Chapter III: Influenzas and Epidemic Agues (3)

It is clear from the accounts by Huxham, Wintringham, Hillary, and Warren, of Bury St Edmunds[616], that much of the excessive sickness in 1727-29 was aguish, although much of it, and probably the most fatal part of it, was the low putrid fever so often mentioned after the first quarter of the 18th century. At Norwich, where the burials for three years, 1727-29, were nearly double the registered baptisms, many were carried off, says Blomefield, “by fevers and agues, and the contagion was general.” In Ireland also, a country rarely touched by true agues, Rutty enters intermittent fever as very frequent in May, 1728; and again, in the spring of 1729: “Intermittent fevers were epidemic in April; and some of the petechial kind. Nor was this altogether peculiar to us; for at that same time we were informed that intermittent and other fevers were frequent in the neighbourhood of Gloucester and London; and very mortal in the country places, but less in the cities.”

* * * * *

In the midst of this epidemic constitution of agues and other fevers there occurred one or more horse-colds, and one or more epidemic catarrhs of mankind. The most definitely marked or best recorded of these was the influenza of 1729.

The universal cold or catarrh of 1729 fell upon London in October and November, and upon York, Plymouth and Dublin about the same time. It prevailed in various parts of Europe until March, 1730, its incidence upon Italy being entirely after the New Year. The rise in the London deaths was characteristic: the level was high when the epidemic began, but the epidemic nearly doubled the already high mortality during the worst week and trebled the deaths from “fever.”

_London Weekly Mortalities._

1729

Week ending Fever All causes

October 21 88 564
28 118 603
November 4 213 908
11 267 993
18 166 783
25 124 635

The high mortalities of the weeks following may be taken as due to the sequelae of the epidemic (pneumonias, pleurisies, malignant fevers) and are indeed so explained in one contemporary account:

Week ending Fever All causes

December 2 92 678
9 132 779
16 116 707
23 123 710
30 109 628

The influenza of October and November, 1729, was the occasion of a London essay[617], which appears to treat solely of the epidemic catarrh and its after-effects, and not of the two years’ previous sicknesses, which are the subject of another essay, by Strother, written before the influenza began. London, says this author, as well as Bath, and foreign parts, have been on a sudden seized universally with the disorders named in his title (fevers, coughs, asthmas, rheumatisms, defluxions etc.). These had come in the course of an unusually warm and wet, or relaxing, winter; “we have for some time past dwelt in fogs, our air has been hazy, our streets loaden with rain, and our bodies surrounded with water.” So many different symptoms attend the “New Disease” that a volume, he says, would not suffice to describe them, but he thus summarizes them:

Sudden pain in the head, heaviness or drowsiness, and anon their noses
began to run; they coughed or wheezed, and grew hoarse; they felt an
oppression and load on their breasts, and turned vapourish, either
because they apprehended ill consequences, or because their spirits
were oppressed with a load of humours. The victims of the epidemic, he
says again, were very subject to vapours; they are, upon the least
fatigue or emotion of mind, dispirited, and flag upon every emergency.
Among other symptoms were, quick pulse, thirst, loss of appetite and
vertigo: the mouth and jaws hot, rough and dry, the thrush raising
blisters thereon; the throat hoarse; a fierce brutal cough, which
weakens by bringing on profuse sweats; the urine, muddy and white, “if
they who are seized have been old asthmaticks.”

He speaks of cases that had proved suddenly fatal and says that all who died of “epidemical catarrhs” had been found to have polypuses in their hearts. If reference be made to the Table, it will be seen that the high mortality continued in London for at least a month after the epidemic had passed through its ordinary course of rise, maximum and decline; and it is probably to that post-epidemic mortality that the author refers in the following passages:

“Numbers, as appears by our late bills, are taken with malignant
fevers, or malignant pleurisies or with pleuritic fevers....
Whosoever, then, would prevent a defluxion from turning into a fever,
or from anything yet worse, if worse can be, must keep warm and
observe a diluting regimen so long as till their water subsides and
the symptoms are vanquished.... I am convinced by experience that many
poor creatures have perished under these late epidemical fevers, from
the fatal mistake of never retiring from their usual employments till
they have rivetted a fever upon them, and till they have neglected
twelve or fourteen days of their precious time.” This was fully
endorsed by Huxham for the influenza of 1733: “Morbus raro lethalis,
quem tamen, multi, vel ob ipsam frequentiam, temeri spernentes, seras
dedêre poenas stultitiae, asthmatici, hectici, tabidi.”

Hillary’s account for Ripon is very brief[618]:

“The season continuing very wet, and the wind generally in the
southern points, about the middle of November [1729] an epidemical
cough seized almost everybody, few escaping it, for it was
universally felt over the kingdom; they had it in London and Newcastle
two or three weeks before we had it about Ripon.”

Wintringham, of York, says the epidemic in the early winter of 1729 was “a febricula with slight rigors, lassitude, almost incessant cough, pain in the head, hoarseness, difficulty in breathing, and attended with some deaths among feeble persons, from pleuritic and pulmonary affections[619].” There was a tradition at Exeter as late as 1775 that two thousand were seized in one night in the epidemic of 1729. Huxham, of Plymouth, says of the epidemic in November:

“A cartarrhal febricula, with incessant cough, slight dyspepsia,
anorexia, languor, and rheumatic pains, is raging everywhere. When it
is more vehement than usual, it passes into bastard pleurisy or
peripneumony; but for the most part it is easily got rid of by letting
blood and by emetics.” In December, the coughs and catarrhal fever
continued, while mania was more frequent than usual, and in January,
1730, the cartarrhal fever still infested some persons.

Rutty, of Dublin, merely says: “In November raged an universal epidemic catarrh, scarce sparing any one family. It visited London before us[620].”

These references to the unusual catarrhal febricula in November, 1729, are all that occur in the epidemiographic records kept by some four British writers who recorded the weather and prevalent diseases of those years. The epidemic catarrh made a slight impression upon them beside some other epidemics, and hardly a greater impression than another of the same kind, which seems to have occurred in the beginning of 1728. Thus, Rutty says, under November, 1727: “In Staffordshire and Shropshire their horses were suddenly seized with a cough and weakness. In December, it was in Dublin and remote parts of Ireland; some bled at the nose.” On December 25th, he enters: “The horses growing better, a cough and sore throat seized mankind in Dublin[621].” Huxham, for Devonshire, under Oct.-Nov. 1727 confirms this: “a vehement cough in horses, which lasted to the end of December; the greater number at length recovered from it.” He does not say in that context that an epidemic cough followed among men, as Rutty does say for Dublin; but in a subsequent note upon horse-colds, he says: “In 1728 and 1733 it [the precedence of the horse-cold] was most manifest; in which years a most severe cough seized almost all the horses, one or two months earlier than men.” From which it would appear that the influenza of Nov.-Dec. 1729, was not the only one during the aguish years 1727-29.

In the weekly London bills the other series of mortalities that look most like those of an influenza are in the month of February, 1728 (748, 889, 850 and 927 in four successive weeks, being more than double the average).

The Influenza of 1733.

The next influenza was three years after that of 1729--in January, 1733. In London, it raised the weekly deaths for a couple of weeks to a far greater height than the preceding had done. Also the purely catarrhal symptoms of running from the eyes and nose are more prominent in the accounts for 1733 than for the influenza of 1729. The first notice of it comes from Edinburgh. The horses having been “attacked with running of the nose and coughs towards the end of October and beginning of November,” the same symptoms began suddenly among men on the 17th December, 1732[622]. By the 25th the epidemic was general in Edinburgh, very few escaping, and it continued in that city until the middle of January, 1733. In a great many it began with a running of lymph at the eyes and nose, which continued for a day. Generally the patients were inclined to sweat, and some had profuse sweats. It was noted as remarkable that the prisoners in the gaol escaped; also the boys in Heriot’s Hospital, as well as the inhabitants of houses near to that charity. The Edinburgh deaths rose as in the following table; the bulk of these extra burials are said to have been at the public charges, the epidemic having swept away a great number of poor, old, and consumptive people:

Buried in November, 1732 89
" " December, 1732 109
" " January, 1733 214
" " February, 1733 135

Hillary[623] fixes the date of its beginning at Leeds on 3 February, one week later than at York, three weeks later than at Newcastle, or than in London and the south of England generally. At Leeds in three days’ time about one-third part of the people were seized with chills, catarrh, violent cough, sneezing and coryza; the epidemic lasted five or six weeks in the town and country near. Dr John Arbuthnot, who was then living in Dover Street, is clear that the outbreak in London was later than in Edinburgh, which indeed appears also from the paragraph in the _Gentleman’s Magazine_, dated Wednesday the 11th January, and from a comparison of the dates of highest mortalities in London (p. 349) and Edinburgh. It was in Saxony from the 15th November to the 29th of that month, and in Holland before it broke out in England. But it had begun in New England in the middle of October, and had broken out soon after in Barbados, Jamaica, Mexico and Peru. Its outbreak in Paris was at the beginning of February, 1733, and at Naples in March. The symptoms, says Arbuthnot, were uniform in every place--small rigors, pains in the back, a thin defluxion occasioning sneezing, a cough with expectoration. In France the fever ended after several days in miliary eruptions, in Holland often in imposthumations of the throat. In some, the cough outlasted the fever six weeks or two months. The horses were seized with the catarrh before mankind[624].

The account of the influenza of 1733 in London in the _Gentleman’s
Magazine_ is under the date of 11 January: “About this time coughs and
colds began to grow so rife that scarce a family escaped them, which
carried off a good many, both old and young. The distemper discovered
itself by a shivering in the limbs, a pain in the head, and a
difficulty of breathing. The remedies prescribed were various, but
especially bleeding, drinking cold water, small broths, and such thin
liquids as dilute the blood[625].”

Huxham says that it was in Cornwall and the west of Devon in February, 1733, and that at Plymouth, on the 10th of that month, some were suddenly seized: “the day after they fell down in multitudes, and on the 18th or 20th of March, scarce anyone had escaped it.”

It began with slight shivering, followed by transient erratic heats,
headache, violent sneezing, flying pains in the back and chest,
violent cough, a running of thin sharp mucus from the nose and mouth.
A slight fever followed, with the pulse quick, but not hard or tense.
The urine was thick and whitish, the sediment yellowish-white, seldom
red. Several had racking pain in the head, many had singing in the
ears and pain in the meatus auditorius, where sometimes an abscess
formed: exulcerations and swelling of the fauces were likewise very
common. The sick were in general much given to sweating, which, when
it broke out of its own accord and was very plentiful, continuing
without striking in again, did often in the space of two or three days
carry off the fever. The disorder in other cases terminated with a
discharge of bilious matter by stool, and sometimes by the breaking
forth of fiery pimples. It was rarely fatal, and then mostly to
infants and old worn out people. Generally it went off about the
fourth day, leaving a troublesome cough often of long duration, “and
such dejection of strength as one would hardly have suspected from the
shortness of the time.” The cough in all was very vehement, hardly to
be subdued by anodynes: and it was so protracted in some as to throw
them into consumption, which carried them off within a month or
two[626].

Huxham is unusually full on the coughs and anginas of horses for several months before the influenza of men. In August, 1732, coughs were troubling some horses; in September, a coughing angina (called “the strangles”) everywhere among horses which almost suffocates most of them; in October the disease of horses is raging at its worst; and in December it is still among them.

The Influenza of 1737.

After several years, unhealthy in other ways, the influenza came again in the autumn of 1737. In Devonshire, according to Huxham, the horses began to suffer from cough and angina, and some of them to die, as early as January, 1737, the epizootic being mentioned again in February, but not subsequently. The same observer says the influenza began at Plymouth in November and lasted to the end of December, 1737, seizing almost everyone, and proving much more severe than the epidemic catarrhal febricula of 1733[627]. In London it must have begun in the end of August, to judge by the characteristic rise in the weekly bills, and in the item of “fevers” more especially; and although the deaths kept high for a longer period than in 1733, yet no single week of 1737 had much more than half the highest weekly mortality of the preceding influenza season.

_London Weekly Mortalities._

1733

Week ending Fevers All causes

January 16 69 531
23 83 783
30 243 1588
February 6 170 1166
13 110 628
20 66 591

1737

Week ending Fevers All causes

August 30 117 611
September 6 161 720
13 201 837
20 229 861
27 167 770
October 4 143 687
11 114 551

In Dublin the worst week’s mortality in 1737, in the month of October, was 144, whereas in the influenza of 1733 the highest weekly bill had been only 98[628]. Hardly any particulars of the influenza of 1737 remain, although it appears to have been widely diffused, being recorded for Barbados and New England. The only source of English information is Huxham of Plymouth, who mentions some symptoms which should serve to characterize this outbreak, namely: violent swelling of the face, the parotids and maxillary glands, followed by an immense discharge of an exceedingly acrid pituita from the mouth and nose; toothache and, in some, hemicrania; “in multitudes,” wandering rheumatic pains; in others violent sciatics; in some griping of the bowels. Huxham makes one interesting statement: “This catarrhal fever has prevailed more or less for several winters past;” or, in other words, the interval between the severe influenza of 1733 and the milder influenza of 1737 was not altogether clear of the disease. He adds that it put on various forms, according to the different constitutions of those it attacked.

The Influenza of 1743.

Six years after, in 1743, came another influenza, which presents some interesting points. A writer in the _Gentleman’s Magazine_ for May, 1743, says that the epidemic began in September last in Saxony, that it progressed to Milan, Genoa, and Venice, and to Florence and Rome, where it was called the Influenza; in February last (1743) no fewer than 80,000 were sick of it [? in Rome] and 500 buried in one day. At Messina it was suspected to be the forerunner of a plague--which did, indeed, ensue. It is now (May) in Spain, depopulating whole villages. The outbreak in Italy is authenticated by many notices collected by Corradi, Brescia having had the epidemic in October, 1742, Milan and Venice in November, Bologna in December, Rome, Pisa, Leghorn, Florence and Genoa in January, 1743, Naples and the Sicilian towns in February. The English troops, in cantonments near Brussels, were little touched by it when it reached that capital about the end of February, but, strangely enough, “many who in the preceding autumn had been seized with intermittents then relapsed[629].”

In London the epidemic appears to have begun in the end of March, and had trebled the deaths in the week ending 12th April; by the beginning of May it was practically over.

_London Weekly Mortalities._

1743

Week ending Fevers All causes

March 29 94 579
April 5 189 1013
12 300 1448
19 223 1026
26 115 629
May 3 82 537

The familiar view of the influenza in London is given in a letter by Horace Walpole from Arlington Street, 25 March, 1743[630]:

“We have had loads of sunshine all the winter: and within these ten
days nothing but snows, north-east winds and _blue plagues_. The last
ships have brought over all your epidemic distempers; not a family in
London has scaped under five or six ill; many people have been forced
to hire new labourers. Guernier, the apothecary, took two new
apprentices, and yet could not drug all his patients. It is a cold and
fever. I had one of the worst, and was blooded on Saturday and Sunday,
but it is quite gone; my father was blooded last night; his is but
slight. The physicians say there has been nothing like it since the
year thirty-three, and then not so bad [the bill of mortality almost
the same]; in short our army abroad would shudder to see what streams
of blood have been let out! Nobody has died of it [as yet, but later
some 1000 in a week above the usual bill] but old Mr Eyres of Chelsea,
through obstinacy of not bleeding; and his ancient Grace of York;
Wilcox of Rochester succeeds him, who is fit for nothing in the world
but to die of this cold too.”

The account in the _Gentleman’s Magazine_ confirms the vast shedding of blood: “In the last two months it visited almost every family in the city; so that the surgeons and all the phlebotomists had full employment. Bleeding, sweating and blistering were the remedies usually prescribed. All over the island it cut off old people. At Greenwich upwards of twenty hospital men and boys were buried in a night[631].” In Edinburgh, as in London, the weekly burials were trebled. On Sunday, May 6th, fifty sick persons were prayed for in the Edinburgh churches, and in the preceding week there had been seventy burials in the Greyfriars, being three times the usual number[632]. It reached Dublin in May, proving milder and less fatal than in London (perhaps that is why the writer in the _Gentleman’s Magazine_ says it did not visit Ireland at all); it visited, also, the remote parts of Ulster and Munster, scarce sparing a family[633].

It had reached Plymouth in the end of April. Huxham, who is again the chief witness to its symptoms, says that it was much less severe there than in the south of Europe or even than in London.

Innumerable persons were seized at once with a wandering kind of
shiver and heaviness in the head; presently also came on a pain
therein, as well as in the joints and back; several, however, were
troubled with a universal lassitude. Immediately there ensued a very
great and acrid defluxion from the eyes, nostrils and fauces, and very
often falling upon the lungs, which occasioned almost perpetual
sneezings, and commonly a violent cough. The tongue looked as if
rubbed with cream. The eyes were slightly inflamed; and, being
violently painful in the bottom of the orbit, shunned the light. The
greater part of the sick had easy, equal and kindly sweats the second
or third day, which, with the large spitting, gave relief. Great loss
of strength, however, remained. Frequently towards the end of this
“feveret,” several red angry pustules broke out: often, likewise, a
sudden, nay a profuse, diarrhoea with violent griping. In many cases
Huxham was astonished at the vast sediment (yellowish white), which
the urine threw down, “than which there could not be a more favourable
symptom[634].” One remarkable feature of the epidemic of 1743 was
recalled by W. Watson in a letter to Huxham on the epidemic of 1762:
“In the disorder of 1743 the skin was very frequently inflamed when
the fever ran high; and it afterwards peeled off in most parts of the
body[635].”

Some Localized Influenzas and Horse-colds.

For the space of nineteen years, from 1743 to 1762, there occurred no universal cold common to all the countries of Europe; the convergence of positive testimony, which is so remarkable on many occasions from the 16th century onwards, is found on no occasion during that interval. And yet the period is not wanting in instructive notices of epidemic catarrh, which I shall take from English writings only. British troops occupied Minorca during some of those years, and the epidemics of the island were carefully noted by Cleghorn. Under the year 1748 he writes:

“About the 20th April there appeared suddenly a catarrhal fever, which
for three weeks raged so universally that almost everybody in the
island was seized with it. This disease exactly resembled that which
was so epidemical in the year 1733. For in most part of the sick the
feverish symptoms went off with a plentiful sweat in two or three
days; while the cough and expectoration continued sometime longer. In
a few athletic persons, who were not blooded in time, it terminated in
a fatal pleurisy or phrensy[636].”

Another English epidemiographist, Hillary, who had begun his records at Ripon, was in those years resident in Barbados; and in that island, as in Minorca, we hear of unmistakeable universal colds, although none of them at the same time as the one recorded by Cleghorn. The Barbados annalist records a general catarrhous fever in September, 1752[637], and a recurrence of the same in the end of December, lasting until February 1753 (catarrh and coryza, cough, hoarseness, a great defluxion of rheum, some having fever with it). As it ceased in February, 1753, a slow nervous fever began, and continued epidemic for eighteen months, until September, 1784, when it totally disappeared, and was not seen again so long as Hillary remained in the island (1758). In 1755 there was another epidemic catarrhal fever, first in February and again in the end of the year. In the earlier outbreak, few escaped having more or less of it, the symptoms being cold ague for a few hours, followed by a hot fever with great pain in the head, or pains in the back and all over the body, which lasted two or three days, or longer, and then went off in some by a critical sweat. In the October outbreak it affected children mostly. Once more, in 1757, the same catarrhous fever returned, with almost the same circumstances[638]. That year there was a universal catarrh in North America.

Not less remarkable than the epidemic catarrhal fever in Minorca in 1748, or those in Barbados in 1752-3, 1755 and 1757, was the epidemic of 1758 in Scotland[639]. It was first noticed with east winds from the 16th to 20th September, several children having taken fever like a cold. In the last week of September thirty out of sixty boys at the Grammar School of Dalkeith were seized with it in two or three days. In October it became more general, among old and young, and increased till about the 24th, when it began to abate. In Edinburgh not one in six or seven escaped. It was in most parts of Scotland in October--Kirkaldy, St Andrews, Perthshire (where many died of it), Ayrshire, Glasgow, Aberdeenshire, Rossshire (end of October). A gentleman told Dr Whytt that in the Carse of Gowrie, in September, “before this disease was perceived, the horses were observed to be more than usually affected with a cold and a cough.”

The symptoms in Scotland were of the Protean kind of “influenza”: there might be fever with no cold; or a coryzal attack with little or no fever; or some had bleeding at the nose for several days, which might be profuse; or the soreness and pains in the bones might be in all parts of the body, or confined to the cheekbones, teeth and sides of the head. Others had a fever without any distinctive concomitant, but a cough when the fever subsided[640]. One of Whytt’s patients, a lady aged thirty, had been feverish for four days, when a scarlet rash appeared, but did not come fully out; the fall of the pulse and fever coincided with the beginning of a troublesome tickling cough, “so that the cough might be said to have been truly critical.” Those who exposed themselves too soon frequently relapsed. Few died of the disease, except some old people. “In some parts of the country, when the disease was not taken care of in the beginning, as being attended with no alarming symptoms, it assumed the form of a slow fever, which sometimes proved mortal.”

The year after the localised influenza of Scotland there was an epidemic of the same kind in Peru and Bolivia, that year, 1759, being one in which no universal fever or catarrh is reported from any other country. It extended from south to north, along the coast as well as over the high table-lands of Bolivia and the sierra region of Peru, invading, among others, the populous towns of Chuquisaca, Potosi, La Paz, Cuzco and Lima. In five or six days hardly one inhabitant of a place had escaped it, although some had it very slightly. As it was swift in its attack, so it was soon over, lasting about a month in each place. Its symptoms were great dizziness and heaviness of the head (vertigo and gravedo), feebleness of all the senses, deafness, strong pains over all the body, moderate fever, weariness, great prostration, complete loss of appetite, bleeding from the mouth and nostrils (this had been noted in Scotland the year before), and a long convalescence. Dogs shared the disorder, and might have been seen lying stretched out in the streets, unable to stand. It will be observed that the symptoms given do not include catarrh[641].

Before we come to the next general influenza in Britain, that of 1762, there are some facts to be mentioned as to agues and horse-colds in the interval since 1743. In Rutty’s Dublin chronology, agues are entered as prevalent in 1745. In 1750, about the middle or end of December, the most epidemic and universally spreading disease among horses that anyone living remembered made its appearance in Dublin, and in Ulster and Munster almost as soon. It had been in England in November, and was like that which preceded the universal catarrhs of mankind in 1737 and 1743. In 1751, irregular agues were frequent in March, as were also tumours of the face, jaws and throat. Agues also continued to be frequent in April, both in Dublin and in several parts of the country. In December, 1751, and January, 1752, there was another horse-cold, the same as a twelvemonth before. In 1754 the spring agues were frequent in Kilkenny and Carlow, though rare in Dublin. In 1757, “intermittent fevers, which had not appeared since April, 1746,” came in the end of February. In 1760, a great catarrh among horses became general in Dublin in April. Coughs and tumours about the fauces and throat, with a slight fever, often occurred in March; and regular intermittents, tertians or quotidians, were more frequent than for some years past. These, according to Sims, of Tyrone, abated after 1762, so that he had not seen an intermittent since 1764 until the date of his writing, 1773.

The horse-cold of 1760 was observed in London in January. The _Annual Register_ says under date 27 Jan.: “A distemper which rages amongst horses makes great havock in and about town. Near a hundred died in one week.” In a letter a day later (28 Jan.) Horace Walpole writes: “All the horses in town are laid up with sore throats and colds, and are so hoarse you cannot hear them speak.... I have had a nervous fever these six or seven weeks every night, and have taken bark enough to have made a rind for Daphne[642].” This same horse-cold is reported from the Cleveland district of Yorkshire: “In February, [1760] horses were invaded by the most epidemic cold or catarrh that has ever happened in the remembrance of the oldest men living[643].” The same authority for Cleveland says that intermittents were frequent and obstinate in the spring of 1760.

Among these miscellanies of the history may be mentioned an outbreak of “violent pleuritic fever or peripneumene” in the spring of 1747, which was fatal to a comparatively large number in the parish of George Ham, North Devon. Thirteen died of it from the 20th to the 31st March, four in April, four in May, and one in June, “most of them in four or five days after the first seizure.” The same family names recur in the list[644].

The Influenza of 1762.

The universal slight fever or catarrhal fever of 1762 was, in London, much less mortal than those of 1733 and 1743.

_London Weekly Mortalities._

1762

Week ending Fevers All causes

May 4 72 467
11 104 626
18 159 750
25 162 659
June 1 121 516
8 85 504

It began in London about the 4th of April, and by the 24th of that month “pervaded the whole city far and wide, scarcely sparing anyone.” It was in Edinburgh by the beginning of May, and in Dublin about the same time, but did not reach some parts of Cumberland until the end of June. Short, who was then living at Rotherham, says that it “continued most of the summer[645].” It had the usual variety of symptoms in the individual cases, of which only a few need be again particularized. Where the fever was sharp, it usually remitted during the day, having its exacerbation in the night. Sometimes it proved periodical, and of the tertian type: “it usually returned every night with an aggravation of the feverish symptoms” (Rutty). Perspiration was a constant symptom; the tongue was as if covered with cream (Baker repeats this figure of Huxham’s in 1743). “Depression of mind and failure of strength were in all cases much greater than was proportionate to the amount of disease. A great number of those affected were very slowly restored to health, languishing for months, and some even for a whole year with cough and feverishness--relics of the disease which it was difficult to shake off. Some, after struggling long with impaired health, fell victims to pulmonary consumption. In some there were pains in all the joints and in the head, with lassitude and vehement fever, but with little signs of catarrh.” Rutty, of Dublin, says that in some a measly efflorescence or a red rash was seen, attended by violent itching[646]. Among labourers in the country, the pestilence was so violent as to destroy many within four days, from complications of pneumonia, pleurisy and angina. Sometimes it took the form of a slow fever, “and approximated to that form of malady which the ancients denominated ‘cardiac’[647].”

The mortality is said to have varied much. White, of Manchester, declared that fewer died there than in ordinary while the epidemic lasted. On the other hand Offley, of Norwich, said there were more victims there than by the epidemic of 1733 “or by the more severe visitation called influenza in 1743”--the two visitations which were incomparably the worst in the whole history, according to the London bills. Baker says that it infested cities and the larger towns crowded with inhabitants earlier than the surrounding villages, and is inclined to think that it was mostly brought by persons coming from London[648].

The progress of this epidemic over Europe had been peculiar. It was seen in the end of February, 1762, at Breslau, where the deaths rose from 30 or 40 in a week to 150. It was in Vienna at the end of March, and in North Germany about the same time as in England--April and May. There were at that time British troops in Bremen, among whom the epidemic appeared shortly after the 10th April[649].

“It looked at first as if they were going to have agues, but soon they
were attacked with a cough and a difficulty of breathing and pain of
the breast, with a headache, and pains all over the body, especially
in the limbs. The first nights they commonly had profuse sweats. In
several it had the appearance of a remitting fever for the two or
three first days.” The cough in many was convulsive. The epidemic
seized most of the people in the town of Bremen: very few of the
British escaped, but none of them died, except one or two, from a
complication of drunkenness and pneumonia.

It is said to have been nowhere in France except in Strasburg and the rest of Alsace, in June. Baker says, “Whilst it raged everywhere else, it did not reach Paris or its vicinity, a fact which I learned from trustworthy persons.” On board British ships of war in the Mediterranean it occurred in July. Its severity appears to have varied greatly in different cities of the same country. Rutty, for Ireland, agrees with Baker, for England, that it was more fatal in the country than in the towns.

The Influenza of 1767.

The next influenza, that of 1767, was so unimportant that its existence in England would hardly have been known but for Dr Heberden’s paper, “The Epidemical Cold in June and July 1767[650].” Those few who were affected by a cold in London early in June observed that it differed from a common cold, and resembled the epidemical cold of the year 1762, on account of the great languor, feverishness, and loss of appetite. It became more common, was at its height in the last week of June or beginning of July, and before the end of July had entirely ceased. It was less epidemical and far less dangerous than the cold of 1762, so much so that the London bills of mortality hardly witness at all to its existence. The attack began with several chills; then came a troublesome and almost unceasing cough, very acute pains in the head, back, and abdomen under the left ribs, occasioning want of sleep. Many of the symptoms hung upon several for at least a week, and sometimes lasted a month. The fever might be great enough to bring on deliriousness, yet had plain remissions and intermissions. The same disorder was reported to be common about the same time in many other parts of England, and more fatal than it was in London. Heberden did not anticipate from it the lingering effects in the individual, for months or years, which marked so many of the cases in 1762[651].

The Influenza of 1775.

Heberden invited physicians in the provinces to send in accounts of the epidemic of June and July, 1767, but no one seems to have responded. However, the next epidemic catarrh, of November and December, 1775, was made the subject of many communications from all parts of Britain, in response to a circular drawn up by Dr John Fothergill. This was a distinctly catarrhal epidemic, running of the nose and eyes, cough and (or) diarrhoea, being commonly noted.

At Northampton some had “a severe pain in one side of the face, affecting the teeth and ears, and returning periodically at certain hours in the evening, or about midnight, attended with vertigo, delirium and limpid urine during the exacerbation. Some whose cases were complicated with the above symptoms had a general rash, but without its proving critical.... Many of those who escaped the catarrh have been more or less sensible of giddiness, or pains in the head or face,” with limpid urine, etc., as if they had a full attack[652]. The epidemic began in London about the 20th October, and made a slight impression upon the bills of mortality in some weeks of November and December[653]. Grant says that it lasted nearly five months in London, having been attended by the same “comatose” fever which Sydenham associated with the epidemic catarrh of 1675. The fatalities in Grant’s practice occurred late in the epidemic:

“On the 23rd December [1775] I had lost one patient, and soon after
two others; all died comatous, owing, as I then imagined, to the
remains of the comatose fever of Sydenham, which had raged all the
autumn, was complicated with the catarrhous fever, and continued by
the wet, warm uncommon weather for the season of the year; and I still
[1782] am of opinion that this complication is the reason why the
epidemic catarrh of 1775 proved much more fatal than it did in 1782--a
fact known to all of us[654].”

A Liverpool writer also says that the catarrh of 1782 “distinguished by the same title,” was a much slighter complaint than the “influenza” of 1775. The latter, however, was a summer epidemic, and was naturally less complicated with pneumonia and bronchitis, whatever the “comatose” fever of 1775 may have been. Grant’s statement that the influenza of 1775 lasted five months in London is borne out by the Foundling Hospital records: on 11 November, there were 16 in the Infirmary with “epidemic fever and cough,” next week 22 with “fevers, coughs and colds,” and so on week by week under the same names until the 9th of March, 1776[655]. At Dorchester it was general after 10th November; about the same time it was in Exeter, where within a week it seized all the inmates, but two children, in the Devon and Exeter Hospital, to the number of 173 persons. The middle of November is also the date of its decided outbreak at Birmingham, at Worcester, and at Chester, where Howard found the prisoners suffering from it. At York in the north, as at Blandford in the south, it is claimed to have begun earlier than in London. At Lancaster it was not seen until three weeks after the accounts of its prevalence in London began to come in, but only three days after it was first heard of in Liverpool. At Aberdeen it was fully a month later than in London. It did not visit Fraserburgh, though there was a putrid fever there very fatal at that time[656].

In many cases the disease assumed the type of an intermittent towards its decline, but bark was not useful (Fothergill, Ash, while Baker says that bark did good when the fever was spent). All the observers agree both as to its slight fatality and its universality. At Chester it attacked 73 out of 97 affluent persons, neighbours in the Abbey Square; at the Cross, inhabited by people in trade, 109 had the disease out of 144; in the House of Industry, not one escaped out of 175; it attacked people in the country rather later than in the town, and less generally, but it was in villages and even in solitary houses.

The unusual prevalence of catarrh among horses (and dogs) is asserted by John Fothergill (“during this time”), Cuming (“after the middle of August very generally in Yorkshire”), Glass (in September), Haygarth (in North Wales, about August and September), Pulteney (“before we heard of it among the human race”). The fullest statement is by Dr Anthony Fothergill, of Northampton:

“This distemper prevailed some time among horses before it attacked
the human species. The cough harassed them severely and rendered them
unfit for work, though few died. About the same time also it infested
the canine species and with great fatality, especially hounds. An
experienced huntsman informed me that it ran through whole packs in
many parts of England and that several dogs died[657].”

The progress of influenza from other countries towards Britain was so much a matter of rumour or vague statement in the earlier periods that it has not seemed worth while to make a point of it under each epidemic. It happens, however, that there is good evidence of the line of progress of the epidemic of 1775. The afterwards celebrated Professor Gregory, of Edinburgh, encountered it in Italy in the autumn, and followed it all the way home to Scotland. He saw it successively in Genoa, in the south of France, in the north of France, in London, and last of all in Edinburgh, where he himself at length fell ill with it, several of his travelling companions having taken it in Italy two or three months before. In his lectures long after (as reported by Christison, who heard them about 1817) he traced the influenza of 1775 from south to north: “It appears to have broken out somewhere on the north and west coast of Africa, whence it spread not only north into Europe, but likewise eastward to Arabia, Egypt, Syria, Palestine, Asia Minor, Hindostan, China, and was ascertained to have spread over the whole immense empire of the Chinese. From China it returned westward by a northern route through the extensive dominions of Russia and from that country it was sent again over Europe in 1782[658].”

The Influenza of 1782.

Seven years after, in the early summer of 1782, there came another swift and brief wave of catarrhal fevers over England, Scotland and Ireland, in the midst of a great “constitution” of epidemic agues which continued for several years. This was the occasion when the Italian name of “influenza” was formally adopted by the College of Physicians. Perhaps the first appearance of the name in English was in an account of the epidemic in Italy in 1729, given by a London periodical devoted to political news from foreign countries, and called, “The Political State of Great Britain[659].” In 1743 the news of the Italian epidemic under its native name reached London before the infection itself, the Italian name being frequently given to it while it lasted that season in England. When the next epidemic came, in 1762, it was not called the influenza as a matter of course, but was compared to the disease in 1743 “called the influenza.” In the epidemic of 1775, “influenza” came more into use, and in 1782 it was the name usually given to the epidemic malady. The adoption of this name put an end at length to the ambiguity between epidemic agues and influenzas, leaving the curious correspondences between them in time and place, or the nosological affinities between them, as interesting as ever.

As late as the very fatal aguish years 1727-29, there was no clear separation of the epidemic agues from the influenzas, of which latter there were two or more, the one in the end of 1729 being easy to identify. In the great aguish constitution of 1678-81, Sydenham distinguished the epidemic coughs and catarrhs in Nov. 1679; but Morley made no such distinction, describing the whole series of agues for two seasons (and he might have done so for two seasons more) as the “new fever,” “new ague,” or “new delight,” as in Derbyshire, without a suspicion that the universal coughs, catarrhs and fevers in November, 1679, were something nosologically distinct, which the future would identify as “influenza.” In like manner Whitmore, in the great aguish period immediately preceding, that of 1658-59, had described the “new disease” as one single Proteus. In the still earlier epidemic seasons of 1557-58 and 1580-82, everything was “ague,” although we now discover influenza mixed therewith. I do not say that this inclusive naming was the better scientifically; nor do I uphold Willis and Sydenham in their teaching that the intermittent constitution passed into the catarrhal, in 1658 and 1679 respectively. But it is necessary to bear in mind the matter of fact, namely, that those agues, amidst which the “great colds” occurred, were epidemic agues, and not the endemic fevers of malarious places; and I have now to show that the “influenza” of 1782 was in like manner a brief episode in the midst of several successive seasons of agues, which were as much “new” or “strange” as any of those in the earlier history. Whether the epidemic agues of 1780-85 were the last of the kind in Britain had better be left an open question until our most recent and most strange experiences in 1890-93 are read in the light of history.

The influenza of 1782 was a very definite incident of a few weeks--_teres atque rotundus_. It is easily discoverable in the weekly bills of mortality in London to have fallen in the month of June:

_London Weekly Mortalities._

1782

Week ending Fevers All causes

May 21 45 336
28 49 390
June 4 57 385
11 121 560
18 110 473
25 89 434
July 2 49 296

The sudden rise and fall of the deaths and the height reached are much the same as in other such epidemics in the summer--the “gentle correction” of 1580, the “transient slight fever” of 1688, and the epidemic catarrh of 1762. On the other hand the epidemics of autumn, winter or spring in 1729, 1733, 1737 and 1743 were far more severe, while the winter epidemics of 1675 and 1679 had figures almost the same as the summer epidemics.

The influenza of 1782 was not remarkable, whether in its fatality or in its characters; but it received far more attention than any that had preceded it. Two collective inquiries were held upon it, one by a Society for promoting Medical Knowledge[660], the other by a committee of the College of Physicians of London[661], many physicians all over England, Scotland and Ireland contributing to one or other. There were also three or more separate essays[662].

The epidemic appeared in 1782 at Newcastle in the end of April, and raged there all May and part of June. In London it appeared between the 12th and 18th of May, in the Eastern Counties about the middle of May, in Surrey and at Portsmouth, Oxford and Edinburgh, also about the third week of May, but not in Musselburgh until the 9th or 10th of June. It was at Chester on the 26th of May, at Plymouth on the 30th, at Ipswich, Yarmouth, York, Liverpool and Glasgow in the first week of June. In Northumberland it was raging in July, and did not cease until the third week of August. In Scotland it was at a height in July, during the haymaking[663]. The most curious fact in its incidence comes from North Devon; it was prevalent in Barnstaple at the usual time, the month of June; but the neighbouring town of Torrington was not then affected by it, having previously gone through the epidemic, it is said, from a date as early as the 24th of March[664]. In all places it spread quickly, affecting from three-fourths to four-fifths of the adult inhabitants, but children not so much. At Christ’s Hospital, London, only fourteen out of seven hundred boys had it. Wherever it attacked children, it did so mildly. It lasted under six weeks in each place that it came to. There were some strange attacks of it in London in September, “two months after the late epidemical catarrh had entirely disappeared from England.” The king’s ships ‘Convert’ and ‘Lizard’ arrived in the Thames from the West Indies in September. Their crews were perfectly healthy till they reached Gravesend, where they took on board three custom-house officers; and in a very few hours after that the influenza began to make its appearance. Hardly a man in either ship escaped it; and many both of the officers and common seamen had it in a severe degree[665]. Others who came to London from the West Indies in merchantmen in the end of September were attacked by influenza in their lodgings in the beginning of October[666]. To this epidemic belong also the strange experiences of the Channel Fleet in its two divisions under Howe and Kempenfelt; but I postpone for the present the whole question of influenza at sea.

Gray thus sums up the great variety of symptoms as related by his numerous correspondents:

Chilliness and shivering, sometimes succeeded by a hot fit, the
alternation continuing for some hours; languor and lassitude,
sneezing, discharge from the nose and eyes, pain in the head
(particularly between or over the eyes), cough, sometimes dry,
sometimes accompanied with expectoration, inflammation in one or both
eyes, oppression and tightness about the praecordia, difficulty of
breathing, pain in the breast or side, pain in the loins, neck,
shoulders or limbs, sense of heat or soreness in the throat and
trachea, hoarseness, bleeding from the nose, spitting of blood and
loss of smell and taste, nausea, flatulence. Also watery blisters
about the upper parts of the body, and swellings in the face and other
parts, attended with considerable soreness, apparently erysipelatous.
In some the catarrhal symptoms were very slight, or entirely wanting,
the disorder in those cases being like a common fever.

The committee of the College of Physicians said that “the universal and almost pathognomonic symptom was a distressing pain and sense of constriction in the forehead, temples, and sometimes in the whole face, accompanied with a sense of soreness about the cheek-bones under the muscles,” reminding one of the _fierro chuto_ or “iron cap” of the South American epidemic in 1719. Sometimes no catarrhous affection followed these strange head pains. The languor of body and depression of spirits were thought to be more protracted than in 1762, but the fatalities at the time were fewer than in the earlier epidemic, and there were fewer consumptions following. Sweating, also, was said by some to be less remarkable than in 1762; but Carmichael Smyth said: “The late influenza [1782] might very properly have been named the sweating sickness, as sweating was the natural and spontaneous solution of it[667].” One distinctive thing in the epidemic of 1762 was missed by most in 1782, namely, the peculiar constriction of the breast, with heat and soreness of the trachea, as if excoriated; but Hamilton describes that very thing for 1782 in Bedfordshire[668]. As in other epidemics of the kind, especially those which have been least catarrhal, there were hardly two cases quite the same.

The Epidemic Agues of 1780-85.

Let us now take up the strange history of epidemic agues for two or three years preceding and following the influenza of June, 1782. Sir George Baker begins his account of them thus[669]: “The predominance of certain diseases observable in some years, and the total or partial disappearance of the same in other years, constitute a subject worthy of our contemplation.”

These agues were first noticed in London in the spring and autumn of
1780, but they infested various parts of England a little earlier. In
the more inland counties the agues were “often attended with
peculiarities extraordinary and alarming. For the cold fit was
accompanied by spasm and stiffness of the whole body, the jaws being
fixed, the eyes staring and the pulse very small and weak.” When the
hot fit came on the spasms abated, and ceased in the sweating stage;
but sometimes the spasm was accompanied by delirium, both lasting to
the very end of the paroxysm. Even in the intermissions a convulsive
twitching of the extremities continued to such a degree that it was
not possible to distinguish the motion of the artery at the wrist.
“This fever had every kind of variety, and whether at its first
accession it were a quotidian, a tertian or a quartan, it was very apt
to change from one type to another. Sometimes it returned two days
successively, and missed the third day; and sometimes it became
continual. I am not informed that any died of this fever whilst it
intermitted. It is, however, certain that many country people whose
illness had at its beginning put on the appearance of intermission,
becoming delirious, sank under it in four or five days.”