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,