Chapter III: Influenzas and Epidemic Agues (1)

Epidemic agues are joined in the same chapter with influenzas for the reason that they can hardly be separated in the earlier part of the history. Until 1743 the name influenza was not used at all in this country. The thing itself can be identified clearly enough in certain instances from the earliest times. But there are periods, such as 1657-59, 1678-79, and 1727-29 when short waves of epidemic catarrhs or catarrhal fevers came in the midst of longer waves of epidemic agues, “hot agues,” or intermittents, the whole being called by the people “the new disease,” or “the new ague,” while by physicians, such as Willis and Sydenham, they were taken to be the distinguishable constituent parts of one and the same epidemic constitution. The last period in which epidemic agues were so recognised and named in England was from 1780 to 1785; and in the midst of that also there occurred an epidemic catarrh--the “influenza” of the year 1782. It is possible that our own recent experience of a succession of influenzas, or strange fevers, from 1889 to 1893, in some respects the most remarkable in the whole history, would have seemed an equally composite group if they had fallen in the 17th century and had been described in the terminology of the time and according to the then doctrines or nosological methods. Without prejudice to the distinctness and unity of the influenza-type in all periods of the history, I am unable, after trying the matter in various ways, to do otherwise than take the epidemics of ague in chronological order along with the influenzas. As the history will require the frequent use of the name “ague,” and, in due course, that of the name “influenza,” it will be useful to examine at the outset their respective etymologies and the meanings that usage has given to them.

Originally the English name ague did not mean a paroxysmal or intermittent fever, or a fever with a long cold fit followed by a hot fit, or the malarial cachexia with sallowness, dropsy and enlarged spleen, or any other state of health arising from the endemic conditions which are known as malarial over so large a part of the globe in the tropical and sub-tropical zones. It meant simply _acuta_, the adjective of _febris acuta_ made into a substantive. Thus Higden’s reference in the _Polychronicon_ (which is exactly in the words of Giraldus Cambrensis a century and a half before) to the _febris acuta_ of Ireland is translated by Trevisa (14th cent.): “Men of that lond haue no feuere, but onliche the feuere agu, and that wel silde whanne”; and by an anonymous translator: “The dwellers of hit be not vexede with the axes excepte the scharpe axes, and that is but selde[533].” Again in the MS. English translation of the Latin essay on plague by the bishop of Aarhus, the acute fever which is described as the attendant or variant of bubo-plague proper (well known long after as the pestilential fever, a malignant form of typhus), is thus rendered:

“As we see a sege or prevy next to a chambre, or of any other
particuler thyng which corrupteth the ayer in his substance and
qualitee: whiche is a thing maye happe every daye. And therof cometh
the ague of pestilence. And aboute the same many physicions be
deceyved, not supposing this axes to be a pestilence.... And suche
infirmite sometime is an axes, sometime a postume or a swellyng--and
that ys in many thinges.”

The same use of ague is continued in the first native English book on fevers, Dr John Jones’s ‘Dyall of Agues,’ which has chapters on plague as well as on pestilential fever and on all other fevers including intermittents. In Ireland the name of ague was applied until a comparatively late period to the indigenous typhus of the country, as if in literal translation of the _febris acuta_ first spoken of by Giraldus in the 12th century. Ague in early English meant any sharp fever, and most commonly a continued fever. The special limitation to intermittents appears to have followed the revival of the study of the Graeco-Roman writers on medicine, Galen above all, in the sixteenth century. But Jones, who was freer than the more academical physicians of his time from classical influences, is shrewd enough to see that it was a mistake to transfer the experiences of Greece verbatim to England and to make them our standard of authority: he is speaking, however, not of intermittents but of the simple ephemeral fever, or inflammatory fever of one day:

“Such as have the fever of heat or burning of the sun, sayeth Galen,
theyr skin is drye and hot as that which is perched with the sun; of
the which, in this orizon and countrye of oures, we have no great nede
to entreate of, leaving it to the phisitions and inhabitantes that
dwell nerer to the meridionall line and hoter regions, as Hispaine and
Africke[534].”

At a later date, when the Hippocratic tradition had displaced the Galenic, Rogers of Cork, perhaps the earliest writer on fevers whose observations are essentially modern, has occasion thus to reflect upon the extreme deference of Sydenham to his Greek model: “Again we learn from Hippocrates that fevers in the warmer climates of Greece, at Naxos, Thasos or Paros, ran their course in certain periods of time, which no ways answers in regions removed at a farther distance from the sun,”--Rogers himself having had no experience of intermittents among all the fevers and dysenteries that he saw from 1708 to 1734, although Cork was surrounded by marshes[535].

At the time of the Latin translations of Greek medical writings by Linacre and Caius in the Tudor period, there were in this country actual experiences of strange fevers, which were interpreted according to the Greek teaching of quotidians, tertians and quartans, with their several bastard or hybrid or larval forms. These, as I have said, were certainly not the endemic fevers of malarious districts; they were, on the contrary, widely prevalent all over the country during one or more seasons in succession and more occasional for a few years longer; then there would be a clear interval of years, and again an universal epidemic of “the new fever,” “the new acquaintance,” “the new ague” or the like.

Sydenham, for example, has much to say of agues or intermittents prevalent in town and country for a series of years, and then disappearing for as long a period as thirteen years at a stretch. But he does not count these as the agues of the marsh; his single reference to the latter is in his essay on Hysteria, where he interpolates a remark that, if one spends two or three days in a locality of marshes and lakes, the blood is in the first instance impressed with a certain spirituous miasma, which produces quartan ague, and that in turn is apt to be followed, especially in the more aged, by a permanent cachectic state[536]. If Sydenham had intended to bring all the intermittents of his experience into that class, he would not have left the paludal origin of them to a casual interpolated remark. On the other hand, he refers the epidemic agues, which occupy his pen so much, to emanations from the bowels of the earth, according to a theory of his friend Robert Boyle, applied by the latter to epidemical infections in general and to epidemic colds or influenzas in particular. Sydenham and his learned colleagues were not ignorant of the endemic agues of marshy localities, but they made little account of them in comparison with the aguish or intermittent fevers that came in epidemics all over England.

In admitting the reality of such agues, we must be careful not to ascribe them to such conditions as Talbor, the ague-curer, found in one village in Essex. We must be careful not to do so, because there are plausible reasons for doing so. The ground is much better drained now than formerly; there is less standing water, fewer marshes, a much smaller extent of water-logged soil. But the malarious parts of England have been tolerably well defined at all times; and at all times the greater part of the country was as little malarious as it is now. It is the frequent reference to agues in old medical writings that has led some modern authors to construct a picture of a marshy or water-logged England, for which there is no warrant. Cromwell died of a tertian ague which he caught at Hampton Court; therefore “the country round London in Cromwell’s time” must needs have been “as marshy as the fens of Lincolnshire are now.” The country round London was much the same then as now, or as in John Stow’s time, or as in the medieval monk Fitzstephen’s time, or as it has ever been since the last geological change. The ague of which Cromwell died in the autumn of 1658 was one of those which raged all over England from 1657 to 1659--so extensively that Morton, who was himself ill of the same for three months, says the country was “one vast hospital.” Whatever was the cause of that great epidemic of “agues,” and of others like it, we have no warrant to assume that “the country round London,” or wherever else the epidemic malady prevailed, was then as marshy as the fens of Lincolnshire[537].

The other name in the title of this chapter, influenza, appeared comparatively late in the history. It is an Italian name, which is usually taken to mean the influence of the stars. It may have got that sense by popular usage, but the original etymology was probably different. As early as the year 1554 the Venetian ambassador in London called the sweating sickness of 1551 an _influsso_, which is the Italian form of _influxio_. The latter is the correct classical term for a humour, catarrh, or defluxion, the Latin _defluxio_ itself having a more special limited meaning. It was not astrology, but humoral pathology, that brought in the words _influxio_ and _influsso_; and I suspect that influenza grew out of the latter, but not out of the notion of an influence rained down by the heavenly bodies.

It was in 1743 that the Italian name of “influenza” first came to England[538], the rumour of a great epidemic, so called, at Rome and elsewhere in Italy having reached London a month or two before the disease itself. The epidemic of 1743 was soon over and the Italian name forgotten; so that when the same malady became common in 1762, some one with a good memory or a turn for history remarked that it resembled “the disease called influenza” nearly twenty years before. After the epidemic of 1782, the Italian name came into more general use, and from the beginning of the present century it became at once popular and vague. The great epidemics of it in 1833 and 1847 fixed its associations so closely with catarrh that an “influenza cold” became an admitted synonym for coryza or any common cold attended with sharp fever. Lastly, the series of epidemics from 1889 to 1893 effectually broke the association with coryza or catarrh.

Before influenza became adopted as the common English name towards the end of last century, what were the names popularly given to the malady in this country? The earliest references to it are in the medieval Latin chronicles under the name of _tussis_ or cough, or in some periphrasis. In the fifteenth century the English name was “mure” or “murre,” which appears to be the same root as in murrain. Thus the St Albans Chronicle, under the year 1427, enters a certain “infirmitas rheumigata,” which in English was called “mure”; and the obituary of the monks of Canterbury abbey has two deaths from “empemata, id est, tussis et le murra[539].” In the Tudor period there is no single distinctive name, unless it be “hot ague”: in 1558 the name is “the new burning ague,” in 1562 “the new acquaintance,” in 1580 “the gentle correction,” and at various times in the 17th century “the new disease,” “the new ague,” “the strange fever,” “the new delight,” “the jolly rant.” Robert Boyle called one sudden outbreak “a great cold.” Molyneux, of Dublin, mentions “a universal cold” in one year (1688), and “a universal transient fever” in another (1693). The earlier 18th century writers mostly use the word catarrh or catarrhal fever, either in Latin or in English, the popular names probably continuing fanciful as before, as for example Horace Walpole’s “blue plagues.” That which stands out most clearly in the English naming from the earliest times is the idea of something new or strange; but the newness or strangeness pertained quite as much to the agues as to the catarrhs. The notion of ague may be said to be uppermost in the 16th and 17th centuries, that of catarrh in the 18th and 19th; while our very latest experiences have once more brought a suggestion of ague to the front.

Retrospect of Influenzas and Epidemic Agues in the 16th and 17th centuries.

In the former volume of this history I have dealt with the various epidemics of “hot ague,” “new disease” or the like down to the epidemic of 1657-59. It will be convenient to go over some of that ground again, with a view to distinguish, if possible, the catarrhal types from the aguish, and to illustrate the use of the word ague as applied to a universal epidemic. Two of the epidemic seasons in the 16th century, 1510 and 1539, are too vaguely recorded for our purpose; but I shall review briefly the seasons from 1557-58 onwards.

It is known from the general historians that there were two seasons of
fever all over England in 1557 and 1558, of which the latter was the
more deadly, the type according to Stow, being “quartan agues.” In
letters of the time the epidemic of 1557 is variously named: thus
Margaret, Countess of Bedford, writes on 9 August from London to Sir
W. Cecil that she “trusts the sickness that reigns here will not come
to the camp [near St Quentin, where Francis, Earl of Bedford was]....
As for the ague, I fear not my son.” On the 18th of the same month,
Sir Nicholas Bacon writes from Bedford to Cecil: “Your god-daughter,
thanks be to God, is somewhat amended, her fits being more easy, but
not delivered of any. It is a double tertian that holds her, and her
nurse had a single, but it is gone clearly;” to which letter Lady
Bacon adds a postscript about “little Nan, trusting for all this
shrewd fever, to see her.” On 21 September, it appears that the
sickness had reached the English camp near St Quentin, for the Earl of
Bedford writes: “Our general is sick of an ague, our pay very slack,
and people grudge for want.” As late as the 25th October the Countess
of Bedford writes from London to Cecil that she “would not have him
come yet without great occasions, as there reigns such sickness at
London[540].”

Next year, 1558, the epidemic sickness returned in the summer and
autumn, in a worse form than before. Stow calls it “quartan agues,”
which destroyed many old people and especially priests, so that a
great number of parishes were unserved. Harrison, a canon of Windsor,
says that a third part of the people did taste the general sickness.
On the 6th September, sickness affected more than half the people in
Southampton, Portsmouth, and the Isle of Wight. From the 20th October
to the end of the year, no fewer than seven of the London aldermen
died, a number hardly equalled in the first sweating sickness of 1485,
and the queen (Mary) died of the lingering effects of an ague, which
was doubtless the reigning sickness. On 17th October, the English
commissioners being at Dunkirk to negotiate the surrender of Calais,
one of them, Sir William Pickering, fell “very sore sick of this new
burning ague: he has had four sore fits, and is brought very low, and
in danger of his life if they continue as they have done.” That year
Dr Owen published _A Meet Diet for the New Ague_, and himself died of
it in London on the 18th of October[541].

Fuller quaintly describes the ague of 1558 as “a dainty-mouthed
disease, which, passing by poor people, fed generally on principal
persons of greatest wealth and estate[542].” Roger Ascham wrote in
1562 to John Sturmius that, for four years past, or since 1558, “he
was afflicted with continual agues, that no sooner had one left him
but another presently followed; and that the state of his health was
so impaired and broke by them that an hectic fever seized his whole
body; and the physicians promised him some ease, but no solid
remedy[543].” Thoresby, the Leeds antiquary of the end of the 17th
century, found in the register of the parish of Rodwell, next to
Leeds, a remarkable proof of the fatality of these agues, which fully
bears out the general statements of Stow and Harrison. In 1557 the
deaths in the register rose from 20 to 76, and in 1558, which the
historians elsewhere say was the most fatal year, they rose to
124[544]. This was as severe as the sweating sickness of 1551, for
example in the adjoining parish of Swillington, or in the parish of
Ulverston, in Lancashire[545].

The English names of the epidemic sickness in the summers and autumns of 1557 and 1558 are all in the class of agues--“this new burning ague,” “a strange fever,” “divers strange and new sicknesses taking men and women in their heads, as strange agues and fevers,” “quartan agues.” One medical writer, Dr John Jones, says in a certain place that “quartans were reigning everywhere,” and in another place, still referring to 1558, that he himself had the sickness near Southampton, that it was attended by a great sweat, and that it was the same disease as the sweating sickness of 1551. There were certainly two seasons of these agues, 1557 and 1558, the latter being the worst; and it is probable from Short’s abstracts of a few parish registers in town and country that there was a third season of them in 1559. The year 1557 has been made an influenza year, perhaps because the Italian writers have emphasized catarrhal symptoms here or there in the epidemic of that year; while both the years 1557 and 1558 have been received into the chronology of epidemic or pandemic agues or malarial fevers[546]. There are perhaps a dozen English references in letters and chronicles to the sicknesses of those years, either to particular cases or to a general prevalence, but they do not enable us to distinguish a catarrhal type in 1557 from the aguish type which they assert for both 1557 and 1558.

Four years after, another very characteristic influenza was prevalent in Edinburgh.

Randolph writes from Edinburgh to Cecil in the end of November, 1562:
“Maye it please your Honer, immediately upon the Quene’s (Mary’s)
arivall here, she fell acquainted with a new disease that is common in
this towne, called here the newe acqayntance, which passed also
throughe her whole courte, neither sparinge lordes, ladies nor
damoysells, not so much as ether Frenche or English. It ys a plague in
their heades that have yt, and a sorenes in their stomackes, with a
great coughe, that remayneth with some longer, with others shorter
tyme, as yt findeth apte bodies for the nature of the disease. The
queen kept her bed six days. There was no appearance of danger, nor
manie that die of the disease, excepte some olde folkes. My lord of
Murraye is now presently in it, the lord of Lidingeton hathe had it,
and I am ashamed to say that I have byne free of it, seinge it seketh
acquayntance at all men’s handes[547].”

It is not improbable that the interval between 1558 and 1562 may have been occupied with milder revivals of the original great epidemic, the one at Edinburgh counting in the series.

It appears from a Brabant almanack for the year 1561 that a sudden catarrhal epidemic was quite on the cards in those years: the astronomer foretells for the month of September, 1561: “Coughs innumerable, which shall show such power of contagion as to leave few persons unaffected, especially towards the end of the month[548].” There is an actual record from more than one country (Italy, Barcelona, as well as Edinburgh) of such universal catarrhs and coughs a year later than the one foretold. The Italian writers assign the universal catarrhs and coughs to the autumn of 1562, the Barcelona writer to the winter solstice of that year, and the letter from Edinburgh to “the laste of November.”

The next undoubted influenza, that of 1580, was compared abroad to the English sweat:

“In some places,” says Boekel, “the sick fell into sweats, flowing
more copiously in some than in others, so that a suspicion arose in
the minds of some physicians of that English sweat which laid waste
the human race so horribly in 1529;” and again, “the bodies were
wonderfully attenuated in a short time as if by a malignant sudden
colliquation, which made an end of the more solid parts, and took away
all strength[549].” The season of it was the summer.

The outbreak attracted much attention from its universality, and was
described by many abroad.

Boekel says that it was of such fierceness “that in the space of six
weeks it afflicted almost all the nations of Europe, of whom hardly
the twentieth person was free of the disease, and anyone who was so
became an object of wonder to others in the place.... Its sudden
ending after a month, as if it had been prohibited, was as marvellous
as its sudden onset.” It came up, he says, from Hungary and Pannonia
and extended to Britain. The principal English account of this
epidemic comes from Ireland[550]. In the month of August, 1580, during
the war against the Desmonds, an English force had advanced some way
through Kerry for the seizing of Tralee and Dingle; “but suddenlie
such a sicknes came among the soldiers, which tooke them in the head,
that at one instant there were above three hundred of them sicke. And
for three daies they laie as dead stockes, looking still when they
should die; but yet such was the good will of God that few died; for
they all recovered. This sicknesse not long after came into England
and was called the gentle correction.”

This outbreak among the troops in Ireland is said to have been in
August, before the sickness came to England. But it can be shown to
have been at its height in London in the month of July. The year 1580
was almost free from plague in London; the weekly deaths are at a
uniform low level (a good deal below the births) from January to
December, except for the abrupt rise shown in the following
table,--the kind of rise which we shall see from many other instances
to be the infallible criterion of an influenza[551]:

_Weekly Deaths in London._

1580.

Deaths by Dead of
Week ending all causes plague Baptised

June 23 55 2 59
" 30 47 4 57
July 7 77 4 65
" 14 133 4 66
" 21 146 3 61
" 28 96 5 64
Aug. 4 78 5 73
" 11 51 4 53
" 18 49 1 72

As in 1557-58, the English references are to agues, both before and
after the Gentle Correction of July-August, 1580. Cogan says that for
a year or two after the Oxford gaol fever (1577) “the same kind of
ague raged in a manner all over England and took away many of the
strongest sort in their lustiest age, etc.” And he seems to have the
name “gentle correction” in mind when he says: “This kind of sickness
is one of those rods, and the most common rod, wherewith it pleaseth
God to brake his people for sin.” Cogan’s dates are indefinite. But
there is a letter of the Earl of Arundel to Lord Burghley, 19th
October, 1582, which shows that “hot ague” was epidemic as late as the
second autumn after the influenza proper: “The air of my house in
Sussex is so corrupt, even at this time of the year, as when I came
away I left twenty-four sick of hot agues.”

Two such epidemics in England as those of 1557-8 and 1580-82, of hot agues or strange fevers, taking the forms of simple tertian or double tertian or quartan or other of the classical types, would have made ague a familiar disease, and its name a household word. For not only were there two or more aguish seasons (usually the summer and autumn) in succession, but to judge by later experience there would have been desultory cases in the years following, and in many of the seizures acquired during the height of the epidemic, relapses or recurrences would have happened from time to time or lingering effects would have remained. Hence it is unnecessary to assume that the agues that we hear casual mention of had been acquired by residence in a malarious locality. They may have been, and most probably were, the agues of some epidemic prevalent in all parts of the country. These epidemics were the great opportunities of the ague-curers, as we shall see more fully in the sequel. It is to the bargaining of such an empiric with a patient that Clowes refers in 1579: “He did compound for fifteen pound to rid him within three fits of his ague, and to make him as whole as a fish of all diseases.”

There were more sicknesses of that kind, perhaps not without a sweating character, in the last ten years of the 16th century[552]. But they are indefinitely given as compared with earlier and later epidemics, and I shall pass to the next authentic instance.

The autumn of 1612 was undoubtedly a season of epidemic ague or “new
disease” in England[553]. When Prince Henry, eldest son of James I.,
fell ill in November, in London, during the gaieties attending the
betrothal of his sister the Princess Elizabeth to the Count Palatine
of the Rhine, a letter-writer of the time said of his illness: “It is
verily thought that the disease was no other than the ordinary ague
that hath reigned and raged almost all over England since the latter
end of summer[554].” The attack began in the end of October. The
spirited and popular prince had been leading the gaieties in place of
his father, who could not stand the fatigue, and was “seized by a
fever that came upon him at first with a looseness, but hath continued
a quotidian ever since Wednesday last [before the 4th of November],
and with more violence than it began, so that on Saturday he was let
blood by advice of most physicians, though Butler, of Cambridge, was
loth to consent. The blood proved foul: and that afternoon he grew
very sick.... I cannot learn that he had either speech or perfect
memory after Wednesday night, but lay, as it were, drawing on till
Friday between eight and nine of the evening that he departed. The
greatest fault is laid on Turquet, who was so forward to give him a
purge the day after he sickened, and so dispersed the disease, as
Butler says, into all parts; whereas if he had tarried till three or
four fits had been passed, they might the better have judged of the
nature of it; or if, instead of purging, he had let him blood before
it was so much corrupted, there had been more probability.” At the
dissection, the spleen was found “very black, the head full of clear
water and all the veins of the head full of clotted blood. Butler had
the advantage, who maintained that his head would be found full of
water, and Turquet that his brains would be found overflown and as it
were drowned in blood[555].” Butler, it appears, was “a drunken sot.”
When King James asked him what he thought of the prince’s case, he
replied “in his dudgeon manner” with a tag of verse from Virgil ending
with “et plurima mortis imago.” The Princess Elizabeth could not be
admitted to see her brother “because his disease was doubted to be
contagious[556].” It was at least epidemic, for in the same week
alderman Sir Harry Row and Sir George Carey, master of the wards, died
“of this new disease[557].” The earliest reference to it that I find
is the death, previous to 11 September, of Sir Michael Hicks at his
house Rackholt in Essex, “of a burning ague,” which came, as was
thought, by his often going into the water this last summer, he being
a man of years[558]; but much more probably was a case of “the
ordinary ague that hath reigned and raged almost all over England
since the latter end of summer.” The next year was still more
unhealthy, to judge by samples of parish registers; agues are
mentioned also in letters; thus, one going on 25 March, 1613, to visit
Sir Henry Savile, found him “in a fit, an ague having caught hold of
him[559].”

The winter of 1613-14 was marked by most disastrous floods in Romney
Marsh, in Lincolnshire, in the Isle of Ely, and about Wisbech, and
most of all in Norfolk[560]; but the malarious conditions so brought
about, being subsequent to, were not conceivably the cause of, the
epidemics of ague in the autumn of 1612 and 1613, which made so great
an excess of burials over christenings in the parish registers.

A curious record remains of an aguish sickness in a child, which had
begun about January, 1614. On 18 March, of that year, the dowager
Countess of Arundel wrote from Sutton, near Guildford, to her son Earl
Thomas, who was making the grand tour to Rome and elsewhere with his
wife, and had left the children to the care of their grandmother:
“Your two elder boys be very well and merry, but my swett Willm.
continueth his tersion agu still. This day we expect his twelfth fitt.
I assur myselfe teeth be the chefe cause. I look for so spedy ending
of it, he is so well and merry on his good days, and so strong as I
never saw old nor yonge bear it so well. I thank Jesu he hath not any
touch of the infirmity of the head, but onely his choler and flushe
apareth, but he is as lively as can be but in the time of his fits
onely, which continueth some eight hours[561].”

The epidemic of ague or “new disease,” which began to rage all over
England in the end of the summer, 1612, had probably recurred in the
years following, down to 1616. There is not a trace of plague during
those years in any known record; and yet they are among the most
unhealthy years in Short’s abstracts of town and country parish
registers[562].

The first half of the 17th century is a period which is almost a blank in the conventional annals of “influenza” in Europe. But that period, which was the period of the Thirty Years’ War, had many widespread sicknesses. I do not wish to claim these as influenzas, or to contend that they were infections equivalent thereto in diffusiveness. We may, however, find a place for them in this context; for they were certainly as mysterious as any epidemics admitted into the canon of influenzas. So far as concerns Britain, the first was the epidemic ague, or “new disease,” of 1612 and 1613, probably recurring until 1616. The second was the universal spotted fever of 1623 and 1624, of which I have given an account in the chapter on typhus. That was followed by the plague of 1625, and that again by a harvest ague in the country in the end of the same year. The next epidemic ague or “general sickness, called the new disease,” fell mostly in England upon the two years 1638 and 1639. It was in part a harvest ague, “a malignant fever raging so fiercely about harvest that there appeared scarce hands enough to take in the corn[563]”; but it was also a winter disease. I pass over the war-typhus of 1643, to which the name of “new disease” was also given, and the widespread fever of the year following. In 1651 we hear again of a strange ague, which “first broke out by the seaside in Cheshire, Lancashire and North Wales,” eighty or a hundred being sick of it at once in small villages. Whitmore, who saw this epidemic in Cheshire, identified it with the Protean disease which he described in 1657-58, and hazarded the theory that the former was a diluted or “more remiss” infection carried by the wind from Ireland, where the plague was then raging, in Dublin, Galway, Limerick and other places, after their sieges or occupations by the army of the Commonwealth.

Thus in the first half of the 17th century we have more or less full evidence of epidemics of “new disease” in 1612-13, 1623-24, 1625, 1638-9, 1643-4 and 1651, not one of which was an influenza as we understand the term[564].

We come at length to the years 1657-59, in the course of which one catarrhal epidemic, or perhaps two, did prevail for a few weeks. The hot agues or “new disease” had been raging all over the country from the summer of 1657; then in April, 1658, there came suddenly universal coughs and catarrhs, “as if a blast from the stars”; they ceased, and the hot agues dragged on through the summer and autumn. A letter from London, 26 October, 1658, says: “A world of sickness in all countries round about London: London is now held to be the wholesomest place,” and adds that “there is a great death of coach-horses almost in every place, and it is come into our fields[565].” It was after this, in the spring of 1659, if Whitmore has made no mistake in his dates, that coughs and catarrhs “universally infested London, scarce leaving a family where any store were, without some being ill of this distemper.” The details have been given fully in the former volume[566]. I wish merely to remark here that the two catarrhal epidemics, or influenzas proper, in two successive springs, were sharply defined episodes in the midst of a period of epidemic agues, and that the “new disease” as a whole, during the two or three years that it lasted, had such an effect in the way of ill health and mortality that it was afterwards viewed as a “little plague” worthy of being set in comparison with the Great Plague of 1665.

Willis does not say that the epidemic agues lasted after 1658, perhaps because his essay was printed early in 1659; but Whitmore, whose preface is dated November, 1659, says, without distinguishing the hot ague from the catarrhal fever but speaking of them both as one Protean malady: “it now begins again, seizing on all sorts of people of different nature, which shows that it is epidemic.” Sydenham does not appear upon the scene until 1661; but when his epidemic constitutions do begin, it is with intermittents or agues, which lasted, according to him, until 1664. Perhaps if Sydenham’s experience had extended back to 1657 he would have made his aguish constitution to begin with that year, and to go on continuously until 1664. At all events it does not appear that the year 1660 was a clear interval between Willis’s and Whitmore’s period of 1657-59, Sydenham’s period of 1661-64; for it so happens that John Evelyn has left the following note of his own illness:

“From 17 February to 5 April [1660] I was detained in bed with a kind
of double tertian, the cruell effects of the spleene and other
distempers, in that extremity that my physicians, Drs Wetherburn,
Needham and Claude were in great doubts of my recovery.” Towards the
decline of his sickness he had a relapse, but on the 14th April “I was
able to go into the country, which I did to my sweete and native aire
at Wooton.” On the 9th of May he was still so weak as to be unable to
accompany Lord Berkeley to Breda with the address inviting Charles II.
to assume the crown.

Sydenham makes the “constitution” which began for him in 1661 to decline gradually, and to end definitely in 1664, after which he finds intermittents wholly absent for thirteen years, or until 1677. This clear interval will make a convenient break in the chronology, whereat we may bring in the popular and professional notions of ague then current, and the popular practice in that disease by empirics.

The Ague-Curers of the 17th Century.

It is to be observed that all the respectable writers of the profession speak of agues or intermittents as epidemic over the country for a definite period, and as disappearing thereafter for years together. At the same time they say little or nothing of the endemic malarious fevers of marshy localities. Further, it appears that the professed ague-curers, although they would wish to represent ague as a perennial disease, are really basing upon the same experiences of occasional epidemics which Willis, Whitmore and Sydenham recorded as occasional. The best instance of this is the ‘Pyretologia’ by Drage of Hitchin. It was published for practice in 1665, being designed to show forth the author’s skill as an ague-curer[567]. When we examine its generalities closely, we find that they all come from the sickly season of 1657, the first of those described by Willis.

The great autumnal epidemic of that year (and the following), which we
know from other sources to have been reckoned a “little plague,” he
describes as “a malignant sickness,” which was followed in the winter
by quartans. He himself escaped the autumnal fever but he incurred the
quartan later in the year. In his own case, while the original
paroxysm of this ague was still going on, a new one arose towards
evening, and again, on the following day, a new paroxysm gathered
vigour and supplanted the old, becoming the substantive paroxysm. Many
of those who died of the quartan in 1657 had either the paroxysms
duplicated, or a total want of them, or, in another passage, “the
quartan which followed the autumnal disease of heterogeneous quality
in 1657, cut off divers old people, the fever being erratic,
duplicated or triplicated.” It was a bad sign when the quartan became
doubled or trebled; regularity of the paroxysm was a sign of a good
recovery. The symptoms of a quartan are various; but it is not easy to
pronounce that these all are the symptoms of an intermittent fever, or
the prodromal signs thereof, unless intermittent fevers be epidemic at
the time. He gives the case of a civil and pious priest who had a
tedious quartan from being struck with lightning; he was confined to
bed for two years, with loss of hearing, but, strangely enough,
retaining the use of his eyes; sometimes he was vexed with
convulsions, sometimes with quartan fever. The “plebs medicorum” say
that a quartan fever comes of melancholy, a tertian of choler, a
quotidian of putrefied pituitous matter. The “plebs plebis” think that
the cause is wind or flatus, and that they get rid of the ague by
belching. In his own case he observed that if he drank more cold ale
than usual, he was seized with distension in the loins and with
palpitation, and belched up “flatus and crass vapours infected with
the quality of a quartan.” He knew a man who, in the fourth or fifth
month of a quartan, drank wine too freely, so that the paroxysms came
every day, and that violently; after a week he had an especially
severe paroxysm, and then no more for three weeks, when the fever
returned under the type of an exquisite quartan. One case, which he
mentions twice, led him to doubt whether quartans were not catching:
a certain girl suffering from a quartan asked her father, who was
skilled in the art, to open a vein; her parent declared that during
the blooding the morbid smell of the flowing blood reached his
nostrils, so that he was seized of his daughter’s fever at the proper
time of her paroxysms, having three or four ague fits in due order;
meanwhile the girl was free from the paroxysms for a whole week, but
no longer. The singular nature of quartans is further brought out in
the fact that papules, pustules and exanthems breaking out on the skin
were quite common in the quartan fever which followed the malignant
epidemic of the autumn of 1657. “In the fevers hardly any heat is
perceived; and so the unskilled vulgar say ‘This is an ague’ (Hoc est
anglicè _Ague_), and ‘This is fever and ague’ (Et hoc est febris et
anglicè _Ague_) when cold and heat are mixed equally or combined
regularly.” Peruvian bark does not evacuate the morbific matter unless
by chance it provokes vomiting; cases treated by it often relapse, and
are not well in the intervals. Bark does not occur in his own
prescriptions; but he had cured many with “pentaphyllum.” He knew
several physicians in the epidemic of quartans in 1657 who trusted to
narcotics entirely.

Drage must have had a real experience of aguish distempers of one kind or another during the sickly seasons of 1657-59. But it is clear from the essays or advertisements of empirics that agues were discovered in many forms of sickness that were neither intermittent fevers nor fevers of any distinctive type. One of these practitioners in the time of Charles I. claims to be “the king’s majesty’s servant in ordinary[568]”; which is not incredible, as Sir Robert Talbor, whom Charles II. deigned to honour, was an ague-curer of the same class.

“An ague, which hitherto amongst all sorts hath been accounted the
physitian’s shame, both for definition and cure (thus farre hath
ignorance prevailed), but that the contrary is manifest appeareth
sufficiently by this following definition: and shall be cured whether
tertian, quartern or quotidian, by me Aaron Streater, physitian of
Arts in Oxford, approved by Authority, the King’s Majesties servant in
ordinary, and dwelling against the Temple, three houses up in
Chancerie Lane, next house to the Golden Anchor.” An ague, he goes on,
“is either interpolate (intermittent) or continual; it is either
engendered of a melancholic humour or it is a splenetic effect; the
liver is obstructed by abundance of choler proceeding from a salt
rheum that cometh from the brain” etc. Agues are to be dreaded most
for their remote effects: “Say not therefore, ‘It is but an ague, but
a feaver; I shall wear it out.’ Dally not with this disease;” and he
adds a case to show what people may come to if they neglect an ague at
the beginning: “Being carried downe from London to South-hampton by
Master Thomas Mason,--September 1640, word was brought me of a Mayd
dead, 16 years of age: and being requested to see what disease she
dyed of, I took my chirurgion with me and went. And after section or
search, I found as followeth: a gallon and a half of green water in
the belly, that stunk worse than carrion; under the lyver an impostume
as bigg as my fist, full of green black corrupted matter, and the
lyver black and rot. The spleen and kidneys wholly decayed, and the
place as black as soot; the bowels they were fretted, ulcerated and
rotten. In the chesse was two great handfuls of black burnt blood in
dust or powder; the heart was all sound, but not a drop of blood in
it; nor one spoonfull in the whole body.

Here was an Annatomy indeed, skinne and bone; and I verily beleeve
that there was no braine left, but that she lived while that was
moyst: the sent was so ill, and I not well, that I forbore to search
it.

God that knowes the secrets of all hearts knowes this is a truth, and
nothing else here written. Arthur Fauset, chirurgion at Southampton,
was the man I employed to cut her up, as many there can witness that
were present.

And what of all this, may some say? Why this. An eight weeks’ ague in
the neglect of it breeds all these diseases, and finally death.”

Let us take next the advertisement of an apothecary a generation after, who professed to cure Kentish agues,--“the description and cure of Kentish and all other agues ... and humbly showing (in a measure) the author’s judgment why so many are not cured, with advice in relation thereunto, whether it be Quotidian, Tertian or Quartan, simple, double or triple[569].” Before the Fire of London he had practised in Mark Lane, but after his house was destroyed he removed to Kent, attending Maidstone market every Thursday, and residing at Rochester, a city which, “besides being subject to diseases in common with others, hath two diseases more epidemical, namely, the Scurvey for one but the Ague in special.” The symptoms of scurvy, as he gives them, cover perhaps the one moiety of disease, and those of ague the other.

Agues are of two sorts, curable and incurable; the curable are those
that come in a common way of Providence, the incurable those that are
sent more immediately from God in the way of special judgment, as
instances adduced from Scripture show. What is an ague? Some think it
is a strange thing, they know not what; the more ignorant think it is
an evil spirit, but coming they know not whence. Agues have their seat
in the humours either within the vessels or without them; those
residing within are continual quotidians, continual tertians,
continual quartans; those without are intermittent ditto. (This
distinction of within and without the vessels is traditional, and is
found in Jones’s _Dyall of Agues_ as well as in Dutch medical books a
century later.) The paroxysms of the intermittents are really the
uprising of the Archaeus [of van Helmont], or spirit, to oppose the
rottenness of the humours. A quartan is harder to cure than any other
ague; part of its cure is an old 14th-century rule of letting blood in
the plague; “let blood in the left hand in the vein between the ring
finger and the little finger, which said thing to my knowledge was
done about sixteen years ago [to say nothing of three hundred years
ago] by the empiric Parker in this country, with very good success and
to his great honour and worldly advancement.” This ague-curer says
little of Peruvian bark; his specific is the powder of Riverius, “the
preparation of which, as well as some of the powder itself is lately
and providentially come to my hands.” Three doses cost not above five
shillings, “and I never yet gave more in the most inveterate of these
diseases.... My opinion is that he that will not freely part with a
crown out of his pocket to be eased of such a disease in his body
deserves to keep it.”

The most celebrated ague-curer of the Restoration period was Sir Robert Talbor, who thus describes the high motives that made him a specialist[570]:

“When I first began the study and practice of Physick, amongst other
distempers incident to humane bodies I met with a quartan ague, a
disease that seemed to me the _ne plus ultra_ of physic, being
commonly called Ludibrium et Opprobrium Medicorum, folly and derision
of my profession, did so exasperate my spirit that I was resolved to
do what study or industry could perform to find out a certain method
for the cure of this unruly distemper.... I considered there was no
other way to satisfy my desire but by that good old way, observation
and experiment. To this purpose I planted myself in Essex near to the
seaside, in a place where agues are the epidemical diseases, where you
will find but few persons but either are, or have been afflicted with
a tedious quartan. In this place I lived some years, making the best
use of my time I could for the improving my knowledge.”

Talbor’s first chapter is a fluent account of how agues are produced by “obstructions” of the spleen. This was a matter of theoretical pathology which an empiric could make a show with as well as another. But the empiric betrays himself as soon as he comes to practice. The enlarged spleen of repeated agues, or of the malarial cachexia, is commonly known as the ague-cake. There is no doubt that much of the unhappiness of the aguish habit resides in the ague-cake, and that one of the best pieces of treatment is to apply counter-irritants or the actual cautery to the left side, against which the enlarged spleen presses as a cake-like mass. Talbor, however, desired to free the patient from his “ague-cake” altogether:

“I have observed these in four patients: two were cast out the stomach
by nature, and the other two by emetic medicines. One of them was like
a clotted piece of phlegm, about the bigness of a walnut, pliable like
glue or wax, weighing about half an ounce; another about the bigness
of the yolk of a pullet’s egg, and like it in colour, but stiffer,
weighing about five drachms; the other two of a dark colour, more
tough, about the like bigness, and heavier. It is a general
observation amongst them that their ague comes away when they see
those ague-cakes[571].”

Having followed this “good old way of observation and experiment” for several years among the residents of the Essex marshes, Talbor came to London, and set up his sign next door to Gray’s Inn Gate in Holborn. In 1672 (14th July) he issued a small work with a Greek title--the quacks were fond of the Greek character on their title-pages--“Πυρετολογια, a rational account of the cause and cure of agues, with their signs: whereunto is added a short account of the cause and cure of feavers.” He made a bid also for practice in “scurvy,” a disease of landsmen in those times which was more a bogey than ague itself--“a strange monster acting its part upon the stage of this little world in various shapes, counterfeiting the guise of most other diseases ... sometimes it is couchant, other times rampant, so alternately chronic and acute.”

Most of the agues which Talbor professed to have met with in London in those years must have been equally factitious: for Sydenham, who makes more of “intermittents” than other writers of repute, was of opinion that, for thirteen years from 1664 to 1677, fevers of that type had not been seen in London, except some sporadic cases or cases in which the attack had begun in the country. But the air was then full of talk and controversy about Peruvian bark, or Jesuits’ powder (_pulvis patrum_), or “the cortex,” which was cried up as a specific in agues by some, and cried down by others. Talbor had seized upon this specific, and claimed to have an original way of administering it, whereby its success was assured. We get a glimpse of his practice from Dr Philip Guide, a Frenchman who came to London and practised for many years as a member of the College of Physicians[572]. Talbor had cured the daughter of Lady Mordaunt of an ague, and the cure had reached the ears of Charles II. One of the French princesses having been long afflicted with a quartan ague,

“The king commanded Mr Talbor to take a turn at Paris, and as a mark
of distinction he honoured him with the title of knight. He succeeded
wonderfully. But he could not cure Lady Mordaunt’s daughter a second
time, whom he had cured once before at London, by whom he gained most
of his reputation.” He tried for two months, but did not relieve the
symptoms. Dr Guide was called in, and being asked to give his opinion
of the ague that the young lady was afflicted with, “after some
inquiry I found her distemper was complicated and quite different from
the ague, which made me lay the thought of the ague aside, and apply
myself wholly to the complicated disease, which I effectually cured in
twelve days, together with her ague, without having any further need
of the infallible specific of Sir Robert Talbor.”

The Peruvian Bark Controversy.