Chapter IV · THE FOURTH VISITATION OF THE DISEASE.—1528, 1529. (continued 2)

This plainly appears from the pamphlet of a physician in great practice at Ghent, Tertius Damianus, from Vissenaecken, near Tirlemont[325], whose own wife fell sick of the sweating fever, and fortunately was again restored[326]. The cases whereof Damianus gives an account, are among the most marked of which any mention is made, and it also seems, that the disease, contrary to the opinion of many, arose from fear alone, and manifested in the Netherlands a much greater power of contagion than in Germany, to which the hot treatment may have contributed[327]. The manner in which Damianus restrained his patients from indulging in their propensity to sleep, is worthy of notice. When the usual means failed, he directed that their hair should be torn out, that their limbs should be tied together in painful positions, and that vinegar should be dropped into their eyes[328]: the danger justified these means, but violence does not easily attain its end. For the rest, the views of this physician do not differ from those commonly entertained, and if he complains[329] of the great extortions of the apothecaries, this was a natural effect of the customary prescriptions, whereof he himself recommends many that are very objectionable.

Whatever the science of medicine of the sixteenth century could oppose to so fearful an enemy, is set forth in the very excellent treatise of Joachim Schiller[330] of Freiburg, which, however, did not appear until two years later, and unfortunately does not give the wished-for information on the development of the pestilence in the Briesgau. Schiller is moderate in his views, and shews throughout, that he is a very well informed physician, and well versed in Greek literature: and although he cannot steer clear of the rubbish of clumsy remedies, yet the fault should not be charged on him, but on the age in which he lived. This, like every other, had its evils, and enveloped in clouds and darkness the genius of medicine, which, free, great, and elevated above human short-sightedness, is respected only by the intellectual servants of nature.

Sect. 12.—Form of the Disease.

The notions of contemporary writers respecting the phenomena and the course of the sweating epidemic are, it is true, individually unsatisfactory and defective[331]; yet collectively, we may gather from them a lively and complete picture of its effect on the human frame; especially from the German observers, who reported truly and honestly their own, as well as the general experience of their age; for the English had up to that period described little more than the external appearances of this epidemic, which had already attacked them for the fourth time.

It is ascertained that the Sweating Fever was in general very inflammatory; and, leaving out of the account its sequel, came to a crisis at most in four and twenty hours; yet, within this narrow limit as to time, very various symptoms occurred[332], so that by a more exact observation than could be expected from the physicians of those days, several gradations of its development and violence might have been distinguished from each other. Thus one form of this disease appeared that was wanting in precisely that symptom which was the most essential, namely, the colliquative sweating[333], (as in the most dangerous form of cholera, neither vomiting nor purging takes place,) and which, by its overpowering attack, either destroyed life within a few hours, or perhaps took some other turn of a nature unknown to us.

Premonitory symptoms were wanting altogether, unless we may reckon as such, first, an anguish, combined with palpitation of the heart, which may not have been of corporeal origin, but may have proceeded from the general alarm; or secondly, an irresistible sinking of the powers resembling a swoon, which, perhaps, preceded the disorder, in the same manner as it had preceded the general eruption of the plague in northern Germany[334]: or thirdly, rheumatic pains of various kinds, which were frequently felt in the summer of 1529[335]; or finally, a disagreeable taste in the mouth and foul breath, which were very commonly the subject of complaint at that time[336].

In most instances the disease set in like the generality of fevers, with a short shivering fit[337] and trembling, which in very malignant cases even passed into convulsions of the extremities[338]; in many it began with a moderate and constantly increasing heat[339] either without any evident occasion, even in the midst of sleep, so that the patients on waking lay in a state of perspiration, or from a state of intoxication, and during hard work[340], especially in the morning at sunrise[341]. Many patients experienced at the commencement a disagreeable creeping sensation or formication on their hands and feet[342], which passed into pricking pains, and an exceedingly painful sensation under the nails. At times likewise it was combined with rheumatic cramps, and with such a weariness in the upper part of the body, that the sufferers were totally incapable of raising their arms[343]. Some were seen during these attacks, especially women and those who were weak, with their hands and feet swollen[344].

Serious affections of the brain quickly followed; many fell into a state of violent feverish delirium[345], and these generally died[346]. All complained of obscure pain in the head[347]; and it was not long before an alarming lethargy supervened[348], which, if it was not firmly resisted, led to inevitable death by apoplexy. Thus the unconscious sufferers were, at least, relieved from the pain of separation from their friends, which would have been much more distressing to them in this than in any other complaint, since they lay, as it were, in a stinking swamp, tortured with suffering.

This mortal anguish accompanied them so long as they were in possession of their senses, throughout the whole disease[349]. In many the countenance was bloated and livid, or at least the lips and cavities of the eyes were of a leaden tint; whence it evidently appears, that the passage of the blood through the lungs was obstructed in the same way as in violent asthma[350]; hence they breathed with great difficulty, as if their lungs were seized with a violent spasm or incipient paralysis; at the same time, the heart trembled and palpitated constantly under the oppressive feeling of inward burning, which, in the most malignant cases, flew to the head, and excited fatal delirium[351]. In the course of a short time, and in many cases at the very commencement, the stinking sweat broke out in streams over the whole body, either proving salutary when life was able to obtain the mastery over the disease, or prejudicial when it was subdued by it—as is the case in every ineffectual effort of nature to produce a cure. And in this respect, as in diseases of less importance, great differences appeared according to the constitution of the patient; for some perspired very easily, others, on the contrary, with great difficulty, especially the phlegmatic, who, in consequence, were threatened with the greatest danger[352].

In this severe struggle the spinal marrow was sometimes, at a later stage, so much affected, that even convulsions came on; and it happened not unfrequently, that, in consequence of the constriction of the chest, the stomach indicated its excited condition by nausea and vomiting[353]. These symptoms, however, manifested themselves principally in those who were attacked with the disease upon a full stomach.

Such is the testimony of the contemporary writers of 1529, to whose accounts but little is added by Kaye, an English eye-witness of the epidemic Sweating Sickness of 1551. The observations of this perfectly trustworthy physician, so far as they relate to the form of the disorder, may be here annexed, since no essential differences between the diseases on these two occasions can be discovered. At the first onset the disease in some attacked the neck or shoulders, and in others one leg or one arm, with dragging pains[354]; others felt at the same time a warm glow that spread itself over the limbs, immediately after which, without any visible cause, the perspiration broke out, accompanied by constant and increasing heat of the inward parts, gradually extending towards the surface. The patients suffered from a very quick and irritable pulse[355] and great thirst, and threw themselves about in the utmost restlessness. Under the violent headache which they suffered, they frequently fell into a talkative state of wandering, yet this did not generally happen before the ninth hour, and in very various gradations of mental aberration[356], after which the drowsiness commenced. In others the sweating was longer delayed, while, in the mean time, a slight rigor of the limbs existed: it then broke out profusely, but did not always trickle down the skin in equal abundance, but alternately, sometimes more, sometimes less. It was thick and of various colours, but in all cases of a very disagreeable odour[357], which, when it broke out again, after any interruption to its flow, was still more penetrating[358].

Kaye adds to what we already know of the oppression of the chest, the very important statement that those affected were observed to have a whining, sighing voice, whence we have every reason to conclude that there was a serious affection of the eighth pair of nerves. He, moreover, describes a very mild form of the disease, such as was prevalent in the south of Germany in 1529. It passed off under proper care, without any danger, in the very short period of fifteen hours, and was brought to a termination by moderate heat through the medium of a very gentle perspiration[359].

It is remarkable that during this violent disorder neither the activity of the kidneys nor the evacuation by stool was entirely interrupted, for there passed continually turbid and dark urine, although, as may be conceived, in small quantity and with great uncertainty as to the prognosis; whereupon those physicians who judged by the urine were not a little perplexed[360]. It was observed, too, sometimes in the more easily curable cases, that patients at the moment when the perspiration broke out upon them passed urine in great quantity[361], on which account a French physician proposed to draw off the water in those who suffered from this disease[362]; yet this practice has no higher therapeutical worth than the excitement of perspiration in diabetes or in cholera, and is, moreover, much less practicable. That occasionally diarrhœa supervened, and even to a degree which was not to be restrained, may be gathered from the frequent medical directions as to how it ought to be arrested, which Kaye also repeats[363]. In some patients, likewise, nature appears to have effected a simultaneous crisis by the skin, the kidneys, and the bowels.

Much more important, however, is the observation of a respectable Dutch physician, that after the perspiration was over there appeared on the limbs small vesicles[364], which were not confluent, but rendered the skin uneven, and these were not noticed by any other medical observer, but are spoken of by the author of an old Hamburgh chronicle, and, with this addition, that they had been seen on the dead[365]. By these it is very likely that a miliary eruption, and perhaps spots also, are to be understood; yet every thing militates against the supposition that this phenomenon was constant, or that the Sweating Fever was an eruptive disorder[366]. For in that case, some mention would have been made of it in the numerous accounts of historians, many of whom, doubtless, had themselves seen the disease, and the eruptions would have been more evidently and decidedly formed in the numerous relapses of those who recovered. They certainly indicate a relationship with the miliary fever, but only in so far as that both diseases are of rheumatic origin, and this slight participation in the nature of an eruptive disease would seem to have been observed in the English Sweating Sickness only in perfectly isolated cases. What would have taken place under such an indication had the Sweating Sickness run a longer course, whether, in fact, it might not possibly have passed into a regular miliary fever, is a question unsolved by the past, since even later transitions of this kind have never been observed. The two diseases are, both in their course and their nature, perfectly distinct from each other, and the miliary fever was not developed as an independent epidemic until the following century, under circumstances altogether different, and its more decided precursors are not to be discovered until a period posterior to the five eruptions of the Sweating Sickness.

The powers of the constitution were much shaken by the Sweating Sickness, so that a rapid recovery was observed to take place only in the mildest form of this disease. Those, however, whom it attacked more severely, remained very feeble and powerless for at least a week, and their restoration was but gradual, and effected only by great care and strengthening diet. After the perspiration had passed off, the patient was taken carefully from his bed, cautiously dried in a warm chamber, placed by the fireside, and, as a first restorative, usually fed with egg soup, yet the generality could not entirely get over the effects of the fever for a long time. Those who had recovered could seldom go out so early as the second or third day[367].

Those patients were placed in still greater danger in whom the perspiration was in any way suppressed: most of them were consigned to inevitable death, (the popular voice ever since the year 1485 confirms this.) Over those, however, in whom the powers of life were roused to a renewed effort, there broke out, after a short period, a new perspiration far more offensive than the first; so that the body dripped as it were with a foul fluid, and it seemed as if the inward parts wanted to disburthen themselves at once of their putridity by an immoderate effort[368]. It is clear that this repetition of the attack must have been destructive to many who, had it not been for an obstruction of the crisis, would have been saved; for nothing is more dangerous in inflammatory diseases than when those secretions are interrupted which Nature has ordained as the only means of relief.

Relapses were frequent, because convalescents, after the disease was subdued, remained for a long time very excitable. These were seen for the third and fourth time seized with the Sweating Sickness[369], nay, later writers notice a repetition of the disease even to the twelfth time[370], whereby at least the health was completely shattered, for dropsy or some other destructive sequelæ supervened, until death put a period to incurable sufferings, and it is important to observe that even the bowels participated in the great excitability of the system, for too early an exposure to the air easily brought on diarrhœa[371].

How great the decomposition of the organic matter was is convincingly proved from all the testimony hitherto adduced, but it might have been inferred from the very rapid putrefaction of the body, which rendered it necessary everywhere to use the greatest despatch in the performance of burials[372]; and fortunately did away with all fear of being buried alive. Of post mortem examinations we have no information, and even if they could have been instituted, they would, from the manner of conducting researches in those times, scarcely have thrown any important light on the disease. Hardly any physicians but those who had studied in Italy knew the inward structure of the body from their own observation, superficial as it was; the rest learned it only from Galenic manuals; how could they with such slender knowledge have distinguished between healthy and diseased parts? Moreover, the Sweating Sickness could not in so short a period cause such a palpable and substantial destruction of the viscera as they would alone have sought for. Details respecting the condition of the blood in the dead body, which after such an enormous loss of watery fluid, such severe oppression at the chest, and so great an impediment to the function of respiration, would in all probability be thickened and darkened in colour, as well as respecting the condition of the lungs and of the heart, it would be highly desirable to obtain; but these likewise are wanting altogether, and after the lapse of so long a period there only remains room for conjectures.

The observation was repeated in Germany which had been so frequently made since the year 1485, that the middle period of life was especially exposed to the Sweating Fever. Children, on the contrary, remained almost entirely exempt from this disease, and when the aged were affected by it, it was as individual exceptions to a general rule[373], and this as it would appear, only during the height of the epidemic; as for example at Zwickau, where a woman of 112 years of age was carried off by it[374]. We have already in part discovered the cause of this perfectly constant phenomenon in the luxurious mode of living of robust young men, and if we look back to the moral condition of the Germans in the 16th century, we find among them the same immoderate luxury as among the English, the same drunkenness, the same intemperance at their frequent banquets, where the wine-cups and beer-jugs were emptied with but too eager draughts; finally, also, the same relaxation of skin consequent upon the use of warm baths and warm clothing. All contemporary writers mention these circumstances[375], and our bold forefathers, with respect to these matters, were not in the best repute with their southern neighbours.

But we have, moreover, to survey the disease in another point of view, namely, in relation to its peculiar character. In the outset we designated the Sweating Sickness as a rheumatic fever, and if we take the notion of a rheumatic affection, as in propriety we ought, in its widest acceptation, weighty and convincing grounds have been adduced in the course of our whole inquiry in confirmation of this view. When we observe that those very nations were visited by the Sweating Fever, which are characterized by a fair skin, blue eyes, and light hair—the marks of the German race, it may with justice be assumed, that even this peculiarity in the structure of the body rendered it susceptible of this extraordinary disease. It is this which causes the proneness to fluxes of all kinds, and which makes these diseases endemic in the north of Europe, whilst the dark-haired southern nations and the blacks in the tropical climates remain, under similar circumstances[376], more free from them. If it be remembered further how overcharged with water were the lower strata of the atmosphere in which the pestilent Sweating Fevers existed, what thick and even offensive mists prepared the way for the disease and indicated its approach, what rapid alternations of freezing cold and excessive heat took place in the summer of 1529; and, moreover, how frequent all kinds of fluxes were in this very year, the complete form of the rheumatic constitution will be recognised in every individual feature.

Did we possess in the showy systems of modern times a maturer knowledge of the electricity of living bodies, much light would of necessity hence be thrown on the great object of our research. We should not then be compelled to rest satisfied with the fact that a cloudy atmosphere abstracts electricity from the body, robs the skin and lungs of their electrical atmosphere, disturbs their mutual electrical relation with the external world, and by this disturbance prepares the body for rheumatic indisposition, with all that peculiar decomposition of the fluids, irritable tension of the nerves, fever, and painful affection of particular parts, with which it is accompanied. If this disturbance be represented according to certain new and inviting hypotheses, supported by some important facts[377], as being perhaps an accumulation of electricity in the interior of the body, owing to a morbid, isolating activity of the skin, we may expect a more perfect knowledge of the nature of rheumatism through the medium of future diligent researches; and until these be made, some evident signs of connexion between rheumatic affections and the English Sweating Sickness will perhaps be sufficient to demonstrate the rheumatic nature of this latter disease.

In the first place, the very great susceptibility of those affected with the Sweating Fever to every change of temperature—the decidedly great danger of chill. In no known disease does this irritability of the skin shew itself in so prominent a degree as in rheumatic fevers and in those non-febrile fluxes in which there even exists a very evident sensitiveness to metallic action.

Secondly, The tendency of the rheumatic diathesis to come to a crisis through the medium of a profuse, sour and offensive perspiration without any assistance from art[378]. The English Sweating Sickness manifests this commotion of the organism in the most exquisite form hitherto known; for it admits of no kind of doubt that the sweat in this disease was of itself, and in itself, critical, in the fullest acceptation of the term.

Thirdly, The peculiar alteration in the fundamental composition of organic matter in rheumatic diseases, in consequence of which volatile acids of a strange odour are prevalent in the sweat, and urine, and animal excretions. The English Sweating Sickness exhibits also this result of morbid activity in a greater and more striking manner than any other disease. Nor can we regard the tendency to putridity, which has been observed, as any thing but an increased degree of this condition.

Fourthly, The shooting pains in the limbs, the most decided sign of rheumatism, were not wanting in the English Sweating Sickness; nay, they became developed even to the extent of an incipient paralysis, and even the convulsions of those affected with this disease may not unjustly be attributed to the same source.

Fifthly, The tendency of rheumatism when it takes an unfavourable course to pass into regular dropsy, which is a consequence of the peculiar decomposition, manifested itself in the Sweating Fever in so marked a manner that the dropsy itself gradually destroyed the patient.

Should the sceptical still need another link in the comparison, we may adduce the miliary fever, a disease of decidedly rheumatic character. We must not, however, take as our standard the degenerate forms of miliary fever existing in modern times, but those grand and fully developed forms of the disease which occurred in the 17th and 18th centuries, and in which we find a similar odour in the perspiration, the same oppression, and the same inexpressible anguish, with palpitation and restlessness. The arms became enfeebled as if seized with paralysis, violent pains of the limbs set in, and unpleasant pricking sensations in the fingers and toes, resembling in all these particulars the Sweating Sickness, only pursuing a more lengthened and irregular course, and becoming developed altogether in a different manner.

According to this representation, the English Sweating Sickness appears as a rheumatic fever in the most exquisite form that has ever yet been seen in the world, violently affecting the vitality of the brain and spinal marrow with their nerves, without, however, at all molesting the plexuses of the abdomen. The immoderate excretion of watery fluid, which in the mild cases alone took place, through a spontaneous curative power, while in the malignant forms it betokened paralysis of the vessels and an actual colliquation, directs our attention further to the consequent state of inanition, which very probably passed into a stagnation of the circulation, in the same manner as takes place after every other sudden loss of the fluids, whether from sanguineous effusion or evacuations by vomit and stool. Hence the uncommonly rapid course of the disease, and partly, too, the fatal stupor[379]; hence, likewise, the very pardonable misconception with respect to the nature of the Sweating Fever existing even in more modern times. The sequela was more important and more fatal than the original rheumatic affection itself, which in its minor forms was mild and easily managed.

And thus is explained the wonderfully fortunate result of the old English treatment, which prevented this sequela, and avoided increasing the already too powerful efforts of nature to effect a cure. We have, therefore, nothing further to add to this judicious and truly scientific practice but our unqualified approbation; for it is the part of the physician, in diseases which have a spontaneous power of curing themselves, to leave this power free scope to act, and merely by fostering care to remove all obstacles to its exercise. Should it be the destiny of mankind to be again visited by the disease of the sixteenth century, (and it is by no means impossible that at some time or other similar events may recur,) we would recommend our posterity to bear in mind this eternal truth, and to treasure up the golden words of the Wittenberg pamphlet, namely, to guard the healing art from strange and unnatural farragos, for it is only when it is subordinate to nature that it bears the stamp of reason—the mistress of all earthly things.