CHAPTER III.

INFLUENZAS AND EPIDEMIC AGUES.

Epidemic agues are joined in the same chapter with influenzas for the

reason that they can hardly be separated in the earlier part of the

history. Until 1743 the name influenza was not used at all in this

country. The thing itself can be identified clearly enough in certain

instances from the earliest times. But there are periods, such as 1657-59,

1678-79, and 1727-29 when short waves of epidemic catarrhs or catarrhal

fevers came in the midst of longer waves of epidemic agues, “hot agues,”

or intermittents, the whole being called by the people “the new disease,”

or “the new ague,” while by physicians, such as Willis and Sydenham, they

were taken to be the distinguishable constituent parts of one and the same

epidemic constitution. The last period in which epidemic agues were so

recognised and named in England was from 1780 to 1785; and in the midst of

that also there occurred an epidemic catarrh--the “influenza” of the year

1782. It is possible that our own recent experience of a succession of

influenzas, or strange fevers, from 1889 to 1893, in some respects the

most remarkable in the whole history, would have seemed an equally

composite group if they had fallen in the 17th century and had been

described in the terminology of the time and according to the then

doctrines or nosological methods. Without prejudice to the distinctness

and unity of the influenza-type in all periods of the history, I am

unable, after trying the matter in various ways, to do otherwise than take

the epidemics of ague in chronological order along with the influenzas. As

the history will require the frequent use of the name “ague,” and, in due

course, that of the name “influenza,” it will be useful to examine at the

outset their respective etymologies and the meanings that usage has given

to them.

Originally the English name ague did not mean a paroxysmal or intermittent

fever, or a fever with a long cold fit followed by a hot fit, or the

malarial cachexia with sallowness, dropsy and enlarged spleen, or any

other state of health arising from the endemic conditions which are known

as malarial over so large a part of the globe in the tropical and

sub-tropical zones. It meant simply _acuta_, the adjective of _febris

acuta_ made into a substantive. Thus Higden’s reference in the

_Polychronicon_ (which is exactly in the words of Giraldus Cambrensis a

century and a half before) to the _febris acuta_ of Ireland is translated

by Trevisa (14th cent.): “Men of that lond haue no feuere, but onliche the

feuere agu, and that wel silde whanne”; and by an anonymous translator:

“The dwellers of hit be not vexede with the axes excepte the scharpe axes,

and that is but selde[533].” Again in the MS. English translation of the

Latin essay on plague by the bishop of Aarhus, the acute fever which is

described as the attendant or variant of bubo-plague proper (well known

long after as the pestilential fever, a malignant form of typhus), is thus

rendered:

“As we see a sege or prevy next to a chambre, or of any other

particuler thyng which corrupteth the ayer in his substance and

qualitee: whiche is a thing maye happe every daye. And therof cometh

the ague of pestilence. And aboute the same many physicions be

deceyved, not supposing this axes to be a pestilence.... And suche

infirmite sometime is an axes, sometime a postume or a swellyng--and

that ys in many thinges.”

The same use of ague is continued in the first native English book on

fevers, Dr John Jones’s ‘Dyall of Agues,’ which has chapters on plague as

well as on pestilential fever and on all other fevers including

intermittents. In Ireland the name of ague was applied until a

comparatively late period to the indigenous typhus of the country, as if

in literal translation of the _febris acuta_ first spoken of by Giraldus

in the 12th century. Ague in early English meant any sharp fever, and most

commonly a continued fever. The special limitation to intermittents

appears to have followed the revival of the study of the Graeco-Roman

writers on medicine, Galen above all, in the sixteenth century. But Jones,

who was freer than the more academical physicians of his time from

classical influences, is shrewd enough to see that it was a mistake to

transfer the experiences of Greece verbatim to England and to make them

our standard of authority: he is speaking, however, not of intermittents

but of the simple ephemeral fever, or inflammatory fever of one day:

“Such as have the fever of heat or burning of the sun, sayeth Galen,

theyr skin is drye and hot as that which is perched with the sun; of

the which, in this orizon and countrye of oures, we have no great nede

to entreate of, leaving it to the phisitions and inhabitantes that

dwell nerer to the meridionall line and hoter regions, as Hispaine and

Africke[534].”

At a later date, when the Hippocratic tradition had displaced the Galenic,

Rogers of Cork, perhaps the earliest writer on fevers whose observations

are essentially modern, has occasion thus to reflect upon the extreme

deference of Sydenham to his Greek model: “Again we learn from Hippocrates

that fevers in the warmer climates of Greece, at Naxos, Thasos or Paros,

ran their course in certain periods of time, which no ways answers in

regions removed at a farther distance from the sun,”--Rogers himself

having had no experience of intermittents among all the fevers and

dysenteries that he saw from 1708 to 1734, although Cork was surrounded by

marshes[535].

At the time of the Latin translations of Greek medical writings by Linacre

and Caius in the Tudor period, there were in this country actual

experiences of strange fevers, which were interpreted according to the

Greek teaching of quotidians, tertians and quartans, with their several

bastard or hybrid or larval forms. These, as I have said, were certainly

not the endemic fevers of malarious districts; they were, on the contrary,

widely prevalent all over the country during one or more seasons in

succession and more occasional for a few years longer; then there would be

a clear interval of years, and again an universal epidemic of “the new

fever,” “the new acquaintance,” “the new ague” or the like.

Sydenham, for example, has much to say of agues or intermittents prevalent

in town and country for a series of years, and then disappearing for as

long a period as thirteen years at a stretch. But he does not count these

as the agues of the marsh; his single reference to the latter is in his

essay on Hysteria, where he interpolates a remark that, if one spends two

or three days in a locality of marshes and lakes, the blood is in the

first instance impressed with a certain spirituous miasma, which produces

quartan ague, and that in turn is apt to be followed, especially in the

more aged, by a permanent cachectic state[536]. If Sydenham had intended

to bring all the intermittents of his experience into that class, he would

not have left the paludal origin of them to a casual interpolated remark.

On the other hand, he refers the epidemic agues, which occupy his pen so

much, to emanations from the bowels of the earth, according to a theory of

his friend Robert Boyle, applied by the latter to epidemical infections in

general and to epidemic colds or influenzas in particular. Sydenham and

his learned colleagues were not ignorant of the endemic agues of marshy

localities, but they made little account of them in comparison with the

aguish or intermittent fevers that came in epidemics all over England.

In admitting the reality of such agues, we must be careful not to ascribe

them to such conditions as Talbor, the ague-curer, found in one village in

Essex. We must be careful not to do so, because there are plausible

reasons for doing so. The ground is much better drained now than formerly;

there is less standing water, fewer marshes, a much smaller extent of

water-logged soil. But the malarious parts of England have been tolerably

well defined at all times; and at all times the greater part of the

country was as little malarious as it is now. It is the frequent reference

to agues in old medical writings that has led some modern authors to

construct a picture of a marshy or water-logged England, for which there

is no warrant. Cromwell died of a tertian ague which he caught at Hampton

Court; therefore “the country round London in Cromwell’s time” must needs

have been “as marshy as the fens of Lincolnshire are now.” The country

round London was much the same then as now, or as in John Stow’s time, or

as in the medieval monk Fitzstephen’s time, or as it has ever been since

the last geological change. The ague of which Cromwell died in the autumn

of 1658 was one of those which raged all over England from 1657 to

1659--so extensively that Morton, who was himself ill of the same for

three months, says the country was “one vast hospital.” Whatever was the

cause of that great epidemic of “agues,” and of others like it, we have no

warrant to assume that “the country round London,” or wherever else the

epidemic malady prevailed, was then as marshy as the fens of

Lincolnshire[537].

The other name in the title of this chapter, influenza, appeared

comparatively late in the history. It is an Italian name, which is usually

taken to mean the influence of the stars. It may have got that sense by

popular usage, but the original etymology was probably different. As early

as the year 1554 the Venetian ambassador in London called the sweating

sickness of 1551 an _influsso_, which is the Italian form of _influxio_.

The latter is the correct classical term for a humour, catarrh, or

defluxion, the Latin _defluxio_ itself having a more special limited

meaning. It was not astrology, but humoral pathology, that brought in the

words _influxio_ and _influsso_; and I suspect that influenza grew out of

the latter, but not out of the notion of an influence rained down by the

heavenly bodies.

It was in 1743 that the Italian name of “influenza” first came to

England[538], the rumour of a great epidemic, so called, at Rome and

elsewhere in Italy having reached London a month or two before the disease

itself. The epidemic of 1743 was soon over and the Italian name forgotten;

so that when the same malady became common in 1762, some one with a good

memory or a turn for history remarked that it resembled “the disease

called influenza” nearly twenty years before. After the epidemic of 1782,

the Italian name came into more general use, and from the beginning of the

present century it became at once popular and vague. The great epidemics

of it in 1833 and 1847 fixed its associations so closely with catarrh that

an “influenza cold” became an admitted synonym for coryza or any common

cold attended with sharp fever. Lastly, the series of epidemics from 1889

to 1893 effectually broke the association with coryza or catarrh.

Before influenza became adopted as the common English name towards the end

of last century, what were the names popularly given to the malady in this

country? The earliest references to it are in the medieval Latin

chronicles under the name of _tussis_ or cough, or in some periphrasis. In

the fifteenth century the English name was “mure” or “murre,” which

appears to be the same root as in murrain. Thus the St Albans Chronicle,

under the year 1427, enters a certain “infirmitas rheumigata,” which in

English was called “mure”; and the obituary of the monks of Canterbury

abbey has two deaths from “empemata, id est, tussis et le murra[539].” In

the Tudor period there is no single distinctive name, unless it be “hot

ague”: in 1558 the name is “the new burning ague,” in 1562 “the new

acquaintance,” in 1580 “the gentle correction,” and at various times in

the 17th century “the new disease,” “the new ague,” “the strange fever,”

“the new delight,” “the jolly rant.” Robert Boyle called one sudden

outbreak “a great cold.” Molyneux, of Dublin, mentions “a universal cold”

in one year (1688), and “a universal transient fever” in another (1693).

The earlier 18th century writers mostly use the word catarrh or catarrhal

fever, either in Latin or in English, the popular names probably

continuing fanciful as before, as for example Horace Walpole’s “blue

plagues.” That which stands out most clearly in the English naming from

the earliest times is the idea of something new or strange; but the

newness or strangeness pertained quite as much to the agues as to the

catarrhs. The notion of ague may be said to be uppermost in the 16th and

17th centuries, that of catarrh in the 18th and 19th; while our very

latest experiences have once more brought a suggestion of ague to the

front.

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

centuries.

In the former volume of this history I have dealt with the various

epidemics of “hot ague,” “new disease” or the like down to the epidemic of

1657-59. It will be convenient to go over some of that ground again, with

a view to distinguish, if possible, the catarrhal types from the aguish,

and to illustrate the use of the word ague as applied to a universal

epidemic. Two of the epidemic seasons in the 16th century, 1510 and 1539,

are too vaguely recorded for our purpose; but I shall review briefly the

seasons from 1557-58 onwards.

It is known from the general historians that there were two seasons of

fever all over England in 1557 and 1558, of which the latter was the

more deadly, the type according to Stow, being “quartan agues.” In

letters of the time the epidemic of 1557 is variously named: thus

Margaret, Countess of Bedford, writes on 9 August from London to Sir

W. Cecil that she “trusts the sickness that reigns here will not come

to the camp [near St Quentin, where Francis, Earl of Bedford was]....

As for the ague, I fear not my son.” On the 18th of the same month,

Sir Nicholas Bacon writes from Bedford to Cecil: “Your god-daughter,

thanks be to God, is somewhat amended, her fits being more easy, but

not delivered of any. It is a double tertian that holds her, and her

nurse had a single, but it is gone clearly;” to which letter Lady

Bacon adds a postscript about “little Nan, trusting for all this

shrewd fever, to see her.” On 21 September, it appears that the

sickness had reached the English camp near St Quentin, for the Earl of

Bedford writes: “Our general is sick of an ague, our pay very slack,

and people grudge for want.” As late as the 25th October the Countess

of Bedford writes from London to Cecil that she “would not have him

come yet without great occasions, as there reigns such sickness at

London[540].”

Next year, 1558, the epidemic sickness returned in the summer and

autumn, in a worse form than before. Stow calls it “quartan agues,”

which destroyed many old people and especially priests, so that a

great number of parishes were unserved. Harrison, a canon of Windsor,

says that a third part of the people did taste the general sickness.

On the 6th September, sickness affected more than half the people in

Southampton, Portsmouth, and the Isle of Wight. From the 20th October

to the end of the year, no fewer than seven of the London aldermen

died, a number hardly equalled in the first sweating sickness of 1485,

and the queen (Mary) died of the lingering effects of an ague, which

was doubtless the reigning sickness. On 17th October, the English

commissioners being at Dunkirk to negotiate the surrender of Calais,

one of them, Sir William Pickering, fell “very sore sick of this new

burning ague: he has had four sore fits, and is brought very low, and

in danger of his life if they continue as they have done.” That year

Dr Owen published _A Meet Diet for the New Ague_, and himself died of

it in London on the 18th of October[541].

Fuller quaintly describes the ague of 1558 as “a dainty-mouthed

disease, which, passing by poor people, fed generally on principal

persons of greatest wealth and estate[542].” Roger Ascham wrote in

1562 to John Sturmius that, for four years past, or since 1558, “he

was afflicted with continual agues, that no sooner had one left him

but another presently followed; and that the state of his health was

so impaired and broke by them that an hectic fever seized his whole

body; and the physicians promised him some ease, but no solid

remedy[543].” Thoresby, the Leeds antiquary of the end of the 17th

century, found in the register of the parish of Rodwell, next to

Leeds, a remarkable proof of the fatality of these agues, which fully

bears out the general statements of Stow and Harrison. In 1557 the

deaths in the register rose from 20 to 76, and in 1558, which the

historians elsewhere say was the most fatal year, they rose to

124[544]. This was as severe as the sweating sickness of 1551, for

example in the adjoining parish of Swillington, or in the parish of

Ulverston, in Lancashire[545].

The English names of the epidemic sickness in the summers and autumns of

1557 and 1558 are all in the class of agues--“this new burning ague,” “a

strange fever,” “divers strange and new sicknesses taking men and women in

their heads, as strange agues and fevers,” “quartan agues.” One medical

writer, Dr John Jones, says in a certain place that “quartans were

reigning everywhere,” and in another place, still referring to 1558, that

he himself had the sickness near Southampton, that it was attended by a

great sweat, and that it was the same disease as the sweating sickness of

1551. There were certainly two seasons of these agues, 1557 and 1558, the

latter being the worst; and it is probable from Short’s abstracts of a few

parish registers in town and country that there was a third season of them

in 1559. The year 1557 has been made an influenza year, perhaps because

the Italian writers have emphasized catarrhal symptoms here or there in

the epidemic of that year; while both the years 1557 and 1558 have been

received into the chronology of epidemic or pandemic agues or malarial

fevers[546]. There are perhaps a dozen English references in letters and

chronicles to the sicknesses of those years, either to particular cases or

to a general prevalence, but they do not enable us to distinguish a

catarrhal type in 1557 from the aguish type which they assert for both

1557 and 1558.

Four years after, another very characteristic influenza was prevalent in

Edinburgh.

Randolph writes from Edinburgh to Cecil in the end of November, 1562:

“Maye it please your Honer, immediately upon the Quene’s (Mary’s)

arivall here, she fell acquainted with a new disease that is common in

this towne, called here the newe acqayntance, which passed also

throughe her whole courte, neither sparinge lordes, ladies nor

damoysells, not so much as ether Frenche or English. It ys a plague in

their heades that have yt, and a sorenes in their stomackes, with a

great coughe, that remayneth with some longer, with others shorter

tyme, as yt findeth apte bodies for the nature of the disease. The

queen kept her bed six days. There was no appearance of danger, nor

manie that die of the disease, excepte some olde folkes. My lord of

Murraye is now presently in it, the lord of Lidingeton hathe had it,

and I am ashamed to say that I have byne free of it, seinge it seketh

acquayntance at all men’s handes[547].”

It is not improbable that the interval between 1558 and 1562 may have been

occupied with milder revivals of the original great epidemic, the one at

Edinburgh counting in the series.

It appears from a Brabant almanack for the year 1561 that a sudden

catarrhal epidemic was quite on the cards in those years: the astronomer

foretells for the month of September, 1561: “Coughs innumerable, which

shall show such power of contagion as to leave few persons unaffected,

especially towards the end of the month[548].” There is an actual record

from more than one country (Italy, Barcelona, as well as Edinburgh) of

such universal catarrhs and coughs a year later than the one foretold. The

Italian writers assign the universal catarrhs and coughs to the autumn of

1562, the Barcelona writer to the winter solstice of that year, and the

letter from Edinburgh to “the laste of November.”

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

English sweat:

“In some places,” says Boekel, “the sick fell into sweats, flowing

more copiously in some than in others, so that a suspicion arose in

the minds of some physicians of that English sweat which laid waste

the human race so horribly in 1529;” and again, “the bodies were

wonderfully attenuated in a short time as if by a malignant sudden

colliquation, which made an end of the more solid parts, and took away

all strength[549].” The season of it was the summer.

The outbreak attracted much attention from its universality, and was

described by many abroad.

Boekel says that it was of such fierceness “that in the space of six

weeks it afflicted almost all the nations of Europe, of whom hardly

the twentieth person was free of the disease, and anyone who was so

became an object of wonder to others in the place.... Its sudden

ending after a month, as if it had been prohibited, was as marvellous

as its sudden onset.” It came up, he says, from Hungary and Pannonia

and extended to Britain. The principal English account of this

epidemic comes from Ireland[550]. In the month of August, 1580, during

the war against the Desmonds, an English force had advanced some way

through Kerry for the seizing of Tralee and Dingle; “but suddenlie

such a sicknes came among the soldiers, which tooke them in the head,

that at one instant there were above three hundred of them sicke. And

for three daies they laie as dead stockes, looking still when they

should die; but yet such was the good will of God that few died; for

they all recovered. This sicknesse not long after came into England

and was called the gentle correction.”

This outbreak among the troops in Ireland is said to have been in

August, before the sickness came to England. But it can be shown to

have been at its height in London in the month of July. The year 1580

was almost free from plague in London; the weekly deaths are at a

uniform low level (a good deal below the births) from January to

December, except for the abrupt rise shown in the following

table,--the kind of rise which we shall see from many other instances

to be the infallible criterion of an influenza[551]:

_Weekly Deaths in London._

1580.

Deaths by Dead of

Week ending all causes plague Baptised

June 23 55 2 59

" 30 47 4 57

July 7 77 4 65

" 14 133 4 66

" 21 146 3 61

" 28 96 5 64

Aug. 4 78 5 73

" 11 51 4 53

" 18 49 1 72

As in 1557-58, the English references are to agues, both before and

after the Gentle Correction of July-August, 1580. Cogan says that for

a year or two after the Oxford gaol fever (1577) “the same kind of

ague raged in a manner all over England and took away many of the

strongest sort in their lustiest age, etc.” And he seems to have the

name “gentle correction” in mind when he says: “This kind of sickness

is one of those rods, and the most common rod, wherewith it pleaseth

God to brake his people for sin.” Cogan’s dates are indefinite. But

there is a letter of the Earl of Arundel to Lord Burghley, 19th

October, 1582, which shows that “hot ague” was epidemic as late as the

second autumn after the influenza proper: “The air of my house in

Sussex is so corrupt, even at this time of the year, as when I came

away I left twenty-four sick of hot agues.”

Two such epidemics in England as those of 1557-8 and 1580-82, of hot agues

or strange fevers, taking the forms of simple tertian or double tertian or

quartan or other of the classical types, would have made ague a familiar

disease, and its name a household word. For not only were there two or

more aguish seasons (usually the summer and autumn) in succession, but to

judge by later experience there would have been desultory cases in the

years following, and in many of the seizures acquired during the height of

the epidemic, relapses or recurrences would have happened from time to

time or lingering effects would have remained. Hence it is unnecessary to

assume that the agues that we hear casual mention of had been acquired by

residence in a malarious locality. They may have been, and most probably

were, the agues of some epidemic prevalent in all parts of the country.

These epidemics were the great opportunities of the ague-curers, as we

shall see more fully in the sequel. It is to the bargaining of such an

empiric with a patient that Clowes refers in 1579: “He did compound for

fifteen pound to rid him within three fits of his ague, and to make him as

whole as a fish of all diseases.”

There were more sicknesses of that kind, perhaps not without a sweating

character, in the last ten years of the 16th century[552]. But they are

indefinitely given as compared with earlier and later epidemics, and I

shall pass to the next authentic instance.

The autumn of 1612 was undoubtedly a season of epidemic ague or “new

disease” in England[553]. When Prince Henry, eldest son of James I.,

fell ill in November, in London, during the gaieties attending the

betrothal of his sister the Princess Elizabeth to the Count Palatine

of the Rhine, a letter-writer of the time said of his illness: “It is

verily thought that the disease was no other than the ordinary ague

that hath reigned and raged almost all over England since the latter

end of summer[554].” The attack began in the end of October. The

spirited and popular prince had been leading the gaieties in place of

his father, who could not stand the fatigue, and was “seized by a

fever that came upon him at first with a looseness, but hath continued

a quotidian ever since Wednesday last [before the 4th of November],

and with more violence than it began, so that on Saturday he was let

blood by advice of most physicians, though Butler, of Cambridge, was

loth to consent. The blood proved foul: and that afternoon he grew

very sick.... I cannot learn that he had either speech or perfect

memory after Wednesday night, but lay, as it were, drawing on till

Friday between eight and nine of the evening that he departed. The

greatest fault is laid on Turquet, who was so forward to give him a

purge the day after he sickened, and so dispersed the disease, as

Butler says, into all parts; whereas if he had tarried till three or

four fits had been passed, they might the better have judged of the

nature of it; or if, instead of purging, he had let him blood before

it was so much corrupted, there had been more probability.” At the

dissection, the spleen was found “very black, the head full of clear

water and all the veins of the head full of clotted blood. Butler had

the advantage, who maintained that his head would be found full of

water, and Turquet that his brains would be found overflown and as it

were drowned in blood[555].” Butler, it appears, was “a drunken sot.”

When King James asked him what he thought of the prince’s case, he

replied “in his dudgeon manner” with a tag of verse from Virgil ending

with “et plurima mortis imago.” The Princess Elizabeth could not be

admitted to see her brother “because his disease was doubted to be

contagious[556].” It was at least epidemic, for in the same week

alderman Sir Harry Row and Sir George Carey, master of the wards, died

“of this new disease[557].” The earliest reference to it that I find

is the death, previous to 11 September, of Sir Michael Hicks at his

house Rackholt in Essex, “of a burning ague,” which came, as was

thought, by his often going into the water this last summer, he being

a man of years[558]; but much more probably was a case of “the

ordinary ague that hath reigned and raged almost all over England

since the latter end of summer.” The next year was still more

unhealthy, to judge by samples of parish registers; agues are

mentioned also in letters; thus, one going on 25 March, 1613, to visit

Sir Henry Savile, found him “in a fit, an ague having caught hold of

him[559].”

The winter of 1613-14 was marked by most disastrous floods in Romney

Marsh, in Lincolnshire, in the Isle of Ely, and about Wisbech, and

most of all in Norfolk[560]; but the malarious conditions so brought

about, being subsequent to, were not conceivably the cause of, the

epidemics of ague in the autumn of 1612 and 1613, which made so great

an excess of burials over christenings in the parish registers.

A curious record remains of an aguish sickness in a child, which had

begun about January, 1614. On 18 March, of that year, the dowager

Countess of Arundel wrote from Sutton, near Guildford, to her son Earl

Thomas, who was making the grand tour to Rome and elsewhere with his

wife, and had left the children to the care of their grandmother:

“Your two elder boys be very well and merry, but my swett Willm.

continueth his tersion agu still. This day we expect his twelfth fitt.

I assur myselfe teeth be the chefe cause. I look for so spedy ending

of it, he is so well and merry on his good days, and so strong as I

never saw old nor yonge bear it so well. I thank Jesu he hath not any

touch of the infirmity of the head, but onely his choler and flushe

apareth, but he is as lively as can be but in the time of his fits

onely, which continueth some eight hours[561].”

The epidemic of ague or “new disease,” which began to rage all over

England in the end of the summer, 1612, had probably recurred in the

years following, down to 1616. There is not a trace of plague during

those years in any known record; and yet they are among the most

unhealthy years in Short’s abstracts of town and country parish

registers[562].

The first half of the 17th century is a period which is almost a blank in

the conventional annals of “influenza” in Europe. But that period, which

was the period of the Thirty Years’ War, had many widespread sicknesses. I

do not wish to claim these as influenzas, or to contend that they were

infections equivalent thereto in diffusiveness. We may, however, find a

place for them in this context; for they were certainly as mysterious as

any epidemics admitted into the canon of influenzas. So far as concerns

Britain, the first was the epidemic ague, or “new disease,” of 1612 and

1613, probably recurring until 1616. The second was the universal spotted

fever of 1623 and 1624, of which I have given an account in the chapter on

typhus. That was followed by the plague of 1625, and that again by a

harvest ague in the country in the end of the same year. The next epidemic

ague or “general sickness, called the new disease,” fell mostly in England

upon the two years 1638 and 1639. It was in part a harvest ague, “a

malignant fever raging so fiercely about harvest that there appeared

scarce hands enough to take in the corn[563]”; but it was also a winter

disease. I pass over the war-typhus of 1643, to which the name of “new

disease” was also given, and the widespread fever of the year following.

In 1651 we hear again of a strange ague, which “first broke out by the

seaside in Cheshire, Lancashire and North Wales,” eighty or a hundred

being sick of it at once in small villages. Whitmore, who saw this

epidemic in Cheshire, identified it with the Protean disease which he

described in 1657-58, and hazarded the theory that the former was a

diluted or “more remiss” infection carried by the wind from Ireland, where

the plague was then raging, in Dublin, Galway, Limerick and other places,

after their sieges or occupations by the army of the Commonwealth.

Thus in the first half of the 17th century we have more or less full

evidence of epidemics of “new disease” in 1612-13, 1623-24, 1625, 1638-9,

1643-4 and 1651, not one of which was an influenza as we understand the

term[564].

We come at length to the years 1657-59, in the course of which one

catarrhal epidemic, or perhaps two, did prevail for a few weeks. The hot

agues or “new disease” had been raging all over the country from the

summer of 1657; then in April, 1658, there came suddenly universal coughs

and catarrhs, “as if a blast from the stars”; they ceased, and the hot

agues dragged on through the summer and autumn. A letter from London, 26

October, 1658, says: “A world of sickness in all countries round about

London: London is now held to be the wholesomest place,” and adds that

“there is a great death of coach-horses almost in every place, and it is

come into our fields[565].” It was after this, in the spring of 1659, if

Whitmore has made no mistake in his dates, that coughs and catarrhs

“universally infested London, scarce leaving a family where any store

were, without some being ill of this distemper.” The details have been

given fully in the former volume[566]. I wish merely to remark here that

the two catarrhal epidemics, or influenzas proper, in two successive

springs, were sharply defined episodes in the midst of a period of

epidemic agues, and that the “new disease” as a whole, during the two or

three years that it lasted, had such an effect in the way of ill health

and mortality that it was afterwards viewed as a “little plague” worthy of

being set in comparison with the Great Plague of 1665.

Willis does not say that the epidemic agues lasted after 1658, perhaps

because his essay was printed early in 1659; but Whitmore, whose preface

is dated November, 1659, says, without distinguishing the hot ague from

the catarrhal fever but speaking of them both as one Protean malady: “it

now begins again, seizing on all sorts of people of different nature,

which shows that it is epidemic.” Sydenham does not appear upon the scene

until 1661; but when his epidemic constitutions do begin, it is with

intermittents or agues, which lasted, according to him, until 1664.

Perhaps if Sydenham’s experience had extended back to 1657 he would have

made his aguish constitution to begin with that year, and to go on

continuously until 1664. At all events it does not appear that the year

1660 was a clear interval between Willis’s and Whitmore’s period of

1657-59, Sydenham’s period of 1661-64; for it so happens that John Evelyn

has left the following note of his own illness:

“From 17 February to 5 April [1660] I was detained in bed with a kind

of double tertian, the cruell effects of the spleene and other

distempers, in that extremity that my physicians, Drs Wetherburn,

Needham and Claude were in great doubts of my recovery.” Towards the

decline of his sickness he had a relapse, but on the 14th April “I was

able to go into the country, which I did to my sweete and native aire

at Wooton.” On the 9th of May he was still so weak as to be unable to

accompany Lord Berkeley to Breda with the address inviting Charles II.

to assume the crown.

Sydenham makes the “constitution” which began for him in 1661 to decline

gradually, and to end definitely in 1664, after which he finds

intermittents wholly absent for thirteen years, or until 1677. This clear

interval will make a convenient break in the chronology, whereat we may

bring in the popular and professional notions of ague then current, and

the popular practice in that disease by empirics.

The Ague-Curers of the 17th Century.

It is to be observed that all the respectable writers of the profession

speak of agues or intermittents as epidemic over the country for a

definite period, and as disappearing thereafter for years together. At the

same time they say little or nothing of the endemic malarious fevers of

marshy localities. Further, it appears that the professed ague-curers,

although they would wish to represent ague as a perennial disease, are

really basing upon the same experiences of occasional epidemics which

Willis, Whitmore and Sydenham recorded as occasional. The best instance of

this is the ‘Pyretologia’ by Drage of Hitchin. It was published for

practice in 1665, being designed to show forth the author’s skill as an

ague-curer[567]. When we examine its generalities closely, we find that

they all come from the sickly season of 1657, the first of those described

by Willis.

The great autumnal epidemic of that year (and the following), which we

know from other sources to have been reckoned a “little plague,” he

describes as “a malignant sickness,” which was followed in the winter

by quartans. He himself escaped the autumnal fever but he incurred the

quartan later in the year. In his own case, while the original

paroxysm of this ague was still going on, a new one arose towards

evening, and again, on the following day, a new paroxysm gathered

vigour and supplanted the old, becoming the substantive paroxysm. Many

of those who died of the quartan in 1657 had either the paroxysms

duplicated, or a total want of them, or, in another passage, “the

quartan which followed the autumnal disease of heterogeneous quality

in 1657, cut off divers old people, the fever being erratic,

duplicated or triplicated.” It was a bad sign when the quartan became

doubled or trebled; regularity of the paroxysm was a sign of a good

recovery. The symptoms of a quartan are various; but it is not easy to

pronounce that these all are the symptoms of an intermittent fever, or

the prodromal signs thereof, unless intermittent fevers be epidemic at

the time. He gives the case of a civil and pious priest who had a

tedious quartan from being struck with lightning; he was confined to

bed for two years, with loss of hearing, but, strangely enough,

retaining the use of his eyes; sometimes he was vexed with

convulsions, sometimes with quartan fever. The “plebs medicorum” say

that a quartan fever comes of melancholy, a tertian of choler, a

quotidian of putrefied pituitous matter. The “plebs plebis” think that

the cause is wind or flatus, and that they get rid of the ague by

belching. In his own case he observed that if he drank more cold ale

than usual, he was seized with distension in the loins and with

palpitation, and belched up “flatus and crass vapours infected with

the quality of a quartan.” He knew a man who, in the fourth or fifth

month of a quartan, drank wine too freely, so that the paroxysms came

every day, and that violently; after a week he had an especially

severe paroxysm, and then no more for three weeks, when the fever

returned under the type of an exquisite quartan. One case, which he

mentions twice, led him to doubt whether quartans were not catching:

a certain girl suffering from a quartan asked her father, who was

skilled in the art, to open a vein; her parent declared that during

the blooding the morbid smell of the flowing blood reached his

nostrils, so that he was seized of his daughter’s fever at the proper

time of her paroxysms, having three or four ague fits in due order;

meanwhile the girl was free from the paroxysms for a whole week, but

no longer. The singular nature of quartans is further brought out in

the fact that papules, pustules and exanthems breaking out on the skin

were quite common in the quartan fever which followed the malignant

epidemic of the autumn of 1657. “In the fevers hardly any heat is

perceived; and so the unskilled vulgar say ‘This is an ague’ (Hoc est

anglicè _Ague_), and ‘This is fever and ague’ (Et hoc est febris et

anglicè _Ague_) when cold and heat are mixed equally or combined

regularly.” Peruvian bark does not evacuate the morbific matter unless

by chance it provokes vomiting; cases treated by it often relapse, and

are not well in the intervals. Bark does not occur in his own

prescriptions; but he had cured many with “pentaphyllum.” He knew

several physicians in the epidemic of quartans in 1657 who trusted to

narcotics entirely.

Drage must have had a real experience of aguish distempers of one kind or

another during the sickly seasons of 1657-59. But it is clear from the

essays or advertisements of empirics that agues were discovered in many

forms of sickness that were neither intermittent fevers nor fevers of any

distinctive type. One of these practitioners in the time of Charles I.

claims to be “the king’s majesty’s servant in ordinary[568]”; which is not

incredible, as Sir Robert Talbor, whom Charles II. deigned to honour, was

an ague-curer of the same class.

“An ague, which hitherto amongst all sorts hath been accounted the

physitian’s shame, both for definition and cure (thus farre hath

ignorance prevailed), but that the contrary is manifest appeareth

sufficiently by this following definition: and shall be cured whether

tertian, quartern or quotidian, by me Aaron Streater, physitian of

Arts in Oxford, approved by Authority, the King’s Majesties servant in

ordinary, and dwelling against the Temple, three houses up in

Chancerie Lane, next house to the Golden Anchor.” An ague, he goes on,

“is either interpolate (intermittent) or continual; it is either

engendered of a melancholic humour or it is a splenetic effect; the

liver is obstructed by abundance of choler proceeding from a salt

rheum that cometh from the brain” etc. Agues are to be dreaded most

for their remote effects: “Say not therefore, ‘It is but an ague, but

a feaver; I shall wear it out.’ Dally not with this disease;” and he

adds a case to show what people may come to if they neglect an ague at

the beginning: “Being carried downe from London to South-hampton by

Master Thomas Mason,--September 1640, word was brought me of a Mayd

dead, 16 years of age: and being requested to see what disease she

dyed of, I took my chirurgion with me and went. And after section or

search, I found as followeth: a gallon and a half of green water in

the belly, that stunk worse than carrion; under the lyver an impostume

as bigg as my fist, full of green black corrupted matter, and the

lyver black and rot. The spleen and kidneys wholly decayed, and the

place as black as soot; the bowels they were fretted, ulcerated and

rotten. In the chesse was two great handfuls of black burnt blood in

dust or powder; the heart was all sound, but not a drop of blood in

it; nor one spoonfull in the whole body.

Here was an Annatomy indeed, skinne and bone; and I verily beleeve

that there was no braine left, but that she lived while that was

moyst: the sent was so ill, and I not well, that I forbore to search

it.

God that knowes the secrets of all hearts knowes this is a truth, and

nothing else here written. Arthur Fauset, chirurgion at Southampton,

was the man I employed to cut her up, as many there can witness that

were present.

And what of all this, may some say? Why this. An eight weeks’ ague in

the neglect of it breeds all these diseases, and finally death.”

Let us take next the advertisement of an apothecary a generation after,

who professed to cure Kentish agues,--“the description and cure of Kentish

and all other agues ... and humbly showing (in a measure) the author’s

judgment why so many are not cured, with advice in relation thereunto,

whether it be Quotidian, Tertian or Quartan, simple, double or

triple[569].” Before the Fire of London he had practised in Mark Lane, but

after his house was destroyed he removed to Kent, attending Maidstone

market every Thursday, and residing at Rochester, a city which, “besides

being subject to diseases in common with others, hath two diseases more

epidemical, namely, the Scurvey for one but the Ague in special.” The

symptoms of scurvy, as he gives them, cover perhaps the one moiety of

disease, and those of ague the other.

Agues are of two sorts, curable and incurable; the curable are those

that come in a common way of Providence, the incurable those that are

sent more immediately from God in the way of special judgment, as

instances adduced from Scripture show. What is an ague? Some think it

is a strange thing, they know not what; the more ignorant think it is

an evil spirit, but coming they know not whence. Agues have their seat

in the humours either within the vessels or without them; those

residing within are continual quotidians, continual tertians,

continual quartans; those without are intermittent ditto. (This

distinction of within and without the vessels is traditional, and is

found in Jones’s _Dyall of Agues_ as well as in Dutch medical books a

century later.) The paroxysms of the intermittents are really the

uprising of the Archaeus [of van Helmont], or spirit, to oppose the

rottenness of the humours. A quartan is harder to cure than any other

ague; part of its cure is an old 14th-century rule of letting blood in

the plague; “let blood in the left hand in the vein between the ring

finger and the little finger, which said thing to my knowledge was

done about sixteen years ago [to say nothing of three hundred years

ago] by the empiric Parker in this country, with very good success and

to his great honour and worldly advancement.” This ague-curer says

little of Peruvian bark; his specific is the powder of Riverius, “the

preparation of which, as well as some of the powder itself is lately

and providentially come to my hands.” Three doses cost not above five

shillings, “and I never yet gave more in the most inveterate of these

diseases.... My opinion is that he that will not freely part with a

crown out of his pocket to be eased of such a disease in his body

deserves to keep it.”

The most celebrated ague-curer of the Restoration period was Sir Robert

Talbor, who thus describes the high motives that made him a

specialist[570]:

“When I first began the study and practice of Physick, amongst other

distempers incident to humane bodies I met with a quartan ague, a

disease that seemed to me the _ne plus ultra_ of physic, being

commonly called Ludibrium et Opprobrium Medicorum, folly and derision

of my profession, did so exasperate my spirit that I was resolved to

do what study or industry could perform to find out a certain method

for the cure of this unruly distemper.... I considered there was no

other way to satisfy my desire but by that good old way, observation

and experiment. To this purpose I planted myself in Essex near to the

seaside, in a place where agues are the epidemical diseases, where you

will find but few persons but either are, or have been afflicted with

a tedious quartan. In this place I lived some years, making the best

use of my time I could for the improving my knowledge.”

Talbor’s first chapter is a fluent account of how agues are produced by

“obstructions” of the spleen. This was a matter of theoretical pathology

which an empiric could make a show with as well as another. But the

empiric betrays himself as soon as he comes to practice. The enlarged

spleen of repeated agues, or of the malarial cachexia, is commonly known

as the ague-cake. There is no doubt that much of the unhappiness of the

aguish habit resides in the ague-cake, and that one of the best pieces of

treatment is to apply counter-irritants or the actual cautery to the left

side, against which the enlarged spleen presses as a cake-like mass.

Talbor, however, desired to free the patient from his “ague-cake”

altogether:

“I have observed these in four patients: two were cast out the stomach

by nature, and the other two by emetic medicines. One of them was like

a clotted piece of phlegm, about the bigness of a walnut, pliable like

glue or wax, weighing about half an ounce; another about the bigness

of the yolk of a pullet’s egg, and like it in colour, but stiffer,

weighing about five drachms; the other two of a dark colour, more

tough, about the like bigness, and heavier. It is a general

observation amongst them that their ague comes away when they see

those ague-cakes[571].”

Having followed this “good old way of observation and experiment” for

several years among the residents of the Essex marshes, Talbor came to

London, and set up his sign next door to Gray’s Inn Gate in Holborn. In

1672 (14th July) he issued a small work with a Greek title--the quacks

were fond of the Greek character on their title-pages--“Πυρετολογια, a

rational account of the cause and cure of agues, with their signs:

whereunto is added a short account of the cause and cure of feavers.” He

made a bid also for practice in “scurvy,” a disease of landsmen in those

times which was more a bogey than ague itself--“a strange monster acting

its part upon the stage of this little world in various shapes,

counterfeiting the guise of most other diseases ... sometimes it is

couchant, other times rampant, so alternately chronic and acute.”

Most of the agues which Talbor professed to have met with in London in

those years must have been equally factitious: for Sydenham, who makes

more of “intermittents” than other writers of repute, was of opinion that,

for thirteen years from 1664 to 1677, fevers of that type had not been

seen in London, except some sporadic cases or cases in which the attack

had begun in the country. But the air was then full of talk and

controversy about Peruvian bark, or Jesuits’ powder (_pulvis patrum_), or

“the cortex,” which was cried up as a specific in agues by some, and cried

down by others. Talbor had seized upon this specific, and claimed to have

an original way of administering it, whereby its success was assured. We

get a glimpse of his practice from Dr Philip Guide, a Frenchman who came

to London and practised for many years as a member of the College of

Physicians[572]. Talbor had cured the daughter of Lady Mordaunt of an

ague, and the cure had reached the ears of Charles II. One of the French

princesses having been long afflicted with a quartan ague,

“The king commanded Mr Talbor to take a turn at Paris, and as a mark

of distinction he honoured him with the title of knight. He succeeded

wonderfully. But he could not cure Lady Mordaunt’s daughter a second

time, whom he had cured once before at London, by whom he gained most

of his reputation.” He tried for two months, but did not relieve the

symptoms. Dr Guide was called in, and being asked to give his opinion

of the ague that the young lady was afflicted with, “after some

inquiry I found her distemper was complicated and quite different from

the ague, which made me lay the thought of the ague aside, and apply

myself wholly to the complicated disease, which I effectually cured in

twelve days, together with her ague, without having any further need

of the infallible specific of Sir Robert Talbor.”

The Peruvian Bark Controversy.

It can hardly be doubted that the conflicting opinions as to the benefit

of Peruvian bark in ague, which have been often cited in disparagement of

medicine and as an example of its intolerance, arose from the

indiscriminate use of it in “agues” diagnosed as such by quacks and

pushing practitioners. The bark had been brought first to Spain in 1632

and had been tried medicinally in 1639[573]. It was under the powerful

patronage of the Jesuits, especially of Cardinal de Lugo, and most of it

at that time found its way to Rome, the centre of a malarious district. In

1652 it failed to cure a “double quartan” in an Austrian archduke, and

thereafter fell into some disrepute. A violent controversy on its specific

use in agues arose in the Netherlands; it had failed in every case at

Brussels, it had not failed in a single case at Delft. Meanwhile it

remained, very dear, sixty florins having been paid at Brussels in 1658

for as much as would make twenty doses, to be sent to Paris. The London

‘Mercurius Politicus’ of the week 9-16 December, 1658, contained an

advertisement[574] that a supply of it had been brought over by James

Thompson, merchant of Antwerp, and was to be had either at his own

lodgings at the Black Spotted Eagle in the Old Bailey or at Mr John

Crook’s, bookseller, at the sign of the Ship in St Paul’s Churchyard. The

London physicians such as Prujean and Brady countenanced it, and Willis,

in reprinting his essay on Fevers in 1660, spoke of it as coming into

daily use. Sydenham, whose publisher was the same Crook at the sign of the

Ship, made a brief reference to it in the first edition (1666) of his

_Observationes Medicae_, in the section upon the epidemic constitution of

intermittents during the years 1661-64. He admits that the bark could keep

down fermentation for the time being; but the _materies_ which the

fermentation would have dissipated if it had been allowed its way, will

remain in the system and quickly renew its power. He had known a quartan

continue for several years under the use of bark. It had even killed some

patients when given immediately before the paroxysm. Prudently and

cautiously given, in the decline of such fevers, it had been sometimes

useful and had stopped the paroxysms altogether, especially if the aguish

fits were occurring at a season when the malady was less epidemical. But

it is clear that Sydenham in 1666 inclined strongly to non-interference

with the natural depuratory action of the fever upon the _materies_ of the

disease. His teaching that the cortex, while it kept down the fermentation

of the blood for a time, left the dregs of the fever behind, was thus

popularly stated some years after by Roger North in relating the fatal

illness of his brother the Lord Keeper Guilford in the summer of

1685[575].

The fever of Lord Guilford was not an intermittent at all, but a

“burning acute fever without any notable remissions and no

intermissions,” a case of the epidemic typhus of that and the

succeeding year, elsewhere described. The treatment was first in the

hands of Dr Masters, pupil and successor of Dr Willis, whose cardinal

doctrine of fevers was that they were a natural fermentation of the

blood. He ordered phlebotomy. Next Dr Short, of another school, was

sent for: “So to work with his cortex to take it off: and it was so

done; but his lordship continued to have his headache and want of

sleep. He gave him quieting potions, as they called them, which were

opiates to make him sleep; but he ranted and renounced them as his

greatest tormentors, saying ‘that they thought all was well if he did

not kick off the clothes and his servant had his natural rest; but all

that while he had axes and hammers and fireworks in his head, which he

could not bear.’ All these were very bad signs; but yet he seemed to

mend considerably; and no wonder, his fever being taken off by the

cortex. And it is now found that, without there be an intermission of

the fever, the cortex doth but ingraft the venom to shoot out again

more perniciously.” The Lord Keeper’s illness dragged on, and at

length the physicians “found he had a lent fever which was growing up

out of the dregs which the cortex had left; and if it were not taken

off, they knew he would soon perish. So they plied him with new doses

of the same under the name of cordial powders, whereof the quantity he

took is scarce credible; but they would not touch his fever any more

than so much powder of port. And still he grew worse and worse. At

length the doctors threw up[576].”

Sydenham having indicated in his edition of 1666 that bark was dangerous

when given immediately before a paroxysm, but that it was sometimes useful

in the decline of the fever, and that its benefits were greatest in those

desultory agues which appeared at, or continued into, a season when agues

had become less epidemical, he proceeded in his third edition of 1675 to

enlarge these indications for giving bark in ague. He begins, as Talbor

had begun in his essay of 1672, and as the empiric Streater had in his

advertisement of 1641, by calling quartans the _opprobrium medicorum_, and

he then lays down precisely how bark was to be given in those obstinate

fevers, as well as in tertians of the aged or feeble: namely, after the

fever had exhausted itself _suo Marte_, in the intervals between two

paroxysms, an ounce of bark (in two ounces of syrup of roses) to be taken

in the course of the two free days, a fourth part at a time morning and

evening. The dosage may have been borrowed from Talbor, as Sir George

Baker alleges[577]; it matters little for anyone’s fame. Sydenham,

however, in a letter of October, 1677, thus claimed to have been

independent of Talbor so far as concerned the directions for giving bark

which he inserted in his edition of 1675:

“I have had but few trials, but I am sure that an ounce of bark, given

between the two fits, cures; which the physicians in London not being

pleased to take notice of in my book, or not believing me, have given

an opportunity to a fellow that was but an apothecary’s man, to go

away with all the practice on agues, by which he has gotten an estate

in two months, and brought great reproach on the faculty[578].”

Talbor was patronised by Charles II., who caused him to be made one of his

physicians. On 2 May, 1678, a few months after the date of Sydenham’s

letter, Lord Arlington wrote to the president of the College of

Physicians[579]: “His Majesty, having received great satisfaction in the

abilities and success of Dr Talbor for the cure of agues, has caused him

to be admitted and sworn one of his physicians.” Next year, 1679, the king

had an attack of the reigning ague, and a recurrence of it in 1680. It is

probably to the occasion of one or other of these attacks that an undated

letter belongs from the Marquis of Worcester to the marchioness: “The

physicians came to the Council to acquaint them that they intend to give

the king the Jesuit’s powder five or six times before he goes to

Newmarket, which they agreed to. He looks well, eats two meals of meat a

day, as he used to do[580].” Evelyn has preserved a story told him by the

Marquis of Normanby, which probably relates to the same aguish attack of

Charles II.[581]:

“The physicians would not give the _quinquina_ to the king, at a time

when, in a dangerous ague, it was the only thing that could cure him

(out of envy, because it had been brought into vogue by Mr Tudor

[Talbor] an apothecary), till Dr Short, to whom the king sent to know

his opinion of it privately, sent word to the king that it was the

only thing which could save his life, and then the king enjoined his

physicians to give it to him, which they did, and he recovered. Being

asked by this lord [Normanby] why they would not prescribe it, Dr

Lower said it would spoil their practice, or some such expression.”

What Dr Lower was most likely to have said was, that it went against his

principles to give bark in fevers. He was a physiologist, in the sense of

an anatomist, the pupil of Willis at Oxford and his successor in practice

in London. It was the teaching of Willis that blood was like the juice of

vegetables, particularly the juice of the grape, in respect of fermenting,

just as it was like milk in respect of curdling. Fever was a sudden access

of fermentation, apt to arise in spring and autumn, from internal or

constitutional occasions, as well as to come at any time by infection; by

this febrile ferment, ebullition or commotion, the blood was purged of

certain impurities, comparable to the lees of wine, which were removed

from the body in the sweat, the urine or other critical evacuation.

Jesuit’s bark was believed to check fermentation, or, in the later phrase

of Pringle and others, it was antiseptic; and it was probably because he

thought it would check the natural defaecating action of the blood in an

ague that Lower refused to prescribe it. Sydenham was more tentative,

pliant, empirical. He cavilled at Willis’s doctrine of the ebullition or

fermentation of the blood without actually rejecting it; for he held

practically the same view of the salutary or depuratory nature of fever,

which was indeed the Hippocratic view of it. Accordingly in his first

reference to bark, in 1666, he sustains the objection to it, that it

interfered with a natural depuratory action; and it was only in following

the lead of Talbor, a more empirical person than himself, that Sydenham

overcame his doctrinal scruples. Dr Short, to whom Charles II. sent

privately for advice, was of Sydenham’s party; soon after that occasion,

the latter dedicated to Short his ‘Tractate on Gout and Dropsy’ (1683). It

was Short who “went to work with his cortex” upon the Lord Keeper in 1685,

after Dr Masters, of the school of Willis, had tried his hand with

phlebotomy. The king’s experiences, a few months before the Lord Keeper’s

death, had been just the same, and with the same result: the deathbed of

Charles II., it is well known, was the scene of ecclesiastical rivalries;

but the physicians at the bedside of the king had their rivalries too.

On Monday the 2nd of February, at eight in the morning, the king had a

seizure of some kind in his bed-chamber, which was currently said to have

been an “apoplectic fit[582],” although there is nothing said of

paralysis. A letter of the 3rd February[583] says the king “was seized in

his chair and bed-chamber with a surprising convulsion fit which lasted

three hours.” Dr King, an expert operator who had assisted Lower in the

delicate operation before the Royal Society on 23 November, 1667, of

transfusing blood from one body to another, happened to be at hand, and,

at once drawing his lancet, bled the king. His promptitude in action,

which probably left him little time for diagnosis, was much applauded, and

the Privy Council voted him a reward of a thousand pounds, which Burnet

says he never received.

“This rescued his Majesty for the instant,” says Evelyn, (who came up

from Wooton on hearing the news, and is probably correct in his

narrative), “but it was only a short reprieve. He still complained,

and was relapsing, often fainting, with sometimes epileptic symptoms,

till Wednesday, for which he was cupp’d, let blood in both jugulars,

had both vomit and purges, which so reliev’d him that on Thursday

hopes of recovery were signified in the public Gazette; but that day,

about noone, the physitians thought him feverish. This they seem’d

glad of, as being more easily allay’d and methodically dealt with than

his former fits; so as they prescribed the famous Jesuit’s powder: but

it made him worse, and some very able doctors who were present did not

think it a fever, but the effect of his frequent bleeding and other

sharp operations us’d by them about his head, so that probably the

powder might stop the circulation, and renew his former fits, which

now made him very weake. Thus he pass’d Thursday night with greate

difficulty, when, complaining of a paine in his side, they drew 12

ounces more of blood from him; this was by 6 in the morning on Friday,

and it gave him reliefe; but it did not continue, for being now in

much paine, and struggling for breath, he lay dozing, and after some

conflicts, the physitians despairing of him, he gave up the ghost at

halfe an houre after eleven in the morning, being 6 Feb. 1685, in the

36th yeare of his reigne, and 54th of his age.... Thus died King

Charles II. of a vigorous and robust constitution, and in all

appearance promising a long life[584].”

Whether the bark would have saved him if the aguish nature of the

paroxysms (such as he had in 1679 and again in 1680) had been clear from

the first, may be doubted. But his chances of recovery were certainly made

worse by the halting and stumbling diagnosis, (according to Evelyn)--now

apoplexy, now epilepsy, now fever[585].

The true value of cinchona bark in medicine was not seen until much that

was vague in the use of the term “ague” had been swept away. In the last

great epidemic period of agues in this country, as we shall see, from 1780

to 1786, bark was found, for some reason, to be ineffective. It is not in

the treatment of epidemic agues, but of agues in malarious countries, that

the benefits of Jesuits’ bark have been from first to last most obvious.

The practice in so-called agues was long in the hands of empirics, who,

like their class in general, made business out of ignorant or lax

diagnosis. I shall add here what remains to be said of specialist

ague-curers in later times. They are heard of in London in the Queen Anne

period, and as late as 1745.

Swift writes in his Journal to Stella, 25 December, 1710, from Bury

Street, St James’s: “I tell you a good pun: a fellow hard by pretends

to cure agues, and has set out a sign, and spells it _egoes_; a

gentleman and I observing it, he said, ‘How does that fellow pretend

to cure agues?’ I said, I did not know, but I was sure it was not by a

_spell_. That is admirable.” In 1745, Simon Mason, of Cambridge,

published by subscription and dedicated to Dr Mead an essay, _The

Nature of an Intermitting Fever and Ague considered_ (Lond. 1745), in

which he has the following on “charm-doctors”:--“When one of these

poor wretches apply to a doctor of this stamp, he enquires how many

fits they have had; he then chalks so many strokes upon a heater as

they tell him they have had fits, and useth some other delusions to

strengthen the conceit of the patient” (p. 167). Francis Fisher, who

had been upper hostler in a livery stable in Crutched Friars near

forty years, “told me he seldom missed a week without several ague

patients applying to him, and he cured great numbers by a charm they

wore in their bosoms” (p. 239). Another, who kept a public-house near

St George’s Fields, Southwark, sold “febrifuge ale” at a shilling a

pint. It was a small ale brewed without hops, but with bark,

serpentery, rhubarb and cochineal mixed in the brewing. The receipt

was given him by an old doctor who was a prisoner in the King’s Bench.

His customers came in the morning fasting, and drank their shilling’s

worth after the publican had given them faith by a cordial grip of the

hand. “By this means,” he told Mason, “I got a good trade to my house,

and a comfortable maintenance too.”

We may now return to the actual history of the epidemic fevers upon which

the Peruvian bark was first tried on a large scale in England. The

“intermittent” constitution which began in 1677 and lasted year after year

until 1781 or even longer was a very remarkable one. It was called at the

time the new fever, or the new ague, and it had at least one short

interlude of influenza or epidemic catarrhal fever in the winter of 1679,

just as the last epidemic of the kind, in 1657-59, had at least one, and

probably two, short and swift epidemic catarrhs in spring. But before we

come to that epidemic of 1678-81, there falls to be noticed an epidemic in

the month of November, 1675, which has always been counted among the

influenzas proper. After giving the particulars of it from Sydenham and

from the London bills of mortality, I shall show from Sydenham and the

bills of mortality that there was an exactly similar epidemic in the month

of November, 1679, which has not been admitted into the conventional list

of influenzas. Thereafter I shall proceed to the epidemic constitution of

1678-81 as a whole, which has been reckoned among the epidemic agues or

malarious epidemics.

The Influenza of 1675.

The first that we hear of the universal cold of 1675 is an entry which

Evelyn makes in his diary under 15 October: “I got an extreme cold, such

as was afterwards so epidemical as not only to afflict us in this island,

but was rife over all Europe, like a plague. It was after an exceeding dry

summer and autumn.” It was not until November that the epidemic cold made

an impression upon the death-rate in London; the deaths mounted up from

275 in the week ending 2 November, to 420 and 625 in the two weeks

following, and thereafter gradually declined to an ordinary level. Part of

the excess, but by no means the greater part of it, was set down under

fevers, as the following section from the weekly bills of the year will

show:

1675

Griping in

Week Ending Fever Smallpox the Guts All causes

Nov. 2 42 9 29 275

9 60 12 42 420

16 130 13 43 625

23 99 2 28 413

30 61 6 29 349

Dec. 7 54 7 25 308

14 43 5 12 266

This shows the characteristic rise and fall of an epidemic catarrh both

in the article of fever deaths and in the column of deaths from all

causes. The other excessive articles besides fever in the two worst weeks

are also characteristic of influenza mortality:

Week ending Week ending

9 Nov. 16 Nov.

Consumption 68 99

Aged 40 67

Tissick 10 35

Sydenham’s account bears out the figures[586]. At the end of October, he

says, the mild, warm weather turned to cold, while catarrhs and coughs

became more frequent than at any time within his memory. They lasted until

the end of November, when they ceased suddenly. Afterwards he gives a

special chapter to the “Epidemic Coughs of the year 1675, with Pleurisies

and Pneumonias supervening.” The epidemic spared, he says, hardly anyone

of whatever age or temperament; it went through whole families at once. A

fever which he calls _febris comatosa_ had been raging far and wide since

the beginning of July, with which in the autumn dysenteric and diarrhoeal

disorders were mingled (it was an exceedingly dry season). This

constitution held the mastery all the autumn, affecting now the head, now

the bowels, until the end of October, when catarrhs and coughs became

universal and continued for a month. Sydenham’s view of the sequence of

events was his usual one, namely, that one constitution, by change of

season, passed by transition into another. Whatever the constitution of

“comatose” fevers may have been, which prevailed “far and near,” it has

left no trace upon the bills of mortality in London, which are remarkably

low until the beginning of November. But as soon as the epidemic of coughs

begins, the weekly deaths mount up in an unmistakeable manner, so that for

two or three weeks in November, the mortality is nearly double that of the

weeks preceding or following.

The “severe cold and violent cough,” of 1675, says Thoresby of Leeds[587],

who was then a boy, “too young or unobservant to make such remarks as

might be of use,” was known in the north of England “profanely” by the

name of the “jolly rant.” Thoresby well remembered that it affected all

manner of persons, and that so universally that it was impossible, owing

to the coughing, to hear distinctly an entire sentence of a sermon. He

gives December as the month of it in Leeds, and says that it affected

York, Hull, and Halifax, as well as the counties of Westmoreland, Durham,

and Northumberland. In Scotland also we find a trace of a strange epidemic

sickness. It was the time of the persecution of the Covenanters, whose

preachers moved hither and thither among the farm-houses. One of them,

John Blackadder, was at the Cow-hill in the parish of Livingstown in

August, 1675. He came in one evening from the fields very melancholy, and

in reply to questions, he said he was afraid of a very dangerous

infectious mist to go through the land that night. He desired the family

to close doors and windows, and keep them closed as long as they might,

and to take notice where the mist stood thickest and longest, for there

they would see the effects saddest. “And it remained longest upon that

town called the Craigs, being within their sight, and only a few families;

and within four months thereafter, thirty corpses went out of that

place[588].” The prophecy was fulfilled within four months, which would

bring us to the date of the influenza, although the mortality for a small

place is somewhat excessive.

The Influenza of 1679.

For the sake of comparison, I pass at once to an epidemic of coughs and

colds in the month of November, 1679, which Sydenham has chronicled, but

no one except Cullen[589] has thought of including among the influenzas.

It produced the characteristic effect of influenza on the London weekly

bills, and it came in the midst of epidemic agues, just as the epidemic

catarrhs of 1658 and 1659 had done. The following rise and fall are just

as distinctive of an influenza as on the last occasion in 1675:

1679

Griping of

Week ending Fever Smallpox the Guts All causes

Nov. 11 50 18 34 328

18 89 27 39 541

25 126 21 55 764

Dec. 2 82 27 38 457

9 63 12 38 388

Sydenham’s account[590] of this remarkable November outburst of sickness

in London, written within a few weeks of its occurrence, is almost exactly

a repetition of his language concerning the epidemic coughs of November,

1675. The prevailing intermittent fevers, he says, gave place to a new

epidemic depending upon a manifest crasis of the air. The new epidemic was

one of coughs, which were so much more general than at the same season in

other years that in nearly every family they affected nearly every person.

In some cases of the cough, the aid of a physician was hardly needed; but

in others the chest was so shaken by the violent convulsive cough as to

bring on vomiting, and the head was affected with vertigo. For the first

few days the cough was almost dry, and so purely paroxysmal as to remind

Sydenham of the whooping-cough of children. Everyone was surprised, he

says, at the frequency of these coughs in this season. His own suggestion

was that the rains of October[591] had filled the blood with crude and

watery particles, that the first access of cold had checked transpiration

through the skin, and that Nature had contrived to eliminate this serous

colluvies either by the branches of the “vena arteriosa” or (as some will

have it) by the glands of the trachea, and to explode it by the aid of a

cough. Phlebotomy and purging were the best cures; diaphoretics he

considered less safe, and he ascribed to their abuse the fever into which

some fell, and the pleurisies which were apt to attack patients with great

violence during the subsidence of the epidemic catarrh.

The Epidemic Agues of 1678-80.

The other English writer on the epidemic constitution of 1678-79 is Dr

Christopher Morley[592]. Like Sydenham, he is occupied almost exclusively

with the epidemic agues; but he also records the extraordinary rise of the

mortality in London for a few weeks in the last months of the year, and

the causes thereof, although it did not occur to him to count that as a

separate part of “the new disease,” still less as the principal part,

which it really was in London so far as concerned the death-rate. Dating

his preface from London, the 31st of December, 1679, he says in the text:

“Within the very days of my present writing, it happens that as many as

four hundred deaths more than usual have taken place in a fortnight,” the

excessive mortality having been due to “coryza, bronchitis, catarrh, cough

and fever,” which were the effects of “most pernicious destillations.”

I shall now go back to the beginning of the epidemic constitution in the

midst of which this November interlude occurred, and I shall follow it

season after season to the end, so as to set forth in historical

prominence that which was regarded at the time as “the new disease.” When

Sydenham returned to London in the autumn of 1677, after six months’ rest

from practice, he was told by his professional friends that intermittents

were being seen here and there (after a clear interval of thirteen years),

being more frequent in the country than in the city. In the letter of

October, 1677, cited above, he speaks of Talbor having made a fortune in

two months by his cures of agues with bark.

The first particular notice of the “new fever” occurs in a London

letter of 23 February, 1677/78: “Lady Katherin Brudenhall has been in

great danger of death by the new feaver[593].” A severe aguish illness

of Roger North, fully described in his ‘Autobiography,’ was probably

another instance of the reigning malady; it came upon him in the hot

weather of 1678, while he was residing with his brother, Lord

Guilford, at Hammersmith[594]. In the autumn of 1678, the “new fever”

came more into notice. On the 8th of September, a letter was brought

to Evelyn in church, from Mr Godolphin (afterwards celebrated as the

minister of William III.), to say that his wife was exceedingly ill

and to ask Evelyn’s prayers and assistance. Evelyn and his wife took

boat at once to Whitehall, and found the young and much-beloved Mrs

Godolphin “attacqu’d with the new fever then reigning this excessive

hot autumn, and which was so violent that it was not thought she could

last many hours.” She died next day, in her twenty-ninth year; but, as

she had been brought to bed of a son six days before, her fever may

have been more from puerperal causes than from “the new fever then

reigning.” Other known cases of ague the next season were those of Sir

James Moore, his majesty’s engineer, who, in August, 1679, coming from

Portsmouth “was seized with an ague, and had two or three violent

fits, which carried him off[595];” and of the king, Charles II., who

was congratulated on his recovery by the lord mayor and aldermen, on

15 September, and had a recurrence of the aguish attack (“two or three

fits”) on 15 May, 1680[596]. There are also references to the agues of

1679 in the country, in the letters of Lady North[597].

Sydenham wrote his account of this epidemic of intermittents in compliance

with a request from Dr Brady, Master of Gonville and Caius College,

Cambridge, that he would continue the method of his ‘Observationes

Medicae’ into the years following, and in particular give an account of

his method of administering bark. He occupied most of his space with

treatment; but he gives here and there the following epidemiological

details. The agues were mostly tertians, or quotidians, or duplex forms of

these, whereas on a former occasion they had been mostly quartans; after

two or three intermissions they were apt to become continual fevers. The

agues, which had occurred in the spring of 1678, became more common in the

summer and autumn, when they raged so extensively that no other disease

deserved the name of epidemic so much. In winter smallpox took the lead;

but early in July, 1679, the agues began again, and so increased day by

day that in August they were raging excessively and destroying many. It

was in August that the king had his “great cold” at Windsor, which

afterwards changed to an ague. Sydenham then comes to the November

interlude of epidemic catarrhs, which was followed by “a fever without

cough” (_non penitus deleta, sed manente adhuc in sanguine, malae crasis

impressione_), lasting to the beginning of 1680. As that year wore on, the

intermittent fevers began again, and continued more or less until 1685,

becoming indeed less common in London, and less severe, than in the first

four years of the constitution, but in other places, now here, now there,

not less so than at first[598].

I have kept to the last the special account of this epidemic written by

Morley at the end of the second year of it, namely, in December, 1679. He

had been a witness of this fever, first at Leyden in the autumn of 1678,

and next in England in the autumn of 1679, and he made it the subject of a

treatise at the request of an eminent physician in London. It was not so

severe by half in England as in Holland, but the English made a great deal

more of it, calling it the New Disease, the New Ague, the New Fever, the

New Ague Fever, and, in Derbyshire sarcastically, the New Delight. In

Holland they called it neither new nor old, neither intermittent nor

continued, nor a conjunction of both, but simply _morbus epidemicus_, or

_febris epidemica_. His master at Leyden, Professor Lucas Schacht, taught

very decidedly that it was of a scorbutic nature, and as early as the

month of June, 1678, had prophesied the arrival of such an epidemic fever

because “tertians were becoming more and more scorbutic,” just as they had

done before the great epidemic of fever in Holland in 1669. Morley claims,

however, that the fever of 1678 was in some respects different from that

of 1669, as well as from that of the year immediately preceding, 1677,

when “an incredible multitude of people all over Belgium, and in every

city and town, fell sick.” The Dutch, it appears, called these occasional

outbreaks simply “the epidemic fever,” neither intermittent nor continued;

and certainly that of 1669, which is sometimes counted among the epidemic

agues, was a very remarkable “ague.” (See Chapter I. p. 19.)

The epidemic fever of 1678, wherever it may have been bred or engendered,

was prevalent in England at the same time as in Holland--in an exceedingly

hot and dry autumn. The most constant symptoms, says Morley (and he writes

both for Holland[599] in 1678 and for the country districts of England in

the autumn of the following year), were nausea, severe vomiting,

incredible tightness about the breast, weight in all the limbs, weariness,

giddiness, vigils, thirst, restless tossing, and languor remaining after

the disease was gone. Among the more remarkable symptoms were the

following: Many had aphthae of the mouth, some twice or thrice, some being

endangered by the severity and closeness of the patches of thrush. In some

there occurred bleeding from the nose, or from piles, stranguary, etc.

Round worms were observed, issuing both by the mouth and anus. In some few

there were spots on the skin, but hardly ever petechiae or tumours near

the ears. It affected all classes equally, all ages and both sexes. Some

said it was easier to children than to adults, but others denied this.

Some said it was more pernicious in the country than in the towns. In

Leyden, the deaths never exceeded 150 in the week, being about twenty in a

week above the ordinary level. More died from the coughs, anginas,

peripneumonies and pleurisies that followed, than from the disease itself.

Schacht says that the wind for nearly two years had been steadily from the

North, or veering to the East or West. The Leyden faculty, and the Dutch

generally, did not think the disease a malignant one; it was very freely

called so, however, in England, the chorus being led by empirics and

illiterate persons: “Ac indicio est,” says Morley, “libellus perexiguus

nostra lingua ab Empirico conscriptus de hoc morbo.” This seems to refer

to the tract by one Simpson, which I shall notice briefly[600].

Simpson styles himself a Doctor of Physic, and denies that he is an

empiric. One sign of his affinity to that order, however, is that he

objects to the orthodox treatment--emetics, drenches, a too cooling

regimen, and purges, while he thinks blood-letting of doubtful

utility. The symptoms were chills at the outset, pains in the head and

back (in some with shaking), then intense burning heat, thirst,

profuse immoderate sweats and great debility, a general lassitude,

dulness, and stupor which in many were followed by delirium and a

comatose state. Sometimes the fever simulated a quotidian, sometimes a

tertian. He calls it “this new fever so grassant in city and country”

and says that in many it assumed “the guise of a morbus cholera, known

by the much vomitings or often retchings to vomit; and in others under

the livery of the gripes with looseness, or, in some, looseness

without gripes.” This choleraic tendency concurring with other usual

causes from the late season of fruit-eating etc., had swelled the

bills of mortality. The morbus cholera and the gripes were to the new

fever “like the circumjoviales that move in the same sphere with (but

at some distance from) their master-planet.”

The meaning of all this is obvious on turning to the London weekly, bills

of mortality. In the months of August and September for three years in

succession, 1678-80, the deaths from “griping in the guts” and from

“convulsions” rose greatly. These were, indeed, three successive seasons

of fatal diarrhoea, mostly infantile, as I shall show in the chapter on

that disease.

The following extracts from the London weekly bills of mortality show how

“fevers,” as well as other diseases, contributed to the great rise in the

autumns of 1678, 1679, and 1680.

_Autumnal London Mortality in 1678._

1678

Griping

Week ending Fever Smallpox in Guts All causes

Aug. 20 77 31 87 459

27 79 37 130 510

Sept. 3 82 37 121 530

10 103 27 164 621

17 82 23 178 580

24 83 20 152 528

Oct. 1 82 25 117 485

8 77 27 106 456

_Summer and Autumnal London Mortality in 1679._

1679

Griping

Week ending Fever Smallpox in Guts All causes

July 22 42 55 101 442

29 60 50 134 565

Aug. 5 78 63 143 531

12 62 43 161 579

19 55 64 149 545

26 68 53 112 514

Sept. 2 96 40 97 466

9 92 47 75 471

16 85 50 87 462

(For the Influenza weeks, see former Table.)

_Autumnal London Mortality in 1680._

1680

Griping

Week ending Fever Smallpox in Guts All causes

Aug. 10 70 17 108 427

17 90 6 132 494

24 98 17 127 552

31 140 18 228 816

Sept. 7 101 14 215 671

14 94 13 173 635

21 106 9 175 628

28 130 9 159 615

Oct. 5 125 16 138 597

12 121 10 94 530

19 109 14 68 488

26 93 5 58 407

Nov. 2 77 10 53 396

The last of the three autumnal seasons, 1680, is one of the few in the

bills with high deaths from fever along with high deaths from choleraic

disease; and that excess of fever mortality may have been due in part to

the ague epidemic, then in its third season.

The following extracts from Short’s summation of parish registers show the

great excess of burials over baptisms in various parts of England during

the years of the aguish epidemic constitution.

_Country Parishes._

Registers Sickly Baptisms Burials

Year examined parishes in do. in do.

1678 136 17 312 527

1679 137 44 800 1203

1680 137 54 1093 1649

1681 137 41 679 1156

1682 140 30 632 975

_Market Towns._

Registers Sickly Baptisms Burials

Year examined parishes in do. in do.

1678 22 5 578 789

1679 23 7 877 1371

1680 24 7 946 1494

1681 24 9 945 1333

1682 25 9 795 1092

1683 25 8 1109 1398

1684 25 8 865 1243

1685 25 4 741 1191

The Influenza of 1688.

The seasons continued, according to Sydenham, to produce epidemic agues

until 1685, when the constitution radically changed to one of pestilential

fevers, affecting many in all ranks of society and reaching a height in

1686. Sydenham records nothing beyond that date, having shortly after

fallen into ill health and ceased to write or even to practise. One would

wish to have known what he made of the “new distemper” in the summer of

1688, for it was a sudden universal fever, and yet not a catarrh or a

“great cold.” It is thus referred to in a letter of the month of June,

from Belvoir, Rutlandshire[601]: “The man that dos the picturs in inemaled

is gon up to London for a weke.... I wish the man dos not get this new

distemper and die before he comes agane.” On turning to the London weekly

bills of mortality we find in the first weeks of June the characteristic

rise of one of those sudden epidemic fevers or new diseases, of which the

earliest with recorded figures was the “gentle correction” of July, 1580.

The following are the weekly London figures corresponding to the “new

distemper” of 1688:

_Weekly London Mortalities._

1688

Week ending Fevers All causes

May 29 58 368

June 5 76 518

12 101 559

19 65 435

26 66 437

The contemporary London notice of this “influenza” comes from Dr Walter

Harris, who mentioned it in a book written the year after[602]:

“From the middle of the month of May in the year 1688, for some weeks,

a slight sort of fever became epidemical. It affected the joints of

the patients with slight pains, and they complained of a pain in their

heads, especially in the fore-part, and of a sort of giddiness. It was

more rife than any that I ever observed before, from any cause

whatsoever, or in any time of the year. A great many whole families

were taken at once with this fever, so that hardly one out of a great

number escaped this general storm. Now this so epidemical or febrile

insult seemed plainly to me to depend upon the variety of the season

of the year, the most intense heat of some days being suddenly changed

to cold.... Never were so many people sick together: never did so few

of them die. They recovered under almost any regimen,--almost everyone

of them.”

It will be seen, however, that the bills rose very considerably for four

weeks, and that, too, in the healthiest season of the year.

A somewhat fuller account of its symptoms is given by Molyneux for

Dublin[603]. He had been informed by a learned physician from London that

it had been as general there as in Dublin, which we know to have been the

case from Harris’s account. Both Molyneux and Harris call it a slight

fever, without mentioning catarrhal symptoms. The spring months

immediately preceding had been remarkable for drought.

At Dublin this “short sort of fever” was first observed about the

beginning of July, or some six weeks later than in London. “It so

universally seized all sorts of men whatever, that I then made an

estimate not above one in fifteen escaped. It began, as generally

fevers do, with a chilness and shivering all over, like that of an

ague, but not so violent, which soon broke out into a dry burning

heat, with great uneasiness that commonly confined them to their beds,

where they passed the ensuing night very restless; they commonly

complained likewise of giddiness, and a dull pain in their heads,

chiefly about the eyes, with unsettled pains in their limbs, and about

the small of their back, a soreness all over their flesh, a loss of

appetite, with a nausea or aptness to vomit, an unusual ill taste in

their mouths, yet little or no thirst. And though these symptoms were

very violent for a time, yet they did not continue long: for after the

second day of the distemper the patient, usually of himself, fell into

a sweat (unless ’twas prevented by letting blood, which, however

beneficial in other fevers, I found manifestly retarded the progress

of this): and if the sweat was encouraged for five or six hours by

laying on more cloaths, or taking some sudorifick medicine, most of

the disorders before mentioned would entirely disappear or at least

very much abate. The giddiness of their head and want of appetite

would often continue some days afterwards, but with the use of the

open fresh air they certainly in four or five days at farthest

recovered these likewise and were perfectly well. So transient and

favourable was this disease that it seldom required the help of a

physician; and of a thousand that were seized with it, I believe

scarce one dyed. By the middle of August following, it wholly

disappeared, so that it had run its full course through all sorts of

people in seven weeks time.... This fever spread itself all over

England; whether it extended farther I did not learn.”

This short fever of men was preceded by a slight but universal

horse-cold[604].

The Influenza of 1693.

Molyneux considered the strange transient fever of the summer of 1688 to

have been the most universal fever that perhaps had ever appeared, and he

thought the universal catarrh of five years’ later date (1693) to have

been “the most universal cold.” We have thus a means of contrasting in the

descriptions of the same author a universal slight fever and a universal

catarrh, which happened within five years of each other, and were neither

of them called at the time by the name of influenza,--a name not known in

Britain until half a century later. Before coming to Molyneux’s

description, it should be said that the London bills of mortality bear no

decided trace of an influenza in the end of the year 1693, the following

being the highest weekly mortalities nearest to the date given for the

epidemic at Dublin[605]:

_London Weekly Mortalities._

1693

Week ending Fever All causes

October 10 43 353

17 62 353

24 53 384

31 69 457

November 7 68 455

14 48 365

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

“The coughs and colds that lately so universally prevailed gave us a

most extraordinary instance how liable at certain times our bodies

are, however differing in constitution, age and way of living, to be

affected much in the same manner by a spreading evil.... ’Twas about

the beginning of November last, 1693, after a constant course of

moderately warm weather for the season, upon some snow falling in the

mountains and country about the town [Dublin], that of a sudden it

grew extremely cold, and soon after succeeded some few days of very

hard frost, whereupon rheums of all kinds, such as violent coughs that

chiefly affected in the night, great defluxion of thin rheum at the

nose and eyes, immoderate discharge of the saliva by spitting,

hoarseness in the voice, sore throats, with some trouble in

swallowing, whesings, stuffings and soreness in the breast, a dull

heaviness and stoppage in the head, with such like disorders, the

usual effects of cold, seized great numbers of all sorts of people in

Dublin.

“Some were more violently affected, so as to be confined awhile to

their beds; those complained of feverish symptoms, as shiverings and

chilness all over them, that made several returns, pains in many parts

of their body, severe head-aches, chiefly about their foreheads, so as

any noise was very troublesome: great weakness in their eyes, that the

least light was offensive; a perfect decay of all appetite; foul

turbid urine, with a brick-coloured sediment at the bottom; great

uneasiness and tossing in their beds at night. Yet these disorders,

though they very much frightened both the sick and their friends,

usually without help of remedy would abate of themselves, and

terminate in universal sweats, that constantly relieved.... When the

cold was moderate, it usually was over in eight or ten days; but with

those in whom it rose to a greater height, it continued a fortnight,

three weeks, and sometimes a month. One way or other it universally

affected all kinds of men; those in the country as well as city; those

that were much abroad in the open air, and those that stay’d much

within doors, or even kept close in their chambers; those that were

robust and hardy, as well as those that were weak and tender--men,

women and children of all ranks and conditions.... Not one in thirty,

I may safely say, escaped it. In the space of four or five weeks it

had its rise, growth, and decay; and though from first to last it

seized such incredible numbers of all sorts of men, I cannot learn

that any one truly dyed of it, unless such whose strength was before

spent by some tedious fit of sickness, or laboured under some heavier

disease complicated with it.... It spread itself all over England in

the same manner it did here, particularly it seized them at London and

Oxford as universally and with the same symptoms as it seized us in

Dublin; but with this observable difference that it appeared three or

four weeks sooner in London, that is, about the beginning of

October.... Nor was its progress, as I am credibly informed, bounded

by these Islands for it spread still further and reached the

Continent, where it infested the northern parts of France (as about

Paris) Flanders, Holland, and the rest of the United Provinces with

more violence and no less frequency than it did in these countries.”

Yet no other writer, English or foreign, appears to have mentioned it. Its

existence rests on the authority of Molyneux alone, according to the above

very circumstantial narrative.

The Influenza of 1712.

There were so many fevers from 1693 to the end of the century that it is

not easy to distinguish epidemic agues or catarrhs among them. If we

follow the continental writers, it is not until 1709 and 1712 that there

is any concurrence of testimony for such widespread maladies. Evelyn,

however, says that in the remarkably dry and fine months of February and

March, 1705, “agues and smallpox prevail much in every place” (21st

February). The very general coughs and catarrhs of 1709 seem to have been

really caused by the severity of the memorable hard winter, the frost

having begun in October, 1708 and lasted until March, 1709. The evidences

of a truly epidemic infectious catarrh or influenza all over Europe in

1709 are scanty and ambiguous. It is probably to this “universal cold”

that Molyneux refers under the year 1708[607]; but English writers have

not otherwise mentioned an epidemic in 1709.

The next, in 1712, was a “new ague” of the kind without catarrhal

symptoms, like that of 1688. One German writer called it the

“Galanterie-Krankheit,” another the “Mode-Krankheit,” and it was about the

same time that the French name “la grippe” came into use. These names all

mean “the disease _a la mode_” or the reigning fashion[608]; they remind

one of the earlier “trousse galante” and “coqueluche” (a kind of bonnet),

and of the “grande gorre” of 1494. It appears to have made little or no

impression on the mortality, and would hardly have been noticed but for

its wide prevalence. In England it was the subject of a brief essay by Dr

John Turner under the title of “Febris Britannica Anni 1712[609]”--a

certain epidemic fever, of the milder kind, fatal to none, but prevalent

far and wide and leaving very few families untouched. It was marked by

aching and heaviness of the head, burning or lancinating pains in the

back, pains in the joints like those of rheumatism, loss of appetite,

vomiting, pains of the stomach and intestines. The venom though not sharp,

acted quickly. Turner ascribed it to malign vapours from the interior of

the earth (_malignos terrae matris halitus_). Its season in England, as in

Germany, was probably the summer or autumn. Turner begins his discourse

with a reference to the plague in the East of Europe, which, he says, had

been kept out of England by quarantine, to the murrain which was then

raging in Italy (and appeared in England in 1714), and to fevers of a bad

type which had traversed all France during the past spring, invading noble

houses and even the royal palace. Having begun his discourse thus, he ends

it by remarking that the slight British fever did not, in his opinion,

forebode a plague to follow. It may have been a recurrence of this

epidemic next year that Mead speaks of under the name of the “Dunkirk

rant” (supposed to have been brought over from Dunkirk by returning troops

after the Peace of Utrecht) in September, 1713; it was, he says, a mild

fever, which began with pains in the head and went off easily in large

sweats after a day’s confinement[610]. The weekly bills of mortality in

London are no help to us to fix the date of the one or more slight fevers

or influenzas about 1712-13. The great fever-years of the period were 1710

and 1714; but the fever was typhus, probably mixed with relapsing fever,

according to the evidence in another chapter. Even compared with the

universal fever or influenza of 1688, that of 1712 must have been

unimportant; for the former sent up the London mortality considerably,

whereas there is no characteristic rise to be found in any month of 1712

or 1713.

Either to this period, or to the undoubted aguish years 1727-28, belongs a

curious statement as to “burning agues, fevers never before heard of to be

universal and mortal,” in Scotland, the same having been a “sad stroke and

great distress upon many families and persons.” The authority is Patrick

Walker, who traces these hitherto unheard of troubles to the Union of the

Crowns (1707)[611].

On other and perhaps better authority, it does appear that Scotland before

that period was reputed to be remarkably free from agues; and it is

probable that the universal and mortal burning agues some time between

1707 and 1728, had come in one of those strange epidemic visitations, just

as the agues of 1780-84 did. It would be erroneous to conclude from such

references to ague that Scotland had ever been a malarious country. Robert

Boyle refers in two places to the rarity of agues in Scotland in the time

of Charles II.; the Duke of York, he says[612], on his return out of

Scotland, 1680, mentioned that agues were very unfrequent in that country,

“which yet that year were very rife over almost all England”--to wit, the

epidemic of 1678-80. Again, agues, especially quartans, are rare in many

parts of Scotland, “insomuch that a learned physician answered me that in

divers years practice he met not with above three or four[613].” However,

Sir Robert Sibbald, while he admits the rarity of quartans, does allege

that quotidians, tertians and the anomalous forms occurred, that agues

might be epidemic in the spring, with different symptoms from year to

year, and that certain malignant fevers, not called agues, were wont to

rage in the autumn[614].

Epidemic Agues and Influenzas, 1727-29.

The contemporary annalist of epidemics in England is Wintringham, of York,

who enters remittents and intermittents almost every year from 1717 to the

end of his first series of annals in 1726; but none of his entries points

very clearly to an epidemic of ague[615]. It is not until the very

unwholesome years 1727-29 that we hear of intermittent fevers being

prevalent everywhere, with one or more true influenzas or epidemic

catarrhs interpolated among them. To show how unhealthy England was in

general, I give a table compiled from Short’s abstracts of the parish

registers, showing the proportion of parishes, urban and rural, with

excess of burials over christenings:

_Country Parishes._

Registers

Registers showing high Births Deaths

Year examined death-rate in ditto in ditto

1727 180 55 1091 1368

1728 180 80 1536 2429

1729 178 62 1442 2015

1730 176 39 1022 1302

_Market Towns._

Registers

Registers showing high Births Deaths

Year examined death-rate in ditto in ditto

1727 33 19 2441 3606

1728 34 23 2355 4972

1729 36 27 3494 6673

1730 36 16 2529 3445

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