Now, the same century and the same state of society which witnessed the most remarkable of those flying ripples of infection over the whole surface of Europe witnessed also some waves of infection which did not travel so far, nor were mere influenzas. The English sweat travelled over England in that way; it was called the posting sweat, because it posted from town to town: thus in 1551 it suddenly appeared one day in Oxford, and next day it was in the villages around, as if carried in the air; in like manner it posted to Devonshire, to Leicestershire, to Cheshire, and doubtless all over England, like the influenzas of recent memory. And while the English sweat was thus flying about in England, influenza was flying about the same year (1551) in France, a country which never suffered from any of the five sweating sicknesses of 1485-1551. Again, the influenza in England in 1558 had the symptom of sweating so marked that it was compared to the true sweat of 1551 by Dr Jones, who himself suffered from it. Also the influenza of 1580 all over Europe had so much of a sweating character that in some places they said the English sweat had come back. Lastly, the gaol-fever of Oxford in 1577 was thought by some to present the symptoms described by Leonard Fuchs for sudor Anglicus; and Cogan, an English medical writer then living, specially mentions the phenomenon of sweating (as well as the intestinal profluvium called a “lask”), both at Oxford and in the more widely prevalent diseases of that year and the years following. The gaol-fever of Exeter in 1586 illustrates still another side of the question; it diffused itself—probably by other means than contact with the sick—all over the county of Devon, and had not ceased six months after it began in the month of March at Exeter. The Devonshire diffusion was like the spreading circles in a still pool. The spread of influenza was like the flying ripples on a broad surface of water. The spread of plague, on the occasions when it was universal, was like the massive rollers of the depths, the onward march of cholera from the East having, in our own times, illustrated afresh the same momentum.
In using hitherto the name of influenza for the universal fevers in England in 1557-58 and in 1580-82, I have done so because those years are usually reckoned in the annals of influenza. But the name is at best a generic one, and need not commit us to any nosological definition. I shall have to deal at more length with this question in the tenth chapter, when speaking of the fevers of 1657-59 described by Willis and Whitmore, two competent medical observers; in those years the vernal fever was a catarrhal fever, or influenza proper, while the fever of the hot and dry season, autumnal or harvest-fever, was a pestilential fever, a spotted fever, a burning ague, a contagious malignant fever. There were also differences in their epidemological as well as in their clinical characters, the influenza wave being soonest past. But so far as regarded universality of diffusion and generality of incidence, both types were much alike.
Molineux, writing in 1694, a generation after Willis, “On the late general coughs and colds,” brought into comparison with them another epidemic which he had observed in Dublin in the month of July, 1688: “The transient fever of 1688 ... I look upon to have been the most universal fever, as this [1693] the most universal cold, that has ever appeared[821].”
When we come to the 18th century, to great epidemics not only in connexion with famine in Ireland, but also in England, we shall find the same diffusiveness associated with the clear type of disease which we now call typhus. Influenza is the only sickness familiar to ourselves which shows the volatile character, and we are apt to conclude that no other type of fever ever had that character. But, without going farther back than the 18th century we shall find epidemics of spotted typhus resting like an atmosphere of infection over whole tracts of Britain and Ireland, town and country alike; and even if we give the name of influenza to the epidemical “hot agues” with which we are here immediately concerned, in the years 1540, 1557-8, and 1580-82, we may also regard them as in a manner corresponding to, if not as embracing, the types of fever that prevailed from time to time over wide districts of country in the centuries following.
The term “ague,” often used at the time, is no more decisive for the nosological character than the term “influenza.” Ague originally meant a sharp fever (febris acuta, ὄξυς), and in Ireland, from the time of Giraldus Cambrensis down to the 18th century, it meant the acute fever of the country, which has not been malarial ague, in historical times at least, but typhus. “Irish ague” was in later times a well-understood term for contagious pestilential fever or typhus. In the Dyall of Agues by Dr John Jones (1564 ?), just as in the writings of Sydenham a century later, intermittents were mixed up with continued fevers which had nothing malarial in their cause or circumstances. Thus, Jones has a chapter on “Hot Rotten Agues,” which he identifies with the synochus or continued fever of the Greeks; in another chapter on “The Continual Rotten Ague,” he locates the continued fevers within the vessels and the “interpolate” without their walls, and proceeds:
“It happeneth where all the vessels, but most chiefly in the greatest which are annexed about the flaps of the lungs and spiritual members, all equally putrefying, which often happeneth, as Fuchsius witnesseth, of vehement binding and retaining the filth in the cavity or hollowness of the vessels, inducing a burning heat. Wherefore, this kind of fever chanceth not to lean persons, nor to such as be of a thin constitution and cold temperament, nor an old age (that ever I saw), but often in them which abound with blood and of sanguine complexion, replenished with humour, fat and corpulent, solemners of Bacchus’ feasts,—gorge upon gorge, quaff upon quaff—not altogether with meat or drink of good nourishment but of omnium gatherum, as well to the destruction of themselves as uncurable to the physician, as by my prediction came to pass (besides others) upon a gentleman of Suffolk, a little from Ipswich, who by the causes aforesaid got his sickness, and thereof died the ninth day, according to my prediction, as his wife and friend knoweth.”
Again, in his eighth chapter, “Of the Pestilential Fever, or Plague, or Boche [Botch],” he remarks upon the varying types of pestilential diseases, mentioning among other national types the English sweat:
“As we, not out of mind past, with a sweat called stoupe galante, as that worthy Doctor Caius hath written at large in his book De Ephemera Britannica,” adding the remark that here concerns us:—“and sethence [since then], with many pestilential agues, and, lastly of all, with the pestilential boche [botch or plague rightly termed].” These continued fevers, pestilential agues, or hot rotten agues, Jones distinguishes from quotidians, tertians and quartans. Of the last he says: “and when quartans reign everywhere, as they did of no long years past; of the which then I tasted part, besides my experience had of others,”—probably the fevers of 1558, elsewhere called by him the sweating sickness, and by Stow called “quartan agues.” He mentions also quintains, which he had never seen in England, “but yet in Ireland, at a place called Carlow, I was informed by Mr Brian Jones, then there captain, of a kerne or gentleman there that had the quintain long.”
Not only the term “ague,” but also the terms “intermittent,” “tertian,” and more especially “quartan,” can hardly be taken in their modern sense as restricted to malarial or climatic fevers. An intermittent or paroxysmal character of fevers was made out on various grounds, to suit the traditional Galenic or Greek teaching; but the paroxysms and intermissions were not associated specially with rise and fall of the body-temperature. The curious history of agues, and of the specialist ague-curers, properly belongs to the time of the Restoration, when Peruvian bark came into vogue, and will be fully dealt with in the first chapter of another volume.
The last years in the Tudor period that stand out conspicuously in the parish registers for a high mortality, not due to plague, are 1597-8. The year 1597 was a season of influenza in Italy, and perhaps elsewhere in Europe; so that the epidemic in England that year may have been the same, but more probably was famine-fever. In the parish register of Cranbrooke the deaths for the year are 222, against 56 births; and 181 of the deaths are marked with the mark which is supposed to mean plague proper. The register of Tiverton has 277 deaths, against 66 births, but it is almost certain that the cause of the excess was not plague, of which the nearest epidemic in that town was in 1591. In a country parish of Hampshire, with a population of some 2700, the deaths in 1597 were 117, against 48 births, the mortality being about twice as great as in any year from the commencement of the register in 1569, and after until 1612[822]. In the north of England the type of disease in 1597-8 was plague proper.