The Epidemics of the Middle Ages by J. F. C. Hecker and John Caius

et Oise.) SECT. 3.—THE ROETTINGEN SWEATING SICKNESS. We now come to a phenomenon which, notwithstanding its short duration and very limited extension, is one of the most memorable of this century. Up to the present time, its real importance has not been recognised, because the clouds of self-sufficient ignorance have prevented our taking a survey of the formation of diseases, throughout long periods of time. It has been sunk for an age in the sea of oblivion, from whence we will now draw it forth to the light of day. In November, 1802, a very hot and dry summer had been succeeded by incessant rain. Thick fogs spread over the country, and enveloped such places in central Germany as were inaccessible to ventilation. Amongst others, the small Franconian town of Roettingen, situated on the river Tauber, and surrounded by mountains[863]. Scarcely had a few weeks elapsed, when unexpectedly, towards the 25th of November, an extremely fatal disease broke out in the town, which was without example in the memory of its inhabitants, and totally unknown to the physicians of the country. Strong vigorous young men were suddenly seized with _unspeakable dread_; the heart became _agitated_ and _beat violently against_ the ribs, a _profuse, sour, ill-smelling perspiration_ broke out over the whole body, and at the same time, they experienced a _lacerating pain_ in the nape of the neck, as if a violent rheumatic fever had taken possession of the tendinous tissues. This pain ceased sometimes very quickly, and if it then shifted to the chest, the distressing palpitation of the heart recommenced; a spasmodic trembling of the whole body ensued; the sufferers fainted, their limbs became rigid, and thus they breathed their last. _In most cases, all this occurred within four and twenty hours._ They did not all, however, succumb under the first attack, but as soon as the accelerated pulse had sunk to the lowest ebb of smallness and feebleness, a corresponding effect being observable in the respiration, the violent pain would in some cases return to the outward parts. The patient then felt a benumbing pressure and stiffness in the nape of the neck; and the pulse and respiration became restored again as in health, but the perspiration continued to pour incessantly down the skin. This apparent safety was, however, very deceptive, for a renewed palpitation of the heart unexpectedly commenced, accompanied by a feeble pulse; and then death was often inevitable. It was remarkable, that the patients, though bathed in perspiration, had very little thirst, and the tongue was not dry, nor ever even foul, but retained its natural moisture. With most, however, the urine was scanty; as the skin, under the increasing debility, permitted too much fluid to stream forth through its pores. _If the disease passed off without heating sudorifics, then in general no eruption made its appearance._ The malady then continued till the sixth day, but on the first only, did it display its malignant symptoms, for by the second, the sweating diminished and lost every unfavourable quality, so that increased transpiration of the skin, without any other symptoms of importance, alone remained, and on the sixth day the patient was perfectly restored. Had there been in Roettingen a physician at hand from the commencement, _well skilled in medical history_, and who would have adopted the old English treatment of the Sweating Sickness, this new fever would have appeared but as a perfectly mild disease, and would certainly have carried off but few of the inhabitants of this peaceful little town. As it was, however, the scenes of Lübeck and Zwickau were renewed, and it seemed as if the innumerable victims to the hot treatment, and to _Kegeler’s_ truculent medical work, had descended to the grave in vain. _The sufferers were, as in the sixteenth century, literally stewed to death!_ for the moment the people imagined that they knew how nature meant to escape, they ordered feather-beds to be heaped on the perspiring patient, so that the mouth and nose alone remained uncovered. Doors and windows were tightly closed, and the stove emitted a glowing heat, whilst a most intolerable odour of perspiration streamed forth from beneath the broad and lofty beds; added to which, that two and even more patients were often lying in the same room; nay, even stowed together under the same mountain of feathers, and in order that inward heat might not be wanting, pots of theriaca were swallowed, and the patient was incessantly plied with elder electuary. Thus the bad humours were expelled together with the perspiration; and whether the sufferers were suffocated, or surmounted, as by a miracle, this mal-treatment of nature, a conviction was felt, that the most salutary remedies had been employed, and when at last, eruptions of various colours broke out, it was considered as certain, that the poison had been carried off in them. The citizens of Roettingen, therefore, fell into the same erroneous opinion, which, upheld by medical schools, had, time immemorial, increased inflammatory diseases, particularly the exanthematous, and caused them to become malignant. The above-mentioned eruptions were of various sorts; miliary vesicles of every form and colour, filled with an acrid fluid; actual blistery eruptions, (pemphigus,) and even petechiæ; and it is to be observed, that the patients, during the first days of the sweating fever, never suffered from that peculiar pricking sensation over the whole body, which precedes the eruption of miliaria, but complained only, and that not always, of a local itching, where the eruption had broken out. It was equally rare to observe a regular desquamation of the skin, and it is therefore to be assumed, that _the eruptions were only symptomatic_, and not by any means necessarily connected with the disease, as in the decidedly miliary fevers. The disease excited, from its very commencement, the greatest consternation; and as it was increased, even from the first days of its appearance, by the sudorific system of treatment, deaths were multiplied; the continual peal of funeral bells struck mortal terror, as of old at Shrewsbury, into the hearts of both sick and healthy; and this oppressed little town was shunned as a pesthole by the inhabitants of the surrounding neighbourhood. At the commencement of the disease, they were entirely without medical advice, till a skilful physician arrived from the vicinity[864], and as _most of the inhabitants_ were already attacked with the sweating fever, he immediately prescribed the proper treatment. But the powers of one man are not sufficient, amid such confusion, to contend with the deeply rooted prejudices of the people, and so they continued in most houses to expel by heat and theriaca both perspiration and life together; till at last, on the third of December, _Dr. Sinner_ of Würzburg arrived, without whom the remembrance of this remarkable disease would have been obliterated, and conjointly with his gallant colleague, like the anonymous physician formerly in Zwickau, subdued the destructive prejudices of the people. He found eighty-four patients[865] under piles of feather-beds, who, when pure air was admitted, breathed once more freely, and by a prudent cooling system, all recovered easily, and without danger, one only excepted. His method reminds us of the old English treatment[866]. The disease was confined entirely to Roettingen, it did not make its appearance anywhere beyond the gates of this little town. On the fifth of December, however, clear, frosty weather set in; from that time no new cases occurred, and all traces of this Roettingen sweating fever, which was never either preceded or followed by miliary fever in any part of Franconia, have from that time disappeared. The resemblance of this fever to the English Sweating Sickness is manifest, and is proved even by the short (_only ten days’_) duration of the visitation, which, as we have stated, is a most essential characteristic of the English sweating epidemic, at least as it appeared in Germany, the miliary epidemics always having lasted a much longer period. But if we confine ourselves merely to the symptoms of the disease, we shall find, that in the Roettingen sweating fever, there are, throughout, none that can be considered essential, except the _palpitation of the heart, accompanied with anguish_, the _profuse perspiration_, and the _rheumatic pains in the nape of the neck_, which never were wanting in any case; and the very same symptoms are clearly and perceptibly to be discerned in like proportion as compared with others, in the representation of the English Sweating Sickness; whereas, the eruptions were altogether as unessential as in the epidemic of the sixteenth century. The irritability of the skin, and tendency to dangerous metastases, were less marked in the Roettingen fever than in the English Sweating Sickness; for the patients could, without injury, change their linen in the midst of the perspiration, which, in the English Sweating Sickness, could not have been done without fatal consequences; but this difference can easily be accounted for, from the greater degree of suffering in the latter disease than in the former. It only now remains to examine the duration of the disease, and here we plainly perceive that the principal paroxysm was over in the Roettingen epidemic within the first four and twenty hours, at least when it was undisturbed by treatment; and the sole symptom which continued until the sixth day—the increased perspiration, (we speak here only of perfectly pure cases,) could only reasonably be regarded as a sequela. The crisis did not occur all on a sudden, as in the English Sweating Sickness, but this cannot constitute any essential difference. We do not hesitate, therefore, to pronounce _the Roettingen fever to have been the same disease as the English Sweating Sickness_. To give, however, this phenomenon its proper interpretation—to have a clear conception of the causes which again drew down from the clouds, into the midst of Germany, this mist-born spectre of 1529, and allowed it to expend its brief fury upon a single place, is beyond the power of human wisdom. Science is not comprehensive enough to discover, in the crossings of these unknown comet-paths, the moving causes of this visitation of disease. But as all insight into the works of nature must be preceded by a strict investigation and search after phenomena in all countries, at all times, and under all circumstances of development, so an improved knowledge of diseases and of the whole human system, will not fail to follow, when the investigations of epidemics throughout extensive periods have increased in number and success. _The present age demands such a knowledge of medical men, whose vocation it is to investigate life minutely in all its bearings. It demands of them an historical pathology, and to this branch of the study of nature is the present work intended to contribute._ CHRONOLOGICAL SURVEY. POLITICAL EVENTS. FIRST VISITATION OF THE SWEATING SICKNESS. 1461–1483. Louis XI. 1472–1482. Swarms of locusts 1485–1509. Henry VII. in the south of Europe. 1493–1519. Maximilian I. 1480–1485. Wet years. Mercenary troops are introduced. 1483. Overflow of the Severn, (the _great water_ of the Duke 1483–1498. Charles VIII. of Buckingham.) 1483–1485. Richard III. 1480 and 1481. Famine in 1483, October. First abortive Germany and France. attempt of the Earl of Richmond, 1477–1485. Glandular plague (who had fled to France in Italy. in 1471,) against Richard III. 1480, 1481. Encephalitis in The Duke of Buckingham Germany. executed. 1482. Febrile cerebritis in