1675. The prevailing intermittent fevers, he says, gave place to a new

epidemic depending upon a manifest crasis of the air. The new epidemic was one of coughs, which were so much more general than at the same season in other years that in nearly every family they affected nearly every person. In some cases of the cough, the aid of a physician was hardly needed; but in others the chest was so shaken by the violent convulsive cough as to bring on vomiting, and the head was affected with vertigo. For the first few days the cough was almost dry, and so purely paroxysmal as to remind Sydenham of the whooping-cough of children. Everyone was surprised, he says, at the frequency of these coughs in this season. His own suggestion was that the rains of October[591] had filled the blood with crude and watery particles, that the first access of cold had checked transpiration through the skin, and that Nature had contrived to eliminate this serous colluvies either by the branches of the “vena arteriosa” or (as some will have it) by the glands of the trachea, and to explode it by the aid of a cough. Phlebotomy and purging were the best cures; diaphoretics he considered less safe, and he ascribed to their abuse the fever into which some fell, and the pleurisies which were apt to attack patients with great violence during the subsidence of the epidemic catarrh. The Epidemic Agues of 1678-80. The other English writer on the epidemic constitution of 1678-79 is Dr Christopher Morley[592]. Like Sydenham, he is occupied almost exclusively with the epidemic agues; but he also records the extraordinary rise of the mortality in London for a few weeks in the last months of the year, and the causes thereof, although it did not occur to him to count that as a separate part of “the new disease,” still less as the principal part, which it really was in London so far as concerned the death-rate. Dating his preface from London, the 31st of December, 1679, he says in the text: “Within the very days of my present writing, it happens that as many as four hundred deaths more than usual have taken place in a fortnight,” the excessive mortality having been due to “coryza, bronchitis, catarrh, cough and fever,” which were the effects of “most pernicious destillations.” I shall now go back to the beginning of the epidemic constitution in the midst of which this November interlude occurred, and I shall follow it season after season to the end, so as to set forth in historical prominence that which was regarded at the time as “the new disease.” When Sydenham returned to London in the autumn of 1677, after six months’ rest from practice, he was told by his professional friends that intermittents were being seen here and there (after a clear interval of thirteen years), being more frequent in the country than in the city. In the letter of October, 1677, cited above, he speaks of Talbor having made a fortune in two months by his cures of agues with bark. The first particular notice of the “new fever” occurs in a London letter of 23 February, 1677/78: “Lady Katherin Brudenhall has been in great danger of death by the new feaver[593].” A severe aguish illness of Roger North, fully described in his ‘Autobiography,’ was probably another instance of the reigning malady; it came upon him in the hot weather of 1678, while he was residing with his brother, Lord Guilford, at Hammersmith[594]. In the autumn of 1678, the “new fever” came more into notice. On the 8th of September, a letter was brought to Evelyn in church, from Mr Godolphin (afterwards celebrated as the minister of William III.), to say that his wife was exceedingly ill and to ask Evelyn’s prayers and assistance. Evelyn and his wife took boat at once to Whitehall, and found the young and much-beloved Mrs Godolphin “attacqu’d with the new fever then reigning this excessive hot autumn, and which was so violent that it was not thought she could last many hours.” She died next day, in her twenty-ninth year; but, as she had been brought to bed of a son six days before, her fever may have been more from puerperal causes than from “the new fever then reigning.” Other known cases of ague the next season were those of Sir James Moore, his majesty’s engineer, who, in August, 1679, coming from Portsmouth “was seized with an ague, and had two or three violent fits, which carried him off[595];” and of the king, Charles II., who was congratulated on his recovery by the lord mayor and aldermen, on 15 September, and had a recurrence of the aguish attack (“two or three fits”) on 15 May, 1680[596]. There are also references to the agues of 1679 in the country, in the letters of Lady North[597]. Sydenham wrote his account of this epidemic of intermittents in compliance with a request from Dr Brady, Master of Gonville and Caius College, Cambridge, that he would continue the method of his ‘Observationes Medicae’ into the years following, and in particular give an account of his method of administering bark. He occupied most of his space with treatment; but he gives here and there the following epidemiological details. The agues were mostly tertians, or quotidians, or duplex forms of these, whereas on a former occasion they had been mostly quartans; after two or three intermissions they were apt to become continual fevers. The agues, which had occurred in the spring of 1678, became more common in the summer and autumn, when they raged so extensively that no other disease deserved the name of epidemic so much. In winter smallpox took the lead; but early in July, 1679, the agues began again, and so increased day by day that in August they were raging excessively and destroying many. It was in August that the king had his “great cold” at Windsor, which afterwards changed to an ague. Sydenham then comes to the November interlude of epidemic catarrhs, which was followed by “a fever without cough” (_non penitus deleta, sed manente adhuc in sanguine, malae crasis impressione_), lasting to the beginning of 1680. As that year wore on, the intermittent fevers began again, and continued more or less until 1685, becoming indeed less common in London, and less severe, than in the first four years of the constitution, but in other places, now here, now there, not less so than at first[598]. I have kept to the last the special account of this epidemic written by Morley at the end of the second year of it, namely, in December, 1679. He had been a witness of this fever, first at Leyden in the autumn of 1678, and next in England in the autumn of 1679, and he made it the subject of a treatise at the request of an eminent physician in London. It was not so severe by half in England as in Holland, but the English made a great deal more of it, calling it the New Disease, the New Ague, the New Fever, the New Ague Fever, and, in Derbyshire sarcastically, the New Delight. In Holland they called it neither new nor old, neither intermittent nor continued, nor a conjunction of both, but simply _morbus epidemicus_, or _febris epidemica_. His master at Leyden, Professor Lucas Schacht, taught very decidedly that it was of a scorbutic nature, and as early as the month of June, 1678, had prophesied the arrival of such an epidemic fever because “tertians were becoming more and more scorbutic,” just as they had done before the great epidemic of fever in Holland in 1669. Morley claims, however, that the fever of 1678 was in some respects different from that of 1669, as well as from that of the year immediately preceding, 1677, when “an incredible multitude of people all over Belgium, and in every city and town, fell sick.” The Dutch, it appears, called these occasional outbreaks simply “the epidemic fever,” neither intermittent nor continued; and certainly that of 1669, which is sometimes counted among the epidemic agues, was a very remarkable “ague.” (See Chapter I. p. 19.) The epidemic fever of 1678, wherever it may have been bred or engendered, was prevalent in England at the same time as in Holland--in an exceedingly hot and dry autumn. The most constant symptoms, says Morley (and he writes both for Holland[599] in 1678 and for the country districts of England in the autumn of the following year), were nausea, severe vomiting, incredible tightness about the breast, weight in all the limbs, weariness, giddiness, vigils, thirst, restless tossing, and languor remaining after the disease was gone. Among the more remarkable symptoms were the following: Many had aphthae of the mouth, some twice or thrice, some being endangered by the severity and closeness of the patches of thrush. In some there occurred bleeding from the nose, or from piles, stranguary, etc. Round worms were observed, issuing both by the mouth and anus. In some few there were spots on the skin, but hardly ever petechiae or tumours near the ears. It affected all classes equally, all ages and both sexes. Some said it was easier to children than to adults, but others denied this. Some said it was more pernicious in the country than in the towns. In Leyden, the deaths never exceeded 150 in the week, being about twenty in a week above the ordinary level. More died from the coughs, anginas, peripneumonies and pleurisies that followed, than from the disease itself. Schacht says that the wind for nearly two years had been steadily from the North, or veering to the East or West. The Leyden faculty, and the Dutch generally, did not think the disease a malignant one; it was very freely called so, however, in England, the chorus being led by empirics and illiterate persons: “Ac indicio est,” says Morley, “libellus perexiguus nostra lingua ab Empirico conscriptus de hoc morbo.” This seems to refer to the tract by one Simpson, which I shall notice briefly[600]. Simpson styles himself a Doctor of Physic, and denies that he is an empiric. One sign of his affinity to that order, however, is that he objects to the orthodox treatment--emetics, drenches, a too cooling regimen, and purges, while he thinks blood-letting of doubtful utility. The symptoms were chills at the outset, pains in the head and back (in some with shaking), then intense burning heat, thirst, profuse immoderate sweats and great debility, a general lassitude, dulness, and stupor which in many were followed by delirium and a comatose state. Sometimes the fever simulated a quotidian, sometimes a tertian. He calls it “this new fever so grassant in city and country” and says that in many it assumed “the guise of a morbus cholera, known by the much vomitings or often retchings to vomit; and in others under the livery of the gripes with looseness, or, in some, looseness without gripes.” This choleraic tendency concurring with other usual causes from the late season of fruit-eating etc., had swelled the bills of mortality. The morbus cholera and the gripes were to the new fever “like the circumjoviales that move in the same sphere with (but at some distance from) their master-planet.” The meaning of all this is obvious on turning to the London weekly, bills of mortality. In the months of August and September for three years in succession, 1678-80, the deaths from “griping in the guts” and from “convulsions” rose greatly. These were, indeed, three successive seasons of fatal diarrhoea, mostly infantile, as I shall show in the chapter on that disease. The following extracts from the London weekly bills of mortality show how “fevers,” as well as other diseases, contributed to the great rise in the autumns of 1678, 1679, and 1680. _Autumnal London Mortality in 1678._ 1678 Griping Week ending Fever Smallpox in Guts All causes Aug. 20 77 31 87 459 27 79 37 130 510 Sept. 3 82 37 121 530 10 103 27 164 621 17 82 23 178 580 24 83 20 152 528 Oct. 1 82 25 117 485 8 77 27 106 456 _Summer and Autumnal London Mortality in 1679._ 1679 Griping Week ending Fever Smallpox in Guts All causes July 22 42 55 101 442 29 60 50 134 565 Aug. 5 78 63 143 531 12 62 43 161 579 19 55 64 149 545 26 68 53 112 514 Sept. 2 96 40 97 466 9 92 47 75 471 16 85 50 87 462 (For the Influenza weeks, see former Table.) _Autumnal London Mortality in 1680._ 1680 Griping Week ending Fever Smallpox in Guts All causes Aug. 10 70 17 108 427 17 90 6 132 494 24 98 17 127 552 31 140 18 228 816 Sept. 7 101 14 215 671 14 94 13 173 635 21 106 9 175 628 28 130 9 159 615 Oct. 5 125 16 138 597 12 121 10 94 530 19 109 14 68 488 26 93 5 58 407 Nov. 2 77 10 53 396 The last of the three autumnal seasons, 1680, is one of the few in the bills with high deaths from fever along with high deaths from choleraic disease; and that excess of fever mortality may have been due in part to the ague epidemic, then in its third season. The following extracts from Short’s summation of parish registers show the great excess of burials over baptisms in various parts of England during the years of the aguish epidemic constitution. _Country Parishes._ Registers Sickly Baptisms Burials Year examined parishes in do. in do. 1678 136 17 312 527 1679 137 44 800 1203 1680 137 54 1093 1649 1681 137 41 679 1156 1682 140 30 632 975 _Market Towns._ Registers Sickly Baptisms Burials Year examined parishes in do. in do. 1678 22 5 578 789 1679 23 7 877 1371 1680 24 7 946 1494 1681 24 9 945 1333 1682 25 9 795 1092 1683 25 8 1109 1398 1684 25 8 865 1243 1685 25 4 741 1191 The Influenza of 1688. The seasons continued, according to Sydenham, to produce epidemic agues until 1685, when the constitution radically changed to one of pestilential fevers, affecting many in all ranks of society and reaching a height in