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].