1686. Sydenham records nothing beyond that date, having shortly after

fallen into ill health and ceased to write or even to practise. One would wish to have known what he made of the “new distemper” in the summer of 1688, for it was a sudden universal fever, and yet not a catarrh or a “great cold.” It is thus referred to in a letter of the month of June, from Belvoir, Rutlandshire[601]: “The man that dos the picturs in inemaled is gon up to London for a weke.... I wish the man dos not get this new distemper and die before he comes agane.” On turning to the London weekly bills of mortality we find in the first weeks of June the characteristic rise of one of those sudden epidemic fevers or new diseases, of which the earliest with recorded figures was the “gentle correction” of July, 1580. The following are the weekly London figures corresponding to the “new distemper” of 1688: _Weekly London Mortalities._ 1688 Week ending Fevers All causes May 29 58 368 June 5 76 518 12 101 559 19 65 435 26 66 437 The contemporary London notice of this “influenza” comes from Dr Walter Harris, who mentioned it in a book written the year after[602]: “From the middle of the month of May in the year 1688, for some weeks, a slight sort of fever became epidemical. It affected the joints of the patients with slight pains, and they complained of a pain in their heads, especially in the fore-part, and of a sort of giddiness. It was more rife than any that I ever observed before, from any cause whatsoever, or in any time of the year. A great many whole families were taken at once with this fever, so that hardly one out of a great number escaped this general storm. Now this so epidemical or febrile insult seemed plainly to me to depend upon the variety of the season of the year, the most intense heat of some days being suddenly changed to cold.... Never were so many people sick together: never did so few of them die. They recovered under almost any regimen,--almost everyone of them.” It will be seen, however, that the bills rose very considerably for four weeks, and that, too, in the healthiest season of the year. A somewhat fuller account of its symptoms is given by Molyneux for Dublin[603]. He had been informed by a learned physician from London that it had been as general there as in Dublin, which we know to have been the case from Harris’s account. Both Molyneux and Harris call it a slight fever, without mentioning catarrhal symptoms. The spring months immediately preceding had been remarkable for drought. At Dublin this “short sort of fever” was first observed about the beginning of July, or some six weeks later than in London. “It so universally seized all sorts of men whatever, that I then made an estimate not above one in fifteen escaped. It began, as generally fevers do, with a chilness and shivering all over, like that of an ague, but not so violent, which soon broke out into a dry burning heat, with great uneasiness that commonly confined them to their beds, where they passed the ensuing night very restless; they commonly complained likewise of giddiness, and a dull pain in their heads, chiefly about the eyes, with unsettled pains in their limbs, and about the small of their back, a soreness all over their flesh, a loss of appetite, with a nausea or aptness to vomit, an unusual ill taste in their mouths, yet little or no thirst. And though these symptoms were very violent for a time, yet they did not continue long: for after the second day of the distemper the patient, usually of himself, fell into a sweat (unless ’twas prevented by letting blood, which, however beneficial in other fevers, I found manifestly retarded the progress of this): and if the sweat was encouraged for five or six hours by laying on more cloaths, or taking some sudorifick medicine, most of the disorders before mentioned would entirely disappear or at least very much abate. The giddiness of their head and want of appetite would often continue some days afterwards, but with the use of the open fresh air they certainly in four or five days at farthest recovered these likewise and were perfectly well. So transient and favourable was this disease that it seldom required the help of a physician; and of a thousand that were seized with it, I believe scarce one dyed. By the middle of August following, it wholly disappeared, so that it had run its full course through all sorts of people in seven weeks time.... This fever spread itself all over England; whether it extended farther I did not learn.” This short fever of men was preceded by a slight but universal horse-cold[604]. The Influenza of 1693. Molyneux considered the strange transient fever of the summer of 1688 to have been the most universal fever that perhaps had ever appeared, and he thought the universal catarrh of five years’ later date (1693) to have been “the most universal cold.” We have thus a means of contrasting in the descriptions of the same author a universal slight fever and a universal catarrh, which happened within five years of each other, and were neither of them called at the time by the name of influenza,--a name not known in Britain until half a century later. Before coming to Molyneux’s description, it should be said that the London bills of mortality bear no decided trace of an influenza in the end of the year 1693, the following being the highest weekly mortalities nearest to the date given for the epidemic at Dublin[605]: _London Weekly Mortalities._ 1693 Week ending Fever All causes October 10 43 353 17 62 353 24 53 384 31 69 457 November 7 68 455 14 48 365 Molyneux’s account of the flying epidemic of 1693 is as follows[606]: “The coughs and colds that lately so universally prevailed gave us a most extraordinary instance how liable at certain times our bodies are, however differing in constitution, age and way of living, to be affected much in the same manner by a spreading evil.... ’Twas about the beginning of November last, 1693, after a constant course of moderately warm weather for the season, upon some snow falling in the mountains and country about the town [Dublin], that of a sudden it grew extremely cold, and soon after succeeded some few days of very hard frost, whereupon rheums of all kinds, such as violent coughs that chiefly affected in the night, great defluxion of thin rheum at the nose and eyes, immoderate discharge of the saliva by spitting, hoarseness in the voice, sore throats, with some trouble in swallowing, whesings, stuffings and soreness in the breast, a dull heaviness and stoppage in the head, with such like disorders, the usual effects of cold, seized great numbers of all sorts of people in Dublin. “Some were more violently affected, so as to be confined awhile to their beds; those complained of feverish symptoms, as shiverings and chilness all over them, that made several returns, pains in many parts of their body, severe head-aches, chiefly about their foreheads, so as any noise was very troublesome: great weakness in their eyes, that the least light was offensive; a perfect decay of all appetite; foul turbid urine, with a brick-coloured sediment at the bottom; great uneasiness and tossing in their beds at night. Yet these disorders, though they very much frightened both the sick and their friends, usually without help of remedy would abate of themselves, and terminate in universal sweats, that constantly relieved.... When the cold was moderate, it usually was over in eight or ten days; but with those in whom it rose to a greater height, it continued a fortnight, three weeks, and sometimes a month. One way or other it universally affected all kinds of men; those in the country as well as city; those that were much abroad in the open air, and those that stay’d much within doors, or even kept close in their chambers; those that were robust and hardy, as well as those that were weak and tender--men, women and children of all ranks and conditions.... Not one in thirty, I may safely say, escaped it. In the space of four or five weeks it had its rise, growth, and decay; and though from first to last it seized such incredible numbers of all sorts of men, I cannot learn that any one truly dyed of it, unless such whose strength was before spent by some tedious fit of sickness, or laboured under some heavier disease complicated with it.... It spread itself all over England in the same manner it did here, particularly it seized them at London and Oxford as universally and with the same symptoms as it seized us in Dublin; but with this observable difference that it appeared three or four weeks sooner in London, that is, about the beginning of October.... Nor was its progress, as I am credibly informed, bounded by these Islands for it spread still further and reached the Continent, where it infested the northern parts of France (as about Paris) Flanders, Holland, and the rest of the United Provinces with more violence and no less frequency than it did in these countries.” Yet no other writer, English or foreign, appears to have mentioned it. Its existence rests on the authority of Molyneux alone, according to the above very circumstantial narrative. The Influenza of 1712. There were so many fevers from 1693 to the end of the century that it is not easy to distinguish epidemic agues or catarrhs among them. If we follow the continental writers, it is not until 1709 and 1712 that there is any concurrence of testimony for such widespread maladies. Evelyn, however, says that in the remarkably dry and fine months of February and March, 1705, “agues and smallpox prevail much in every place” (21st February). The very general coughs and catarrhs of 1709 seem to have been really caused by the severity of the memorable hard winter, the frost having begun in October, 1708 and lasted until March, 1709. The evidences of a truly epidemic infectious catarrh or influenza all over Europe in 1709 are scanty and ambiguous. It is probably to this “universal cold” that Molyneux refers under the year 1708[607]; but English writers have not otherwise mentioned an epidemic in 1709. The next, in 1712, was a “new ague” of the kind without catarrhal symptoms, like that of 1688. One German writer called it the “Galanterie-Krankheit,” another the “Mode-Krankheit,” and it was about the same time that the French name “la grippe” came into use. These names all mean “the disease _a la mode_” or the reigning fashion[608]; they remind one of the earlier “trousse galante” and “coqueluche” (a kind of bonnet), and of the “grande gorre” of 1494. It appears to have made little or no impression on the mortality, and would hardly have been noticed but for its wide prevalence. In England it was the subject of a brief essay by Dr John Turner under the title of “Febris Britannica Anni 1712[609]”--a certain epidemic fever, of the milder kind, fatal to none, but prevalent far and wide and leaving very few families untouched. It was marked by aching and heaviness of the head, burning or lancinating pains in the back, pains in the joints like those of rheumatism, loss of appetite, vomiting, pains of the stomach and intestines. The venom though not sharp, acted quickly. Turner ascribed it to malign vapours from the interior of the earth (_malignos terrae matris halitus_). Its season in England, as in Germany, was probably the summer or autumn. Turner begins his discourse with a reference to the plague in the East of Europe, which, he says, had been kept out of England by quarantine, to the murrain which was then raging in Italy (and appeared in England in 1714), and to fevers of a bad type which had traversed all France during the past spring, invading noble houses and even the royal palace. Having begun his discourse thus, he ends it by remarking that the slight British fever did not, in his opinion, forebode a plague to follow. It may have been a recurrence of this epidemic next year that Mead speaks of under the name of the “Dunkirk rant” (supposed to have been brought over from Dunkirk by returning troops after the Peace of Utrecht) in September, 1713; it was, he says, a mild fever, which began with pains in the head and went off easily in large sweats after a day’s confinement[610]. The weekly bills of mortality in London are no help to us to fix the date of the one or more slight fevers or influenzas about 1712-13. The great fever-years of the period were 1710 and 1714; but the fever was typhus, probably mixed with relapsing fever, according to the evidence in another chapter. Even compared with the universal fever or influenza of 1688, that of 1712 must have been unimportant; for the former sent up the London mortality considerably, whereas there is no characteristic rise to be found in any month of 1712 or 1713. Either to this period, or to the undoubted aguish years 1727-28, belongs a curious statement as to “burning agues, fevers never before heard of to be universal and mortal,” in Scotland, the same having been a “sad stroke and great distress upon many families and persons.” The authority is Patrick Walker, who traces these hitherto unheard of troubles to the Union of the Crowns (1707)[611]. On other and perhaps better authority, it does appear that Scotland before that period was reputed to be remarkably free from agues; and it is probable that the universal and mortal burning agues some time between 1707 and 1728, had come in one of those strange epidemic visitations, just as the agues of 1780-84 did. It would be erroneous to conclude from such references to ague that Scotland had ever been a malarious country. Robert Boyle refers in two places to the rarity of agues in Scotland in the time of Charles II.; the Duke of York, he says[612], on his return out of Scotland, 1680, mentioned that agues were very unfrequent in that country, “which yet that year were very rife over almost all England”--to wit, the epidemic of 1678-80. Again, agues, especially quartans, are rare in many parts of Scotland, “insomuch that a learned physician answered me that in divers years practice he met not with above three or four[613].” However, Sir Robert Sibbald, while he admits the rarity of quartans, does allege that quotidians, tertians and the anomalous forms occurred, that agues might be epidemic in the spring, with different symptoms from year to year, and that certain malignant fevers, not called agues, were wont to rage in the autumn[614]. Epidemic Agues and Influenzas, 1727-29. The contemporary annalist of epidemics in England is Wintringham, of York, who enters remittents and intermittents almost every year from 1717 to the end of his first series of annals in 1726; but none of his entries points very clearly to an epidemic of ague[615]. It is not until the very unwholesome years 1727-29 that we hear of intermittent fevers being prevalent everywhere, with one or more true influenzas or epidemic catarrhs interpolated among them. To show how unhealthy England was in general, I give a table compiled from Short’s abstracts of the parish registers, showing the proportion of parishes, urban and rural, with excess of burials over christenings: _Country Parishes._ Registers Registers showing high Births Deaths Year examined death-rate in ditto in ditto 1727 180 55 1091 1368 1728 180 80 1536 2429 1729 178 62 1442 2015 1730 176 39 1022 1302 _Market Towns._ Registers Registers showing high Births Deaths Year examined death-rate in ditto in ditto 1727 33 19 2441 3606 1728 34 23 2355 4972 1729 36 27 3494 6673 1730 36 16 2529 3445 It is clear from the accounts by Huxham, Wintringham, Hillary, and Warren, of Bury St Edmunds[616], that much of the excessive sickness in 1727-29 was aguish, although much of it, and probably the most fatal part of it, was the low putrid fever so often mentioned after the first quarter of the 18th century. At Norwich, where the burials for three years, 1727-29, were nearly double the registered baptisms, many were carried off, says Blomefield, “by fevers and agues, and the contagion was general.” In Ireland also, a country rarely touched by true agues, Rutty enters intermittent fever as very frequent in May, 1728; and again, in the spring of 1729: “Intermittent fevers were epidemic in April; and some of the petechial kind. Nor was this altogether peculiar to us; for at that same time we were informed that intermittent and other fevers were frequent in the neighbourhood of Gloucester and London; and very mortal in the country places, but less in the cities.” * * * * * In the midst of this epidemic constitution of agues and other fevers there occurred one or more horse-colds, and one or more epidemic catarrhs of mankind. The most definitely marked or best recorded of these was the influenza of 1729. The universal cold or catarrh of 1729 fell upon London in October and November, and upon York, Plymouth and Dublin about the same time. It prevailed in various parts of Europe until March, 1730, its incidence upon Italy being entirely after the New Year. The rise in the London deaths was characteristic: the level was high when the epidemic began, but the epidemic nearly doubled the already high mortality during the worst week and trebled the deaths from “fever.” _London Weekly Mortalities._ 1729 Week ending Fever All causes October 21 88 564 28 118 603 November 4 213 908 11 267 993 18 166 783 25 124 635 The high mortalities of the weeks following may be taken as due to the sequelae of the epidemic (pneumonias, pleurisies, malignant fevers) and are indeed so explained in one contemporary account: Week ending Fever All causes December 2 92 678 9 132 779 16 116 707 23 123 710 30 109 628 The influenza of October and November, 1729, was the occasion of a London essay[617], which appears to treat solely of the epidemic catarrh and its after-effects, and not of the two years’ previous sicknesses, which are the subject of another essay, by Strother, written before the influenza began. London, says this author, as well as Bath, and foreign parts, have been on a sudden seized universally with the disorders named in his title (fevers, coughs, asthmas, rheumatisms, defluxions etc.). These had come in the course of an unusually warm and wet, or relaxing, winter; “we have for some time past dwelt in fogs, our air has been hazy, our streets loaden with rain, and our bodies surrounded with water.” So many different symptoms attend the “New Disease” that a volume, he says, would not suffice to describe them, but he thus summarizes them: Sudden pain in the head, heaviness or drowsiness, and anon their noses began to run; they coughed or wheezed, and grew hoarse; they felt an oppression and load on their breasts, and turned vapourish, either because they apprehended ill consequences, or because their spirits were oppressed with a load of humours. The victims of the epidemic, he says again, were very subject to vapours; they are, upon the least fatigue or emotion of mind, dispirited, and flag upon every emergency. Among other symptoms were, quick pulse, thirst, loss of appetite and vertigo: the mouth and jaws hot, rough and dry, the thrush raising blisters thereon; the throat hoarse; a fierce brutal cough, which weakens by bringing on profuse sweats; the urine, muddy and white, “if they who are seized have been old asthmaticks.” He speaks of cases that had proved suddenly fatal and says that all who died of “epidemical catarrhs” had been found to have polypuses in their hearts. If reference be made to the Table, it will be seen that the high mortality continued in London for at least a month after the epidemic had passed through its ordinary course of rise, maximum and decline; and it is probably to that post-epidemic mortality that the author refers in the following passages: “Numbers, as appears by our late bills, are taken with malignant fevers, or malignant pleurisies or with pleuritic fevers.... Whosoever, then, would prevent a defluxion from turning into a fever, or from anything yet worse, if worse can be, must keep warm and observe a diluting regimen so long as till their water subsides and the symptoms are vanquished.... I am convinced by experience that many poor creatures have perished under these late epidemical fevers, from the fatal mistake of never retiring from their usual employments till they have rivetted a fever upon them, and till they have neglected twelve or fourteen days of their precious time.” This was fully endorsed by Huxham for the influenza of 1733: “Morbus raro lethalis, quem tamen, multi, vel ob ipsam frequentiam, temeri spernentes, seras dedêre poenas stultitiae, asthmatici, hectici, tabidi.” Hillary’s account for Ripon is very brief[618]: “The season continuing very wet, and the wind generally in the southern points, about the middle of November [1729] an epidemical cough seized almost everybody, few escaping it, for it was universally felt over the kingdom; they had it in London and Newcastle two or three weeks before we had it about Ripon.” Wintringham, of York, says the epidemic in the early winter of 1729 was “a febricula with slight rigors, lassitude, almost incessant cough, pain in the head, hoarseness, difficulty in breathing, and attended with some deaths among feeble persons, from pleuritic and pulmonary affections[619].” There was a tradition at Exeter as late as 1775 that two thousand were seized in one night in the epidemic of 1729. Huxham, of Plymouth, says of the epidemic in November: “A cartarrhal febricula, with incessant cough, slight dyspepsia, anorexia, languor, and rheumatic pains, is raging everywhere. When it is more vehement than usual, it passes into bastard pleurisy or peripneumony; but for the most part it is easily got rid of by letting blood and by emetics.” In December, the coughs and catarrhal fever continued, while mania was more frequent than usual, and in January, 1730, the cartarrhal fever still infested some persons. Rutty, of Dublin, merely says: “In November raged an universal epidemic catarrh, scarce sparing any one family. It visited London before us[620].” These references to the unusual catarrhal febricula in November, 1729, are all that occur in the epidemiographic records kept by some four British writers who recorded the weather and prevalent diseases of those years. The epidemic catarrh made a slight impression upon them beside some other epidemics, and hardly a greater impression than another of the same kind, which seems to have occurred in the beginning of 1728. Thus, Rutty says, under November, 1727: “In Staffordshire and Shropshire their horses were suddenly seized with a cough and weakness. In December, it was in Dublin and remote parts of Ireland; some bled at the nose.” On December 25th, he enters: “The horses growing better, a cough and sore throat seized mankind in Dublin[621].” Huxham, for Devonshire, under Oct.-Nov. 1727 confirms this: “a vehement cough in horses, which lasted to the end of December; the greater number at length recovered from it.” He does not say in that context that an epidemic cough followed among men, as Rutty does say for Dublin; but in a subsequent note upon horse-colds, he says: “In 1728 and 1733 it [the precedence of the horse-cold] was most manifest; in which years a most severe cough seized almost all the horses, one or two months earlier than men.” From which it would appear that the influenza of Nov.-Dec. 1729, was not the only one during the aguish years 1727-29. In the weekly London bills the other series of mortalities that look most like those of an influenza are in the month of February, 1728 (748, 889, 850 and 927 in four successive weeks, being more than double the average). The Influenza of 1733. The next influenza was three years after that of 1729--in January, 1733. In London, it raised the weekly deaths for a couple of weeks to a far greater height than the preceding had done. Also the purely catarrhal symptoms of running from the eyes and nose are more prominent in the accounts for 1733 than for the influenza of 1729. The first notice of it comes from Edinburgh. The horses having been “attacked with running of the nose and coughs towards the end of October and beginning of November,” the same symptoms began suddenly among men on the 17th December, 1732[622]. By the 25th the epidemic was general in Edinburgh, very few escaping, and it continued in that city until the middle of January, 1733. In a great many it began with a running of lymph at the eyes and nose, which continued for a day. Generally the patients were inclined to sweat, and some had profuse sweats. It was noted as remarkable that the prisoners in the gaol escaped; also the boys in Heriot’s Hospital, as well as the inhabitants of houses near to that charity. The Edinburgh deaths rose as in the following table; the bulk of these extra burials are said to have been at the public charges, the epidemic having swept away a great number of poor, old, and consumptive people: Buried in November, 1732 89 " " December, 1732 109 " " January, 1733 214 " " February, 1733 135 Hillary[623] fixes the date of its beginning at Leeds on 3 February, one week later than at York, three weeks later than at Newcastle, or than in London and the south of England generally. At Leeds in three days’ time about one-third part of the people were seized with chills, catarrh, violent cough, sneezing and coryza; the epidemic lasted five or six weeks in the town and country near. Dr John Arbuthnot, who was then living in Dover Street, is clear that the outbreak in London was later than in Edinburgh, which indeed appears also from the paragraph in the _Gentleman’s Magazine_, dated Wednesday the 11th January, and from a comparison of the dates of highest mortalities in London (p. 349) and Edinburgh. It was in Saxony from the 15th November to the 29th of that month, and in Holland before it broke out in England. But it had begun in New England in the middle of October, and had broken out soon after in Barbados, Jamaica, Mexico and Peru. Its outbreak in Paris was at the beginning of February, 1733, and at Naples in March. The symptoms, says Arbuthnot, were uniform in every place--small rigors, pains in the back, a thin defluxion occasioning sneezing, a cough with expectoration. In France the fever ended after several days in miliary eruptions, in Holland often in imposthumations of the throat. In some, the cough outlasted the fever six weeks or two months. The horses were seized with the catarrh before mankind[624]. The account of the influenza of 1733 in London in the _Gentleman’s Magazine_ is under the date of 11 January: “About this time coughs and colds began to grow so rife that scarce a family escaped them, which carried off a good many, both old and young. The distemper discovered itself by a shivering in the limbs, a pain in the head, and a difficulty of breathing. The remedies prescribed were various, but especially bleeding, drinking cold water, small broths, and such thin liquids as dilute the blood[625].” Huxham says that it was in Cornwall and the west of Devon in February, 1733, and that at Plymouth, on the 10th of that month, some were suddenly seized: “the day after they fell down in multitudes, and on the 18th or 20th of March, scarce anyone had escaped it.” It began with slight shivering, followed by transient erratic heats, headache, violent sneezing, flying pains in the back and chest, violent cough, a running of thin sharp mucus from the nose and mouth. A slight fever followed, with the pulse quick, but not hard or tense. The urine was thick and whitish, the sediment yellowish-white, seldom red. Several had racking pain in the head, many had singing in the ears and pain in the meatus auditorius, where sometimes an abscess formed: exulcerations and swelling of the fauces were likewise very common. The sick were in general much given to sweating, which, when it broke out of its own accord and was very plentiful, continuing without striking in again, did often in the space of two or three days carry off the fever. The disorder in other cases terminated with a discharge of bilious matter by stool, and sometimes by the breaking forth of fiery pimples. It was rarely fatal, and then mostly to infants and old worn out people. Generally it went off about the fourth day, leaving a troublesome cough often of long duration, “and such dejection of strength as one would hardly have suspected from the shortness of the time.” The cough in all was very vehement, hardly to be subdued by anodynes: and it was so protracted in some as to throw them into consumption, which carried them off within a month or two[626]. Huxham is unusually full on the coughs and anginas of horses for several months before the influenza of men. In August, 1732, coughs were troubling some horses; in September, a coughing angina (called “the strangles”) everywhere among horses which almost suffocates most of them; in October the disease of horses is raging at its worst; and in December it is still among them. The Influenza of 1737. After several years, unhealthy in other ways, the influenza came again in the autumn of 1737. In Devonshire, according to Huxham, the horses began to suffer from cough and angina, and some of them to die, as early as January, 1737, the epizootic being mentioned again in February, but not subsequently. The same observer says the influenza began at Plymouth in November and lasted to the end of December, 1737, seizing almost everyone, and proving much more severe than the epidemic catarrhal febricula of 1733[627]. In London it must have begun in the end of August, to judge by the characteristic rise in the weekly bills, and in the item of “fevers” more especially; and although the deaths kept high for a longer period than in 1733, yet no single week of 1737 had much more than half the highest weekly mortality of the preceding influenza season. _London Weekly Mortalities._ 1733 Week ending Fevers All causes January 16 69 531 23 83 783 30 243 1588 February 6 170 1166 13 110 628 20 66 591 1737 Week ending Fevers All causes August 30 117 611 September 6 161 720 13 201 837 20 229 861 27 167 770 October 4 143 687 11 114 551 In Dublin the worst week’s mortality in 1737, in the month of October, was 144, whereas in the influenza of 1733 the highest weekly bill had been only 98[628]. Hardly any particulars of the influenza of 1737 remain, although it appears to have been widely diffused, being recorded for Barbados and New England. The only source of English information is Huxham of Plymouth, who mentions some symptoms which should serve to characterize this outbreak, namely: violent swelling of the face, the parotids and maxillary glands, followed by an immense discharge of an exceedingly acrid pituita from the mouth and nose; toothache and, in some, hemicrania; “in multitudes,” wandering rheumatic pains; in others violent sciatics; in some griping of the bowels. Huxham makes one interesting statement: “This catarrhal fever has prevailed more or less for several winters past;” or, in other words, the interval between the severe influenza of 1733 and the milder influenza of 1737 was not altogether clear of the disease. He adds that it put on various forms, according to the different constitutions of those it attacked. The Influenza of 1743. Six years after, in 1743, came another influenza, which presents some interesting points. A writer in the _Gentleman’s Magazine_ for May, 1743, says that the epidemic began in September last in Saxony, that it progressed to Milan, Genoa, and Venice, and to Florence and Rome, where it was called the Influenza; in February last (1743) no fewer than 80,000 were sick of it [? in Rome] and 500 buried in one day. At Messina it was suspected to be the forerunner of a plague--which did, indeed, ensue. It is now (May) in Spain, depopulating whole villages. The outbreak in Italy is authenticated by many notices collected by Corradi, Brescia having had the epidemic in October, 1742, Milan and Venice in November, Bologna in December, Rome, Pisa, Leghorn, Florence and Genoa in January, 1743, Naples and the Sicilian towns in February. The English troops, in cantonments near Brussels, were little touched by it when it reached that capital about the end of February, but, strangely enough, “many who in the preceding autumn had been seized with intermittents then relapsed[629].” In London the epidemic appears to have begun in the end of March, and had trebled the deaths in the week ending 12th April; by the beginning of May it was practically over. _London Weekly Mortalities._ 1743 Week ending Fevers All causes March 29 94 579 April 5 189 1013 12 300 1448 19 223 1026 26 115 629 May 3 82 537 The familiar view of the influenza in London is given in a letter by Horace Walpole from Arlington Street, 25 March, 1743[630]: “We have had loads of sunshine all the winter: and within these ten days nothing but snows, north-east winds and _blue plagues_. The last ships have brought over all your epidemic distempers; not a family in London has scaped under five or six ill; many people have been forced to hire new labourers. Guernier, the apothecary, took two new apprentices, and yet could not drug all his patients. It is a cold and fever. I had one of the worst, and was blooded on Saturday and Sunday, but it is quite gone; my father was blooded last night; his is but slight. The physicians say there has been nothing like it since the year thirty-three, and then not so bad [the bill of mortality almost the same]; in short our army abroad would shudder to see what streams of blood have been let out! Nobody has died of it [as yet, but later some 1000 in a week above the usual bill] but old Mr Eyres of Chelsea, through obstinacy of not bleeding; and his ancient Grace of York; Wilcox of Rochester succeeds him, who is fit for nothing in the world but to die of this cold too.” The account in the _Gentleman’s Magazine_ confirms the vast shedding of blood: “In the last two months it visited almost every family in the city; so that the surgeons and all the phlebotomists had full employment. Bleeding, sweating and blistering were the remedies usually prescribed. All over the island it cut off old people. At Greenwich upwards of twenty hospital men and boys were buried in a night[631].” In Edinburgh, as in London, the weekly burials were trebled. On Sunday, May 6th, fifty sick persons were prayed for in the Edinburgh churches, and in the preceding week there had been seventy burials in the Greyfriars, being three times the usual number[632]. It reached Dublin in May, proving milder and less fatal than in London (perhaps that is why the writer in the _Gentleman’s Magazine_ says it did not visit Ireland at all); it visited, also, the remote parts of Ulster and Munster, scarce sparing a family[633]. It had reached Plymouth in the end of April. Huxham, who is again the chief witness to its symptoms, says that it was much less severe there than in the south of Europe or even than in London. Innumerable persons were seized at once with a wandering kind of shiver and heaviness in the head; presently also came on a pain therein, as well as in the joints and back; several, however, were troubled with a universal lassitude. Immediately there ensued a very great and acrid defluxion from the eyes, nostrils and fauces, and very often falling upon the lungs, which occasioned almost perpetual sneezings, and commonly a violent cough. The tongue looked as if rubbed with cream. The eyes were slightly inflamed; and, being violently painful in the bottom of the orbit, shunned the light. The greater part of the sick had easy, equal and kindly sweats the second or third day, which, with the large spitting, gave relief. Great loss of strength, however, remained. Frequently towards the end of this “feveret,” several red angry pustules broke out: often, likewise, a sudden, nay a profuse, diarrhoea with violent griping. In many cases Huxham was astonished at the vast sediment (yellowish white), which the urine threw down, “than which there could not be a more favourable symptom[634].” One remarkable feature of the epidemic of 1743 was recalled by W. Watson in a letter to Huxham on the epidemic of 1762: “In the disorder of 1743 the skin was very frequently inflamed when the fever ran high; and it afterwards peeled off in most parts of the body[635].” Some Localized Influenzas and Horse-colds. For the space of nineteen years, from 1743 to 1762, there occurred no universal cold common to all the countries of Europe; the convergence of positive testimony, which is so remarkable on many occasions from the 16th century onwards, is found on no occasion during that interval. And yet the period is not wanting in instructive notices of epidemic catarrh, which I shall take from English writings only. British troops occupied Minorca during some of those years, and the epidemics of the island were carefully noted by Cleghorn. Under the year 1748 he writes: “About the 20th April there appeared suddenly a catarrhal fever, which for three weeks raged so universally that almost everybody in the island was seized with it. This disease exactly resembled that which was so epidemical in the year 1733. For in most part of the sick the feverish symptoms went off with a plentiful sweat in two or three days; while the cough and expectoration continued sometime longer. In a few athletic persons, who were not blooded in time, it terminated in a fatal pleurisy or phrensy[636].” Another English epidemiographist, Hillary, who had begun his records at Ripon, was in those years resident in Barbados; and in that island, as in Minorca, we hear of unmistakeable universal colds, although none of them at the same time as the one recorded by Cleghorn. The Barbados annalist records a general catarrhous fever in September, 1752[637], and a recurrence of the same in the end of December, lasting until February 1753 (catarrh and coryza, cough, hoarseness, a great defluxion of rheum, some having fever with it). As it ceased in February, 1753, a slow nervous fever began, and continued epidemic for eighteen months, until September, 1784, when it totally disappeared, and was not seen again so long as Hillary remained in the island (1758). In 1755 there was another epidemic catarrhal fever, first in February and again in the end of the year. In the earlier outbreak, few escaped having more or less of it, the symptoms being cold ague for a few hours, followed by a hot fever with great pain in the head, or pains in the back and all over the body, which lasted two or three days, or longer, and then went off in some by a critical sweat. In the October outbreak it affected children mostly. Once more, in 1757, the same catarrhous fever returned, with almost the same circumstances[638]. That year there was a universal catarrh in North America. Not less remarkable than the epidemic catarrhal fever in Minorca in 1748, or those in Barbados in 1752-3, 1755 and 1757, was the epidemic of 1758 in Scotland[639]. It was first noticed with east winds from the 16th to 20th September, several children having taken fever like a cold. In the last week of September thirty out of sixty boys at the Grammar School of Dalkeith were seized with it in two or three days. In October it became more general, among old and young, and increased till about the 24th, when it began to abate. In Edinburgh not one in six or seven escaped. It was in most parts of Scotland in October--Kirkaldy, St Andrews, Perthshire (where many died of it), Ayrshire, Glasgow, Aberdeenshire, Rossshire (end of October). A gentleman told Dr Whytt that in the Carse of Gowrie, in September, “before this disease was perceived, the horses were observed to be more than usually affected with a cold and a cough.” The symptoms in Scotland were of the Protean kind of “influenza”: there might be fever with no cold; or a coryzal attack with little or no fever; or some had bleeding at the nose for several days, which might be profuse; or the soreness and pains in the bones might be in all parts of the body, or confined to the cheekbones, teeth and sides of the head. Others had a fever without any distinctive concomitant, but a cough when the fever subsided[640]. One of Whytt’s patients, a lady aged thirty, had been feverish for four days, when a scarlet rash appeared, but did not come fully out; the fall of the pulse and fever coincided with the beginning of a troublesome tickling cough, “so that the cough might be said to have been truly critical.” Those who exposed themselves too soon frequently relapsed. Few died of the disease, except some old people. “In some parts of the country, when the disease was not taken care of in the beginning, as being attended with no alarming symptoms, it assumed the form of a slow fever, which sometimes proved mortal.” The year after the localised influenza of Scotland there was an epidemic of the same kind in Peru and Bolivia, that year, 1759, being one in which no universal fever or catarrh is reported from any other country. It extended from south to north, along the coast as well as over the high table-lands of Bolivia and the sierra region of Peru, invading, among others, the populous towns of Chuquisaca, Potosi, La Paz, Cuzco and Lima. In five or six days hardly one inhabitant of a place had escaped it, although some had it very slightly. As it was swift in its attack, so it was soon over, lasting about a month in each place. Its symptoms were great dizziness and heaviness of the head (vertigo and gravedo), feebleness of all the senses, deafness, strong pains over all the body, moderate fever, weariness, great prostration, complete loss of appetite, bleeding from the mouth and nostrils (this had been noted in Scotland the year before), and a long convalescence. Dogs shared the disorder, and might have been seen lying stretched out in the streets, unable to stand. It will be observed that the symptoms given do not include catarrh[641]. Before we come to the next general influenza in Britain, that of 1762, there are some facts to be mentioned as to agues and horse-colds in the interval since 1743. In Rutty’s Dublin chronology, agues are entered as prevalent in 1745. In 1750, about the middle or end of December, the most epidemic and universally spreading disease among horses that anyone living remembered made its appearance in Dublin, and in Ulster and Munster almost as soon. It had been in England in November, and was like that which preceded the universal catarrhs of mankind in 1737 and 1743. In 1751, irregular agues were frequent in March, as were also tumours of the face, jaws and throat. Agues also continued to be frequent in April, both in Dublin and in several parts of the country. In December, 1751, and January, 1752, there was another horse-cold, the same as a twelvemonth before. In 1754 the spring agues were frequent in Kilkenny and Carlow, though rare in Dublin. In 1757, “intermittent fevers, which had not appeared since April, 1746,” came in the end of February. In 1760, a great catarrh among horses became general in Dublin in April. Coughs and tumours about the fauces and throat, with a slight fever, often occurred in March; and regular intermittents, tertians or quotidians, were more frequent than for some years past. These, according to Sims, of Tyrone, abated after 1762, so that he had not seen an intermittent since 1764 until the date of his writing, 1773. The horse-cold of 1760 was observed in London in January. The _Annual Register_ says under date 27 Jan.: “A distemper which rages amongst horses makes great havock in and about town. Near a hundred died in one week.” In a letter a day later (28 Jan.) Horace Walpole writes: “All the horses in town are laid up with sore throats and colds, and are so hoarse you cannot hear them speak.... I have had a nervous fever these six or seven weeks every night, and have taken bark enough to have made a rind for Daphne[642].” This same horse-cold is reported from the Cleveland district of Yorkshire: “In February, [1760] horses were invaded by the most epidemic cold or catarrh that has ever happened in the remembrance of the oldest men living[643].” The same authority for Cleveland says that intermittents were frequent and obstinate in the spring of 1760. Among these miscellanies of the history may be mentioned an outbreak of “violent pleuritic fever or peripneumene” in the spring of 1747, which was fatal to a comparatively large number in the parish of George Ham, North Devon. Thirteen died of it from the 20th to the 31st March, four in April, four in May, and one in June, “most of them in four or five days after the first seizure.” The same family names recur in the list[644]. The Influenza of 1762. The universal slight fever or catarrhal fever of 1762 was, in London, much less mortal than those of 1733 and 1743. _London Weekly Mortalities._ 1762 Week ending Fevers All causes May 4 72 467 11 104 626 18 159 750 25 162 659 June 1 121 516 8 85 504 It began in London about the 4th of April, and by the 24th of that month “pervaded the whole city far and wide, scarcely sparing anyone.” It was in Edinburgh by the beginning of May, and in Dublin about the same time, but did not reach some parts of Cumberland until the end of June. Short, who was then living at Rotherham, says that it “continued most of the summer[645].” It had the usual variety of symptoms in the individual cases, of which only a few need be again particularized. Where the fever was sharp, it usually remitted during the day, having its exacerbation in the night. Sometimes it proved periodical, and of the tertian type: “it usually returned every night with an aggravation of the feverish symptoms” (Rutty). Perspiration was a constant symptom; the tongue was as if covered with cream (Baker repeats this figure of Huxham’s in 1743). “Depression of mind and failure of strength were in all cases much greater than was proportionate to the amount of disease. A great number of those affected were very slowly restored to health, languishing for months, and some even for a whole year with cough and feverishness--relics of the disease which it was difficult to shake off. Some, after struggling long with impaired health, fell victims to pulmonary consumption. In some there were pains in all the joints and in the head, with lassitude and vehement fever, but with little signs of catarrh.” Rutty, of Dublin, says that in some a measly efflorescence or a red rash was seen, attended by violent itching[646]. Among labourers in the country, the pestilence was so violent as to destroy many within four days, from complications of pneumonia, pleurisy and angina. Sometimes it took the form of a slow fever, “and approximated to that form of malady which the ancients denominated ‘cardiac’[647].” The mortality is said to have varied much. White, of Manchester, declared that fewer died there than in ordinary while the epidemic lasted. On the other hand Offley, of Norwich, said there were more victims there than by the epidemic of 1733 “or by the more severe visitation called influenza in 1743”--the two visitations which were incomparably the worst in the whole history, according to the London bills. Baker says that it infested cities and the larger towns crowded with inhabitants earlier than the surrounding villages, and is inclined to think that it was mostly brought by persons coming from London[648]. The progress of this epidemic over Europe had been peculiar. It was seen in the end of February, 1762, at Breslau, where the deaths rose from 30 or 40 in a week to 150. It was in Vienna at the end of March, and in North Germany about the same time as in England--April and May. There were at that time British troops in Bremen, among whom the epidemic appeared shortly after the 10th April[649]. “It looked at first as if they were going to have agues, but soon they were attacked with a cough and a difficulty of breathing and pain of the breast, with a headache, and pains all over the body, especially in the limbs. The first nights they commonly had profuse sweats. In several it had the appearance of a remitting fever for the two or three first days.” The cough in many was convulsive. The epidemic seized most of the people in the town of Bremen: very few of the British escaped, but none of them died, except one or two, from a complication of drunkenness and pneumonia. It is said to have been nowhere in France except in Strasburg and the rest of Alsace, in June. Baker says, “Whilst it raged everywhere else, it did not reach Paris or its vicinity, a fact which I learned from trustworthy persons.” On board British ships of war in the Mediterranean it occurred in July. Its severity appears to have varied greatly in different cities of the same country. Rutty, for Ireland, agrees with Baker, for England, that it was more fatal in the country than in the towns. The Influenza of 1767. The next influenza, that of 1767, was so unimportant that its existence in England would hardly have been known but for Dr Heberden’s paper, “The Epidemical Cold in June and July 1767[650].” Those few who were affected by a cold in London early in June observed that it differed from a common cold, and resembled the epidemical cold of the year 1762, on account of the great languor, feverishness, and loss of appetite. It became more common, was at its height in the last week of June or beginning of July, and before the end of July had entirely ceased. It was less epidemical and far less dangerous than the cold of 1762, so much so that the London bills of mortality hardly witness at all to its existence. The attack began with several chills; then came a troublesome and almost unceasing cough, very acute pains in the head, back, and abdomen under the left ribs, occasioning want of sleep. Many of the symptoms hung upon several for at least a week, and sometimes lasted a month. The fever might be great enough to bring on deliriousness, yet had plain remissions and intermissions. The same disorder was reported to be common about the same time in many other parts of England, and more fatal than it was in London. Heberden did not anticipate from it the lingering effects in the individual, for months or years, which marked so many of the cases in 1762[651]. The Influenza of 1775. Heberden invited physicians in the provinces to send in accounts of the epidemic of June and July, 1767, but no one seems to have responded. However, the next epidemic catarrh, of November and December, 1775, was made the subject of many communications from all parts of Britain, in response to a circular drawn up by Dr John Fothergill. This was a distinctly catarrhal epidemic, running of the nose and eyes, cough and (or) diarrhoea, being commonly noted. At Northampton some had “a severe pain in one side of the face, affecting the teeth and ears, and returning periodically at certain hours in the evening, or about midnight, attended with vertigo, delirium and limpid urine during the exacerbation. Some whose cases were complicated with the above symptoms had a general rash, but without its proving critical.... Many of those who escaped the catarrh have been more or less sensible of giddiness, or pains in the head or face,” with limpid urine, etc., as if they had a full attack[652]. The epidemic began in London about the 20th October, and made a slight impression upon the bills of mortality in some weeks of November and December[653]. Grant says that it lasted nearly five months in London, having been attended by the same “comatose” fever which Sydenham associated with the epidemic catarrh of 1675. The fatalities in Grant’s practice occurred late in the epidemic: “On the 23rd December [1775] I had lost one patient, and soon after two others; all died comatous, owing, as I then imagined, to the remains of the comatose fever of Sydenham, which had raged all the autumn, was complicated with the catarrhous fever, and continued by the wet, warm uncommon weather for the season of the year; and I still [1782] am of opinion that this complication is the reason why the epidemic catarrh of 1775 proved much more fatal than it did in 1782--a fact known to all of us[654].” A Liverpool writer also says that the catarrh of 1782 “distinguished by the same title,” was a much slighter complaint than the “influenza” of