A History of Epidemics in Britain, Volume 2 (of 2) by Charles Creighton

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