Chapter III · (continued 2)

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.

Year Registers examined Registers showing high death-rate Births in ditto Deaths in ditto

1727 180 55 1091 1368

1728 180 80 1536 2429

1729 178 62 1442 2015

1730 176 39 1022 1302

Market Towns.

Year Registers examined Registers showing high death-rate Births in ditto Deaths 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 1775. The latter, however, was a summer epidemic, and was naturally less complicated with pneumonia and bronchitis, whatever the “comatose” fever of 1775 may have been. Grant’s statement that the influenza of 1775 lasted five months in London is borne out by the Foundling Hospital records: on 11 November, there were 16 in the Infirmary with “epidemic fever and cough,” next week 22 with “fevers, coughs and colds,” and so on week by week under the same names until the 9th of March, 1776[655]. At Dorchester it was general after 10th November; about the same time it was in Exeter, where within a week it seized all the inmates, but two children, in the Devon and Exeter Hospital, to the number of 173 persons. The middle of November is also the date of its decided outbreak at Birmingham, at Worcester, and at Chester, where Howard found the prisoners suffering from it. At York in the north, as at Blandford in the south, it is claimed to have begun earlier than in London. At Lancaster it was not seen until three weeks after the accounts of its prevalence in London began to come in, but only three days after it was first heard of in Liverpool. At Aberdeen it was fully a month later than in London. It did not visit Fraserburgh, though there was a putrid fever there very fatal at that time[656].

In many cases the disease assumed the type of an intermittent towards its decline, but bark was not useful (Fothergill, Ash, while Baker says that bark did good when the fever was spent). All the observers agree both as to its slight fatality and its universality. At Chester it attacked 73 out of 97 affluent persons, neighbours in the Abbey Square; at the Cross, inhabited by people in trade, 109 had the disease out of 144; in the House of Industry, not one escaped out of 175; it attacked people in the country rather later than in the town, and less generally, but it was in villages and even in solitary houses.

The unusual prevalence of catarrh among horses (and dogs) is asserted by John Fothergill (“during this time”), Cuming (“after the middle of August very generally in Yorkshire”), Glass (in September), Haygarth (in North Wales, about August and September), Pulteney (“before we heard of it among the human race”). The fullest statement is by Dr Anthony Fothergill, of Northampton:

“This distemper prevailed some time among horses before it attacked the human species. The cough harassed them severely and rendered them unfit for work, though few died. About the same time also it infested the canine species and with great fatality, especially hounds. An experienced huntsman informed me that it ran through whole packs in many parts of England and that several dogs died[657].”

The progress of influenza from other countries towards Britain was so much a matter of rumour or vague statement in the earlier periods that it has not seemed worth while to make a point of it under each epidemic. It happens, however, that there is good evidence of the line of progress of the epidemic of 1775. The afterwards celebrated Professor Gregory, of Edinburgh, encountered it in Italy in the autumn, and followed it all the way home to Scotland. He saw it successively in Genoa, in the south of France, in the north of France, in London, and last of all in Edinburgh, where he himself at length fell ill with it, several of his travelling companions having taken it in Italy two or three months before. In his lectures long after (as reported by Christison, who heard them about 1817) he traced the influenza of 1775 from south to north: “It appears to have broken out somewhere on the north and west coast of Africa, whence it spread not only north into Europe, but likewise eastward to Arabia, Egypt, Syria, Palestine, Asia Minor, Hindostan, China, and was ascertained to have spread over the whole immense empire of the Chinese. From China it returned westward by a northern route through the extensive dominions of Russia and from that country it was sent again over Europe in 1782[658].”

The Influenza of 1782.

Seven years after, in the early summer of 1782, there came another swift and brief wave of catarrhal fevers over England, Scotland and Ireland, in the midst of a great “constitution” of epidemic agues which continued for several years. This was the occasion when the Italian name of “influenza” was formally adopted by the College of Physicians. Perhaps the first appearance of the name in English was in an account of the epidemic in Italy in 1729, given by a London periodical devoted to political news from foreign countries, and called, “The Political State of Great Britain[659].” In 1743 the news of the Italian epidemic under its native name reached London before the infection itself, the Italian name being frequently given to it while it lasted that season in England. When the next epidemic came, in 1762, it was not called the influenza as a matter of course, but was compared to the disease in 1743 “called the influenza.” In the epidemic of 1775, “influenza” came more into use, and in 1782 it was the name usually given to the epidemic malady. The adoption of this name put an end at length to the ambiguity between epidemic agues and influenzas, leaving the curious correspondences between them in time and place, or the nosological affinities between them, as interesting as ever.

As late as the very fatal aguish years 1727-29, there was no clear separation of the epidemic agues from the influenzas, of which latter there were two or more, the one in the end of 1729 being easy to identify. In the great aguish constitution of 1678-81, Sydenham distinguished the epidemic coughs and catarrhs in Nov. 1679; but Morley made no such distinction, describing the whole series of agues for two seasons (and he might have done so for two seasons more) as the “new fever,” “new ague,” or “new delight,” as in Derbyshire, without a suspicion that the universal coughs, catarrhs and fevers in November, 1679, were something nosologically distinct, which the future would identify as “influenza.” In like manner Whitmore, in the great aguish period immediately preceding, that of 1658-59, had described the “new disease” as one single Proteus. In the still earlier epidemic seasons of 1557-58 and 1580-82, everything was “ague,” although we now discover influenza mixed therewith. I do not say that this inclusive naming was the better scientifically; nor do I uphold Willis and Sydenham in their teaching that the intermittent constitution passed into the catarrhal, in 1658 and 1679 respectively. But it is necessary to bear in mind the matter of fact, namely, that those agues, amidst which the “great colds” occurred, were epidemic agues, and not the endemic fevers of malarious places; and I have now to show that the “influenza” of 1782 was in like manner a brief episode in the midst of several successive seasons of agues, which were as much “new” or “strange” as any of those in the earlier history. Whether the epidemic agues of 1780-85 were the last of the kind in Britain had better be left an open question until our most recent and most strange experiences in 1890-93 are read in the light of history.

The influenza of 1782 was a very definite incident of a few weeks—teres atque rotundus. It is easily discoverable in the weekly bills of mortality in London to have fallen in the month of June:

London Weekly Mortalities.

1782

Week ending Fevers All causes

May 21 45 336

28 49 390

June 4 57 385

11 121 560

18 110 473

25 89 434

July 2 49 296

The sudden rise and fall of the deaths and the height reached are much the same as in other such epidemics in the summer—the “gentle correction” of 1580, the “transient slight fever” of 1688, and the epidemic catarrh of 1762. On the other hand the epidemics of autumn, winter or spring in 1729, 1733, 1737 and 1743 were far more severe, while the winter epidemics of 1675 and 1679 had figures almost the same as the summer epidemics.

The influenza of 1782 was not remarkable, whether in its fatality or in its characters; but it received far more attention than any that had preceded it. Two collective inquiries were held upon it, one by a Society for promoting Medical Knowledge[660], the other by a committee of the College of Physicians of London[661], many physicians all over England, Scotland and Ireland contributing to one or other. There were also three or more separate essays[662].

The epidemic appeared in 1782 at Newcastle in the end of April, and raged there all May and part of June. In London it appeared between the 12th and 18th of May, in the Eastern Counties about the middle of May, in Surrey and at Portsmouth, Oxford and Edinburgh, also about the third week of May, but not in Musselburgh until the 9th or 10th of June. It was at Chester on the 26th of May, at Plymouth on the 30th, at Ipswich, Yarmouth, York, Liverpool and Glasgow in the first week of June. In Northumberland it was raging in July, and did not cease until the third week of August. In Scotland it was at a height in July, during the haymaking[663]. The most curious fact in its incidence comes from North Devon; it was prevalent in Barnstaple at the usual time, the month of June; but the neighbouring town of Torrington was not then affected by it, having previously gone through the epidemic, it is said, from a date as early as the 24th of March[664]. In all places it spread quickly, affecting from three-fourths to four-fifths of the adult inhabitants, but children not so much. At Christ’s Hospital, London, only fourteen out of seven hundred boys had it. Wherever it attacked children, it did so mildly. It lasted under six weeks in each place that it came to. There were some strange attacks of it in London in September, “two months after the late epidemical catarrh had entirely disappeared from England.” The king’s ships ‘Convert’ and ‘Lizard’ arrived in the Thames from the West Indies in September. Their crews were perfectly healthy till they reached Gravesend, where they took on board three custom-house officers; and in a very few hours after that the influenza began to make its appearance. Hardly a man in either ship escaped it; and many both of the officers and common seamen had it in a severe degree[665]. Others who came to London from the West Indies in merchantmen in the end of September were attacked by influenza in their lodgings in the beginning of October[666]. To this epidemic belong also the strange experiences of the Channel Fleet in its two divisions under Howe and Kempenfelt; but I postpone for the present the whole question of influenza at sea.

Gray thus sums up the great variety of symptoms as related by his numerous correspondents:

Chilliness and shivering, sometimes succeeded by a hot fit, the alternation continuing for some hours; languor and lassitude, sneezing, discharge from the nose and eyes, pain in the head (particularly between or over the eyes), cough, sometimes dry, sometimes accompanied with expectoration, inflammation in one or both eyes, oppression and tightness about the praecordia, difficulty of breathing, pain in the breast or side, pain in the loins, neck, shoulders or limbs, sense of heat or soreness in the throat and trachea, hoarseness, bleeding from the nose, spitting of blood and loss of smell and taste, nausea, flatulence. Also watery blisters about the upper parts of the body, and swellings in the face and other parts, attended with considerable soreness, apparently erysipelatous. In some the catarrhal symptoms were very slight, or entirely wanting, the disorder in those cases being like a common fever.

The committee of the College of Physicians said that “the universal and almost pathognomonic symptom was a distressing pain and sense of constriction in the forehead, temples, and sometimes in the whole face, accompanied with a sense of soreness about the cheek-bones under the muscles,” reminding one of the fierro chuto or “iron cap” of the South American epidemic in 1719. Sometimes no catarrhous affection followed these strange head pains. The languor of body and depression of spirits were thought to be more protracted than in 1762, but the fatalities at the time were fewer than in the earlier epidemic, and there were fewer consumptions following. Sweating, also, was said by some to be less remarkable than in 1762; but Carmichael Smyth said: “The late influenza [1782] might very properly have been named the sweating sickness, as sweating was the natural and spontaneous solution of it[667].” One distinctive thing in the epidemic of 1762 was missed by most in 1782, namely, the peculiar constriction of the breast, with heat and soreness of the trachea, as if excoriated; but Hamilton describes that very thing for 1782 in Bedfordshire[668]. As in other epidemics of the kind, especially those which have been least catarrhal, there were hardly two cases quite the same.

The Epidemic Agues of 1780-85.

Let us now take up the strange history of epidemic agues for two or three years preceding and following the influenza of June, 1782. Sir George Baker begins his account of them thus[669]: “The predominance of certain diseases observable in some years, and the total or partial disappearance of the same in other years, constitute a subject worthy of our contemplation.”

These agues were first noticed in London in the spring and autumn of 1780, but they infested various parts of England a little earlier. In the more inland counties the agues were “often attended with peculiarities extraordinary and alarming. For the cold fit was accompanied by spasm and stiffness of the whole body, the jaws being fixed, the eyes staring and the pulse very small and weak.” When the hot fit came on the spasms abated, and ceased in the sweating stage; but sometimes the spasm was accompanied by delirium, both lasting to the very end of the paroxysm. Even in the intermissions a convulsive twitching of the extremities continued to such a degree that it was not possible to distinguish the motion of the artery at the wrist. “This fever had every kind of variety, and whether at its first accession it were a quotidian, a tertian or a quartan, it was very apt to change from one type to another. Sometimes it returned two days successively, and missed the third day; and sometimes it became continual. I am not informed that any died of this fever whilst it intermitted. It is, however, certain that many country people whose illness had at its beginning put on the appearance of intermission, becoming delirious, sank under it in four or five days.”

Reynolds, another London physician, in a letter to Sir George Baker confirms all that the latter says of these singular epidemic agues: “No two cases resembled each other except in very few circumstances[670]”—the remark commonly made about the influenza itself. If these descriptions of the epidemic ague had not been given by physicians living as late as 1782, and altogether modern in their methods, we might have supposed that they were confusing influenzas with agues, or using the latter term inexactly. “The ague with a hundred names” is the striking phrase of Abraham Holland, in his poem on the plague of 1625. Whitmore, describing the fatal epidemic ague (with an episode of influenza) in 1658-59, does not say that it had a hundred names, but that it assumed a hundred shapes, “which render it such a hocus-pocus to the amazed and perplexed people, they being held after most strange and diverse ways with it.... So prodigious in its alterations that it seems to outvie even Proteus himself[671].”

As farther showing the anomalous character of these epidemic agues, or their difference from the endemic, Baker adds:—

“It is a remarkable fact, and well attested, that in many places, whilst the inhabitants of the high grounds were harassed by this fever, in its worst form, those of the subjacent valleys were not affected by it. The people of Boston and of the neighbouring villages in the midst of the Fens were in general healthy at a time when fever was epidemic in the more elevated situations of Lincolnshire.” Women were nearly exempt, but few male labourers in the fields escaped it.

Baker heard from all parts that the same constitution continued through 1781 and 1782; and that since that time, though it seemingly abated, yet agues had been much more prevalent than usual, and had even been frequent in places where before that period they were uncommon. They were very noticeable in London from 1781 to 1785, not least so during the very severe cold of the winter and spring of 1783-84. We hear of great numbers attacked at Hampstead with common intermittents in February and the following months of 1781, during which time even the measles, in the greater number of cases, “ended in very troublesome intermittents[672]”—just as they were apt to end often in troublesome coughs.

The annals of Barker, of Coleshill, are full of references to agues, among other fevers, from 1780 onwards. Under 1781 he writes:—

“This spring that very peculiar, irregular, dangerous and obstinate disease, the burning, or as the people in Kent properly enough called it, the Plague-ague, made its appearance, became very epidemical in the eastern part of the kingdom, and raged in Leicestershire, the lower part of Northamptonshire, Bedfordshire, and in the fens throughout the year.... This strongly pestilential disease had such an effect upon them that the complexion of their faces continued for a time as white as paper, and they went abroad more like walking corpses than living subjects.”

As many as five persons in an evening were buried from it in some large towns in Northamptonshire; and about Boston it was so general and grievous that out of forty labourers hired for work in harvest, half of them, it was said, would be laid up in three days[673]. In 1783 the “pestilential agues” were as bad in Northamptonshire and eastern parts as the year before. A Liverpool writer says:

“In the autumn of 1782 the quartan ague was very prevalent on the opposite shore of the river in Cheshire: it was universal in the neighbourhood of Hoylake, where many died of it. Yet it was scarcely heard of in Liverpool, although from the uncommon wetness of the season it prevailed throughout the kingdom[674].”

On October 25, 1783, a correspondent of the Gentleman’s Magazine offered an explanation of the “present epidemic disorder, which has so long ravaged this country, and that in the most healthy situations of it,” namely, “the putrescent air caused by the number of enclosures, and the many inland cuts made for navigation[675].” Next year, 1784, appears to have been the principal season of epidemic agues on both sides of the Severn valley, one practitioner at Bridgenorth making them the subject of a special essay[676].

It was at this time that Fowler brought into use his solution of arsenic as a substitute for bark in agues, the latter having notably failed in the epidemics since 1780.

Baker says: “The distinguishing character of this fever was its obstinate resistance to the Peruvian bark; nor, indeed, was the prevalence of the disease more observable than the inefficacy of the remedy:” in that respect the epidemic agues had belied the experience with bark in ordinary agues. Again, it is singular that bark had failed most, and arsenic been especially useful in those parts of England where ordinary malarious agues were never seen. One practitioner in Dorset laid in a large stock of arsenic, wherewith he “hardly ever failed to stop the fits soon[677].” Another, at Painswick, in Gloucestershire, used it successfully in two hundred cases of epidemic agues from 1784 onwards. He gives the following account of these unusual agues at Painswick:

“This town, which is situated on the side of a hill, and is remarkable for the purity of its air, is very populous. In the year 1784 the epidemic ague, that prevailed in many parts of the kingdom, made its appearance in this place, and has continued till the present time [Nov. 1787], although previously to that period the disease was hardly ever seen here, unless a stranger came with it for the recovery of his health, on account of the healthy situation of the place. It affected whole families, and appeared to be most violent in spring and autumn. In the summer of 1786 it was followed by a fever of the kind called typhus, or low nervous fever, which not unfrequently degenerated into a putrid fever and proved very fatal[678].” In May, 1785, at a general inoculation of smallpox, “many had been afflicted with intermittents of several months’ duration attended with anasarcous swellings[679].”

It will be seen from the following table of cases treated at the Newcastle Dispensary, under the direction of Dr John Clark, during twelve years from 1 October, 1777, to 1 September, 1789, that influenza makes the smallest show among them, being far surpassed by the intermittent fevers and dysenteries, while all three together are greatly exceeded by the perennial typhus fever:

Cases treated

Putrid fever 1920

Intermitting fever 313

Epidemic dysentery in 1783 and 1785 329

Influenza of 1782 53

In Scotland, also, agues became epidemic about the year 1780. There is no reason to suppose that their prevalence in these years was less exceptional there than in England and Ireland. It will be seen, indeed, from the following table compiled from the books of the Kelso Dispensary that the only years of their considerable prevalence were the same as the years of epidemic ague in England.

Kelso Dispensary[680].

Year All Cases Cases of Ague

1777 302 17

1778 306 33

1779 460 70

1780 675 161

1781 510 103

1782 440 61

1783 510 73

1784 459 40

1785 573 62

1786 563 48

1787 525 24

1788 577 25

1789 546 48

1790 640 18

1791 715 13

1792 570 16

1793 666 19

1794 447 9

1795 513 23

1796 355 12

1797 318 9

1798 415 7

1799 558 2

1800 665 4

1801 433 9

1802 377 5

1803 308 2

1804 422 5

1805 469 0

1806 318 1

It was doubtless the recollection of these epidemic agues that led the parish ministers who wrote in the ‘Statistical Account of Scotland’ from 1791 to 1799 to remark upon a supposed progressive decline of endemic ague, which they set down to drainage of the land[681]. It is probable, however, that each tradition of ague in Scotland dated from one of its epidemic periods; it has been shown, indeed, in the foregoing that Scotland in the end of the 17th century was reputed tolerably free from ague, and that the severe agues previous to 1728, which belonged to the epidemical kind, were thought to be something new.

The Influenza of 1788.

According to Barker, of Coleshill, who kept systematic notes of the epidemic maladies from year to year, there were several recurrences of the influenza of 1782[682]. But there is only one of these seasons, the summer of 1788, that other English writers have singled out as a time of influenza. It was undoubtedly of a very mild type, producing hardly any effect upon the bills of mortality; but it attracted the notice of several. Dr Simmons, the editor of the London Medical Journal, became the recorder of it, collecting reports from various parts, as others had done in 1782. He himself treated 160 cases at the Westminster General Dispensary, and 65 more elsewhere. It was most prevalent in London from the second to the fourth week of July, but the mortalities for those weeks show no abrupt rise. It was at Chatham, Dover, Plymouth and Bath about the same time, at Manchester in the beginning of August, in Cornwall in the middle of August, and at Montrose about the end of August, or perhaps most certainly in October. On 5 August, a physician at York wrote: “We have not had the slightest appearance of a catarrh in our city or neighbourhood during the year.” The epidemic was undoubtedly a partial one in Britain, and so slight as to have made little impression where it did occur. It is said to have been very general at Warsaw in April or May, at Vienna in April (20,000 cases before the 20th), at Munich in June, at Paris in the end of August and still continuing on the 24th October, at Geneva on the 10th October. Its most constant symptom in England was pain in the fore-part of the head, with vertigo; next most constant was a pain at the pit of the stomach and along the breast-bone; cough was wanting in perhaps a third of the cases and was always slight, diarrhoea was somewhat general, running from the eyes exceptional, sore-throat in perhaps one-sixth of the cases[683]. At Plymouth where it was seen earliest and clearest among the regiment of artillery and in the guardships, the symptoms were pain in the head and limbs, soreness of the throat, pain in the breast, a feeling of coldness all over the skin, and these followed by cough, a great discharge from the nose and eyes, and slight nausea. It was much less noticeable among the townspeople than among the troops and sailors[684]. It occurred chiefly among soldiers or sailors also at Dover and Chatham. At Bath it was marked by chills, headache, swelling of the throat, difficult swallowing, quick pulse, hot, dry skin (but not pungent as in malignant fever), ending in a sweat; no delirium, but broken sleep or vigil; the eyes scarcely affected, cough in some, but not vehement; in some, sublingual swellings which suppurated[685]. At Manchester it looked as if it had been brought in by travellers who had acquired it in London[686].

At Portsmouth a singular thing happened two or three months after the epidemic had passed. The frigate ‘Rose’ arrived on 4 November from Newfoundland; within a short time all the dogs on board were seized with cough and catarrh, and soon after the whole ship’s company were affected in the same way[687]. Simmons says of the epidemic of 1788 in general: “During the progress of the influenza, a complaint which was evidently an inflammatory affection of the mucous membrane of the fauces, etc. was frequently observed among horses and other cattle, and was generally as violent among them as it was mild among their rational neighbours”—many dying after four or six days.

The very slight and partial influenza of July and August, 1788, happened at a time when there was much fever of a more serious kind in the country. The history of the latter belongs to another chapter; but there was in Cornwall, in the same season as the influenza, an epidemic fever which might in former times have been described as a part, and the most fatal part, of the “new disease,” and may be taken in this context rather than in the chapter on typhus. The same physician, Dr William May, of Truro, gave an account of the influenza first[688] and of the other fever afterwards[689].

The latter began at Truro in the end of April, 1788, and was also at St Ives and other small towns in various parts of the county. A malignant fever had for near two years before been exceedingly rife among the poor (owing to distress from loss of pilchard fishing), and had carried off a great number of them; but this was something new. Yet it was “truly a fever of the typhus type,” one of its symptoms being constant wakefulness. It passed through whole families, affecting all ages and constitutions. It ended on the 17th day, whereas the influenza (says May in his other paper) ended with a sweat on the fourth or fifth day. In one small neighbourhood this epidemic fever affected chiefly the aged, who were blooded owing to dyspnoea: out of ten or eleven so affected, not one recovered, an experience that reminded May of what Willis said of the village elders being swept off by the “new fever” of 1658. Surgeons at St Austel, East Looe and Falmouth are cited as having seen much of the same fever. In like manner the Manchester chronicler of the influenza of 1788 says: “Fevers of different kinds, but chiefly of the type now distinguished by the appellation of typhus, were exceedingly prevalent after the epidemic catarrh had in great measure ceased to be general; but from which, by tracing the symptoms, the fever might usually be found to have originated[690].”

For a good many years after the period last dealt with, nothing is heard in Britain either of epidemic agues or of influenza[691]. Writing in 1800, Willan said that intermittents had not, to his knowledge, been epidemic in London at any time within twenty years. He explains this by “the practice of draining, and the improved modes of cultivating land in Essex, Kent, and some other adjoining counties, from which either agues were formerly imported, or the effluvia causing them were conveyed by particular winds”—the latter being the doctrine of Lancisi for the country round Rome. But he forgets that their appearance nearly twenty years before was a strange phenomenon to the practitioners of that generation, and that Sydenham, whom he cites to prove agues in London in former times, had also remarked their absence, except in occasional cases, for as long a period as thirteen years. Of such occasional agues acquired in London, Willan and Bateman had each one or two examples in the autumn of 1794, and the spring of 1805.

As in the case of epidemic agues, so also in the case of influenzas, there was immunity in Britain for a good many years after 1788; and, as the slight epidemic catarrh of 1788 was something less than universal, the clear interval may almost be reckoned from the summer of 1782, a space of over twenty years. Willan’s monthly reports of the weather and diseases in London from March, 1796, to December, 1800, twice mention epidemic catarrhs,—in February and March, 1797, and in February, 1800, the latter chiefly among children. But to neither of them will he concede the name of “influenza,” as the complaint was merely epidemical from a particular state of the atmosphere, and not propagated by contagion, nor quite general.

The symptoms, however, were headache, sometimes attended with vertigo, a thin acrid discharge from the nostrils, slight inflammation of the throat, a sense of constriction in the chest, with a frequent dry cough, pains in the limbs, a white tongue, a quick and small pulse, with a sensation of languor and general debility. These symptoms, fairly complete for influenza of the correct type, lasted about eight days and ended in a gentle sweat or in a diarrhoea. Coughs had been remarkably severe and obstinate; they were frequently attended with painful stitches and spitting of blood[692].

The Influenza of 1803.

The number of the Medical and Physical Journal for March, 1803, announced that “a cold attended by symptoms of a very alarming nature has been general in the city of Paris for some time”; but it said nothing of the alarming disorder being in London. It is in the next number, under the date of Soho Square, March 11th, that a correspondent identifies the Paris epidemic with “the complaint now general in this metropolis, and called by some the Influenza.” In a report upon the diseases “in an Eastern District of London from February 20 to March 20, 1803,” the “catarrhal fever” is thus described:

“This disease has been so general as to claim the title of the reigning epidemic, and is very similar to one which prevailed a few years ago, and was denominated Influenza. It has generally been introduced by chilliness and shivering, which have been succeeded by violent pains in the head, with some discharge from the eyes and nostrils, as in a common catarrh, together with hoarseness and cough. The pains in the head have in some cases been the first symptoms and have been succeeded by giddiness, sickness and vomiting” &c. There were also rheumatic pains in the limbs, intercostals &c.

Meanwhile the information from various sources showed that the old influenza was once more really in this country. Two collective inquiries were made on the influenza of 1803: one by Dr Beddoes of Bristol, who issued a circular of five queries, and received answers to them (with other information) from one hundred and twenty-four correspondents[693]; the other by the Medical Society of London[694]. The Medical and Physical Journal and Duncan’s Annals each received a few independent papers on it; and several pamphlets were issued, mostly devoted to treatment—two in London[695], one at Edinburgh[696], one at Bath[697], and one at Bristol[698].

In these abundant data there is little novelty and not much variety.

The attack began with chills and severe pain in the head, along with slight running of the eyes and nose, as typhus fever might have begun. After the slightly catarrhal onset the malady was mostly a fever, with dry cough, dry and hot skin, pain in the forehead and about the eyeballs, pains in the limbs, “spontaneous” weariness and extreme prostration—a group of symptoms which led Hooper to find a rheumatic character in the malady. Among other symptoms were vertigo, nausea, vomiting and diarrhoea. Much sweating is not reported; but there was often a gentle sweat in recovering after about a week, less or more. There was the usual range from mildness to severity. Pneumonia and pleurisy were not rare, and were commonly the cause of fatalities.

The deaths were for the most part among the phthisical, the asthmatic and the aged; but these were not many, certainly not so many as in 1729, 1733 and 1743, and probably in about the same proportion as in 1762, 1775 and 1782. In the London bills the weekly deaths rose in March, to an average of 537 from an average of 429 in February, and of 375 in January, falling to an average of 417 in April. In Ireland the epidemic is said to have been seen among the troops in garrisons as early as December, 1802; it became universal in spring and summer. In Edinburgh the rise in the burials at Greyfriars churchyard was in the weeks ending 5th and 12th April, making them about a half more than usual for the brief period. When the wave of influenza was past, the public health in nearly all places became unusually good, as had happened immediately after the influenza of 1782.

The question most to the front in the influenza of 1803 was its manner of spreading. Beddoes, who believed in personal contagion, had this in view in his five queries:

1. When did the influenza appear and disappear with you?

2. Was its date different in remote places within your reach?

3. After being general, did it occur for some time in single instances?

4. Did it ever seem to pass from person to person?

5. If so, is it likely that clothes or fomites conveyed it in any case?

The dates of commencement were earlier or later according to no rule of direction or of distance from London. In some large towns of Yorkshire it appeared to be unusually late, in Chester unusually early; Edinburgh, certainly, was as long behind London as London was behind Paris. Haygarth, who took the most narrow view of contagion, made out the incidence thus: London first, then the towns which have the greatest intercourse with London, such as Bath and Chester, then smaller towns, and last of all the villages around each of the more populous centres. Several towns had the brunt of the epidemic in the same weeks (of March) as London; in very few was it later than the first weeks of April. In some towns it attracted little notice. In North Devon, it was said to have been at Hartland and Clovelly a fortnight before it was seen in Bideford; the first of it seen by one of the doctors of that town was in a solitary potter’s house four miles to the eastward, on a peninsula made by the confluence of a small stream with the Torridge, all the inmates of the house being attacked; in the town itself from first to last he saw but few cases, whereas there were many in the adjacent country[699].

The general rule seems to have been that the more sparse populations had it later, the nearer they were to the extremities of the kingdom, as in Cornwall, the north of Scotland, and in Ireland. Opinion was divided as to the part played by persons in carrying contagion from place to place, some holding that the facts of diffusion could be explained on no other hypothesis, while most held that the influenza was in the air. Beddoes got as many answers favouring the doctrine of personal contagion as made a respectable show for it; but when these had all been set forth to the best advantage, a practitioner wrote to say that, after all, nine-tenths of professional opinion was against the contagiousness of influenza. The practical question for Haygarth, Beddoes, and other contagionists was whether influenza was not a disease, like smallpox or scarlet fever, which could be kept from spreading by means of isolation, disinfection (with the fumes of mineral acids) and other precautions.

Some curious facts came out, showing the effect of influenza upon other epidemic diseases, or the effect of other epidemic diseases upon influenza. One writer applied to influenza what used to be said of the plague or pestilential fever, that these Leviathan constitutions swallowed up all other reigning epidemics. Holywell, a town in Flintshire, with a large cotton-weaving industry, had not been free from a bad kind of typhus for two years. “On the appearance of the influenza the typhus entirely ceased, and only one case of fever has occurred since. I have not for many years known this country so healthy as since the influenza disappeared[700].” The influenza was said also to have superseded typhus fever at Navan, in Meath[701]. At St Neots typhus was peculiarly prevalent for three months before the influenza, but ceased thereafter[702]. Another relation to typhus was seen at Clifton: “In the low, confined, and ill-ventilated houses in the Hot Well road, where typhus often abounds, the influenza was very unfrequent; while in the exposed high-lying buildings on Clifton Hill it was almost universal[703].” As to ague, which had often before stood in a remarkable relation to epidemics of catarrhal fever, there is one possibly relevant fact related from the Lincolnshire fens. A Wisbech physician writes:

“The influenza which ceased here about the middle of April made its appearance again in May; the leading symptoms were the same as in the first attack. About the same time also a most malignant fever, having some symptoms in common with the influenza, began to rage in that part of Lincolnshire contiguous to us, which has proved fatal to hundreds[704].”

From 1803 to 1831, nothing is heard in England of a universal influenza, although there was one such in the end of 1805 and beginning of 1806 in Russia, Germany, France and Italy; and there were four great influenzas in the Western Hemisphere (1807, 1815-16, 1824-25, and 1826). Catarrhs were perhaps commoner than usual in England and Scotland in the winter of 1807-8, but they cannot be reckoned an epidemic of influenza[705]. The summer following (1808) was unusually hot and agues became more epidemic in the fens than at any time since the great aguish period of 1780 and following years[706]. Agues were again unusually rife in England in 1826, 1827 and 1828, at the same time as the remarkable epidemics of them, from inundations and subsequent drought, in Holland and along the German coast of the North Sea. Dr John Elliotson, of London, met with cases of agues in his practice in those years in the following scale:

Year Cases

1823 8

1824 14

1825 15

1826 44

1827 53

1828 27

1829 8

They had increased, he says, throughout the country as well as in London, owing, as he thought, in agreement with Macmichael, to the higher mean temperature of the respective years; and he would apply the same law of increase to the epidemic periods of ague in Britain in former times[707]. Christison saw his first case of ague at Edinburgh in the autumn of 1827, in a labourer who had caught it working at the harvest in the fen-country of Lincolnshire.

The Influenza of 1831.

The next influenza in Britain fell in the early summer of 1831. It was a mild epidemic of the catarrhal type, which attracted hardly any notice in England. In one of the London medical journals there is no other notice of it but this, dated 2 July, 1831[708]: “In consequence of the sudden variations of temperature which have prevailed since the last fortnight of May an epidemic bronchitis has shown itself in Paris.” Another London journal[709], on the very same day, wrote: “Influenza in a severe form is at present prevailing in London and some of the provincial towns. It commences like a common cold, but is soon discovered to be more serious, &c.” The physician to the public dispensary in Chancery Lane found that more than half of the seventy applicants on 23 June came with the symptoms of influenza—severe, harsh, dry cough, in paroxysms, pain behind the sternum, a fixed pain in one side, congested state of the throat, nose and eyes, heaviness of the head, languor, debility, hot skin, foul tongue, impaired sense of taste. The symptoms went off after three or four days with a sweat in the night and a discharge from the nostrils[710].

This epidemic hardly affected the London bills of mortality, according to the following figures:

Four weeks, 25 May to 21 June,1579 births, 1430 deaths.

Five weeks, 22 June to 26 July,2153 births, 2010 deaths.

Four weeks, 27 July to 23 Aug.,1997 births, 1652 deaths.

The rise in the last four weeks was due to summer diarrhoea, or choleraic diarrhoea, which was unusually common in 1831. This slight influenza was also reported from Plymouth by a surgeon who had seen the disease, and suffered from it, at Manilla in September, 1830[711], and by a Plymouth practitioner, who wrote, on 14 July, that it had been extensively prevalent there and in the neighbouring towns and villages[712]. It is recorded also from the Isle of Man, Glasgow[713], and Ayr[714], and it is supposed to have been in Aberdeen[715]. But, while there are many accounts of this epidemic in Germany in May and June, and undoubted evidence of it in France and Italy, as well as in Sweden, and in Poland and Russia earlier in the year, the accounts of it in Britain are so meagre and casual as to make one doubt whether it really was an influenza worth reckoning.

The Influenza of 1833.

The next year, 1832, which was the first great season of Asiatic cholera in Britain, is absolutely free from records of influenza in all Europe. It was in the spring of the year following, 1833, that the really serious influenza came. The continental literature of the epidemic of 1833 is immense, the English literature of it is all but non-existent: and yet it was a very severe influenza with us, just as with other European peoples. There was no collective inquiry in Britain on this occasion, such as had been made first by Fothergill in 1775, by the College of Physicians and another Society in 1782, by Simmons in 1788, and by Beddoes and the Medical Society of London in 1803, or such as was made in the next influenza, that of 1837, by a committee of the Provincial Medical Association. But enough is known of it to place it among the severer influenzas. In London the bills of mortality, which relate only to a part of London, showed the characteristic sudden rise and fall:

Baptisms Burials

Four weeks, 20 Feb. to 16 March 2310 2352

Five " 17 March to 23 April 1955 2105

Four " 24 April to 21 May 2016 3350

Four " 22 May to 18 June 2070 1685

For a whole month the burials in London were nearly doubled, and for the two worst weeks they were nearly quadrupled. This mortality, by all accounts, fell most on the richer classes, to whom it was a much more serious calamity than the Asiatic cholera of the year before. The president of the Medical Society said, on the 22nd April, that he had “heard of nine lords or ladies who had been carried off by it or by its indirect agency, in the course of last week[716].” Its type in the month of May was worse than in April[717]. When it was first seen it was a somewhat short catarrhal attack, ending in a sweat after two, three or four days, with the usual head-pains, soreness of the ribs and limbs, languor and prostration. Later, it became a more “adynamic” illness, beginning indeed with slight catarrhal symptoms, but soon passing into subacute nervous fever which might last for three weeks, involving much risk to life[718]. Hence arose the warnings, just as in 1890-92, that the influenza was a much more serious thing than it had been thought when the epidemic began, and hence the delay, as it were, in the bills of mortality to show the effects of the epidemic until it had been two or three weeks prevalent. It is to the month of April, before the highest death-rate was reached in London, that the following, in the Gentleman’s Magazine, applies[719]:

“During the month a severe form of catarrhal epidemic, generally termed influenza, has been extremely prevalent in London. It has laid up at once all the members of many large households, and has attacked great numbers in several public offices, particularly the Bank of England and some divisions of the new police. The performers at the theatres have much suffered, and their houses have been closed for several nights. It commences suddenly with headache and feeling of general discomfort, attended or soon followed by cough, hoarseness, or loss of voice; oppression, and sometimes severe pain in the chest, tenderness about the ribs, and sense of having been bruised about the limbs or muscles.... The disease is generally attributed to the constant north-east winds; but by some of the learned is regarded as the epidemic influenza which has lately prevailed in the eastern parts of Europe, and that is travelling, like many of its predecessors, to the west.”

It would have been in this earlier stage of the epidemic, when it was laying up whole households, thinning workshops and closing theatres, that a practitioner was heard to say (as reported by the Lancet): “Best thing I ever had! Quite a godsend! Everybody ill, nobody dying!” The seriousness of the disease was, however, at length recognized, so that the members of the Medical Society debated the subject at three successive meetings. One of the questions was, whether the malady called for blooding—a question that had divided opinion as long ago as 1658[720]. On 13 May, the following passed at the Medical Society: