We are still in possession of a very distinct account, which we will here detail, of an epidemic at Abbeville in the year 1733, where the miliary fever had existed fifteen years previously. There were scarcely any premonitory symptoms, but the disease commenced at once with pinching pains in the stomach, extreme prostration of strength, dull headache, and difficulty of breathing, interrupted by sighing. Patients complained of violent heat, and were bathed in a pungent sweat of foul odour, while nausea was occasionally felt. Sparks appeared before the eyes, and the countenance became flushed. Patients were tormented with burning thirst; and yet the tongue was as moist as in perfect health. The pulse was frequent and undulating, without hardness; and in the course of a few hours, an insufferable itching came on over the whole body, accompanied by distressing jactitation: upon this, thickly studded, red, round pustules, not bigger than mustard-seeds, broke out, wherefrom patients emitted an extremely disagreeable urinous odour, which was imparted to those who were about their persons. Sometimes they had evacuations, at other times they suffered from constipation, but all complained of want of sleep; and when they felt an inclination to doze, they were again aroused by fresh chilliness. Many bled at the nose till they fainted; and with women, the menstrual discharge often appeared, though not at the proper time. The urine was at times deficient in quantity, at others discharged in abundance, and without any critical signs; if pale and plentiful, it betokened delirium; then the eyelids twitched convulsively, a humming noise commenced in the ears, and the patient tossed about restlessly. The pulse became strong, irregular, and, like the breathing, very quick. The countenance grew redder and redder; and soon after, the sufferers, as though struck by lightning, were seized with lethargy, and expired, generally in the act of coughing and spitting blood.
Such was the nature of the disease when it attacked many at once: there were, however, several varieties. With some the miliary vesicles broke out on the second day, with others not before the third; and if all went on favourably, they lost their redness on the seventh day, and the skin all over the body scaled off like bran. The fever was sometimes extremely violent; at others, without apparent cause, very mild; at least one might be deceived at the commencement of the attack, by the apparently favourable symptoms; for those who in the morning had scarcely any notable degree of fever, who neither suffered from any anxious sensation nor violent heat, in whom no subsultus tendinum was perceptible, no want of perspiration, nor any retrocession of the eruption, were sometimes towards evening seized with phrenzy, and died in a state of lethargy. Evacuations, which alleviate other diseases, made this miliary fever worse. Favourable symptoms could never be depended on. In the midst of profuse perspiration the patient died, either from constipation or diarrhœa. A copious discharge of urine was a bad sign; composure was succeeded by delirium, cheerfulness by lethargy: the disease was throughout treacherous and disguised. It was particularly necessary for those suffering from pleurisy or any inflammatory fevers to be guarded against its approach. Many fell sacrifices to this epidemic who thought themselves in a state of convalescence; and with such it was easier to foretell than to prevent the consequences. In cases of this kind the miliary vesicles were less red and grew pale sooner; but if the disease attacked a healthy person, then they were redder, and continued longer. Of those who recovered, not a few suffered for many months, nay, even for a whole year, from night perspirations, without fever or sleeplessness, but with an eruption of little miliary vesicles, which disappeared[510] again on the slightest exposure to cold. The later miliary epidemic fevers in France, which are distinguished by the name of the Picardy Sweating Sickness, are generally very well described[511]; so much so, that we have few epidemics of modern times whose course and succession we can trace so well. But the epidemic of 1821, which raged in the departments of the Oise, and of the Seine and Oise, from March to October, has been observed by all with the greatest care, including men of distinguished talent[512].
We shall give the description of this disease. There were no constant premonitory symptoms; it often broke out quite suddenly, but many complained some days before of debility, despondency, want of appetite, nausea, headache; sometimes also of giddiness and slight chilliness. Many retired to rest in health, and awoke during the night with the disease, covered with a perspiration, which ceased only with death or recovery. With some the sweating was preceded for some hours, or even only for some moments, by a scarcely perceptible feverish commotion, accompanied with burning heat, or with a sensation of pain which ran through every limb, and nearly always with spasms in the stomach. With others the disease announced itself by lacerating rheumatic pains, which gradually increasing, they became bed-ridden. The mouth was foul, the taste at times bitter, the tongue white, more rarely tinged with yellow, and thus it remained till the patient was restored. The sufferer was shortly covered with a thick, peculiarly fetid sweat, that certainly produced alleviation, but became very intolerable to him from its unpleasant stench, which was even communicated to the clothes of the bystanders. In the mean time it was discovered by the pulse, that the fever had considerably abated; but, on the third day, the patient was seized with convulsive spasms in the stomach, great oppression at the chest, and a sensation of suffocation—symptoms which caused him insupportable anguish. These attacks accompanied by hiccup and eructation, continued for several hours, and returned from time to time, an eruption, partly papular, simultaneously breaking out first on the neck, then on the shoulders down to the hands and breast, less frequently on the thighs and face. The little pimples were of a pale red colour and conical, with glistening heads, and between them appeared innumerable small miliary pustules, filled with transparent serous fluid, which soon thickened and assumed a whiter hue. At the time and previous to the breaking out of the exanthem, the patient experienced a very severe burning and pricking sensation in the skin, which nevertheless sometimes occurred on the second or fourth day, and which increased sometimes in one part, sometimes in another, when the sweating declined.
Towards the fifth day, however, after the sweating had entirely ceased, the complaint grew worse again. The spasms and paroxysms of suffocation returned, and they were succeeded by renewed eruptions of the exanthem; a decided improvement, however, shortly took place; the little pimples lost their redness, the miliary vesicles dried away, and at a period from the seventh to the tenth day recovery commenced under a general exfoliation of the cuticle. Sometimes the eruption did not appear, whether the patients were under medical treatment, or left to their own guidance, but with those few in whom there was an absence of miliary vesicles, that peculiar pricking and itching of the skin did not take place.
Between the fifth and seventh day the patients usually complained of great weakness, and had a desire to eat. A few tablespoonfuls of wine then agreed with them very well; for the rest, neither thirst nor lethargy was observable, but it was particularly remarkable that the urine was clear and abundant. Up to the seventh day a confined state of bowels was usual, and, with the exception of the already mentioned attacks of tightness and oppression, the breathing remained free, though with great sleeplessness, during the whole malady. Nothing morbid was to be observed in the chest, and the patients lay stretched out at full length, so that there was no occasion at any time to raise their heads.
Such was the regular course of this miliary fever, but its progress was often accelerated by very dangerous symptoms, and occasionally it proved fatal within a very few hours. If at the time of the attack the patients were very restless and talkative, the eyes glistening, the pulse, without being hard, tumultuous, and the edges of the tongue reddened, delirium soon succeeded and then convulsions and death. Great depression of the spirits was a very bad symptom; bleeding was never of any avail, yet the menstrual discharge did not interrupt the course of the disease. There was in general a great degree of malignancy perceptible in the malady, as was also rendered apparent by the course of the epidemic. If the miliary Sweating Fever broke out in a fresh place, two or three persons only were thereupon attacked, and that favourably, which led to a supposition that the evil had all passed away, for during the next fifteen or twenty days, not any fresh attacks were heard of. Suddenly, however, the epidemic reappeared with increased virulence. The great number of the sufferers spread consternation and terror amongst the inhabitants, and the cases of death became frequent. After this first burst of fury, the epidemic grew more mild again, so that many patients were not confined to their beds at all. This mitigation of the miliary fever was likewise manifested[513] by the prolongation of its course beyond the seventh day.
If we compare this epidemic with the one observed at Abbeville in 1773, we shall find between them but very trifling differences, which would appear still more clearly in some of the intermediate visitations, thus conforming to what has been observed in other eruptive maladies. It is consequently evident that the miliary fevers[514] which have appeared in France in recent times, do not differ in any essential point from those of more ancient date. The surest proof of their identity is, their persistence for nearly two centuries; and from the manner in which they have presented themselves to observation, they are to be considered as distinct from the English Sweating Sickness, though certainly allied to it. It would exceed our limits to pursue this inquiry further, but it may be as well to give the following short catalogue[515] of the most important miliary epidemics.
| 1652. | Leipzig. |
| 1660. | Augsburg. |
| 1666. | Bavaria. |
| 1672. | Hungary. |
| 1675. | Hamburgh. |
| 1680. | Germany to a great extent. |
| 1689. | Philippsburg. |
| 1690. | Stuttgard. Düsseldorf. Erfurt. Jena. |
| 1694. | Berlin. |
| 1700. | Breslau. |
| 1709. | Dantzic, Marienburg. |
| 1712. | Mümpelgart. |
| 1713. | Saint Valery. (Somme.) |
| 1714, 15. | Laybach. |
| 1715. | Breslau. Turin. |
| 1718. | Tübingen. Abbeville. (Somme.) |
| 1720. | Canton de Bray. (Lower Seine.) |
| 1723. | Francfort on the Maine. |
| 1724. | Turin. Vercelli. |
| 1726. | Acqui. Guise. (Aisne.) |
| 1728. | Chambéry, Annecy, St. Jean de Maurienne. (Savoy.) Carmagnola. Vercelli. Ivrea. Biella. |
| 1729. | Vienna. (Austria.) |
| 1730. | Pignerol. |
| 1731. | Fossano. |
| 1732. | Nizza. Rivoli. |
| 1733. | Fossano. Asti. Lanti. Acqui. Basle. Silesia. |
| 1734. | Strasburg. (Lower Rhine.) Acqui. Lanti. |
| 1735. | Trino. Lanti. Fresneuse. (Lower Seine.) Vimeux. (Seine et Oise.) Orleans. (Loiret.) Pluviers. (Loiret.) Meaux. Villeneuve. Saint George. (Seine et Marne.) Bohemia. Denmark. Sweden. Russia. |
| 1738. | Luzarches, Royaumont. (Seine et Oise.) Susa. Crescentino. |
| 1740. | Caen. (Calvados.) Provins. (Seine et Marne.) Vire. (Calvados.) Berthonville. (Eure.) Falaise. (Calvados.) |
| 1741. | Rouen. (Lower Seine.) Tartana. Valencia. Alexandria. London. |
| 1742. | Caudebec. (Lower Seine.) Ceva. Turin. Sorillano. Alba. Ivrea. Cherasco. Fossano. |
| 1743. | Villafranca. |
| 1744. | Acqui. |
| 1746. | Zurich. |
| 1747. | Paris. (Seine.) Beaumont. (Seine et Oise.) Chambly. (Oise.) Modena. Lodi. Mantua. Piacenza. |
| 1750. | Schaffhausen. Bern. Geneva. Beauvais. (Oise.) |
| 1751. | Villafranca. |
| 1752. | Fernaise. (Seine et Oise.) |
| 1753. | Susa. |
| 1754. | Valepuiseux. (Seine et Oise.) |
| 1755. | Novara. |
| 1756. | Cusset. (Allier.) Boulogne. (Pas de Calais.) |
| 1757. | Montaigu les Combrailles. (Puy de Dôme.) |
| 1758. | Amiens, environs. (Somme.) |
| 1759. | Paris. (Seine.) Guise. (Aisne.) Caudebec. (Lower Seine.) |
| 1760. | Alençon. (Orne.) |
| 1763. | Vire. (Calvados.) |
| 1763, 64. | Bayeux. (Calvados.) |
| 1765. | Balleroy, Basoques. (Calvados.) Saint-George, Saint-Quentin. (Calvados.) |
| 1766. | Campagny. (Calvados.) |
| 1767. | Thinchebray, Truttemer. (Orne.) |
| 1768, 69. | St. Quentin. (Aisne.) |
| 1770. | Louviers. (Eure.) |
| 1771. | Montargis. (Loiret.) |
| 1772. | Hardivilliers, environs. |
| 1773. | Hardivilliers. (Oise.) |
| 1776. | Laigle. (Orne.) |
| 1777. | Jouy. (Seine et Oise.) |
| 1782. | Castelnaudary. (Aude.) Boissy Saint-Léger. (Seine et Oise.) |
| 1783. | Beaumont. (Seine et Oise.) |
| 1791. | Méru. (Oise.) |
| 1810. | Nourare, Villotran. (Oise.) |
| 1812. | Rosheim, and many other places. (Lower Rhine.) |
| 1821. | La Chapelle, Saint-Pierre and sixty places around. (Oise; Seine et Oise.) |
Sect. 3.—The Roettingen Sweating Sickness.
We now come to a phenomenon which, notwithstanding its short duration and very limited extension, is one of the most memorable of this century. Up to the present time, its real importance has not been recognised, because the clouds of self-sufficient ignorance have prevented our taking a survey of the formation of diseases, throughout long periods of time. It has been sunk for an age in the sea of oblivion, from whence we will now draw it forth to the light of day.