Fever and Influenza, 1657-9.
The account by Willis of three consecutive epidemics in the autumn of 1657, the spring of 1658, and the autumn of 1658, is of peculiar interest for the reason that it is the first systematic piece of epidemiology written in England, and that the middle epidemic of the three was one of influenza[1116]. On reading the narrative of events by Willis, we can understand how it was that the physicians of that period were so impressed by the doctrine of an epidemic constitution of the season, and by its counterpart doctrine of a seasonal predisposition in the human constitution. That teaching was afterwards expounded in successive essays by Sydenham; but it was held generally in those times, and Willis found apt illustrations of it in the three epidemics one after the other in 1657-58. Let us follow his narrative, and add to it some particulars from Whitmore.
The spring and summer of 1657 were extremely dry and hot; but especially after the summer solstice the heats were so intense for many weeks following that, day and night, there was none that did not complain of the heat of the air, and were almost in a continual sweat and were not able to breathe freely. About the calends of July, the fever which was at first sporadic and particular, began to break forth in some places, perhaps two or three cases in the same city or village. The fever fits at this period occurred every other day, but there was no cold fit or rigor preceding, as in an ordinary ague, the heat being intense from the outset. Vomiting and bilious stools occurred plentifully to most, with sweat succeeding, not however an easy, uninterrupted and critical sweat. The remission of the fever fit was rarely complete in the intermediate day, weakness, languor, thirst and restlessness always remaining. In some the type improved after three or four of these quasi-tertian paroxysms; the later fits were ushered in with a rigor and a cold stage, so that the fever became an exact tertian intermittent. But in most the type became worse, which may have been due to errors of regimen and physicking. The fever became, indeed, a continued one, and might end in nervous symptoms—lethargy, delirium, cramps or convulsions.
In August it was spreading far and near, so that in every region or village round Oxford, many were sick of it; but it was much more frequent in the country cottages and in the smaller villages than in cities or towns. It was called “the new disease,” as the war-typhus of 1643 had been called, and other epidemics both earlier and later.
Willis continues: It crept from house to house, infecting most of the same family, and especially those in familiar converse with the sick. “Yea old men, and men of ripe age, it ordinarily took away.” It lasted many days in an individual, nay even months, attended with much evacuation and almost daily vomits and sweats. “Scarce one in a thousand died of it, which I never knew in an epidemical synochus.” This singular malady, which differed from ague not only in its want of clear intervals between the fits of fever, but also in being propagated by contagion, raged throughout all England in the autumn of 1657. Only in some few limited localities, and in these only in some cases, was it accompanied by true dysentery. Willis is not satisfied with the facile explanation of an infection of the air, “the little bodies of which infections, being admitted within, did ferment with the blood and humours.” There must have been something equally general in the human body, a predisposition to be so acted upon; and of that proneness to fever he finds the cause in the intemperance of the year, namely the great heat of the summer and autumn.
But the most remarkable illustration of these doctrines was the epidemic of the following spring, which was a pure and unmistakeable epidemic of influenza-cold. After the very hot summer and autumn, there was a long winter of intense frost. From the ides of December to the vernal equinox the earth was covered with snow, the wind blowing steadily from the north. The state of health through the winter was fairly good. The north wind continued until June. “About the middle of April, suddenly a distemper arose as if sent by some blast of the stars, which laid hold of very many together; and in some towns in the space of a week above a thousand fell sick together.” They had a troublesome cough, great spitting, and catarrh “falling down on the palate, throat, and nostrils.” The illness approached with fever, thirst, want of appetite, weariness, grievous pains in the head, back, loins and limbs, and heat in the praecordia. Some were very ill in bed, with hoarseness and almost continual coughing; others had bleeding at the nose, bloody spittle or bloody flux. Not a few old and infirm died, but the more strong, and almost all the healthy constitutions recovered. Those that died “wasted leisurely,” like persons sick of a hectic fever. About the third part of mankind was distempered in a month. Willis’s explanation of it is that the constant north wind checked the natural action of the blood in spring. The spring blood is more lively, like the juices of vegetables. The catarrhal fever was a disorder of the spring blood, like new wine close shut up in bottles.
This outbreak about the middle of April is evidently described for Oxford and the country around. Willis then describes his third epidemic, that of the summer and autumn of 1658, which was the same type of fever as in the summer and autumn of 1657. The vernal fever of 1658 did not last longer than six weeks. The wind continued still north, until the summer solstice; a little before the beginning of July there was a most fierce heat for a few days, and when the dog-days were begun, the air grew most cruelly hot, so that one could scarce endure it in the open. The new fever arose mostly about the end of August, and began to spread through whole regions about us (at Oxford), and chiefly, like that of 1657, in country houses and villages; but in the meantime few of the inhabitants of the greater towns and cities fell sick. The symptoms were much the same as in the previous autumn. The fever was continual in some; in others it was of an intermitting type at first; but very many were ill “in their brain and nervous stock,” with cruel headache, noises in the ears, dullness of hearing, stupor, vertigo, waking, and delirium. In some, on the first or second day, “little broad and red spots like to the measles have leisurely broken forth in the whole body, which being shortly vanished, the fever and headache became worse.” The patients lay for a few days as if dying, without speaking or knowing their friends, after which came lethargy and delirium. The young men mostly recovered, the old men died. In the fits of old men, the heat was not very sharp, but there were restlessness, tossing about, idle and random talking, with dryness of the mouth, surfiness of the tongue, and viscous sordes. Usually the pulse was strong and equal; a weak, unequal and intermittent pulse, with contractures of the tendons and convulsive motions in the wrists, was an omen of death. Those who died passed away in a stupor, without consciousness to dispose of their goods; the recovery of others was long and doubtful. One notable thing in this fever was the exanthem, which reminds one more of the rash of sweating sickness or dengue (breakbone fever), than of the spots of typhus.
Willis ends his book on fevers with that account of the autumnal epidemic of 1658, “taken the 13th of September,” his work having been published at the Hague in 1659. Whitmore, whose short essay is dated from London, November, 1659, begins with the autumnal epidemic of 1658, which is the last of Willis’s three; and, strangely enough, he also has a vernal epidemic of influenza to describe—an epidemic clearly belonging to the spring of 1659. Unless there be some error in Whitmore’s dates, it is impossible to avoid the conclusion that the second autumnal fever, that of 1658, was followed by a spring influenza, just as the first, of 1657, had been.
Whitmore’s account of the autumnal fever of 1658 agrees in the main with that given by Willis. He defines it as “a putrid continued and malignant fever containing in it the seeds of contagion.” It raged in the last autumn through all England, “and now begins again,” (his preface being dated November, 1659), seizing on all sorts of people of different nature, which shows that it is epidemic. The part affected is chiefly the heart, and therefore some call it cordis morbus.
“In this, as in the plague at the first catching of it, some seem to be very pleasant, so far are they from perceiving themselves to be amiss, when indeed death itself hath set his foot within the threshold of their earthly houses.” There were pains in the head, inclination to vomit, sudden fainting of spirits, and weakness without any manifest cause, the pulse feeble and sometimes intermittent, so as very lusty and strong men in Cheshire (in the year 1651 where this disease then raged) in a very short space so lost their strength that they were not able to stand or turn themselves in their beds. Some also are taken with bleeding, purging, and sweating, and many have the spots. But for the most part it appears in the livery of some other kind of ague. It begins to show its malignity after the 5th, 7th, or 9th day, with loss of appetite, thirst, and a dry black tongue.