The Ague-Curers of the 17th Century.
It is to be observed that all the respectable writers of the profession speak of agues or intermittents as epidemic over the country for a definite period, and as disappearing thereafter for years together. At the same time they say little or nothing of the endemic malarious fevers of marshy localities. Further, it appears that the professed ague-curers, although they would wish to represent ague as a perennial disease, are really basing upon the same experiences of occasional epidemics which Willis, Whitmore and Sydenham recorded as occasional. The best instance of this is the ‘Pyretologia’ by Drage of Hitchin. It was published for practice in 1665, being designed to show forth the author’s skill as an ague-curer[567]. When we examine its generalities closely, we find that they all come from the sickly season of 1657, the first of those described by Willis.
The great autumnal epidemic of that year (and the following), which we know from other sources to have been reckoned a “little plague,” he describes as “a malignant sickness,” which was followed in the winter by quartans. He himself escaped the autumnal fever but he incurred the quartan later in the year. In his own case, while the original paroxysm of this ague was still going on, a new one arose towards evening, and again, on the following day, a new paroxysm gathered vigour and supplanted the old, becoming the substantive paroxysm. Many of those who died of the quartan in 1657 had either the paroxysms duplicated, or a total want of them, or, in another passage, “the quartan which followed the autumnal disease of heterogeneous quality in 1657, cut off divers old people, the fever being erratic, duplicated or triplicated.” It was a bad sign when the quartan became doubled or trebled; regularity of the paroxysm was a sign of a good recovery. The symptoms of a quartan are various; but it is not easy to pronounce that these all are the symptoms of an intermittent fever, or the prodromal signs thereof, unless intermittent fevers be epidemic at the time. He gives the case of a civil and pious priest who had a tedious quartan from being struck with lightning; he was confined to bed for two years, with loss of hearing, but, strangely enough, retaining the use of his eyes; sometimes he was vexed with convulsions, sometimes with quartan fever. The “plebs medicorum” say that a quartan fever comes of melancholy, a tertian of choler, a quotidian of putrefied pituitous matter. The “plebs plebis” think that the cause is wind or flatus, and that they get rid of the ague by belching. In his own case he observed that if he drank more cold ale than usual, he was seized with distension in the loins and with palpitation, and belched up “flatus and crass vapours infected with the quality of a quartan.” He knew a man who, in the fourth or fifth month of a quartan, drank wine too freely, so that the paroxysms came every day, and that violently; after a week he had an especially severe paroxysm, and then no more for three weeks, when the fever returned under the type of an exquisite quartan. One case, which he mentions twice, led him to doubt whether quartans were not catching: a certain girl suffering from a quartan asked her father, who was skilled in the art, to open a vein; her parent declared that during the blooding the morbid smell of the flowing blood reached his nostrils, so that he was seized of his daughter’s fever at the proper time of her paroxysms, having three or four ague fits in due order; meanwhile the girl was free from the paroxysms for a whole week, but no longer. The singular nature of quartans is further brought out in the fact that papules, pustules and exanthems breaking out on the skin were quite common in the quartan fever which followed the malignant epidemic of the autumn of 1657. “In the fevers hardly any heat is perceived; and so the unskilled vulgar say ‘This is an ague’ (Hoc est anglicè Ague), and ‘This is fever and ague’ (Et hoc est febris et anglicè Ague) when cold and heat are mixed equally or combined regularly.” Peruvian bark does not evacuate the morbific matter unless by chance it provokes vomiting; cases treated by it often relapse, and are not well in the intervals. Bark does not occur in his own prescriptions; but he had cured many with “pentaphyllum.” He knew several physicians in the epidemic of quartans in 1657 who trusted to narcotics entirely.
Drage must have had a real experience of aguish distempers of one kind or another during the sickly seasons of 1657-59. But it is clear from the essays or advertisements of empirics that agues were discovered in many forms of sickness that were neither intermittent fevers nor fevers of any distinctive type. One of these practitioners in the time of Charles I. claims to be “the king’s majesty’s servant in ordinary[568]”; which is not incredible, as Sir Robert Talbor, whom Charles II. deigned to honour, was an ague-curer of the same class.
“An ague, which hitherto amongst all sorts hath been accounted the physitian’s shame, both for definition and cure (thus farre hath ignorance prevailed), but that the contrary is manifest appeareth sufficiently by this following definition: and shall be cured whether tertian, quartern or quotidian, by me Aaron Streater, physitian of Arts in Oxford, approved by Authority, the King’s Majesties servant in ordinary, and dwelling against the Temple, three houses up in Chancerie Lane, next house to the Golden Anchor.” An ague, he goes on, “is either interpolate (intermittent) or continual; it is either engendered of a melancholic humour or it is a splenetic effect; the liver is obstructed by abundance of choler proceeding from a salt rheum that cometh from the brain” etc. Agues are to be dreaded most for their remote effects: “Say not therefore, ‘It is but an ague, but a feaver; I shall wear it out.’ Dally not with this disease;” and he adds a case to show what people may come to if they neglect an ague at the beginning: “Being carried downe from London to South-hampton by Master Thomas Mason,—September 1640, word was brought me of a Mayd dead, 16 years of age: and being requested to see what disease she dyed of, I took my chirurgion with me and went. And after section or search, I found as followeth: a gallon and a half of green water in the belly, that stunk worse than carrion; under the lyver an impostume as bigg as my fist, full of green black corrupted matter, and the lyver black and rot. The spleen and kidneys wholly decayed, and the place as black as soot; the bowels they were fretted, ulcerated and rotten. In the chesse was two great handfuls of black burnt blood in dust or powder; the heart was all sound, but not a drop of blood in it; nor one spoonfull in the whole body.
Here was an Annatomy indeed, skinne and bone; and I verily beleeve that there was no braine left, but that she lived while that was moyst: the sent was so ill, and I not well, that I forbore to search it.
God that knowes the secrets of all hearts knowes this is a truth, and nothing else here written. Arthur Fauset, chirurgion at Southampton, was the man I employed to cut her up, as many there can witness that were present.
And what of all this, may some say? Why this. An eight weeks’ ague in the neglect of it breeds all these diseases, and finally death.”
Let us take next the advertisement of an apothecary a generation after, who professed to cure Kentish agues,—“the description and cure of Kentish and all other agues ... and humbly showing (in a measure) the author’s judgment why so many are not cured, with advice in relation thereunto, whether it be Quotidian, Tertian or Quartan, simple, double or triple[569].” Before the Fire of London he had practised in Mark Lane, but after his house was destroyed he removed to Kent, attending Maidstone market every Thursday, and residing at Rochester, a city which, “besides being subject to diseases in common with others, hath two diseases more epidemical, namely, the Scurvey for one but the Ague in special.” The symptoms of scurvy, as he gives them, cover perhaps the one moiety of disease, and those of ague the other.
Agues are of two sorts, curable and incurable; the curable are those that come in a common way of Providence, the incurable those that are sent more immediately from God in the way of special judgment, as instances adduced from Scripture show. What is an ague? Some think it is a strange thing, they know not what; the more ignorant think it is an evil spirit, but coming they know not whence. Agues have their seat in the humours either within the vessels or without them; those residing within are continual quotidians, continual tertians, continual quartans; those without are intermittent ditto. (This distinction of within and without the vessels is traditional, and is found in Jones’s Dyall of Agues as well as in Dutch medical books a century later.) The paroxysms of the intermittents are really the uprising of the Archaeus [of van Helmont], or spirit, to oppose the rottenness of the humours. A quartan is harder to cure than any other ague; part of its cure is an old 14th-century rule of letting blood in the plague; “let blood in the left hand in the vein between the ring finger and the little finger, which said thing to my knowledge was done about sixteen years ago [to say nothing of three hundred years ago] by the empiric Parker in this country, with very good success and to his great honour and worldly advancement.” This ague-curer says little of Peruvian bark; his specific is the powder of Riverius, “the preparation of which, as well as some of the powder itself is lately and providentially come to my hands.” Three doses cost not above five shillings, “and I never yet gave more in the most inveterate of these diseases.... My opinion is that he that will not freely part with a crown out of his pocket to be eased of such a disease in his body deserves to keep it.”
The most celebrated ague-curer of the Restoration period was Sir Robert Talbor, who thus describes the high motives that made him a specialist[570]:
“When I first began the study and practice of Physick, amongst other distempers incident to humane bodies I met with a quartan ague, a disease that seemed to me the ne plus ultra of physic, being commonly called Ludibrium et Opprobrium Medicorum, folly and derision of my profession, did so exasperate my spirit that I was resolved to do what study or industry could perform to find out a certain method for the cure of this unruly distemper.... I considered there was no other way to satisfy my desire but by that good old way, observation and experiment. To this purpose I planted myself in Essex near to the seaside, in a place where agues are the epidemical diseases, where you will find but few persons but either are, or have been afflicted with a tedious quartan. In this place I lived some years, making the best use of my time I could for the improving my knowledge.”
Talbor’s first chapter is a fluent account of how agues are produced by “obstructions” of the spleen. This was a matter of theoretical pathology which an empiric could make a show with as well as another. But the empiric betrays himself as soon as he comes to practice. The enlarged spleen of repeated agues, or of the malarial cachexia, is commonly known as the ague-cake. There is no doubt that much of the unhappiness of the aguish habit resides in the ague-cake, and that one of the best pieces of treatment is to apply counter-irritants or the actual cautery to the left side, against which the enlarged spleen presses as a cake-like mass. Talbor, however, desired to free the patient from his “ague-cake” altogether:
“I have observed these in four patients: two were cast out the stomach by nature, and the other two by emetic medicines. One of them was like a clotted piece of phlegm, about the bigness of a walnut, pliable like glue or wax, weighing about half an ounce; another about the bigness of the yolk of a pullet’s egg, and like it in colour, but stiffer, weighing about five drachms; the other two of a dark colour, more tough, about the like bigness, and heavier. It is a general observation amongst them that their ague comes away when they see those ague-cakes[571].”
Having followed this “good old way of observation and experiment” for several years among the residents of the Essex marshes, Talbor came to London, and set up his sign next door to Gray’s Inn Gate in Holborn. In 1672 (14th July) he issued a small work with a Greek title—the quacks were fond of the Greek character on their title-pages—“Πυρετολογια, a rational account of the cause and cure of agues, with their signs: whereunto is added a short account of the cause and cure of feavers.” He made a bid also for practice in “scurvy,” a disease of landsmen in those times which was more a bogey than ague itself—“a strange monster acting its part upon the stage of this little world in various shapes, counterfeiting the guise of most other diseases ... sometimes it is couchant, other times rampant, so alternately chronic and acute.”
Most of the agues which Talbor professed to have met with in London in those years must have been equally factitious: for Sydenham, who makes more of “intermittents” than other writers of repute, was of opinion that, for thirteen years from 1664 to 1677, fevers of that type had not been seen in London, except some sporadic cases or cases in which the attack had begun in the country. But the air was then full of talk and controversy about Peruvian bark, or Jesuits’ powder (pulvis patrum), or “the cortex,” which was cried up as a specific in agues by some, and cried down by others. Talbor had seized upon this specific, and claimed to have an original way of administering it, whereby its success was assured. We get a glimpse of his practice from Dr Philip Guide, a Frenchman who came to London and practised for many years as a member of the College of Physicians[572]. Talbor had cured the daughter of Lady Mordaunt of an ague, and the cure had reached the ears of Charles II. One of the French princesses having been long afflicted with a quartan ague,
“The king commanded Mr Talbor to take a turn at Paris, and as a mark of distinction he honoured him with the title of knight. He succeeded wonderfully. But he could not cure Lady Mordaunt’s daughter a second time, whom he had cured once before at London, by whom he gained most of his reputation.” He tried for two months, but did not relieve the symptoms. Dr Guide was called in, and being asked to give his opinion of the ague that the young lady was afflicted with, “after some inquiry I found her distemper was complicated and quite different from the ague, which made me lay the thought of the ague aside, and apply myself wholly to the complicated disease, which I effectually cured in twelve days, together with her ague, without having any further need of the infallible specific of Sir Robert Talbor.”