was “a white, soft, sudden, puffed up tumour on the neck behind the ears, in the armpit, or in the flank;” also a “large extended hard tumour under the chin, swelling downwards upon the throat and fetching a great compass” (the brawny swelling of the submaxillary salivary glands and surrounding tissues). Tokens came out after a violent sweat, which was often induced of purpose by nurses, who said, ‘Cochineal is a fine thing to bring out the tokens.’ Nurses often killed their patients by giving them cold drinks. Many also were killed by the shutting-up of houses, by wickedness (of nurses ?), by confident and ignorant mountebanks, by over-hasty cutting and burning of buboes. Servants and poor people removed to the pest-house or to other houses in their sickness, took harm therefrom. People using corrosives, actual cauteries and many intolerable applications put their patients to more pain than the disease did.
The botches, or buboes (swollen lymph-glands in the neck, armpits or groins), were the most distinctive sign of the plague, having given to it the old name of “the botch.” Besides these, there were the “tokens” (specially limited in meaning to livid spots on the skin), carbuncles and blains. Carbuncles, says Boghurst, commonly rose upon the most substantial, gross, firm flesh, as the thighs, legs, backside, buttock; they never occurred, that he saw, on the head among the hair, or on the belly. They were not seen until the end of July, were most rife in September and October, commonly in old people, never in children.
Hodges saw one carbuncle on the thigh, the size of two handbreadths, with a large blister on it, “which being opened by the chirurgeon and scarification made where the mortification did begin, the patient expired under the operation.” But most commonly carbuncles did not exceed the breadth of three or four fingers. Boghurst continues:
“Blains are a kind of diminutive carbuncle, but are not so hard, black, and fiery; sometimes there is a little core in them. Generally they are no bigger than a two penny piece, or a groat at the biggest, with a bladder full of liquor on the top of them, which, if you open but a little, will come out whitish or of a lemon or straw colour.” “Besides a blain there is a thing you may call a blister, puffing up the skin, long like one’s finger in figure, like a blister raised with cantharides; and such usually die.” The following experience is remarkable, but it is doubtful whether Boghurst has not taken it from Diemerbroek: “Towards the latter end of a plague, many people that stayed, and others that returned, have little angry pustules and blains rising upon them, especially upon the hands, without being sick at all. But such never die, nor infect others; and I remember Diemerbroeck saith, etc.” Can this be the meaning of “smallpox” following the plague, as in the 16th century books by Alphanus, Kellwaye and others?
The tokens proper, according to Hodges, were spots on the skin “proceeding from extravasated blood.” The body of the youth dissected by Thomson was “beset with spots, black and blue,” some of which when opened “contained a coagulated matter.” The tokens, as the name implies, were made the most distinctive sign of the plague; but they were far from being so constant as the botches or buboes. Boghurst says that “tokens appeared not much until about the middle of June;” and, according to a letter of September 14, they must have been very variable even at the height of the plague: “The practitioners in physic stand amazed to meet with so many various symptoms which they find among their patients; one week the general distempers are blotches and boils, the next week as clear-skinned as may be, but death spares neither; one week full of spots and tokens, and perhaps the succeeding bill none at all[1218].”
The account of the dissection by Thomson, of a youth dead of the plague, is perhaps all the morbid anatomy that has come down to us. He found what appear to have been infarcts in the lungs; the surface was “stigmatised with several large ill-favoured marks, much tumified and distended,” from which, on section, there issued “sanious, dreggy corruption and a pale ichor destitute of any blood.” The stomach contained a black, tenacious matter, like ink. The spleen gave out on section an ichorish matter. The liver was pallid and the kidneys exsanguine. There were “obscure large marks” on the inner surface of the intestines and stomach. The peritoneal cavity contained a “virulent ichor or thin liquor, yellowish, or greenish.” There was a decoloured clot in the right ventricle, but “not one spoonful of that ruddy liquor properly called blood could be obtained in this pestilential body.” In all other cadavers that he ever dissected he had found that the right ventricle had blackish blood condensed, but this one had a pale clot “like a lamb-stone cut in twain,” which puzzled him greatly; perhaps it came, he conjectures, from a sumption of mere crude milk which an indiscreet nurse had given the boy not long before he died.
Among the symptoms of a fatal issue, Boghurst mentions the following: Hiccough, continual vomiting, sudden looseness, or two or three stools in succession, shortness of breath, stopping of urine, great inward burning and outward cold, continual great thirst, faltering in the voice, speaking in the throat and occasionally sighing, with a slight pulling-in one side of the mouth when they speak, sleeping with the eyes half-open, trembling of the lips and hands and shaking of the head, staggering in going about rooms, unwillingness to speak, hoarseness preventing speech, cramp in the legs, stiffness of one side of the neck, contraction of the jaws, the vomit running out from the side of the mouth, prolonged bleeding at the nose, the sores decreasing and turning black on a sudden.
It is to be remarked that Boghurst says very little of the gentle or the violent delirium, on which Defoe enlarges picturesquely; nor does he emphasize the extreme pain of the hard and tense buboes, which is another of Defoe’s themes. Hodges, however, says that “some of the infected run about staggering like drunken men, and fall and expire in the streets; while others lie half-dead and comatous.... Some lie vomiting as if they had drunk poison.”
The progress of the epidemic would seem to have been little influenced by the weather or by what was done, unless the shutting-up of houses had helped to intensify the virus. Boghurst says: “If very hot weather followed a shower of rain, the disease increased much;” and again: “If, in the heat of the disease the wind blew very sharp and cold, people died very quickly, many lying sick but one day.” We are told, however, by Hodges that “the whole summer was refreshed with moderate breezes,” and that “the heat was too mild to encourage corruption and fermentation.” The air itself, he says, “remained uninfected.” Rain fell from time to time in the end of summer, copious enough to put out the fires in the streets. There was at least one very hot day, near the beginning of the epidemic, the 5th of June, which Pepys says was “the hottest day that I ever felt in my life.” On September 20, however, he says that the increase of the plague could not have been expected “from the coldness of the late season.”