Chapter III: Influenzas and Epidemic Agues (2)

It can hardly be doubted that the conflicting opinions as to the benefit of Peruvian bark in ague, which have been often cited in disparagement of medicine and as an example of its intolerance, arose from the indiscriminate use of it in “agues” diagnosed as such by quacks and pushing practitioners. The bark had been brought first to Spain in 1632 and had been tried medicinally in 1639[573]. It was under the powerful patronage of the Jesuits, especially of Cardinal de Lugo, and most of it at that time found its way to Rome, the centre of a malarious district. In 1652 it failed to cure a “double quartan” in an Austrian archduke, and thereafter fell into some disrepute. A violent controversy on its specific use in agues arose in the Netherlands; it had failed in every case at Brussels, it had not failed in a single case at Delft. Meanwhile it remained, very dear, sixty florins having been paid at Brussels in 1658 for as much as would make twenty doses, to be sent to Paris. The London ‘Mercurius Politicus’ of the week 9-16 December, 1658, contained an advertisement[574] that a supply of it had been brought over by James Thompson, merchant of Antwerp, and was to be had either at his own lodgings at the Black Spotted Eagle in the Old Bailey or at Mr John Crook’s, bookseller, at the sign of the Ship in St Paul’s Churchyard. The London physicians such as Prujean and Brady countenanced it, and Willis, in reprinting his essay on Fevers in 1660, spoke of it as coming into daily use. Sydenham, whose publisher was the same Crook at the sign of the Ship, made a brief reference to it in the first edition (1666) of his _Observationes Medicae_, in the section upon the epidemic constitution of intermittents during the years 1661-64. He admits that the bark could keep down fermentation for the time being; but the _materies_ which the fermentation would have dissipated if it had been allowed its way, will remain in the system and quickly renew its power. He had known a quartan continue for several years under the use of bark. It had even killed some patients when given immediately before the paroxysm. Prudently and cautiously given, in the decline of such fevers, it had been sometimes useful and had stopped the paroxysms altogether, especially if the aguish fits were occurring at a season when the malady was less epidemical. But it is clear that Sydenham in 1666 inclined strongly to non-interference with the natural depuratory action of the fever upon the _materies_ of the disease. His teaching that the cortex, while it kept down the fermentation of the blood for a time, left the dregs of the fever behind, was thus popularly stated some years after by Roger North in relating the fatal illness of his brother the Lord Keeper Guilford in the summer of 1685[575].

The fever of Lord Guilford was not an intermittent at all, but a
“burning acute fever without any notable remissions and no
intermissions,” a case of the epidemic typhus of that and the
succeeding year, elsewhere described. The treatment was first in the
hands of Dr Masters, pupil and successor of Dr Willis, whose cardinal
doctrine of fevers was that they were a natural fermentation of the
blood. He ordered phlebotomy. Next Dr Short, of another school, was
sent for: “So to work with his cortex to take it off: and it was so
done; but his lordship continued to have his headache and want of
sleep. He gave him quieting potions, as they called them, which were
opiates to make him sleep; but he ranted and renounced them as his
greatest tormentors, saying ‘that they thought all was well if he did
not kick off the clothes and his servant had his natural rest; but all
that while he had axes and hammers and fireworks in his head, which he
could not bear.’ All these were very bad signs; but yet he seemed to
mend considerably; and no wonder, his fever being taken off by the
cortex. And it is now found that, without there be an intermission of
the fever, the cortex doth but ingraft the venom to shoot out again
more perniciously.” The Lord Keeper’s illness dragged on, and at
length the physicians “found he had a lent fever which was growing up
out of the dregs which the cortex had left; and if it were not taken
off, they knew he would soon perish. So they plied him with new doses
of the same under the name of cordial powders, whereof the quantity he
took is scarce credible; but they would not touch his fever any more
than so much powder of port. And still he grew worse and worse. At
length the doctors threw up[576].”

Sydenham having indicated in his edition of 1666 that bark was dangerous when given immediately before a paroxysm, but that it was sometimes useful in the decline of the fever, and that its benefits were greatest in those desultory agues which appeared at, or continued into, a season when agues had become less epidemical, he proceeded in his third edition of 1675 to enlarge these indications for giving bark in ague. He begins, as Talbor had begun in his essay of 1672, and as the empiric Streater had in his advertisement of 1641, by calling quartans the _opprobrium medicorum_, and he then lays down precisely how bark was to be given in those obstinate fevers, as well as in tertians of the aged or feeble: namely, after the fever had exhausted itself _suo Marte_, in the intervals between two paroxysms, an ounce of bark (in two ounces of syrup of roses) to be taken in the course of the two free days, a fourth part at a time morning and evening. The dosage may have been borrowed from Talbor, as Sir George Baker alleges[577]; it matters little for anyone’s fame. Sydenham, however, in a letter of October, 1677, thus claimed to have been independent of Talbor so far as concerned the directions for giving bark which he inserted in his edition of 1675:

“I have had but few trials, but I am sure that an ounce of bark, given
between the two fits, cures; which the physicians in London not being
pleased to take notice of in my book, or not believing me, have given
an opportunity to a fellow that was but an apothecary’s man, to go
away with all the practice on agues, by which he has gotten an estate
in two months, and brought great reproach on the faculty[578].”

Talbor was patronised by Charles II., who caused him to be made one of his physicians. On 2 May, 1678, a few months after the date of Sydenham’s letter, Lord Arlington wrote to the president of the College of Physicians[579]: “His Majesty, having received great satisfaction in the abilities and success of Dr Talbor for the cure of agues, has caused him to be admitted and sworn one of his physicians.” Next year, 1679, the king had an attack of the reigning ague, and a recurrence of it in 1680. It is probably to the occasion of one or other of these attacks that an undated letter belongs from the Marquis of Worcester to the marchioness: “The physicians came to the Council to acquaint them that they intend to give the king the Jesuit’s powder five or six times before he goes to Newmarket, which they agreed to. He looks well, eats two meals of meat a day, as he used to do[580].” Evelyn has preserved a story told him by the Marquis of Normanby, which probably relates to the same aguish attack of Charles II.[581]:

“The physicians would not give the _quinquina_ to the king, at a time
when, in a dangerous ague, it was the only thing that could cure him
(out of envy, because it had been brought into vogue by Mr Tudor
[Talbor] an apothecary), till Dr Short, to whom the king sent to know
his opinion of it privately, sent word to the king that it was the
only thing which could save his life, and then the king enjoined his
physicians to give it to him, which they did, and he recovered. Being
asked by this lord [Normanby] why they would not prescribe it, Dr
Lower said it would spoil their practice, or some such expression.”

What Dr Lower was most likely to have said was, that it went against his principles to give bark in fevers. He was a physiologist, in the sense of an anatomist, the pupil of Willis at Oxford and his successor in practice in London. It was the teaching of Willis that blood was like the juice of vegetables, particularly the juice of the grape, in respect of fermenting, just as it was like milk in respect of curdling. Fever was a sudden access of fermentation, apt to arise in spring and autumn, from internal or constitutional occasions, as well as to come at any time by infection; by this febrile ferment, ebullition or commotion, the blood was purged of certain impurities, comparable to the lees of wine, which were removed from the body in the sweat, the urine or other critical evacuation. Jesuit’s bark was believed to check fermentation, or, in the later phrase of Pringle and others, it was antiseptic; and it was probably because he thought it would check the natural defaecating action of the blood in an ague that Lower refused to prescribe it. Sydenham was more tentative, pliant, empirical. He cavilled at Willis’s doctrine of the ebullition or fermentation of the blood without actually rejecting it; for he held practically the same view of the salutary or depuratory nature of fever, which was indeed the Hippocratic view of it. Accordingly in his first reference to bark, in 1666, he sustains the objection to it, that it interfered with a natural depuratory action; and it was only in following the lead of Talbor, a more empirical person than himself, that Sydenham overcame his doctrinal scruples. Dr Short, to whom Charles II. sent privately for advice, was of Sydenham’s party; soon after that occasion, the latter dedicated to Short his ‘Tractate on Gout and Dropsy’ (1683). It was Short who “went to work with his cortex” upon the Lord Keeper in 1685, after Dr Masters, of the school of Willis, had tried his hand with phlebotomy. The king’s experiences, a few months before the Lord Keeper’s death, had been just the same, and with the same result: the deathbed of Charles II., it is well known, was the scene of ecclesiastical rivalries; but the physicians at the bedside of the king had their rivalries too.

On Monday the 2nd of February, at eight in the morning, the king had a seizure of some kind in his bed-chamber, which was currently said to have been an “apoplectic fit[582],” although there is nothing said of paralysis. A letter of the 3rd February[583] says the king “was seized in his chair and bed-chamber with a surprising convulsion fit which lasted three hours.” Dr King, an expert operator who had assisted Lower in the delicate operation before the Royal Society on 23 November, 1667, of transfusing blood from one body to another, happened to be at hand, and, at once drawing his lancet, bled the king. His promptitude in action, which probably left him little time for diagnosis, was much applauded, and the Privy Council voted him a reward of a thousand pounds, which Burnet says he never received.

“This rescued his Majesty for the instant,” says Evelyn, (who came up
from Wooton on hearing the news, and is probably correct in his
narrative), “but it was only a short reprieve. He still complained,
and was relapsing, often fainting, with sometimes epileptic symptoms,
till Wednesday, for which he was cupp’d, let blood in both jugulars,
had both vomit and purges, which so reliev’d him that on Thursday
hopes of recovery were signified in the public Gazette; but that day,
about noone, the physitians thought him feverish. This they seem’d
glad of, as being more easily allay’d and methodically dealt with than
his former fits; so as they prescribed the famous Jesuit’s powder: but
it made him worse, and some very able doctors who were present did not
think it a fever, but the effect of his frequent bleeding and other
sharp operations us’d by them about his head, so that probably the
powder might stop the circulation, and renew his former fits, which
now made him very weake. Thus he pass’d Thursday night with greate
difficulty, when, complaining of a paine in his side, they drew 12
ounces more of blood from him; this was by 6 in the morning on Friday,
and it gave him reliefe; but it did not continue, for being now in
much paine, and struggling for breath, he lay dozing, and after some
conflicts, the physitians despairing of him, he gave up the ghost at
halfe an houre after eleven in the morning, being 6 Feb. 1685, in the
36th yeare of his reigne, and 54th of his age.... Thus died King
Charles II. of a vigorous and robust constitution, and in all
appearance promising a long life[584].”

Whether the bark would have saved him if the aguish nature of the paroxysms (such as he had in 1679 and again in 1680) had been clear from the first, may be doubted. But his chances of recovery were certainly made worse by the halting and stumbling diagnosis, (according to Evelyn)--now apoplexy, now epilepsy, now fever[585].

The true value of cinchona bark in medicine was not seen until much that was vague in the use of the term “ague” had been swept away. In the last great epidemic period of agues in this country, as we shall see, from 1780 to 1786, bark was found, for some reason, to be ineffective. It is not in the treatment of epidemic agues, but of agues in malarious countries, that the benefits of Jesuits’ bark have been from first to last most obvious.

The practice in so-called agues was long in the hands of empirics, who, like their class in general, made business out of ignorant or lax diagnosis. I shall add here what remains to be said of specialist ague-curers in later times. They are heard of in London in the Queen Anne period, and as late as 1745.

Swift writes in his Journal to Stella, 25 December, 1710, from Bury
Street, St James’s: “I tell you a good pun: a fellow hard by pretends
to cure agues, and has set out a sign, and spells it _egoes_; a
gentleman and I observing it, he said, ‘How does that fellow pretend
to cure agues?’ I said, I did not know, but I was sure it was not by a
_spell_. That is admirable.” In 1745, Simon Mason, of Cambridge,
published by subscription and dedicated to Dr Mead an essay, _The
Nature of an Intermitting Fever and Ague considered_ (Lond. 1745), in
which he has the following on “charm-doctors”:--“When one of these
poor wretches apply to a doctor of this stamp, he enquires how many
fits they have had; he then chalks so many strokes upon a heater as
they tell him they have had fits, and useth some other delusions to
strengthen the conceit of the patient” (p. 167). Francis Fisher, who
had been upper hostler in a livery stable in Crutched Friars near
forty years, “told me he seldom missed a week without several ague
patients applying to him, and he cured great numbers by a charm they
wore in their bosoms” (p. 239). Another, who kept a public-house near
St George’s Fields, Southwark, sold “febrifuge ale” at a shilling a
pint. It was a small ale brewed without hops, but with bark,
serpentery, rhubarb and cochineal mixed in the brewing. The receipt
was given him by an old doctor who was a prisoner in the King’s Bench.
His customers came in the morning fasting, and drank their shilling’s
worth after the publican had given them faith by a cordial grip of the
hand. “By this means,” he told Mason, “I got a good trade to my house,
and a comfortable maintenance too.”

We may now return to the actual history of the epidemic fevers upon which the Peruvian bark was first tried on a large scale in England. The “intermittent” constitution which began in 1677 and lasted year after year until 1781 or even longer was a very remarkable one. It was called at the time the new fever, or the new ague, and it had at least one short interlude of influenza or epidemic catarrhal fever in the winter of 1679, just as the last epidemic of the kind, in 1657-59, had at least one, and probably two, short and swift epidemic catarrhs in spring. But before we come to that epidemic of 1678-81, there falls to be noticed an epidemic in the month of November, 1675, which has always been counted among the influenzas proper. After giving the particulars of it from Sydenham and from the London bills of mortality, I shall show from Sydenham and the bills of mortality that there was an exactly similar epidemic in the month of November, 1679, which has not been admitted into the conventional list of influenzas. Thereafter I shall proceed to the epidemic constitution of 1678-81 as a whole, which has been reckoned among the epidemic agues or malarious epidemics.

The Influenza of 1675.

The first that we hear of the universal cold of 1675 is an entry which Evelyn makes in his diary under 15 October: “I got an extreme cold, such as was afterwards so epidemical as not only to afflict us in this island, but was rife over all Europe, like a plague. It was after an exceeding dry summer and autumn.” It was not until November that the epidemic cold made an impression upon the death-rate in London; the deaths mounted up from 275 in the week ending 2 November, to 420 and 625 in the two weeks following, and thereafter gradually declined to an ordinary level. Part of the excess, but by no means the greater part of it, was set down under fevers, as the following section from the weekly bills of the year will show:

1675

Griping in
Week Ending Fever Smallpox the Guts All causes

Nov. 2 42 9 29 275
9 60 12 42 420
16 130 13 43 625
23 99 2 28 413
30 61 6 29 349
Dec. 7 54 7 25 308
14 43 5 12 266

This shows the characteristic rise and fall of an epidemic catarrh both in the article of fever deaths and in the column of deaths from all causes. The other excessive articles besides fever in the two worst weeks are also characteristic of influenza mortality:

Week ending Week ending
9 Nov. 16 Nov.

Consumption 68 99
Aged 40 67
Tissick 10 35

Sydenham’s account bears out the figures[586]. At the end of October, he says, the mild, warm weather turned to cold, while catarrhs and coughs became more frequent than at any time within his memory. They lasted until the end of November, when they ceased suddenly. Afterwards he gives a special chapter to the “Epidemic Coughs of the year 1675, with Pleurisies and Pneumonias supervening.” The epidemic spared, he says, hardly anyone of whatever age or temperament; it went through whole families at once. A fever which he calls _febris comatosa_ had been raging far and wide since the beginning of July, with which in the autumn dysenteric and diarrhoeal disorders were mingled (it was an exceedingly dry season). This constitution held the mastery all the autumn, affecting now the head, now the bowels, until the end of October, when catarrhs and coughs became universal and continued for a month. Sydenham’s view of the sequence of events was his usual one, namely, that one constitution, by change of season, passed by transition into another. Whatever the constitution of “comatose” fevers may have been, which prevailed “far and near,” it has left no trace upon the bills of mortality in London, which are remarkably low until the beginning of November. But as soon as the epidemic of coughs begins, the weekly deaths mount up in an unmistakeable manner, so that for two or three weeks in November, the mortality is nearly double that of the weeks preceding or following.

The “severe cold and violent cough,” of 1675, says Thoresby of Leeds[587], who was then a boy, “too young or unobservant to make such remarks as might be of use,” was known in the north of England “profanely” by the name of the “jolly rant.” Thoresby well remembered that it affected all manner of persons, and that so universally that it was impossible, owing to the coughing, to hear distinctly an entire sentence of a sermon. He gives December as the month of it in Leeds, and says that it affected York, Hull, and Halifax, as well as the counties of Westmoreland, Durham, and Northumberland. In Scotland also we find a trace of a strange epidemic sickness. It was the time of the persecution of the Covenanters, whose preachers moved hither and thither among the farm-houses. One of them, John Blackadder, was at the Cow-hill in the parish of Livingstown in August, 1675. He came in one evening from the fields very melancholy, and in reply to questions, he said he was afraid of a very dangerous infectious mist to go through the land that night. He desired the family to close doors and windows, and keep them closed as long as they might, and to take notice where the mist stood thickest and longest, for there they would see the effects saddest. “And it remained longest upon that town called the Craigs, being within their sight, and only a few families; and within four months thereafter, thirty corpses went out of that place[588].” The prophecy was fulfilled within four months, which would bring us to the date of the influenza, although the mortality for a small place is somewhat excessive.

The Influenza of 1679.

For the sake of comparison, I pass at once to an epidemic of coughs and colds in the month of November, 1679, which Sydenham has chronicled, but no one except Cullen[589] has thought of including among the influenzas. It produced the characteristic effect of influenza on the London weekly bills, and it came in the midst of epidemic agues, just as the epidemic catarrhs of 1658 and 1659 had done. The following rise and fall are just as distinctive of an influenza as on the last occasion in 1675:

1679

Griping of
Week ending Fever Smallpox the Guts All causes

Nov. 11 50 18 34 328
18 89 27 39 541
25 126 21 55 764
Dec. 2 82 27 38 457
9 63 12 38 388

Sydenham’s account[590] of this remarkable November outburst of sickness in London, written within a few weeks of its occurrence, is almost exactly a repetition of his language concerning the epidemic coughs of November, 1675. The prevailing intermittent fevers, he says, gave place to a new epidemic depending upon a manifest crasis of the air. The new epidemic was one of coughs, which were so much more general than at the same season in other years that in nearly every family they affected nearly every person. In some cases of the cough, the aid of a physician was hardly needed; but in others the chest was so shaken by the violent convulsive cough as to bring on vomiting, and the head was affected with vertigo. For the first few days the cough was almost dry, and so purely paroxysmal as to remind Sydenham of the whooping-cough of children. Everyone was surprised, he says, at the frequency of these coughs in this season. His own suggestion was that the rains of October[591] had filled the blood with crude and watery particles, that the first access of cold had checked transpiration through the skin, and that Nature had contrived to eliminate this serous colluvies either by the branches of the “vena arteriosa” or (as some will have it) by the glands of the trachea, and to explode it by the aid of a cough. Phlebotomy and purging were the best cures; diaphoretics he considered less safe, and he ascribed to their abuse the fever into which some fell, and the pleurisies which were apt to attack patients with great violence during the subsidence of the epidemic catarrh.

The Epidemic Agues of 1678-80.

The other English writer on the epidemic constitution of 1678-79 is Dr Christopher Morley[592]. Like Sydenham, he is occupied almost exclusively with the epidemic agues; but he also records the extraordinary rise of the mortality in London for a few weeks in the last months of the year, and the causes thereof, although it did not occur to him to count that as a separate part of “the new disease,” still less as the principal part, which it really was in London so far as concerned the death-rate. Dating his preface from London, the 31st of December, 1679, he says in the text: “Within the very days of my present writing, it happens that as many as four hundred deaths more than usual have taken place in a fortnight,” the excessive mortality having been due to “coryza, bronchitis, catarrh, cough and fever,” which were the effects of “most pernicious destillations.”

I shall now go back to the beginning of the epidemic constitution in the midst of which this November interlude occurred, and I shall follow it season after season to the end, so as to set forth in historical prominence that which was regarded at the time as “the new disease.” When Sydenham returned to London in the autumn of 1677, after six months’ rest from practice, he was told by his professional friends that intermittents were being seen here and there (after a clear interval of thirteen years), being more frequent in the country than in the city. In the letter of October, 1677, cited above, he speaks of Talbor having made a fortune in two months by his cures of agues with bark.

The first particular notice of the “new fever” occurs in a London
letter of 23 February, 1677/78: “Lady Katherin Brudenhall has been in
great danger of death by the new feaver[593].” A severe aguish illness
of Roger North, fully described in his ‘Autobiography,’ was probably
another instance of the reigning malady; it came upon him in the hot
weather of 1678, while he was residing with his brother, Lord
Guilford, at Hammersmith[594]. In the autumn of 1678, the “new fever”
came more into notice. On the 8th of September, a letter was brought
to Evelyn in church, from Mr Godolphin (afterwards celebrated as the
minister of William III.), to say that his wife was exceedingly ill
and to ask Evelyn’s prayers and assistance. Evelyn and his wife took
boat at once to Whitehall, and found the young and much-beloved Mrs
Godolphin “attacqu’d with the new fever then reigning this excessive
hot autumn, and which was so violent that it was not thought she could
last many hours.” She died next day, in her twenty-ninth year; but, as
she had been brought to bed of a son six days before, her fever may
have been more from puerperal causes than from “the new fever then
reigning.” Other known cases of ague the next season were those of Sir
James Moore, his majesty’s engineer, who, in August, 1679, coming from
Portsmouth “was seized with an ague, and had two or three violent
fits, which carried him off[595];” and of the king, Charles II., who
was congratulated on his recovery by the lord mayor and aldermen, on
15 September, and had a recurrence of the aguish attack (“two or three
fits”) on 15 May, 1680[596]. There are also references to the agues of
1679 in the country, in the letters of Lady North[597].

Sydenham wrote his account of this epidemic of intermittents in compliance with a request from Dr Brady, Master of Gonville and Caius College, Cambridge, that he would continue the method of his ‘Observationes Medicae’ into the years following, and in particular give an account of his method of administering bark. He occupied most of his space with treatment; but he gives here and there the following epidemiological details. The agues were mostly tertians, or quotidians, or duplex forms of these, whereas on a former occasion they had been mostly quartans; after two or three intermissions they were apt to become continual fevers. The agues, which had occurred in the spring of 1678, became more common in the summer and autumn, when they raged so extensively that no other disease deserved the name of epidemic so much. In winter smallpox took the lead; but early in July, 1679, the agues began again, and so increased day by day that in August they were raging excessively and destroying many. It was in August that the king had his “great cold” at Windsor, which afterwards changed to an ague. Sydenham then comes to the November interlude of epidemic catarrhs, which was followed by “a fever without cough” (_non penitus deleta, sed manente adhuc in sanguine, malae crasis impressione_), lasting to the beginning of 1680. As that year wore on, the intermittent fevers began again, and continued more or less until 1685, becoming indeed less common in London, and less severe, than in the first four years of the constitution, but in other places, now here, now there, not less so than at first[598].

I have kept to the last the special account of this epidemic written by Morley at the end of the second year of it, namely, in December, 1679. He had been a witness of this fever, first at Leyden in the autumn of 1678, and next in England in the autumn of 1679, and he made it the subject of a treatise at the request of an eminent physician in London. It was not so severe by half in England as in Holland, but the English made a great deal more of it, calling it the New Disease, the New Ague, the New Fever, the New Ague Fever, and, in Derbyshire sarcastically, the New Delight. In Holland they called it neither new nor old, neither intermittent nor continued, nor a conjunction of both, but simply _morbus epidemicus_, or _febris epidemica_. His master at Leyden, Professor Lucas Schacht, taught very decidedly that it was of a scorbutic nature, and as early as the month of June, 1678, had prophesied the arrival of such an epidemic fever because “tertians were becoming more and more scorbutic,” just as they had done before the great epidemic of fever in Holland in 1669. Morley claims, however, that the fever of 1678 was in some respects different from that of 1669, as well as from that of the year immediately preceding, 1677, when “an incredible multitude of people all over Belgium, and in every city and town, fell sick.” The Dutch, it appears, called these occasional outbreaks simply “the epidemic fever,” neither intermittent nor continued; and certainly that of 1669, which is sometimes counted among the epidemic agues, was a very remarkable “ague.” (See Chapter I. p. 19.)

The epidemic fever of 1678, wherever it may have been bred or engendered, was prevalent in England at the same time as in Holland--in an exceedingly hot and dry autumn. The most constant symptoms, says Morley (and he writes both for Holland[599] in 1678 and for the country districts of England in the autumn of the following year), were nausea, severe vomiting, incredible tightness about the breast, weight in all the limbs, weariness, giddiness, vigils, thirst, restless tossing, and languor remaining after the disease was gone. Among the more remarkable symptoms were the following: Many had aphthae of the mouth, some twice or thrice, some being endangered by the severity and closeness of the patches of thrush. In some there occurred bleeding from the nose, or from piles, stranguary, etc. Round worms were observed, issuing both by the mouth and anus. In some few there were spots on the skin, but hardly ever petechiae or tumours near the ears. It affected all classes equally, all ages and both sexes. Some said it was easier to children than to adults, but others denied this. Some said it was more pernicious in the country than in the towns. In Leyden, the deaths never exceeded 150 in the week, being about twenty in a week above the ordinary level. More died from the coughs, anginas, peripneumonies and pleurisies that followed, than from the disease itself. Schacht says that the wind for nearly two years had been steadily from the North, or veering to the East or West. The Leyden faculty, and the Dutch generally, did not think the disease a malignant one; it was very freely called so, however, in England, the chorus being led by empirics and illiterate persons: “Ac indicio est,” says Morley, “libellus perexiguus nostra lingua ab Empirico conscriptus de hoc morbo.” This seems to refer to the tract by one Simpson, which I shall notice briefly[600].

Simpson styles himself a Doctor of Physic, and denies that he is an
empiric. One sign of his affinity to that order, however, is that he
objects to the orthodox treatment--emetics, drenches, a too cooling
regimen, and purges, while he thinks blood-letting of doubtful
utility. The symptoms were chills at the outset, pains in the head and
back (in some with shaking), then intense burning heat, thirst,
profuse immoderate sweats and great debility, a general lassitude,
dulness, and stupor which in many were followed by delirium and a
comatose state. Sometimes the fever simulated a quotidian, sometimes a
tertian. He calls it “this new fever so grassant in city and country”
and says that in many it assumed “the guise of a morbus cholera, known
by the much vomitings or often retchings to vomit; and in others under
the livery of the gripes with looseness, or, in some, looseness
without gripes.” This choleraic tendency concurring with other usual
causes from the late season of fruit-eating etc., had swelled the
bills of mortality. The morbus cholera and the gripes were to the new
fever “like the circumjoviales that move in the same sphere with (but
at some distance from) their master-planet.”

The meaning of all this is obvious on turning to the London weekly, bills of mortality. In the months of August and September for three years in succession, 1678-80, the deaths from “griping in the guts” and from “convulsions” rose greatly. These were, indeed, three successive seasons of fatal diarrhoea, mostly infantile, as I shall show in the chapter on that disease.

The following extracts from the London weekly bills of mortality show how “fevers,” as well as other diseases, contributed to the great rise in the autumns of 1678, 1679, and 1680.

_Autumnal London Mortality in 1678._

1678

Griping
Week ending Fever Smallpox in Guts All causes

Aug. 20 77 31 87 459
27 79 37 130 510
Sept. 3 82 37 121 530
10 103 27 164 621
17 82 23 178 580
24 83 20 152 528
Oct. 1 82 25 117 485
8 77 27 106 456

_Summer and Autumnal London Mortality in 1679._

1679

Griping
Week ending Fever Smallpox in Guts All causes

July 22 42 55 101 442
29 60 50 134 565
Aug. 5 78 63 143 531
12 62 43 161 579
19 55 64 149 545
26 68 53 112 514
Sept. 2 96 40 97 466
9 92 47 75 471
16 85 50 87 462

(For the Influenza weeks, see former Table.)

_Autumnal London Mortality in 1680._

1680

Griping
Week ending Fever Smallpox in Guts All causes

Aug. 10 70 17 108 427
17 90 6 132 494
24 98 17 127 552
31 140 18 228 816
Sept. 7 101 14 215 671
14 94 13 173 635
21 106 9 175 628
28 130 9 159 615
Oct. 5 125 16 138 597
12 121 10 94 530
19 109 14 68 488
26 93 5 58 407
Nov. 2 77 10 53 396

The last of the three autumnal seasons, 1680, is one of the few in the bills with high deaths from fever along with high deaths from choleraic disease; and that excess of fever mortality may have been due in part to the ague epidemic, then in its third season.

The following extracts from Short’s summation of parish registers show the great excess of burials over baptisms in various parts of England during the years of the aguish epidemic constitution.

_Country Parishes._

Registers Sickly Baptisms Burials
Year examined parishes in do. in do.

1678 136 17 312 527
1679 137 44 800 1203
1680 137 54 1093 1649
1681 137 41 679 1156
1682 140 30 632 975

_Market Towns._

Registers Sickly Baptisms Burials
Year examined parishes in do. in do.

1678 22 5 578 789
1679 23 7 877 1371
1680 24 7 946 1494
1681 24 9 945 1333
1682 25 9 795 1092
1683 25 8 1109 1398
1684 25 8 865 1243
1685 25 4 741 1191

The Influenza of 1688.

The seasons continued, according to Sydenham, to produce epidemic agues until 1685, when the constitution radically changed to one of pestilential fevers, affecting many in all ranks of society and reaching a height in 1686. Sydenham records nothing beyond that date, having shortly after fallen into ill health and ceased to write or even to practise. One would wish to have known what he made of the “new distemper” in the summer of 1688, for it was a sudden universal fever, and yet not a catarrh or a “great cold.” It is thus referred to in a letter of the month of June, from Belvoir, Rutlandshire[601]: “The man that dos the picturs in inemaled is gon up to London for a weke.... I wish the man dos not get this new distemper and die before he comes agane.” On turning to the London weekly bills of mortality we find in the first weeks of June the characteristic rise of one of those sudden epidemic fevers or new diseases, of which the earliest with recorded figures was the “gentle correction” of July, 1580. The following are the weekly London figures corresponding to the “new distemper” of 1688:

_Weekly London Mortalities._

1688

Week ending Fevers All causes

May 29 58 368
June 5 76 518
12 101 559
19 65 435
26 66 437

The contemporary London notice of this “influenza” comes from Dr Walter Harris, who mentioned it in a book written the year after[602]:

“From the middle of the month of May in the year 1688, for some weeks,
a slight sort of fever became epidemical. It affected the joints of
the patients with slight pains, and they complained of a pain in their
heads, especially in the fore-part, and of a sort of giddiness. It was
more rife than any that I ever observed before, from any cause
whatsoever, or in any time of the year. A great many whole families
were taken at once with this fever, so that hardly one out of a great
number escaped this general storm. Now this so epidemical or febrile
insult seemed plainly to me to depend upon the variety of the season
of the year, the most intense heat of some days being suddenly changed
to cold.... Never were so many people sick together: never did so few
of them die. They recovered under almost any regimen,--almost everyone
of them.”

It will be seen, however, that the bills rose very considerably for four weeks, and that, too, in the healthiest season of the year.

A somewhat fuller account of its symptoms is given by Molyneux for Dublin[603]. He had been informed by a learned physician from London that it had been as general there as in Dublin, which we know to have been the case from Harris’s account. Both Molyneux and Harris call it a slight fever, without mentioning catarrhal symptoms. The spring months immediately preceding had been remarkable for drought.

At Dublin this “short sort of fever” was first observed about the
beginning of July, or some six weeks later than in London. “It so
universally seized all sorts of men whatever, that I then made an
estimate not above one in fifteen escaped. It began, as generally
fevers do, with a chilness and shivering all over, like that of an
ague, but not so violent, which soon broke out into a dry burning
heat, with great uneasiness that commonly confined them to their beds,
where they passed the ensuing night very restless; they commonly
complained likewise of giddiness, and a dull pain in their heads,
chiefly about the eyes, with unsettled pains in their limbs, and about
the small of their back, a soreness all over their flesh, a loss of
appetite, with a nausea or aptness to vomit, an unusual ill taste in
their mouths, yet little or no thirst. And though these symptoms were
very violent for a time, yet they did not continue long: for after the
second day of the distemper the patient, usually of himself, fell into
a sweat (unless ’twas prevented by letting blood, which, however
beneficial in other fevers, I found manifestly retarded the progress
of this): and if the sweat was encouraged for five or six hours by
laying on more cloaths, or taking some sudorifick medicine, most of
the disorders before mentioned would entirely disappear or at least
very much abate. The giddiness of their head and want of appetite
would often continue some days afterwards, but with the use of the
open fresh air they certainly in four or five days at farthest
recovered these likewise and were perfectly well. So transient and
favourable was this disease that it seldom required the help of a
physician; and of a thousand that were seized with it, I believe
scarce one dyed. By the middle of August following, it wholly
disappeared, so that it had run its full course through all sorts of
people in seven weeks time.... This fever spread itself all over
England; whether it extended farther I did not learn.”

This short fever of men was preceded by a slight but universal horse-cold[604].

The Influenza of 1693.

Molyneux considered the strange transient fever of the summer of 1688 to have been the most universal fever that perhaps had ever appeared, and he thought the universal catarrh of five years’ later date (1693) to have been “the most universal cold.” We have thus a means of contrasting in the descriptions of the same author a universal slight fever and a universal catarrh, which happened within five years of each other, and were neither of them called at the time by the name of influenza,--a name not known in Britain until half a century later. Before coming to Molyneux’s description, it should be said that the London bills of mortality bear no decided trace of an influenza in the end of the year 1693, the following being the highest weekly mortalities nearest to the date given for the epidemic at Dublin[605]:

_London Weekly Mortalities._

1693

Week ending Fever All causes

October 10 43 353
17 62 353
24 53 384
31 69 457
November 7 68 455
14 48 365

Molyneux’s account of the flying epidemic of 1693 is as follows[606]:

“The coughs and colds that lately so universally prevailed gave us a
most extraordinary instance how liable at certain times our bodies
are, however differing in constitution, age and way of living, to be
affected much in the same manner by a spreading evil.... ’Twas about
the beginning of November last, 1693, after a constant course of
moderately warm weather for the season, upon some snow falling in the
mountains and country about the town [Dublin], that of a sudden it
grew extremely cold, and soon after succeeded some few days of very
hard frost, whereupon rheums of all kinds, such as violent coughs that
chiefly affected in the night, great defluxion of thin rheum at the
nose and eyes, immoderate discharge of the saliva by spitting,
hoarseness in the voice, sore throats, with some trouble in
swallowing, whesings, stuffings and soreness in the breast, a dull
heaviness and stoppage in the head, with such like disorders, the
usual effects of cold, seized great numbers of all sorts of people in
Dublin.

“Some were more violently affected, so as to be confined awhile to
their beds; those complained of feverish symptoms, as shiverings and
chilness all over them, that made several returns, pains in many parts
of their body, severe head-aches, chiefly about their foreheads, so as
any noise was very troublesome: great weakness in their eyes, that the
least light was offensive; a perfect decay of all appetite; foul
turbid urine, with a brick-coloured sediment at the bottom; great
uneasiness and tossing in their beds at night. Yet these disorders,
though they very much frightened both the sick and their friends,
usually without help of remedy would abate of themselves, and
terminate in universal sweats, that constantly relieved.... When the
cold was moderate, it usually was over in eight or ten days; but with
those in whom it rose to a greater height, it continued a fortnight,
three weeks, and sometimes a month. One way or other it universally
affected all kinds of men; those in the country as well as city; those
that were much abroad in the open air, and those that stay’d much
within doors, or even kept close in their chambers; those that were
robust and hardy, as well as those that were weak and tender--men,
women and children of all ranks and conditions.... Not one in thirty,
I may safely say, escaped it. In the space of four or five weeks it
had its rise, growth, and decay; and though from first to last it
seized such incredible numbers of all sorts of men, I cannot learn
that any one truly dyed of it, unless such whose strength was before
spent by some tedious fit of sickness, or laboured under some heavier
disease complicated with it.... It spread itself all over England in
the same manner it did here, particularly it seized them at London and
Oxford as universally and with the same symptoms as it seized us in
Dublin; but with this observable difference that it appeared three or
four weeks sooner in London, that is, about the beginning of
October.... Nor was its progress, as I am credibly informed, bounded
by these Islands for it spread still further and reached the
Continent, where it infested the northern parts of France (as about
Paris) Flanders, Holland, and the rest of the United Provinces with
more violence and no less frequency than it did in these countries.”

Yet no other writer, English or foreign, appears to have mentioned it. Its existence rests on the authority of Molyneux alone, according to the above very circumstantial narrative.

The Influenza of 1712.

There were so many fevers from 1693 to the end of the century that it is not easy to distinguish epidemic agues or catarrhs among them. If we follow the continental writers, it is not until 1709 and 1712 that there is any concurrence of testimony for such widespread maladies. Evelyn, however, says that in the remarkably dry and fine months of February and March, 1705, “agues and smallpox prevail much in every place” (21st February). The very general coughs and catarrhs of 1709 seem to have been really caused by the severity of the memorable hard winter, the frost having begun in October, 1708 and lasted until March, 1709. The evidences of a truly epidemic infectious catarrh or influenza all over Europe in 1709 are scanty and ambiguous. It is probably to this “universal cold” that Molyneux refers under the year 1708[607]; but English writers have not otherwise mentioned an epidemic in 1709.

The next, in 1712, was a “new ague” of the kind without catarrhal symptoms, like that of 1688. One German writer called it the “Galanterie-Krankheit,” another the “Mode-Krankheit,” and it was about the same time that the French name “la grippe” came into use. These names all mean “the disease _a la mode_” or the reigning fashion[608]; they remind one of the earlier “trousse galante” and “coqueluche” (a kind of bonnet), and of the “grande gorre” of 1494. It appears to have made little or no impression on the mortality, and would hardly have been noticed but for its wide prevalence. In England it was the subject of a brief essay by Dr John Turner under the title of “Febris Britannica Anni 1712[609]”--a certain epidemic fever, of the milder kind, fatal to none, but prevalent far and wide and leaving very few families untouched. It was marked by aching and heaviness of the head, burning or lancinating pains in the back, pains in the joints like those of rheumatism, loss of appetite, vomiting, pains of the stomach and intestines. The venom though not sharp, acted quickly. Turner ascribed it to malign vapours from the interior of the earth (_malignos terrae matris halitus_). Its season in England, as in Germany, was probably the summer or autumn. Turner begins his discourse with a reference to the plague in the East of Europe, which, he says, had been kept out of England by quarantine, to the murrain which was then raging in Italy (and appeared in England in 1714), and to fevers of a bad type which had traversed all France during the past spring, invading noble houses and even the royal palace. Having begun his discourse thus, he ends it by remarking that the slight British fever did not, in his opinion, forebode a plague to follow. It may have been a recurrence of this epidemic next year that Mead speaks of under the name of the “Dunkirk rant” (supposed to have been brought over from Dunkirk by returning troops after the Peace of Utrecht) in September, 1713; it was, he says, a mild fever, which began with pains in the head and went off easily in large sweats after a day’s confinement[610]. The weekly bills of mortality in London are no help to us to fix the date of the one or more slight fevers or influenzas about 1712-13. The great fever-years of the period were 1710 and 1714; but the fever was typhus, probably mixed with relapsing fever, according to the evidence in another chapter. Even compared with the universal fever or influenza of 1688, that of 1712 must have been unimportant; for the former sent up the London mortality considerably, whereas there is no characteristic rise to be found in any month of 1712 or 1713.

Either to this period, or to the undoubted aguish years 1727-28, belongs a curious statement as to “burning agues, fevers never before heard of to be universal and mortal,” in Scotland, the same having been a “sad stroke and great distress upon many families and persons.” The authority is Patrick Walker, who traces these hitherto unheard of troubles to the Union of the Crowns (1707)[611].

On other and perhaps better authority, it does appear that Scotland before that period was reputed to be remarkably free from agues; and it is probable that the universal and mortal burning agues some time between 1707 and 1728, had come in one of those strange epidemic visitations, just as the agues of 1780-84 did. It would be erroneous to conclude from such references to ague that Scotland had ever been a malarious country. Robert Boyle refers in two places to the rarity of agues in Scotland in the time of Charles II.; the Duke of York, he says[612], on his return out of Scotland, 1680, mentioned that agues were very unfrequent in that country, “which yet that year were very rife over almost all England”--to wit, the epidemic of 1678-80. Again, agues, especially quartans, are rare in many parts of Scotland, “insomuch that a learned physician answered me that in divers years practice he met not with above three or four[613].” However, Sir Robert Sibbald, while he admits the rarity of quartans, does allege that quotidians, tertians and the anomalous forms occurred, that agues might be epidemic in the spring, with different symptoms from year to year, and that certain malignant fevers, not called agues, were wont to rage in the autumn[614].

Epidemic Agues and Influenzas, 1727-29.

The contemporary annalist of epidemics in England is Wintringham, of York, who enters remittents and intermittents almost every year from 1717 to the end of his first series of annals in 1726; but none of his entries points very clearly to an epidemic of ague[615]. It is not until the very unwholesome years 1727-29 that we hear of intermittent fevers being prevalent everywhere, with one or more true influenzas or epidemic catarrhs interpolated among them. To show how unhealthy England was in general, I give a table compiled from Short’s abstracts of the parish registers, showing the proportion of parishes, urban and rural, with excess of burials over christenings:

_Country Parishes._

Registers
Registers showing high Births Deaths
Year examined death-rate in ditto in ditto

1727 180 55 1091 1368
1728 180 80 1536 2429
1729 178 62 1442 2015
1730 176 39 1022 1302

_Market Towns._

Registers
Registers showing high Births Deaths
Year examined death-rate in ditto in ditto

1727 33 19 2441 3606
1728 34 23 2355 4972
1729 36 27 3494 6673
1730 36 16 2529 3445