CHAPTER VI.

SWEATING SICKNESSES. Ἔστι γὰρ τὸ πάθος λύσις τῶν δεσμῶν τῆς εἰς ζωὴν δυνάμιος. ARETÆUS. SECT. 1.—THE CARDIAC DISEASE OF THE ANCIENTS. (MORBUS CARDIACUS.) Thus by the autumn of 1551, the Sweating Sickness had vanished from the earth: it has never since appeared as it did then and at earlier periods; and it is not to be supposed, that it will ever again break forth as a great epidemic in the same form, and limited to a four-and-twenty hours’ course; for it is manifest, that the mode of living of the people had a great share in its origin; and this will never again be the same as in those days. Yet nature is not wanting in similar phenomena, which have appeared in ancient and modern times; and if we take into the account the great frequency of cognate rheumatic maladies, it is possible that isolated cases may have sometimes occurred, in which repletion of impure fluids, and violently inflammatory treatment have augmented a rheumatic fever, even to the destruction of nervous vitality, by means of profuse perspiration—only, perhaps, that they ran a longer course, (which does not constitute an essential difference,) and under totally different names, whereby attention is misled. Of all the diseases that have ever appeared which can in any way be compared to the English Sweating Sickness, we have principally three to look back upon—the _cardiac disease_ of the ancients, the _Picardy sweat_, and the _sweating fever of Rötingen_. The first was, for reasons which have been already mentioned[812], almost unknown to the learned of the sixteenth century; and it is matter of surprise, that Kaye himself, who had chosen for his favourite the best Roman physician, we mean Celsus, could have so entirely overlooked his by no means unimportant statements respecting this disease. _Houlier_ is the only author who ventures a comparison of the English Sweating Sickness with the ancient cardiac disease; his few, and almost lost words[813], remained however unheeded; nor are the differences between the two diseases small: but to return. The disease of which we are speaking appeared for a period of 500 years, (from 300 B.C. to 200 after Christ,) and was a common, almost every day occurrence, which is often mentioned even by non-medical writers. It was exceedingly dangerous, and even esteemed fatal; and as it was far above the reach of Greek physiology, there were not wanting extraordinary opinions respecting its nature, and bold and singular modes of treatment, to which those who were attacked were subjected. The name _Cardiac disease_ (morbus cardiacus, νόσος καρδιακὴ and probably also νόσος καρδίτις,) was not bestowed by medical men, but by the people; who, in the fourth century before Christ, for the name is as ancient as that period, could not know that the learned would dispute on that subject. Some affirmed, and among them men of great authority, such as _Erasistratus_, _Asclepiades_, and _Aretæus_, that the people were in the right so to call the disease; that the heart was actually the part affected, and that their knowledge of the heart’s functions was by no means small[814]. Others, on the contrary, would only acknowledge in that name an expression indicative, not of the particular seat of the disease, but only of its importance, inasmuch as the heart is well adapted, as the centre and source of life, to indicate this[815]. Others again, who attempted more refined conjectures, wished to represent the pericardium as the seat of the malady, because darting pains were sometimes felt[816] in the region of the heart, or the diaphragm, or the lungs, or even the liver. The opinions were numerous; the actual knowledge was small[817]. The cardiac disease began with rigors and a numbness in the limbs[818], and sometimes even throughout the whole body. The pulse then took on the worst condition, was small, weak, frequent, empty, and as if dissolving; in a more advanced stage, unequal and fluttering, until it became completely extinct. Patients were affected with hallucinations[819]; they were sleepless, despaired of their recovery, and were usually covered suddenly with an ill-savoured perspiration over the whole body, whence the disorder was likewise called _Diaphoresis_. Sometimes, however, a washy sweat broke out, first on the face and neck. This then spread itself over the whole body; assumed a very disagreeable odour, became clammy and like water in which flesh had been macerated, and ran through the bed-clothes in streams, so that the patient seemed to be melting away[820]. The breath was short and panting almost to annihilation (insustentabilis). Those affected were in continual fear of suffocation[821]; tossed to and fro in the greatest anguish, and with _a very thin and trembling voice_ uttered forth only broken words. They constantly felt an insufferable oppression in the _left side_, or even over the whole chest[822]; and in the paroxysms which were ushered in with _a fainting fit_, or were followed by one, _the heart was tumultuous and palpitated_, without any alteration in the smallness of the pulse[823]. The countenance was _pale as death_, the eyes sunk in their sockets, and when the disease took a fatal turn, all was darkness around them. _The hands and feet turned blue_; and whilst the heart, notwithstanding the universal coldness of the body, still beat violently, they for the most part retained possession of their senses. A few only wandered a short time before death, while others were even seized with convulsions and endowed with the power of prophecy[824]. _Finally, the nails became curved on their cold hands_, the skin was wrinkled, and thus the sufferers resigned their spirit without any mitigation of their miserable condition[825]. A striking resemblance is plainly perceived, from this description, between the ancient cardiac disease and the English Sweating Sickness in the most exquisite cases of each. In both the same palpitation of the heart, the same alteration of the voice, the same anxiety, the same impediment to respiration, and thence the same affection of the nerves of the chest, the same ill-scented sweat, and, by means of this sweat, the same fatal evacuation; in short, all the essential symptoms arising from the same circle of functions. For in the sweating pestilences of the ancients[826], as well as the moderns, the nerves of the abdomen remained unaffected; the liver, intestines, and kidneys, took no part in the primary affection; the diaphragm, as in the English Sweating Sickness, formed the partition. Hence the acute _Aretæus_ did not hesitate to call the cardiac disease _fainting_ (syncope), with certainly an unusual extension of the notion implied by this term, which in its common acceptation excludes the turbulent commotion of the heart. In the affection of the brain some difference occurs, for though the hallucination afforded an unfavourable prognostic in both diseases, yet the fatal stupor was peculiar to the English Sweating Sickness, no observer having made mention of it in the cardiac disease. Greater and altogether essential differences between this affection and the English Sweating Sickness appear in another respect. There is every reason to suppose that the cardiac disease first appeared in the time of _Alexander_ the Great, that is to say, at the end of the fourth century before Christ; for the Hippocratic physicians were unacquainted with it, _Erasistratus_, who was body physician to Seleucus Nicator, and was a universally celebrated professor at Alexandria under the first Ptolemy, being the first to mention it. If that age be compared even superficially with that of Henry the VIIth and Henry the VIIIth; and Africa, Asia Minor, and the South of Europe with England, we shall easily be convinced that the two diseases, notwithstanding the agreement in their main symptoms, could not be the same; moreover, much was comprehended by the ancients under the name of morbus cardiacus, which, on a nearer examination, proves not to be one and the same definite form of morbid action: for sometimes this affection is spoken of as an independent disease; sometimes it is mentioned only as a symptom superadded to others—as a kind of transition from other very various diseases, such as has occurred in modern times. _Soranus_ mentions, as such diseases, continued fevers, accompanied by much heat[827]; and reckons among them the “Causus,” that is, an inflammatory bilious fever, to which _Aretæus_ also saw the cardiac disease superadded. These fevers passed, on the fifth or sixth day, into the cardiac disease, and such a transition occurred chiefly on the critical days[828]. In a similar sense _Celsus_ speaks even of _Phrenitis_, under which name we are here to understand all inflammatory fevers accompanied by violent delirium, with the exception of actual inflammation of the brain. Thus we see that the cardiac disease arose and increased on a very different soil from other diseases, and was, to furnish an ancient example, as far from being independent under these circumstances as _lethargy_ was in similar cases. But there was doubtless an independent idiopathic form of the cardiac disease. Whether this was febrile or not, the most celebrated physicians of ancient times were not agreed. Now, how could they ever have differed upon the subject, if the cardiac disease had always appeared only as a sequela on the fifth or sixth day of inflammatory fevers? _Apollophanes_, a disciple of Erasistratus, and physician to _Antiochus the First_, considered it, with his master, as constantly febrile, and his opinion prevailed for a long time: perhaps he was in the right, for it is probable that in the first half of the third century, the disorder was much more violent than at a subsequent period. His celebrated contemporary, _Demetrius_ of Apamea, disciple of Herophilus, affirmed, that he had recognised fever only in the beginning of the disease, and that it disappeared in its further progress. Very soon, most physicians decided that it was not febrile, but _Asclepiades_ distinguished a febrile and a non-febrile form of the cardiac disease, and it is certain that this physician was a very accurate observer. _Themison_ and _Thessalus_ also agreed with him. _Aretæus_ described, in a cursory manner, the febrile form only, and perhaps was not acquainted with any other. _Soranus_ followed, in the essential points, _Asclepiades_, the founder of his school; and later writers generally regarded the inward heat, the hot breath, and the burning thirst—symptoms which were occasionally less marked, as proofs of the febrile nature of the disease. Numerous theoretical views, belonging to particular schools, of which we do not here treat, were intermingled with these, and upon the whole, that form seems to have been esteemed as non-febrile, in which the signs of feverish excitement appeared less marked. In all cases the cardiac disease set in with external coldness, and with a small contracted quick pulse, symptoms which with certainty indicate fever[829]. Respecting the course of the cardiac disease, we are not furnished with sufficient information. It was no doubt very rapid, for the frame could not long endure symptoms of so violent a kind, and the disorder must of necessity soon have come to a crisis; yet from the ample directions for treatment, we may conclude that it lasted at least some days. If the perspiration was well surmounted, patients seemed to recover rapidly, and their sufferings appeared to them, according to the expressions of _Aretæus_, like a dream, out of which they awoke to a consciousness of the increased acumen of their senses[830]. But the termination was not always so fortunate. The disease was very dangerous, and in many, after the occurrence of an incomplete crisis, an insidious fever remained behind, which ended in a consumption[831]. The whole phenomenon was altogether peculiar, and among existing diseases there are none which bear any comparison with it. There must therefore have been something in the whole state of existence among the ancients which favoured the formation of the cardiac disease. That it arose oftener in summer than in winter, that it attacked men more frequently than women, and especially young people full of life, and hot-blooded plethoric persons, who used much bodily exercise, we learn from credible observers[832]. In this respect, therefore, it bore a resemblance to the English Sweating Sickness. We may also add, that indigestion, repletion, drunkenness, as likewise grief and fear, but especially vomiting and the employment of the bath after dinner, occasioned an attack of the malady[833]. Let us call to mind the habits of the ancients. It was in the time of _Alexander_ that oriental luxury was first introduced. Gluttony became a part of the enjoyment of life, and warm baths a necessary refinement in sensuality, which just at this time were philosophically established by _Epicurus_; nor was this the last instance in which philosophers encouraged the errors and infirmities of human society. Here, again, therefore, as in the English Sweating Sickness, we meet with _the relaxed state of skin, and the foul repletion_ engendered by the same indulgence in sensuality which we have found to exist in the sixteenth century. How this corruption of morals increased, and to what a frightful height it was carried among the Romans, it is not necessary here further to elucidate; and we may take it for a fact, that in consequence of it, the general constitution of the ancients underwent a peculiar modification; that this relaxation of skin and gross repletion were propagated from generation to generation; and that, as among chronic diseases, those of _a gouty character_ were its more frequent results, so among the inflammatory, _the cardiac disease_ made its appearance as the general effect of this kind of life. Where, however, such a system of life existed among whole communities, the original and peculiar occasion was not needed in every individual case to bring the predisposition for a disease which propagated itself by hereditary taint, to an actual eruption. Shocks to the constitution of quite a different kind were often sufficient for the purpose. Thus, among the Romans, it was by no means always the case, that gluttony and relaxation of the skin immediately gave rise to the cardiac disease; while, on the other hand, the usual faintness, induced by too copious blood-letting, passed into this impetuous agitation of the heart, accompanied by colliquative sweats[834]; and all overviolent perspirations in other diseases were apt to take the same dangerous course[835]. We must here also take into account a practice among the Romans, which was very injurious, and yet rendered sacred by the laws; namely, visiting the public baths late in the evening, just after the principal meal, and awaiting the digestion of their food in these places of soft indulgence[836]. How much must the tendency of sweating disorders have been favoured by these means! Surmises founded on the facts already stated, can alone be offered respecting the nature of the ancient cardiac disease. The ancients give us no certain intelligence upon it; for their mode of observing did not lead to that object at which modern medicine aims. _That the cardiac disease was not of a rheumatic character_ seems deducible from several circumstances—from the quality of the atmosphere in southern climates, which is not so favourable to rheumatic maladies, as to give rise to a distinctly defined form of that complaint throughout a period of five hundred years; from the nature of the so-called inflammatory fever, which exhibited no rheumatic symptoms in its course; and lastly, from the treatment of the cardiac disease, for it was a common practice to cool down the “diaphoretic” patients in the midst of their perspiration, by sponging them with cold water, to expose them to the air, and some physicians went so far as to advise cold baths and affusions[837]. How could they have ventured upon such remedies if the cardiac disease had been of a rheumatic nature? In the sweating fevers of the sixteenth century, every abrupt refrigeration, every exposure of the skin, was fatal. It is thence to be inferred, _that the English Sweating Sickness differed from the ancient cardiac disease in its rheumatic character_; even although both diseases were founded in common on an impure gross repletion and relaxation of skin, and the essential phenomena of both went through the same course: not to advert to other differences which are manifest from what has been stated. The remaining treatment of the cardiac disorder should not be altogether passed over in this place, because it shews very clearly the general style of thinking of the medical profession, as also certain metaphysical excitations which are innate in that profession, and of which there is therefore a repetition in all ages. For whilst some proceeded with commendable care and caution, and _Aræteus_ feared[838] a fatal result from the slightest error, others again, would fain render excited nature obedient to their rough command by means of the most violent remedies. It, therefore, occasionally happened that in their over hasty activity they were unable to distinguish between a salutary perspiration and a dangerous “diaphoresis.” This they suppressed at all hazards, and thus sent their patients to the shades of their fathers. Others forthwith flew to Chrysippic bandaging, the great means of suppressing profuse evacuations, and even violent spasms[839]. Others were for obviating the debility as quickly as possible by means of nourishing diet; and overloaded the stomach, as if the recovery of strength depended entirely upon eating. Others allowed as much wine as possible to be drunk for twenty-four hours together, even to the extent of producing intoxication[840]; and _Asclepiades_ selected for this extraordinary death-bed carousal the Greek salt wine[841], for the sake of bringing on a diarrhœa, whereby the opened pores of the skin might again close, and the too mobile atoms might be carried towards the bowels. With the same object he ordered active clysters[842], for if they succeeded in causing a full evacuation, he maintained that the perspiration must necessarily be arrested! _Endemus_, of the Methodic sect, recommended even clysters of cold water[843], and whatever else the rashness of medical men had fool-hardily contrived; acting on the ancient notion, that severe diseases always required violent remedies. _Aretæus_ recommended blood-letting, which others pronounced to be nothing short of certain death[844]. He had, however, a notion that the Causus was the foundation of the cardiac disease, and perhaps he was right. A cautious employment of wine was apparently of great use[845], and what may excite surprise, physicians gave detailed and frivolous precepts on the choice and enjoyment of food. If the irritable stomach rejected this repeatedly, they even went so far, according to the Roman method, as to make the patient vomit both before and after his meals, in order that the organ might thus bear the repeated use of nourishment. It was also asserted that the stomach retained food and wine better if the body were previously rubbed all over with bruised onions[846]. All this affords us an insight into the nature of this remarkable disease, which has now so completely vanished from the world. Finally, when astringent decoctions proved fruitless, particular confidence was placed in the application of various powders[847] to the surface of the body, conjointly with the use of light bed-clothes and the avoidance of feather-beds, which the effeminacy of the ancients had already introduced[848]. As astringents they selected pomegranate bark, the leaves of roses, blackberries, and myrtles, as also fullers’ earth, gypsum, alum, litharge, slaked lime[849], and, when nothing else was at hand, even common road dust[850]! The efficacy of some of these extraordinary remedies cannot be denied. At least it has been proved in modern times with respect to alkalies, which are of a somewhat similar nature, that they are of great service where there is an abundant determination of acid towards the skin, and it is very probable that the perspiration of these diaphoretic patients contained much acid. SECT. 2.—THE PICARDY SWEAT. (SUETTE DES PICARDS—SUETTE MILIAIRE.) The Picardy Sweat is a decided miliary fever, which has often prevailed, not only in Picardy, but also in other provinces of France, for more than a hundred years, and even at the present time exists in some places as an endemic disease[851]. We have pointed out the affinity between the English Sweating Sickness and miliary fever. Both are rheumatic fevers—the former of twenty-four hours’ duration, the latter running a course of at least seven days. In the former there was no eruption, or if in isolated cases an eruption made its appearance, it was doubtless subordinate, not essential. In the miliary fever, on the contrary, the eruption is so essential, that this disease may be considered as a completely exanthematous form of rheumatic fever. The history of miliary fever is full of important facts, and the sweating fever of Picardy forms but a variety of it. The eruption in itself is of very ancient occurrence, and was most probably, as at present, observed time immemorial in conjunction with petechiæ, occurring as a critical metastasis in the oriental glandular plague, perhaps even in the ancient plague recorded by Thucydides. It also occasionally accompanied petechial fever, as unquestionably it did small-pox and many other diseases, in the same manner as we now see; for the miliary eruption is a very common symptom, which is easily induced, and increases the danger of various other accidental complications. This is different, however, from the _idiopathic miliary fever_, which did not exist either before, or even at the period of the English Sweating Sickness, but occurred as an epidemic, frequently mentioned in Saxony, a hundred years later[852], (1652.) We cannot, therefore, consider this eruptive disease as having proceeded from the English Sweating Sickness, in the same manner as the petechial fever had its probable origin in the glandular plague, even supposing a more decided inclination of the Sweating Sickness to the eruptive character could be proved than is possible from the facts afforded. A whole century intervened, and what vast national revolutions! This same separation of so long a period makes also against the supposition, that the English Sweating Sickness was an interrupted miliary fever, which exhausted its power by a too luxuriant activity of the skin on the first day, before the eruption made its appearance. Moreover, the similarity and isolation of all the five epidemic sweating fevers, as regards the brevity of the course of the disease, and the absence of all transition forms of any duration, which certainly would have existed had nature intended gradually to form a miliary fever out of the English Sweating Sickness, lead to the same conclusion. But to return to the miliary fever. Some forms of this disease have been observed, in which a profuse perspiration, in combination with nervous symptoms, has endangered life on the first day of the attack; equally often, too, the eruption has appeared fully formed on the very first day; and if we duly consider, as we ought, the regular course of miliary fever whenever it has assumed an epidemic character, we shall always find, even in that case, a development of symptoms differing fundamentally from those of the English Sweating Sickness. If, occasionally, instances of miliary fever occurred, in which no eruption came out, as was the case recently (in 1821), they were to be considered in the same light as other acute eruptive diseases, as, for example, scarlet fever, in which nature indulges in a like irregularity, without, however, altering the essence of those diseases. And since, finally, it has been observed in many cases[853], that the miliary eruption could be prevented by the application of cold at the commencement, a distinguished modern physician has attached great consequence to this circumstance, as showing that miliary fever and the English Sweating Sickness were the same disease[854]; but a check of this kind is, at all events, impossible in those miliary fevers where the eruption breaks forth on the first or second day; and moreover, experience tells us, that many other diseases also, such as inflammations, rheumatisms, gastric fevers, and even abdominal typhus, may be arrested in their course, and confined within narrower bounds, so as not to manifest all their symptoms. We are, therefore, completely entitled to consider the appearance of the miliary sweating fevers as altogether a novelty, originating in the middle of the 17th century, and having no discoverable connexion with the English Sweating Sickness. There have been in Germany, since the year 1652, many visitations of miliary fever; but this disease did not increase much in extent until about the year 1715, when it spread into France and the neighbouring countries, particularly Piedmont[855], whilst England remained almost entirely free from it. The French epidemics were, upon the whole, much more severe than the German; and on this account we select one of the most ancient, and also the most recent of them, in order to give a general view of miliary fever, as compared with the English Sweating Sickness. The miliary fever first appeared in Picardy, in the year 1718, in le Vimeux (Vinnemacus pagus), a district on the north of the Somme and on the south of the Bresle and the department of the Lower Seine. It increased annually in extent; most places in Picardy were visited by it, and it was not long before it was seen in Flanders[856]. We are still in possession of a very distinct account, which we will here detail, of an epidemic at Abbeville in the year 1733, where the miliary fever had existed fifteen years previously. There were scarcely any premonitory symptoms, but the disease commenced at once with pinching pains in the stomach, extreme prostration of strength, dull headache, and difficulty of breathing, interrupted by sighing. Patients complained of violent heat, and were bathed in a pungent sweat of foul odour, while nausea was occasionally felt. Sparks appeared before the eyes, and _the countenance became flushed_. Patients were tormented with burning thirst; and yet the tongue was as moist as in perfect health. The pulse was frequent and undulating, without hardness; and in the course of _a few hours_, an insufferable itching came on over the whole body, accompanied by distressing jactitation: upon this, thickly studded, _red, round pustules_, not bigger than mustard-seeds, broke out, wherefrom patients emitted an extremely disagreeable urinous odour, which was imparted to those who were about their persons. Sometimes they had evacuations, at other times they suffered from constipation, but all complained of want of sleep; and when they felt an inclination to doze, they were again aroused by fresh chilliness. Many bled at the nose till they fainted; and with women, the menstrual discharge often appeared, though not at the proper time. The urine was at times deficient in quantity, at others discharged in abundance, and without any critical signs; if pale and plentiful, it betokened delirium; then the eyelids twitched convulsively, a humming noise commenced in the ears, and the patient tossed about restlessly. The pulse became strong, irregular, and, like the breathing, very quick. The countenance grew redder and redder; and soon after, the sufferers, as though struck by lightning, were seized with lethargy, and expired, generally in the act of coughing and spitting blood. Such was the nature of the disease when it attacked many at once: there were, however, several varieties. With some the miliary vesicles broke out on the _second_ day, with others not before the _third_; and if all went on favourably, they lost their redness on the _seventh day_, and _the skin all over the body scaled off like bran_. The fever was sometimes extremely violent; at others, without apparent cause, very mild; at least one might be deceived at the commencement of the attack, by the apparently favourable symptoms; for those who in the morning had scarcely any notable degree of fever, who neither suffered from any anxious sensation nor violent heat, in whom no subsultus tendinum was perceptible, no want of perspiration, nor any retrocession of the eruption, were sometimes towards evening seized with phrenzy, and died in a state of lethargy. Evacuations, which alleviate other diseases, made this miliary fever worse. Favourable symptoms could never be depended on. In the midst of profuse perspiration the patient died, either from constipation or diarrhœa. A copious discharge of urine was a bad sign; composure was succeeded by delirium, cheerfulness by lethargy: the disease was throughout treacherous and disguised. It was particularly necessary for those suffering from pleurisy or any inflammatory fevers to be guarded against its approach. Many fell sacrifices to this epidemic who thought themselves in a state of convalescence; and with such it was easier to foretell than to prevent the consequences. In cases of this kind the miliary vesicles were less red and grew pale sooner; but if the disease attacked a healthy person, then they were redder, and continued longer. Of those who recovered, not a few suffered for many months, nay, even for a whole year, from night perspirations, without fever or sleeplessness, but with an eruption of little miliary vesicles, which disappeared[857] again on the slightest exposure to cold. The later miliary epidemic fevers in France, which are distinguished by the name of the Picardy Sweating Sickness, are generally very well described[858]; so much so, that we have few epidemics of modern times whose course and succession we can trace so well. But the epidemic of 1821, which raged in the departments of the Oise, and of the Seine and Oise, from March to October, has been observed by all with the greatest care, including men of distinguished talent[859]. We shall give the description of this disease. There were no constant premonitory symptoms; it often broke out quite suddenly, but many complained some days before of debility, despondency, want of appetite, nausea, headache; sometimes also of giddiness and slight chilliness. Many retired to rest in health, and awoke during the night with the disease, covered with a perspiration, which ceased only with death or recovery. With some the sweating was preceded for some hours, or even only for some moments, by a scarcely perceptible feverish commotion, accompanied with burning heat, or with a _sensation of pain_ which ran through every limb, and nearly always with spasms in the stomach. With others the disease announced itself by lacerating rheumatic pains, which gradually increasing, they became bed-ridden. The mouth was foul, the taste at times bitter, the tongue white, more rarely tinged with yellow, and thus it remained till the patient was restored. The sufferer was shortly covered with _a thick, peculiarly fetid sweat_, that certainly produced alleviation, but became very intolerable to him from its unpleasant stench, which was even communicated to the clothes of the bystanders. In the mean time it was discovered by the pulse, that the fever had considerably abated; but, on the third day, the patient was seized with convulsive _spasms in the stomach_, great _oppression at the chest_, and a sensation of suffocation—symptoms which caused him insupportable anguish. These attacks accompanied by hiccup and eructation, continued for several hours, and returned from time to time, an eruption, partly papular, simultaneously breaking out first on the neck, then on the shoulders down to the hands and breast, less frequently on the thighs and face. The little pimples were of a pale red colour and conical, with glistening heads, and between them appeared innumerable small miliary pustules, filled with transparent serous fluid, which soon thickened and assumed a whiter hue. At the time and previous to the breaking out of the exanthem, the patient experienced a very severe _burning and pricking sensation in the skin_, which nevertheless sometimes occurred on the second or fourth day, and which increased sometimes in one part, sometimes in another, when the sweating declined. Towards the fifth day, however, after the sweating had entirely ceased, the complaint grew worse again. The spasms and paroxysms of suffocation returned, and they were succeeded by renewed eruptions of the exanthem; a decided improvement, however, shortly took place; the little pimples lost their redness, the miliary vesicles dried away, and at a period from the seventh to the tenth day recovery commenced under _a general exfoliation of the cuticle_. Sometimes the eruption did not appear, whether the patients were under medical treatment, or left to their own guidance, but with those few in whom there was an absence of miliary vesicles, that peculiar pricking and itching of the skin did not take place. Between the fifth and seventh day the patients usually complained of great weakness, and had a desire to eat. A few tablespoonfuls of wine then agreed with them very well; for the rest, neither thirst nor lethargy was observable, but it was particularly remarkable that the urine was clear and abundant. Up to the seventh day a confined state of bowels was usual, and, with the exception of the already mentioned attacks of tightness and oppression, the breathing remained free, though with great sleeplessness, during the whole malady. Nothing morbid was to be observed in the chest, and the patients lay stretched out at full length, so that there was no occasion at any time to raise their heads. Such was the regular course of this miliary fever, but its progress was often accelerated by very dangerous symptoms, and occasionally it proved fatal within a very few hours. If at the time of the attack the patients were very restless and talkative, the eyes glistening, the pulse, without being hard, tumultuous, and the edges of the tongue reddened, delirium soon succeeded and then convulsions and death. Great depression of the spirits was a very bad symptom; bleeding was never of any avail, yet the menstrual discharge did not interrupt the course of the disease. There was in general a great degree of malignancy perceptible in the malady, as was also rendered apparent by the course of the epidemic. If the miliary Sweating Fever broke out in a fresh place, two or three persons only were thereupon attacked, and that favourably, which led to a supposition that the evil had all passed away, for during the next fifteen or twenty days, not any fresh attacks were heard of. Suddenly, however, the epidemic reappeared with increased virulence. The great number of the sufferers spread consternation and terror amongst the inhabitants, and the cases of death became frequent. After this first burst of fury, the epidemic grew more mild again, so that many patients were not confined to their beds at all. This mitigation of the miliary fever was likewise manifested[860] by the prolongation of its course beyond the seventh day. If we compare this epidemic with the one observed at Abbeville in 1773, we shall find between them but very trifling differences, which would appear still more clearly in some of the intermediate visitations, thus conforming to what has been observed in other eruptive maladies. It is consequently evident that the miliary fevers[861] which have appeared in France in recent times, do not differ in any essential point from those of more ancient date. The surest proof of their identity is, their persistence for nearly two centuries; and from the manner in which they have presented themselves to observation, they are to be considered as distinct from the English Sweating Sickness, though certainly allied to it. It would exceed our limits to pursue this inquiry further, but it may be as well to give the following short catalogue[862] of the most important miliary epidemics.