THE THIRD VISITATION OF THE DISEASE.—1517
“This learned Lord, this Lord of wit and art,
This metaphysick Lord, holds forth a Glasse,
Through which we may behold in every part
This boisterous prince.”—HOWELL[443].
SECT. 1.—POVERTY.
The ordinances of Henry the VIIth, which, although adapted to the
times, bore hard upon the people, soon produced their fruits. The great
diminished the number of their servants, and as, moreover, many of the
peasantry were thrown out of employment in consequence of a conversion
of large tracts of arable land into pasture[444], the population of
towns increased even to an overflow, and the consequent activity of
trade gradually rendered the towns flourishing. But this change took
place too rapidly. Wealth and luxury engendered, it is true, numerous
wants which were a source of gain, so that the English were at this
time considered luxurious and effeminate[445], but there was a general
scarcity of workmen and artists, and hence it happened, that from
Genoa, Lombardy, France, Germany and Holland, innumerable foreigners
immigrated and took possession of the most lucrative branches of
employment. This was a peculiar hardship on the natives, who from
their imperfect knowledge of the arts, could not compete with the more
skilful foreigners, and were besides treated by them with insolence and
contempt. The distresses of the poor thus increased yearly, and their
indignation at length broke out. A great insurrection of the English
artisans arose throughout London, and might have proved destructive to
the foreigners, had affairs been in a less orderly state. The popular
commotion was, however, suppressed without any considerable sacrifice,
and Henry the VIIIth on a solemn day, appointed at Westminster, for
passing judgment upon the prisoners, bestowed a pardon on them; for he
saw into the causes of their discontent, and very soon after caused
restrictive alien laws to be enacted[446].
SECT. 2.—SWEATING SICKNESS.
All this took place in April and May of the ever memorable year 1517,
and London was again indulging in hopes of better days, when the
Sweating Sickness once more broke out quite unexpectedly in July, and
in spite of all former experience, and the most sedulous attention,
inexorably demanded its victims. On this occasion it was so violent and
so rapid in its course, that it carried off those who were attacked in
two or three hours, so that the first shivering fit was regarded as the
announcement of certain death. It was not ushered in by any precursory
symptoms. Many who were in good health at noon, were numbered among
the dead by the evening, and thus as great a dread was created at
this new peril as ever was felt during the prevalence of the most
suddenly destructive epidemic: for the thought of being snatched away
from the full enjoyment of existence without any preparation, without
any hope of recovery, is appalling even to the bravest, and excites
secret trepidation and anguish. Among the lower classes the deaths
were innumerable[447]. The city was moreover crowded with poor; but
even the ranks of the higher classes were thinned, and no precaution
averted death from their palaces. Ammonius of Lucca, a scholar of
some celebrity, and in this capacity private secretary to the king,
was cut off in the flower of his age, after having boasted to Sir
Thomas More, only a few hours before his death, that by moderation
and good management he had secured both himself and his family from
the disease[448]. Also of those immediately about the king, Lords
Grey and Clinton were carried off, besides many knights, officers and
courtiers. Mourning supplanted the hilarity and brilliancy of the
festivals, and the king, while in miserable solitude, into which he
had retired with a few followers, received message after message from
different towns and villages, announcing, that in some a third, in
others even half the inhabitants were swept off by this pestilence.
It had never before raged with so much fatality. The minds of men had
never before been so frightfully appalled. The festival of Michaelmas,
(29th September,) which in England was always kept with much religious
pomp, was of necessity postponed; nor was the solemnity of Christmas
observed, for there was a dread of collecting together large assemblies
of people[449], on account of the contagion; and just about this time,
when the Sweating Sickness had abated, the plague, according to the
account of some historians, began, which, although probably not very
virulent, prevailed during the whole winter in most English towns,
and continued to keep up the distress of the people. The king on this
occasion also quitted his capital, and retreated, in company with a few
attendants, before the contagion, frequently shifting his court from
place to place. It was during this period of trouble (11th of February,
1518) that the Princess Mary, afterwards Queen, was born[450].
Thus the Sweating Sickness lasted full six months, reached its
greatest height[451] about six weeks after its appearance, and
probably spread from London over the whole of England. In Oxford and
Cambridge it raged with no less violence than in the capital. Most of
the inhabitants of those places were, in the course of a few days,
confined to their beds, and the sciences, which then flourished, for
they were never more zealously cultivated in England than at that time,
suffered severe losses by the death of many able and distinguished
scholars[452]. Scotland, Ireland and all other countries beyond sea,
were on this occasion spared. The neighbouring town of Calais alone was
reached[453] by the pestilence; and according to later observations,
it may be considered as certain, that only the English who resided
there, and not the French inhabitants, were affected, as it is also
ascertained that the rest of France continued throughout free from
the disease. Had this not been the case, contemporary writers would
undoubtedly not have omitted to make mention of so important an
occurrence.
SECT. 3.—CAUSES.
The influences which gave rise to this third eruption of the disorder
among the English nation are obscure, and do not altogether correspond
with those of the years 1485 and 1506. Thus it is especially
remarkable, that, on this occasion, there is no express mention of
the humidity which had so decided a share in the origin of the two
former visitations of the Sweating Sickness, and the year 1517 was in
most respects one of an ordinary kind. The English Chronicles state
nothing remarkable on the subject, and from those of Germany we only
learn that the winter of 1516 was very mild, and that a fruitful summer
with an abundant vintage[454] and a cold winter followed. The summer
of 1517 was unfruitful, although not on account of wet weather, so
that in some parts, especially in Swabia, provision was made against
a scarcity[455]. A great comet appeared in 1516[456], and in 1517 an
earthquake was felt at Tübingen, Nördlingen, and Calw, during a violent
storm, whereupon the “Haupt Krankheit”[457] (encephalitis), accompanied
by fever, became more prevalent, although not remarkably fatal[458].
This phenomenon (the earthquake) was by no means unimportant[459] in
its effects, and there is reason to suppose that it was followed by
subterraneous commotions of still greater extent, for earthquakes
occurred also in Spain[460]. As the date of this event is specified as
the 16th of June, and as earthquakes occurring in unusual localities,
that is to say, in districts not volcanic, are frequently cited as
prognostics of great diseases, although in volcanic districts they
evidently betoken nothing of the kind, we may hence with some reason
assume a telluric influence, which perhaps reached the locality of the
pestilence that broke out at the beginning of July, if not earlier.
Besides, we cannot find any greater phenomenon, which, according to
human conception, could have had a more immediate connexion with the
English Sweating Sickness; and in this instance too, inquiry the most
circumspect does not penetrate through the thick veil which envelopes
the inscrutable causes of epidemics.
SECT. 4.—HABITS OF THE ENGLISH.
That next to the peculiar constitution which England imparts to her
inhabitants, the predisposing causes of the Sweating Sickness lay in
the habits of the English of those times, no one can possibly doubt.
The limitation of the pestilence to England plainly indicates this.
Not a single ship conveyed it to the French, or to the Dutch, who
breathed a much moister atmosphere; and yet the intercourse between the
English seaports and these immediately neighbouring nations was very
frequent. Of intemperance, which most generally lays the foundation
for disorders, both high and low were at this time accused. This vice
of the English was proverbial in foreign countries[461]. Flesh meats
highly seasoned with spices were indulged in to excess; noisy nocturnal
carousings were become customary, and it was also the practice to
drink strong wine[462] immediately after rising in the morning. Cyder,
which in some parts, as for instance in Devonshire, is the common
beverage[463], was, even in those times, considered by medical men
as injurious, for it was observed that its use caused debility with
paleness, and sapped the vigour of youth in both sexes[464]. Other
similar facts respecting the mode of living at that time might perhaps
be adduced, from which it would appear that, owing to the total want
of refinement in diet, much that was improper was employed in English
cookery, and that on this account the constitution was much injured.
Horticulture, which the French had already brought to a state of
great improvement[465], was still quite in its infancy in England.
It is even said that Queen Catherine had pot-herbs brought from
Holland for the preparation of salads, as they were not procurable in
England[466]. Allowing that this account may not be strictly true,
since it admits of other explanations, still it proves in itself what
we would here enforce, and leaves us to draw conclusions from it beyond
the mere fact of there being a scarcity of culinary vegetables. Much
more important, however, as respects our subject, was the custom of
wearing immoderately warm clothing, of which we have accounts worthy
of credence. From youth upwards the head was covered with thick
caps, in order to secure it from every chance of cold, and from the
least draught of air; and as, by this injurious practice, the brain
was subjected to a continual determination of blood, and a tenderness
of the skin was induced, there was no disorder more frequent among
the English in this century than catarrh[467], which was constantly
reproduced by relaxing perspirations and heating medicines. If this
malady be complicated with a scorbutic habit, or if it befall persons
of debauched habits, whose vessels contain nourishment not properly
concocted, the preservative vital power seeks a vent through the
relaxed skin, and that which in itself is a needful and alleviating
excitement of this tissue becomes a disease; the wholesome excretion
degenerates into a colliquative drain, which forcibly carries off
with it unusual animal matters that ought not to pass away through
such an outlet, and the body yields to an attack to which it has been
thus long predisposed. When we consider this debilitated state of the
skin as the general complaint in England, taking into account the
prejudicial influence of hot baths[468], which were much in use, and
the diaphoretic medicines employed in most disorders; when we bear in
mind the rare use of soap at that time, and the high price of linen, as
also the extreme indigence of the lower classes, which almost always
breeds pestilences, the utterly miserable condition and truly Scythian
filth of the English habitations[469], and finally, the crowded state
of London in the year 1517, we shall, as far as human research can
penetrate, find the origin of the Sweating Sickness in this very year
explicable from causes which have long been known to be capable of
producing such effects. Something remains in the background, of which
hereafter.
SECT. 5.—CONTAGION.
The rapid spread of the Sweating Sickness all over England as far as
the Scottish borders, and across to Calais, now demands a more especial
consideration. Most fevers which are produced by general causes, as
well transient (epidemic) as constant and peculiar to the country
(endemic), or a union of both, which almost always takes place, and was
here evidently the case, propagate themselves for a time spontaneously.
The exhalations of the affected become the germs of a similar
decomposition in those bodies which receive them, and produce in these
a like attack upon the internal organs; and thus a merely morbid
phenomenon of life shews that it possesses the fundamental property
of all life, that of propagating itself in an appropriate soil. On
this point there is no doubt,—the phenomena which prove it have been
observed from time immemorial, in an endless variety of circumstances,
but always with a uniform manifestation of the fundamental law. All
nations too, and from the most ancient times, have invented ingenious
designations for these occurrences, which, however, seldom represent
the general notion, but commonly only the peculiar propagation of
individual diseases. Certainly one of the best and the most ingenious
is that which is conveyed by the German word “Ansteckung,” “setting
on fire,” which compares the exciting a disease in the appropriate
body, with the inflammation of combustible matter by the application
of fire, or with the kindling of powder by a spark. But how various
are these “Ansteckungen!”, from the purely mental, on the one hand,
which, through the mere sight of a disagreeable nervous malady—through
an excitement of the senses that shakes the mind, penetrates into the
nerves, those channels of its will and of its feelings, and produces
the same disorder in the beholder, to those, on the other hand, which
propagate diseases that principally operate only upon matter, and are
distinguishable but little, if at all, from animal poisons. The reader
must not here expect all the features of a doctrine which extends
through the whole immeasurable domain of life. They are clearly
derived from the confirmed and well applied experience of _the past_,
and have been delineated by men[470] who had not forgotten, like their
modern successors, to take a comprehensive view of epidemic diseases.
It may, however, be permitted me just to call to mind the difference
between those infectious diseases which are _permanent_ and for
centuries together _unchangeable_, and those which are _temporary_ and
_transient_. The infecting matter of the former may aptly be called
the perfect or unchangeable in contradistinction to the imperfect or
mutable character of the latter. The former, when once formed, whether
in diseased persons or inanimate substances (fomites), are always
in existence, and are but called into activity by those causes of
general disease (epidemic constitutions) which are favourable to their
propagation; and it is to be remarked that under all circumstances, and
at all times, they excite the same unchangeable diseases, and, varying
only in particular ramifications or degenerations and mild forms, never
lose their proper essence. Examples are furnished in the small-pox, the
plague, the measles, and, if we may include diseases not febrile, the
leprosy, the itch, and the venereal disease. The latter, on the other
hand, are not always in existence, they are called forth from nonentity
by the causes of general diseases or epidemic constitutions, and they
disappear again after the extinction of the epidemic diseases by which
they were bred; they likewise vary in their development and their
course in each particular epidemic. Examples are found in the yellow
fever, in catarrh or influenza, in nervous and putrid fever, and, among
many other disorders, in miliary fever, a disease which first grew
to a national pestilence in the 17th century, and which, in the kind
and manner of its infecting power, approaches nearest to the sweating
fever. To this latter category the English Sweating Sickness likewise
belongs; a disease altogether of a temporary character, which, after
its cessation, left no infecting material behind, and consequently was
incapable of propagating itself after the manner of those diseases
which are completely contagious. The animal matters, which were
expelled along with the profuse perspiration, and spread so horrible a
stench around the sick, contained amid their alkaline salts, (probably
ammonia in various states of combination,) and their superabundant
acid, the ferment of the disease; and this penetrated into the
lungs of the bystanders as they breathed, and provided they were but
predisposed for its reception, as above stated, continually produced
it. It may be considered as certain that mere manual contact was not
sufficient to communicate the infection, and that this was propagated,
either by the pestilential atmosphere which surrounded the beds of the
sick, or by exhalations generated in unclean situations where there was
no vent for their escape. On this account it was that the residence at
common inns and public-houses was looked upon as dangerous[471].
I would not, however, be understood to maintain that, during the
three epidemics with which, up to the present stage of our inquiry,
we have become acquainted, the spread of the sweating fever alone
was occasioned by infection; for if the general epidemic causes
were powerful enough to excite the disease, without any previously
existing poison, why might they not produce the same effect still more
independently throughout the course of the pestilence, since, as is
the case in all epidemics, those causes in all probability continued
to increase in intensity? That the plague grew worse on the occasion
of any great assemblages of the people, was at that time known, and
the notion of contagion thence very naturally arose. Yet, must it
here be taken into account, that even without this notion, and merely
from the assemblage itself of many people in whom the like malady
was germinating, and already had shewn tokens of its approach, that
approach might easily be accelerated, and the disease increased among
those merely slightly indisposed, by the reciprocal communication of
morbid exhalations. For as the predisposition to any malady, which
is an intermediate condition between that malady and the previous
state of good health[472], plainly displays the properties of the
disease in those whom it _threatens_ to attack, so these exhalations
(or epidemic causes which give rise to Sweating Sickness in the first
instance) certainly differ from those which occur in a sweating
sickness which has already broken out, only in unessential respects,
and might consequently stimulate the mere disposition to the disease
more and more, even to the actual eruption of the disease itself.
Yet a contagion was likewise in operation at the same time which was
destructive even to the temperate, and to those who were apparently
in health, nay, even to foreigners, who were living in an English
atmosphere and on English food, as the example of the Italian Ammonius
plainly proves[473].
In all epidemics which increase to such a degree as to become
contagious, it is of importance to distinguish which of these causes
are the more powerful, the predisposing or epidemic causes, which
originate the proneness to the disease, or the proximate causes, among
which, in the generality of cases, contagion is the most prominent. The
predisposing were here evidently the more operative; contagion was not
added till the disease was at its height, and although it contributed
not a little to its spread, yet it always remained subordinate to
the other sources of the disease, and all the matter of infection
vanished without a trace, on the cessation of the disorder, so that the
subsequent eruptions of it were always produced by the renewal of those
general causes which are in operation upon and under the earth. It is,
however, as little within the compass of human knowledge to discover
the essential foundation of this renewal, as the proximate causes of
the appearance of the mould spots at the commencement of the sixteenth
century, or any other of those processes which are prepared and brought
into activity by the hidden powers of nature.
SECT. 6.—INFLUENZAS.
Several epidemics thus originating in causes beyond human comprehension
appeared in the 16th century. Among the most remarkable was a violent
and extensive catarrhal fever in 1510, of that kind which the Italians
call Influenza, thus recognising an inscrutable influence which affects
numberless persons at the same time. It prevailed principally in
France, but probably also over the rest of Europe, of which, however,
the accounts do not inform us, for in those times they took little
pains to record the particulars of epidemics which were not of a
character to affect life. According to recent experience we should be
warranted even in supposing that this malady had its origin in the
remotest parts of the East. During the whole of the winter, which was
very cold, violent storms of wind prevailed, and the north and middle
of Italy were shaken by frequent earthquakes; whereupon there followed
so general a sickness in France, that we are assured by the historians
that few of the inhabitants escaped it. The catarrhal symptoms,
which on the appearance of disorders of this kind usually form their
commencement, seem to have been quite thrown into the background by
those of violent rheumatism and inflammation. The patient was first
seized with giddiness and severe headache; then came on a shooting
pain through the shoulders, and extending to the thighs. The loins
too were affected with intolerably painful dartings, during which
an inflammatory fever set in with delirium and violent excitement.
In some the parotid glands became inflamed, and even the digestive
organs participated in the deep-rooted malady; for those affected had,
together with constant oppression at the stomach, a great loathing for
all animal food, and a dislike even to wine. Among the poor as well as
the rich many died, and some quite suddenly, of this strange disease,
in the treatment of which the physicians shortened life not a little by
their purgative treatment and phlebotomy, seeking an excuse for their
ignorance in the influence of the constellations, and alleging that
astral diseases were beyond the reach of human art[474].
From this prejudicial effect of our chief antiphlogistic remedy,
bleeding, as well as of evacuations from the bowels, we may conclude
that the disease, though in its commencement rheumatic, yet had an
essential tendency to produce relaxation and debility of the nerves,
and in this respect, as well as in its extension to all classes,
accorded with the modern influenzas, in which the same phenomena have
manifested themselves only much less vividly and plainly. The French,
who, from the levity of their character, have always called serious
things by jocose names, designate this disease “Coqueluche” (the monk’s
hood), because, owing to the extreme sensibility of the skin to cold
and currents of air, this kind of hood was generally necessary, and
was a protection against an attack of the malady, as well as against
its increase. That in the accounts, which are, to be sure, very
incomplete, there should be no express mention of any affection of the
air-passages, is remarkable, since this could not in all likelihood
have failed to exist; although it might perhaps have been only slightly
manifested. Nearly a century before (1414), this affection appeared
far more prominently on the occurrence of a no less general disorder
of the same kind; so that all those who had the complaint, suffered
from a considerable hoarseness, and all public business in Paris
was interrupted on this account[475]. It was on that very occasion
that the name Coqueluche was first employed, and this having, as is
well known, been transferred to the whooping-cough, it is easier to
suppose, with respect to the influenza of 1510, which was similarly
named, an omission in the account, than the real absence of a symptom
so very generally prevalent; for in these kinds of comparisons and
denominations, the common sense of the people errs much less than the
learned profundity of political historians.
We must not omit here to remark that three years before (1411), and
thirteen years afterwards, two diseases entirely similar and equally
general, made their appearance in France, of which we nowhere find that
any notice has been taken up to the present time. The first was called
_Tac_, the second _Ladendo_, which designations have since entirely
gone out of use. Both were accompanied by very severe cough, so that
in the former, ruptures not unfrequently occurred, and pregnant women
were in consequence prematurely confined, and by the latter, from
its universality, the public worship was disturbed. In the ladendo,
there seems to have been an affection of the kidney of an inflammatory
character, and much more severe than in the coqueluche of 1510, a
memorable example of epidemic influence, and without a parallel in
modern times. This pain in the kidneys, which was as severe as a
fit of the stone, was followed by fever with loss of appetite, and
an incessant cough that terminated in disagreeable eruptions about
the mouth and nose. The disorder ran a course of about fifteen days,
and was generally prevalent throughout October, being unattended
with danger, notwithstanding the severity of its symptoms. One might
almost be tempted to regard the tac of 1411 as the coqueluche of 1414,
which is only slightly alluded to by Mezeray, and whereof the author
from whom we are now quoting, has made no mention; for a false date
might easily occur here. Yet this must remain undecided until we can
obtain fuller information, for we have experienced, even in the most
recent times, an example of influenzas (1831 and 1833) following each
other in quick succession. Gastric symptoms and an inordinate degree
of irritability accompanied the spasmodic cough, and the complaint
terminated with evacuations of blood. However, the disease was
unattended with danger, and lasted upon the whole only three weeks[476].
Four other epidemics similar to that of 1510 appeared in the sixteenth
century, two which were quite general in the years 1557 and 1580, and
two less extensively prevalent in the years 1551 and 1564[477]. Of
the two former we possess accurate descriptions; it will therefore
aid us in forming a correct judgment respecting the influenza
of 1510, if we here take a review of these also, since the most
experienced contemporaries classed all these disorders together as of
a similar kind. During the dry unfavourable summer of 1557, invalids
were suddenly seized with hoarseness and oppression at the chest,
accompanied with a pressure on the head, and followed by shivering and
such a violent cough, that they thought they should be suffocated,
especially during the night. This cough was dry at first, but about the
seventh day, or even later, an abundant secretion took place either
of thick mucus or of thin frothy fluid. Upon this the cough somewhat
abated, and the breathing became freer. During the whole course of
the disorder, however, patients complained of insufferable languor,
loss of strength, want of appetite and even nausea at the sight of
food, restlessness and want of sleep. The malady ended in most cases
in abundant perspiration, but occasionally in diarrhœa. Rich and
poor, people of every occupation and of all ages, were seized with
this disease in whole crowds simultaneously, and it passed easily
from a single case to a whole household. On this occasion death
rarely occurred, except in children who had not power to endure the
severity of the cough, and medicine was of little avail, either in
alleviating the disorder or arresting its destructive course. The
already established name of this disease was immediately called to
mind again in France. It was not, however, confined to that kingdom,
but prevailed as generally, with some considerable varieties of form,
in Italy, Germany, Holland, and doubtless over a still wider range of
country[478]. The same was the case with the influenza of 1580, which
spread over the whole of Europe, and seems to have been less severe;
thus bearing a closer resemblance[479] to that of 1831 and 1833,
which is still in the recollection of most of our readers from their
own experience. A more elaborate research into this very important
subject would far surpass the limits of this treatise, for phenomena
deeply affecting the whole system of human collective life are here
to be considered, which can only become apparent when received as a
connected whole, yet we must at least point out the relation which the
influenzas bear to the greater epidemics. This is quite apparent; for
as catarrhs are not unfrequently the forerunners, accompaniments or
sequelæ of important diseases in individual cases[480], excitement of
the mucous membrane being often merely an outward sign of more deeply
seated commotion, so also are influenzas usually only the _first
manifestations, but sometimes also the last remains of extensive
epidemics_. The most recent example is still fresh in our memories. The
influenza of 1831 was immediately followed by the Indian cholera, and
scarcely had this, after its revival in Eastern and central Europe,
vanished, when the influenza of 1833 appeared, as if to announce a
general peace. After the influenza of 1510, a plague followed in
the north of Europe, which in Denmark carried off the son of King
John[481]; 1551 was the year of the fifth epidemic sweating sickness.
In 1557, the influenza in Holland, was followed by a bubo plague, which
lasted the following year, and carried off 5000 of the inhabitants at
Delft[482]. In 1564, a very destructive plague raged in Spain, of which
10,000 people died at Barcelona, and finally, in 1580, the last year
of influenza in that century, a plague of which 40,000 died in Paris,
appeared over the greater part of Europe and in Egypt[483].
SECT. 7.—EPIDEMICS OF 1517.
We now revert to the year 1517, and shall consider the epidemics
which accompanied the English sweating sickness. First of all, the
_Hauptkrankheit_, that brain fever which so often recurred in the
central parts of Europe, appeared extensively throughout Germany. Many
died of this dangerous disease, and we are assured by contemporaries
that other inter-current inflammatory fevers were also very fatal[484].
Such was the case in Germany, the heart of Europe. Another disease,
however, much more important, and till that time wholly unknown to
medical men, appeared in Holland, which broke out in January, 1517,
and from its dangerous and quite inexplicable symptoms, spread fear
and horror around. It was a malignant, and, according to the assurance
of a very respectable medical eye-witness, an infectious inflammation
of the throat, so rapid in its course that, unless assistance were
procured within the first eight hours, the patient was past all hope
of recovery before the close of the day. Sudden pains in the throat,
and violent oppression of the chest, especially in the region of the
heart, threatened suffocation, and at length actually produced it.
During the paroxysms the muscles of the throat and chest were seized
with violent spasm, and there were but short intervals of alleviation
before a repetition of such seizures terminated in death. Unattended
by any premonitory symptoms, the disease began with a severe catarrhal
affection of the chest, which speedily advanced to inflammation of the
air passages, and where death did not occur on the day of the attack,
ran on to a dangerous inflammation of the lungs, which followed the
usual course, but was accompanied by a very high fever. Occasionally
a less perilous transition into intermittent fever was observed, but
in no case did a sudden recovery take place; for even when the fever
subsided, the patient continued to suffer, for at least a month, from
pain in the stomach and great debility, which symptoms admit of easy
explanation to a medical man of the present day, from the fissures and
small ulcers of the tongue, which appeared when the fever was at its
height, and obstinately resisted the usual treatment.
The remedies employed shew the circumspection and ability of the Dutch
physicians. They had recourse, as soon as possible, at the latest
within six hours, to venesection, and followed this up immediately
by purgatives, of which, however, some eminent men disapproved,
and this to the great detriment of their patients, for without the
combined effect of both these means, the sudden suffocation could not
be averted. Moreover, the employment of detergent gargles, whereby
the extension of the affection to the lungs was prevented, as also
of demulcent pectoral remedies, was decidedly beneficial, and it is
affirmed that all who were thus treated were easily restored[485].
Extraordinary and peculiar as this disease, for which contemporaries
found no name, was, its rapid onset and its sudden disappearance were
still more so. Most of those affected were taken ill at the same time,
and eleven days of suffering and misery had scarcely elapsed when not
another case occurred; the numbers who had fallen victims were buried;
and but for the journal of the worthy Tyengius[486], no distinct
record would have existed of this remarkable epidemic, which however,
it is certain, spread further than merely over the misty territory of
Holland, and apparently with still greater malignity; for in the same
year we find it in Basle, where, within the space of eight months, it
destroyed about 2000 people, and its symptoms would seem to have been
still more strongly marked. Respecting the intermediate countries,
which it is highly probable that the disease passed through from
Holland before it reached Basle, we unfortunately have no information.
The tongue and gullet were white as if covered with mould, the patient
had an aversion to food and drink, and suffered from malignant fever,
accompanied with continued headache and delirium. Here also, in
addition to an internal method of cure which has not been particularly
detailed, the cleansing of the mouth was perceived to be an essential
part of the treatment: the viscous white coating was removed every two
hours, and the tongue and fauces were afterwards smeared with honey of
roses[487], whereby patients were restored more easily than when this
precaution was omitted[488].
It appears, according to modern experience, to admit of no doubt that
this disease consisted of an inflammation of the mucous membrane which,
accompanied by a secretion of lymph, spread from the œsophagus to the
stomach, and likewise through the air passages to the lungs, being
thus identical with pharyngeal croup, which was represented a few
years ago as a new disease, and has in consequence been designated by
a special name[489]. Its subsequent appearance in the memorable year
1557, respecting which we have a still more complete account, gives
additional weight to this supposition. In that year it broke out in
October, and was observed by Forest, who was himself the subject of
it, at Alkmaar, where it attacked whole families, and in the course of
a few weeks destroyed more than 200 people. It was not, however, so
excessively rapid in its course as in 1517, but began with a slight
fever like a common catarrh, and shewed its great malignity only by
degrees. Sudden fits of suffocation then came on, and the pain of the
chest was so dreadfully distressing that the sufferers imagined they
must die in the paroxysm. The complaint was increased still more by
a tight convulsive cough, and until this was relieved by a secretion
of mucus, proved dangerous, especially to pregnant women, sixteen of
whom died within the space of eight days, whilst those who survived
were all prematurely brought to bed. The fever which accompanied the
inflammation was very various in its course. It was rarely observed
to continue without intermission, but where this was the case, was
attended with the greatest peril. Yet death did not take place on this
visitation until the ninth or fourteenth day, whereas in the year 1517
as many hours would have sufficed to produce a fatal termination.
After this period the danger diminished, and those patients were most
secure from suffocation, provided they had good medical attendance,
whose complaint had been accompanied throughout its course by fever
of only an intermittent character. So marked was the influence of the
Dutch soil, that until this intermittent passed into continued fever
of different gradations, it appeared of the purest and most unmixed
type. In these cases the inflammation was less completely formed, so
that even bleeding, a remedy otherwise indispensable, was sometimes
unnecessary. Those affected all suffered most at night and in the
morning, the latter generally bringing with it the inflammation of
the larynx and trachea, which, however, they had not at that time
experience enough to recognise as such, perceiving as they did only
a slight redness in the fauces. The painful affection of the stomach
was also in this epidemic very distinctly marked, so that a sense of
pressure at the præcordia, accompanied by continual acid eructations,
continued to exist even after a succession of six or seven fits of
fever; and convalescents were troubled for a long time with dyspepsia,
debility and hypochondriasis. The inflammation of the mucous membrane,
no doubt, affected the nervous plexuses of the abdomen, as is usually
the case, and totally changed the secretion. This was proved by the
treatment, for, by administering the necessary purgative remedies, a
vast quantity of offensive mucus, mixed with bile, was evacuated.
Our excellent eye-witness assures us that the people sickened as
suddenly as if they had inhaled a poisonous blast, so that more than a
thousand people in Alkmaar betook themselves to their beds in a single
day, a thick stinking mist having previously for several days spread
over the land. This pestilence did not terminate so speedily as that of
the year 1517; on the contrary, it delayed until the winter, and seems
to have formed the conclusion of a whole series of morbid phenomena,
particularly of the already mentioned influenza throughout Europe, and
of the bubo plague in Holland, which had occurred in the middle of
the summer,—phenomena that were accompanied by the usual attendants
of epidemics, namely great scarcity, and unusual occurrences in the
atmosphere, such, for instance, as electric illuminations of prominent
objects, and so forth[490].
The close connexion between this inflammation of the air-passages
and gullet and the epidemic catarrh is quite apparent; for these
are but gradations and gradual transitions in the affection of the
mucous membrane, as also in the power of atmospherical causes, which
especially influence the organs of respiration. We believe, therefore,
that we are fully justified in classing the epidemic described to have
taken place in Holland and Germany in 1517, with the influenzas; and
in declaring the morbid commotion in human collective life which thus
manifested itself, to have been a forerunner of the English pestilence,
which was simultaneously prepared by the altered condition of the
atmosphere, and broke out a few months later.
We ought not to omit here to mention that, in this same year, 1517, the
small-pox, and with it, as field-poppies among corn, the measles, was
conveyed by Europeans to Hispaniola, and committed dreadful ravages at
that time, as afterwards, among the unfortunate inhabitants. Whether
the eruption of these infectious diseases in the new world was favoured
by an epidemic influence or not, can no longer be ascertained; yet the
affirmative seems probable from the fact, that the small-pox did not
commit its greatest ravages in Hispaniola[491] until the following
year, and, according to recent experience, those epidemic influences
which extend from Europe westward, always require some time to reach
the eastern coasts of America.
But even without this phenomenon in the New World, which is now for the
first time placed within the pale of observations on epidemics, we have
facts at hand sufficiently numerous and worthy of credit to prove—_that
the English Sweating Sickness of 1517, made its appearance, not alone,
but surrounded by a whole group of epidemics, and that these were
called forth by general morbific influences of an unknown nature_.