III. INFLUENZAS AND EPIDEMIC AGUES

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

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

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

Week ending Fever All causes

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

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

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

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

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

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

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

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

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

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

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

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

The Influenza of 1733.

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

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

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

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

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

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

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

The Influenza of 1737.

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

London Weekly Mortalities.

1733

Week ending Fevers All causes

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

1737

Week ending Fevers All causes

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

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

The Influenza of 1743.

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

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

London Weekly Mortalities.

1743

Week ending Fevers All causes

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

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

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

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

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

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

Some Localized Influenzas and Horse-colds.

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

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

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

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

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

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

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

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

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

The Influenza of 1762.

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

London Weekly Mortalities.

1762

Week ending Fevers All causes

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

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

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

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

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

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

The Influenza of 1767.

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

The Influenza of 1775.

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

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

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

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

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

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

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

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

The Influenza of 1782.

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

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

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

London Weekly Mortalities.

1782

Week ending Fevers All causes

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

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

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

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

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

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

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

The Epidemic Agues of 1780-85.

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

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

Reynolds, another London physician, in a letter to Sir George Baker confirms all that the latter says of these singular epidemic agues: “No two cases resembled each other except in very few circumstances[670]”--the remark commonly made about the influenza itself. If these descriptions of the epidemic ague had not been given by physicians living as late as 1782, and altogether modern in their methods, we might have supposed that they were confusing influenzas with agues, or using the latter term inexactly. “The ague with a hundred names” is the striking phrase of Abraham Holland, in his poem on the plague of 1625. Whitmore, describing the fatal epidemic ague (with an episode of influenza) in 1658-59, does not say that it had a hundred names, but that it assumed a hundred shapes, “which render it such a hocus-pocus to the amazed and perplexed people, they being held after most strange and diverse ways with it.... So prodigious in its alterations that it seems to outvie even Proteus himself[671].”

As farther showing the anomalous character of these epidemic agues, or their difference from the endemic, Baker adds:--

“It is a remarkable fact, and well attested, that in many places, whilst the inhabitants of the high grounds were harassed by this fever, in its worst form, those of the subjacent valleys were not affected by it. The people of Boston and of the neighbouring villages in the midst of the Fens were in general healthy at a time when fever was epidemic in the more elevated situations of Lincolnshire.” Women were nearly exempt, but few male labourers in the fields escaped it.

Baker heard from all parts that the same constitution continued through 1781 and 1782; and that since that time, though it seemingly abated, yet agues had been much more prevalent than usual, and had even been frequent in places where before that period they were uncommon. They were very noticeable in London from 1781 to 1785, not least so during the very severe cold of the winter and spring of 1783-84. We hear of great numbers attacked at Hampstead with common intermittents in February and the following months of 1781, during which time even the measles, in the greater number of cases, “ended in very troublesome intermittents[672]”--just as they were apt to end often in troublesome coughs.

The annals of Barker, of Coleshill, are full of references to agues, among other fevers, from 1780 onwards. Under 1781 he writes:--

“This spring that very peculiar, irregular, dangerous and obstinate disease, the burning, or as the people in Kent properly enough called it, the Plague-ague, made its appearance, became very epidemical in the eastern part of the kingdom, and raged in Leicestershire, the lower part of Northamptonshire, Bedfordshire, and in the fens throughout the year.... This strongly pestilential disease had such an effect upon them that the complexion of their faces continued for a time as white as paper, and they went abroad more like walking corpses than living subjects.”

As many as five persons in an evening were buried from it in some large towns in Northamptonshire; and about Boston it was so general and grievous that out of forty labourers hired for work in harvest, half of them, it was said, would be laid up in three days[673]. In 1783 the “pestilential agues” were as bad in Northamptonshire and eastern parts as the year before. A Liverpool writer says:

“In the autumn of 1782 the quartan ague was very prevalent on the opposite shore of the river in Cheshire: it was universal in the neighbourhood of Hoylake, where many died of it. Yet it was scarcely heard of in Liverpool, although from the uncommon wetness of the season it prevailed throughout the kingdom[674].”

On October 25, 1783, a correspondent of the Gentleman’s Magazine offered an explanation of the “present epidemic disorder, which has so long ravaged this country, and that in the most healthy situations of it,” namely, “the putrescent air caused by the number of enclosures, and the many inland cuts made for navigation[675].” Next year, 1784, appears to have been the principal season of epidemic agues on both sides of the Severn valley, one practitioner at Bridgenorth making them the subject of a special essay[676].

It was at this time that Fowler brought into use his solution of arsenic as a substitute for bark in agues, the latter having notably failed in the epidemics since 1780.

Baker says: “The distinguishing character of this fever was its obstinate resistance to the Peruvian bark; nor, indeed, was the prevalence of the disease more observable than the inefficacy of the remedy:” in that respect the epidemic agues had belied the experience with bark in ordinary agues. Again, it is singular that bark had failed most, and arsenic been especially useful in those parts of England where ordinary malarious agues were never seen. One practitioner in Dorset laid in a large stock of arsenic, wherewith he “hardly ever failed to stop the fits soon[677].” Another, at Painswick, in Gloucestershire, used it successfully in two hundred cases of epidemic agues from 1784 onwards. He gives the following account of these unusual agues at Painswick:

“This town, which is situated on the side of a hill, and is remarkable for the purity of its air, is very populous. In the year 1784 the epidemic ague, that prevailed in many parts of the kingdom, made its appearance in this place, and has continued till the present time [Nov. 1787], although previously to that period the disease was hardly ever seen here, unless a stranger came with it for the recovery of his health, on account of the healthy situation of the place. It affected whole families, and appeared to be most violent in spring and autumn. In the summer of 1786 it was followed by a fever of the kind called typhus, or low nervous fever, which not unfrequently degenerated into a putrid fever and proved very fatal[678].” In May, 1785, at a general inoculation of smallpox, “many had been afflicted with intermittents of several months’ duration attended with anasarcous swellings[679].”

It will be seen from the following table of cases treated at the Newcastle Dispensary, under the direction of Dr John Clark, during twelve years from 1 October, 1777, to 1 September, 1789, that influenza makes the smallest show among them, being far surpassed by the intermittent fevers and dysenteries, while all three together are greatly exceeded by the perennial typhus fever:

Cases treated

Putrid fever 1920 Intermitting fever 313 Epidemic dysentery in 1783 and 1785 329 Influenza of 1782 53

In Scotland, also, agues became epidemic about the year 1780. There is no reason to suppose that their prevalence in these years was less exceptional there than in England and Ireland. It will be seen, indeed, from the following table compiled from the books of the Kelso Dispensary that the only years of their considerable prevalence were the same as the years of epidemic ague in England.

Kelso Dispensary[680].

All Cases Year Cases of Ague

1777 302 17 1778 306 33 1779 460 70 1780 675 161 1781 510 103 1782 440 61 1783 510 73 1784 459 40 1785 573 62 1786 563 48 1787 525 24 1788 577 25 1789 546 48 1790 640 18 1791 715 13 1792 570 16 1793 666 19 1794 447 9 1795 513 23 1796 355 12 1797 318 9 1798 415 7 1799 558 2 1800 665 4 1801 433 9 1802 377 5 1803 308 2 1804 422 5 1805 469 0 1806 318 1

It was doubtless the recollection of these epidemic agues that led the parish ministers who wrote in the ‘Statistical Account of Scotland’ from 1791 to 1799 to remark upon a supposed progressive decline of endemic ague, which they set down to drainage of the land[681]. It is probable, however, that each tradition of ague in Scotland dated from one of its epidemic periods; it has been shown, indeed, in the foregoing that Scotland in the end of the 17th century was reputed tolerably free from ague, and that the severe agues previous to 1728, which belonged to the epidemical kind, were thought to be something new.

The Influenza of 1788.

According to Barker, of Coleshill, who kept systematic notes of the epidemic maladies from year to year, there were several recurrences of the influenza of 1782[682]. But there is only one of these seasons, the summer of 1788, that other English writers have singled out as a time of influenza. It was undoubtedly of a very mild type, producing hardly any effect upon the bills of mortality; but it attracted the notice of several. Dr Simmons, the editor of the London Medical Journal, became the recorder of it, collecting reports from various parts, as others had done in 1782. He himself treated 160 cases at the Westminster General Dispensary, and 65 more elsewhere. It was most prevalent in London from the second to the fourth week of July, but the mortalities for those weeks show no abrupt rise. It was at Chatham, Dover, Plymouth and Bath about the same time, at Manchester in the beginning of August, in Cornwall in the middle of August, and at Montrose about the end of August, or perhaps most certainly in October. On 5 August, a physician at York wrote: “We have not had the slightest appearance of a catarrh in our city or neighbourhood during the year.” The epidemic was undoubtedly a partial one in Britain, and so slight as to have made little impression where it did occur. It is said to have been very general at Warsaw in April or May, at Vienna in April (20,000 cases before the 20th), at Munich in June, at Paris in the end of August and still continuing on the 24th October, at Geneva on the 10th October. Its most constant symptom in England was pain in the fore-part of the head, with vertigo; next most constant was a pain at the pit of the stomach and along the breast-bone; cough was wanting in perhaps a third of the cases and was always slight, diarrhoea was somewhat general, running from the eyes exceptional, sore-throat in perhaps one-sixth of the cases[683]. At Plymouth where it was seen earliest and clearest among the regiment of artillery and in the guardships, the symptoms were pain in the head and limbs, soreness of the throat, pain in the breast, a feeling of coldness all over the skin, and these followed by cough, a great discharge from the nose and eyes, and slight nausea. It was much less noticeable among the townspeople than among the troops and sailors[684]. It occurred chiefly among soldiers or sailors also at Dover and Chatham. At Bath it was marked by chills, headache, swelling of the throat, difficult swallowing, quick pulse, hot, dry skin (but not pungent as in malignant fever), ending in a sweat; no delirium, but broken sleep or vigil; the eyes scarcely affected, cough in some, but not vehement; in some, sublingual swellings which suppurated[685]. At Manchester it looked as if it had been brought in by travellers who had acquired it in London[686].

At Portsmouth a singular thing happened two or three months after the epidemic had passed. The frigate ‘Rose’ arrived on 4 November from Newfoundland; within a short time all the dogs on board were seized with cough and catarrh, and soon after the whole ship’s company were affected in the same way[687]. Simmons says of the epidemic of 1788 in general: “During the progress of the influenza, a complaint which was evidently an inflammatory affection of the mucous membrane of the fauces, etc. was frequently observed among horses and other cattle, and was generally as violent among them as it was mild among their rational neighbours”--many dying after four or six days.

The very slight and partial influenza of July and August, 1788, happened at a time when there was much fever of a more serious kind in the country. The history of the latter belongs to another chapter; but there was in Cornwall, in the same season as the influenza, an epidemic fever which might in former times have been described as a part, and the most fatal part, of the “new disease,” and may be taken in this context rather than in the chapter on typhus. The same physician, Dr William May, of Truro, gave an account of the influenza first[688] and of the other fever afterwards[689].

The latter began at Truro in the end of April, 1788, and was also at St Ives and other small towns in various parts of the county. A malignant fever had for near two years before been exceedingly rife among the poor (owing to distress from loss of pilchard fishing), and had carried off a great number of them; but this was something new. Yet it was “truly a fever of the typhus type,” one of its symptoms being constant wakefulness. It passed through whole families, affecting all ages and constitutions. It ended on the 17th day, whereas the influenza (says May in his other paper) ended with a sweat on the fourth or fifth day. In one small neighbourhood this epidemic fever affected chiefly the aged, who were blooded owing to dyspnoea: out of ten or eleven so affected, not one recovered, an experience that reminded May of what Willis said of the village elders being swept off by the “new fever” of 1658. Surgeons at St Austel, East Looe and Falmouth are cited as having seen much of the same fever. In like manner the Manchester chronicler of the influenza of 1788 says: “Fevers of different kinds, but chiefly of the type now distinguished by the appellation of typhus, were exceedingly prevalent after the epidemic catarrh had in great measure ceased to be general; but from which, by tracing the symptoms, the fever might usually be found to have originated[690].”

For a good many years after the period last dealt with, nothing is heard in Britain either of epidemic agues or of influenza[691]. Writing in 1800, Willan said that intermittents had not, to his knowledge, been epidemic in London at any time within twenty years. He explains this by “the practice of draining, and the improved modes of cultivating land in Essex, Kent, and some other adjoining counties, from which either agues were formerly imported, or the effluvia causing them were conveyed by particular winds”--the latter being the doctrine of Lancisi for the country round Rome. But he forgets that their appearance nearly twenty years before was a strange phenomenon to the practitioners of that generation, and that Sydenham, whom he cites to prove agues in London in former times, had also remarked their absence, except in occasional cases, for as long a period as thirteen years. Of such occasional agues acquired in London, Willan and Bateman had each one or two examples in the autumn of 1794, and the spring of 1805.

As in the case of epidemic agues, so also in the case of influenzas, there was immunity in Britain for a good many years after 1788; and, as the slight epidemic catarrh of 1788 was something less than universal, the clear interval may almost be reckoned from the summer of 1782, a space of over twenty years. Willan’s monthly reports of the weather and diseases in London from March, 1796, to December, 1800, twice mention epidemic catarrhs,--in February and March, 1797, and in February, 1800, the latter chiefly among children. But to neither of them will he concede the name of “influenza,” as the complaint was merely epidemical from a particular state of the atmosphere, and not propagated by contagion, nor quite general.

The symptoms, however, were headache, sometimes attended with vertigo, a thin acrid discharge from the nostrils, slight inflammation of the throat, a sense of constriction in the chest, with a frequent dry cough, pains in the limbs, a white tongue, a quick and small pulse, with a sensation of languor and general debility. These symptoms, fairly complete for influenza of the correct type, lasted about eight days and ended in a gentle sweat or in a diarrhoea. Coughs had been remarkably severe and obstinate; they were frequently attended with painful stitches and spitting of blood[692].

The Influenza of 1803.

The number of the Medical and Physical Journal for March, 1803, announced that “a cold attended by symptoms of a very alarming nature has been general in the city of Paris for some time”; but it said nothing of the alarming disorder being in London. It is in the next number, under the date of Soho Square, March 11th, that a correspondent identifies the Paris epidemic with “the complaint now general in this metropolis, and called by some the Influenza.” In a report upon the diseases “in an Eastern District of London from February 20 to March 20, 1803,” the “catarrhal fever” is thus described:

“This disease has been so general as to claim the title of the reigning epidemic, and is very similar to one which prevailed a few years ago, and was denominated Influenza. It has generally been introduced by chilliness and shivering, which have been succeeded by violent pains in the head, with some discharge from the eyes and nostrils, as in a common catarrh, together with hoarseness and cough. The pains in the head have in some cases been the first symptoms and have been succeeded by giddiness, sickness and vomiting” &c. There were also rheumatic pains in the limbs, intercostals &c.

Meanwhile the information from various sources showed that the old influenza was once more really in this country. Two collective inquiries were made on the influenza of 1803: one by Dr Beddoes of Bristol, who issued a circular of five queries, and received answers to them (with other information) from one hundred and twenty-four correspondents[693]; the other by the Medical Society of London[694]. The Medical and Physical Journal and Duncan’s Annals each received a few independent papers on it; and several pamphlets were issued, mostly devoted to treatment--two in London[695], one at Edinburgh[696], one at Bath[697], and one at Bristol[698].

In these abundant data there is little novelty and not much variety.

The attack began with chills and severe pain in the head, along with slight running of the eyes and nose, as typhus fever might have begun. After the slightly catarrhal onset the malady was mostly a fever, with dry cough, dry and hot skin, pain in the forehead and about the eyeballs, pains in the limbs, “spontaneous” weariness and extreme prostration--a group of symptoms which led Hooper to find a rheumatic character in the malady. Among other symptoms were vertigo, nausea, vomiting and diarrhoea. Much sweating is not reported; but there was often a gentle sweat in recovering after about a week, less or more. There was the usual range from mildness to severity. Pneumonia and pleurisy were not rare, and were commonly the cause of fatalities.

The deaths were for the most part among the phthisical, the asthmatic and the aged; but these were not many, certainly not so many as in 1729, 1733 and 1743, and probably in about the same proportion as in 1762, 1775 and 1782. In the London bills the weekly deaths rose in March, to an average of 537 from an average of 429 in February, and of 375 in January, falling to an average of 417 in April. In Ireland the epidemic is said to have been seen among the troops in garrisons as early as December, 1802; it became universal in spring and summer. In Edinburgh the rise in the burials at Greyfriars churchyard was in the weeks ending 5th and 12th April, making them about a half more than usual for the brief period. When the wave of influenza was past, the public health in nearly all places became unusually good, as had happened immediately after the influenza of 1782.

The question most to the front in the influenza of 1803 was its manner of spreading. Beddoes, who believed in personal contagion, had this in view in his five queries:

1. When did the influenza appear and disappear with you?

2. Was its date different in remote places within your reach?

3. After being general, did it occur for some time in single instances?

4. Did it ever seem to pass from person to person?

5. If so, is it likely that clothes or fomites conveyed it in any case?

The dates of commencement were earlier or later according to no rule of direction or of distance from London. In some large towns of Yorkshire it appeared to be unusually late, in Chester unusually early; Edinburgh, certainly, was as long behind London as London was behind Paris. Haygarth, who took the most narrow view of contagion, made out the incidence thus: London first, then the towns which have the greatest intercourse with London, such as Bath and Chester, then smaller towns, and last of all the villages around each of the more populous centres. Several towns had the brunt of the epidemic in the same weeks (of March) as London; in very few was it later than the first weeks of April. In some towns it attracted little notice. In North Devon, it was said to have been at Hartland and Clovelly a fortnight before it was seen in Bideford; the first of it seen by one of the doctors of that town was in a solitary potter’s house four miles to the eastward, on a peninsula made by the confluence of a small stream with the Torridge, all the inmates of the house being attacked; in the town itself from first to last he saw but few cases, whereas there were many in the adjacent country[699].

The general rule seems to have been that the more sparse populations had it later, the nearer they were to the extremities of the kingdom, as in Cornwall, the north of Scotland, and in Ireland. Opinion was divided as to the part played by persons in carrying contagion from place to place, some holding that the facts of diffusion could be explained on no other hypothesis, while most held that the influenza was in the air. Beddoes got as many answers favouring the doctrine of personal contagion as made a respectable show for it; but when these had all been set forth to the best advantage, a practitioner wrote to say that, after all, nine-tenths of professional opinion was against the contagiousness of influenza. The practical question for Haygarth, Beddoes, and other contagionists was whether influenza was not a disease, like smallpox or scarlet fever, which could be kept from spreading by means of isolation, disinfection (with the fumes of mineral acids) and other precautions.

Some curious facts came out, showing the effect of influenza upon other epidemic diseases, or the effect of other epidemic diseases upon influenza. One writer applied to influenza what used to be said of the plague or pestilential fever, that these Leviathan constitutions swallowed up all other reigning epidemics. Holywell, a town in Flintshire, with a large cotton-weaving industry, had not been free from a bad kind of typhus for two years. “On the appearance of the influenza the typhus entirely ceased, and only one case of fever has occurred since. I have not for many years known this country so healthy as since the influenza disappeared[700].” The influenza was said also to have superseded typhus fever at Navan, in Meath[701]. At St Neots typhus was peculiarly prevalent for three months before the influenza, but ceased thereafter[702]. Another relation to typhus was seen at Clifton: “In the low, confined, and ill-ventilated houses in the Hot Well road, where typhus often abounds, the influenza was very unfrequent; while in the exposed high-lying buildings on Clifton Hill it was almost universal[703].” As to ague, which had often before stood in a remarkable relation to epidemics of catarrhal fever, there is one possibly relevant fact related from the Lincolnshire fens. A Wisbech physician writes:

“The influenza which ceased here about the middle of April made its appearance again in May; the leading symptoms were the same as in the first attack. About the same time also a most malignant fever, having some symptoms in common with the influenza, began to rage in that part of Lincolnshire contiguous to us, which has proved fatal to hundreds[704].”

From 1803 to 1831, nothing is heard in England of a universal influenza, although there was one such in the end of 1805 and beginning of 1806 in Russia, Germany, France and Italy; and there were four great influenzas in the Western Hemisphere (1807, 1815-16, 1824-25, and 1826). Catarrhs were perhaps commoner than usual in England and Scotland in the winter of 1807-8, but they cannot be reckoned an epidemic of influenza[705]. The summer following (1808) was unusually hot and agues became more epidemic in the fens than at any time since the great aguish period of 1780 and following years[706]. Agues were again unusually rife in England in 1826, 1827 and 1828, at the same time as the remarkable epidemics of them, from inundations and subsequent drought, in Holland and along the German coast of the North Sea. Dr John Elliotson, of London, met with cases of agues in his practice in those years in the following scale:

Year Cases

1823 8 1824 14 1825 15 1826 44 1827 53 1828 27 1829 8

They had increased, he says, throughout the country as well as in London, owing, as he thought, in agreement with Macmichael, to the higher mean temperature of the respective years; and he would apply the same law of increase to the epidemic periods of ague in Britain in former times[707]. Christison saw his first case of ague at Edinburgh in the autumn of 1827, in a labourer who had caught it working at the harvest in the fen-country of Lincolnshire.

The Influenza of 1831.

The next influenza in Britain fell in the early summer of 1831. It was a mild epidemic of the catarrhal type, which attracted hardly any notice in England. In one of the London medical journals there is no other notice of it but this, dated 2 July, 1831[708]: “In consequence of the sudden variations of temperature which have prevailed since the last fortnight of May an epidemic bronchitis has shown itself in Paris.” Another London journal[709], on the very same day, wrote: “Influenza in a severe form is at present prevailing in London and some of the provincial towns. It commences like a common cold, but is soon discovered to be more serious, &c.” The physician to the public dispensary in Chancery Lane found that more than half of the seventy applicants on 23 June came with the symptoms of influenza--severe, harsh, dry cough, in paroxysms, pain behind the sternum, a fixed pain in one side, congested state of the throat, nose and eyes, heaviness of the head, languor, debility, hot skin, foul tongue, impaired sense of taste. The symptoms went off after three or four days with a sweat in the night and a discharge from the nostrils[710].

This epidemic hardly affected the London bills of mortality, according to the following figures:

Four weeks, 25 May to 21 June, 1579 births, 1430 deaths. Five weeks, 22 June to 26 July, 2153 births, 2010 deaths. Four weeks, 27 July to 23 Aug., 1997 births, 1652 deaths.

The rise in the last four weeks was due to summer diarrhoea, or choleraic diarrhoea, which was unusually common in 1831. This slight influenza was also reported from Plymouth by a surgeon who had seen the disease, and suffered from it, at Manilla in September, 1830[711], and by a Plymouth practitioner, who wrote, on 14 July, that it had been extensively prevalent there and in the neighbouring towns and villages[712]. It is recorded also from the Isle of Man, Glasgow[713], and Ayr[714], and it is supposed to have been in Aberdeen[715]. But, while there are many accounts of this epidemic in Germany in May and June, and undoubted evidence of it in France and Italy, as well as in Sweden, and in Poland and Russia earlier in the year, the accounts of it in Britain are so meagre and casual as to make one doubt whether it really was an influenza worth reckoning.

The Influenza of 1833.

The next year, 1832, which was the first great season of Asiatic cholera in Britain, is absolutely free from records of influenza in all Europe. It was in the spring of the year following, 1833, that the really serious influenza came. The continental literature of the epidemic of 1833 is immense, the English literature of it is all but non-existent: and yet it was a very severe influenza with us, just as with other European peoples. There was no collective inquiry in Britain on this occasion, such as had been made first by Fothergill in 1775, by the College of Physicians and another Society in 1782, by Simmons in 1788, and by Beddoes and the Medical Society of London in 1803, or such as was made in the next influenza, that of 1837, by a committee of the Provincial Medical Association. But enough is known of it to place it among the severer influenzas. In London the bills of mortality, which relate only to a part of London, showed the characteristic sudden rise and fall:

Baptisms Burials

Four weeks, 20 Feb. to 16 March 2310 2352 Five " 17 March to 23 April 1955 2105 Four " 24 April to 21 May 2016 3350 Four " 22 May to 18 June 2070 1685

For a whole month the burials in London were nearly doubled, and for the two worst weeks they were nearly quadrupled. This mortality, by all accounts, fell most on the richer classes, to whom it was a much more serious calamity than the Asiatic cholera of the year before. The president of the Medical Society said, on the 22nd April, that he had “heard of nine lords or ladies who had been carried off by it or by its indirect agency, in the course of last week[716].” Its type in the month of May was worse than in April[717]. When it was first seen it was a somewhat short catarrhal attack, ending in a sweat after two, three or four days, with the usual head-pains, soreness of the ribs and limbs, languor and prostration. Later, it became a more “adynamic” illness, beginning indeed with slight catarrhal symptoms, but soon passing into subacute nervous fever which might last for three weeks, involving much risk to life[718]. Hence arose the warnings, just as in 1890-92, that the influenza was a much more serious thing than it had been thought when the epidemic began, and hence the delay, as it were, in the bills of mortality to show the effects of the epidemic until it had been two or three weeks prevalent. It is to the month of April, before the highest death-rate was reached in London, that the following, in the Gentleman’s Magazine, applies[719]:

“During the month a severe form of catarrhal epidemic, generally termed influenza, has been extremely prevalent in London. It has laid up at once all the members of many large households, and has attacked great numbers in several public offices, particularly the Bank of England and some divisions of the new police. The performers at the theatres have much suffered, and their houses have been closed for several nights. It commences suddenly with headache and feeling of general discomfort, attended or soon followed by cough, hoarseness, or loss of voice; oppression, and sometimes severe pain in the chest, tenderness about the ribs, and sense of having been bruised about the limbs or muscles.... The disease is generally attributed to the constant north-east winds; but by some of the learned is regarded as the epidemic influenza which has lately prevailed in the eastern parts of Europe, and that is travelling, like many of its predecessors, to the west.”

It would have been in this earlier stage of the epidemic, when it was laying up whole households, thinning workshops and closing theatres, that a practitioner was heard to say (as reported by the Lancet): “Best thing I ever had! Quite a godsend! Everybody ill, nobody dying!” The seriousness of the disease was, however, at length recognized, so that the members of the Medical Society debated the subject at three successive meetings. One of the questions was, whether the malady called for blooding--a question that had divided opinion as long ago as 1658[720]. On 13 May, the following passed at the Medical Society:

Mr Williams remembered the similar influenza of 1803, and said that depletion was then regarded as an injurious plan of treatment.

Mr Proctor:--Yes, but the Brunonian doctrines were then in full fling, and practitioners had not learned the full use of the lancet.

Graves states very fairly the reasons that induced them to take blood in the influenza of 1833, as well as the results of the practice[721]:

“The sudden manner in which the disease came on, the great heat of skin, acceleration of pulse, and the intolerable violence of the headache,--together with the oppression of the chest, cough, and wheezing--all encouraged us to the employment of the most active modes of depletion; and yet the result was but little answerable to our expectations; for these means were found to induce an awful prostration of strength, with little or no alleviation of the symptoms.”

The prostration, be it said, was probably as great and as frequent in the epidemics of 1890-93, when bleeding had gone out altogether; still it was not understood that all these signs of sthenic action in the attack were really paradoxical, as Whitmore, in the passage cited in the note, saw clearly two centuries before.

The epidemic became rapidly prevalent all over England, Scotland and Ireland in April and May, following no very definite order of progression. The Liverpool newspapers asserted that ten thousand were down with it in that town in one week. A doctor at Lincoln wrote, on 13 May, that few families there had escaped it[722]. Other towns in which it is said to have been “more or less” prevalent were Portsmouth, Sheffield, Birmingham, Leeds, York, Halifax, Glasgow, Edinburgh[723], Dublin and Armagh; so that we may fairly assume, although we are without the detailed evidence available for earlier epidemics, that it was ubiquitous in town and country.

At Birmingham[724], among the outpatients of the Infirmary, the cases of influenza were as follows, the 25th and 26th April being the days when cases came first in rapid succession, while the middle of May was practically the limit:

Cases of Influenza Males Females

April 151 52 99 May 464 159 305 June 28 9 19 --- --- --- 643 220 423

The great excess of females is remarkable, but was probably due to some local circumstances. Of the 643 cases, 122 were under ten years of age. Of the females, 9 died, of the males 3. But the deaths in Birmingham caused by the epidemic directly or indirectly were many; the burial registers of four churches and chapels showed a marked increase of burials above those of the corresponding months of 1832:

1832 1833

April 205 245 May 211 434 June 193 230 --- --- 609 909

Medical opinion in 1833 was decidedly adverse to the contagiousness of influenza. The common remark was that it was just as little contagious as the cholera of the year before had proved to be. As in 1837 and 1847, when the doctrine of contagiousness was equally out of favour, the disease was observed to spread rapidly, in no very definite line, affecting most parts of the country in the same two or three weeks, affecting the population within a considerable radius almost at once, and the inmates of houses all together. These, it was said, are not the marks of a disease that persons hand on one to another, quasi cursores.

The Influenza of 1837.

Between the influenza of April-May, 1833, and that of January-February, 1837, it seems probable that there were minor catarrhal outbreaks, distinguishable from ordinary colds. One writer on the influenza of 1837 refers to those “who had it in 1834 or in the intervening period between the two epidemics.” The table of diseases of the outpatients at the Birmingham Infirmary for the year 1836 contains a large total of catarrhs, and, in another line, 24 cases of “epidemic catarrh” in the summer months. The Gentleman’s Magazine begins its notice of the epidemic of 1837 by calling it “an influenza of a peculiar character,” which shows that influenza of the ordinary kind was a familiar thing. Probably the name was a good deal misapplied in the years following every great epidemic from 1782 onwards: thus in ‘St Ronan’s Well,’ which was written in 1823, or twenty years from the last general influenza, a tradesman’s widow in easy circumstances and given to good living comes to the Spa on account of a supposed malady which she calls the influenzy. But our recent experiences of four great influenza seasons in succession from 1889-90 to 1893, although it is without precedent in the history, will incline us the more to credit what is recorded of influenza cases in the intervals between the years of great historical epidemics[725]. However that may be for the years following 1833, the influenza of January, 1837, was sudden, simultaneous, universal.

The first cases, which Watson compares to the first drops of a thunder-shower, were seen earlier in some places than in others; but from all parts of England it was reported that the influenza was at its height from the middle of January to the end of the first week of February. Possibly it was a few days earlier in London than in most other towns, inasmuch as the great increase of the deaths that is shown in the following table, in the second and third weeks of January, would imply a prevalence of the epidemic for at least a fortnight before.

Weekly Mortalities in London (by the old Bills).

1837

Week ending Influenza All causes

Jan. 10 0 284 17 13 477 24 106 871 31 99 860 Feb. 7 63 589 14 35 558 21 20 350 28 8 321 March 7 4 262

This sudden rise in the deaths from all causes is a characteristic influenza bill, comparable with those already given from 1580 onwards. But the bill is far from showing the whole of the mortality in London in 1837. The London bills of mortality compiled by the Parish Clerks’ Company had fallen into the last stage of inadequacy, and were on the eve of being superseded by the general system of registration for all England and Wales[726].

The London bills, so long as they existed, never took in the great parishes of St Pancras, Marylebone, Kensington and Chelsea. The area “within the bills of mortality” was that of London about the middle of the 18th century. But, instead of becoming more and more crowded as time went on, it had actually become much less populous, especially in the old City and Liberties, owing to the erection of warehouses, workshops, counting-houses and other non-residential buildings where dwelling houses used to be; so that the decrease of mortality “within the bills” in the 19th century is in part due to the decrease of population within the same area. This has to be kept in mind when the above table is compared with one of those for former influenzas, such as that of 1737, exactly a hundred years before.

It was thought that the 1837 influenza in London was worse than that of 1833, but the figures show the contrary as regards the number of deaths from all causes[727]. Both of them, however, were in the first rank of severity, finding their nearest parallels in the three great influenzas of the 18th century, in 1733, 1737 and 1743, when the deaths from all causes during the influenza rose, indeed, to a much larger total within the bills, but rose from a much higher mean level.

In Dublin the great increase of burials from the influenza of 1837 fell at the same time as in London, according to the following comparison with the year before for Glasnevin Cemetery[728]:

1835-36

Dec. 1835 355 Jan. 1836 392 Feb. " 362 Mar. " 392 ---- 1501

1836-37

Dec. 1836 413 Jan. 1837 821 Feb. " 537 Mar. " 477 ---- 2248

At Glasgow the deaths from influenza were as follows[729]:

1837

Males Females Total

January 111 118 229 February 37 62 99 March 9 20 29 --- --- --- 157 200 357

But the heading of “influenza” did not nearly show the full effects of the epidemic upon the mortality, which was enormous in Glasgow in January, as compared with the same month of 1836:

--------------------------------------------------------------- || All causes||Catarrh| Aged| Asthma| Fever| Decline ----------||-----------||-------|-----|-------|------|--------- Jan. 1836 || 790 || 4 | 73 | 31 | 45 | 124 Jan. 1837 || 1972 || 229 | 274 | 185 | 201 | 247

There was also a great increase in the deaths of infants by bowel complaint. The only period of life which did not show a great rise of mortality was from five to twenty; the greatest rise was between the ages of forty and seventy, corresponding to the London experience in the epidemic of 1847.

At Bolton, Lancashire, the great rise in the deaths, as compared with the average of five years before, was in February:

Average of five years 1831-36 1837

January 111·2 115 February 79·0 205 March 97·8 100 ----- --- 288·0 420

At Exeter, the burials in the two chief graveyards were 227 in January and February, 1837, as compared with 125 in the same months of 1836. These mortalities, although large, were but a small ratio of the attacks. In 2347 cases enumerated in the collective inquiry, there were 54 deaths, a ratio of two deaths in a hundred cases being considered a full average. The attacks were mostly in middle life, and the deaths nearly all among the asthmatic, the consumptive and the aged. The ages of one hundred persons attacked at Birmingham were as follows[730]:

Ages 1- 5- 10- 20- 30- 40- 50- 60- 70- 80-90

Cases 3 2 12 23 21 19 12 7 0 1

At Evesham only five out of 93 were under five years. At Leamington, in a list of 170 cases, there were 26 under fourteen years, 119 from fourteen to sixty-five years, and 25 above the age of sixty-five[731]. In some places males seemed to be most attacked, just as at Birmingham in 1833 there was a great excess of female cases; but the collective inquiry showed that the sexes shared about equally all over. The type of the malady was on the whole catarrhal, as in 1833. Nearly all the cases had symptoms of sneezing, coughing, and defluxions; many cases had nothing more than the symptoms of a severe feverish cold; the more dangerous cases had dyspnoea, pneumonia and the like; while all had the languor, weariness, and soreness in the bones which mark every influenza, whether it incline more to the moist type of catarrhal fever or to the dry type of the old “hot ague.”

The influenza of 1837 having been remarkably simultaneous, sudden and brief, the doctrine of personal contagiousness found little favour, just as in 1833. The 12th query sent out by the committee of the Provincial Medical Association was: “Are you in possession of any proof of its having been communicated from one person to another?” The answers are said to have been nearly all negative; namely, that there was “no proof of the existence of any contagious principles by which it was propagated from one individual to another.” Shapter, a learned physician at Exeter, inclined to a certain modified doctrine of contagion by persons. Blakiston, of Birmingham, an exact mathematician, declared that the question as ordinarily stated did not admit of an answer.

At Liverpool there was an interesting observation made, exactly parallel with those made at Gravesend in 1782 and Portsmouth in 1788. The influenza of 1837 was practically over by the first or second week of March; but “that the atmosphere of Liverpool was still contaminated by the epidemic influence up to the middle and latter end of April was apparent from the fact that many of the officers and men of the American ships, and generally the most robust, were violently attacked shortly after their arrival in port,”--the same being the case also with black sailors on ships arriving from the Brazils and the West Coast of Africa[732]. At the naval stations of Sheerness, Portsmouth, Plymouth and Falmouth, every one of the ships of war had been attacked in January, the ships cruising on the south coast of Spain, or lying at Barcelona, in February, the ships at Gibraltar in April, and those at Malta in May. The ‘Thunderer,’ on the passage from Malta to Plymouth, had the first cases of influenza at sea on the 3rd of January, four days before reaching Plymouth[733], as if she had sailed into an atmosphere of it somewhere near the coast of Brittany.

* * * * *

For fully ten years, from March or April 1837 to November 1847, there was no great and universal influenza in England. But there were several undoubted minor, and perhaps localized, outbreaks of an epidemic malady which was in each case judged to be truly the influenza, and not a common cold. The earliest of these was in the spring of 1841. It was recognized by the Registrar-General to have been in London from 20 February to 24 April, the mortality having been little affected by it. It was also recognized in Dublin in March, and remarked upon by two physicians to the Cork Street Fever Hospital; it was characterized by the usual languor, weariness, and pains in the head, by defluxions of the eyes, nose and throat, but not by any affection of the lungs, and was in all respects mild[734]. Exactly a year after, in March, 1842, influenza was described as epidemic at York[735]: it was noted also in London in March[736], and is mentioned as having been again in Ireland in 1842[737]. The next undoubted influenza is reported from a rural part of Cheshire (Holme Chapel) in January, 1844, in the wake of an epidemic of scarlatina; it continued in all kinds of weather until June, and had a remarkable intercurrent episode, for some weeks from the middle of March, in the form of an epidemic of pneumonia among young children, which passed into mild bronchitis in the cases last attacked[738]. Coincidently with the influenza in Cheshire, there is a report of a series of catarrhal cases in Dublin about the beginning of January, 1844, in which the sense of constriction and suffocation under the sternum and the paroxysmal character of the attacks seemed to point to influenza[739]. Two years after, a Dublin physician in extensive practice among the rich wrote, at the request of a medical editor, an account of an epidemic of influenza in January and February, 1847; he had sixty cases among children under fourteen in his private practice, usually several children in one house, and sometimes the adults in the house[740]. This was in the midst of the great epidemic of relapsing fever in Dublin and all over Ireland, due to the potato famine. The same prevalence of influenza to a slight extent is recorded also for London at the end of 1846 and beginning of 1847[741]. It is easy to object that these “influenzas” between 1837 and 1847 were but the ordinary catarrhal maladies of the seasons. But the physicians who took the trouble to record them--probably more might have done so--were, of course, aware of the distinction that had to be made between many common feverish colds concurring in the ordinary way, and a truly epidemic influenza, however slight.

The Influenza of 1847-48.

The great influenza of 1847 began in London about the 16th or 18th of November, was at its height from the 22nd to the 30th, had “ceased to be very prevalent” by the 6th or 8th of December, but affected the bills of mortality for some time longer, as in the following table:

Weekly Mortalities in London.

1847

Week ending All causes Influenza Pneumonia Bronchitis Asthma Typhus

Nov. 20 1086 4 95 61 12 86 27 1677 36 170 196 77 87 Dec. 4 2454 198 306 343 86 132 11 2416 374 294 299 78 136 18 1946 270 189 234 52 131 25 1247 142 131 107 14 83 Jan. 1 1599 127 148 138 26 74

In the thirteen weeks of the first quarter of 1848 the influenza deaths declined as follows: 102, 102, 89, 56, 59, 47, 27, 33, 18, 11, 10, 16, 8.

This was the first great epidemic of influenza under the new system of registration. According to the Superintendent of Statistics, it caused an excess of 5000 deaths during the six weeks that it lasted, of which about a fourth part only were set down to influenza, and the rest to pneumonia, bronchitis, asthma, etc. During the three worst weeks it raised the deaths in the age of childhood 83 per cent., in the age of manhood 104 per cent., in old age 247 per cent., whereas the deaths between fifteen years and twenty-five were but little raised by it, and those between ten and fifteen hardly at all. It raised the deaths during six weeks in St George’s-in-the East to a rate per annum of 73 per 1000 living: in some other parishes it increased the death-rate very little. But it had the usual effect of lengthening enormously the obituary columns of the newspapers, which shows that it fell, as usual, to a large extent upon the richer classes. It went all over England in a short time, the month of December being the time of excessive mortality in the towns, according to the following sample totals of deaths from all causes:

1847

Manchester Sheffield York Places in (Ancoats) (West) (Walmgate) Scotland

October 169 27 61 521 November 135 27 52 728 December 270 85 99 1001

In some parts of England, as in Kendal, a district of Anglesea and in the Isle of Wight, the mortality of the last quarter of 1847 was actually lower than that of the year before. From St Albans the sub-registrar reported that there had been “no epidemic.” In most parts of the country, including the medium-sized towns, the mortality directly or indirectly due to influenza was lower than in London. The principal returns did not come in from the country until after the new year, the effects of the epidemic having been, as usual, later in rural districts. Hence, while London had 1253 deaths put down to “influenza” in 1847 (nearly all in December), and 659 in 1848 (nearly all in the first quarter), the rest of England had 4881 influenza deaths before the New Year, and 7963 after it[742]. This influenza in the mid-winter of 1847-8 made a great impression everywhere[743]. As regards its range and its fatality, it was like those of 1833 and 1837; and it had once more so much of the catarrhal type, that the name of influenza became still more firmly joined to the idea of a feverish cold or defluxion.

* * * * *

By the year 1847, agues had almost ceased to be written of in England, although they still occurred in the Fens. But Peacock begins his account of the influenza of that winter with an enumeration of prevailing diseases, which reads somewhat like an old “constitution” by Sydenham or Huxham. The summers and autumns of 1846 and 1847, he says, were both highly choleraic, and dysentery (as well as enteric fever) was unusually common in the former year. Fatal cases of “ague and remittent fever” were also more numerous than usual. Then came much enteric fever, “not unfrequently complicated with catarrhal symptoms.” Throughout the spring and early summer of the influenza year, 1847, “intermittent fevers were common, and in March, April and May, purpura was frequently met with, either as a primary or secondary disease. Scurvy also, owing to the deficiency of fresh vegetables, and from the general failure of the potato crop in the previous year was occasionally seen.” Then follows much concerning a fever called remittent, which reads more like relapsing fever than anything else[744]. “The remittent form of fever was frequent in the course of the epidemic [of influenza], though seldom registered as the cause of death.” Peacock says truly that the rather unusual concurrence of so many sicknesses was “not peculiar to the recent influenza alone;” and he can “scarcely refrain from acknowledging that these several affections are not merely coetaneous but correlative, and types and modifications of one disease, with which they have a common origin. Assuming this inference to be admitted, we may advance to the solution of the further question of what is the essential nature or proximate cause of the disease.” But the inquiry led him to no result: the precise cause he leaves “involved in the obscurity that veils the origin of epidemics generally”--which are surely not all equally obscure[745].

* * * * *

Influenza having continued epidemic for a few weeks in the beginning of 1848, ceased thereafter to attract popular notice in Britain during a period of more than forty years. But a certain number of “influenza” deaths continued to appear steadily year after year in the registration tables. In 1851 this number was nearly doubled, in 1855 it was more than trebled; and those two years were undoubtedly seasons (about January and February) of real influenza epidemics in Europe, recorded by several but not by English writers. A slight epidemic was described for Scotland in 1857, and one for Norfolk in 1878, neither of which seems to have influenced the registration returns in an obvious degree. After the undoubted influenza of 1855, the annual total of deaths in England set down to that cause steadily declined from four figures, to three figures, and then to two figures, standing at 55 in the bill of mortality for 1889. It is improbable that those small annual totals of deaths in all England and Wales were caused by the real influenza; the name at that time was synonymous with a feverish cold, and would have been given here or there to fatalities from some such ordinary cause. An epidemic ague was reported from Somerset in 1858[746].

The Influenzas of 1889-94.

More than a generation had passed with little or no word of epidemic influenza in this country, when in the early winter of 1889 the newspapers began to publish long telegrams on the influenza in Moscow, St Petersburg, Berlin, Paris, Madrid and other foreign capitals. This epidemic wave, like those immediately preceding it in the Eastern hemisphere, in 1833, 1837 and 1847, and like one or more, but by no means all, of the earlier influenzas, had an obvious course from Asiatic and European Russia towards Western Europe[747]. In due time it reached London, and produced a decided effect upon the bills of mortality for the first and second weeks of January, 1890, but a moderate effect compared with that of 1847, which was the first to be recorded under the same system of registration. It spread all over England, Scotland and Ireland in the months of January and February, 1890, proving itself everywhere a short and sharp influenza of the old kind, but with catarrhal symptoms on the whole a less constant feature than in the epidemics of most recent memory. At the end of February it looked as if Great Britain and Ireland had got off lightly from the visitation which had caused high mortalities in many countries of Continental Europe. But this epidemic in the beginning of 1890 was only the first of four, and less severe than the second and third. It returned in the spring and early summer of 1891, in the first weeks of 1892, and in the winter of 1893-94. To understand this influenza prevalence as a whole, its four great seasons should be compared. The following tables show its incidence upon London on each occasion:

Four epidemics of Influenza in London, 1890-94.

1890

Annual death-rate Deaths Week per 1000 from all ending living causes Influenza Bronchitis Pneumonia

Jan. 4 28·0 2371 4 530 215 11 32·4 2747 67 715 253 18 32·1 2720 127 630 281 25 26·3 2227 105 468 193 Feb. 1 21·8 1849 75 339 145 8 20·6 1749 38 369 117

1891

Annual death-rate Deaths Week per 1000 from all ending living causes Influenza Bronchitis Pneumonia

April 25 21·0 1809 10 240 179 May 2 23·3 2006 37 280 241 9 25·6 2069 148 302 230 16 27·7 2245 266 352 207 23 27·6 2235 319 337 219 30 28·9 2337 310 353 189 June 6 27·0 2189 303 320 176 13 23·3 1886 249 255 166 20 23·0 1865 182 248 159 27 19·0 1538 117 151 113 July 4 16·8 1363 56 108 103

1891-92

Annual death-rate Deaths Week per 1000 from all ending living causes Influenza Bronchitis Pneumonia

Dec. 26 21·9 1771 19 355 131 Jan. 2 42·0 3399 37 927 256 9 32·8 2679 95 740 246 16 40·0 3271 271 867 285 23 46·0 3761 506 1035 317 30 41·0 3355 436 844 255 Feb. 6 30·6 2500 314 492 215 13 24·6 2010 183 368 140 20 20·7 1693 79 259 137

1893-94

Annual death-rate Deaths Week per 1000 from all ending living causes Influenza Bronchitis Pneumonia

Nov. 4 20·2 1695 8 191 125 11 21·4 1679 20 220 137 18 24·4 2016 22 318 228 25 26·5 2190 36 384 215 Dec. 2 27·1 2235 74 426 248 9 31·0 2556 127 491 266 16 29·1 2401 164 421 232 23 26·3 2170 147 387 203 30 23·3 1920 108 306 157 Jan. 6 24·5 2040 87 342 169 13 29·5 2462 75 490 211 20 23·7 1975 69 320 172 27 19·8 1655 41 232 152

It will be seen that the third epidemic, that of Jan.-Feb. 1892, had the highest maximum weekly mortality from influenza (506) as well as the highest maxima from bronchitis and pneumonia not specially associated in the certificates with influenza; that the second epidemic, of 1891, had the next highest maxima, and that the first and last of the four outbreaks were both milder than the two intermediate ones. All but the second, which fell in early summer, are strictly comparable as regards season (mid-winter). But although the second, in 1891, had the advantage of falling in some of the healthiest weeks of the year, it was more protracted than the original outbreak, much more fatal than it in the article influenza, more fatal also in the article pneumonia, and less fatal only in the article bronchitis. The third outbreak was not only more protracted than the first, in the same season of the year, but much more fatal in all the associated articles. As to the deaths referred to influenza (whether as primary or secondary cause), the numbers are not strictly comparable in all the outbreaks; they are probably too few in the first table, more nearly exact in the second, third, and fourth, the diagnosis having at length become familiar and the fashion of nomenclature established. It is undoubted that many of the deaths from bronchitis and pneumonia in January, 1890, were due to the epidemic; for, “while the ordinary rise of mortality in cold seasons is mainly among the very aged, the increased mortality in this fatal month was mainly among persons between 20 and 60 years” (Ogle).

While the first epidemic of the series was universal and of short duration all over the kingdom, the second and third were more partial in their incidence and more desultory or prolonged. The second, which began in Hull (and at the same time on the borders of Wales), produced the following highest weekly death-rates per annum from all causes among 1000 persons living:

Highest Weekly Death-rates in the Second Influenza.

1891

Annual death-rate from all Week causes per ending 1000 living

Hull Apr. 11 42·5 Sheffield May 2 70·5 Halifax " 2 42·1 Leeds " 9 48·5 Manchester " 9 43·6 Bradford " 16 56·7 Huddersfield " 16 54·5 Leicester " 16 44·6 Oldham " 23 50·4 London " 30 28·9 Salford " 30 45·9 Blackburn June 6 48·5

The third was heard of first in the west of Cornwall and in the east of Scotland, in the last quarter of 1891. It was in the following English towns that it produced the maximum weekly death-rates per annum from all causes:

Highest Weekly Death-rates in the Third Influenza.

1892

Annual death-rate Week from all causes Town ending per 1000 living

Portsmouth Jan. 16 57·0 London " 23 46·0 Norwich " 23 44·7 Brighton " 23 60·9 Croydon " 30 47·2

These highest death-rates in the third successive season of influenza were all in the southern or eastern counties; in the latter, Colchester also had a maximum death-rate during one week of about 80 per 1000 per annum. Liverpool, among the northern great towns, appears to have had most of the third influenza. The fourth outbreak, in the end of 1893, was noticed first in the Midlands (Birmingham especially), and was afterwards heard of in the mining and manufacturing districts of Staffordshire, South Wales, Lancashire, Yorkshire and Durham, as well as in Scotland and Ireland, London, as in the table, having a share of it. The tables given of the London mortality in each of the four outbreaks, from influenza and the chest-complaints which were its most usual secondary effects, are a fair index both of the period and of the severity of the disease all over the kingdom in each of its successive appearances[748]. Everywhere the first and the fourth were the mildest, the second and third the most fatal. Deaths from “influenza” were reported from all the counties of England and Wales in the first and second epidemics, the highest rates of mortality per 1000 inhabitants in the corresponding calendar years having been in the following counties, while in all the counties the greater fatality of the second epidemic is equally marked:

1890

Cumberland ·35 North Wales ·28 Herefordshire ·28 Salop ·28 Wilts ·28 Somerset ·26 Dorset ·25 Bucks ·25

1891

Rutland 1·36 Lincolnshire 1·19 North Wales 1·09 Westmoreland 1·02 Monmouth 1·00 E. Riding Yorks ·98 Herefordshire ·98 Northamptonshire ·95

In London the entry of influenza is in the weekly bills of mortality throughout the whole period, with the exception of a few weeks; but the deaths were often reduced to unity, and there was perhaps only one occasion, besides the four great outbursts, namely the months of March and April, 1893, when cases were so numerous or so close together in households or neighbourhoods as to constitute a minor epidemic.

The type of the influenza of 1890-93 was not quite the same as on the last historical occasions. When it was announced as approaching from the Continent, everyone looked for “influenza colds”; but the catarrhal symptoms, although not wanting, were soon found to be unimportant beside the nameless misery, prostration and ensuing weakness. Some, indeed, contended that the disease was not influenza but dengue, so pronounced were the symptoms of break-bone fever[749]. Many cases had a decided aguish or intermittent character. The name of ague itself was once more heard in newspaper paragraphs, and more freely used in private talk; but, as we have long ceased to write of epidemic agues, equally as of marsh intermittents, in this country, it is not probable that there will remain any record of agues in Britain accompanying the influenzas of the years 1890-94. On the other hand the complications and after-effects of our latest influenza, more especially as affecting the nervous system, have been very fully studied[750].

That which chiefly distinguishes the influenza of the end of the 19th century from all other invasions of the disease is the revival of the epidemic in three successive seasons, the first recurrence having been more fatal than the original outbreak, and the second recurrence more fatal (in London at least) than the first. The closest scrutiny of the old records, including the series of weekly bills of mortality issued by the Parish Clerks of London for nearly two hundred years, discovers no such recurrences of influenza on the great scale in successive seasons. It is true that several of the old influenzas came in the midst of sickly periods of two or more years’ duration, such as the years 1557-58, 1580-82, 1657-59, 1678-80, 1727-29 and 1780-85. But in those periods the bulk of the sickness was aguish, the somewhat definite episodes of catarrhal fever having been distinguished from the epidemic agues by Willis in 1658, by Sydenham in 1679, by several in 1729, and by Baker, among others, in 1782. It is probable, indeed, that there were two strictly catarrhal epidemics in successive years in the periods 1657-59 and 1727-29, just as we know that, in New England, there was a catarrhal epidemic in the autumn of 1789 and an equally severe influenza, less catarrhal in type, in the spring of 1790[751]. But history does not appear to supply a parallel case to the four successive influenzas in the period 1889-94, unless we count the seasonal epidemic agues of former “constitutions” as equivalent to influenzas for the purpose of making out a series.

The Theory of Influenza.

Influenza is not an infection which lends itself to a simple theory of its nature or a neat formula of its cause. All that one can do is to indicate the direction in which the truth lies. Something broad, comprehensive, steady from age to age, telluric if not cosmic, must be sought for. Some have thought that the legendary or representative universal sickness at the siege of Troy was influenza, because it began upon the horses and dogs, as so many historical influenzas have done. But it will be sufficient to show that influenza was the same in the Middle Ages as now; for what circumstances make a broader contrast than medieval and modern? The first writer in England to mention influenza--of course not under that name--was a dean of St Paul’s in the reign of Henry II., Radulphus de Diceto[752]. He is narrating the journey to Rome of the archbishop-elect of Canterbury: his election in England was in June, 1173, he had got as far as Placentia by Christmas, whence he turned aside to Genoa, and at length reached Rome, to have his election confirmed by the pope in the nones of April, 1174. It is in the midst of this account of the archbishop’s journey, that reference is made to an influenza, otherwise known, from German and Italian chronicles, to have happened in December, 1173: “In those days the whole world was infected by a nebulous corruption of the air, causing catarrh of the stomach and a general cough, to the detriment of all and the death of many”--universus orbis infectus ex aeris nebulosa corruptione. What kind of infection can that be which has befallen men on both sides of the Alps within the same short time in the 12th century as in the 19th? And what kind of infection is it which has outlived so many changes in the great pestilences of mankind, has seen the extinction of plague and the rise of cholera, and all other variations, most of them for the better, in the reigning types of epidemic sickness? To have lasted unchanged through so many mutations of things, from medieval to modern, and from modern to ultra-modern, and to have become more inveterate or protracted at the end of the 19th century than it had ever been, is unique in this history. Influenza appears to correspond with something broadly the same in human life at all times. Or is it rather a thing telluric, of the crust of the earth or the bowels of the earth? Or is it perhaps cosmic, affecting men as the vintage is affected by a comet, or as if it came from the upper spheres? My belief is that we need not transcend the globe to look for its source, and that, upon the earth, we need not go deeper than the surface, nor beyond the inhabited spots. I shall come back to this from giving the history of English opinion upon it.

The best known influenzas of the 16th century all came in summer, as some of the later ones have done, so that no one thought of them as exaggerated common colds. But it happened that the influenzas observed by Willis in 1658, and by Sydenham in 1675 and 1679, came in spring or winter and in such weather as to suggest to each of those physicians that the catarrhal symptoms corresponded to the season. Robert Boyle, their great philosophical contemporary, was also a witness of one or more of these influenzas, and it appeared to him that there was more than season and weather in them.

“I have known a great cold,” he says, “in a day or two invade multitudes in the same city with violent, and as to many persons, fatal symptoms; when I could not judge (as others also did not), that the bare coldness of the air could so suddenly produce a disease so epidemical and hurtful; and it appeared the more probable that the cause came from under ground, by reason that it began with a very troublesome fog[753].”

I am unable to say whether Boyle was the first to apply the doctrine of telluric or subterranean emanations to influenza; he was certainly not the first to apply it to pestilences in general, for it is found in Seneca among the ancients[754], and it is clearly stated in Ambroise Paré’s essay “Sur les Venins,” having been probably a familiar notion of the sixteenth century, although a mystical and undefined one. Sydenham also, who must have discussed these questions with Boyle, referred all the more obscure or “stationary” epidemic constitutions to effluvia discharged into the air from “the bowels of the earth”: those hypothetical miasmata were for him the τὸ θεῖον of Hippocrates, the mysterious something which had to be assumed so as to explain plague, pestilential fever, intermittent and remittent fevers, the “new fever” of 1685-6, and all other epidemic constitutions which were not caused by obvious changes of season and weather. But it does not appear, and it is not probable, that he ascribed to that mysterious cause the two transient waves of influenza which fell within his own experience, those of November, 1675, and of November, 1679. On the other hand, Boyle certainly did so; he included influenza in his hypothesis explicitly; and if one examines its general terms, it will appear as if it had been made specially for influenza.

Boyle’s general expression, for both endemial and epidemic maladies, is that they are due to subterranean effluvia sent up into the air. As a chemist, and as dealing with the new knowledge then most in vogue, he assumed the sources of these miasmata to be for the most part mineral deposits in the crust of the globe, especially “orpimental and other mischievous fossiles”; but later in his writing he says:

“To speak candidly I do not think that these minerals are the causes of even all those pestilences whose efficients may come from under ground”; there were many mischievous fossils of which physicians and even chymists had no knowledge, and “the various associations of these, which nature may, by fire and menstruums, make under ground and perhaps in the air itself, may very much increase the number and variety of hurtful matters.”

He makes provision, also, for the hurtful matters multiplying in their underground seats, according to a principle which we know now to be true for organic, instead of mineral matters, and to be true for them above ground, or in the air, as well as under ground:

“I think it possible that divers subterraneal bodies that emit effluvia may have in them a kind of propagative or self-multiplying power. I will not here examine whether this proceeds from some seminal principle, which many chymists and others ascribe to metals and even to stones; or (which is perhaps more likely) to something analogous to a ferment, such as, in vegetables, enables a little sour dough to extend itself through the whole mass, or such as, when an apple or pear is bruised in one part, makes the putrefied part by degrees to transmute the sound into its own likeness; or else some maturative power ... as ananas in the Indies, and medlars ... after they are gathered, acquire (as it were spontaneously) in process of time a consistence and sweetness and sometimes colour and odour, and, in short, such a state as by one word we call maturity or ripeness.”

Other of Boyle’s fruitful principles (I am separating them out from amidst much other matter not specially related to influenza) are these:

“It is possible that these effluvia may be, in their own nature, either innocent enough, or at least not considerably hurtful, and yet may become very noxious if they chance to find the air already imbued with certain corpuscles fit to associate with them.”

Again, the effluvia sent up into the air may pass by certain places without causing an epidemic, because these “are not inhabited enough to make their ill qualities taken notice of; but, more frequently, because by being diffused through a greater tract of air, they are more and more dispersed in their passage, and thereby so diluted (if I may so speak) and weakened as not to be able to do any notorious mischief.”

Again, the effluvia may not produce epidemic disease at the part of the globe where they had emerged from under ground; an illustration of which may be intended in the case of the Black Death, which, as he says, came from China, yet plague is little heard of in that country, a Jesuit, Alexander de Rhodes, who spent thirty years in those parts, testifying that the plague is not so much as spoken of there. Again, why are some epidemics of so short duration at a given place? Either, he answers, because the morbific expiration from under ground had ascended almost at once, and been easily spent; or the subterraneal commotion which sends up the miasmata “may pass from one place to another and so cease to afford the air incumbent on the first place the supplies necessary to keep it impregnated with noxious exhalation; and it agrees well with this conjecture that sometimes we may observe certain epidemical diseases to have, as it were, a progressive motion, and leaving one town free, pass on to another”--as notably in the case of sweating sickness and influenza.

Lastly there are ever new forms of epidemic disease appearing, not to count every variation of an autumnal ague “which the vulgar call a New Disease.” Of the really new types Boyle offers the following explanation: “Some among the emergent variety of exotick and hurtful steams may be found capable to disaffect human bodies after a very uncommon way, and thereby to produce new diseases, whose duration may be greater or smaller according to the lastingness of those subterraneal causes that produce them. On which account it need be no wonder that some new diseases have but a short duration, and vanish not long after their appearing, the sources or fumes being soon destroyed or spent; whereas some others may continue longer upon the stage, as having under ground more settled and durable causes to maintain them.”

As a chemist, Boyle sought for the source of the pestilential emanations in underground minerals, in the new combinations of these under the action of “fire and menstruums,” in their self-multiplying power as if by subterraneous fermentation (“which many chymists and others ascribe to metals and even to stones”), and in their meeting with suitable “corpuscles” in the air of an inhabited spot wherewith to combine for their morbific effects. He assumed, also, their discharge into the air at particular spots of the globe (where they might not be directly morbific in their effects), or in a series of localities from the wave-like progress of the underground commotion; in which assumption he seems to be applying the very old idea of classical times that earthquakes and volcanic eruptions were a cause or antecedent of epidemics. Sometimes his mineral fossils were deep in the crust of the globe, touched only by the greater cataclysms; and then we might expect novelties in the forms of epidemic disease. But he does not exclude emanations from the earth’s surface proceeding more gently or insensibly.

It would be a mistake to set aside Boyle’s hypothesis of epidemical miasmata as made altogether void by his choosing strange minerals to be the source of them, and by his assuming a kind of fermentation in these inorganic matters so as to explain the continuance and spreading of the infections. Substitute organic matters in the soil for minerals in the crust of the earth, and read a modern meaning into the doctrine of underground or aërial fermentation or leavening, and we shall find Boyle’s hypothesis, especially as applied to influenza, far from obsolete. Some such adaptation of the doctrine of miasmata was made two generations later by Dr John Arbuthnot in his ‘Essay concerning the Effects of Air upon Human Bodies,’ the immediate occasion of which was the London influenza of 1733. There is nothing to note between Boyle and Arbuthnot; for Willis and Sydenham, using the Hippocratic language of “constitutions,” explained, as we have seen, the epidemic catarrhs of the spring or winter as the reigning febrile constitution modified to suit the season and weather.

Arbuthnot’s essay makes more modern reading than Boyle’s. He assumes emanations from the ground, but they are no longer from the bowels of the earth, or from deposits of strange minerals requiring earthquakes to set them free, or “fire and menstruums” to give potency to them. Of all the things that pass into the atmosphere, he makes most of the various steams and other volatile decomposing matters of men and animals; and when he brings in the earth, it is as the storehouse or receptacle of such matters, in a surface stratum no deeper than the effects of drought and rainfall could reach. While he accepts the Hippocratic doctrine of epidemic constitutions, and recognizes the air with its various organic contents as the τὸ θεῖον, the quid divinum or mysterious something of epidemical causation, he does not forget that the earth is inhabited by creatures, human and other, who befoul the atmosphere by “their own steams”; again, he lays stress upon alternations of drought and moisture in the soil and subsoil as a cause of morbific emanations, not, indeed, stating the matters of fact in the very terms of Pettenkofer’s law, but assuming the presence of special organic matters in the soil as much as that does. Although Arbuthnot was hardly a serious epidemiologist, any more than Boyle, yet in the growth of opinion on the subject of morbific matters in the air, he may be said to have shifted the interest from inorganic or mineral substances and gases, to organic matters chiefly of human or animal origin, and from the deeper regions of the globe, such as only earthquakes reach, to the surface stratum of soil and subsoil which is affected by every rise and fall of the ground-water. I shall now give a few extracts, to bear out the above summary, from Arbuthnot’s essay.

“Air,” he says, “is the τὸ θεῖον in diseases, which Hippocrates takes notice of. Air is what he means by the powers of the universe, which, he says, human nature cannot overcome; and he lays it down as a maxim ‘that whoever intends to be master of the art of physick must observe the constitution of the year; that the powers and influence of the seasons (what are seldom uniform) produce great changes in human bodies.’” He then pays a compliment to Sydenham as “endowed with the genius of Hippocrates,” and passes on to his own analytic method. “Many great effects must follow, and many sudden changes may happen in human bodies by absorbing outward air with all its qualities and contents. Nothing accounts more clearly for epidemical diseases seizing human creatures inhabiting the same tract of earth, who have nothing in common that affects them except air: such as that epidemical catarrhous fever of 1728 and of this present year [1733].... It seems to be occasioned by effluvia, uncommon either in quantity or quality, infecting the air.... It is likewise evident that these effluvia were not of any particular or mineral nature, because they were of a substance that was common to every part of the surface of the earth: and therefore one may conclude that they were watery exhalations, or, at least, such mixed with other exhalable substances that are common to every spot of ground.”

In his account of the qualities and contents of the air, he enumerates them, not so much as detected in the air on analysis, but as having of necessity passed into it, and in some instances been deposited again from it, as in strange dews. One class of substances that pass into the air are the oils, salts, seeds and insensible abrasions of vegetables. Also all excrements and all the carcases of animals vanish into air. Another ingredient of the air is the perspirable matters of animals, the amount of which for human beings he works out by a curious calculation of a column of their own steams raised so many feet high in so many days. Perhaps there are insects in the air invisible to human eyes: one may observe, in that part of a room which is illuminated with the rays of the sun, flies sometimes darting like hawks as if it were upon a prey. Some have imagined the plague to proceed from invisible insects: this system agrees with many of the appearances in the progress or manner of propagation of that disease, but is altogether inconsistent with others. Air replete with the steams of animals, especially such as are rotting, has often produced pestilential fevers in that place: of which there are many instances.

But why should certain years or seasons have a pestilential atmosphere, for example the season of the catarrhous fever of 1733? There had been, he says, an unusual drought for these two years past, the best estimate of the dryness of the surface of the earth being taken from the falling of the springs, “the consequence of which has been unusual diseases amongst several animals, and a great mortality amongst mankind. It is true, this did not happen during the dry weather.... The previous great drought must have been particularly hurtful to mankind. Great droughts exert their effects after the surface of the earth is again opened by moisture, and the perspiration of the ground, which was long suppressed, is suddenly restored. It is probable that the earth then emits several new effluvia hurtful to human bodies: this appeared to be the case by the thick and stinking fogs which succeeded the rain that had fallen before.”

Arbuthnot knew the progress of the influenza of 1732-33. Its worst week in London was from the 23rd to the 30th January, 1733; but he tells us that it had been at a height in Saxony from the 15th to the 29th November, 1732, had been earlier in Holland than in England, earlier in Edinburgh than in London, in New England before Great Britain. Again, it appeared in Paris in February, somewhat later than in London, and in Naples in March. This progress, he says, was often against the wind. Nor does he assume a progressive infection of regions of atmosphere. The effluvia, he says, were of a substance that was common to every part of the surface of the earth; they were exhalable substances that were common to every spot of ground; the excessive drought of two years, followed by heavy rains in the end of 1732, is also assumed to have been common, for, in Germany and France, especially in November, 1732, the air was filled with frequent fogs. It is clear that Arbuthnot traced the universality of influenza, the uniform symptoms of which he recognized, to certain conditions of soil and atmosphere common to all the countries visited by the epidemic.

Throughout the rest of the 18th century there were numerous and varied experiences of influenza, in summer and winter, spring and autumn, coming up from the south as if from Africa, or from the east as if from Central Asia, or appearing in America sooner than in Europe--experiences which made a theory of the disease difficult. Some inclined to Arbuthnot’s view of unusual seasons and weather producing the same effects everywhere; others favoured the hypothesis of contagion from a remote source, which might be China or might be some other territory. Geach, a surgeon at Plymouth who was a Fellow of the Royal Society, actually went back to the astrological cause, pointing out that Jupiter and Saturn were in a certain conjunction during the influenza of 1775. The only elaborate theory of the strange disease that calls for notice, besides those of Boyle and Arbuthnot, is that of Noah Webster, the famous lexicographer of Hartford, Connecticut.

While Webster was a journalist in New York about the years 1794-6, the subject of yellow fever, which was then of great practical moment, set him reading and speculating about pestilences in general. Writing to Priestley, he said that in the course of his inquiries he found the American libraries ill supplied with books[755]; but he certainly made diligent and skilful use of his literary materials, and produced in his ‘Brief History of Epidemic and Pestilential Diseases,’ a work which was better than any before it in the chronological part, and remains to the present time unique in its philosophical part for the boldness of its generalities[756]. He saw that influenza was the crux of epidemiology, and paid special attention to it.

In looking for the antecedents of influenza, he kept in view the greater telluric changes and convulsions, such as earthquakes and volcanic eruptions. He did not regard these as the cause of influenza, but as the index of some hidden cause to which both they and the universal catarrh were due.

“It is probable to me,” he says, “that neither seasons, earthquakes, nor volcanic eruptions are the causes of the principal derangements we behold in animal and vegetable life, but are themselves the effects of those motions and invisible operations which affect mankind. Hence catarrh and other epidemics often appear before the visible phenomena of eruptions and earthquakes[757].” As to influenza, he found “reason to conclude the disease to be the effect of some access of stimulant powers to the atmosphere by means of the electrical principle. No other principle in creation, which has yet come under the cognizance of the human mind, seems adequate to the same effects.”

And again: “It is more probable that it is to be ascribed to an insensible action of atmospheric fire, which is more general and violent about the time of eruptions, and which fire is probably agitated in all parts of the globe, although it produces visible effects in explosions in some particular places only.” It is due to Webster to give his reason for preferring a physical force to an organic poison: “If a deleterious vapour were the cause, I should suppose its effects would be speedy, and its force soon expended, the atmosphere being speedily purified by the winds. But if stimulus is the cause, it may exist for a long time in the atmosphere, and the human body not yield to its force in many weeks or months. This would better accord with facts. For, although diseases appear soon after an earthquake, yet the worst effects are often many months or years after[758].”

Dr Blagden also saw a difficulty in “the prodigious quantity of matter required in the air to infect the space not only of the Chinese land, but to a hundred leagues of the coast, or, as in this instance [1782] all Europe and the circumjacent sea,” and was accordingly driven to Arbuthnot’s view of an origin in the unusual weather of each locality.

Webster drew up a chronological table of influenzas in either Hemisphere, with the volcanic eruptions, earthquakes, comets, etc., to suit[759]. A few instances from near the beginning may serve as samples:

1647. First catarrh mentioned in American annals, in the same year with violent earthquakes in South America, and a comet.

1655. Influenza in America, in the same year with violent earthquakes in South America and an eruption of Vesuvius. It began about the end of June.

1658. Influenza in Europe after a severe winter: the summer cool.

1675. Influenza in Europe while Etna was still in a state of explosion: the winter mild.

1679-80. Influenza in Europe during or just after the eruption of Etna: the season wet: a comet.

1688. Influenza in Europe in the same year with an eruption of Vesuvius, after a severe winter, and earthquakes: it began in a hot summer.

1693. Influenza in Europe in the same year with an eruption in Iceland and great earthquakes: the season cool.

1697-98. Influenza in America after a great earthquake in Peru: a comet the same year: the winter severe.

In most instances the region of the earthquake is not specified in the table; but it is sometimes named in the text of the annals under the respective years. Volcanoes are on the whole made more of than earthquakes, Webster’s object being to find evidence of “electrical stimulus,” and not of material miasmata discharged into the air. Etna and Hecla are much in request. Any earthquake suits, as if “earthquake” and “volcano” were like algebraic symbols, always a and b, and never anything but a and b, “influenza” being always x. One begins to realize the difficulties of the volcano or earthquake theory of influenza on turning to Mallet’s Catalogue of Earthquakes[760]. Here, indeed, is an embarrassing choice between China and Peru, Asia Minor and North Africa, Portugal and Sicily or Calabria, Iceland and Jamaica, the Azores and the Philippines, Caracas or Acapulco and Valparaiso, Hungary and Savoy, Kamtschatka and Amboina; between earthquakes great and small; between earthquakes and volcanoes. Any influenza year might be suited with one or more earthquakes, perhaps in either Hemisphere; but there are some long clear intervals between the greater influenzas in Europe, for example the interval from 1803 to 1831, which seem to occupy as many pages of the catalogue of earthquakes as the years wherein influenzas came thickest, for example from 1729 to 1743, or from 1831 to 1847.

None the less, Webster, like Boyle, obeyed a true impulse when he looked for the cause of influenzas in something telluric, occasional, phenomenal. A wave of influenza comes up unexpectedly from a particular point of the compass, passes quickly over many degrees of latitude and longitude, lasting a few weeks at any given place, disappears in the distance, and does not return again perhaps for a whole generation. Influenza has the qualities of suddenness, swiftness, transitoriness; it has a certain sameness in its symptoms; it can be identified as certainly in the brief phrases of medieval chronicles as in elaborate modern descriptions; it has had no season for its own, as plague and cholera have had the summer and autumn, but has reached a height in Europe sometimes in midsummer, sometimes in midwinter. No other epidemic malady can compare with it in these respects; all the rest seem to have been provoked more or less by the turns and changes in human affairs, some being of a medieval colour, others of a modern, each in its own way admitting of explanation from unwholesome living, or from famine, or from over-population, or from something more recondite but still within the sphere of things insanitary in an intelligible sense. Other plagues besides influenza were, it is true, once reckoned mysterious, or associated in the popular mind with earthquakes and comets. But several such plagues have disappeared from among us, while their alleged causes, the earthquakes or comets, continue as before. Influenza alone returns at intervals as of old, untouched by civilization, by sanitation, by the immense differences between medieval and modern, making the same impression upon England in the year 1890 as it did in 1173, or 1427, or 1580, or, if changed at all, then changed for the worse inasmuch as the epidemic came back more severely in 1891, and still more severely in 1892. It is not surprising that for such a disease something telluric or even cosmic should have been assigned as the cause, something as occasional as itself, phenomenal, if not cataclysmic. It may be proper, therefore, that we should try over again the philosophic generalities of Boyle, Arbuthnot and Webster, peradventure a combination of them may yield a true theory. From Boyle we may take the great principle of a progressive infection through regions of air (or leagues of ground), which was expressed once for all by Lucretius in the sixth book of the ‘De Rerum Natura’:

... atque aer inimicus serpere coepit; Ut nebula ac nubes paulatim repit, et omne Qua graditur, conturbat et immutare coactat; Fit quoque ut in nostrum quum venit denique coelum Corrumpat reddatque sui simile atque alienum.

From Arbuthnot we may take the organic source and nature of the influenzal miasmata, and the association with changes in the level of the water in the soil. From Webster we may take the idea that the historic influenzas, having been sudden, occasional or phenomenal, must have had phenomenal causes somewhere in either Hemisphere. Instead of sketching a theory in the abstract, and safeguarding it by following all its ramifications, I shall proceed by the way of instances, choosing them so as to bring out particular points in order.

The only generality which may be indicated at starting is one that has presented itself time after time in the foregoing history, namely that there is something more than accident in the association between epidemics of influenza and epidemics of ague. So close was this association in former times that both the influenza and the widely prevalent ague were included together under such names as “the new ague,” “the new fever,” “the new distemper.” As late as 1679, Morley did not distinguish the epidemic of influenza from the epidemic agues in the midst of which it was set, although the distinction was real, and was actually made by Sydenham on that occasion, as it had been made by Willis and in a manner by Whitmore on the occasion immediately preceding, and as it was made by everyone on the last great occasion when an influenza made an interlude among epidemic agues in the year 1782. It has often been suspected that influenza was related to some other infection: at one time it was taken for a volatile emanation of plague, in our own time it has been regarded as a volatile emanation of Asiatic cholera. In a wider historical view the question may arise, whether the real relation is not rather to those remarkable agues which have been epidemic in company with influenza when there was no plague and no cholera.

I come now to certain influenzas, as illustrating particular points of theory, in order.

I.

It is probable that Webster’s theory of influenza as related to earthquakes and volcanoes, first published in 1799, was suggested to him by a communication to the Royal Society on the volcanic waves seen at Barbados on the 31st of March, 1761, and on the epidemic of influenza thereafter ensuing all over the island. At Bridgetown, in the afternoon of the 31st of March, 1761, the water in the bay and harbour ebbed and flowed to the extent of eighteen inches or two feet at intervals of eight minutes, and continued to do so for the space of three hours, the oscillation regularly decreasing till night when it was no more observable. These tidal waves were due to volcanic upheavals somewhere; and it was found that the centre of disturbance had been in the Atlantic near the coast of Portugal, and the time some hours earlier than the waves were felt at Bridgetown. The Barbados chronicler proceeds:

“It is very remarkable that since that time the island has been in a very deplorable condition, having suffered under the severest colds that have been ever known. The distress has been so general that I may venture to assert (with confidence) that nineteen twentieths of the inhabitants of the island have felt the effects of the contagion; and to some it has been repeated several times. It has puzzled all the adepts in pharmacy to find out the cause and cure of it. One favourable circumstance has attended it, viz. few have died with it. The Leeward Islands have not escaped, it having raged there more violently and more fatal. His Majesty’s ships have severely felt the effects of it, some of them not being capable of keeping the seas for want of men fit for service. This happening at a season of the year remarkably the healthiest, makes it the more surprising[761].”

This is as good an instance as we shall find, of explaining something sudden, swift, and phenomenal, by something else sudden, swift, and phenomenal, in a purely empirical way and without pausing to ask whether the latter could have been a vera causa of the former. That the influenza came to Barbados in the wake, as it were, of the volcanic waves, had been a common subject of talk among the residents; and that common opinion of the colony had found expression in the paper sent to the Royal Society. The influenza was not only in Barbados, in the Leeward Islands, and in the ships on the West Indian Station, but also in New England and “over the whole country” of the North American Colonies. Dr Tufts, of Weymouth, New England, wrote to Webster that “it began in April, and in May ran into a malignant fever which proved fatal to aged persons. It spread over the whole country and the West India Islands[762].” It was not until some nine months after that influenza appeared in Europe, at first in the east of that continent,--Hungary, Vienna, Breslau, Copenhagen--in February and March, 1762, in central Germany and Scotland in April, in London about the first of May and all over England and Ireland thereafter, but not in France until June and July.

Precisely the same order was followed by the influenza twenty years after: it began in North America in March, 1781, and, says Webster, spread over that continent; it appeared in the East Indies in October and November, 1781, and on the eastern confines of Europe in January, 1782, having been traced from Tobolsk, made a slow progress westwards, and was at its height in London about the end of May or beginning of June. Assuming, says Webster, that the American influenza of 1781 had been continuous with the European of 1782, it must have “passed the Pacific in high northern latitudes,” traversed Siberia and Tartary, and so reached Russia in Europe. In like manner, if the European influenza of 1762 were continuous with the American of 1761, it must have made the circuit of the globe in the same order, as if it were following the first impulse of the volcanic waves across the Atlantic from the coast of Portugal westwards, and so round the earth until it came back to Europe on its eastern frontier. So much may be fairly advanced on the ground of a particular set of facts. But then there were many other facts, both in 1761-62, and in 1781-82. Meanwhile let us take another instance of volcanic waves felt at Barbados six years before, on the same afternoon as the great earthquake of Lisbon.

II.

At Bridgetown, on the 1st November, 1755, Dr Hillary saw the peculiar flux and reflux of the water in the harbour from 2.20 p.m. to 9 p.m. and pronounced that there must have been an earthquake somewhere. The waves came at first at intervals of five minutes, and at last at intervals of twenty minutes. The day was calm, and the ships in the bay were not touched; but small craft lying in the channel over the bar were driven to and fro with great violence. There was no motion of the earth, and no noise. The distance from Lisbon was 3400 miles, the vibrations having taken seven and a half hours to reach Barbados. The one notable effect in the harbour of Bridgetown was that the water flowed in and out with such a force that it tore up the black mud in the bottom of the channel, so that a great stench was sent forth and the fishes caused to float on the surface, many of them being driven a considerable distance on to the dry land where they were taken up by the negroes[763].

It so happened that there was an epidemic catarrh prevalent at that very time all over the island of Barbados, chiefly among children, few or none of whom, white or black, escaped it. It had begun in October, says Hillary[764] (who chronicled the epidemiology very exactly), and continued into November, so that it both preceded and followed the great convulsion in the bed of the Atlantic, which destroyed Lisbon and tore up the mud in the harbour of Bridgetown, disengaging a great stench therefrom and poisoning the fish. Webster’s theory of a relation between earthquakes and influenzas provides for such discrepancies in the dates of each: it is probable, he says, that seasons, earthquakes and volcanic eruptions are themselves the effects of those motions and invisible operations which affect mankind, so that catarrh and other epidemics often appear before the visible phenomena of eruptions and earthquakes. In like manner, the chronicler of the earthquake of Lisbon in the Philosophical Transactions drew attention to the fact that there had been a remarkable drought for several years before, and that some of the springs near Lisbon were actually dried up at the time. That droughts precede earthquakes is perhaps the most instructive generality that has yet been reached as to the cause of the latter.

Let us see, then, whether any such remote antecedents, in a possible relation to the influenza epidemics, hold good for the island of Barbados. Hillary’s chronicle is sufficiently full to let us answer the question.

Following the seasons and prevalent maladies backwards from the influenza of children in October-November, 1755, we find a catarrhal fever all over Barbados in February of the same year, which “few escaped having more or less of.” The immediate precursor of that influenza had been a very definite constitution, eighteen months long, of a “slow nervous fever,” from February, 1753 to September, 1754, which corresponds in every respect to the “remittent” fever of nearly the same period in England and Ireland, described by Fothergill, Rutty, Huxham and Johnstone, and to the famous Rouen fever described by Le Cat. Hillary is clear that the “slow nervous fever” was not seen again so long as he remained in the colony (1758). Just before it began, there had been an influenza so general in December, 1752, and January, 1753, “that few people, either white or black, escaped having it,” and that, in turn, was preceded by a season of agues, which, says Hillary, “are never seen in Barbados now [1758], unless brought hither from some place of the Leeward Islands.”

So many influenzas in Barbados, and so many things possibly relevant to them among their antecedents. So also in New England, the influenza which seemed to follow the earthquake along the coast of Portugal on the 31st of March, 1761, had the same remittent and intermittent fevers among its antecedents.

In the winter and spring of 1760-61 there had been much fever in New England, which was believed to be malarious. Webster, however, says: “There is no necessity of resorting to marsh exhalations for the source of this malady. The same species of fever [as at Bethlem] prevailed in that winter and the spring following in many other parts of Connecticut where no marsh existed. In Hartford it carried off a number of robust men, in two or three days from the attack.... In North Haven it attacked few persons, but everyone of them died. In East Haven died about forty-five men in the prime of life, mostly heads of families. The same disease prevailed in New Haven among the inhabitants and students in college.” In Bethlem the sickness began in November, 1760, and carried off about forty of the inhabitants in the winter following. This was the fever, generally reckoned malarious, which preceded the influenza of April and May, 1761[765].

III.

The next great influenza, twenty years after, which was in America in the spring of 1781 and in Europe in the winter and spring following, will repay the same kind of scrutiny. There had been influenza here or there in Europe since the beginning of 1780, but no great epidemic of it; and in England, as elsewhere, there had been epidemic agues and dysenteries since that year, or the autumn before. The epidemic agues became worse in England in 1783, 1784, and 1785, appearing in places which had never been thought malarious. The whole period from 1780 to 1784 was remarkable for hot and dry summers and great earthquakes. Italy and Sicily were troubled by earthquakes to an unusual extent in 1780, 1781, 1782, and 1783; they were so frequent in 1781 that the pope ordered public prayers. The great earthquake of the period was in Calabria at half an hour after noon of the 5th of February, 1783, about six months after the great influenza of the period was over. Sir William Hamilton, the British ambassador at Naples, visited the numerous scenes of the earthquake in Calabria and Sicily in the first fortnight of May, 1783, and sent to the Royal Society an account of what he saw. At several places he found fever epidemic, part of it from the overcrowding and filth of the temporary barracks in which the people were living, part of it malarious from the damming of water by changes in the river beds. At Palmi the spilt oil mixed with the corn of the overthrown granaries, and the corrupted bodies, had a sensible effect on the air, which threatened an epidemic; at the village of Torre del Pezzolo an epidemical disorder had already manifested itself[766].

But the most striking effect of the earthquake was that a dry fog began in Calabria in February, and overspread until autumn the greater part of Europe, extending even to the Azores. This fog, though not consisting apparently of moisture, was so dense that the sky was quite obscured, appearing a light grey colour instead of blue, while the sun became a blood-red disc. In Calabria the darkness was so great that lights were needed in the houses, and ships came into collision at sea. There was a most disagreeable odour[767]. The fog spreading over all Europe from Calabria was not at all mythical, as we are apt to suppose that similar recorded phenomena of the wonder-loving Middle Ages may have been. The phenomenon was independently reproduced in Iceland the same year, from the 1st to the 11th of June, causing the same darkness at sea, the same atmospheric effects at a distance, but not to so great a distance, and some amount of sickness, but seemingly not aguish or febrile, among the population[768].

Those two great convulsions of the year 1783, each of them the cause of a widely spreading dry fog, may have been conceivably the cause of pestiferous miasmata in the air, such as the corresponding hypothesis of influenza requires; but how little comparable or equivalent were the miasmata--in the one case from the ancient and well-peopled soil of Southern Italy, in the other from the inhospitable Danish colony just without the Arctic Circle! In any case, the earthquakes of 1783 were both too late for the great influenza of the period. The antecedent common alike to the influenza and the earthquakes was the extraordinary droughts, which caused famine and famine-fever in Iceland, and, according to old experience, was probably related to the epidemic prevalence of agues in Britain and on the continent of Europe.

IV.

What kind or kinds of epidemic sickness earthquakes may produce as an effect immediate and at the place, will appear from other instances. One of the most remarkable of earthquakes was that which destroyed Port Royal and nearly all the planters’ houses and sugar-works throughout the island of Jamaica on the 7th of June, 1692. Jamaica had been an English colony for little more than thirty years, during which time it had passed from its state of lethargy under the Spaniards into an emporium of commerce with a rapidly growing population of slaves and whites. The business capital was at Port Royal, wholly built since the British occupation. The site of it was a sandy key or shoal which was said to have risen perceptibly within the memory of original settlers; a writer in September, 1667, said of it: “wherever you dig five or six feet, water will appear which ebbs and flows as the tide. It is not salt, but brackish[769].” A quay had been built along this spit of land, at which vessels of 700 tons could lie afloat. It was here that the havoc of the earthquake was most complete.

Sloane, who had visited Jamaica a few years before, said that the inhabitants expect an earthquake every year, and that some of them were of opinion that they follow their great rains[770]. The year 1692 began in Jamaica with very dry and hot weather which continued until May: then came gales and heavy rains until the end of the month, and from that time until the day of the earthquake, the 7th of June, the weather was excessively hot, calm and dry. The shakes began at 11.40 a.m., and at the third shake, the ground of nearly all Port Royal fell in suddenly, so that in the course of a minute or two most of the houses were under water and the whole wharf was covered by the sea to the depth of several fathoms. The loss of life was, of course, greatest where population was densest; but in the interior of the island the effects on the soil were greater than at the shore: in the north a thousand acres of land sank and thirteen people with it; mountains on either side of a narrow gorge came together and blocked the way; wide chasms appeared in the ground, and on one mountain side there were some dozen openings from which brackish water spouted forth. The first effect in the streets of Port Royal was that men and women seemed all at once to be floundering up to the neck in the wet shifting sand, and were speedily drowned or floated away by the inrushing water. The shakes ceased for days at a time, and then began again, five or six perhaps in twenty-four hours; so that those who had escaped to ships in the bay remained on board for two months, being afraid to come ashore. The weather was hotter after the earthquake than before, and mosquitoes swarmed in unheard of numbers.

During the upheavals or subsidences in Port Royal, and the rushing of water into or from the gapings in the ground, “ill stenches and offensive smells” arose, so that “by means of the openings and the vapours at that time belcht forth from the earth into the air, the sky, which before was clear and blue, was in a minute’s time become dull and reddish looking (as I have heard it compared often) like a red-hot oven.” A very great mortality followed among those who had escaped the earthquake. Some of them settled at Leguanea, others at the place on the bay which became the Kingston of later history, enduring many hardships in their hastily built shelters, from the heavy rains that followed the earthquake, and from want of clothes, food and comforts.

One writes: “Our people settled a town at Leguanea side; and there is about five hundred graves already [20th September, 1692], and people every day is dying still. I went about once to see it, and I had like to have tipt off.” Another says: “Almost half the people that escaped upon Port Royal are since dead of a malignant fever”: and another, referring to the hasty settlement on the bay at Kingston, says “they died miserably in heaps.” But the most interesting information is his next sentence: “Indeed there was a general sickness (supposed to proceed from the hurtful vapours belched from the many openings of the earth) all over the island, so general that few escaped being sick: and ’tis thought it swept away in all parts of the island three thousand souls, the greatest part from Kingstown, only yet an unhealthy place[771].”

That great mortality from a malignant fever after the earthquake of 7th June, 1692, is usually counted an epidemic of the yellow fever which became established at Kingston and Port Royal from that time for at least a century and a half. I have not found any contemporary medical account of it, but all the later writers on yellow fever at Kingston and Port Royal have accepted the tradition that it was yellow fever. But there was one peculiarity, which marks it off from all subsequent epidemics of yellow fever--the sickness was all over the island, so general that few escaped being sick, and was supposed to proceed from the hurtful vapours belched from the many openings of the ground in and near Port Royal. In all subsequent experience yellow fever has been almost confined to the shore or to the ships in the bay[772]. Certainly it has never been all over the island as in 1692, “so general that few escaped being sick”: that is rather in the manner of influenza, although there is nothing to show that the sickness of the interior was so different from that of the shore as to be counted an influenza, or that the mortality of the sick was other than that of a “malignant fever.”

The earthquake at Port Royal in 1692 produced “ill stenches and offensive smells.” The tidal waves, or the subterranean vibrations which caused them, in tearing up the mud at the bottom of the channel at Bridgetown, Barbados, in 1755, had in like manner sent forth a great stench which poisoned the fish. Such offensive vapours were supposed in former times to come, as in a figure, from “the bowels of the earth”; and undoubtedly the sulphurous fumes which have overhung the region of Sicilian earthquakes must have had a source as deep as the strange minerals or “fossils” of Boyle’s hypothesis. But, while the commotion of an earthquake is deep, it is also superficial; whatever miasmata issue from the ground in the ordinary alternations of wet and drought, would be discharged into the atmosphere in unusual quantity and with unusual force in such disturbances of soil as sunk Port Royal in 1692 or were felt at Barbados across the whole width of the Atlantic in 1755. Nor is that effect upon miasmata instantaneous or quickly past; in Jamaica the rumblings and shakes lasted for nearly two months, during which time the pressure upon the gases in the subsoil must have been such as to make them pass into the atmosphere in stronger ascending currents than the mere alternations of moisture and drought would have done. And just as the ordinary seasonal changes in the level of the ground-water are of little or no account for miasmatic-infective disease unless the soil in which they occur be full of organic impurities from human occupancy, so one may reason that the great cataclysmic changes of the earth’s crust are, in this hypothesis of influenza, of most account as touching the stratum of soil wherein lie organic impurities, and as touching those areas of the surface,--the sites of cities, the populous plains, the shores of bays, the bottoms of harbours or any other definite spots--in which the products of organic decomposition are present in largest amount and, perhaps, of somewhat special kind. Such impurities of the soil are indeed a vera causa of infective disease, known to be capable of the effect which has to be accounted for; and, as discharged into the air in great volume and with great force by some upheaval, they would make a local beginning of that “aer inimicus” which the Roman poet figures as creeping like a mist from one region of the heavens to another so that it corrupts each successive tract of air with its own baleful qualities, “reddatque sui simile atque alienum.”

But, as soon as we begin to apply this formula to particular historic cases, difficulties and ambiguities arise[773]. To come back to the instance of Jamaica in 1692, did the general sickness of the island, manifestly miasmatic as it was, and due to disturbances of soil, become an influenza for other regions of the globe? About fifteen months after there was, indeed, a universal catarrh in Britain and Ireland, of no great fatality, which is said by Molyneux, of Dublin, to have prevailed also in the northern parts of France, Flanders, and Holland, but is not reported in the usual way from Europe generally nor from America. Let us suppose a miasmatic cloud formed over the island of Jamaica in June, July, August and September, a cloud of infective particles which might produce influenza at a distance from its place of origin, whatever disease the miasmata after the earthquake may have produced in Jamaica itself. Let this invisible cloud, or emanation, get into the warm atmosphere over the great oceanic current that sets out from the Gulf of Mexico. The vehicle lies ready to hand,--to receive the miasmata not far from their place of origin, to carry them far into the Atlantic, and to bring them, perhaps, to the shores of Britain. This may seem a sufficiently plausible source of the influenza of October and November, 1693, which appears to have been felt only in the British Isles and on the opposite shores of the North Sea. But Webster’s own choice is the volcanic eruption in Iceland in the same year as the influenza; and if we prefer, in this hypothesis, an earthquake to an active volcano, there is a rival source for the British influenza of 1693, nearer both in place and time than that of Jamaica in 1692, and not less important in respect of miasmatic disease in its own locality. This was the disastrous series of earthquakes in Calabria and Sicily, culminating on the 9th of January, 1693. The following extracts from the account sent to the Royal Society will show how great was the commotion of soil, of underground water, and of atmosphere, and how close the connexion of these with the sickness ensuing[774]:

“In the plain of Catania, an open place, it is reported that from one of the clefts in the ground, narrow but very long and about four miles off the sea, the water was thrown forth altogether as salt as that of the sea, [as in Jamaica the year before]. In Syracuse and other places near the sea, the waters in many wells, which at first were salt, are become fresh again.... The fountain Arethusa for the space of some months was so brackish that the Syracusans could make no use of it, and now that it is grown sweeter the spring is increased to near double. In the city of Termini all the running waters are dried up.... It was contrary with the hot-baths, which were augmented by a third part.

Darkness and obscurity of the air has always been over us, but still inferior to that on the 10th and 11th of January; and often these clouds have been thin and light, and of a great extent, such as the authors call rarae nubeculae. The sun often and the moon always obscured at the rising and setting, and the horizon all day long dusky....

The effects it has had on humane bodies (although I do not believe they have all immediately been caused by the earthquake) have (yet) been various: such as foolishness (but not to any great degree), madness, dulness, sottishness, and stolidity everywhere: hypochondriack, melancholick and cholerick distempers. Every-day fevers have been common, with many continual and tertian: malignant, mortal and dangerous ones in a great number, with deliria and lethargies. Where there has been any infection caused by the natural malignity of the air, infinite mortality has followed. The smallpox has made great destruction among children.”

Thus we find in Sicily a great disturbance of soil followed, as in Jamaica, by a great increase of local sickness, and by an atmosphere visibly charged with products of the earthquake for months after. This is a nearer source than the Jamaican for the British influenza of Oct.-Nov. 1693,--nearer in time, if that be any advantage for the theory, nearer also in place. There are, however, no intermediate stages to connect the influenza on the northern edge of the European continent with the disturbance of soil and the miasmata arising therefrom in Sicily and Calabria. If there had been any such dry fog as spread all over Europe from the Calabrian earthquake of January, 1783, it would have been a help at least to the imagination in bridging over a gulf of space and time.

As to the interval of time, it should at all events be kept in mind that the same difficulty has to be reckoned with in any hypothesis of influenza and in every great historic instance. In the instance still before us, the infection began in England, according to Molyneux, in October, 1693, and was in Dublin a month later. But we must assume it to have been in the air for some time before it became effective upon mankind. Influenza has been observed, with curious uniformity, to attack the horses, say of London, of Plymouth, of Edinburgh, or of Dublin (as on the occasion before this, 1688) two months or more in advance of the inhabitants of the respective places; and if it had waited, so to speak, for two months before it showed its effects upon men, it may have waited equally long, or longer, before it showed its effects upon horses. That would give at least four months; and then we know, from such an influenza as that of 1743, that there may be weeks, perhaps months, between its prevalence in Naples, Rome or Milan, and its prevalence in London or Edinburgh, and, from the influenza of 1693 itself, that it was a month later in Dublin than in London. An earthquake in Sicily on the 9th of January, 1693, with effects there for months after upon the water, the air, and the prevalent diseases, is not excluded by lapse of time from being a vera causa of an influenza in England in October of the same year, and in Ireland in November. The sort of proof which most men desire, a proof such as we rarely get, and one that is suspiciously neat when we do get it, would be to find an influenza in Sicily and Calabria following the earthquake, and to trace the same step by step over Europe. But the miasmatic sickness in the countries of the earthquakes was not influenza, so far as is known; and there was no epidemic catarrh, so far as is known, in any other part of Europe but the British Isles and the neighbouring shores of the North Sea.

V.

Molyneux, who recorded with a good deal of circumstance the influenza of 1693, is the principal authority, along with Dr Walter Harris, of London, for another influenza in 1688, seemingly peculiar to the British Isles. Its effects can be discovered with the utmost certainty in the London bills of mortality for two or three weeks at the end of May and beginning of June, and it is mentioned as “the new distemper” in letters of the time. Is it possible to find an earthquake for it? Webster’s note is: “in the same year with an eruption of Vesuvius, after a severe winter and earthquakes”--which is somewhat general. Turning to Evelyn’s diary, where these matters are often recorded, we find, in the very weeks when the influenza was at a height in London, this entry: “News arrived of the most prodigious earthquake that was almost ever heard of, subverting the city of Lima and country in Peru, with a dreadfull inundation following it”--as if the influenza and the news of the earthquake had reached London at the same time. This was the earthquake of 20th October, 1687, which destroyed Lima, Callao and an immense district along the coast of Peru. The rocking of the earth was most violent, the sea retreated like a sudden immense ebb and filled again like a sudden immense flood, the effect of the commotion being felt on board ships a hundred and fifty leagues out in the Pacific. It was remarked that wheat and barley would not thrive in Peru after that earthquake[775]. Here was undoubtedly a great disturbance of soil and of subsoil, almost certainly attended with the discharge of effluvia or miasmata into the air, as in other great earthquakes. But the universal slight fever of the British Isles in the months of June and July, 1688, is remote from the earthquake of Lima in place; and, if it be a question of earthquakes at all, there are others nearer to it both in place and time, such as that in the Basilicata province of Naples in January, 1688, and the Jamaica earthquake, felt through all the island, on the 1st of March, 1688. The greatest of them all, that of Smyrna, on the 10th of July, was a few weeks too late for the hypothesis.

VI.

A continent so subject to earthquakes as South America might be expected, in this hypothesis, to have had some corresponding influenzas. It has indeed had influenzas, some of them peculiar to itself. The Western Hemisphere as a whole has, on several great occasions, had influenzas which were not felt in the Old World. Again, there are one or two instances in which the infection, while it spread widely over the table-lands of Bolivia and Peru, does not appear by existing testimony to have been carried north of the Isthmus. One of these was the influenza of 1720, as special to a region of South America as that of 1688 was to the British Isles. The account of it was given in an essay by Botoni ‘On the Circulation of the Blood,’ published at Lima in 1723[776]. He calls it catarro maligno; it was popularly known as fierro chuto or “iron cap.” It appeared at Cuzco in the end of March, or beginning of April, 1720, and was over about November. Four thousand are said to have died of it in the diocese of Cuzco, and it is said to have made so great a scarcity of hands that the first harvest after it was imperfectly gathered. It had all the marks of an influenza, with the addition of bleeding from the nose and lungs. It had also the grand characteristic common to influenza and epidemic ague: “the symptoms were so diverse and even contradictory that no correct diagnosis, or curative plan, could be fixed.” The Lima writer of 1723 says that it followed an eclipse of the sun on the 15th of August, 1719, having begun on the eastern side of the Andes, in the basin of La Plata, about that time, and travelled northwards and westwards, as the South American influenza of 1759 did.

This is a localized influenza in a country of earthquakes. But the two great earthquakes in 1719 are not South American. They both happened in July: one along the coast of Fez and Morocco, which ruined many villages and a part of the city of Morocco (there is also a later disturbance in the Azores in December, followed by the upheaval of a new island), the other in North China. Here we have the choice of following the “aer inimicus” of Lucretius either from China or from the African coast; and if it be the case that the influenza began in the latter part of the year 1719 in the basin of the La Plata, to cross the Andes next year, it may seem, in this hypothesis, that a course from east to west, bringing the infection across the Atlantic from Africa, is to be preferred to a course from west to east, bringing it across the Pacific from North China. In either case there need be no difficulty in finding local clouds of miasmata. Some traces of the corresponding great earthquake in China were found in November of the following year, by Bell, an English traveller who crossed from Moscow to Peking:

“Jumy,” he says, “suffered greatly by the earthquakes that happened in the month of July the preceding year [1719], above one half of it being thereby laid in ruins. Indeed more than one half of the towns and villages through which we travelled this day had suffered much on the same occasion, and vast numbers of people had been buried in the ruins. I must confess it was a dismal scene to see everywhere such heaps of rubbish[777].”

The atmospheric effects of Chinese earthquakes have been pictured since medieval times, in obviously superstitious colours; and there are reasons why a great disturbance of soil in that country should produce remarkable miasmata. The surface soil of China is peculiar in having the bodies of the dead dispersed at large in it, insomuch that excavations for the foundations of houses, or for roads and railway cuttings, can hardly be made without the constant risk of exposing graves[778].

If the soil of China is peculiar in one way, that of the West Coast of Africa is peculiar in another. Without entering on the large question of “malaria” in each of them, I shall take an old illustration of the miasmata of the West Coast of Africa as a cause of dengue-fever, a disease curiously like influenza in its symptoms, and like it also in its occasional wave-like dispersion over wide regions. The authority is Dr Aubrey, who resided many years on the coast of Guinea, saw much of the slave-trade, and wrote a very sensible book in 1729, called ‘The Sea Surgeon, or the Guinea Man’s Vade Mecum.’ He describes quite clearly the fever which was long after described by West Indian physicians as dengue, or three-days’ fever, or break-bone fever, including in his description the characteristic exanthems of it and the penetrating odour of the sweat. He gives also, in clinical form, a series of cases on board the galley ‘Peterborough’ in December, 1717, which are exquisite examples of break-bone fever. This disease, he says, “many times runs over the whole ship, as well negroes as white men, for they infect one the other, and the ship is then in a very deplorable condition unless they have an able man to take care of them.” But the original source of infection, he believed, was the fogs that hung at nightfall over the estuaries of the rivers; and he gives an experimental proof, remarkable but not quite incredible, of the poisonous nature of the miasmata:

“But to let you see the evil, malevolent, contagious, destructive quality of those fogs that fall there in the night, and how far they are inimical to human nature, I will tell you of an experiment of my own. I made a lump of paste with oat-meal somewhat hard, and about the bigness of a hen’s egg, which was exposed to the fog from twilight to twilight, i.e. from the dusk of the evening till daybreak in the morning; after which I crumbled it, and gave it to fowls, which we had on board, and soon after they had eaten it, they turned round and in a kind of vertigo dropt down and expired.”

A great mortality in Guinea in 1754 or 1755 was ascribed by Lind, the least credulous in such matters, to “a noxious stinking fog[779].”

What the alternations of heat and chill, of moisture and drought, produce ordinarily in the way of miasmata, the same, we may suppose, is produced on the great scale, as a phenomenon at some particular time and place, by one of those cataclysms which break the surface of the earth or the bed of the sea, lower or raise the level of wells and springs, and fill the air with particles of dust or vapour which may overhang the locality for months and visibly disperse themselves to a great distance. Nothing relating to miasmata in the air need be hard for belief after the wonderful diffusion and permanence in the atmosphere of the whole globe, for two years or more, of finely divided particles shot up by the earthquakes and eruptions of Krakatoa in the Straits of Sunda on the 27th and 28th of August, 1883[780].

A theory of influenza constructed from such generalities as those of Boyle, Arbuthnot and Webster will have attractions for many over the theory that influenza is always present in some remote country and becomes dispersed now and then over the world by contagion from person to person: it will have superior attractions, for the reason that influenza is a phenomenal thing which needs a phenomenal cause to account for it. But if anyone were to attempt to fit each historic wave of influenza with its particular earthquake, or to find the precise locality where clouds of infective matter had arisen, or the particular circumstances in which they arose, he would certainly find his fragile structure of probabilities pulled to pieces by the professed discouragers and depravers. I make no such attempt; but I am not the less persuaded of the direction in which the true theory of influenza lies.

Influenza at Sea.

There is no point more essential to a correct theory of influenza than to find out in what circumstances it has occurred among the crews of ships on the high seas. If it be true that a ship may sail into an atmosphere of influenza, just as she may sail into a fog, or an oceanic current, or the track of a cyclone, then the possible hypotheses touching the nature, source, and mode of diffusion of influenza become narrowed down within definite limits.

One of the first observations was made in the case of a Scotch vessel in the influenza of 1732-33[781]. The epidemic was earlier in Scotland than in England; it began suddenly in Edinburgh on 17 December, 1732, the horses having been attacked with running of the nose towards the end of October. About the time when the disease began among mankind, in December, a vessel, the ‘Anne and Agnes’ sailed from Leith for Holland. One sailor was sick on this voyage. She sailed on the return voyage to Leith, with the other ten of her crew in perfect health. Just as she made the English coast at Flamborough Head on the 15th of January, 1733, six of the sailors fell ill together, two more the next day, and one more on the day after that, so that when the vessel anchored in Leith Roads there was only one man well, and he fell ill on the day following the arrival. The symptoms were the common ones of the reigning epidemic. The dates are not given more precisely or fully than as above. Influenza was prevalent in Germany and Holland somewhat earlier than in Scotland or England; the men may, of course, have imbibed the infection when they were in the Dutch port, just as it is almost certain that the crews of Drake’s fleet in 1587 had received during a ten days’ stay upon the island of St Jago, of the Cape de Verde group, the miasmatic infection of which they suddenly fell sick in large numbers together in mid-Atlantic some six days after sailing to the westward.

This early case of the ‘Anne and Agnes’ in 1733 may pass as an ambiguous one. The next occasion when influenza on board ship attracted much notice was the epidemic of 1782.

On the 6th of May, Admiral Kempenfelt sailed from Spithead with seven ships of the line and a frigate, on a cruize to the westward; on the 18th May, he came into Torbay, and sailed again soon after; on the 30th May he came again into Torbay with eight sail of the line and three frigates, and on 1 June sailed again to the westward. Sometime before his squadron put into Torbay for the second time, influenza had appeared among them at sea, it is said in the ‘Goliath’ on the 29th of May[782]. A letter from Plymouth, of the 2nd June, after referring to the violence of influenza in that town, at the Dock, and on board the men-of-war lying there, says that the ‘Fortitude’ of 74 guns, and ‘Latona’ frigate came in that afternoon with 250 sick men from the fleet under Admiral Kempenfelt, mostly with fevers. Another Plymouth letter two days later (4 June) says: “Kempenfelt is returning to Torbay: he could keep the sea no longer, on account of the sickness that rages on board his fleet. More than 400 men have been brought to the hospital this morning. Our men drop down with it by scores at a time. The ‘Latona’ frigate, that sailed the other day is returned, the officers being the only hands that could work the ship[783].”

This outbreak on board ships in the Channel was fully as early as the great development of influenza in 1782 on shore, whether in London or Plymouth; but there were almost certainly cases of it at the latter port before the ‘Latona’ sailed to join Kempenfelt’s squadron. Robertson, however, who was surgeon on the ‘Romney’ in the Channel service at that time, says that “hundreds in different ships, towns, and counties, which had no communication with one another, were seized nearly as suddenly and so nigh the same instant as if they had been electrified.... The companies of many of the ships were very well at bed-time, and in the morning there were hardly enough able to do the common business of the ship[784].” This is confirmed by McNair, surgeon of the ‘Fortitude,’ who told Trotter that two hundred of her men, as she lay in Torbay, were seized in one night and were unable to come on deck in the morning[785].

There was another English fleet in the North Sea at the same time, under Lord Howe, watching the Dutch fleet or seeking to intercept the Dutch East Indiamen.

Howe sailed from St Helen’s on the 9th May, with twelve ships of the line. Towards the end of that month he had his fleet in the Texel; the men were in excellent health, “when a cutter arrived from the Admiralty, and the signal was given for an officer from each ship [to come on board the admiral]. An officer was accordingly sent with a boat’s crew from every vessel, and returned with orders, carrying with them also, however, the influenza”--which soon prostrated the crews to the same extraordinary extent as in the ships under Kempenfelt at the other end of the Channel. This was the oral account given to Professor Gregory of Edinburgh, by a lieutenant on board a sixty-four gun ship[786]. Another account says that the disorder first appeared in Howe’s fleet on the Dutch coast about the end of May, on board the ‘Ripon,’ and in two days after in the ‘Princess Amelia’; other ships of the same fleet were affected with it at different periods, some indeed, not until their return to Portsmouth about the second week of June. “This fleet, also, had no communication with the shore until their return to the Downs, on their way back to Portsmouth, towards the 3d and 4th of June[787].”

But, apart from the story of the Admiralty despatch-boat carrying the influenza to Howe’s squadron, it appears that both Kempenfelt and Howe were joined from time to time by additional ships, which might have carried an atmosphere of influenza with them[788]. Still, it was an influenza atmosphere that they had carried, and not merely so many sick persons. The doctrine of contagion from person to person would have to be so widened as to become meaningless, if all those experiences of the fleet in 1782 were to be brought within it. In the history both of sweating sickness and of influenza, there are instances of the disease breaking out suddenly in a place after someone’s arrival; but the new arrival may not have had the disease, it was enough that he came from a place where the disease was[789]. That was, perhaps, the reason why Beddoes, in his inquiry of 1803, framed one of his questions so as to elicit information about the dispersal of influenza by fomites.

It is not easy to prove that a ship may meet with an atmosphere of influenza on the high seas; but many have believed that ships have done so. Webster says: “The disease invades seamen on the ocean in the same [western] hemisphere, when a hundred leagues from land, at the same time that it invades people on shore. Of this I have certain evidence from the testimony of American captains of vessels, who have been on their passage from the continent to the West India Islands during the prevalence of this disease[790].” There are several instances of this, authenticated with times, places, and other data of credibility.

The best known of these is the voyage of the East Indiaman ‘Asia’ in September, 1780, through the China Sea from Malacca to Canton: “When the ship left Malacca, there was no epidemic disease in the place; when it arrived at Canton it was found that at the very time when they had the Influenza on board the Atlas (sic) in the China seas, it had raged at Canton with as much violence as it did in London in June, 1782, and with the very same symptoms[791].”

In the present century, the cases nearly all come from the medical reports of the navies of Great Britain, France, Germany and the Netherlands, and they relate to ships on foreign service--in the East Indies, the Pacific, Africa, or other foreign stations. In some of the instances influenza went through a ship’s company in port or in a roadstead, others are examples of outbreaks at sea:

1837: “The ship’s company of the ‘Raleigh,’ were attacked by epidemic catarrh--influenza--first in March, while at sea between Singapore and Manilla, and again, although less severely, in June and July while on the coast of China.... Influenza also made its appearance amongst the crew of the ‘Zebra’ in April while she lay at Penang; it was supposed to have been contracted by infection from the people on shore, as they were then suffering from it. No death occurred under this head[792].”

1838: In the ‘Rattlesnake,’ at Diamond Harbour, in the Hooghly River, a large proportion of the men were suffering from epidemic catarrh. Intermittent fever made its appearance; “the change from the catarrhal to the febrile form was sudden and complete, the one entirely superseding the other[793].”

1842: In the ‘Agincourt’ on a voyage from the Cape of Good Hope to Hongkong in August and September, the greater part of 102 cases of catarrh occurred; many of these were accompanied with inflammation of tonsils and fauces, and in some there was deafness with discharge from the ear. This is not claimed as an instance of epidemic influenza, but as an aggregate of common colds, due to cold weather in the Southern Ocean and to wet decks[794].

1857: “Influenza broke out in the ‘Monarch’ while at sea, on the passage from Payta [extreme north of Peru] to Valparaiso. She left the former place on the 23d August, and arrived at the latter on the last day of September. About the 12th of the month [twenty days out], the wind suddenly changed to the south-west, when nearly every person in the ship began to complain of cold, although the thermometer did not show any marked change in the temperature. On the 12th and 13th seven patients were placed on the sick list with catarrhal symptoms; and during the following ten days, upwards of eighty more were added, but by the end of the month the attacks ceased. [She carried 690 men, and had 191 cases of “influenza and catarrh,” in the year 1857.] Some of the cases were severe, ending either in slight bronchitis or pneumonia, accompanied with great prostration of the vital powers. On the arrival of the ship at Valparaiso, the surgeon observes: ‘We found the place healthy, but in the course of a few days some cases of influenza made their appearance, and very soon afterwards the disease extended over the whole town. It was generally believed that we imported it, and the authorities took the trouble to send on board a medical officer to investigate the matter.’ He further observes that the whole coast, from Vancouver’s Island southward to Valparaiso was visited by the epidemic.” It made its appearance on board the ‘Satellite’ at Vancouver’s Island in September, and among the residents ashore, both on the island and mainland, at the same time[795].

1857: Catarrh “assumed the form of influenza in the ‘Arachne’ [149 men, 114 cases] while the vessel was cruizing off the coast of Cuba, with which, however, she had no communication. There was nothing in the state of the atmosphere to attract special attention. A question therefore arises whether it might not have been caused by infection wafted from the shore.” It was prevalent at the time at Havana[796].

1857: “Australian Station:--An eruption of epidemic catarrh occurred in the ‘Juno’ [200 men, 131 cases], but long after she left the station[797].”

Whilst the influenza was on the American Pacific coast in September, 1857, it was on the coast of China three months earlier--on board the ‘Inflexible’ at Hongkong on the 18th of May, and in the ‘Amethyst’ and ‘Niger’ in a creek near Hongkong early in June[798]. But it had been on the Pacific coast of South America the year before, according to the following:

“1856: Epidemic catarrh broke out in the ‘President’ when lying off the island of San Lorenzo in the bay of Callao, first on the 20th October, and the last cases were placed on the sick list on 1st November,--the usual period which influenza takes to pass through a frigate ship’s company. About sixty required to be placed on the sick list.” It had occurred on board English ships of war at Rio de Janeiro, on the other side of the continent, some two months before, in August, 1856[799].

1863: The following, in the experience of the French navy, has been elaborately recorded[800]: The frigate ‘Duguay-Trouin’ left Gorée, Senegambia, for Brest, in February. There were no cases of influenza in Gorée when she left; but four days out, an epidemic of influenza began on board, the weather being fine and the temperature genial at the time. Another French frigate, which had left Gorée, on the same voyage to Brest, two days earlier, did not have a single case.

The following instance, here published for the first time, belongs to the most recent pandemics of influenza, 1890-93. It relates to only a single case of influenza, in the captain of a merchantship; it would have been a more satisfactory piece of evidence, if there had been several cases in the ship; but among the comparatively small crew of a merchantman, the same groups of cases are not to be looked for that we find on board crowded men of war; and in this particular case the only other occupants of the quarter-deck were the first mate and the steward.

The ship ‘Wellington,’ sailed from the Thames, for Lyttelton, New Zealand, on the 19th December, 1891. The epidemic of influenza in London in that year had been in May, June and July; the mate of the ‘Wellington’ had had an attack of it ashore, on that occasion, but not the captain nor the steward. On the 2nd of March, 1892, when seventy-four days out and in latitude 42° S., longitude 63 E., near Kerguelen’s Land, the captain began to have lumbago and bilious headaches, for which he took several doses of mercurial purgative followed by saline draughts. The treatment at length brought on continual purging, which, together with three days’ starving from the 22nd to the 24th of March, caused him a loss of weight of eight pounds. The navigation had meanwhile been somewhat difficult and anxious, owing to a long spell of easterly head winds. Quite suddenly, on the 26th March, when the ship was in latitude 44 S., longitude 145 E., or about two hundred miles to the south of Tasmania, he had an aguish shake followed by prolonged febrile heat, which sent him to his berth. The symptoms were acute from the 26th to the 30th March,--intense pain through and through the head, as if it were being screwed tight in an iron casing, pain behind the eyeballs, a perception of yellow colour in the eyes when shut, a feeling of soreness all over the body, which he set down at the time to his uneasy berth while the ship was ploughing through the seas at about twelve knots, and a pulse of 110. The head pains were by far the worst symptom, and were so unbearable as to make the patient desperate. This acute state lasted for four days, and suddenly disappeared leaving great prostration behind. The captain, who had long experience with crews and passengers, and a considerable amateur knowledge of medicine, summed up his illness as a bilious attack, passing into “ague” with “neuralgia of the head.” While the acute attack lasted the ship had covered the distance from Tasmania to the southern end of New Zealand, and on the 31st of March the captain by an effort came on deck to navigate the vessel in stormy weather up the coast to Lyttelton, which was reached on the 2nd of April. The pilot coming on board found the captain ill in his berth, and on being told the symptoms, at once said, “It is the influenza: I have just had it myself.” The doctor who was sent for found the captain “talking foolishly,” as he afterwards told him, and had him removed to the convalescent home at Christchurch, where he remained a fortnight slowly regaining strength. The doctor[801] could find no other name for the illness but influenza, although he had not supposed such a thing possible in mid-ocean. They had just passed through an epidemic of it in New Zealand, and it is reported about the same time in New South Wales, afterwards in the Tonga group, and still later in the summer in Peru. The symptoms of this case are sufficiently distinctive: the intense constricting pain of the head is exactly the “fierro chuto” or “iron cap” of South American epidemics; the pain in the eyeballs, the soreness of the limbs and body, and the unparalleled depression and despair, are the marks of influenza without catarrh. The patient was of abstemious habits, and had made the same voyage year after year for a long period without any illness that he could recall. He had reduced himself by purging and starving, on account of a bilious attack during a fortnight of foul winds from the eastward, and had doubtless become peculiarly susceptible of the influenza miasm before the ship came into the longitude of Tasmania on the 26th March.

The Influenzas of Remote Islands.

The full and correct theory of influenza will not be reached by the great pandemics only. On the other hand some very localized epidemics may prove to be signal instances for the pathology, although they do not bear upon the source of the great historic waves of influenza. The instances in view are the influenzas started among a remote community on the arrival of strangers in their ordinary health. This phenomenon has been known at the island of St Kilda, in the Outer Hebrides of Scotland, since the year 1716, when it was recorded in the second edition of an essay upon the island by Martin. Some thought these “strangers’ colds” mythical, so much so that Aulay Macaulay, in preparing a work upon St Kilda, was advised to leave them out; he declined to do so, and Dr Johnson commended him for his magnanimity in recording this marvel of nature. There is now no doubt about the fact. H.M.S. ‘Porcupine’ visited the island in 1860; a day or two after she sailed again, the entire population, some 200 souls, were afflicted with “the trouble,” and another visitor, who landed ten days after the ‘Porcupine’s’ visit, saw the epidemic of influenza in progress. The same thing happened in 1876, on the occasion of the factor landing, and again in 1877 on the occasion of a crew coming ashore from a wrecked Austrian ship. A medical account of this epidemic catarrh was given in 1886: The patient complains of a feeling of tightness, oppression and soreness of the chest, lassitude in some cases, pains in the back and limbs, with general discomfort and lowness of spirits. In severe cases there is marked fever, and great prostration. A cough ensues, at first dry, then attended with expectoration, which may go on for weeks[802].

In the remote island of Tristan d’Acunha, in the South Atlantic midway between the River Plate and the Cape of Good Hope, the same thing happens “invariably” on the arrival of a vessel from St Helena[803]. It is reported also as a common phenomenon of the island of Wharekauri, of the Chatham Group, about 480 miles to the eastward of New Zealand. Residents, both white and coloured, suddenly fall into an illness, one symptom of which is that they feel “intensely miserable.” It lasts acutely for about four days, and gradually declines. It resembles influenza in all respects, and is known by the name of murri-murri, which is curiously like the old English name of mure or murre. “The mere appearance of murri-murri is proof to the inhabitants, even at distant parts of the island, which is thirty miles long, that a ship is in port, insomuch that, on no other evidence, people have actually ridden off to Waitangi to fetch their letters[804].”

About equally distant in the Pacific from Brisbane, as Wharekauri from Christchurch, lies Norfolk Island, originally colonized by the mutineers of the ‘Bounty.’ A writer in a newspaper says:

“During a seven years’ residence in Norfolk Island, I had opportunities of verifying the popular local tradition that the arrival of a vessel was almost invariably accompanied by an epidemic of influenza among the inhabitants of the island. In spite of the apparent remoteness of cause and effect, the connexion had so strongly impressed itself on the mind of the Norfolk Islanders that they were in the habit of distinguishing the successive outbreaks by the name of the vessel during whose visit it had occurred[805].”

Something similar has long been known in connexion with the Danish trade to Iceland, the first spring arrivals from the mother country bringing with them an influenza which the crews did not suffer from during the voyage, nor, in most cases, during the progress of the epidemic in Reikjavik. The experience at Thorshaven, in the Faröe Islands, has been the same[806].

These are important indications for the pathology of influenza in general. They point to its inclusion in that strange class of infections which fall most upon a population, or upon those orders of a population, who are the least likely to breed disease by anything that they do or leave undone. Veterinary as well as human pathology presents instances of the kind[807]. In seeking for the source of such an infectious principle, we are not to look for previous cases of the identical disease, but for something else of which it had been an emanation or derivative or equivalent, something which may have amounted to no more than a disparity of physical condition or a difference of race. And as the countries of the globe present now as formerly contrasts of civilized and barbarous, nomade and settled, rude and refined, antiquated and modern, with the aboriginal varieties of race, it may be said, in this theory of infection, that mere juxtaposition has its risks. But, in the theory of influenza, the first requisite is an explanation of its phenomenal uprisings and wave-like propagation, at longer or shorter intervals, during a period of many centuries.