BOUGHT WITH THE INCOME PROM THE SAGE ENDOWMENT FUND THE GIFT OF Henrg W. Sage 1891 Ji.,mAii............. , , S'ppi Cornel) University Library RC 150.6.G6T47 Annals of influenza or epidemic catarrha 3 1924 012 509 190 ANNALS "f'^'lf;!- (VV INFLUENZA EPIDEMIC CATARRHAL EEVER &EEAT BEITAIN FROM 1510 TO 1837. PEEPARED AND EDITED BY THEOPHILUS THOMPSON, M.D. F.R.S. FRLLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON; PHYSICIAN TO THE HOSPITAL FOH CONSUMPTION, ETC. LONDON: PRINTED FOR THE SYDENHAM SOCIETY. HDCCC LII. C. AND J. ADLARD, PRINTERS, BARTHOLOMEW CLOSE. PEEEACE. The disorder which it is the object of this work to illustrate, sparing no part of the world in its circuit, has visited the British Isles with great severity, and has of late returned with increased frequency. A complete chronological history of its visitations (hitherto a desideratum) was doubtless regarded by the Council of the Sydenham Society as calculated to be of considerable value, in various ways, to medical practitioners ; enabling them to compare the disorder, on any occasion of its recurrence, with those previous epidemics which it may most resemble, and suggesting particulars requiring further investi- gation, whenever such an opportunity is renewed. The infor- mation extant on the subject, although considerable, was not readily accessible, being sometimes, as it were, concealed in volumes devoted chiefly to other topics, or otherwise scattered through the pages of periodicals long since discontinued. The Editor, in endeavouring to fulfil the difficult but honorable task with which he has been intrusted by the Council, has spared no pains in the search, or care in the selection of materials; and he has shared with the Council a desire to present the facts which are recorded, as far as possible, in the words of the original observers, although, especially as respects vi PREFACE. the visitation of 1803, the miscellaneous character of the communications has rendered such an attempt by no means easy. He has much satisfaction in being the first to put into an English form the classical production of Sir George Baker. In the office of selecting, he has aimed to avoid the omission of any Treatise remarkable either for the importance of the information conveyed, or for the high character of intellect evinced in the composition. In this respect he cannot but congratulate himself in the belief, that the work includes abundant materials of interest, irrespective of its immediate subject. Such writers as Huxham, Arbuthnot, Gray, Pringle, Fothergill, Hamilton, Whytt, Falconer, and Heberden, can scarcely be studied without profit. If we bring to the advantages of modern light the manly sense of the Fathers of British Medicine, we may reasonably expect to make more rapid advances in the practice of our art. In reference to the typographical arrangement of the volume, it will be observed, that quotations are distinguished by the usual mark of inverted commas, and that the Editor's observations, whenever a distinction is required, are included in brackets. The Editor cannot flatter himself with the conviction of having, on the one hand, entirely avoided the omission of facts of interest, and, on the other, the introduction of an undue copiousness of detail; but the latter error may find some excuse in the difficulty and interest of the subject, whilst the curious inquirer may escape the disadvantages incident to the former, by availing himself of the references given to the original observers. In the concluding remarks appended to the work, he has abstained from any elaborate description of the phenomena of PREFACE. vii the disease, since his own views in tMs respect so nearly cor- respond with those introduced into the volume from other authors, and especially as presented in the admirable report, by Dr. Streeten, of the epidemic of 1 837. It only remains for him to express his obligations to Dr. Risdon Bennett, the Secretary of the Society, and to Dr. Pereira, as well as to his accomplished friends. Dr. Stroud and Dr. Boott, for valuable suggestions as the work has been passing through the press. There are others whom he abstains from specifying, but who will always be gratefully associated in his mind with the work which he now commends to his professional brethren, not without dififidence, but with a conviction, considering the nature of the undertaking, that the facility of judgment will not lessen the readiness of their indulgence. T. T. 3, Bedford Square; February, 1852. Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924012509190 INTRODUCTION. The laws which regulate Epidemic Diseases are well en- titled to careful investigation. The variations of the same disease on different occasions of its epidemic prevalence, are so considerable, as to have elicited from the observant and judi- cious Sydenham the remark, that on each fresh visit of such disease he had to work out for himself a fresh knowledge of the appropriate plan of treatment. But the advantages which the inquiry presents are not confined to its practical relation to individual instances of such disease. They spread through- out the whole compass of Etiology, and tend to illustrate the causes which affect human life in the aggregate. Influenza, the epidemic to the description of which this Volume is de- voted, possesses, in this point of view, a special interest, being of all epidemics the most extensively diff'used, and apparently the least liable to essential modification, either by appreciable atmospheric changes, or by hygienic conditions under the control of man. It is not like Smallpox, communicable by inoculation; and, however, its fatality may be infiuenced by defective drainage, it is not like Typhus, traceable to this neglect as its cause. Unlike Cholera, it outstrips in its course the speed of human intercourse. It does not, like Plague, desert for ages a country which it has once afflicted, nor is it accustomed, like the Sweating- Sickness, in any marked manner X INTRODUCTION. to limit its attack to particular nationSj or races of mankind. There is a grandeur in its constancy and immutability superior to the influence of national habits. The changes in our national system of diet during the period which this Volume embraces, have been calculated to effect remarkable modifi- cations in the condition of the people in reference to disease, yet, as respects Influenza, they are not proved to have exerted any manifest influence. The disease, moreover, exhibits in the well-ordered mansions of modern days, phenomena similar to those which it presented in the time when rushes strewed the ground in the presence chamber of our monarchs, and decaying animal and vegetable matter obstructed the porticoes of palaces. The importance of the subject cannot be estimated simply by the number of deaths recorded as directly attributable to the disease ; indeed we frequently find visitations of Influenza represented as by no means fatal. It is necessary to extend our consideration to the fact, that during the prevalence of Epidemic Catarrhal Fever the mortality is usually increased, often to a very remarkable degree; the cause of Influenza, independently of its agency in producing characteristic sym- ptoms, appearing to exert a power to modify any pre-existing disease with which it may combine ; to impair extensively the vital energy, so as to increase, in the population of an affected district, the liability to contract other diseases ; and also to lessen the ability to resist any degree of fatal tendency which such concurrent diseases may possess. The analogies traceable between Influenza and other dis- orders, and its seeming relation to them in the way of transition or succession, are so remarkable, as to encourage the hope, that the study of this malady may help us to distinguish be- tween the essential circumstances and the modifying influences concerned in producing the phenomena of epidemic disease in general. It is by explaining the laws obeyed by the most INTRODUCTION. xi simple affections of this clasSj that we may most reasonably expect to elucidate those which are apparently dependent on more complicated conditions. No single generation of medical practitioners can be ex- pected to possess a sufficient range of observation^ or to accumulate adequate materials of information on the subject, to enable them to detect the clue by which to thread the intricacies of this inquiry. The past must be scrutinised, and its reflected light brought to our aid ; old and new facts when collated, by the harmony which they exhibit, become mutuallj' illustrative, and acquire a value previously unknown. It is true, that medical records abound in fallacious and imperfect observations, transmitted from one generation to another, and that popular prejudices have exercised an in- fluence in disseminating error, which the obstinacy engendered by the evidence of imperfectly observed facts has tended to confirm and perpetuate ; but it is possible to manifest too in- discriminate a contempt for statements which partake of popular superstition. Popular opinion is not always necessarily incorrect, because inconsistent with the views of contemporary philosophers. The " fiery tears " recorded in old Church Calendars, as having fallen from meteors, owed their appearance to something more than the superstitious fancies of the nar- rators, and the days of their recorded appearance harmonise in an interesting manner with those on which the observations of modern astronomers would lead us to expect them. It would be presumptuous to set aside, as absurd, frivolous, or erroneous, observations given in this Volume, on the testimony of honest observers, merely because such observations may not be con- sistent with our preconceived opinions, or explicable by our schemes of philosophy. Signacula, " blood rains," " bloody springs," wheat similarly coloured, and such like phenomena, noticed in recent history, and in the annals of the sixteenth century, although in the intermediate period rarely recorded, xii INTRODUCTION. perhaps from the fear of seeming superstitious, are brought by modern research within the limits of explanation and belief. The copiousness and variety of observation admitted into this treatise will not be without value, if, as respects theoretical opinion, they serve only to establish such negative conclusions as often prove the first and most secure steps in true philosophy, and convince the most confident theorists that they still have something to unlearn. The Editor of this Volume has en- deavoured to present the picture of Influenza exactly as it is delineated by the original observers, for he is convinced that it is expedient to avoid the colouring which the existence of any bias in his own mind might occasion, since narratives free from all preconceived impressions contribute far more effectually than compilations to the formation of clear and independent opinion. Authentic information has been incorporated regarding epidemic disease among lower animals, occurring contempora- neously with the prevalence of Influenza amongst mankind, and presenting analogous appearances. Remarkable variations in the proportion of certain insect tribes are incidentally recorded in this work, with reference to a theory lately canvassed regarding the dependence of epidemics on insect origin. Such an idea is not altogether novel : it was popularly entertained in the last century. Dr. Grant, indeed, in his Essay on 'Influenza,' published in the year 178.2, asserts that the French term, la grippe, was derived from an insect of that name, remarkably common in France during the previous spring, and which the people imagined contaminated the air. The question has naturally arisen, whether the morbid influence, affecting at the same time the human species and the inferior animals, has extended to the vegetable kingdom; but no facts sufficiently striking have been obtained to warrant their introduction as relating to this inquiry. Many instances of INTRODUCTION. xiii disturbed vitality prevailing among particular species of plants appear attributable to great vicissitudes of temperature. In other instancesj the ravages of insects may explain widely spread disease in particular species of plants, of which a good example is afforded in the instance of the larch infested by the Eriosma Laricis.' A similar event has also been observed in the oak, also in that hardy tree, the Pinus Sylvestris, and in other specimens of coniferse : not perhaps from any special liability, but because these trees, under such circumstances, in consequence of their magnitude, attract particular attention. It is worthy of observation, that previous delicacy of plants seems often concerned in producing liability to such assaults. Thus the rose Aphis has been remarked not to visit the cele- brated gardens in Leith Walk, near Edinburgh ; but if the roses are placed in circumstances less favorable to health, and especially if brought to London, they are soon attacked by the insect. Of late years, various plants have suffered from some un- known cause destroying their vegetation. The turnip, the mangel-wurzel, and the onion, have been subject to a disease not unlike that of the potato. The cucumber has often been unfit for use in consequence of a glutinous matter exuding from the fruit when about half grown; and during the last summer the vineyards of England and France have been extensively infested by a fungus or mildew, (probably the Oidium Tuckeri.) Our information regarding the occurrence of extensive blights or deteriorations, such as that affecting the potato crop, is not, however, sufficient to authorise our making any generalisation on the subject, or proceeding beyond the simple suggestion of an inquiry as worthy of future investi- ' For some interesting information on this subject, the Editor is indebted to Mr. Forbes, of Woburn ; but chronological records regarding vegetable epidemics are confessedly deficient. xiv INTRODUCTION. gatioUj into the possible existence of some relationship of cause in the contemporaneous disturbance of the two great classes of animal and vegetable life. The comprehensive accumulation of facts now presented to the profession, by affording materials to those who would aim to interpret their meaning, may render unnecessary any attempt on the part of the author to describe at large his own opinion regarding the essential nature of the malady, even in relation to the principles which should determine its treatment. It may be sufficient to invite attention to the evidence which these Annals afford, that the existence of the disease is de- pendent on some virus introduced into the system, the febrile symptoms thus induced being modified by the amount and virulence of the poison, as well as by the power of reaction, and by other constitutional peculiarities of the individual attacked; and the rapidity with which the febrile manifesta- tions disappear being probably proportionate to the promptness with which remedies appropriate for the elimination of the poison can be employed, consistently with the adoption of measures calculated to sustain the patient's strength. TABLE OE CONTENTS. Peeface ..... PAGE V Inteoduction .... ix History op Epidemics of 1510 — 1581 . Dr. Short's History Erasmus . . . . 1 3 4 Epidemic op 1658 .... Dr. Willis's History 11 ib. Epidemic of 1675 .... Sydenham's Account 17 ib. Epidemic of 1688 .... 23 Epidemic op 1693 .... Dr. Molyneux Dr. Short's History ib. ib. 25 Epidemic of 1709 . ib. Epidemic of 1729 Huxham's Observations Dr. Arbuthnot's Essay Medical Observations in Edinburgh 28 ib. 35 39 Epidemic op 1737 Huxham .... 53 ib. Epidemic op 1743 .... Huxham .... 58 ib. Epidemic op 1758 .... Dr. Whytt .... Dr. Alves .... Dr. Millar .... 61 ib. 66 67 Epidemic op 1762 .... Sir George Baker Dr. Watson .... Dr. Rutty .... 68 ib, 76 79 Epidemic of 1767 , . . .• Heberden .... 84 ib. Epidemic op 1775 .... Dr. Fpthergill 86 ib. xvi CONTENTS. Epidemic of 1775 continued. PAGE Sir John Pringle 89 Dr. Heberden 90 Sir George Baker . 91 Dr. Henry Revell Reynolds . 93 Dr. William Cuming . 94 Dr. Thomas Glass . 96 Dr. Ash . . . . 103 Dr. W. White . 10.5 Dr. Haygarth . 108 Dr. R. Pulteney . Ill Dr. W. Thompson . 112 G. Skene .... . ib. Dr. D. Campbell . 113 Dr. J. C. Fleury . ib. Dr. D. Rainey . 114 Epidemic of 1782 117 Dr. Edward Gray . ib. Dr. Carmichael Smith . 148 London College of Physicians 155 Dr. R. Hamilton . 164 Dr. Blagden . 190 Dr. Haygarth . 191 Epidemic of 1789-90 . 199 Dr. Warren . ib. Epidemic op 1803 .... . 202 Various Authors, and Editor's Annotations 203 Dr. R. Pearson . . 239 Dr. Carrick . 246 Dr. Falconer . 253 Dr. Nelson Scott . 271 Epidemic op 1831 . 278 Dr. Burne .... . ib. Mr. G. Bennett . . 281 Admiralty Reports . 283 Various Authors, and Editor's Annotations 285 Epidemic op 1833 . 286 Mr. Hingeston . ib. Mr. Youatt . 291 Epidemic op 1836 — 37 . 292 Dr. Streeten ib. Dr. Greenhow . 341 Dr. Graves . 342 Dr. Clen dinning . 354 Dr. Bryson, and Annotations . 359 Summary . . . _ . 367 Concluding Remarks . 372 ANNALS OF INFLUENZA GREAT BRITAIN. The Malady which forms the subject of this volume, is described, in an Irish Manuscript of the Fifteenth Century, under the names of Fuacht and Slaodan; and it is mentioned in the 'Annals of the Four Masters' as epidemic in Ireland in the Fourteenth Century. A disease, the symptoms of which answer to those of Influenza, is also alluded to in our early Gaelic manuscripts under the term " Creatan," probably from "Great," the Chest ; but the first visitation of the disease in the British islands, of which we possess an accurate description, is that of the year 1510.^ The Sixteenth Century, the great transition period from feudal tyranny to liberty and order, was ushered in with much commo- tion of the elements, and marked with destructive pestilence. A severe Winter followed the wet Summer of 1505. In 1506 a Comet appeared, and an Eruption of Vesuvius occurred.^ In January the violent Storm arose which drove Philip of Austria, with his consort Johanna, from the Netherlands to Weymouth.^ ' Dublin Quarterly Journal of Medicine, Feb. 1848, p. 256. 2 Spangenherg (Cyriacus), ' Mansfeldische Chronica,' 1572; Webster (Noah), 'A Brief History of Epidemic Diseases.' 2 " The tempest that he suffered on the sea was huge and wonderfull, also upon the lande, insomuch that the violence of the wynde blew downe an Eagle of brasse, being set to shewe on which part the wynde blew from pynacle or spire of Panic's Church ; and in the falling, the same Eagle broke and battered another Eagle that was set uppe for a signe at a Taverne doore in Cheapeside. And hereupon many men that were given to gesse things that shoulde happen, by marking of stronge tokens, decined that the Emperour Maximilian, which gave the Eagle, should suffer some greate mysfortune ; and Hee did shortly after, by the losse of hys sonne, the sayde King Philip.'' (Stow's 'Annals.') 1 3 EPIDEMICS OF 1510-1581. The secret influences which affect Animal Life, gradually- produced sensible manifestations. The unusual combination of circumstances requisite for the exuberant production of Locusts, occurring in Europe, occasioned great swarms of that insect m Seville in the years 1507, 1508, and 1510. About the same period, a great murrain amongst Cattle at Meissen led to the execution of some "bose Buben" (wicked knaves), suspected of poisoning the pastures. A very considerable blight of Cater- pillars in the north of Germany stripped the gardens and woods of their foliage ; and Signacula, or blood-spots, supposed by Agricola, an ingenious writer of that century, to be lichens, so abounded on linen, the veils of women, the food in larders, and even in the atmosphere in the form of blood-rain,^ as to fill the popular mind with superstitious dread.^ Sweating- sickness ravaged England in 1506 ; and for several subsequent years various fevers prevailed in Europe. In 1510, the first well-described and widely-prevalent epidemic of Influenza appeared. The best account which can now be obtained of this epidemic is here presented in the words of Dr. Short, in whose accuracy the Editor has reason to place confidence, although he has not been able, in his endeavours to verify the quotations, to obtain access to all the works to which Dr. Short refers. ' These miraculous blood-spots have, at various periods, excited the alarm of the superstitious; they awakened, for instance, the apprehensions of Alexander's soldiers at the siege of Tyre ; they constituted one of the prodigies which preceded the successes of Hannibal in Italy (Plutarch, in ' Fabius') ; and have been frequently recorded by authors of different countries and periods : but their nature does not appear to have been made an object of strict scientific scrutiny before the year 1819, when a farmer, of Padua, being alarmed by seeing spots of a vivid red colour, closely resembling drops of blood, upon his porridge, which was made of the maize which grew in the neighbourhood, a commission was appointed to investigate the phenomenon. M. Settc supposed them to be formed of microscopical fungi, to which he gave the name of zoogalactina imetrofa. Ehrenberg, however, considers these red spots to consist not of fungi, but of a species of animalcule, which, on account of its extreme small- ness, he names monas prodigiosa. These little beings are transparent, when separately examined, but, when in a mass, appear the colour of blood. They are from a three- thousandth to an eight-thousandth part of a line in length, so that, as calculated by Ehrenberg, the space of a cubic inch may contain from 46,656,000,000,000 to 884,836,000,000,000 of these monads. (Ehrenberg, ' Passat Staub und Blut-regen,' Berhn, 1849; Bericht der Berliner Akadamie, 1848, p. 353. This subject is more fully noticed at a later period of this volume. (See Epidemics of 1803, 1830, 1833, 1837 ; and also concluding remarks. ^ Mezeray (Comtl de), ' Histoire de France' (Paris), 1685, t. ii, p. 819. DR. SHORT'S HISTORY. 3 EPIDEMICS OP 1510-1581. SHORT.^ 1^-,^ "The disease called Coccoluche, or Coccolucio, (be- cause the sick wore a cap or covering close all over their headsj) came from the island Melite in Africa, into Sicily; so into Spain and Italy, from that over the Alps into Portugal, Hungary, and a great part of Germany, even to the Baltic Sea ; every month shifting its situation with the wind from East to West, so into France, Britain, &c., Valeriola, Pechlin, &c. It attacked at once, and raged all over Europe, not missing a family, and scarce a person. A grievous pain of the head, heaviness, difficulty of breathing, hoarseness, loss of strength and appetite, restlessness, watchings, from a terrible taring cough. Presently, succeeded a chilness, and so a violent cough, that many were in danger of suffocation. The first days it was without spitting; but about the seventh or eighth day, much viscid phlegm was spit up. Others (though fewer,) spit only water and froth. When they began to spit, cough and shortness of breath were easier. None died, except some children. In some, it went oiF with a looseness ; in others, by sweating. Bleeding and purging did hurt. Bole Armoniac was chiefly useful, with oily lintus's, pectoral troches, and decoctions. Where blood was let, the disease proved malignant and pestilential, being attended with a violent, cruel, and unheard of malignity, and made bad work. It was preceded by a long, moist air. We shall find it again in '57, '80, and '97, &c. June 20th, at Gulick and Juliers, such extraordinary Thunder and Lightning, as struck all with a pannick. A Thunderbolt fired the magazine, and did great damage." {Hist, of the Iron Age.) [Stones, varying in weight from 60 to 1 20 pounds, fell from the Heavens in Lombardy. {Surius, Cardanus de Rerum Varietate.) During this year, there also occurred great Earthquakes, and a Volcanic Eruption in Iceland. The air was humid. In the following year a Comet appeared. ' A General Chronological History of the Air, Weather, Seasons, Meteors, &c. By Dr. Thomas Short. London, 1749. ' Webster, (op. cit.) 4 EPIDEMICS OF 1510-1581. During the prevalence of Influenza in Britain, Spain was afflicted with Sweating-sickness.] ^ " In the previous year, September 14th, was an Earthquake at Constantinople, and the countries thereabouts ; it demolished a great part of the city walls and stately buildings, and slew 13,000 people. It lasted a month with very little intermis- sion; after it came a Plague, which almost depopulated the city." {Turk's History.) " This year a great mortality prevailed in England, say our historians; they call it (as indeed all dis- eases) the Plague ; but to know what it was, we must consult Foreigners. Says Cole, when dearth, scarcity of corn, famine, rainy seasons, and severe cold ones, had afflicted Italy for two years, and people were forced to eat uncommon and unwhole- some food, arose an epidemic contagious Fever, with a dy- sentery, and black spots over the whole body. And from this want of food, great weakness, and unhealthy juices, they had a pale cacco-chimic and depraved countenance, a swelling of their feet, and difficulty of breathing." [The following account of the habits of our countrymen at this period, in a letter from Erasmus to the Physician of Cardinal Wolsey, may here be appropriately introduced.^ " I often grieve and wonder how it happens, that Britain has now, for so many years, been afflicted with a continual Plague, and chiefly with the Sweating-sickness, which is a malady that seems almost peculiar to the country. We have read of a state being delivered from a long- continued pesti- lence by changing the style of building, upon the advice of a philosopher. If I am not deceived, England may be freed in a similar manner. In the first place, the English have no regard to what quarter of the Heavens their windows or doors are turned ; in the next, their sitting-rooms are generally so constructed, as to be incapable of being ventilated, which is a thing that Galen particularly recommends. Furthermore, a great part of the wall is made transparent by glass plates (or squares), which admit the hght, but exclude the wind: and ' Villalba (Don Joaquin de), 'Epidemiologia Espanola,' 2 torn., Madrid, 1803. ' Des Erasmi. Epist. (LugdunT Batav.), torn, iii, epist. 432, (as translated in 'Retrospective Review,' vol. v, p. 24; 1703.) EEASMUS. 5 yet, through the small creviceSj they admit the air to be strained, which becomes somewhat more pestilent by staying there a long time. The streets, too, are, generally covered with clay and rushes, which are so seldom renewed, that the cover- ing sometimes remains twenty years, concealing beneath a mass of all descriptions of filth, not fit to mention. Hence, upon a change in the atmosphere, a certain vapour is exhaled, in my opinion, not at all wholesome for the human body. Added to this, England is not only surrounded by the sea on every side, but it is also, in many places, marshy, and inter- sected by salt streams, to say nothing at present of the salt food, of which the commou people are amazingly fond. " It is my firm opinion, that the island would become much more wholesome, if the spreading of rushes on the ground were not used, and if the chambers were so built as to be ex- posed to the Heavens on two or three sides, the windows of glass being so made as to open altogether, and close in the same way, and to shut so as not to admit noxious winds through the crevices. Since, as it is sometimes wholesome to admit the air, so it is sometimes as much so to keep it out. The common people laugh, if a person complain of the cloudy sky. If, even twenty years ago, I had entered into a chamber which had been uninhabited for some months, I was imme- diately seized with a fever. It would contribute to this object (to render the island more healthy), if more sparing diet could be more generally recommended, and a more moderate use of salt provisions; and if certain public officers were commis- sioned to keep the roads more free from nuisances. Those parts, too, should be looked to more particularly, which are in the neighbourhood of a town. You will laugh at my having time to trouble myself about these matters. I love the country which has for so long a time given me an hospitable abode, and in it, should circumstances allow, I would willingly spend what remains of life. " I have no doubt from your character for wisdom, that you know these matters better than myself; I resolved, how- ever, to mention them to you, that you may, if my opinion coincides with yours, recommend these hints to the notice of the great. Por, in former days, kings were wont to interest themselves in such things," &c. &c.] 6 EPIDEMICS OF 1510-1581, [In 1556, there were showers of Blood, and an Eruption of Etna. The season was mostly wet; but in some countries dry. In the subsequent year a Comet appeared.] " This year and last (proceeds Dr. Short) was a great ■^^^^' scarcity of Corn from the past great rains. It was a very unseasonable year in England, all the corn was choaked and blasted, the harvest excessive wet and rainy ; before harvest this year, wheat was sold at 4 marks per quarter ; malt, at 44s. per quarter ; pease, at 46s. 8«?. After harvest, wheat was sold at 5s. per quarter in London, 4s. in the country. Malt, at 6s. M., and in the coimtry at 4s. M. Eye, at 3s. 4(?. per quarter in London, and in some places at 4<^. per bushel, {Clark's Ex.) Quartan Agues still reigned fatally. In some more remote countries, July, August, and September, were excessive hot and dry. In the end of September, came a very strong cold North wind; presently after were many Catarrhs, quickly followed by a most severe cough, pain of the side, difficulty of breathing, and a fever. The pain was neither violent nor pricking, but mild. The third day they expectorated freely. The sixth, seventh, or, at the farthest, the eighth day, all who had that pain of the side died; but such as were blooded the first or second day, recovered on the fourth or fifth; but bleeding on the last two days, did no service. Slippery, thickening linctuses, were found of most service. Broths, or spoon-meats, or moist foods, were good. But where the sea- son continued still rainy, the case was very different; for at Mantua Carpentaria, three miles from Madrid, the epidemic began in August, and bleeding or purging was so dangerous, that in the small town 2000 were let blood of, and all died. There it began with a roughness of the jaws, small cough, then a strong fever, with a pain of the head, back, and legs ; some felt as though they were corded over the breast, and had a weight at the stomach ; all which continued to the third day at farthest ; then the fever went off with a sweat, or bleed- ing at the nose. In some few, it turned to a pleurisy, or fatal peripneumony. — At Alcmaria, this year in October, raged such an epidemic, as seized whole families at once. In that small place, died in three weeks 200 persons of this mortal peripneumony. It attacked like a catarrh, with a very slow and malignant fever, bringing, as it were, a sudden suffocation DR. SHORT'S HISTORY. 7 along with it ; tten seized the breast with so great a difficulty of breathing, that the sick seemed dying. Presently it laid hold of the precordia and stomach, and with a violent cough, which either caused abortion, or killed gravid women. Some, but very few, had continual fevers along with it; many had double tertians; others simple slight intermittents. All were worse by night than by day; such as recovered were long vale- tudinary, had a weak stomach, and hypped. This disease seized most countries very suddenly when it entered, catching thousands the same moment. Thick, ill-smelling fogs pre- ceded it some days. In some places, few recovered who had it accompanied with a violent fever. Semitertians were next dangerous. If intermittents accompanied the pain of the throat (which was neither a quinzy, nor scarce a slight inflam- mation, but only from a meer defluxion, of which the sick seemed choaked), they were better off, even without bleeding. But if the fever supervened, and was not well managed, it was often fatal. Gentle bleeding the first day was useful. For the throat, gargles of plantin, scabious, and red rose waters, quinces, mulberries, and sealed earth, were used. For the cough and hoarseness, pectoral and oyly mixtures. Scari- fication with cupping succeeded better than bleeding. The year 1555 had been most excessively rainy, and 1556, as great a drought. After a great scarcity of corn, not from famine, but the rich cornmongers had bought and hoarded it up till it was spoiled, which forced the poor to eat oxes' and swine's dung, &c." [This year, the season was mostly wet, but in some countries dry. The Influenza set in about the time when a cold north wind succeeded intense heat. In the previous year was an eruption of Etna.] ^ "A sudden and terrible Plague broke out between Delph and the Hague, in a small village, and spread over the whole country in June before the rising of the Dog star. In chil- dren it was attended with spots. This plague was presaged by stars and fire falHng to the ground on the streets of Delph. Children in their play digged graves and carried dead coffins on their shoulders; sung funeral hymns like their priests, and ' Webster, (op. cit.) 8 EPIDEMICS OF 1510-1581. pretended to bury living children, their play-fellows. So great was this mortality, that the poor fought for coffins for their dead relations. Abortions and death of child-bed women were common. This plague continued till May, 1558, and killed 5000 of the poor of Delph only. {Dodoneus, Schinckius, Platerus, Stow, l^c.) A dearth afflicted England ; wheat sold at 55s. per quarter; but a good and plentiful crop this harvest brought it to 4s. or 5s. September the 7th, seven o'clock at night, in a black rainy cloud in the West, was seen a rainbow, the moon in the East shining bright, and at full the day before. In September excessive rains and a great death, chiefly of priests. [Baker's ' Chron.') At Numigen, in July, raged an epidemic, which spared none, and so cruel, that it carried off many the fourth, seventh, or fourteenth day. It seized with a fever, roughness or burning inflammation of the throat, and the fever continual. The sick were afflicted with a grievous pain of the head, taring cough, and constant severe pain of the loins that they could not walk; and so large a dis- charge by the nose as would scarce suffer them to breathe. Such as escaped by bleeding, pectorals, and a stinking sweat supervening, had their entire strength in all parts continued. But such as sunk under the fever and want of eating becoming weak, all died. Wherefore the cure turned on the use of speedy universals, recalling the appetite, keeping the vessels of the throat open. Lenitives only were used, strong purges being fatal. In harvest, a pestilential fever raged in France, and carried off many. Dysenteries, with a slight fever, pre- vailed at the same time ; but by the early use of rhubarb, all had their gripes appeased and recovered. {Rever, Holer, §-c.) This year there was a great flood in the South of Languedoc, with so dreadful a tempest, that the people imagined it was the last day. [Vignier.) The rapid descent of the waters about Nismes, removed divers heaps and mountains of ground, and rent and tore up many other places ; by which was discovered much gold and silver coins, plate, and other valuable vessels, supposed to be hid in the Gothish invasion." 1580 '"^^ ■^^^^' ^^^ °" April the 6th, this year, and May the 12th, were general Earthquakes over all England. October the 10th, a Comet in the South bushing toward the East ; it continued from October to January, full two DE. SHORT'S HISTORY. 9 months. (Stow.) The weather for some years past having heen extraordinary moist, wet, and rainy, wind South, at the rising of the Dog star came a cold, dry North wind. From the middle of August to the end of September, raged a malignant epidemic Catarrh; it began with a pain of the head, and feverish heat: some were disposed to sleep, others to watch- ing: presently followed a dry cough, pain of the breast, hask- ness and roughness of the throat, weakness of the stomach; at last, a terrible panting for breath, like dying persons. Though the cough lasted not long, yet the panting for breath continued to the fourteenth day; some sweated,^ such recovered the thirtieth or fortieth day; they did not expectorate much. With some the disease went off by stool, in others by urine. Though all had it, few died in these countries, except such as were let blood of, or had unsound viscera. Of the first, died in Rome at this time 2000. The cure consisted in repeated lenitives, cooling inciders, and pectorals. In other places it appeared somewhat different, according to the varying con- stitution of the season. " In sundry places it begun with a weariness, heaviness, and painful sensation ; heat and horrours seized the whole body, chiefly the breast and head, with a dry cough, hoarseness, roughness of the jaws, dif&culty of breathing, weakness and languor of the stomach, vomiting green bile, like juice of leeks; which symptoms increased with the disease, as the fever, cough, weight and pain of the head, pricking pain of the ex- tremes, watching, dryness and roughness of the tongue, and shortness of breath. At the state of the disease all these were heightened, catarrh, cough, spitting. Some had swellings on the glands of the throat. In some it went off by stool; in others by urine or sweat, or bleeding at the nose. Some had spots. With some it ended in a pleurisy, peripneumony, or consumption ; all recovered very slowly. This disease raged over all Europe at least, and prevailed for six weeks. Yet, if in any place it was preceded by a drought, bleeding gave the speediest and greatest relief; as at Montpelier, so as not one of a thousand died of it. The same epidemic returned in October and November that year ; then bleeding even in these places ' [The violent perspirations which occasionally occurred led some physicians to apprehend that the sweating-sickness was ahout to return.] 10 EPIDEMICS OF 1510-1581. was hurtful, except when a spitting of blood, pleurisy, or peri- pneumony attended it. At the same time a Fever of the same kind prevailed, which, Sennertus says, reigned all over the world; and was the same with that of 1551, as the catarrh and disorders of the breast were the same with those of 1510, 1591, 1597, 1610, &c., over all Europe, with a rheum and dis- tillation from the head, either with or without a fever, pain of the head, heaviness, hoarseness, weakness. To those symptoms this year were joined a cough, pain of the jaws and neck. [Sennertus, Forest, &c.) Says Riverius, after a prodigious plague of Insects in April and May, the like epidemic broke out and strangled many; but where proper means were used, all re- covered. It began with a fever and cough, then followed again a pain of the head, and loins; then the fever intermitted a few days, and returned with fresh vigour. Some had no rest, but the heat increasing, they died ; as some did of a phrenzy, and others of a consumption ; but speedy proper means secured them, viz., bleeding, laxatives, and pectorals^ cuppings, cooling clysters, cordial opiates, and epithems.^' , „- " At six o'clock in the evening, in April, was an Earthquake not far from York, which in some places shook the stones out of the buildings, and made the church bells jangle; the next night the earth trembled once or twice in Kent, as it did also May the 1st following. November the 1st, in Kent and the marshes of Essex, was a sore plague of strange Mice suddenly covering the earth, and gnawing the grass roots ; this poisoned all field herbage, for it raised the plague of murrain among cattle grazing on it. No wit nor art of man could destroy these mice, till another strange flight of Owls came, and killed them all. A great Earthquake in Peru." [The great mortality during this epidemic at Rome, was attributed to the too frequent adoption of bloodletting.^ In April and May a prodigious number of insects, supposed to rise out of the earth, obscured the air, and were crushed by millions on the roads.^ Birds felt the influence of the bad air, for they abandoned the countries where the epidemic appeared. Birds of passage migrated before the usual time, and those accustomed to build on trees and in elevated localities, ' I. Wierus (Opera Omnia), Amstel, 1660, lib. ii, p. 979. ' Riverius (Opera Omnia Medica), Lugd. 1669, p. 585. DE. WILLIS'S DESCRIPTION. 11 rested during the night in low situations, and on the ground. Even animals which feed on herbs and leaves, took a dislike to their pastures, which were apparently iufluenced by some virus in the air.-^ Malignant Fever or Plague, Measles, and Smallpox, also raged with considerable virulence during the year 1580. Catarrh is said to have prevailed throughout Europe in 1610 ; but, with this exception, is scarcely noticed by authors between 1580 and 1658, a worse constitution, namely, that of Plague, superseding it during the greater part of that period.] EPIDEMIC OF 1658. WILLIS.^ " An equally intense frost followed, the next Winter, the immoderate heat of the foregoing Summer, so that no one living could remember such a year, for either excess both of heat and cold. From the ides of December, almost to the vernal equiuox, the earth was covered with snow, and the north wind constantly blowing, all things without doors were frozen; also, afterwards, from the beginning of the Spring, almost to the beginning of June, the same wind still blowing, the season was more like Winter than Spring ; unless now and then a hot day came between. During the Winter (unless that a Quartan Feaver contracted in autumn infested some) among our countrimen, there was a moderate state of health, and freedom from all popular diseases. The Spring coming on, an intermitting Tertian (as tised to do every year before) fell upon some. About the end of April, suddenly a Distemper arose, as if sent by some blast of the stars, which laid hold on very many together : that in some towns, in the space of a week, above a thousand people fell sick together. The par- ticular symptom of this disease, and which first invaded the ' Salius Diversus de Febre Pestilente, Francof. 1586, p. 62. ^ The Description of a Catarrhal Feaver Epidemical in the Middle of the Spring, in the year 1658, taken the 4th June. Dr. Willis's 'Practice of Physic; being the Whole Works of that renowned and famous Physician.' London, 1684. Part I, on Feavers. 12 EPIDEMIC OF 1658. sick, was a troublesome cough, with great spitting, also a Catarrh falling down on the palat, throat, and nostrils ; also it was accompanied with a feaverish distemper, joyned with heat and thirst, want of appetite, a spontaneous weariness, and a grievous pain in the back and limbs : which feaver, however, was more remiss in some, that they could go abroad, and follow their affairs in the time of their sickness, but com- plaining, in the mean time, of want of strength and of lan- guishing, a loathing of food, a cough, and a catarrh. But in some a very hot distemper plainly appeared, that being thrown into bed they were troubled with burning thirst, waking, hoarseness, and coughing, almost continual; sometimes there came upon this a bleeding at the nose, and in some a bloody spittle, and frequently a bloody flux; such as were indued with an infirm body, or men of a more declining age, that were taken with this disease, not a few died of it ; but the more strong, and almost all of an healthful constitution, recovered : those who falling sick of this disease, and died, for the most part died by reason of the strength being leisurely wasted, and a serous heap more and more gathered together in the breast, with the feaver being increased, and a difficulty of breath, like those sick of an hectic feaver. Concerning this disease, we are to inquire, what procatartic cause it had, that it should arise in the middle of the Spring suddenly, and that the third part of mankind, almost, should be distempered with the same, in the space of a month : then the signs and symptoms being carefully collated, the formal reason of this disease, also its crisis and way of cure, ought to be assigned. " That the Northern Wind is most apt to produce Catarrhs, besides the testimony of Hippocrates common experience doth make known : but why catarrhs did not spread, at least in some pecuhar places, all the Winter and Spring, but only in one month's space, and then joyned with a feaver, this dis- temper should become epidemical, doth not so plainly appear. I know many deduce the cause from the unequal temper of the Air, at that time ; which, although for the most part very cold, yet the North wind sometimes lessening, there would be a day or two very hot between : wherefore, from this occasion, as from cold taken after the heat, men should commonly fall sick. But indeed, for the exciting the distemper, so suddenly rising, DE. WILLIS'S DESCEIPTION. 13 and commonly spreading, there is required, besides such an occasion, a great foregoing cause or predisposition, though the other might suffice, perhaps, for an evident cause for to dis- temper them with this sickness ; for we ought to suppose, that almost all men were prone to the receiving this disease, other- wise no evident cause could have exercised its power so potently on so many, wherefore, it seems very likely, that this disease had its origine from the intemperance and great inordination of the year : and as the Autumnal Intermitting Feaver before described, was the product of the preceding immoderate heat, so this Catarrhal Feaver depended altogether upon the following part of the year, being so extremely cold ; for the blood being now thoroughly roasted by the very hot Summer, and prone to the feaver before described, then being made more sourish by the Autumn urging it, and apt for a Quartan Feaver, afterwards being a little eventilated by reason of the strong cold of the Winter, and hindred from its due perspiration, retained yet its dyscrasie or evil disposition, and readily broke forth on the first occasion given : wherefore, when the blood, in the middle of the Spring (as the juice of vegetables), being made more lively, and also begun to flower and grow rank, by reason of the stoppage being still continued, was strained in its circulation, and easily made prone to a feaverish effer- vescency: and as the serous water redounding in the blood, could not evaporate outwardly, because of the pores being still straitned by the cold, restagnating within, and chiefly falling upon the lungs, (where it might be moved about, instead of an outward breathing forth,) excited the so frequent and trouble- some cough. " The original therefore, and formal reason of this disease, are founded chiefly on two things, to wit, that there together hapned a greater eff'ervescency of the blood than usual, from the coming on of the Spring season, and also a stoppage or great constriction of the pores, excited by the too great cold of the foregoing season j that therefore there was not a free space granted to the blood, flowring or luxuriating in the vessels. The business being after the same manner, as if wine begun to grow hot, should be put up into close shut vessels, for by this means either the vessels or the liquor were in danger to be lost. 14 EPIDEMIC OF 1658. " Wherefore, that we may contract the thing in short, the cause that this disease begun in the middle of the Spring, having presently spread largely, seised very many, was not the blast of a malignant air, whereby the sick were distempered, as if struck with a blasting, but that at this time, the blood being inspired by the constitution of the Spring, and so luxuriating, and apt to grow hot, was contracted or straitened in its motion, and the efiluvias being constrained inwardly, could not be sufficiently eventilated or cooled. In every year, though temperate, it is usual in the Spring and Autumn for some epidemical diseases to reign, because at this time, the blood being, as it were, restored, flowers anew; and therefore. Intermitting Feavers, and sometimes the Smallpox, ordinarily spread in this season; wherefore, 'tis no wonder, after a great unequal constitution of the year, and not natural, when in this Spring, the blood boyling up more lively within the vessels, by reason of transpiration being hindred, could not be freely circulated and sufficiently eventilated, if for that cause great disorders follow, and from this most common cause, a Distemper greatly epidemical should be excited. "As to the symptoms joyned with this disease, a feaverish intemperature, and whatsoever belongs to this, the heat of the Prcecordia, thirst, a spontaneous weariness, pain in the head, loyns, and limbs, were induced from the blood growing hot, and not sufficiently eventilated : hence in many, a part of the thinner blood being heated, and the rest of the liquor being only driven into confusion, a simple synochus, or of more days, was induced, and this, for the most part, ceased within a few days ; but in some endued with a vitious disposition of blood, or evil habit of body, this kind of feaver, arising by reason of the same cause, quickly passed into a very dangerous putrid feaver, and often mortal. " The cough accompanying this feaver with a catarrh, draws its origine from a serous humor heaped up together in the blood, by reason of transpiration being hindred for a long time, and then an effervescency being risen, dropping forth more from the little arteries gaping within ; for when the pores are constrained, the superfluous serosities in the blood, being wont to evaporate outwardly, are poured forth on the lungs, by a proper castration or cleansing of the blood, wherefore, by taking DR. WILLIS'S DESCRIPTION. 15 cold, (as they commonly term it,) that is, from transpiration outwardly being hindred, the cough, for the most part, is stirred up ; and for a foregoing cause to this distemper, the flowing forth of the serum into the mass of blood, hath, for the most part, the chief place ; for from the long cold hindring the scorching of the blood, or the provision of the bile, and pro- hibiting the breathing forth of the watry humor, there was a necessity, that very much of the serous humor should be heaped up in the blood : wherefore, when the blood flowring in the Spring conceived an heat, the flowing forth of the serum, and a pouring of it on the interior parts, was wont to cause first the cough, as the proper symptom of this disease ; and those, whose blood was more diluted by the mixtion of the serum, and who were greatly obnoxious to the cough and a rheumatic dis- temper, were cured with less trouble of the feaverish dis- temper. " The prognostick of this disease, concerning private persons, is, for the most part, easie, that one may deliver the event from the first assault ; for if this sickness be excited in a strong body, and healthful before, and that the feaverish distemper be moderate, and without any grievous and horrid symptom, the business is free from danger, and the distemper is to be ac- counted but of light moment, as that commonly is of catching cold, neither needs a physician be consulted, nor remedies, unless trivial and ordinary, be administred. But if this dis- temper happens in a weak and sickly body, with an evil provision, or that the feaver being carried into a putrid feaver, or the cough growing grievous, induces difi&cult breathing, and as it were a rabid or consumptive disposition, the event of the disease is much to be suspected, and often terminates in death. The common prognostic, that was taken from hence, con- cerning the future state of the year, contains nothing to be feared, or ominates any great ill ; by reason of the unequal in- temperance of the year, the great heats, and then excessive cold, we might fear diseases to arise from the dyscrasie of the blood, yet from the present condition we need neither suspect any noted depravation of the air, or infection with poysonous breaths, that from thence may be had any judgment of the plague, or malignant disease to be at hand. " As to what belongs to the cure, when this disease is more 16 EPIDEMIC OF 1658. lightly inflicted, its cure, for the most part, is left to Nature ; for this feaver, whea it is only a simple synochus, is wont to be cured within a few days by sweat : wherefore, by a copious sweating, for the most part about the third or fourth day, the heat, and thirst, the weariness, and heavy pains are allayed ; then the cough being somewhat longer protracted, by little and little, afterwards remits, and at length the sick leisurely grow well ; if this disease hath rooted itself more deeply, there is need of fit remedies, and an exact method of curing ; the feaver growing worse is to be healed, according to the rules to be observed in a putrid feaver : but, nevertheless, with this difference, that, because transpiration being hindred, and the suffusion of the serous humor on the lungs, are chiefly in fault ; therefore diaphoretic remedies, and those called pectoral, are of more frequent use, for these restrain the flowing forth of the serum from the vessels within, or by opening the pores convey it forth of doors ; or precipitating it from the bosom of the blood, send it forth by the urinary passages ; therefore the method of medicine for this disease being brought into the worser state, respects both the feaverish intemperance, for the sake of curing which you are to be directed, according to the intentions shewn in the putrid feaver, and also the rheumatic dis- temper, which however, let it be secondary, and not every ex- pectorating remedy, or those used against a cough are to be admitted, but of that kind only which do not increase the feaver: the forms of these, and the means of curing, are to be sought from the precepts, delivered generally for the cure of the putrid feaver and of the cough ; the helps, which now, by frequent ex- perience, are commonly said to bring cure chiefly in this disease, are sweating, or the provoking of sweat, and letting of blood ; for the vessels being emptied by this or that means, both the immoderate heat of the blood, and the abundance of the serum, are restrained. " The Vernal Feaver, but now described, did not last longer than six weeks, that it plainly was seen that it was only a more light flowering of the blood, which sweUing up in the Spring, and at the same time streightened in space, for want of ventilation most impetuously boyled up, like new wine close shut up in bottles, and then ceased of itself. Yet from thence, as neither the year, so neither our blood did recover its due SYDENHAM'S ACCOUNT. 17 temperature, and so another tinder or nest for a new feaver was quickly gathered together. Because after the Summer solstice, the North wind still blowing, a cold season remained for a long time ; so that the fruit and corn this year was feared by the husbandmen would scarce be throughly ripened ; but after this, a little before the beginning of July, a most fierce heat followed for several days ; and when the dog days were begun, the air grew most cruelly hot, that one could scarce endure the open air. By reason of this heat and cold in excess, the temperature of this year was very unequal ; wherefore there was a necessity for our blood to be now fixed, and as it were congealed, now too much roasted, and so perverted from its natural disposition, to a scorched and melancholy temper; also it came to pass that the pores of the skin were much altered from their right constitution, that by that means an insensible transpiration could not be performed after the wonted manner. "Prom the time that the former feaver ceased, almost to the end of the dog days, there was a state of health and free from all popular diseases ; but then a few here and there among the villages, and in lesser places, first fell sick, but afterwards, about the end of August, a new Feaver suddenly arising, began to spread through whole regions everywhere round about us ; also this, as the other which spread the last Autumn, raged chiefly in country houses and villages ; but, in the mean time, few of the inhabitants of the greater towns and cities fell sick." EPIDEMIC OF 1675. SYDENHAM.^ "1. In the year 1675, warm and mild weather (indeed Summer weather) lasted longer than usual, even to the end of October. However, it was succeeded by weather very different, viz., sudden cold and moisture. Then it was that coughs prevailed in greater number than at any other time ' The Epidemic Coughs of the Year 1675, with the Pleurisy and Peripneumony that supervened. From the Works of Thomas Sydenham, M.D. (Syd. Soc.'s edit., vol. I, p. 226.) 2 ]8 EPIDEMIC OF 1675. within my remembrance. No one escaped them, whatever might be his age or temperament; and they ran through whole families at once. Nor were they only remarkable for their frequency; this being the case every winter. They were remarkable on account of the accidental dangers which they brought upon those they affected. The constitution of both the present time, and the whole of the previous autumn, exerted itself to the utmost in the production of the epidemic fever already de- scribed ; and besides this, there was no other epidemic disease by the antagonism whereof the activity of the present one might be traversed in even the least degree. Hence the coughs paved the way to fever, and passed, without difficulty, into it. Meanwhile, just as the coughs helped the constitution in producing the fever, so also was the fever determined by the cough to the lungs and pleura. These it attacked, just as a week before, it had attacked the head. This sudden change inclined the unthinking to consider the fever as either an essential pleurisy, or an essential peripneumony. Yet it was neither more nor less than what it had been throughout. "2. Now, as before, it. attacked with pain in the head, back, and limbs ; and this was the symptom of the fever of the con- stitution. Doubtless, the febrile matter fell heavily on the lungs and pleura ; but this was the stimulus of the cough. That the fever, however, was the fever that committed all the previous havoc, is proved by the effects of the remedies. Both forms yielded to the same. Bad as might be the stitch of the side, or the difficulty of breathing — and pleuritic as might be the character of the blood, the treatment was the treatment which squared with pleuritic fever, and not the treatment which squared with true pleurisy. This wUl be seen in the sequel. Then as to the season, primary and essential pleurisy is a disease that comes between the Spring and the Summer, and links the two divisions of the year. The secondary pleurisy in question was born under another star, and was nothing beyond the symptom of the proper fever of the year, and an accidental offspring of the cough that accompanied it. " 3. In order that I may proceed to the method which has been dictated by experience for the treatment of the coughs of this year, and of other years, where the cause is the same, I must start with a remark upon those effluvia which are usually got rid of by the means of insensible perspiration. Now, SYDENHAM'S ACCOUNT. 19 these may be chected by the effects of cold, for cold contracts the pores of the skin and throws the transpiration inwards. So thrown in, it falls upon the lungs. These it irritates ; and hence cough is speedily excited. Furthermore, when the hot and recrementitious exhalations of the blood are prevented from escaping from the skin, fever is lit up, for so great may be such abundance of these same vapours, that the lungs may be insufficient for their elimination. Or the natural heat may be increased by the adventitious heat of either the regimen or the remedies, so that fuel may be added to the flaine, and the patient, who was already inclined towards fever, may be thrown into it at once. Now, whatever may be the character of the stationary fever which rages during the year in question, the same will he the character of this secondary fever, that originates in the cough. Dependent upon this cough, it may present certain peculiar symptoms. Its general character, however, will be that of the family into which it is adopted. Now, it is clear, that whatever may be the origin of the cough, it is not the cough alone that must be attended to. The fever must be looked to as well. " 4. On this principle, I treated my patients as follows : — If the cough had not yet brought on the usually concomitant fever, I was satisfied with forbidding animal food, and fer- mented liquors. I recommended moderate exercise, fresh air, and occasional draughts of a cooling pectoral ptisan. This was sufiicient for checking the cough and anticipating the fever. The abstinence from meat and wine, and the refrige- rant draught, tempered the blood, and made it less ready for the febrile impressions, whilst the exercise opened the pores of the skin, and supplied the natural and genuine passage for the exhalations. These were dispersed, and the patient was the better for their dispersion. "5. As to the allaying of the cough, the application of nar- cotics and anodynes was not wholly safe. And just as danger- ous was the use of spirituous liquors and hot cordials. Both modes acted alike. They entangled and hardened the matter of the cough, so that those exhalations which, by departing quietly and gradually from the blood, should vanish into the atmosphere at large, were now denied an exit, corked up in the mass of the blood, and became, thereby, sources of fever. This was most frequently the case with such of the common 30 EPIDEMIC OF 1675. people as thought, by means of burnt brandy and other hot hquors, to check the cough. Instead of this, they brought on pleurisies and peripneumonies, and by their unwise wisdom transformed a disease which, in and of itself, was unimportant and curable, into a disease both dangerous and deadly. Just as insensible (although with a greater show of sense) were they who would force a sweat, and so think to exterminate the cause of the disease. "Nevertheless, it must be owned that spontaneous sweats often did good — more, indeed, than aught else. These, how- ever, are very diflferent things from forced ones. The latter can ouly be extorted by incensing the blood, and by endangering the patient that we would save. " 6. Sometimes, however, there supervene upon the cough the following symptoms : — a succession of chill and flushes ; pains in the head, back, and limbs; an occasional tendency to sweats (especially night sweats); sometimes the addition of pain in the side; sometimes a constriction and tightness at the chest; and, as the result of this last, difficulty of breathing, tightness in the cough, and violent fever. Now all this might happen, not only after the disease had been badly treated, but spontaneously; and this was really the case, more especially with infants and children. Sometimes it began immediately, sometimes a day or two after the cough had left. " 7. As far as very careful observation has informed me, the best treatment for the fever and its worst symptoms were — bleeding at the arm, a blister to the nape of the neck, and a daily clyster. The patient, meanwhile, was ordered to be out of bed a few hours every day, to abstain from animal food, and to take, as his drink, small beer, milk and water, or a cooling lenitive ptisan, as the case might be. If by the end of two or three days the stitch in the side were not removed, I repeated the bleeding, and went on with the clysters. In respect to these last, I must remark, that (in this fever, as in others,) when by their use, the neck of the disease has been broken, and its edge taken off, they should not be too continuously repeated, especially in the case of women who are hysterical, or men who are hypochondriacs. The blood and humours of such patients are endowed with great mobility. A little makes them boil and ferment. This disturbs the economy; and febrile symptoms extended beyond their due time, harass the patient. SYDENHAM'S ACCOUNT. 21 " 8. To return to our subject. By this method we allow time to the disease, and this time allows the blood to throw off, by degrees, those hot particles which had fixed themselves upon the lungs and pleura. Hence, all the symptoms will quietly disappear. If, on the other hand, you attack the dis- ease fiercely and with a hostile hand, waging war against it with a whole armament of remedies, you will either lose your patient, or else have to redeem his Hfe by bleeding him beyond both the genius of the disease and the bounds of safety. I say the genius of the disease, because, in the true pleurisy, re- peated venesections are right and proper^ and provided that overheating remedies and regimen have not stood in the way, cure the complaint single handed; whereas, with the symptom in question, it is quite sufficient to bleed once only — twice at most ; provided always, that the patient be allowed to leave his bed, and use cool drinks. There is no need to bleed oftener, unless the fever be increased by heat from without. Even then a repetition is not always safe. " 9. I will now take occasion to say a few words concerning a very current opinion, viz., that in some years pleurisy is found so malignant as not to bear its usual bleedings. My own doctrine is that the true and essential pleurisy, which, as will be stated hereafter, runs rife under all constitutions of all years, will tolerate a repetition of venesections. When, how- ever, it happens, as it sometimes does, that the proper epidemic fever of the year, from some sudden alteration in the manifest qualities of the atmosphere, deposits the morbific matter of the lungs or pleura, (the fever, nevertheless, remaining the same,) — in such a case, I say, that although venesection may be allowed in an extreme form of the symptom in question, the general rule must be, that the bleeding be apportioned to the fever that generates the symptom, rather than to the symptom itself. Hence, if the fever require bloodletting, the pleuritic symptom will require it also ; if not, bleeding will be either unnecessary or mischievous ; since it is with the fever that the pleurisy either stands or falls. In my mind, this was the case with the symptomatic pleurisy accompanying the fever that prevailed at the time when the coughs came in, viz., the Winter of 1675. And here I must again remark, that in the treatment of fevers, the physician who does not keep con- 22 EPIDEMIC OF 1675. tinually before his eyes the constitution of the year, the extent to which it favours the epidemic production of this or that disease, and the power it has of twisting to its own proper shape and likeness all the other concurrent diseases of the time, wanders wildly in a maze without a clue. " 10. In the November of the aforesaid year, I attended Mr. Thomas Windham, the eldest son of Sir Francis Windham, knight. The patient was sick of the fever in question, and complained of pain in the side, and the other symptoms of the malady. I bled once (and no oftener), blistered the nape of the neck, threw up daily clysters, ordered, one day, ptisan and refrigerant emulsions, another milk and water (sometimes thin small beer), and recommended him to be out of bed a few hours every day. This set him up within a few days, and after a free purge he was thoroughly cured. "11. I must remark that although these symptoms, which were wont to supervene upon the cough, were nearly those that did so much mischief during the Winter in question, the cough itself, single and unaccompanied, was, at the same time, particularly predominant. In treating this, there was occa- sion for neither bleeding nor clysters, provided that the fever was not increased by heating diet. It was sufficient to recom- mend fresh air, and to forbid meat and wine. Furthermore, I ordered the following lozenges, the best I know for checking such coughs as arise from cold: — R Sugar-candy, lb. ijss. Boil in a sufficiency of pump-water, until it stick to the ends of the fingers. Then add— Liquorice-powder, Elecampane, Aniseed, Angelica-seed, a& Jss ; Orris-powder, Flowers of brimstone, aa 5ij ; Essential oil of anise, 9ij. Fiant tabellse s. art. " These, the patient should always have about him, and take frequently." [Influenza prevailed during the same year, in France, after a very thick and pungent fog. The disease was accompanied with violent cough, which was very fatal to pregnant women. PEU— MACAULEY — MOLYNEUX. 23 In many abortion occurred, and extreme menorrhagiaj inducing great inanition.^ Etna was active this year.^ The condition of London, about this period, has been thus described by an eloquent historian.] " If the most fashionable parts of the capital could be placed before us, such as they were in the reign of Charles II., we should be disgusted with their squalid appearance, and poisoned by their noisome atmosphere. In Covent Garden, a filthy and noisy market, was held close to the dwellings of the great. Fruit women screamed, carters fought, cabbage stalks and rotten apples accumulated in heaps at the thresholds of the Countess of Berkshire and of the Bishop of Durham. St. Jameses Square was a receptacle for all the offal and cinders, for all the dead cats and dead dogs of Westminster. At one time, a cudgel player kept the ring there; at another time, an impudent squatter settled himself there, and built a shed for rubbish under the windows of the gilded saloons, in which the first magnates of the realm — Norfolk's, Ormond's, Kent's, and Pembroke's — gave banquets and balls. It was not till these nuisances had lasted a whole generation, and till much had been written about them, that the inhabitants applied to Parliament for permission to put up rails and to plant trees."^ [An Influenza or " Short Fever" visited Dublin, in ■ the year 1688, preceded by a distemper attended with nasal defluxion (probably glanders) among horses, especi- ally those belonging to the Army, then encamped on the Curragh of Kildare.] "About the beginning of November, 1693 (observes Molyneux), after a constant course of moderately warm weather for the season, upon some snow falhng in the mountains and countries about the time, of a sudden it grew extremely cold, and soon after succeeded some few days of very hard frost, whereupon Rheums of all kinds, such as violent coughs that chiefly aff"ected in the night, great defluxion of thin rheum at the nose and eyes, immoderate discharge of the saliva by spitting, hoarseness in the voice, sore throats with some trouble in swallowing, wheezings, stuSings, and soreness in the breast; a dull heaviness and stoppage in the head, with such like dis- ' Peu, ' Pratique des Accouchemens.' ' Webster, (op. cit.) = Macauley, 'History of England.' 24 EPIDEMIC OF 1688-1709. orders, the usual effect of cold, seized great numbers of all sorts of people in Dublin. In some of the persons so affected, the symptoms were more severe, and attended with somewhat more fever, headache, and intolerance of light. This epidemic, as it then appeared, was not attended with many fatal results, and in general the persons recovered without any treatment; the disease usually terminating in a critical diaphoresis. The duration of the distemper was in the mild cases from eight to ten days, and in the more obstinate ones, about a fortnight. So very general did this influenza rage, that few or none escaped. It spared neither rank, age, sex, nor condition; but it rather favoured the very old, who seldom were attacked with it. This disease ran its course in about a month, but it was not confined to Dublin alone; London and Oxford were visited by it. It appeared in London about a month sooner than in Ireland; and it likewise progressed through France, Holland, and Flanders." ^ [For several successive years after 1675, fevers prevailed in England, and there was much disturbance in atmospheric con- ditions. The Winter of 1680 was intensely cold, the subse- quent Summer excessively hot. In the Spring and Summer of 1681, herbs and grass were burnt up for want of moisture in the air. The frost of 1683 was almost unprecedented, that of 1684 almost equally severe. In the Spring of 1685, an immense flight of grasshoppers in Languedoc laid waste the corn, then attacked vines, pulse, willows, and hemp. In 1686 was a terrific hail storm. 1687 was characterised by rain, inundations, abundant fruit, and great swarms of gnats and other insects. Diarrhoea was remarkably fatal, first in the suburbs of London, especially amongst children. On the 10th of October occurred the Earthquake which over- threw the city of Lima. In 1688, there was an Earthquake in Jamaica, and a Hurricane at Sea.] " We find (resuming the narrative of Dr. Short^) that at the middle of May, began a fever in London, all over England and all over Ireland in July. The symptoms were the same in all. It began and ended its course in seven weeks. It seldom ' Dr. Molyneux, ' Philos. Trans. Dub.,' March, 1694. ' Op. cit., vol. I, p. 455. DR. SHORES HISTORY. 25 held the sick above two or three days, except they were let blood, then it lasted seven or eight before the sweat (which was the general crisis) began. Though not one of fifteen escaped it, yet not one of a thousand that had it died. It was generally observed, both in England and Ireland, that sometimes before the fever begun, a slight but universal disease seized horses, viz., a great defluxion of rheum from their noses. This fever spread all over Europe from E. to W. At Jena was an epidemic dysentery, with blackish-red spots, tossings, restlessness, anxiety, and hiccup. It resisted the common methods of cure; but yielded to bolus's of Conserve of Roses, Red Powder, and Japan Earth, with Opiates. (Miscel. Curios.) The preceding season having been very inequal, one while excessively hot, another time severely cold, and great swarms of insects, in August reigned, at Augsburg, an epidemic dysentery, seizing infants with convulsions from their first attack, which killed many the first day. And adults were tormented night and day with terrible defluxions." [In the year 1708 a Comet appeared, and Volcanic Erup- tions.^] 1 700 " ^^^ weather, at the close of the year 1708, in four days' time, froze over the Thames, notwithstanding the motion of the water by tides and stormy winds ; many booths were built on it. The Thermometer, December the 31st, was lower than it had been in eighteen years before; little less next day. It was much the same from February the 12th to the 15th. Several Thermometers sunk within the bubble; others at 90, or colder than the middle state of the air under the pole. Urine froze under the bed, though there was a good fire in the room. Bread and meal were all ice. Bottled beer in deep cellars froze. A nine gallon barrel of small beer set in the chimney comer to thaw, afforded a gallon of ale ; all the rest was dead water. Ships in great numbers came a-shore in Yarmouth Road, not merely by the violence of the wind, but from the impotence of the sailors to find their hands, and from the impossibility of sening the cables, which were thick cased with ice The latter end of the second week, and beginning of the third, countless thousands of bra geese, by flights of five or seven minutes' distance, were con- ' Webster, (op. cit.) 26 EPIDEMIC OF 1709-10. tinually making to the Southward to find open waters, creeping low and slowly along the shore, as the weakest among them were able to fly, some of which they were often dropping. But the moment they came to the mouth of any river they ascended strong and swiftly into the air, whence they might take a view of the waters many miles into the land ; and when they ob- served they were all ice, descending and creeping again as before ; though the farther South the severer the Winter ; for this extreme cold reached not only the northern countries, but over France also, and fiercer by their accounts than here ; even Portugal itself felt the severity of it. Ink froze in my pen, though by a good fire, that I could not write a line at once. The ice was said to be a foot thick at land, but on the coast, where it never freezes so hard, it was eight inches. "January the 14th, 15th, 16th, and 17th, were thaws; from the 23d to the 28th, frost again, but less cold and milder, yet freezed two inches in a night. Frost again, from February the 8th to the 20th ; from that to the end, thaw; yet the ice of the first frost still remained for all these thaws. And, indeed, February the 12th to the 15th, froze five or six inches. From February the 26th to March 6th, hard frost. Thus far no appearance of a Spring, even in the South. From December the 25th, 1708, to March the 12th, 1709, above fifty days' frost ; many of them such as happen not in many years ; fifty days the wind somewhere in the E., at most N. E., thirty days blowing hard, and above half of these dreadful storms or a scout of wind. About — days more the wind N. or N. W., yet some of the coldest weather was, perhaps, December the 30th, and February the 12th, when the wind was S. W., whose efi'ects was ouly to bring back the vapours that had come from the N. E., and had crowded them together against these that were still coming in a heap over the island. In the end of the fourth week of May it still continued cold, the elms yet naked in Norfolk and Suffolk. May the 19th, hawthorns just begin to blow, and on the 21st elms to be green. Wheat now 10*. a bushel. At the end of May, little appearance of a Spring in Norfolk and Suffolk. Take the five months from December the 26th inclusive, and it was much colder in the same space of time in the years 1739, and the following Spring of 1740, as the efi'ects demonstrated. In 1709, wheat did not begin to DR. SHORT'S HISTORY. 27 ear till past the middle of June^ though the weather in that month was summerless. But upon the whole it was not so cold as in 1698. June the 17th, wheat ear breaking its en- closure, hawthorn still in blossom, but fading ; the 25th, wheat not all eared. The first half of this month was fine weather, the latter wet, a great deal of rain the last three days. From Christmas 1708, to June the 16th, 1709, wind E., 100 days, mostly N. E. twenty days, more N. and N. W., hence the cold. First half of July was wet, wind S. W. from the 17th to the 24th, E. S. E. or S. E. the 24th, S. W. to the 28th, W. or N. W. the 22d and 28th, N. the 29th and 30, S. E. the 31st, S. W. the last four days were Summer indeed. August was a mixture, part very hot, and part as cold. On the 8th, barley and oats first cut in the South ; the 27th, wheat cut. Wheat over the kingdom was generally destroyed on the N. E. side of the furrows. Now raged a Malignant Fever, and very mortal in Harwich, &c., from the communication with foreign parts. Wind to the 10th, 12th, and 13th, S. W. ; the 10th, 11th, 14th, 17th, 30th, and 31st, N. W-; the 15th, 16th, 17th, 25th, and 26th, W.; the 18th, 20th, and 24th, N.; the 23d, E.; the 19th and 29th, N. E. September had much wind and rain. Wind chiefly between S. E. and N. E., the 7th, 20th to the 26th, S. W.; the 10th, 17th, and 26th, N. W.; the 16th and 29th, N. October had some windy, and many dead calm days in it, no great rains. Wind the 1st and 2d, S.; the 3d to the 5th, W.; the 6th, 8th, 10th, and 21st, N.; the 7th, 9th, 17th, 18th, and 27th, N. W.; the 11th to the 17th, N. E.; the 19th and 28th, E. N.j the 20th, E.; the 29th and 30th, E. S. November began and ended cold, but was mostly mild ; wind chiefly W. or S. W., little rain. December, wind mostly from S. to W., a few days excepted ; yet the year concludes near as cold as the last, for on the 31st it froze within doors ; wind S. The first half of this year was as cold as any for the last sixty years. In 1698 the cold continued till September; this year only to June or July at farthest, June being rather fine than hot. "The year 1710 was very temperate in the general, only in the end of March were three insufierably hot days. From April the 7th to the 11th, north wind, sleet and cold; then six days excessive heat, with east wind cooled by after rains. In June several unseasonable sharp and cold storms, from which vicissitudes of weather Catarrhs and Athritics were not un- 28 EPIDEMICS OF 1739-43. fashionable. The harvest was less changeable, the year was fruitful and healthy, the Winter late. In the latter end of October and November were great floods. The winds after were very variable, but mostly South; the air foggy, thick^ moist, vapid, often stagnant, long without sun, and very un- wholesome in Carniola and Augsburg. March the 1st began and reigned two months, an epidemic which missed feWj and raged fatally like a plague in France and the Low Countries, and was brought by disbanded soldiers into England, viz., a Catarrhous Fever, called the Dunkirk Rant, or Dunkirk Ague ; it lasted eight, ten, or twelve days. Its symptoms were a severe, short, dry cough, quick pulse, great pain of the head, and over the whole body, moderate thirst ; sweating and diuretics were the cure. Bleeding very pernicious or fatal. This was a very moist, southerly, and unsettled constitution in England."^ [Influenza prevailed in Dublin in the previous year, after a sudden transition of atmospheric temperature from heat to cold.P EPIDEMICS OF 1729-43. HUXHAM.^ 1729 to 1743. " The following observations were made exactly after the manner described by the celebrated Dr. Turin, in the ' Philosophical Transactions,' No. 379, and which has been followed by almost every physical body, particularly that eminent one of Edinburgh. My Baro- meter consisting of a pretty large tube, to which is fitted a wide cistern, the quicksilver with which these are filled I had first of all carefully purified by distillation. The Thermometer, which is one of Hauksbee's, is fixed in a convenient place. The barometer in the month of July, anno 1733, at low water-mark, stood at about forty-six feet ; but from that time to this it has not exceeded thirty feet. I determined the degree of humidity of the air by several hygroscopes; the ' Dr. Short, (op. cit.) vol. I, p. 455. ' Dr. Molyneux, Philosophical Transactions, Dublin, March, 1694. " Observations on the Air and Epidemical Diseases, by John Huxham. Translated from the Latin. Vol.1. London. 1758. HUXHAM'S OBSEEVATIONS. 39 principal one is of the same form with that of Dr. Molyneux^s, in the ' Philosophical Transactions/ No. 172. The funnel I make use of is about twenty-five inches in diameter, and I have it made circular, the better to catch the rain, taking care to place it so that it is open to all points of the compass. "When I have occasion to take notice of the force or direction of the wind, I make use of the common characters on the Mariner's compass, viz., E., W., N., S., for the four cardinal points, and for the other compound ones, N.E., N.W., S.E., S.W., and so on. " The town of Plymouth (where I chiefly made these obser- vations) is situated at the very bottom of a large bay (called the Sound), which is whoUy exposed to the southerly winds. It is sheltered, indeed, towards the East and West, by a ridge of very high hiUs. The bottom of this bay is shut up by large rocks of free-stone, and it stretches forth on each side a considerable arm of the sea; at the back of it, arises a chain of hills, which runs to the Devonshire and Cornwall moun- tains, at about ten miles distance. I have been thus parti- cular in the description of this town, as we may from hence, with some degree of certainty, account for the excessive quan- tities of rain which fall here every year. For the bay lying so open to the main ocean, the vapors and clouds coming from thence have a free access between its two high promontories; where being closely pressed by the surrounding chfl's, they are all driven to the bottom of the harbour, and there rushing against the rocks and hills which obstruct their further passage, they become condensed, and at length fall down in the form of rain. Besides, I should observe, as no small addition to this article, that this part of the coast of Great Britain, runs a long way out in the form of an isthmus between two very large seas. " I was the more readily induced to publish this Meteoro- logic History of Observations, from the consideration of its great usefulness, and that nothing of the kind had to my knowledge been attempted in this western part of our island. The reason of my compiling these observations in Latin, rather than our mother tongue, was the greater facility of communi- cating them to Foreigners, from whom we receive the like ad- vantages. Many learned men of almost all nations have made 30 EPIDEMICS OF 1729-43. a great figure in this study; but it is still to be wished that some time or other, from a long course and number of accurate experiments made in all parts of the world, we may see a general and perfect history of the atmosphere; a work, which, as it is of the greatest use, so has it been a long while wanted : I have, for my part, thrown this my mite into the public treasury, in which I have, indeed, used all the care and exactness in my power, being little solicitous about the elegance of it; my business being to write as a physician, and not as an orator. ' Non nobis licet esse tam disertis Qui musas coliraus severiores.' — Martial. "November, 1739.^ — The whole of this month was very stormy and rainy, the S. and S.W. winds blowing extremely hard, which occasioned the Barometer to fall considerably. There were great irruptions of the tide every where. j_ Jt_ in i/iii jj_ J^ II I II i_ "Rain 1.2-4.6.7.8.9. ll_13— 16 . 18 . 19 . 20 . tli //// / // / 23 . 24 . 25 . 26 . 27 . 30 . = 6 . 333. ' A. B. signifies Aurora Borealis (or the Northern Lights, as they are sometimes called) ; thus A.B. 22 . 10 p.m. W. N. W. 1, implies that there was an Aurora Borealis the 22d day at 10 o'clock at night, the wind being at West-North-West, a light breeze. — This mark set over the number of any day in the column of rain, denotes that on such day there was a good deal of rain. JL This mark signifies a heavy rain to have fell that day. ii This, a very heavy rain. 'JJl This, a violent rain. Where any number of days are joined by a straight line, thus 12 — 16, it signifies that it rained more or less every day, from the 12th to the 16th. X This mark set at the head of a figure which is placed after any particular wind, to denote its force, shows such wind to have blown very strong ; but when it is set at the bottom, the contrary. Thus, in November 1728, you will find 18.2 p.m. S. S. E. 4^., viz. the 18th at 2 in the afternoon there was a violent storm, with the wind at South-South-East. Through the whole of the work I have made use of the Julian or old style. The observations were made generally twice a day, viz. about 8 o'clock in the morning (a.m.), and 6 in the afternoon or evening (p.m.) The Roman characters included in crotchets [A.] [B.] [C] &c., refer to the re- marks and notes at the end of each year. HUXHAM'S OBSERVATIONS. 31 " A Storm, 2d, at S.S.W. — 6, at night, S.W.— 18tli and 19th, at night, S.W. — 24th, at night, S., 6 W.— 27th, very early in the morning, W.N.W. "A great A. B. 5 . 10 . p.m., W.N.W. 1. Mer. highest, 22 . 30 . 2 . W.N.W. 1. ) ^^^^ ^_ ^^ _ lowest, 25 . 28 . 7 . S.W. 3. j """""" "" "" " '^" [ Mean h. 47 Day coldest, 21 . 56 . N.W. 1. „ warmest, 3 . 40 . S.S.W. 3 " The smallpox continues epidemical still. A small catarrhal fever prevails now, attended with a troublesome cough, a slight dyspnce, loss of appetite, and rheumatic pains of the limhs, and if more violent than ordinary, is very apt to end in a pleurisy or peripneumony j but it is easily got the better of by bleeding, a gentle vomit, a blister or two, and the exhi- bition of proper diluents, gentle sudorifics, anodynes now and then between whiles, giving the spt. volat. oleos., &c., as like- wise spt. C. C. and the elixir asthmat. in a draught of small sack whey, a Uttle warm." [In December the coughs, fever, and smallpox continued epidemic, and maniacal disorders more frequent than usual. In January Smallpox prevailed although less fatally, but Catarrhal Fevers invaded many, and severe fits of Asthma were frequent. In March and April Coughs and Peripneumony, and Rheumatic Fevers of a pleuritic kind. In June the only prevalent complaint was languor from the heat of the weather.] " January, 1733. — At the entrance of this year the frequent rains made the atmosphere very moist ; but the wind coming to blow from the eastward a little afterwards, somewhat dispelled the vapours; and the barometer rising, there was tolerable clear weather from the 16th to the 25th. There was hardly any frost this month; and towards the end the air was very foggy and close, and somewhat warm withal. 21 11 Ui -L — "Rain, 1—4 . 5 . 7 . 8 . 9 . 15 . 22 . 29 . 30 . 31 =2 .384. 32 EPIDEMIC OF 1733. "A storm, 7 at night, S. A frost, 14. N.W. 1—21. E.N.E. 2. Mer. Highest 24 . 30 . 2 . E^ 1. ) ^^^^ ^ 39 ^.o. „ Lowest 8 . 29 . 3 . S.W. 3. J Daw CoWes? 21 . 62 . E.N.E. 2. ) , , ,. Kn2 3 M7- . 00 ^w c! 1 \Meanh.5\ii. „ Warmest 28 . 47 . S. 1. ) " Coughs, Defluxions, and the Measles very rife, " Fjebruaky. — The wind hung all this month at West, some- times inclining to the Southward, and not unfrequently to the Northward. The air was damp and chilly, but not quite so thick and foul as in the preceding month. II J_ U 1 J- JL iiJJ ij- " Rain, 1 — 4 — 6.7.8.11. 14 . 17 — 20 . 22 . 24 — 28=3 . 734. "A storm 1 at night, S.W. Asmall A.B. 2 .H. lO.N.N.W. 1. Mer. Highest 15 . 30 . . N.N.W. 1. ) ,, , „„ „,„ r a ^ or. o c! -nr o f Mean h. 29 . &\%. „ Lowest 4 . 29 . 2 . S.W. 2. ) ^^ Day Coldest 10 . 60 . N.W. 1. ] „ Warmest 7 . 49 . S.S.W. 2. [Mean h. 53i|. A white frost and great hoar-frost. J " The Measles this month were fatal to many infants and children, who at the going off of the disorder were in a manner strangled by a violent Peripneumony, nothing did any good here but large and repeated bleedings. " About this time a disease invaded these parts, which was the most compleatly epidemic of any I remember to have met with ; not a house was free from it ; the beggar's hut, and the nobleman's palace were alike subject to its attacks; scarce a person escaping either in town or country: old and young, strong and infirm, shared the same fate. Finding it to prevail so much and with so great force, insomuch that sooner or later it had spread almost all over the country, I resolved to commit a succinct history of the disease and its appearances to writing, with which I now present the reader. HUXHAM'S OBSERVATIONS. 33 "This distemper had raged in Cornwall and the Western parts of Devonshire, from the first coming in of this month (Feb- ruary); hut did not reach us at Plymouth till about the 10th, which was on a Saturday, and that day numbers were suddenly seized : the day afterwards they fell down in multitudes, and by the 18th or 20th of March scarce any one had escaped it. "The disorder began at first with a shght shivering; this was presently followed by a transient erratic heat, an headache, and a violent and troublesome sneezing ; then the back and lungs were seized with flying pains, which sometimes attacked the breast likewise, and though they did not long remain there, yet were very troublesome, being greatly irritated by the violent cough which accompanied the disorder; in the fits, of which a great quantity of a thin sharp mucus was thrown out from the nose and mouth. These complaints were like those arising from what is called catching cold, but presently a slight fever came on, which afterwards grew more violent ; the pulse was now very quick, but not in the least hard and tense like that in a pleurisy; nor was the urine remarkably red, but very thick and inclining to a whitish colour ; the tongue instead of being dry was thick covered with a whitish mucus or slime : there was an universal complaint of want of rest, and a great giddiness. Several likewise were seized with a most racking pain in the head, often accompanied with a slight delirium. Many were troubled with a tinnitus aurium, or singing in the ears ; and numbers suffered from violent earachs or pains in the meatus auditorius, which in some turned to an abscess ; exulcerations and swellings of the fauces were likewise very common. The sick were in general very much given to sweat, which, when it broke out of its own accord, was very plentiful, and continued without striking in again, did often in the space of two or three days wholly carry off the fever ; the urine depositing a copious, whitish, or yellowish coloured sediment, but very seldom a redish one; numbers, however, had great difficulty in making water, whether from their blisters, or from their profuse sweats, I will not take upon me to determine. The disorder often terminated with a discharge of bilious matter by stool, and sometimes by the breaking forth of fiery pimples. ''You have here a description of this epidemic disease, such as it prevailed hereabouts, attacking every one more or less ; but 3 34 EPIDEMIC OF 1733. still, considering tte great multitude that were seized by it, it was fatal to but few, and that chiefly infants and consumptive old people. "It generally went off about the fourth day, leaving behind a troublesome cough, which was very often of long duration ; and such a dejection of strength as one would hardly have suspected from the shortness of the time ; but this chiefly happened where there had been an imprudent and untimely use of the lancet. Bleeding was of the most benefit to such as laboured under a great pain and weight at the breast, and that at the beginning, not decline of the fever. In all, the blood taken away was covered with a thin whitish pellicle, but not very tough ; unless in those where bloodletting had been too long neglected, and the fever had thereby turned to a pleurisy and peripneumony, which was the case with not a few, especially where there had been a preposterous use of hot volatiles and cordial medicines. "A nausea or vomiting indicated a gentle emetic, which always remarkably relieved the sickness of the stomach and weight of the breast ; and did likewise in some sort excite a diaphoresis, to promote which it was absolutely necessary to pour down quantities of warm diluting drinks, whether drought required them or not. White-wine whey drank a little warm was in general found the best diluter, and such quantities of it were used at this time, that the country round could scarce supply milk enough to make it. "Blisters to the back and behind the ears were of eminent service in this disorder, nor were they on any account to be omitted, for they were a certain relief to the violent pains of the head, as well as to the exulceration and swelling of the jaws; add to this, that by diverting the course of the acrid humours they prevented its falling upon the lungs. "The medicines I used to prescribe were chiefly these : — Lap. contrajerv, Sp. volat. oleos., Sp. C. C, Sp. lavend. c. Elixir asthmat. le mort., with draughts made of spermaceti, dissolved in some small pectoral decoction, or else very weak milk -whey, which generally eased the cough, and promoted the salutary sweats. If the difficulty of breathing and expectoration re- mained after the bleeding, I generally found it necessary to give a solution of gum ammoniac with oxymel scillitic; for the ARBUTHNOT'S ESSAY. 35 disease was much in the nature of a peripneumonia notha, and seemed to require the same method of cure, — such as the sharper pectorals, to cut the tough, viscid phlegm, blisters to the legs, and sometimes emetics, or the more lenient cathartics. "The cough was very violent during the whole course of the disease, insomuch that it was often a hard matter to keep it under, even by the use of anodynes ; nay, after the fever was gone off, this symptom would sometimes remain so extra- ordinarily vehement, that it threw several into consumptions, which carried them off within a month or two, especially such as had been formerly subject to disorders of the breast and lungs. Having frequently observed, that if a looseness came on, the cough was commonly carried off by it, following nature as the best guide, I used to give eccoprotics of rhubarb, manna, tartar solubile, &c., about the decline of the fever, and generally found a happy effect from it; for the appetite, which had, during the whole course of the disease, been greatly impaired, if not wholly destroyed, was by this method happily restored. "On the whole, this disorder was rarely mortal, unless by some very great error arising in the treatment of it ; however, this very circumstance proved fatal to some, who, making too shght of it, either on account of its being so common, or not thinking it very dangerous, often found asthmas, hectics, or even consumptions themselves, the forfeitures of their incon- siderate rashness.^^ ARBUTHNOT.' , -«« „ "There have been of late two remarkable instances of the influence of the air in producing an epide- mical disease, perhaps over the greatest part of the surface of the earth; the first happened in the year 1728, the last in the latter end of the year 1732 and beginning of 1733, which, being the more recent and remarkable, I shall give a short description of it, till a more particular one can be procured ' An Essay concerning the Effects of Air on Human Bodies, by John Arbuthnot, M.D . bond. 1751, p. 193. 36 EPIDEMIC OF 1732-3. from the collected memoirs of the several countries which it invaded, of which I have seen only a few. "The previous constitution of the air was, in England and in the greatest part of Europe, a great drought, which may be inferred from the failure of the springs, in the abatement of the fresh water in all its usual currents and reservoirs, which are the best measure of the quantity of moisture falling from the clouds. What is most generally taken notice of, in the ac- counts I have seen from Germany, France, and some other places, was, that the air in the beginning of winter, especially in November, was more than usually filled with thick and fre- quent fogs, the matter of which was not precipitated upon the earth in rain, snow, or any other fruits of the air. Fogs are so usual in this country in November, that there was nothing particular observed about them that I know. But there was hardly anything fell from the clouds during the month of November, except a very small quantity of snow, attended with a frost of no long duration ; and this was all the winter we had. In the northern parts of France, there was a very small quantity of snow, which lasted from their 15th and our 4th of November, till after Christmas. This was succeeded by southerly winds and stinking fogs, during which there was observed, by some chirurgeons, a great disposition in wounds to mortify. Both before and during the continuance of the disease in England, the air was warm, beyond the usual temper of the season, with great quantities of sulphurous vapours, producing great storms of wind from the south-west, and some- times lightening without thunder. "As to the time of invasion of the disease, they were difi'erent in different countries. It invaded Saxony and the neighbour- ing countries in Germany about the 15th of November, and lasted in its vigour till the 29th of the same month. It was earlier in Holland than in England; earlier in Edinburgh than in London. It was in New England before it attacked Britain; in London before it reached some other places west- ward, as Oxford, Bath, &c. ; and, as far as I can collect from accounts, it invaded the northerly parts of Europe before the southerly. It lasted in its vigour in London from about the middle of January, 1732-3, for about three weeks; the bill of mortality, from Tuesday the 23d to Tuesday the 30th of ARBUTHNOT'S ESSAY. 37 January, contained in all 1588, being higher than any time since the plague. It began in Paris about the beginning of their February, or the 21st of our January, and lasted till the beginning of their April, or the 21st of our March; and I think its duration was longest in the southerly countries. It raged in Naples and the southern parts of Italy in our March. The disease, in travelling from place to place, did not observe the direction, but went often contrary to the course, of the winds. "The uniformity of the symptoms of the disease in every place was most remarkable. A small rigor or chilliness, suc- ceeded with a fever, of a duration (in such as recovered) seldom above three days. This fever was attended with a headache, sometimes pains in the back, thirst in no great degree, a catarrh or thin defluxion, occasioning sneezing, a coryza, or running at the nose; a cough with expectoration of a thin pituite at first, and afterwards of a viscous matter, in which, if there was observed a clear oily matter, it proved generally the case to be mortal ; for this clear matter was purulent. These were the most common symptoms ; but a great many, during that season, were affected with spitting of blood, pleurisies, and inflammations of the lungs, dangerous and often mortal; in some places, particularly in France, the fever, after six or seven days, ended in miliary eruptions ; in Holland, often in impos- thumations of the throat; in all, the blood was sizy; and everywhere the disease was particularly fatal to aged people. What was observable was, that the fever left a debility and dejection of appetite and spirits, much more than in proportion to its strength or duration ; and the cough outlasted the fever in some more than six weeks or two months. "There was, during the whole season, a great run of hyste- rical, hypochondriacal, and nervous distempers; in short, all the symptoms of relaxation. These symptoms were so high in some, as to produce a sort of fatuity or madness, in which, for some hours together, they would be seized with a wandering of their senses, mistaking their common affairs; at the same time, they had not any great degree of fever to confine them to their beds; but in several who were thus aff"ected, the urine was observed often to change from pale to turbid, alternately, so that there was some fever; though I did not observe nor hear 38 EPIDEMIC OF 1732-3. that the bark was effectual, but the saline febrifuge draughts had generally a most surprising good effect. Since this disease has been over, the air has continued to be particularly noxious in diseases -which affect the lungs, and, for that reason, occa- sioning a great and unusual mortality of the measles, at the rate of 40 in a week, from which one has reason to expect some specialities in the diseases of the succeeding season. "The remedies commonly successful in this epidemical catar- rhous fever were bleeding, sweating, promoted by watery diaphoretics, bhsters, and the common pectoral medicines, and what I observed before, febrifuge draughts of salt of worm- wood, juice of lemon, &c. I have not particulars enough to enable me to enter into the aetiology of this distemper. "It was matter of fact, that there was a previous ill constitu- tion of the air, noxious to animal bodies. In autumn, and long afterwards, a madness among dogs ; the horses were seized with the catarrh before mankind ; and a gentleman averred to me, that some birds, particularly the sparrows, left the place where he was during the sickness. "The previous great drought, as has been observed before, must have been particularly hurtful to mankind. Great droughts exert their effects after the surface of the earth is again opened by moisture, and the perspiration of the ground, which was long suppressed, is suddenly restored. It is pro- bable that the earth then emits several new effluvia, hurtful to human bodies ; that this appeared to be the case by the thick and stinking fogs which preceded the rain that had fallen before. It is likewise evident, that these effluvia were not of any particular or mineral nature, because they were of a substance that was common to every part of the surface of the earth; and therefore one may conclude that they were watery exhalations, or at least such mixed with other exhalable substances that are common to every spot of ground. "Lastly, it is agreeable to experience, that watery effluvia are hurtful to the glands of the windpipe and the lungs, and productive of catarrhs." OBSERVATIONS IN EDINBUEGH. 39 MEDICAL OBSERVATIONS IN EDINBURGH.^ -1 woo Q "The tertian agues, which were mentioned in the close of our preceding year, continued likewise through June and part of July, 1732. Towards the end of June, this disease did not form into regular paroxysms and perfect intermissions, but appeared more in the shape of a remitting fever. During the remissions, the pulse was much sunk ; but as the sweat came on, the pulse became fuller and stronger. When the sweat did not break out, the patients became delirious, and some continued quite deaf for some days. The urine was pale, and without sediment, till the disease was going off. " Some were cared of this disease after two or three paroxysms, after a vomit or two ; but with others, the disease lasted much longer. Bleeding was not found of use, although some sym- ptoms seemed to require it; but vomiting and blistering suc- ceeded much better, either of them bringing out the sweat when untimely stopped or prevented. "In July, some few tertian agues remained ; they were then more regular and gentle than before. Towards the end of this month, the cholera began to appear, but it was neither very frequent nor violent. "In August, many among the poorer sort of people in the suburbs and villages near Edinburgh were taken with slow fevers, generally attended with a violent headach and ravings ; some with a diarrhoea ; others with pains of the rheumatic kind all over the body. As few of the sick had access to timely assistance, several died in this distemper. "The same fever continued among the poorer people through September and October, and proved mortal the eighth or ninth day. Besides the symptoms before mentioned, many com- plained of great weight of their heads and drowsiness, loath- ing and vomiting ; others had pains of the breast, and difficult breathing. Children in this fever, beside the headache and drowsiness, had pain and tense swelling of the belly. Most of ' Medical Essays and Observations, published by a Society in Edinburgh 3d edit. vol. ii, p. 26. 40 EPIDEMIC OF 1732-3. them passed worms, some the teretes, others the ascarides, and recovered. "In Noveraberj several children were seized with slight aguish fits, returning every other day, but lasting only a few hours, and going off without sweating. Between the paroxysms, the children were pretty easy, and their pulses calm. These fits were carried off by a vomit or two. "About the same time, several people were taken with a cholera, which did not prove very obstinate. "In this month, likewise, the effects of cold appeared in dif- ferent shapes, as coughs, quinseys, rheumatic pains, colic-pains, diarrhoeas, &c. "From the beginning till the middle of December, slow fevers were very rife among young people ; they continued long, and were attended with pains in the breast, and a symptomatic diarrhoea, but were not deadly. About the same time, others were seized with fevers of the nervous kind, with a very fre- quent, but low pulse. "On the 17th December, several people were suddenly at- tacked with fevers of cold. The numbers increased, but insen- sibly, till the 25th; after which, these fevers became greatly epidemic, very few escaping them, and continued universal in this city and neighbourhood till the middle of January, 1733, when they began to decrease, and diminished daily till the end of that month. "This fever began with a coldness, shivering, swimming of the head, pains of the head, breast, and back ; the pulse was very frequent ; the appetite quite lost, and remained palled some time after the disease was removed. With a great many, it began with a running of lymph at the eyes and nose, which continued for a day; then they complained of pain and swell- ing about their throats before the cough began ; and not a few were suddenly seized with the cough, which, after the third day, was incessant and constant in all, by which they discharged great quantities of mucus, and had their pains greatly increased. Some complained of sharp pains in their bellies, and had a diarrhoea, sometimes with bloody stools, especially if they were not sufficiently blooded in the beginning. Several passed their urine in very small quantity, of a high colour, without sediment. OBSERVATIONS IN EDINBUEGH. 41 and continued to do so some time after the fever was gone off. Among the children^ along with the coughj many had violent vomitings, and some a gentle diarrhoea, which carried off the disease. "The fever commonly left the sick in two or three days ; but after the third day, scarce any escaped the constant tickling cough. Generally, all of them inclined to sweat, and were thereby considerably relieved. Some had profuse sweats, with copious reddish or brown, but not lateritious, sediment in their urine, without any previous coldness, shiverings, &c. These soon did well, if the sweating was not discouraged by some other evacuation. Bleeding in the beginning gave relief to the pains, and weakened the fever, and required to be plentiful to many who had violent headaches, and a feeling in their eyes as if they would have started out, or to those who had an uni- versal oppression of the thorax, with stitches and cramps of the muscles employed in breathing ; such in this condition, who de- layed veusesection too long, were seized with a hsemoptoe. Some bled a little at the nose, and were quickly well, without any medicine or other evacuation. A few were at once seized with ugly faintings; when bled, they recovered more slowly; but, when supported with cordials, they were soon well. Vesicatories were of service to the cough; and opiates were of great use, curing several. When the phlegm began to thicken, mixtures, in which gum-ammoniac and oxymel scilliticum were the prin- cipal ingredients, opened the belly, and did remarkable service. The ordinary pectorals and balsamics were not observed to do any good. "This disease was not of itself mortal, but it swept away a great number of poor old and consumptive people, and of those who were much wasted by other distempers. As a proof on whom it fell heaviest, we may remark, that, though the number of burials in the Grayfriars churchyard (where all the dead of Edinburgh are buried) was double of what it uses to be in the month of January, yet the number of those who were buried at the public charge was so great, that the fees of the burials scarce did amount to the sum commonly received in any other month. "It was very remarkable, that, notwithstanding this disease was so universal here, the people in our prison, and the boys. 42 EPIDEMIC OF 1732-3. who are numerous, in Heriot's Hospital, which is contiguous to the west side of the Grayfriars churchyard, and the inha- bitants of the houses near to that hospital, escaped this fever and cough. "This epidemic disease, which was felt sooner at Edinburgh than any other part of this island, spread itself gradually over all Scotland. It did not reach the most northern and western parts till about fifteen days after the time above mentioned, of its attacking this city. The ship Anne and Agnes, David Littlejohn master, having made a voyage to Holland, with one sick sailor on board, returned with the other ten in perfect good health, till they made Flamborough Head, where, on the 15th of January, six sailors were taken ill; next day, two more were in the same condition ; and the day thereafter, one more fell sick ; so that, when the vessel came to the road of Leith, none on board were in health, except one, who was seized the day after he came on shore with the same disease which his comrades had, whose symptoms were the common ones of the raging epidemic distemper. "We believe it will not be improper here to mention, the horses in and about this place being universally attacked with a running of the nose and coughs, towards the end of October and beginning of November, before the appearance of this fever of cold among men. "This epidemic distemper, above described, spread itself over all Europe, and also infested the inhabitants of America ; so that it was, perhaps, the most universal disease upon record. The first accounts we have of anything like it this last year in Europe, was in the middle of November, from Saxony, Hanover, and other neighbouring countries in Germany. It raged at one time in Edinburgh, and Basil in Switzerland. It appeared in London and Flanders after the first week in January; toward the middle of which it reached Paris ; and, about the end of the same month, Ireland began to suffer. In the middle of February, Leghorn was attacked ; and near the end of it, the people of Naples and Madrid were seized with it. In America, it began in New England about the middle of October, and travelled southward to Barbadoes, Jamaica, Peru, and Mexico, much at the same rate as it did in Europe. " There were also some people in Edinburgh labouring under OBSERVATIONS IN EDINBURGH. 43 the fevers of the pleuritic kind, and others under slow, tedious ones, in the month of January. "In February, rheumatic and pleuritic fevers succeeded to the colds; several who had passed through these were seized with those and died. The management of the sick was no other than what is common in pleurisies. "About this time, also, several people died suddenly. "The pleuritic or peripneumonic fevers, which began in February, continued through March. "At the same time, slow fevers were likewise frequent, with- out any topical inflammation. In most patients, these fevers did not appear with any violent symptoms, though some had ravings, but they were neither constant nor high. These fevers often lasted till the 30th or 40th day, and in some to the 60th; and at length the patients gradually wrestled out of them, without any remarkable crisis. The common remedies in such cases availed little here; blistering was found of much more service than bleeding. "Tertian agues began to appear in March, and continued through April and part of May, though not very frequent; many of them were off easily after four or five fits, without much assistance from medicine ; others took the common course. "Some short but sharp fevers were frequent in April, with an erysipelas, for the most part on the face, and sometimes on the body or extremities. "Some few children had the smallpox all the spring, and there were rather more in May; they were generally of the distinct kind; and several had an eruption like the bastard or chicken-pox. It was attended with very little fever, and very slight symptoms ; for, after a little heaviness and loss of appetite, the pustules appeared. They were pretty large and red : they did not suppurate, but had a little vesicle of clear lymph on the top. Some new pustules appeared for four or five days successively, like the first; and about the ninth day all went off." 41 EPIDEMIC OF 1732-3. An Extract from the Public Register of Burials in Edinburgh. Men. Women. Childi-en. Still-born. Sum. 1732 June 23 32 27 82 July 16 21 37 5 79 August 19 20 39 2 80 September . . . 15 32 20 4 71 October .... 20 19 32 4 75 November .... 24 28 33 4 89 December .... 31 41 34 3 109 1733 January .... 56 81 74 3 214 February .... 40 44 48 3 135 March 36 42 34 5 117 April 20 28 41 2 91 May 19 26 57 3 105 Total .... 319 414 476 38 1247 [In France, during the years 1731 and 1732, the Arctia phmorrhma, a moth allied to the brown-tail moth, was so nu- merous, as to occasion a general alarm. The oaks, elms, and whitethorn hedges looked as if some burning wind had passed over them and dried up their leaves ; for the insect devouring only one surface of them, that which is left becomes brown and dry. They also laid waste the fruit-trees, and devoured the fruit ; so that the Parliament published an edict to compel people to collect and destroy them ; but this would, in a great measure, have been ineffectual, had not some cold rains fallen, which so completely annihilated them, that it was difficult to meet with a single individual.^] The weather,^ during the period referred to in the Edinburgh account of this epidemic, is recorded in the Meteorological Register (see pp. 47 — 52). It was carefully observed with the aid of instruments thus described in 'Med. Essays and Observations,' vol. i, art. 2 : — "The Barometer is a simple portable one, the tube of which is about a fourth of an inch diameter in its bore, and has a proportional large cistern for the stagnant mercury. It is kept in a chamber at the height of 270 feet above the level of the ' Reaumur, vol. ii, p. 122; as quoted in Kirby and Spence's Entomology, vol. i, p. 206. ' The Tertian agues, vfhich were mentioned in the close of our preceding year, continued likewise through June, and part of July, 1732. OBSERVATIONS IN EDINBURGH. 45 sea, as we calculated, by carrying this instrument to the sea shore, when the mercury was perfectly stationary ; and allowing, according to Dr. Halley's computation, (confirmed by experi- ments we tried,) 90 feet perpendicular height for every tenth of an inch, which the mercury rose in the barometer, as we descended. "The different heights of the mercury in the tube at the several times of observation are marked in the register by inches and tenths of inches British measure, which we have also made use of in determining the degrees of the Thermometer and Hygroscope. "The Thermometer used in our observations, is the common glass-ball and small tube, containing coloured alcohol, and sealed hermetically at the top. The freezing point is at 8 inches, 2 tenths ; and the heat of a man in health raises the spirits to 22 inches, 2 tenths. "Our Hygroscope is a whip-cord with a plummet appended, which we have endeavoured to make more capable of being compared with other such instruments, than is commonly prac- tised, by ascertaining two fixed points in the following manner. We kept the cord very near to a constant fire for several weeks, and afterwards put it into a warm oven till it was so dry that we could scarce make it straight without breaking ; then having put the end of it through the nose of a funnel, to be secured within the funnel, by the iron pin on which it was afterward to be hanged ; we stuffed the nose of the funnel with spunge, and poured water into the funnel to trickle down along the cord. We supplied new water constantly, till the plummet would neither turn round, nor rise any more with the water which the cord received in this way, nor by soaking it in water, nor by steams of hot water, but began to untwist as soon as we forbore supplying the steams or water. This operation we repeated four times, and always found that the difference in the length of our cord, when fully dried, to its length when fully wet, was four and a half inches. The point of greatest dryness on the scale from which this article of the register is taken, is at five tenths of an inch, and the point of the fullest wetness is five inches. "We must likewise remark, that the Thermometer and Hygroscope are kept in a square wainscot box, placed on the West-side, and without the sash of a North window of the same chamber where the Barometer is. The box is very tight 46 EPIDEMIC OF 1732-3. on every side, when the door of it is shut, except in the side next the sash, where a great many large holes are made. By the situation and make of this box, neither the sun or rain, nor the fire and company in the chamber, can have any bad effect on the instruments within it, and the air has open free access to them. "The Direction of the Wind is observed by the weather-cock of the high-steeple of St. Giles's church, which is the only tole- rable place or instrument for making this sort of observation, in a city situated as ours is. "We were resolved to have determined the force of the wind very exactly, and for that purpose had contrived two instruments, one of which should shew the force at the time when the observations with the other instruments were made; and the second should have pointed the greatest force the wind had, between the times of observation. But not finding any place for setting them up, where the wind could have its full effect, and the observator could have easy access, we laid aside that design, and have followed Dr. Juryn's directions of judging by our senses, without the help of any machine, and in the Tables have marked the several degrees thus, 0, 1, 2, 3, 4. By is denoted a perfect calm ; by I, such a small wind as scarce moved the leaves of trees; by 4, a hurricane; and by 3, 3 intermediate forces. "The instrument by which we have determined the Depth of Rain that faUs,is: — 1. AFunnelof 28 inches diameter at its brim, placed at the top of a garden-wall, about the middle height of the city, and free from aU over-topping houses or trees ; and to prevent evaporation as much as possible, a large share of the body and the nose of the Funnel are sunk into a large very thick box of wood in which a narrow-neck'd receiver is placed, that allows the end of the nose of the Funnel to enter it. 2. The Gage in which the water is measured, is a cylindrical glass, whose diameter is exactly 2"8 inches, or one tenth of the diameter of the Funnel, and has its divisions into inches, and tenths of inches, exactly marked on its length with a diamond. The difference of the diameters of the Funnel and of the Gage, readily shows that one hundredth part of what is measured in the Gage is only to be reckoned as the true quantity that falls, which we have set down in inches and decimals of inches." THE METEOROLOGICAL REGISTEE. JUNE, 1733. (o.s.) JULY, 1732. (o. s.) D. Hour. Baro. Ther. Hyg. Wind. Weather. Rain, 48 EPIDEMIC OF 1732-3. AUGUST, 1732. (o.s.) D. Hour, Baro. Ther. Hyg. Wind. Weatliti-. Kjvin 9 am. 5 p. in 8 a.m. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 6 p.m. loa.m. 6 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 9 a.m. d p.m. 8 a.m. 5 p.m. 9 a.m. 7 p.m. 9 a.m. 5 p.m. 9 a.m. 6 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 7 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 6 p.m. 8 a.m. 6 p.m. 9 a.m. 5 p.m. 9 a.m. 6 p.m. 8 a.m. 5 p.m. 8 a.m. 4 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 6 p.m. S a.m. 5 p.m. 7 a.m, 5 p.m. 9 a.m. 5 p.m. 9 a.m. In. D. 29 8 29 8 29 9 29 9 30 30 30 30 30 30 29 9 29 9 29 8 29 6 29 6 29 S 29 5 29 3 29 6 29 29 29 29 29 29 H. at amed, Gr. height. L. height. In. D. 13 13 9 13 1 14 1 13 6 14 8 13 7 14 9 13 9 29 9 29 9 29 8 7 7 9 30 29 30 30 IS 6 13 7 14 4 13 8 15 13 14 6 13 2 13 8 12 2 13 3 11 9 11 5 12 12 9 12 5 12 U 11 7 12 7 12 6 13 2 12 1 I. B. I 2 1 1 1 6 1 1 1 1 1 1 1 Dir. For. NW t NE 1 SW N NW N S SE SE SE E E SE 6 'VV 4 9 7 1 4 4 4 5 1 4 13 el 14 14 5 15 14 2 14 6 13 6 12 6 13 7 12 4 13 11 6 12 4 12 6 14 2 12 7 13 3 IS 6 11 .'•) W W E NW NW NW E SW W NE NE NE NW WbyS2 W 2 WbySl W 2 NW W SW S NW WbyN2 SW 1 1 5 7 3 7 2 6 6 9 5 is 8 'SW 6 'sW 8 INE 5 lEbyN 2 clear clear clcir clear clear clear clear clear clear cl. high cloudy clear fng clear inwring clear cloudy cloudy cloudy cloudy cloudy cloudy cloudy lowring lowring gr. rain cloudy clear clear clear clear clear 1 clear E 7 'SW W w SW SW SW w WbyN 2 WbyN2 NW NE 3 4 I 1 NE E SW W w cloudy clear cloudy 2 cloudy clear rain cloudy cloudy clear cloudy clear rain raiu clear clear clear rain cloudy rain clear clear cloudy clear clear clear clear clear clear Total depth lu. I), 0,365 0,432 0,828 1,62S SEPTEMBBK, 1732. (o.s.) 8 a.m. 4 p.m. a a.m. 4 p.m. 9 a.m. 6 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 4 p.m. 8 a.m. 4 p.m. 9 a.m. 6 p.m. 9 a.m. (! p.m. 9 a.m. 5 p.m. 9 a.m. 4 p.m. 8 a.m. 6 p.m. 8 a.ni. 4 p.m. 8 am. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 7 p.m. 8 a.m. 7 p.m. 8 a.m. 8 a.m. 4 p.m. 8 a.m. 4 p.m. 8 a.m. 9 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. Baro. 'I'lier. In. D 30 2 30 2 30 2 30 3 30 3 30 3 SO 2 30 30 30 H. at amed. Gr. height. 30 3 h. height. 29 29 6 29 6 29 6 29 5 29 2 29 2 28 6 28 8 29 28 8 5 6 29 9 1 3 4 7 29 5 29 6 29 6 29 7 30 30 2 30 3 30 2 30 29 9 29 9 3D J 3U 1 30 2 30 2 29 6 28 3 In. D. 12 3 14 12 4 14 1 12 5 12 7 11 7 13 6 12 2 13 3 12 6 14 2 12 8 13 12 6 10 8 12 1 11 8 11 5 11 6 11 8 10 8 10 8 10 3 12 8 13 11 8 12 6 11 5 13 2 13 7 12 3 13 1 11 a 11 9 11 8 12 4 11 4 12 1 10 5 11 9 9 8 11 2 12 2 14 6 9 8 Hyg. I. D. 1 6 1 8 2 9 2 6 2 4 9 6 9 5 7 8 7 6 Wind. Weather Dir. Tor. NW NW NE NE E E N N NE NE SW w E E SE SW SW SW aW SW SW SW W NW W W 2 NbyW2 NW SW SW N W NW W W W W W W W W SW SW W SW SW w w SE E E SE SE SE SE SE SB SE 1 7 2 9 1 1 clear clear clear clear mist mist mist mist mist mist clear cloudy cloudy iloudy cloudy clear cloudy cloudy cloudy lowring clear tempest cloudy clear clear cloudy clear cloudy raui rain fair fair fair fair fair fair fair fair fair storm storm cloudy cloudy cloudy cloudy rain fair fair fair fair cloudy cloudy cloudy cloudy f-iir fair fair Total depth OBSERVATIONS IN EDINBURGH. 49 OCTOBER, 1732. (o. s.) D. Horn'. 9 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 4 p.m. 8 a.m. 6 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 4 p.m. 9 a.m. 4 p.m. 9 a.m. 5 p.m. 8 a.m. 4 p.m. 8 a.m. 5 p.m. 9 a.m. 4 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m*. 8 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 4 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 4 p.m. 9 a.m. 4 p.m. 8 a.m. 4 p.m. 9 am. 5 p.m. 8 a.m. 5 p.m. In. D, 30 29 9 Baro. Ther. Hyg. Wind. Weather. Rain, J 3 3 3 1 1 2 29 29 4 2 29 28 9 29 29 1 29 4 29 5 29 5 29 5 29 4 29 4 29 5 29 5 29 7 29 7 29 H. atamed, Gr. height L. height 29 6 29 6 29 6 29 6 29 7 6 4 4 29 29 9 In. 10 11 10 11 10 10 10 10 9 II 9 11 10 11 11 11 12 12 11 11 10 11 11 11 10 11 10 10 11 12 10 11 11 11 10 10 10 11 10 10 10 11 11 u 10 11 11 11 11 11 12 12 11 11 11 10 9 10 10 10 10 10 Dir. I'or, 12 7 9 5 SE SE SE E E NE NE W SW E NW WbyNl SE SE SW SW S SbyWl SW w SE SW SW Sby E 1 SW W 1 SW Sby Wl Sby Wl Sby WO fair fog cloudy cloudy cloudy rain fair cloudy fair rain clear clear rain rain fair cloudy fair fair fair fair fog cloudy SW SW SW SW SW SW SW E NW NE SE SE SW SW SE E NE NE SE SE SE SE SE SE W W W NW W w W SW 3 9 1 3 ram cloudy rain fair fair cloudy cloudy fair rain cloudy cloudy fair cloudy fog cloudy cloudy cloudy loudy fair cloudy cloudy fair cloudy rain rain fog fog fair fair fog fog cloudy fair fair fair cloudy cloudy cloudy 1 cloudy In. D. 0,062 0,213 0,685 D. Hour. Baro. Ther. Hyg. Wind. Weather, llain. Total depth NOYEMBER, 1732. (o. s.) 2,523 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m, 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. 5 p.m. 8 a.m. S p.m. 9 am. 5 p.m. 8 a.m. 5 p.m. 9 a.m. 4 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 6 p.m. 9 a.m. 5 p.m. 9 a.m. 4 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 4 p.m. 9 a.m 4 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 5 p.m. 9 a.m. 3 p.m. 9 a.m. 5 p.m. In. D. 29 9 29 9 29 9 30 1 1 30 1 30 1 30 1 .10 1 30 2 30 2 30 2 30 3 3 3 2 1 29 9 29 8 29 8 29 7 29 8 29 8 29 4 29 5 5 4 29 29 29 29 30 30 30 1 In. D. 9 9 10 3 10 9 6 9 4 10 9 6 9 7 8 3 9 8 2 9 6 9 3 9 4 8 7 9 2 9 7 9 9 9 9 9 9 1 5 4 5 9 H. atamed. Gr. height L. height 30 30 30 30 30 30 30 30 30 30 30 30 30 29 8 29 8 29 7 29 9 29 Dir. I'or 2 1 1 1 1 1 2 S SE E SE SE SE SE SW SW SW SW SW SW W w w w w w s SE SE SE SE SE SE NW NbyWS NbyW2 NE 3 N 3 W 2 WbyS2 1 fair fair cloudy cloudy fog fog cloudy cloudy cloudy fair fair fair fair 30 4 10 6 3 5 2 9 2 9 2 7 NW NW NW NW NW NW NW S s s w w NW w w w w w w NbyWl NbyWl NbyW2 WbyS3 WbyS3 W W fog fog fog fog fog fog fog cloudy fair fog fog rain fog cloudy cloudy doudy cloudy fair fair fair fair fair fair fair cloudy cloudy fair cloudy cloudy cloudy cloudy cloudy fair fair air fair fair fair fair fair fair fair cloudy cloudy cloudy cloudy Total depth 29 4 7 2 14 0,415 50 EPIDEMIC OF 1732-3. DECEMBER, 1732. (o.s.) JANUARY, 1733. (O.S.) D. Hour. Baro. Ther. Hyg. ■Wind. Weather ILain. D. Hour, Baro. Ther. Hyg. Wind. Weather .Rain. In. D. In, B, I. D Dir. For. In. D. In. D In. D I. D Dir. For. In. D. 1 9 a.m. 30 1 8 2 2 3 W 2 fair 1 9 a.m. 29 3 9 4 2 2 NW 2 fair 5 p.m. 30 1 8 8 2 4 W 2 fair 6 pm. 29 6 8 6 2 1 Wbj N2 fair 2 9 a.m. .30 1 8 9 1 9 NW 2 fair 2 9 a.m. 29 5 9 6 2 3 SW 2 rain n,054 4 p.m. 30 1 8 7 1 9 NW 2 fair 4 p.m. 29 3 10 6 2 5 SW 2 cloudy 3 9 a.m. 30 1 9 2 SW 2 cloudy 3 9 a.m. 29 4 9 7 2 3 SW 2 fair 0,135 5 p.m. 29 9 9 7 2 2 SW 2 cloudy 5 p.m. 29 3 9 8 2 3 SW 3 cloudy 4 9 a.m. 29 6 10 2 6 W 2 fair 4 9 a.m. 29 I 10 6 2 2 SW 3 rain 0,217 5 p.m. 29 7 8 8 2 2 NW 1 fair 5 p.m. 29 11 7 2 3 SW 4 cloudy 5 9 am. 29 8 9 2 2 N 1 fair 6 9 a.m. 29 2 10 6 2 SW 3' fair 5 p.m. 29 9 9 1 2 1 N 1 fair 6"p,m. 29 3 10 7 2 SW 2irain 6 9 a.m. 30 8 2 N 1 fair 6 9 a.m. 29 5 9 9 2 SW 2fair 0,190 5 p.m. 30 7 7 2 5 NbyWO fair 4 p.m. 29 6 10 2 SW 2fair 7 9 a.m. 30 1 7 3 N 1 fair 7 9 a.m. 29 7 10 3 2 1 s 2jfair 0,083 5 p.m. 30 3 8 6 2 4 N 1 fog 4 p.m. 29 6 10 2 2 s 2,fog « 9 a.m. 30 4 9 1 2 3 E 1 fog 8 9 a.m. 29 2 10 8 2 4 SW 1 rain 5 p.m. 30 '4 9 1 2 3 E 1 fair 5 p.m. 29 2 10 3 2 2 w 2ifair 9 9 a.m. 30 3 9 1 2 3 EbyS 2 fair 9 9 a.m. 29 2 9 2 2 4 w 2 fair 0,225 6 p.m. 30 3 9 1 2 3 SE 2 fog 0,032 5 p.m. 29 2 10 2 2 2 w 2 fair 1(1 9 a.m. 30 2 8 7 2 SE 2 fair 10 9 a.m. 29 4 , 9 3 2 3 w 2 fair 4 p.m. 30 1 9 2 2 1 SE 2 fair 5 p.m. 29 6 9 5 2 1 SW 3 fair 11 9 a.m. 29 9 7 2 2 SE 1 fog 11 9 a.m. 29 6 10 2 2 SW 2 cloudy 5 p.m. 29 8 7 5 2 3 SE 2 fair 8 p.m. 29 6 10 1 2 SW 2 cloudy 12 9 a.m. 29 8 7 5 2 5 SE ( fog 12 9 a.m. 29 6 e 7 2 1 E 1 fair 0,053 5 p.m. 29 8 8 2 5 SB 1 fog 6 p.m. 29 6 9 6 2 E 1 cloudy 13 9 a.m. 29 9 8 5 2 6 SE 1 fog 13 9 a.m. 29 6 9 I 2 1 s 1 fair 5 p.m. 29 9 8 7 2 3 SE ( fog 5 p.m. 29 6 9 4 2 SW 1 fair 14 9 a.m. 29 8 6 7 2 5 S 2 fair 14 9 a.m. 29 6 8 3 2 2 SW I cloudy 5 p.m. 29 7 6 G 2 4 s 1 fair 5 p.m. 29 6 8 4 2 1 SW 1 fog 15 9 a.m. 29 7 7 4 2 4 s 1 fog 15 9 a.m. 29 6 9 4 2 3 s 1 fair 5 p.m. 29 6 7 5 3 S 1 fog 5 p.m. 29 6 9 2 2 I SW 2 fair 16 9 a.m. 29 6 8 1 3 SE 1 fog 16 9 a.m. 29 7 10 8 2 2 s 2 cloudy 5 p.m. 29 6 8 4 2 6 SE 1 fair 5 p.m. 29 7 10 7 2 2 s 1 cloudy 17 9 a.m. 29 5 9 2 2 8 S 1 fair 17 9 a.m. 29 8 10 7 2 2 SW 1 rain 4 p.m. 29 5 9 4 2 7 S 1 fair 5 p.m. 29 9 10 4 2 6 SW 1 rain 18 9 a.m. 29 4 8 8 3 1 Wby SI fog 18 9 a.m. 30 10 3 2 4 SW 1 cloudy 5 p.m. 29 4 8 1 3 1 Wby S 1 fog 5 p.m. 30 1 10 4 2 4 SW 2 cloudy 19 9 a.m. 29 3 8 3 3 3 Sby El fog 0,09S 19 9 a.m. 30 1 9 3 2 3 s 2 fair 0,093 5 p.m. 29 3 9 3 4 SbyEO fug 5 p.m. 30 1 7 7 2 SW 1 fair 20 9 a.m. 29 2 9 1 3 3 S fog 0,210 20 9 a.m. 30 1 7 7 1 6 w 1 fair 5 p.m. 29 1 9 5 3 2 S fog 5 p.m. 30 1 8 2 1 6 s 1 fair 21 9 a.m. 29 3 10 3 S fog 0,172 21 9 a.m. 30 2 7 1 7 s 1 fair 5 p.m. 29 10 3 3 2 w fog 5 p.m. 30 2 8 5 1 8 s 2 fair 22 9 a.m. 28 9 10 3 4 E 2 rain 0,395 22 9 a.m. 30 2 7 8 2 1 SE 2 fair 5 p.m. 29 1 9 8 3 8 E 2 rain 5 p.m. 30 2 8 2 1 9 SE 2 fair 23 9 a.m. 29 6 9 4 3 6 E 2 rain 0,350 23 9 a.m. 30 1 8 4 2 2 SE 2 fair 5 p.m. 29 6 9 6 3 3 E 2 rain 5 p.m. 30 1 10 2 2 3 SW 2 cloudy 24 9 a.m. 29 6 10 4 3 3 S 3 rain 0,410 24 9 a.m. 30 U 1 2 3 SW 2 cloudy 4 p.m. 29 6 11 8 3 S 3 cloudy 4 p.m. 30 1 11 6 2 2 SW 2 cloudy 0,055 26 9 a.m. 29 5 10 5 2 3 SW cloudy 0,382 25 9 a.m. 30 11 1 2 2 SW 2 fair .5 p.m. 29 4 U 3 3 SW 1 cloudy 5 p.m. 29 9 12 1 2 2 SW 3 fair 26 9 a.m. 29 4 10 5 2 7 SW 1 cloudy 0,266 26 9 a.m. 30 10 8 2 1 SW 3 fair 4 p.m. 29 4 10 3 2 5 SW 1 cloudy 5 p.m. 30 1 11 2 2 SW 2 fair 27 9 a.m. «9 3 9 4 2 7 SW 2 cloudy 0,210 27 9 am. 30 1 10 4 2 2 SW 1 rain* 0,106 4 p.m. 29 3 10 1 2 8 SW 2 cloudy 4 p.m. 30 1 10 4 2 4 SW 2 fair 28 9 a.m. 29 2 9 6 3 SW 2 cloudy 0,467 28 9 a.m. 30 2 9 9 2 4 SW 1 cloudy 0,091 5 p.m. 29 1 9 2 8 w 2 cloudy 5 p.m. 30 1 10 2 2 3 SW 1 cloudy 29 9 a.m. 28 B 9 2 7 w 2 snow 0,365 29 9 a.m. 29 6 10 7 2 SW 2 cloudy 5 p.m. 28 6 9 8 2 6 SW 2 cloudy 5 p.m. 29 3 11 2 2 1 SW 3 cloudy 30 9 a.m. 28 2 10 6 2 5 SW 3 rain 0,198 30 9 a.m. 29 1 10 5 2 1 SW 4 fair 0,068 4 p.m. 28 2 10 5 2 5 SW 3 cloudy 6 p.m. 29 3 10 1 1 9 SW 3 'air 31 9 a.m. 28 8 10 2 4 NW 2 fair 0,085 31 9 a.m. 29 9 1 1 9 SW 3 fair H. 4 p.m. 29 9 S 2 w 2 fair 5 p.m. 29 1 9 7 1 9 SW 2 fair at a med. 29 8 9 I 2 6 Total depth 3,617 II. at a med, Gr. height 29 8 9 6 2 1 Total depth 1,370 6r. height 31 4 11 8 3 8 30 2 12 1 2 6 • Eain when Mer fit ^n 1 ^.. ..A... cnryis extra- L. leight 28 2 6 (; ) 9 L, 'leight 29 7 1 5 ar ou ordin J. 1= vm, ory. OBSERVATIONS IN EDINBURGH. 51 rEBRUARY 1733. (O.S.) MARCH, 1733. ( 3.S ) D. Hour. Bai 0. Ther. Hyg.| Wind. Weather. Uain. D. Hour. Baro. Ther. Hyg. Wind. Weatlier. Ilain. In. D. In. D. I. D. Dir. For. In. 1). In. D In. D. I. D. Dir. For. In. D. 1 9 a.m. 29 2 10 6 2 2 SW 4 rain 0,135 I 9 a.m. 29 7 U 8 2 4 SW 2 cloudy 0,035 5 p.m. 29 1 11 4 2 2 SW 4 rain 5 p.m. 29 5 11 9 2 SW 4 cloudy 2 9 a.m. 28 9 10 1 2 2 SW 2 cloudy 0,193 2 9 a.m. 29 6 10 5 2 1 SW 2 L'loudy 5 p.m. 29 9 2 2 3 SW 2 cloudy 5 p.m. 29 9 10 2 1 7 N" 3 fair 0,073 3 9 a.m. 29 2 9 7 2 1 SW 3 fair 0,233 3 9 a.m. 30 2 9 4 2 2 W 3 fair 5 p.m. 29 1 9 8 2 1 SW 2 fair 5 pm. 30 2 10 8 1 6 w 2 fair 0,042 4 9 a.m. 28 9 9 6 2 I SW 3 fair 0,089 4 9 a.m. 30 2 10 2 4 w 2 f.iir 4 p.m. 28 8 10 1 7 SW 3 cloudy 5 p.m. 30 1 11 2 1 w 2 fair 5 9 a.m. 29 9 6 2 w 2 fair 5 9 a.m. 29 9 11 2 3 NW 3 fair 5 p.m. 29 4 10 6 1 8 NW 2 fair 0,063 5 p.m. 29 9 9 7 1 7 NW 2 fair 6 9 a.m. 29 8 9 2 2 3 w 2 fair 6 9 a.m. 29 9 9 8 2 1 NW 2 fair 0,100 5 p.m. 29 8 10 3 2 2 SW 2 cloudy 6 p.m. 29 8 10 1 9 W 2 fair 7 9 a.m. 29 6 10 8. 2 2 SW 2 cloudy 7 9 a.m. 29 3 9 4 2 2 SW 3 rain 0,072 5 p.m. 29 6 10 6 2 W 2 rain 5 p.m. 29 2 10 1 6 w 2 cloudy 8 9 a.m. 29 4 9 6 2 2 E 1 rain 8 9 a.m. 29 2 8 9 2 NW 3 fair 5 p.m. 29 3 8 8 3 NE 3 rain 5 p.m. 29 4 9 1 1 7 NW 2 cloudy 0,254 9 9 a.m. 29 6 9 2 6 N 2 fair 0,514 9 9 a.m. 29 5 8 2 1 5 NW 2 fair 5 p.m. 29 5 9 6 2 N 1 fair 5 p.m. 29 6 8 I 1 5 NW 2 fair 0,050 10 9 am. 29 6 8 5 2 4 N 1 fair 10 9 a.m. 29 7 8 4 1 6 NW 2 cloudy 5 p.m. 29 6 10 2 3 W 2 fair 6 p.m. 29 7 8 2 4 N 1 snow 11 9 a.m. 29 3 11 3 2 6 SW 3 cloudy 11 9 a.m. 29 7 7 e 2 3 N 1 fair 5 p.m. 29 3 11 2 3 W 3 cloudy p.m. 29 6 9 2 NE 1 cloudy 0,151 12 9 a.m. 29 5 9 4 2 2 SW 3 cloudy 12 9 a.m. 29 7 3 8 2 6 SE 2 rain 5 p.m. 29 6 10 3 2 I w 3 cloudy 5 p.m. 29 8 9 7 2 5 SE 2 cloudy 13 9 a.m. 29 4 11 2 2 2 SW 3 fair 13 9 a.m. 29 9 1 2 2 E 2 hazy 0,096 5 p.m. 29 4 11 7 2 SW 3 cloudy 6 p.m. 29 9 9 2 3 E 2 hazy 14 9 a.m. 29 6 9 8 2 1 SW 2 fair 14 9 a.m. 29 8 9 2 1 SB 1 hazy 5 p.m. 29 7 10 3 1 8 w 2 fair 5 p.m. 29 6 9 7 1 7 SE 2 fair 15 9 a.m. 29 8 9 7 2 2 SW 2 fair 0,137 15 9 a.m. 29 6 8 9 1 8 SE 2 hazy 0,194 5 p.m. 29 8 10 7 2 SW 2!fair 5 p.m. 29 4 8 7 1 8 S 2 cloudy 16 9 a.m. 29 8 10 7 2 2 SW 2 fair 16 9 a.m. 29 1 8 5 2 5 SE 3 snow 0,210 5 p.m. 29 7 11 5 1 9 SW 3 cloudy 5 p.m. 29 1 9 4 2 6 SE 3 rain 17 9 a.m. 29 8 9 5 2 SW 3 fair 17 9 a.m. 29 2 9 5 2 6 SE 1 hazy 5 pm. 29 7 10 7 2 SW 3 fair 6 p.m. 29 2 9 4 2 5 SE 2 rain 18 9 a.m. 29 7 11 2 SW 2 cloudy 18 9 a.m. 29 3 9 1 2 5 SE 3 fair 0,292 5 p.m. 29 fi 10 8 1 8 SW 2!fair 6 p.m. 29 4 8 9 2 6 SE 2 cloudy 19 9 a.m. 29 3 10 3 1 9 SE 2 cloudy 0,092 19 9 a.m. 29 4 9 2 2 2 N 1 fair 5 p.m. 29 4 9 3 1 9 SW 2 cloudy 5 p.m. 29 4 8 9 2 NE 3 hazy 20 9 am. 29 3 9 3 2 1 SE 2Jrain 0,373 20 9 a.m. 29 3 7 6 3 8 NE 4 snow- 5 p.m. 29 3 9 6 2 4 SE 2'rain 5 p.m. 29 3 8 3 4 E 2 cloudy 21 9 a.m. 29 3 9 6 2 6 SW 1 cloudy 21 9 a.m. 29 2 7 9 3 2 SW 2 fair 0,520 5 p.m. 29 4 10 2 2 5 SW 1 cloudy 6 p.ni. 29 1 7 4 2 5 SW 2 fair 22 9 a.m. 29 4 9 5 2 3 s 3 fair 0,315 22 9 a.m. 29 1 3 7 3 E 2 cloudy 5 p.m. 29 4 10 1 2 SW 4 cloudy 5 p.m. 29 1 8 5 3 N 2 hazy 23 9 a.m. 29 2 9 6 1 4 SE 2 cloudy 0,142 23 9 a.m. 29 4 8 7 3 2 N 2 uloudy 0.118 5 p.m. 29 4 10 2 2 1 SE 2 cloudy 5 p.m. 29 4 9 5 2 9 SE 2 rain 24 9 a.m. 29 6 10 2 2 SE 1 cloudy 24 9 a.m. 29 3 9 6 3 1 SE 2 rain 0,070 5 p.m. 29 7 10 7 1 8 SW 1 'cloudy 5 p.m. 29 2 12 1 2 6 SE 2 fair 25 9 a.m. 29 6 9 8 2 W 2 fair 0,094 25 9 a.m. 29 3 11 3 2 8 S 1 tair 5 p.m. 29 7 9 4 2 W sjfair 5 p.m. 29 4 12 5 1 8 S 1 fair 0,130 26 9 a.m. 29 4 10 3 2 1 SW 4rain 0,110 26 9 a.m. 29 4 10 3 3 9 E 2 mist 5 p.m. 29 4 9 7 1 8 SW 2, cloudy 5 p.m. 29 3 10 3 3 4 E 2 mist 0,054 27 9 a.m. 29 4 9 3 2 SW 3 rain 27 9 a.m. 29 4 11 3 3 6 S 1 fair 5 p.m. 29 4 8 6 2 2 SW 2 snow 5 p.m. 29 4 12 4 2 3 s 1 cloudy £8 9 a.m. 29 6 9 8 2 2 SW 2 cloudy 0,665 28 9 a.m. 29 6 12 2 5 SE 1 cloudy S p.m. 29 5 11 1 2 SW 2 cloudy 29 5 p.m. 9 a.m. 5 p.m. 29 29 29 5 6 7 12 11 11 4 4 2 3 3 2 2 SE E E 2 2 2 cloudy hazy rain H atamed. 29 6 9 9 2 1 Total depth 2,525 30 9 a.m. 7 p.m. 29 29 9 9 10 10 5 2 2 2 8 9 Eby Eby N2 N 2 cloudy fair Gr. height 29 8 U 7 3 31 9 a.m. 29 9 U 6 2 6 Eby NO fair 0,177 L. height 28 8 8 6 1 4 H atamed. 29 6 9 9 2 4 Total depth 2,638 Gr. height L. height 30 2 12 5 3 9 29 1 ~ 4 1 5 52 EPIDEMIC OF 1733-3. APRIL, 1733. (O.S.; MAY 1733. (O.S.) D. Hour. Baro. Tlier. Hyg Wind. Weather Rain. D. Hour. Bare. Ther. Hyg. Wind. Weather. Bain. In. D. In. D. I. D. Dir. Eor. In. D. In. D, In. D. D. Dir. For. In. D. 1 9 a.m. 29 9 11 2 2 9 NE 1 mist 1 9 a.m. 30 1 12 2 6 W 1 cloudy 5 p.m. 29 9 12 6 2 6 NE mist 5 p.m. 30 13 7 4 W 2 fair 2 9 a.m. 29 9 12 5 2 4 N 1 cloudy 2 7 a.m. 29 9 12 6 6 W 1 fair 7 p.m. 29 9 12 7 7 N fair 6 p.m. 29 8 12 8 6 E 2 cloudy 3 9 a.m. 30 12 8 NW 2 fair 3 9 a.m. 29 8 12 1 1 E 2 fair 5 p.m. 3U 13 7 NW 1 cloudy 5 p.m. 29 8 10 7 3 E 2 cloudy 4 9 a.m. 30 10 8 8 N Omist 4 8 a.m. 29 9 11 4 5 E 1 fair 7 p.m. 30 10 3 9 N 2 mist 8 p.m. 29 9 11 1 5 E 1 fair 5 gam. 30 12 7 8 NE Imist 5 9 a.m. 30 11 2 5 E 1 fair 7 p.m. 30 12 7 8 N Ifair 8 p.m. 29 9 12 4 4 E 1 fair 6 8 a.m. 30 11 9 7 SW 1 fair 6 8 a.m. 29 9 11 2 6 Eby N2 fair 7 p.m. 29 9 13 1 5 N 1 fair 4 p.m. 29 8 13 4 Eby N2 fair 7 9 a.m. 29 9 11 6 8 SW fair 7 8 a.m. 29 6 n 6 6 3E 1 fair 7 p.m. 29 8 11 8 5 SW 1 fair 5 p,m. 29 6 13 4 2 SE 2 fair 8 9 a.m. 29 6 12 S 6 S 2 cloudy 8 9 a,m. 29 6 10 7 4 NE 1 cloudy 7 p.m. 29 5 11 9 8 SW 1 drizzling 6 p.m. 29 6 12 3 3 NE 2 cloudy S 8 a.m. 7 p.m. 29 29 6 « 11 11 9 8 8 4 WbyS2 W 2 fair fair 9 Sam. 29 6 11 7 4 NE 2 fair 10 8 a.m. 7 p.m. 29 29 6 6 11 12 6 6 S SW 3 SW 1 fair cloudy 11 9 am. 29 6 11 6 6 SW 2 fair 0,023 11 9 a.m. 29 7 12 9 3 E 1 fair 7 p.m. 29 5 11 5 6 S 2 cloudy 5 p.m. 29 7 13 4 4 E 1 fair IS 9 a.m. 29 6 12 2 7 S 2 cloudy 12 9 a.m. 29 7 12 3 3 E 1 fair 7 p.m. 29 5 U 7 7 S 2 cloudy 5 p.m. 29 7 13 8 2 E 1 fair la 9 a.m. 29 4 12 6 7 SE 1 fair 18 9 a.m. 29 8 12 8 4 E 1 fair 7 p.m. 29 4 11 7 2 1 E 1 fog 6 p.m. 29 9 13 I 3 NE 1 fair 14 9 a.m 29 4 11 8 2 3 SE 2 cloudy 0,055 14 9 a.m. 29 9 12 7 7 NE 1 fair 7 p.m. 29 6 11 1 9 SE 2 cloudy 6 p.m. 29 9 13 3 6 E 2fair IS 9 a.m. 29 8 11 3 2 E 1 fair 15 9 a.m. 30 12 5 6 E 2falr 7 p.m. 29 9 10 7 2 S E 2 cloudy 8 p.m. 30 12 9 3 E ijfair M 9 a.m. 30 10 8 3 NE 2 fair 16 9 a.m. 30 13 2 4 SE Ifair 7 p.m. 30 10 6 2 4 NE 2 fair 8 p.m. 30 12 2 6 E 1 fair 1; 9 a.m. 29 8 10 7 2 9 NE 3 fog 0,073 17 9 am. 30 12 3 7 E 1 fair 7 p.m. 29 7 11 2 7 NE 2 fog 6 p.m. 29 9 12 7 8 E 1 fair u 9 a.m. 29 5 10 7 3 NE 2 log 18 9 a.m. 29 9 12 4 2 E 1 rain 7 p.m. 29 2 10 5 3 7 NE 3 rain 6 p.m. 29 9 12 9 a E 1 cloudy IS 9 a.m. 29 3 11 2 3 4 S 2 cloudy 0,187 19 9 a.m. 29 9 12 6 8 E 1 cloudy 0,032 7 p.m. 29 5 12 6 2 1 S 1 fair 6 p.m. 29 8 13 5 3 SW cloudy 2( 9 a.m. 29 7 12 2 2 3 S 1 cloudy 20 9 am. 29 8 13 3 6 W 2 cloudy 8 p.m. 29 8 12 4 2 1 W 1 rain 7 p.m. 29 8 12 8 4 W 2 cloudy 2 9 a.m. 29 9 12 1 2 1 SW 1 fair 21 8 a.m. 29 9 13 2 5 W 2 fair 8 p.m. 29 8 11 9 2 E 1 fair 7 p.m. 29 9 IS 2 3 W 2 cloudy 2S 9 a.m. 29 8 11 4 2 E 2 fair 22 9 a.m. 29 9 13 2 9 W 1 cloudy 5 p.m. 29 8 11 9 2 1 E 2 cloudy 7 p.m. 29 9 14 1 W 2 fair 2: 9 a.m. 29 8 10 7 2 3 NE 2 cloudy 23 9 a.m. 30 1 14 5 NW 2 fair 7 p.m. 29 7 10 6 3 5 NE 3 cloudy 8 p.m. 30 1 13 7 4 N 2 fair a 9 a.m. 29 7 10 4 2 6 NE 3 cloudy 0,262 24 8 a.m. 30 1 12 5 6 E 2 fair 4 p.m. 29 8 10 8 2 NE 2 fair 8 pm. 30 1 12 7 E 2 cloudy 2£ 9 a.m. 29 9 10 5 2 NE 2 fair 25 9 a.m. 30 12 3 4 Eby N2 cloudy 0,045 5 p.m. 29 9 11 5 1 7 NE 2 cloudy 8 pm. 29 9 11 6 6 Eby N2 cloudy 2C 8 a.m. 29 9 10 4 1 8 NE 2 fair 0,09S 26 9 a.m. 29 9 12 2 6 NE 2 cloudy 5 p.m. 29 9 u 1 1 6 NE 2 fair 8 pm. 30 1 12 2 2 6 NE 2 cloudy 2! 9 a.m. 30 10 9 1 8 N 2 fair 27 9 a.m. 30 1 12 3 1 NE 2 cloudy 5 p.m. 29 9 12 6 1 4 N 1 cloudy 7 p.m. 30 2 12 7 2 5 NE 2 fair 28 9 a.m. 30 10 9 2 NE 2 cloudy 28 9 a.m. 30 1 13 8 2 NE fair 7 p.m. 30 1 11 4 2 NE 1 cloudy 7 p.m. 30 15 9 1 NE fair 29 8 a.m. .30 1 12 4 1 9 NW 2 fair 29 9 a.m. 29 9 15 3 3 N fair 5 p.m. 30 1 13 4 1 4 NW 2 fair 9 p.m. 29 9 13 4 6 E cloudy 30 9 a.m. 30 9 n 7 1 6 E 1 cloudy 0,123 30 9 a.m. 29 8 12 9 3 e fair 0,006 8 p.m. 30 2 11 8 1 S E 1 cloudy 31 8 p.m. 9 a,m, « p.m. 29 29 29 8 7 8 12 14 12 8 1 2 3 3 I E NW N 2 2 fair fair fair H. atamed. 29 7 11 6 2 To tal depth 0,818 Gr. height. 30 2 13 4 3 7 H. atamed. Gr. lieight. L. height. 29 8 12 7 1 6 Total depth 0,083 L. height. 29 10 3 1 4 30 2 15 9 3 1 29 9 10 7 T 1 HUXHAM'S OBSERVATIONS. 53 EPIDEMIC OF 1737. HUXHAM.^ " November. — Though the N.E. and N.W. winds kept the barometer up through the first part of this month, yet did they not in the least dry the air ; a southerly wind indeed damped the middle of the month. -IL -L J- _L " Rain 13 — 14—17 . 19 . 23—25 . 26 . 28 = 1-334. "A. B. 1 . 10 . P.M., E.N.E. 1—7 . N.W. b. N. 1. A high wind, 27 . p.m., N.W. b. W. 'ikfer. %Ae«^, 4.30.4.E.N.E. 1.") „ ,. „^ o ^ ' Mean h. 29 . 8 .4. E.N.E. l.\ ).1.W. 1. j „ lowest, 16 . 29 , I ^t i t ^"^"■" '"• •"" ■ " "• "Day, coldest, 30 . 65 . N.E. ix | ^ „ warmest, 12 . 48 . S. b. W. 2. ) ' ^■ "Almost every place, but chiefly this town, was invaded this month by a disorder which spared no constitution or age. It was not unlike in its attack to the epidemic catarrhal fever of the year 1733, but much more violent. " The sick were taken with a violent cough and pain in the back, sickness at the stomach, and continual sneezings; violent defluxions, and very often a cough, which was extremely troublesome. It attacked several at first with a severe pain of the back and the loins, which was commonly a bad symptom ; for this was generally accompanied with a great oppression about the prmcordia and a pretty high fever, which was often evidently peripneumonic ; liquids were rejected immediately, but seldom anything boiled. But it was generally over with these, especially if a phrensy came on. " The defluxion upon the fauces was so violent that it often occasioned a kind of quinsey, and that no inconsiderable one ; there was likewise a violent swelling of the face, parotid and maxillary glands, followed with an immense discharge of an exceeding acrid pituita from the mouth and nose. Numbers were now miserably tortured with the toothach, who had never ' Op. cit., vol. i, p. 164. 54 EPIDEMIC OF 1737. had a bad tooth in their head; and this was confined mostly to one side, and terminating exactly between the denies incisores. In some, one-half of the head was affected as if by an exquisite hemicrania. "A great many persons were much distressed by a fever which lasted them a considerable time, attended with a great heaviness in the head, a catarrh, troublesome pains of the teeth, generally preceded by a swelling and excoriation of the fauces. In the younger and more robust, a delirium generally came on as the disorder increased. Multitudes were cruelly infested with wandering rheumatic pains, others with violent sciatics, which used to last a considerable time; and not a few had most excruciating gripes and pains in the bowels, which was followed by a critical diarrhoea. The tongue of those in this distemper was generally white, seldom dry or scurfy, nor was there any great thirst. The urine was a little turbid, and of reddish colour. The blood was like that of pleurisies. " This catarrhal fever has prevailed, more or less, for several winters past ; it put on various forms indeed, according to different constitutions of those it attacked. Some were only taken with a slight fever, which easily gave way to a gentle sweat. Others, and not a few, were troubled with a severe peripneumony; but, in general, the disorder raged much more severely this year than ever it had done, and required a much larger effusion of blood. " The chief cause appears to me to lie in the thick, damp, chilly disposition which closes up the spiracula or pores of the skin, and at the same time accumulates a quantity of acrid coUuvies within the habit; for it is certain that a moist quality of the atmosphere did always precede and accompany this dis- order, which never made its attack but during the winter time, and, indeed, appeared in many respects of the same genus with the winter-fever described by Sydenham. "December. — The disposition of the air was very various this month ; sometimes very cold with a North wind, at others a great deal warmer when at South-west, or South-east. The barometer was kept up surprisingly by the immense quantity of vapours diffused through the atmosphere, and yet we had a considerable deal of rain. HUXHAM'S OBSERVATIONS. 55 !L iU JL J^ JL JIL J^ " Rain 2.4— 6 .8 . 13 . 14— 16 . 18—20.22 . 23 . 24 . 26 . 30. Hail, 31 = 2.620. "A storm the 18th, S.S.E. 4—30 . S.S.W. 4?, frequent and large rimes. 'Mer. highest, 4 . 30 . 3 . N.N.E. 1 . ") ,^ ^ „^ „ ^ ' ^ Mean h. 29 . 84 lowest, 8 . 29 . 3 . S.W. 3? '1 "Bay, coldest, 29.73. N.E. 1. j ^ „ wames/, 24 . 49 . S.W. 2. ) /«• o^st- " The 5th of this month, early in the evening, the sky, which was then a little cloudy, on a sudden began to shine and glitter extremely, as if from the reflexion of a very large bonfire ; and the light it cast forth at times was not much less than that of the full moon when hid by a few clouds. This wonderful phenomenon lasted till near midnight, but was much brighter between the hours of five and seven than at any other time. The ignorant people were dxeadfully frightened, some holding it portentous of some dire dreadful event, others fearful of immediate danger from the bloody colour the sky put on at times. The air had all that day been very thick, foggy, and close, with frequent small showers of rain, especially about noon. There was hardly any wind all the time ; in the even- ing there was a very offensive fog, and chancing to go by some hedges I tasted the drops of rain that hung upon them, and found them of a disagreeable sweetness. "This light was seen in most of the northern parts of Europe; but at Kilkenny, in Ireland, there was, the same evening, for the space of an hour, a large globe of fire sus- pended in the air, which afterwards broke with a dreadful ex- plosion, scattering a great quantity of flames round it. " The epidemic disorders lasted most part of the month, but towards the end it disappeared; but numbers complained after- wards of great prostration of strength. Some fell into jaun- dices, many into consumptions, and numbers were aflElicted with severe and obstinate pains of the gout and rheumatism. " In the cure of this disorder we departed a little from the method estabhshed for that in the year 1733, which we have above described ; for here there was a much greater call for the lancet, and to have it often repeated, too, if we meant to do good with it, in the urgency of the fever, and violent pains 56 EPIDEMIC OF 1737. of the back and breast. But certainly there is a great mis- take in ordering, as is usually done, venesection in disorders of this nature, which proceed from a sharp pituitous humour, as in a true pleurisy or peripneumony; and this has been taken notice of before me by that worthy and candid physician Dr. Sydenham, who was otherwise no niggard in phlebotomy. See Sect. 5, Chap. V, which I would have the reader consult. "After bleeding I ordered the frequent application of epis- pastics, which drew off a surprising quantity of sharp serum. "Nothing did so much service in this disorder as a mild, gentle, and equal sweat of the whole bodyj and nothing so safely and effectually procured this as thin, white-wine whey, a weak decoction of eryngo-root, or the like, drank warm. I likewise found very good effects from giving now and then a mixture of Sal. C. C. with lemon-juice, in mint or hyssop water. This helped greatly to bring out the sweats, or, if it failed in that, it increased the urinary discharge, and, moreover, kept the belly properly lax ; in short it every way answered the purpose of expelling the pituitous colluvies, and making the sick breath easier, especially with the addition of a little Oxymel scilUtic. The elixir Asthmat of Le Mort was excellent to allay the vehemence of the cough, and would at the same time encourage the sweats. " The belly was not only to be kept lax during the impetus of the disorder, but it was necessary, at its going off, to give a gentle purge or two, to prevent the morbid relicts from creating new disturbances. "After the fever was totally gone, there often remained ob- stinate rheumatic pains, which were best conquered by the mercurial cathartics. But I never found anything of so much benefit as the following preparation of antimony, which does, indeed, possess every quality of that useful mineral ; for which reason allow me to call it the essence of antimony. " I had for a considerable time bent all my thoughts and endeavours towards discovering some useful medicine among the antimonial preparations ; for this purpose I not only turned over all the processes of the most celebrated chemists and alchymists, but tried them on the sick in various cases, and often (be it acknowledged) found many of great virtue ; but, on the whole, I solemnly declare that I never met with any one preparation amongst them all, so good, so safe, and eflfica- HUXHAM'S OBSERVATIONS. 57 cious, as the simple infusion of the powder of glass of antimony in a generous white-wine, guarded with some suitable stomachic spice. " This possesses, experto crede ! this alone possesses the whole virtues of antimony. It is a rough emetic in a large dose; given in a few drops, twenty or thirty for example, it will just excite a breathing sweat : increase the dose a little, you have a mild and safe purge. What will any other pre- paration of antimony do more ? Besides, notwithstanding the great powers this antimonial wine appears possessed of, yet the particles of that mineral are but as it were in effluvia in the menstruum ; so that from their extreme minuteness, they with the greatest ease pervade the most intricate meanders of the vascular system, and at the same time are so powerful as to stimulate even the great alimentary canal itself (much more the smaller ones of the human body), while the tenuity of their parts prevent them from doing any injury to either the one or the other. " Here, worthy reader, I present you with a medicine, simple in its preparation, indeed, but noble in its virtues, since with it you may safely remove most obstructions of the vascular system, whether you aim only at cleansing the prinue via, or thoroughly scouring the minuter canals. It is at once the surest and the safest sweat, for it heats sufficiently without overdoing it; hence it is particularly beneficial in all fevers of the slow and inter- mitting kind, and in most chronical diseases, but above all in an old obstinate rheumatism. In short, I take upon me to affirm, that this medicine does not want one virtue that is to be found in any other preparation of antimony, however dignified by pomp of language or elaborate composition. " The whole quantity of rain this year = 27'36." [Coincident with this visitation were Earthquakes, a Comet, and an Eruption of Vesuvius.^ In February, 1738, coughs and anginas were very common amongst horses, by which numbers of them were suffocated. Although the season was not unhealthy, yet very many persons dwindled away in a pulmonary consumption, occasioned by the catarrhal fever improperly treated, which was rife in the latter end of November and December. In May, apoplexies and palsies were common.] ' Webster, op. cit. 58 EPIDEMIC OP 1743. HUXHAM.^ "Towards the end of April, a kind of fever, in general slight, but sometimes not a little fatal to old men and children who had weak lungs, raged through all this country. At once, and at the same time, innumerable persons were seized with a wandering kind of shiver and heaviness in the head ; presently also came on a pain therein, and also in the joints and back ; several, however, were troubled with a universal lassitude. Immediately a very great and acrid de- fluxion from the eyes, nostrils, and fauces, and very often falling upon the lungs, which occasion almost perpetual sneezings, and commonly a violent cough. They all likewise laboured under a great straitness, and very great load upon the breast. On the second day, the fever grew so strong, that the pulse became very much quicker, and the difficulty of breathing was very greatly increased, especially if bleeding had been neglected. There was no very urgent thirst, but the tongue was very white, and looked as if rubbed over with cream. The eyes were slightly inflamed ; and being violently painful in the bottom of the orbit, shunned the light. " This slight fever did not proceed in one and the same tenour ; but at one time a shivering, then presently a burning heat came on, without any manner of regularity, except that it frequently terminated at length iu a tertian or semi-tertian. However, a peripneumony, or a pleuropneumony, which some- times was occasioned by a too large quantity of blood, and the violence of the cough (particularly to such persons who had used a warmer regimen and course of medicines) was of far worse omen. Nor was a pleurisy or a sharp rheumatism uncommonly produced from the same cause, especially if bleeding had been omitted in the beginning of the disease. The blood drawn ofi" was sometimes very sizy, but nevertheless generally florid, but not abounding in serum : it was various, however, in different people, yet the higher the fever ran, so much the more tena- cious. Indeed, whatsoever the state of the blood appeared to be, this disease would not admit of any great loss of blood; nay, if there was anything of a peripneumony which came on, ' Op. cH., vol. ii, p. 142. HUXHAM'S OBSERVATIONS. 59 it would by no means bear plentiful bleeding without the greatest ruin of the strength, and seldom more than barely once. Nor, indeed, did I only make this remark in this fever alone, but it was always so in every catarrhal epidemic fever ; for by weakening the powers of nature, the perspiration was too much checked, and from thence the acrid colluvies increased. Not- withstanding, some bleeding in the beginning of the disorder, as to robust grown persons, and those who lived luxuriously and were plethoric, was always beneficial. Throughout the whole course of this feveret, the patients expectorated largely, which was a very great relief to the breast. However, the violence of the cough very much exasperated the trachea and the lungs. It required, therefore, such m.edicines as oil of almonds, sper- maceti, and something of the poppy kind, as diacodium tinct. thebaic, or elix. paregoric. ; the last of which, moreover, excited easy and kindly sweats, and at the same time sat easy on the breast. Frequently, indeed, the load upon the lungs, and the oppression of the prsecordia, demanded oxymel scillitic, Lac Ammoniac, Syrup. Croc, or something of that kind. In this case, nevertheless, a gentle emetic served instead of all, which indeed, after bleeding, very often presently removed everything, and was beneficial in all respects. "The greater part by far of the sick had easy, equal, and kindly sweats, the second or third day, which, together with a large spitting which attended them, removed the fever on the fifth day, frequently even sooner; in general, however, there remained after it a very great loss of strength. Nothing, how- ever, was more effectual in recovering this, than diluting, demulcent, and warm liquors, such as very thin milk, barley, or oatmeal whey, or a decoction of preserved eryngo ; an infusion of ground-ivy, colt's-foot, or liquorice; nay coffee, with the addition of a little sweet milk, was very serviceable to numbers. Away, however, with your volatile salts and spirits, as they are called; your hot alexipharmacs, and all other things of that kind, which unquestionably very greatly disturb nature, but are of exceeding little service iji expelling the disease. Indeed, if the fever became more violent, and continued longer, I mode- rated it with a common saline draught. " Frequently, indeed, towards the end of this feveret, several red angry pustules broke out, often likewise a sudden, nay, a profuse diarrhoea, with violent gripings, came on, there being a 60 EPIDEMIC OF 1743. translation of the morbid matter upon the intestines. Hence, probabty, arose several dysenteries, which at this very time were rife up and down here ; I confess that they were mucous, and seldom bloody. Nevertheless, so little was this effort of nature's to relieve herself to be restrained, that very often the disease terminated by a looseness; and therefore it was to be encouraged by manna, rhubarb, tartar solub., tamarinds, &c. The stronger purgatives, however, generally occasioned terrible gripings, and entirely destroyed the strength. " This fever, although exceedingly common far and near, was fatal to few, since, provided that the sick kept within doors in season when they were seized with it, it generally went off on the third or fourth day. Indeed, this was a matter more com- monly requiring an accurate course of diet, and a proper regimen, than a studied heap of medicines, not but at some times it re- quired much more care and attention. Equal and moderate sweats, plentiful spitting, large discharges of urine, and that turbid, easily removed this disorder. Frequently I was asto- nished at the vast sediment which the urine threw down, than which there could not be a more favorable symptom. This fever seemed to have been exactly the same with that which, in the Spring, was rife all over Europe, termed the 'Influenza.' Nevertheless, it was much more destructive in the southerly nations than it was here; nay, even in London it increased very greatly the number of burials, rising them, in one week only, to at least a thousand." [This year was remarkable for Meteors, Earthquakes, and a Comet .^ During the three months preceding this attack of influenza, the atmosphere for the most part was dense and moist. On the 22d of January there was a very stinking fog. In January, rheumatism, quinsy, and low fever raged ; there was much mortality amongst deer, and mange prevailed much amongst horses, many of which in March died emaciated, or were suffocated with glanders and cough. In April, many persons suffered fyom dysentery, and old and young were unusually troubled with round worms. Dr. Huxham inquires : "Was not this owing to an immense quantity of all kinds of fruit which the Summer and Autumn of 1742 every- where abounded with?"] ' ^^'('I)ster, op. cit. DR. WHYXrS ACCOUNT. 61 EPIDEMIC OF 1758. 1. WHYTT.^ "Edinburgh; Nov. 10, 1758. "The month of May, this year, was remarkably dry and hot. June was cold and dry. In July and August we had but just as much rain as was sufficient to bring forward the fruits of the earth ; the air was temperate, or perhaps a little warmer than is common in Scotland during those months. Towards the end of August, and for the first week of September, the weather was warmer than usual in that season; but less so than at the same time in the preceding year. From the 8th to the 16th of September was mild. From the 16th to the 20th, we had a strong easterly wind, which, though not extreamly cold, yet cooled the air considerably. During the whole month of September, and till the 8th of October, we had scarce a shower sufficient to lay the dust. On the 8th of that month, we had a violent wind from the north-east with rain, which continued thirty hours. From the 8th to the 26th, the weather was mostly clear and frosty, with some gentle breezes. From the 28th of October to the 8th of this month, the winds have been southerly, and accompanied with wet. ''During the months of July, August, September, and October, the wind blew more from the East, than ever had been known before in this country, at that time of the year. In August and September, we had seldom any strong winds from the west as usual ; from whatever point they came, they were moderate ; and, although it was calm weather for many days together, yet, as far as I can recollect, there was not one foggy day during the autumn. The barometer was higher throughout September, and the greatest part of October, than ordinary. " I thought it proper to lay before you this account of the weather, in order to judge how far any of the sensible changes of the air might influence the health of the people here. But for my part, considering how remarkably mild and dry our ' Medical Observations and Enquiries by a Society of Physicians in London, vol. ii, pp. 187 — 202. An Account of an Epidemic Distemper at Edinburgh, and several other parts in the South of Scotland, in Autumn 1758. By Robert Whytt, M.D. F.R.S., and Professor of Medicine in the University of Edinburgh ; in a letter to Dr. Pringle, and by him communicated to the Society. Read Feb. 12, 1759. 62 EPIDEMIC OF 1758. season was, I can hardly ascribe the rise of our epidemic to any of the known qualities of the air. "Before I proceed to the description of that distemper, it may be proper to take notice, that during the months of July and August, a fever, with a bloody flux, raged in Lorn, and other parts of Argyleshire; and was not only mortal among the common people, but carried off several persons of a higher rank. The same disease prevailed no less at Newcastle upon Tyne, in August and September; and likewise at Haddington,^ about the same time, and in a less degree. In the months of September and October, we had a bad sort of smallpox at Edinburgh, and in other parts of this country. In some parishes near Cupar in Fife, eight died out of twenty-eight ; and in some parts of Teviotdale, three or four died for one that recovered. "As for what I call the epidemic, it was first taken notice of in this city, soon after the change of the weather, upon the easterly winds, that blew from the 16th to the 30th of September; several children began then to be afi'ected with a slight degree of fever, attended with the common symptoms of a cold ; but this was not thought extraordinary at that season of the year. About the end of September, the distemper grew much more general, both here and in the neighbourhood ; and in the last week of that month, in the space of two or three days, thirty boys out of sixty, at the Grammar School of Dalkeith,^ were seized with it. In the beginning of October, the sickness became still more frequent at Edinburgh, Dalkeith, and throughout a great part of the Lothians.^ Old as well as young were taken ill; nay, even women in childbed, who were not exposed to the cold air, were affected ; and in particular, I knew one, who had but just recovered of a dangerous fever, after her delivery. "The sickness continued to increase in all the places above mentioned, till about the 24th of October, when it began to abate ; but whether the decline was owing to any alteration in the air, or because the distemper had already seized most people, I cannot determine ; though the latter seems more probable, as I am pursuaded, that in Edinburgh and the ' A town within twelve computed miles of Edinburgh. ' A village four miles from Edinburgh. ' The shire of Edinburgh, and the two adjacent shires, so called. DR. WHYXrS ACCOUNT. 63 neighbourhood^ not one out of six or seven escaped ; and I am assured, that, in some places, it was still more general. " Hitherto I have only mentioned the rise and progress of this epidemic here and in the places adjacent. I shall now, as far as I have been able to learn, inform you of the time of its appearance in other parts of the country. In Fife, about Kirkaldy, it was not observed till the first week of October. At St. Andrews, not till the 10th or 12th of that month. In Angus, it began sooner. In Perthshire, it raged most between the middle and end of October ; and many died of it. In the shire of Air, and at Glasgow, it was at the worst after the middle of October. In Teviotdale, it began later. At Ormiston, a village only four miles from Dalkeith, it did not appear before the 15th of October. And at Whitburn, about half-way between Edinburgh and Glasgow, it was little taken notice of, till towards the end of that month. I have been informed that the same kind of illness prevailed through Aberdeenshire, and other parts in the North j but that, at the end of October, it had not reached the shire of Ross. A gentleman told me, that in the Carse of Gowrie,^ in the month of September, before this disease was perceived, the horses were observed to be more than usually afPected with a cold and a cough. "Having given you this summary account of the epidemic, I shall now more particularly describe the symptoms. In general, people were differently affected. Sonae complained first of a slight sore throat, with a feverishness ; and, after a few days, they were seized with a cough. Many had a heavy, dull pain in their forehead, with watery eyes; either a sneezing or dis- charge at the nose; but with little fever. Some, all at once, felt a soreness in the inside of the trachea, as if that part had been excoriated. Others had a hard, dry cough, without this soreness; but generally with a quick pulse. Several were attacked with a slight diarrhoea; and others with bleedings at the nose, sometimes profuse, and continuing for several days ; till either by the hsemorrhage, or by opening a vein, the pulse returned to its natural state; for, in all those who had this symptom, the pulse was not only quick, but, for the most part, remarkably full. Two of my patients were troubled with a severe pain over their whole head, but had little or no fever. ' The name of a large vale, on the north side of the river Tay, in Perthshire. 64 EPIDEMIC OF 1758. la one, the headach becoming periodicalj went off, upon lying a bed, encouraging perspiration, and taking an electuary of the bark, with some glasses of claret : this person having weak nerves could not bear evacuations. The other had his whole head blistered; leeches applied to the temples; took camphire, Tinctura Sacra, and Laudanum; but with little benefit. Sudorific boluses of Gum Guaiac, with Sal Ammoniac, volat., seemed to do him most service. After taking a few doses of this medicine, the pain left his head and seized the loins and right thigh, but more slightly, and then went off gradually; from whence it appears, that those pains were of the rheumatic kind. Some complained of pains only in the cheek-bones, teeth, and sides of their head. Others had a fever without a headach, sore throat, or cough; or, indeed, any other symptom in the beginning; but when the fever began to abate, as it usually did in a few days, if the patient lay a-bed, more or less of a cough succeeded. In two patients the cough seemed to be critical ; for it no sooner took place, than the pulse returned almost to its natural state. One of them, a married lady, aged about thirty, had been feverish for four days ; a rash or scarlet eruption appeared, but did not come fully out ; and as she was restless and uneasy, I was sent for about ten at night. Her pulse then beat 120 times in a minute, and was full; but as she had a moisture on her skin, I delayed ordering her any medicine tiU I should see her again in the morning. About midnight she was seized with a trouble- some tickling cough, which hindered her from sleeping. At half an hour past four, being called upon to see her, I found her skin cooler, her pulse less full, and beating only 96 times in a minute. After this she slept ; and at eight in the morning I found her pulse down at 80. Here it should seem that the morbid matter, not thrown off by the skin, had fallen upon the trachea ; so that the cough might be said to have been truly critical. Few, upon being taken ill, complained of any coldness or shivering, commonly the first feverish symptoms; however, there were some who were seized in a more violent manner, and with the horror febrilis ; especially when, from want of care, they had a relapse, which was often much more severe than the first attack. "In regard to your question, whether the distemper was DR. WHYTT'S ACCOUNT. 65 infectious or not ? As far as I have observed myself, or been informed by others, our epidemic did not spread by contagion, from one person to another, like the plague, smallpox, or measles, but seemed to be owing to some particular quality of the air. Those who attended the sick were not more liable to be affected than others ; and I myself escaped, notwith- standing my visiting many of the sick, and being obliged to travel frequently into the country, and sometimes in the night. I had no opportunity to observe, whether nurses infected the children they suckled, or the infants their nurses ; but I do not believe they did, from what I remarked in other cases. "As to the cure. In the beginning, when the' disease was mildest, it generally yielded to lying in bed, keeping the body open with clysters, and promoting sweat by warm diluent liquors. Afterwards, a higher degree of fever, which many had, required bleeding ; and then the blood was almost always sizy, even in those who had no fixed pain, nor any considerable symptom, except heat, and a quick pulse. In some, especially among the country people, the coat of the blood, instead of being tough, thick, and sizy, was transparent like a jelly ; the crassamentum, was of a loose texture, and separated but little serum. For the cough and soreness of the trachea, the usual medicines were ordered; but when the patients only complained of a dry tickling cough, attended with little or no fever, a dose oi Laudanum at bed-time was the best remedy. "Those who exposed themselves too soon to the cold, before they had perfectly recovered, frequently relapsed; were often worse than at the first attack ; and generally required more bleeding. Many were so slightly affected, as to need no medicine at all. "Few died of the disease, especially when it first appeared, except some old people ; or those whose lungs had been greatly obstructed, or long pressed with phlegm. In such cases, besides bleeding, when the pulse required it, blisters and boluses of Gum Ammoniac, with Sal Ammoniac, vol., were the chief remedies I used, with a slight pectoral decoction, or infusion, acidulated with vinegar. "Towards the end of October, and in the beginning of November, the distemper, especially if neglected at first, became more dangerous, by falling on the lungs, pleura, or 5 66 EPIDEMIC OF 1758. muscles of the thorax. Then, repeated bleedings were requisite; and afterwards, blisters to the parts affected had remarkable good success. "In some parts of the country, when the disease was not taken care of in the beginning, as being attended with no alarming symptoms, it assumed the form of a slow fever, which sometimes proved mortal." 2. ALVES.^ "Inverness; Dec. 22, 1758. "Sir, — The epidemic disease you enquire about, appeared here in the middle of October, and continued to rage, with great violence, till towards the end of November j since which time it has been on the decline, and is now almost quite over. It was attended with all the symptoms you mention to have been common at Edinburgh, the diarrhcea excepted, which I think I only observed in one or two cases. It was the most universal epidemic I ever saw ; and am persuaded, that more people were seized with it than escaped ; but it was not at all mortal here. Bleeding in the beginning, when the degree of fever and violence of the cough required it, moderate sweating, camphorated oil applied to the throat, with Spermaceti linctuses, and Elix. Paregoricum to quiet the cough, commonly carried off the disease in a few days. Many people had it in so slight a degree, that they got free of it by keeping warm, and by gentle sweating for a day or too, without taking any medicine. "So far as my correspondence goes to the northward, i. e., about twenty miles, I find this distemper was common there about the same time we had it; and I am told it has been likewise in the shires of Sutherland and Caithness." 3. MILLAR.'' "Last Summer, which was uncommonly dry and warm, was succeeded, in the beginning of October, by very cold and moist ' Extract of a letter from Dr. John Alves, Physician at Inverness, to Dr. Robert Whytt, Professor of Medicine in the University of Edinburgh. Read Feb. 12, 1759. ' An account of the Epidemic. By John Millar, M.D., Physician at Kelso, in the shire of Roxburgh; in a letter to Dr. Pringle, dated Kelso, Dec. 8, 1758, and by him communicated to the Society. Read Feb. 12, 1759. DR. MILLAR'S ACCOUNT. 67 weather. On the eighth and ninth of that month a great quantity of rain fell, and the air was then very cold. This change was great and sudden, and its effects were no less remarkable. Slight colds generally come on after the autum- nal equinox, but there are few instances of any that have prevailed so universally as the epidemic cold which has raged here for these two months past. It did not seem to be pro- duced by any other contagion than that of the air, because all in the same family that were seized with it generally fell down at once, and those who escaped, at its first entrance into the family, were not afterwards affected ; nor did it spread, as might have been expected, were it infectious ; since, it has rather been upon the decline from within a fortnight of its first appearance. "It came on at first with a listlessness and lassitude all over the body, which was soon followed with coldness and shuddering; acute pains in the head and temples ; violent sneezing ; a dis- charge of a thin, watery rheum from the eyes, nose, and mouth; a dry heat and some thirst ; the pulse was generally frequent, and the urine high coloured ; the body was, for the most part, loose ; and many had gentle diarrhoea, which to some proved critical. " The hale and strong easily recovered of the disease, many without medicine, or any sort of regimen or confinement; others, especially the old, the weak, infirm, or sickly, escaped with difficulty ; and some died unexpectedly. " If the constitution had a disposition to any particular ail- ment, — such as the gout, rheumatism, nervous, hysteric, or hypochondriac disorders, the epidemic cold would frequently introduce them. "As to the cure. Lying in bed, and promoting perspiration by drinking warm, diluting liquors, was generally sufficient to remove the distemper in the beginning ; but if it was more obstinate, or of a longer standing, mild diaphoretics, with small doses of an opiate, (which, at the same time that it assisted the operation of the diaphoretics, removed the pains and violent irritation,) were used with success. Blisters, likewise, had good effects, in] removing an obtuse pain of the head, which sometimes remained after the disease was otherwise mostly subdued." 68 EPIDEMIC OF 1762. [In 1757, the small beetle denominated Bostrichos typo- graphicus appeared in the Hartz forests; and between that year and 1783, is calculated to have destroyed a million and a half of trees, so as to threaten the inhabitants with a total suspension of the working of their mines, when a succession of cold and moist seasons happily diminished their numbers.^ A meteor is recorded by Webster in 1758.] EPIDEMIC OF 1763. BAKER.*' To the Reader. Of two memorable diseases which occurred in the same year, the one the offspring of the Spring, the other of the Autumn, a simple and unadorned history, recommended neither by the colouring of rhetoric nor by the fascinations of theory, is here presented. Little solicitous respecting the causes, which for the most part are latent, my only desire and effort is to show the nature of these diseases, and the means by which they may be sub- dued ; for I am fully persuaded, that conjectural and hypo- thetical views, so far from rendering any real service to rational medicine, have, from the infancy of the art to the present day, proved its greatest impediment and disgrace; and those medical authors must be considered entitled to the highest credit who, without wandering into such bye-paths, but devoted to the observation and treatment of diseases themselves, have faithfully recorded their experience, and regarded nothing but the truth itself and the evident nature of things distinctly obvious to the senses and to sound reason. With such determination I have ventured on this treatise ; and should it give satisfaction, and opportunity is afforded, I may occasionally publish other papers of a similar kind. ' Latreille, ' Hist. Nat.,' xi, 194. = De Catarrho et de Dysenteria Londinensi Epidemicis utrisque an. 1762, Libellus. Auctore Georgio Baker, Coll. Reg. Med. Lond. et Cantab. Soc., et Reg. Soc. Sod., Lond. 1764. Translated for this work by the Editor. DE. GEOEGE BAKEE'S TEEATISE. 69 ON THE EPIDEMIC CATARRH OF THE YEAR 1762. The sunmaer of the year 1761 was unusually dry and warm. Rains and southerly winds so much prevailed during the following Autumn and early Winter, that there was neither frost nor snow before the end of January. Prom that time to the middle of March there was frequent frost, but not sharp and severe, except about the end of February, at which time winds, frosts, snow, and rain, all inordinately vehement, succeeded one another by turns in an unusual manner. At the end of March the weather was wet and stormy, with much rain and hail, but at the beginning of April dry weather set in. The heat of the atmosphere was now considerable during the day; but the nights were cold and frosty. In the middle of the month, before the leaves appeared on the trees, suddenly the sun shone forth fervently, and the heat became un- seasonable and intolerable. Thenceforth there was almost constant warm weather, and a clear sky, which for many days during the month of May, was scarcely obscured by the slightest cloud. During the greater part of the month, an East wind, sometimes veering towards the north, prevailed. By these alternations, the air suffered sudden changes from heat to cold and from cold to heat, and we were sometimes liable on the same day to be scorched in the sun and to shiver in the shade. I have chosen to premise these brief remarks on the state of the atmosphere, however crudely and imperfectly, almost in the style of the journals, lest I should entirely depart from the custom and manner usually adopted by other authors in works of this kind; but I think it would be superfluous to treat the subject more minutely, for I never could be per- suaded that it was reasonable to attribute the origin of epidemic diseases to changeable winds, or to measure their nature and character by the barometer. We seem, in fact, chiefly concerned with effects, and not with causes, which, for the most part, are hidden. If, indeed, the disease now under consideration owed its origin to those properties of the atmos- phere which are obvious to our senses, how did it happen that persons who resided near to each other did not sicken at nearly the same time ? How did it happen that those who 70 EPIDEMIC OF 1762. lived only two miles from town were attacked by the disease much later than the Londoners themselves ? To what cause are we to attribute the fact, that although the disease visited Edinburgh at the beginning of May, it did not reach some parts of the neighbouring county of Cumberland till the end of June ? Our knowledge on the whole of this question is assuredly restricted to very narrow limits, and after much labour sustained in vain, we are obliged to acknowledge with the excellent Sydenham, 'Concerning the nature and quahty of that disposition of the air on which the disease depends, as well as of many other things on which the doting and arrogant crowd of philosophers trifle, we are totally ignorant.' It is not, indeed, unbecoming a philosopher when he is ignorant, to acknowledge his ignorance, if he has used all diligence in searching for the truth ; but it is highly unbecoming to pass off the unknown for the known, and the doubtful for the certain. But to proceed : — On the 4th of April, three persons in the same house were attacked with the disease which, on the 24th of that month, pervaded the whole city far and wide, scarcely sparing any one. Persons of all ranks and con- stitutions, with scarcely any distinction, sickened, and the ro- bust and healthy as much as the weak and delicate. The disease affected most severely the aged, especially those who were asthmatical. It fared iU with those who were in too ple- thoric a state, and with women whose catamenia were inter- rupted. Children suffered lightly, and were easily relieved. Men servants were, for the most part, affected severely, either because they were unwilling to restrict themselves to a moderate diet, or because, owing to the necessity of working, they could not easily obtain the necessary rest. After the expiration of about a fortnight, few remained whom the disease had not in some degree assailed. The symptoms were, — cold and heat alternately pervading the body; a constant teazing cough, which attacked some from the commencement, others not for two days, sometimes raising a scanty thin secretion, sometimes dry and without expectoration ; lassitude, heaviness, and great pain about the temples and forehead ; inflamed, watery eyes, intolerant of light, swollen eyelids, frequent sneezing, flat voice; all, without exception, complained of a DE. GEORGE BAKER'S TREATISE. 71 very acute sensation of heat, as though the lining membrane were abraded, extending through the whole course of the wind- pipe to the ensiform cartilage. Some complained of a similar sensation of heat from the fauces to the stomach, as if the (Esophagus, as well as the windpipe, was inflamed. Some were almost suffocated with a true angina. Many were troubled with oppression at the middle of the sternum, and difficulty of breathing, also with a tearing sensation between the shoulders when the cough was troublesome. To this were added variable and erratic pricklings in the arms, legs, and sides. Sometimes the frequent cough was accompanied with expectoration of blood j and not unfrequently drops of blood issued from the nostrils. With these symptoms, a smart fever was sometimes associated, which usually remitted during the day, and had exacerbations at night, but was sometimes so slight as scarcely to occasion thirst, impair the appetite, or interrupt sleep. Perspiration was a constant symptom, which, breaking forth copiously, sometimes carried off, or at least mitigated the disorder. The thirst was not urgent, but the tongue was in- variably coated with an extremely white mucus, as if it had been covered with cream. ^ The colour and appearance of the blood drawn from a vein varied according to the constitution of the sick. The urine was generally bilious at the commence- ment, but as the disease advanced, deposited a furfuraceous or lateritious sediment. Depression of mind and failure of strength were in all cases much greater than was proportionate to the amount of disease. A great number of those affected were very slowly restored to health, languishing for months, and some even for a whole year with cough and feverishness; relics of the disease which it was difficult to shake off. Some, after struggling long with impaired health, fell victims to pulmonary consumption. Many after they had, in other respects, recovered, were for a long time affected with a very troublesome pain in one of the sides, or in some part of the abdomen. It was observed in London, that many women, suffering from the disease or its consequences, miscarried, or were prematurely dehvered. [' J. Huxhatn formerly oliseived the same circumstance in two epidemics re- sembling this. See mpra.] 73 EPIDEMIC OF 1763. Others were attacked suddenly at the commencement, with severe pain of all the joints and of the head, with a sensation of lassitude and vehement fever ; but the accompanying sym- ptoms of Catarrh or peripneumony were slight. These patients, more than others, suffered as much anxiety and precordial oppression as if some eruptive disease were about to appear ; but as far as I observed, or could ascertain from others, this rarely occurred in London,^ In this manner did the disease manifest itself, and, for the most part yielded to treatment within four days. The phlegm expectorated becoming thicker, there was more trouble and danger when, in consequence of the fever and cough increasing, the violence of the disease kindled a true peripneumony, with which many were attacked. Those most liable to this complication were persons devoted to the indulgence of the palate, or of a full or cachectic habit, old men long afflicted with difficulty of breathing,^ and lastly, those who, neglecting the first indications of the malady, rashly exposed themselves to cold and fatigue. True perip- neumony attacked some at the very onset of the disease; but this was observable to occur more frequently in the country than in the city. I was informed by letters, that this was a property of the epidemic in some places distant from London. Not only peripneumony, but angina also prevailed, and so exten- sively, as to spare neither age nor sex. Those persons suflfered most severely who could not obtain a respite from labour; more especially those who worked daily in the open air. Among this class the pestilence was so violent, that it destroyed many of them within four days in spite of remedies.' The disease ' The following case was communicated to me by William Duncan, a man as experienced in treating disease as sedulous in observing it. "A man-servant, fifty years of age, and of robust habit, laboured under the disease. After he had been four times bled, a. miliary eruption, as it is termed, broke out on the whole body; nevertheless the pain, cough, difficulty of breathing, and hardness of pulse, remained unabated. It was therefore necessary, without paying regard to the eruption, to bleed him again and again, even to the eighth time, on which the fever became intermittent, and very easily yielded to Peruvian bark ; but if this man, even now, after the lapse of two years, catches cold, he has a violent pain between the ribs near the spine of the back, which first originated in his attack of the epidemic.'' ' If those labouring under asthma are attacked with pleurisy or peripneumony, they almost always die. See G. Baglivi, ' Praxeos Med.,' lib. i. ' Whilst in the little towns situated on high ground near the City of London, the epidemic catarrh, above described, proved, during the month of May, very mild and DR. GEORGE BAKER'S TREATISE. 73 did not, however, invariably show an inflammatory character, for sometimes, although rarely, it assumed the aspect of slow fever, and approximated to that form of malady which the ancients denominated "cardiac." Sometimes it proved periodical and of the tertian type; nor is this wonderful, for as human constitutions are so various, they are almost necessarily afiected in different manners by the same cause. Do smallpox, measles, or other contagious diseases, always produce the same effects or observe any inva- riable conditions ? Are not fevers sometimes inflammatory, sometimes nervous, sometimes putrid, although differing ex- ceedingly from each other, often derived from the same source ? In reference to the treatment of this disease, I will now relate in order whatever I have either learnt from my own ex- perience or derived from others. Often, indeed, the treatment was of no great difficulty; for, at the onset of the disease, many persons were cured by confining themselves to the house, avoiding cold and fatigue, abstaining from active business, and refraining from rich food, calculated to load the system with noxious matter. But whenever there was violent fever or pain of the sides, or difficulty of breathing, it was necessary to take away blood without delay, always in proportion to the strength. If the strength was not equal to the loss of blood by vene- section, recourse was had to the milder remedy of cupping. Some abstraction of blood at the beginning was almost always useful, and it sometimes happened, that, in order to preserve life, very free bloodletting was necessary; for internal suppu- rations sometimes unexpectedly befel the patient, and exposed him to rapid danger. This I particularly observed, that some unwary practitioners were unhappily deceived by those patho- gnomonic symptoms of the disease, which I have mentioned, — anxiety and langour; and hence were too sparing of evacua- tions, and too liberal of heating remedies. After bleeding, it was expedient to act on the bowels with clysters, — a kind of tractable, in the lower neighbouring villages, anginas, pleurisies, and peripneumonies, occasioned incredible mortality. The pre-eminent remedy was prompt and copious bleeding ; if this was neglected, alvine fluxes and colic occasioned quick and certain destruction, even to the strongest. Of these facts I am assured by a most ingenious physician, my friend Robert Petrie, of Lincoln. 74> EPIDEMIC OF 1762. remedy which, throughout the whole course of the malady, gave much relief; for the motions were effectual ia removiag the redundant bile, occasioned by the frequent cough and the efforts at vomiting ; and thus the heat and restlessness accom- panying the fever were diminished. For whatever might be the cause, there is no doubt that laxatives were of more utility in this disease than any other remedies, bloodletting alone ex- cepted. Nature herself, indeed, pointed out this mode of treatment, by sometimes relieving the patients through the aid of bilious vomiting or dejections. Medicines, given with a view to elicit perspiration, were scarcely ever salutary; some- times, indeed, they were worse than useless; for they increased the heat of the body, which was too great of itself. It was far better that the patient should rest in bed and make a free use of tepid diluents. It was also appropriate to swallow oil gra- dually, and to use other demulcents, calculated to soften the cough and to promote expectoration. Little advantage, how- ever, accrued from such means, or from nitre, or from that very common remedy, salt of wormwood mixed with lemon-juice; nevertheless, it is sometimes better to try feeble remedies rather than none. The cough, also, usually more troublesome by night than by day, required to be restrained by a small evening dose of opium; but when diflBculty of expectorating or breathing, or pain of the chest or head, were troublesome, blisters afforded the most prompt relief. The same remedy, applied to the sides when they were painful, remarkably relieved the pain and cough; but the irritating phlegm which oppressed the lungs was more quickly removed if cupping-glasses were previously applied. A very different treatment was requisite when the disease had degenerated into a slow fever, of a continued type, with occasional exacerbations ; for it was now necessary to relieve the debility of the patient; to sustain his appetite, to give strength to the arteries, and support to the body. In these cases, Peruvian bark, given freely and frequently, rarely de- ceived our hope; for the weak, small pulse, cough, precordial anxiety, sighings, tremors, giddiness, and faintings yielded rapidly to this noble antidote. It was necessary, however, to maintain the health by the same remedies by which it was re- stored. DR. GEORGE BAKER'S TREATISE. 75 This disease pervaded almost all Europe during the same Springji being especially virulent in the city of Venice. It showed itself in one region earlier, in another later; but in no country, as far as I know, either before^ February or after June. But, whilst it raged every where else, it did not reach Paris or its vicinity, — a fact which I learned from trust- worthy persons. I thought it worth while to inquire, whether this epidemic catarrh pursued any regular course in passing from one part of the island to another, as, for instance, from East to West, or from North to South, or in a contrary direction, but learnt that it no where observed any fixed law, but pursued its uncertain course in a desultory manner, yet infesting cities and the larger towns, crowded with inhabitants, earlier than the surrounding villages. Whether it was infectious or not I ' The disease began at Breslau about the end of February, and so raged there for about two months, that the average weekly burials, as stated by Jackwitz, a cele- brated physician of that place, increased from 30 or 40 to 150. It invaded Vienna about the end of March, according to the testimony of Charles Mertins, private physician to the Russian Ambassador residing in that city, and it there exhibited the same character as in London. Cothenius, chief physician of the King of Prussia, mentions that the same disease first manifested itself in the Duchy of Magdeburg during the month of April, but in that region was not often fatal. I state these facts on the authority of that highly experienced man John Pringle, who obligingly communicated to me all that he had observed or learnt from correspondence regard- ing this subject. X am assured by the letters of two excellent men, C. Rose and J. H. H. Reimer, that the people of Hamburg also were affected at the beginning of April ; but among the British sailors in the Mediterranean Sea, the disease did not appear till the month of July. 2 In a paper which the French call ' La Gazette de France,' a sufficiently accurate account is given of the disease which is said to have afflicted, not, indeed, any part of France, but Strasburg and the whole of Alsace. " During the last month, a sick- ness, that has been almost universal, prevailed at Strasburg as well as in other parts of Alsace. Its symptoms were shiverings over the whole body, great loss of strength, severe sore throat, acute pain in the head, dry and frequent cough, and difficulty of breathing. All the persons who were attacked by it had fever more or less severely, and the accidental circumstances varied according to pecuhar constitutions ; but all the patients complained of pain in the limbs. The greater number were cured by profuse perspirations. Bleeding in the arms and feet was necessary for some. The indisposition has sometimes ended with copious expectoration, and was generally cut short by one or two purgatives. In some persons it passed into pleurisy or peripneumony ; but this was their own fault, from unwillingness to take to their bed early enough. Some soldiers belonging to the garrison, who were afraid to go to the hospital, were also the victims of their reluctance. — Du 5 Juillet, 1 762." ( Gazette de France.") 76 EPIDEMIC OF 1763. cannot positively affirm : this at least appears, that the disease was altogether unknown in Britain before it invaded London; and that, in many towns, those who were first affected had re- cently arrived from the metropolis.' In this city, if the public records can be trusted, the burials during the prevalence of the disease did not much exceed the average. It is remarkable, that at Manchester' fewer than usual died when it prevailed in that place. At Norwich, on the contrary, according to the testimony of the distinguished physician, William Offley, who treated the disease on the three occasions when it raged in that city, a much greater number fell victims than were destroyed by a similar pestilence in 1733,^ or by the more severe visita- tion, called Influenza, in 1743.^ In the whole of this narration, I have not laboured to pro- duce anything abstruse or elaborate, but have thought it suffi- cient lucidly and faithfully to describe the matter as it occurred, and, if I may be allowed to say so, that a correct record of the disease and of its ordinary treatment might be preserved. 2. WATSON.' "London; Dec. 9, 1762. " In the beginning of May, there was, at London and in its neighbourhood, a disease very epidemic, though not fatal, which had some time before been very prevalent both in Italy and Germany. It continued during the course of the month, and some part of June. In it the breast was very much affected, and it was very frequently attended with a fever. It is nearly the same disease which was at London in April and May 1743, and then called Influenza, the name applied to it in Italy. You have very well described it in your second volume 'De 1 This was formerly observed at Norwich, Lincoln, Leicester, and Exeter. 2 This I learnt from the letters of the very skilful surgeon C. White. ' J. Huxham, ' Observ. de Aere et Morb. Epidem. ;' v. supra.— ^ Medical Essays published at Edinburgh,' vol, ii, p. 28 ; v. supra. * J. Huxham, Op. cit., v. supra. ' Extract of a letter from W. Watson, M.D. F.R.S., to John Huxham, M.D. F.R.S., containing some Remarks upon the Catarrhal Disorder, which was very frequent at London and in its neighbourhood in May 1762, and upon the Dysentery which pre- vailed the following Autumn. DR. WATSON'S LETTER. 11 Aere et Morbis Epidemicis/ page 101. Though of the same catarrhal kind, it was by no means so severe or so fatal as the disease of February 1733, of which you have likewise given us the history in your first volume, page 80. The disorder^ though very general, seemed to attack the women more severely than the men. Much bleeding did harm ; and where there was no fever, which was frequently the case, the patients recovered equally well without it. Even without bleeding, or other evacuations, some, more especially women and lax-fibred men, were much debilitated during its whole continuance. The blood in most was not sizey; but the crassamentum was tender, and the serum bilious. Where the heat was great, gentle emetics brought up much bile, and very much lessened the inflammatory state of the disease. The rest was to be left to blisters, if the cough was very troublesome and the stricture upon the breast severe, balsamic medicines, gentle opiates, and light broths ; carefully avoiding cordials of every denomination and volatiles. Towards the end of the disorder, after gentle evacuations by stool, decoctions of Cort. Peruv. were of signal service, both in recruiting the strength, and carrying off the remaining cough. " In the disorder of 1743, the skin was very frequently inflamed, when the fever ran high ; and it afterwards peeled off in most parts of the body; but this was not observed to happen in the present disorder. " We have had here, this Autumn, a disease, which has not been, in my remembrance, epidemic at London. Very few of our physicians have seen this disorder as it has appeared of late. You mention it as frequent at Plymouth in the year 1743, in your treatise ' De Morbis Epidemicis,' vol. i, page 90. As you then observed, many of the children which fell under my care voided the vermes teretes. In the course of my practice, I found many of your observations exceedingly well founded, and collected from them very useful remarks. Dr. Sydenham has left us an admirable history of this disease, as it appeared at London in the year 1669, and the three subsequent years. To this work, as well as to what you have given us upon this subject, I am very much obliged. "As the dysentery is most frequently an autumnal disease, and, as I have not seen any person afflicted with it this 78 EPIDEMIC OF 1762. fortnight past, I flatter myself, that the late cold and frosty weather has put a stop to its progress. "This disorder, though very general, most frequently attacked weak persons, and those recovering from other diseases, women during their lying-in, and children. " The dysentery in some was attended with a fever, in a high degree inflammatory; in others it was without any fever. When it was attended with a fever, bleeding, and gentle evacua- tions by stool, with liberal dilution, did great service. When there was no fever, as well as in those whose fever had been relieved by the methods before mentioned, if the irritating pain in the bowels, bloody or mucous discharges with the tenesmus continued, after the excrementitious Sordes had been carried ofl\, nothing relieved more than drinking large quantities of very small mutton broth, without salt, so as to be discharged but little altered. This not only warmed and nourished the patient, but diluted the acrimony, and served as a most comfortable fomentation to the whole intestinal canal. "Clysters of this with Tinct. Thebaica I directed to be given three, or even, if the symptoms were urgent, four times a day. When these symptoms were abated, as most persons were exceedingly debilitated, and their appetite almost gone, light decoctions of Cort. Peruv. greatly hastened the recovery. " I had the misfortune to see three children die of four or five years old, after the severity of the disease was over. Their bowels had for a week or more been free from pain. They were without fever. Their discharges by stool, both bloody and mucous, were in a manner gone; nevertheless they were so much debilitated, and their stomachs so languid, that they obstinately refused every species of nourishment by the mouth; nor would they retain nutritious clysters ; so that, in the end, they sunk from absolute inanition. In two of these, which, by my direction, were opened, I found their gall-bladders turgid with high-coloured viscid bile. In both, the stomach and bowels were perfectly empty, and their bodies emaciated to a great degree. In one, neither the stomach nor bowels were in the least degree inflamed or discoloured ; except that a very few of the veins were preternaturally enlarged upon the surface of the ccecum and colon. In the other, there had been an inflam- mation upon about ten inches of the jejunum; but that had DR. RUTTY'S HISTORY. 79 been resolved ; as the ^owel was almost restored to its natural colour, and was not in its texture, even after death, more tender than the rest. The other viscera had not the least change of their colour, but exhibited a sound and natural appearance. "Another child, which I saw, was seized with a dysentery, attended with a very ardent fever ; which, notwithstanding my utmost endeavours to relieve it, carried off the poor infant on the third day. Several, almost the whole, of this child's discharges by stool were nothing but blood. Upon opening the body after death, the whole of the intestines were in a very great degree inflamed, and of an intensely deep red colour, and the contents of the abdomen were inexpressibly fetid. " Throughout the whole course of the disease, keeping the patient moderately warm and promoting his perspiration, was of great importance ; and the not sufficiently attending to this, I more than once saw followed by fatal effects.'^ 3. RUTTY.^ "The yearly bill of Dublin this year, 1763, was 2292, viz. much larger than in the two preceding years, which agrees to some former observations of the unwholesomeness of dry "Spring, 1762. "March was a wet month, not many days free from snow, sleet, or rain ; more snow and colder than for several years past. The principal winds N.W, Some brisk gales now and then. The 15th a storm. "April was dry for the season, only a few showers now and then ; cool and calm, yet a few warm days. The principal wind S.B. ' A Chronological History of the Weather and Seasons, and of the prevailing Diseases in Dublin. By John Kutty, M.D. London, 1770. ' The figures indicate the number of days on which the specified winds prevailed. seasons. "MARCH.' N.E. . . 4 S.E. . . 7 N.W. . 13 E. ... 1 N. ... 3 W. .. 4 s.w. . 4 "APRIL. S.E. . . 9 s.w. . . 6 W 4 s 2 N.E. . . 4 E. ... 5 N. ... 2 80 EPIDEMIC OF 1763. " MAY. N. .. . 2 E. .. . 12 S.E. . . 4 W. .. . 5 N.E. . . 8 S.W.. . 5 N.W. . 1 "May was an excessively dry month, and the wind hotter at some point of the East than for some years past, though with a cold wind at the same time, till near the end, when it was very warm. "A cold, and for the most part dry, spring, succeeding an open and somewhat warm winter, the catarrhs, which had infested the winter, prevailed greatly to the end of March; and in the months of March and April, various disorders of the lungs, pleurisies, pleuro-peripneumonies, pulmonary consumptions, coughs, chin-coughs, and quinzies, greatly prevailed, and often proved fatal. Also inflammatory feverish colds, often attended with pleuritic symptoms, were frequent. Some of these ter- minated hy sweat about the fifth or seventh day; when they ran out beyond the seventh day, they were often attended with miliary eruptions; but some other feverish disorders were carried off, partly by diarrhoea and partly by sweat, in eight or nine days. "Rheumatisms and rheumatic fevers were also very frequent in March and April ; and to the above-mentioned disorders in April, add the scarlet fever, with ulcerated tonsils, ophthalmies, inflammations of the gums and ears, and toothache. " Several children recovered of their fever the sixth, seventh, and eighth days, by a critical sweat; in some others, more ad- vanced in age, the fever terminated in fourteen, sixteen, and eighteen days. "Some mild intermittents appeared in April; but in May, intermitting fevers were very frequent, particularly the tertian, and pleurisies and chin-coughs still continued to be epidemical. " In the beginning of May, a fever was common, which re- sembled the scarlet fever in every circumstance, except the eruption. In the beginning, after the shivering, the face was much flushed, with a severe headach, dry, burning skin, quick pulse, and soreness in the throat ; sometimes attended with superficial ulcerations in the tonsils, and often a crick in the neck. In some, it disappeared in three or four days ; in many, after running out to the fourteenth day or longer, the skin peeled off in branny scales, as in the scarlet fever, though no eruption had appeared. DR. RUTTY'S HISTORY. 81 "About the middle of May, began in Dublin the catarrhal fever or feverish cold, scarce sparing a family, or any age, sex, or condition, except that it rather spared children. It was plainly a disease of foreign extraction, having visited Copenhagen a month before it reached London, and London about a month before it arrived herej and it gradually extended itself over every province of the kingdom. In London, it seldom proved fatal, though their weekly bills once rose to 700 ; but in the country it was more fatal. "It generally began here vrith a lassitude, a pain and heavi- ness of the head, and particularly a pain across the eyebrows ; a severe cough, a soreness or rawness in the throat and breast, excited by coughing; generally a great defluxion from the nose, and sometimes eyes; the heat a little greater than natural, and a loss of appetite. "Such was the attack in general; but in many the symptoms advanced to a feverish state, and were very distressing, so that the patients were forced to betake themselves to their beds; in these it began with a shivering pain of the head and back, soreness of the bones, a burning heat, and, in some, a slight delirium and oppression in breathing. In some, the pulse was quick and low; but in general the pulse was not quick, and, even when the feverish symptoms were very high, it was often observed to be not more quick than in health, and generally more low and depressed. " There was generally a disposition to svreat, which usually returned every night with an aggravation of the feverish sym- ptoms ; and the promotion of the sweat, by drinking wine whey and spirit of hartshorn, carried it off in a day or two, in those more slightly affected. "Some had a great oppression in breathing, who were relieved by bleeding; the blood was not often sizy, but the serum was muddy and yellow; and when it had an inflammatory crust, this was of a saffron hue. " Those who, after taking a puke, threw up much bile, generally found great relief from the symptoms, and in some they were totally removed. A smart diarrhoea attended some few with relief, but in the greater number a sweat about the third day proved critical ; yet in several there was observed an efflorescence on the skin, like the measles, or a red rash, with 6 82 EPIDEMIC OF 1762. violent itching, which was observed to carry off the disorder more completely than the sweating. "Without proper care and regimen, the symptoms continued for a week or longer, and a remarkable languor continued, in most, for several days after; and others, especially valetudina- rians, the weakly and aged, and those of bad lungs, did not recover for a much longer time. " The languor yielded to the Cortex Peruvianus. "Compare the years 1729, 1732 3, 1737, and 1743. " JUNE. 1 N.W. . 13 E. . . 3 W. . . 8 S.E. . 5 s.w. . 4 N.E. . 1 N. . . 1 " JULY. N.W. . 6 W. . . . 10 S.E. . . 8 S.W.. . 15 E. .. . 1 N.E. . . 1 S . 1 "Summer. "In June, the weather was generally dry and fair, and warmer than the same month for several years past ; frequently windy, but not much rain. The principal winds, N.W. and W. "The dry weather of the two preceding months continued, in a manner somewhat extraordinary, through July; and even the S.W. winds were not attended with much rain, except on the 8th. From the 9th to the I5th, it was hot, yet not one day so sultry as in July, 1760, by one and a half degree of the thermometer. The winds variable, chiefly S.W. and W. "August was alternately fair, gloomy, and cloudy; there were some great gluts of rain after the long drought. It was not so warm as this month usually is. The winds chiefly N.W. and W. It concluded fair and cold, with N.E. and E. winds. " In June and July appeared several instances of pernicious relics of the late epidemic catarrhal fever in valetudinarians and infirm persons, some of whom died, and their deaths were apparently hastened by it. " In June appeared a bilious, putrid fever, sometimes attended with petechise, but the mihary type was more frequent. In many, it appeared in the beginning with inflammatory sym- ptoms, and was generally attended with a violent fixed pain in the forehead. The miliary pustules appeared from the seventh "AUBCST. W. .. . 10 N.W. . 11 E. .. . 8 S.W.. . 5 S.... . 1 N.E. . . 9 S.E. . . 2 DR. RUTTY'S HISTORY. 83 day to the eleventh ; and some of the fevers in July were at- tended with much the like appearances, and they proved fre- quently fatal in both months. Among these, one terminated happily by a critical sweat on the sixth or seventh day; a second proved fatal the fourteenth dayj and a third, the patient did not survive the 11th day. ''In August, also, fevers, partly petechial and partly miliary, were frequent, but moreover attended with a bilious purging, and not often fatal; they ran out to the seventeenth or twenty- first day. They fell into a lethargic do2sing, and recovered gradually, without any other evacuation. " Intermittent fevers, principally tertian, continued frequent in June, and there were some few in July, in one of which the type was singular, viz. seven or more paroxysms in a day; and these fits grew daily stronger, until the seventh day, when a large critical sweat terminated the disease. " In August, intermittent fevers became frequent, and par- ticularly epidemical among children from one to three years of age. "In July, pleuritic fevers and peripneumonies of a malignant and fatal kind prevailed much, and were seldom relieved by repeated large bleedings. Among these, one young man re- covered the seventh day, but not without a blister applied on the spot, after repeated large bleedings; another, more ad- vanced in years, died the eighth day. The blood was covered with a thick saffron-coloured size, and the serum of a bilious colour. "Towards the end of July, disorders of the bowels, with bilious purging and vomiting, were observed, which in August prevailed much, and dysenteries were common and fatal to some ; also some dysenteric fevers attended. "In July, the measles were very frequent and dangerous; and the smallpox, of an unfavourable kind, not tending to suppura- tion, attended the months of July and August. "The disorders of the bowels mentioned in August, viz. diar- rhoeas, dysenteries, and a dysenteric fever, continued through September and the beginning of October. "Some of the low kind of fevers were observed in September, among which were fatal instances in two girls, aged about 15, one of whom died the nineteenth, the other the twenty-third day. 84. EPIDEMIC OF 1767. " Many of the fevers in October were of the petechial, or at least eruptive, kind, yet no remarkable fatality attended them, many recovering from very bad and alarming symptoms ; the time of their termination was various, most frequently in four- teen days, others in six, seven, eight, or ten days ; a few ran out to twenty-one days, and one to six weeks. "In November there was a remarkable increase of fevers, both as to numbers and malignity; they were mostly of the low kind, often petechial, and some miliary, tliough neither of these eruptions were essential. Several of them were attended with haemorrhages, and other marks of colliquation ; also several of them had a more remarkable exacerbation than usual in the evening. " Many, both young and old, were carried off by them; and in several of these the change proved sudden and unexpected, who died soon, viz. the fifth, sixth, eighth, and tenth days ; whilst others, in whom the fever was longer protracted, as to fourteen and about twenty- one days, more frequently recovered." [1763 was long called the "wormy year," in consequence of the great prevalence of the caterpillar of a very destructive species of lepidopterous insect. The whole herbage on the hills near the sources of the Ettrick and Yarrow was destroyed by it. This plague reappeared in 1803.^] EPIDEMIC OF 1767. HEBERDEN. " In the very beginning of June, if not sooner, a few persons in London were affected with several symptoms of a cold, which of their own accord they, in two or three days, observed to differ from a common cold, and to resemble the epidemical one of the year 1763, on account of its being attended with a greater languor, feverishness, and loss of appetite than what the same degree of such a complaint usually brings on. "About the middle of June, the same disorder began to be ' Farmer's Magazine, vol. i, p. 124. ' Medical Transactions, vol. i, 3d ed. 1785, p. 437. The Epidemical Cold in June and July, 1767. By Dr. William Heberden. Read at the College, August 11, 1767. DR. HEBERDEN'S PAPER. 85 much more common in London, and was manifestly epi- demical. It was at its height about the last week in June and be- ginning of July, and before the end of July had entirely ceased. "The peculiar symptoms were : — A shivering, which returned frequently for the first two or three days ; a troublesome and almost unceasing cough, at least for the first day or two ; very acute pains in the head and back, and abdomen, particularly just under the left ribs, piercing from them to the back, occasioning want of sleep. All these symptoms did not attend the same person, but most had, at least, one of them ; lassitude, loss of appetite, and fever belonged, in some degree, to all. "In some, this disorder began like something worse than a common fever, and in a day or two seemed slighter than a common cold ; but many of the symptoms hung, upon several at least for a week, and sometimes lasted a month. Where its attack was most violent, it brought on anginas, pleurisies, and peripneumonies, with a continual fever. Where it was a little gentler, the fever, though great enough at its height to bring on deliriousness, yet had plain remissions or intermissions. "It attacked equally both sexes and all ages ; I saw some infants ill of it ; and it appeared to be fatal to a very few old and infirm persons ; but in general, it was less epidemical and far less dangerous than the cold of 1763. "This epidemical illness bore bleeding very well, for it was plainly of the inflammatory kind, by bringing on, where it was excessive, inflammations of the throat and pleura, and lungs, and such as sometimes required bleeding to be repeated; when after bleeding, or of itself, it turned to an intermittent, the bark took place and made an effectual cure. These two reme- dies, together with a few others for the relief of some incidental symptoms, were all which it seemed to want where it was bad ; but in the generality of people, it was left to nature, and cured itself. "The season preceding this disorder was only remarkable for being unusually cold ; but then, it is observable, that the similar epidemic cold of the year 1762 was preceded by weather as uncommonly warm. "As the same disorder was reported to be common about the same time in many other parts of England, and more fatal than it was in London, it is very desirable, that the physicians 86 EPIDEMIC OF 1775. of those places would favour the College with what they ob- served relating to its history and cure. "Though this epidemical illness be but just over, yet there seems no reason to apprehend any of those lasting ill conse- quences from it which attended the sufferers in 1762, many of whom continued in a languishing state for several months, and then died ; and others complained for two or three years that its ill effects still hung upon them, and that they had not, in all this time, recovered perfectly from the hurt which it had done their constitution," EPIDEMIC OP 1775. " The late Dr. Fothergill having drawn up a sketch of the epidemic disease which appeared at London and various parts of the nation towards the end of the year 1775, and having sent printed copies thereof to several physicians, both in town and the country, in order to obtain a more complete history of the disease ; this sketch, and also the communications of several of his ingenious correspondents on the same subject, are here inserted, being thought well worthy a place in this collection." 1. FOTHEEGILL. "A sketch of the Epidemic Disease which appeared in London towards the end of the year 1775. "London; Dec. 6, 1775. "1. About the beginning of the last month, it was mentioned to me in many families, that most of the servants were sick; that they had colds, coughs, sore throats, and various other complaints. "2. In the space of a week these complaints became more general ; few servants escaped them, especially the men, who were most abroad : many of the other sex, likewise, and people of higher condition, were attacked ; nor were children exempted. ' Medical Observations and Inquiries, by a Society of Physicians in London, vol. vi, 1784, pp. 340—406. DR. FOTHERGILL'S SKETCH. 87 "3, The disease^ which had hitherto been either left entirely to itself, or had been treated with the usual domestic medicines appropriated to colds, now claimed the attention of the. faculty, and, for the space of near three weeks, kept them, for the most part, universally employed. " 4. Most of those whom I saw, were seized (and often so suddenly as to be sensible of the attack) with a swimming or slight pain in the head, a soreness of the throat, and all over the body with a sense of coldness, particularly in the extremities. A cough soon followed, a running of the nose, watery eyes, slight nausea, frequent calls to make water, and some were seized with a diarrhoea. " 5. More or less of feverish heat, inquietude, pain about the breast, prsecordia, and in the limbs, soon succeeded, but in various degrees. Many were capable of continuing in their usual occupations, under these symptoms ; others were obliged to submit to confinement ; and not a few to their beds. "6. The tongue was always moist; the skin seldom remarkably hot or dry; the pulse often full, quick and harder than one would have expected for such a temperature of the skin. "7. Several were seized with diarrhoea : the stools were always black, or of a deep yellow colour; and so were those, for the most part, which were procured by purgative medicines. "8. In a few days every complaint abated except the cough; this continued the longest of all the symptoms, and, in the fore part of the night, was exceedingly troublesome and vexatious ; towards morning generally came on a sweat and easy expecto- ration. "9. Those who were seized at first with very copious defluxions from the nose and the fauces, or had a plentiful and spontaneous discharge of black biUous stools ; or made large quantities of a high-coloured urine ; or sweated profusely, of their own accord, a night or two after the seizure, soonest grew well. "10. In many cases it was necessary to take away some blood, the condition of the pulse and vehemence of the cough requiring it. The blood was almost universally sizy, representing a flat cake of yellowish tallow, floating in a deep yellow serum. Very few instances occurred where the size formed that cup- like appearance, which occurs in most of the genuine inflamma- tory disorders. 88 EPIDEMIC OF 1775. "11. By warmth, diluting, cooling liquids, mild diaphoretics, gentle and repeated purgatives, the disease, for the most part, soon gave way, in subjects otherwise healthy. Sometimes it was necessary to repeat the bleeding; sometimes blisters became neces- sary, and were serviceable in abating the cough, which was the last of all the symptoms that gave way ; after the proper evacua- tions, anodynes, for the most part, had very salutary effects. " 12. In many instances the disease assumed the type of an intermittent towards its dechne ; the bark, however, did not generally succeed in curing it. The symptoms, as often happens in bilious disorders, were sometimes aggravated by this medicine. A few doses of some mild cathartic most commonly removed it effectually. " 13. Many who neglected themselves and went abroad with the distemper upon them, frequently got additional colds, and brought on a fever of the most dangerous kind ; a few died phrenetic. "14. Ancient, asthmatic persons, were likewise great sufferers for the most part ; a peripneumonic fever came gradually on, which often terminated fatally. And of those that did recover, their amendment was slow, and treatment difficult. "15. And, indeed, it appeared that very few persons wholly escaped the influence of this morbid constitution ; for it seemed to aggravate every present malady. "16. It proved fatal, likewise, to several very young children, disposing them to violent coughs or diarrhoeas. "17. Perhaps, however, there is scarcely an instance to be met with, of any epidemic disease in this city, where so many persons were seized, and in so short a time, and with so little comparative mortality. " 18. Though attempts to ascertain the causes of epidemics are, for the most part, more specious than substantial, it may not be improper to mention a few facts that gained my attention; to others many more may have occurred, and worthy to be recorded. During the greatest part of the summer, in that part of the country where I then was (Cheshire), the air was of the most equal temperature I ever knew. In the space of two mouths the quicksilver in the thermometer once rose to 68, once fell to 56 ; but for six weeks together, it kept between 60 and 66 continually, day and night. SIR JOHN PRINGLE. 89 "19. Tlie.barometer did not vary much more. The weather was, during this time, very changeable, much inchning to wet; and, though it rained more or less every other day for six weeks, yet, upon the whole, no unusual quantity of rain fell ; it sunk into the ground as it fell, and made the earth very soft and miry J but seldom swelled the brooks, or occasioned floods. "20. During this time, horses and dogs were much affected; those especially that were well kept. The horses had severe coughs, were hot, forbore eating, and were long in recovering. Not many of them died that I heard of; but several dogs. "21. To the consideration of the faculty in this city, is this sketch of the late epidemic submitted, with all due deference; and with a request that, if the observations they have made do not correspond with this recital, they will be pleased to com- municate their remarks while the remembrance of the facts are recent ; in order, that as exact an account of this disease as possible may be transmitted to our successors, " 22. If those physicians in the country, into whose hands this essay may come, will be so obliging as to mention the time when this epidemic made its appearance in their neighbourhood, and wherein it differed from the preceding sketch, either in the symptoms or the method of cure, they will likewise contribute to the same good purpose. The united observations of the faculty at large, must greatly exceed the utmost efforts of any individual, however warmly he may be disposed to promote the utility of his profession." 2. SIR JOHN PRINGLE, BART. " The species that I had of the Influenza was a sore throat, with fever and shooting pains through the back part of my head; but these symptoms were never followed by a cough. I heard of several others who, like me, had never been troubled with a cough, and only with this inflammatory angina. "I think you do well to record the state of the weather ; but I think the conclusion ought to be, that the sensible qualities of the air had, most probably, no share in producing this epi- demic. I should be tempted to say, that they had evidently no part; for we hear of the same distemper having been in 90 EPIDEMIC OF 1775. Italy, France, and in the Low Countries, and, I doubt not, in other parts of Europe, had we inquired. But it cannot be supposed that the state of the atmosphere, either as to weight, heat, or moisture, was the same everywhere. And in the same country have we not seen it rage in one district or city, whilst others, at no great distance, were totally free ? Yet between the sound and the sickly there could be no considerable meteoro- logical difference. My conclusion, therefore, should be, that such epidemics (of which there have been four in my re- membrance) do not depend on any principles we are yet acquainted with, but upon some others, to be investigated, and by such means as Dr. Fothergill very properly and most com- mendably proposes to be done, by the united inquiries of his brethren." 3. DE. HEBEEDEN. "Dec. 16, 1775. " The 28th of October was the first day on which the late epidemic cold seized upon any one whom I had an opportunity of observing ; and at the end of three weeks the cause, whatever it was, of this distemper was so far weakened, as to be incapable of infecting those who had escaped it until that time, though many who had suffered before continued to complain of the cough and hoarsness much longer. The violence of this dis- temper usually began to abate in five or six days. " In some it began with a sickness and perpetual vomiting, which were the forerunners of a severe degree of this illness ; in others the first symptoms were sneezing, and a copious de- fluxion from the nose and eyes, and these suffered much less, and were sooner recovered. Many complained of a hoarseness and sore throat, and of a tightness, oppression, and heat of their breasts, and of feeling pains in various parts, particularly in their heads, sides, and backs. Almost every one of these patients was afflicted with a racking cough; with a sense of coldness, frequently returning upon them ; with a failure of appetite and of sleep, and with a languor and weakness much greater than might have been expected from the effects of any of the other symptoms. The degree of fever was seldom great. I saw two persons in this distemper who had eruptions upon SIR GEORGE BAKER. 91 their skins resembling that of a scarlet fever. In two or three young men this disorder was increased to a dangerous height, and became a true peripneumony, attended with bloody phlegm, and manifestly requiring frequent bleedings, by which they were much relieved. Towards the middle or end of this illness, a few were attacked with intolerable stitches in their sides or loins, so that for two or three days they were confined almost to the same posture, and if they were necessitated to change it, they shewed all the marks of exquisite pain. Lighter cramps in the legs and arms were not uncommon at the going off of this malady. "I know none who could properly be said to die of it ; but it seemed to hasten the death of two or three persons, whom it found dying of age, and of other diseases. "The keeping quiet within doors, together with an abstinence from the grosser foods, and from heating liquors, was all which the generality of patients required. Small quantities of an opiate were very serviceable in allaying the incessant teazing of the cough, and in quieting the restlessness. Where the fever or any of the symptoms were considerable, it appeared to me that bleeding was unquestionably useful, and lessened rather than increased the languor. In a few it was necessary, besides bleeding, to employ blisters, with the other usual remedies for inflammations of the lungs." 4. SIR GEORGE BAKER, BART. "January, 1776. "It is certain that many people, both in this town and its neighbourhood, were attacked by the epidemic disease some days preceding the 20th of October. As to the precise day when I first heard of it, I cannot speak of it with accuracy. " Men, confined by their business at home, suffered much less than those who were exposed to the air ; and women, in general, less than men. Very young children were not much affected by this disease. Boys at school were almost universally disordered. Girls at school (I suppose on account of their greater confinement) were remarkably free from the influence of this constitution, at least, were not generally so attacked. 92 EPIDEMIC OF 1775. "Many were suddenly seized with great giddiness and intense pam in the head; some with a considerable nausea, which sometimes continued several days ; some few had, in the begin- ning, successive rigours. An uncommon languor, restlessness, and anxiety seemed to be the general characteristics of this disease. "I saw none whose first indisposition was a diarrhcea. Those who had a diarrhcea had first complained of the common symptoms of a cold, which ceasing, a diarrhcea followed. This, in some, arose even to a dysentery. They had almost constant pains a little above the navel, and a very frequent evacuation of thin excrement, mixed with mucus. This was my case in particular, and that of several whom I visited, and many others, a relation of whose cases has been communicated to me. "Dr. Pothergill says, the tongue was always white. This seems too general an assertion; at least the contrary happened in several instances which fell under my notice. "The blood, in the beginning, was not always sizy; nor did I, in general, observe the deep-yellow serum mentioned by Dr. Fothergill; likewise, the cup-like appearance of the crassa- mentum was remarkable in several cases. " In many cases, it was necessary to take away blood, even three or four times, on account of the violence of the pleuritic and peripneumonic symptoms. " Clysters frequently injected were of singular service. "The fever having sensibly remitted, according to my ex- perience, the Peruvian bark was used with advantage; and, likewise, when a languor and debility (as frequently happened) continued after the vehemence of the disease was subdued, this proved an useful remedy. "Many persons even now feel the efi'ects of this disease ; and I know several who are likely to die tabid. "Accounts received from France, Holland, and Germany, giveus reason to conclude that this epidemic was much more fatal in other countries than in this island. And I believe it will appear, that it was more fatal in several distant countries than in this metropolis and its neighbourhood." DR. REYNOLD'S LETTER. 93 5. DR. HENRY REVELL REYNOLDS. " Jan. 29, 1776. "My wife had this complaint on the 23d of October, and on the 2d of November I visited several patients who had laboured under it for some days. "All my children had it. The order in which the symptoms appeared is as follows : — watery eyes, swelling of the eyelids, running from the nose, cough, diarrhoea ; so that every part of the mucous membrane seemed to be progressively attacked. I saw two others affected in the same way. " In two instances I saw the tongue very dry, parched, and chopped. The patients were both corpulent women, aged between 30 and 40. At the time I was called in to them they laboured under a true peripneumony; but I learned that they were first attacked with the catarrhal symptoms. Blood drawn from both these patients, even at the third bleeding, had a very thick buff coat, and exhibited the cup-like appearance. " Several whom I attended had this kind of diarrhoea; but 1 did not find it of any service to any ; on the contrary, I thought it prejudicial to some, as it seemed to prevent a free expecto- ration, which, to my apprehension, was the most critical and most salutary evacuation. Neither did warm copious sweats, though universal, (unless they happened before the seventh day,) give that relief which one might have expected from them. " With respect to the method of cure, mine was nearly the same as yours, and in the same order. Permit me only to men- tion that I found the Kermes mineral to answer my purpose exceedingly well, both as a diaphoretic and an expectorant. After several trials I preferred it to any other preparation of antimony. " In those cases where the diarrhoea was troublesome, I had recourse to the ipecacuanha in small doses ; a grain of the powder, for instance, once in six hours; and it succeeded to my utmost wish, checking the diarrhoea, and promoting a free perspiration." 94 EPIDEMIC OF 1775. 6. DR. WILLIAM CUMING.^ " DoRCHESTEB ; Dec. 25, 1775. "Dear Doctorj — I received your printed history of the epidemic disorder that has been of late so generally felt, not only over all this island, but in several other parts of Europe : and probably, its influence has been far more extensive. I honour you highly for your exerting yourself in this manner, to obtain as accurate an account as possible of this disorder, and hope that none will be found so perverse and malevolent as to attempt to detract from your merit with your contem- poraries, and with posterity. " The account you have given of the ^state of the atmosphere, in respect of warmth and gravity during the preceding autumn, is, I believe, very just, as far as I can recollect. I often, during that time, examined both the barometer and thermo- meter; but finding the variation of the mercury confined within such narrow limits, I made no minutes of its height ; indeed, I never do now, unless it verges towards one or other of the extremes. It was otherwise in respect to the moisture of the air, as to which I can speak with precision. The autumn here was very wet, as the quantity of rain that fell here during the months of August, September, October, and November, was exactly fourteen inches and twenty-seven hundred parts. This circumstance, joined to the mild temperature of the air, made me to expect diseases of the putrid class ; but in this I was happily disappointed. We had also here many moist, warm, foggy days, in which no sensible quantity of rain fell, when the quicksilver in the barometer stood so high as 30'2. "After the middle of August, I have heard from good authority, that a disorder amongst the horses prevailed very generally in Yorkshire. It has not been so general here as to become the subject of conversation. About the latter end of October, I remember to have heard that one gentleman had lost six dogs, in the usual manner that these animals are seized — a giddiness in the head, an inability to eat, with a paralytic affection of the hinder extremities. ' Extract of a Letter from Dr. William Cuming to Dr. Fothergill. DR. CUMING'S LETTER. 95 " From the middle of October (to which time Dr. Pulteney fixes the commencement of this disorder, when he himself was seized, though he was never confined by it) several individuals complained of colds, which were considered as accidental, and but little attended to; but it was not, I think, till after the 10th of November that the malady became general. On the loth I first visited a patient labouring under it. The manner of seizure and the symptoms were similar here to your descrip- tion of them ; several complained of a heavy, dull pain in the head, and many had fixed pains in the side. The appear- ance of the tongue, the feel of the skin, were as you describe ; and, though the pulse was generally full and quick, yet I was not sensible of that hardness in it that you mentioned ; so that the violence of the cough, with the pains in the breast, and the diflBculty of expectoration, indicated the necessity of taking off blood rather than the state of the pulse. The blood always had the appearance which you describe. I never once saw it cupped or pursed up. In general it was necessary to draw off blood, and many times oftener than once ; but I never once ordered it without the patient's being sensibly relieved by it, and the benefit was commonly felt immediately. I usually directed blisters, too, on account of the pain in the head, the incessant cough, or the fixed pains in the breast, and their salutary effects were, I think, as constantly perceived. " Besides these I ordered the neutral salts, pectoral linctuses, soft lubricating drinks, which, with a suitable diet, universally succeeded, for I lost none ; and I have hardly heard of any that died of this disorder. The medicines and diet directed, kept the bowels properly lax, so that I hardly ever ordered any purgative. None of my patients were seized with a diarrhoea, so that I never observed the colour of the stools; though I have since heard that several young people were attacked in this way, and had the disorder lightly. Towards the decline of the disorder, forty or fifty drops of the elix. paregor., in a draught with oxym. scill., one scruple or one scruple and a half, taken at bed-time, abated the violence of the cough, procured rest, and occasioned a gentle moisture on the skin. In two cases which I saw, the disorder shifted to the putrid class. A gentleman's coachman was seized with the common symptoms, was blooded, &c., got better, went abroad, got well ; the same 96 EPIDEMIC OF 1775. complaints returned, was blooded again, was relieved, but, in a few days, I was sent for, when I found him labouring under a great dejection of spirits despairing of his recovery; a stupifying pain in the head, oppression of the prsecordia, moderate warmth of the skin, with a quick rather than low pulse, and a great general debility. I had the curiosity to examine his throat, of which he did not complain, when I found thin white sloughs in the uvula and tonsils. Blisters, a warm regimen, and the bark with gargles, in about ten days restored him. " The other was butler to a gentleman, six of whose servants I had prescribed for in the reigning disorder, and who had been recovered by bleeding, and the usual regimen. This man, believing himself seized with the common complaint, sent for the apothecary to bleed him ; but four ounces only were taken ofF, as he was faintish. I saw him by accident next day ; the blood was florid and of a weak texture; his pulse quick and feeble ; some ulcers appeared on the tonsils. By the bark and a warm regimen he got well in a few days. In many gentle- men's families in this county not one servant free from this disorder ; in others but one or two infected. I think it raged chiefly in the western and northern parts of this county. Many persons in Dorchester complained of coughs and colds, but a few only confined to the house. "You may remember that, in the Spring of the year 1762, a disorder somewhat similar to this, but not so general, was very frequent in most parts of this kingdom ; but what corresponded with it in almost every particular, was the fever and cold that appeared in the winter of the year 1733, in most parts of Europe, America, and the West Indies, of which a particular account is given in the second volume of the 'Edinburgh Medical Essays.' " 7. DR. THOMAS GLASS, OF EXETER. " In the city of Exeter, and the coimtry about it, colds and coughs were not more frequent than usual, during the latter fart of the past Autumn. But from the 8th of November the number of people who were continually coughing increased so fast, that it was soon evident the epidemical colds, which began DR. GLASS'S OBSERVATIONS. 97 in London, as we were informed by the public papers, more than a week before, had reached us. This disease appeared to be at its height here from the 18th to the 24th of the same month, and attacked very few after the 4th of December ; but by this time almost every one had felt more or less of its effects. "On the 11th or 12th of November it made its appearance in the Devon and Exeter Hospital, and within a week seized 173 persons, being all the servants and patients then in the house, except two children ; 163 of them were coughing together. Is it not remarkable that such a number of hospital patients, afflicted with so various and different kinds of distempers, and under the operations of the most opposite qualities, should have been all affected, almost at the same time and in the same manner, by the cause of these epidemical coughs ? "Two or three days after the hospital had been attacked, the city workhouse was visited by them ; of near 200 poor people, who are in this house, but few escaped ; all the others were complaining at the same time. "Prom Exeter the disease travelled towards Cornwall; about the 1 3th of November it arrived at Okehampton and Ashburton, and about the 15th at Plymouth. I have no certain intelli- gence when or where it passed from Devonshire into Cornwall; but by the 20th it had reached Truro; and, before the end of the first week in December, had spread to all parts of that county. "The constitution, productive of this epidemic, very seldom, I believe, continued to exert its influence with much force in any place more than three weeks or a month, so that, after this time, a few only were attacked by it ; and it was generally observed, that in the churches, for two Sundays following, nothing was to be heard but coughing; and that, on the third Sunday, this disturbance was much less. I cannot find that there is any part of these two counties but what was visited by it. " Its appearance in this city was the same as in London ; except only, that it was here much more favorable, and attended with some symptoms besides those you have mentioned in your sketch; for many of our patients, especially such as had a considerable degree of fever, complained of great lowness of 7 98 EPIDEMIC OF 1775. spirits, and sudden weakness; several of them of a perfect inappetency both to meat and drink (most of these had severe coughs without much fever), and some of them a soreness throughout the windpipe and oesophagus, with a great pain in swallowing even liquids, others of a violent pain in their ears. A few had sloughs of the malignant kind on their tonsils; swellings of these, and of the sub-maxillary glands, were not unfrequent, but occurred oftener in some towns than others. One of my patients had a large parotid, which suppurated slowly and broke at the end of three weeks. Eruptions on the lips, towards the crisis, were a common and very salutary symptom. Many felt no feverish heat, but almost aU, if not all, had more or less of a cough. "This circumstance, probably, induced Sydenham to give the name of Tussis Epidemica to the disease which had been called Febris Catarrhalis Epidemica by his predecessors, who seem to have been of opinion, that a cough, without a fever, was nothing more than a symptom of common cold. The impropriety of calling a cough without any feverish heat, a catarrhal fever, being obvious. " Most people in this part of the kingdom, who had coughs and colds during the late epidemical constitution, took no more notice of them than they would have taken of common colds, and got well, when they were without a fever, sooner than those who, in the like circumstances, submitted to confinement. Nor needed such persons any other treatment than that which Sydenham recommended to his patients, who had epidemical coughs, but no fever, in the year 1675. "But those who appeared to be feverish, and had pains in their head, breast, back, or limbs, were advised by the faculty in this city to confine themselves to their beds, and to drink frequently barley-water, water-gruel, linseed-tea, and other soft diluting liquors, which were sometimes sweetened with honey, very hot. Saline draughts, with spermaceti, were often prescribed ; to which, if the patient felt himself low, and in- clined to be faint, was added cordial confection ; or if he was not disposed to sweat freely, emetic tartar, but not enough to excite a nausea. A plentiful and easy sweat, continued for a suflBcient space of time, carried ofl' the catarrhous fever and pains on the first, second, third, or fourth day of the disease. DR. GLASS'S OBSERVATIONS. 99 This fever, whict has been called a Diary and Decreasing Fever, because it either ends or begins to decline within twenty- four hours, and never exceeds the fourth day, was accounted an essential part of the Catarrhous Epidemic, and seems, indeed, to be an immediate effect of its cause. But the cough generally remained after the fever was subdued, until an easy expec- toration of concocted matter put an end to it. The soft diluting liquors, and the medicines above mentioned, were designed to bring on this critical expectoration, as well as to promote a sweat. And to answer that end, paregoric elixir was likewise given, if the cough was very troublesome, and the matter brought up by it crude and thin, after the fever was gone off or considerably abated. " In a certain town, many persons to whom, as soon as they applied for assistance, wine-whey with spirits of hartshorn was freely given to force out a sweat, and paregoric elixir to quiet their cough, became delirious. " Sometimes a violent cough, with considerable, but not in- flammatory, pains about the breast, seemed to require bleeding on the second or third day of the disease ; but this evacuation weakened the patient, without removing his pains or mitigating his cough in any considerable degree, and seemed to retard his recovery. In several instances, as I am well informed, the loss of blood at this early period of the disease was followed, not immediately, but within a few days, by severe paroxysms, resembling those of an intermittent. And I apprehend that bleeding is then only necessary in this distemper, when it is accompanied with real inflammatory symptoms ; and that purging is also improper, unless a fever, which requires this evacuation, is complicated with the catarrhous complaints ; a spontaneous sweat being the natural remedy of the fever, which is most essential to them. Mercatus has very judiciously re- marked, that this Epidemical Catarrhous Disease is to be treated according to the nature and disposition of the fever with which it happens to be associated ; so that in some cases bleeding is necessary, in others purging; but in most a proper regimen only is required. This judgment of the Spanish physician is confirmed by the experience of our sagacious Sydenham, who cured the Stationary Fever of 1675, when it was united with the Epidemical Cough of that year, in the same manner, and with 100 EPIDEMIC OF 1775. the same success, as he had done before these coughs made their appearance. "If the feverish disorder, accompanying the catarrhous com- plaints, continues increasing for two or three days, it is certain that another fever, besides the Diary or Decreasing Fever, is complicated with them. This adventitious fever has been most commonly found to produce either symptoms peculiar to fevers of the inflammatory kind, or those which were the dis- tinguishing marks of the fever of the season. "Before we were visited by the late epidemic, the atrabilious constitution, which, according to Dr. Grant's accurate obser- vations, begins some time in October or the beginning of November, had takea place ; and, on this account, a plentiful discharge of black, bilious stools, coming on of its own accord, or procured by gentle and repeated purging medicines, when there were pains or uneasiness iti the bowels, or a distension of the belly and prsecordia, with inquietude or other signs of turgid matter in the intestines, soon freed the patient from the fever of the season, and all the complaints arising from it. "But when any danger was apprehended from inflammatory complaints, which did not often happen in this part of the country, more or less blood was taken away. This was always sizy, and the size, for the most part, formed a cup-like ap- pearance. We had, likewise, recourse to antiphlogistic medicines, and occasionally to blisters, which more sensibly abated pleu- ritic pains, being applied to the part affected, than the previous bleeding. - " Peripneumonic complaints, the most alarming symptom of all, were gradually carried off" by a free and easy expectoration of digested matter. Such remedies were therefore administered, as have been found, by experience, to promote the digestion of thick, viscid humours, collected and retained in the lungs, and to faciliate their discharge. " This disease proved fatal to exceeding few in this city or country, and those who died of it were ancient persons, or pul- monics. Such as these have been the principal sufi^erers in every epidemical catarrhous constitution, of which I have read any description. Children, both in Devonshire and Cornwall, were less subject to the distemper than adults ; their com- DR. GLASS'S OBSERVATIONS. 101 plaints, when they had taken it, were slighter ; and they sooner got well. Almost all of them had watery eyes and a running nose. " From the accounts and descriptions given us by physicians of the Febris Catarrhalis Epidemica, of Tussis Epidemica, which since the year 1 557 have made their appearance in Europe, at least a dozen times, it is sufficiently evident that they are the same disease, diversified only as the smallpox are, by the influence of the climate, the seasons of the year, and the constitution of the air. ''Whilst it was the general opinion of philosophers, that all things upon earth were governed by the heavens, physicians im- puted the Epidemical Catarrhous Semi-pestileutial Fever, to the influence of the stars; whence the Italians gave it the name of Influenza. " Wintringham and others, who attribute this general epi- demic to moist, cold weather, coming on suddenly after a lasting, warm, dry season, seem not enough to have apprehended that it is a disease of all seasons and climates, which I think it most certainly is. For we are informed by Willis, in cap. xvii, 'De Pebribus,' that it visited this kingdom in April, 1658 ; and that the whole Spring and the beginning of the Summer this year were uncommonly cold, and the preceding Winter exces- sively hard. And Mercatus relates, in lib. ii. 'De Intern. Morb. Curat.,' that it was raging in some part or other of Spain during the whole Summer of the year 1580, and destroyed not a few. It is recorded by Fonseca, in 'Disputat. de Garotillo,' that in the year 1557 it infested Asia, came from thence to Constantinople, tben spread itself over all Europe, and afterwards attacked America. And by a society of physicians at Edinburgh, in the second volume of their Medical Essays, that about the middle of November 1733, it made its appearance in the northern parts of Germany, and reached Naples and Spain before the end of February 1733, having, in the mean time, over-run all Europe. That about the middle of the following October, it arrived in New England, and travelled southward to Barbadoes, Jamaica, Peru, and Mexico, much at the same rate as it had done in Europe. Now these historical facts being inconsistent with the conjectures of these gentlemen, who would persuade us that this uncommon and most universal disease is produced by 102 EPIDEMIC OF 1775. the same constitution of the air^ as that which produces our common autumnal colds and coughs, if we believe the his- torians, we must necessarily conclude that this notion of the theorists is false. "Nor does this distemper seem to arise, which is, I think, at present, the more general opinion, from contagion. For in this city, in the year 1739, it was conjectured, that two thousand persons at least were seized with it in one night. But what is more extraordinary, before the beginning of Autumn, in the year 1557, it attacked all parts of Spain at once, so that the greatest part of the people in that kingdom were seized with it almost on the same day. This very singular circumstance is related by Mercatus, who says that it happened in his own time. "And after all the attempts that have been made to ascertain the causes of general Epidemical Diseases, not arising from the sensible qualities of the air, we seem to have as little real knowledge of them as the ancient Greek physicians had, who referred these distempers to something in the air, which is not the object of sense, but which, like the Supreme Cause of aU things, only manifests its existence and power to us by its effects. This something, therefore, though different, in dif- ferent epidemical constitutions, was not improperly called by Hippocrates to dtiov. "I have only to add, that in this part of the country, in the month of September, many horses and dogs were severely afflicted with colds and coughs. Which circumstance, it should seem, was not merely accidental; since it has been observed, that horses were infected before men, in three general epidemical constitutions that have happened in our time. And I am inclined to think, that the pestilence mentioned by Homer, which, within the space of nine days, spread itself over all the Grecian quarters, and a httle while after disappeared, was an Epidemic of the same kind ; because neither the true plague, nor any other epidemical disease, with whose history I am acquainted, has been known to make so rapid a progress, or to end so soon, as that pestilence did." DR. ASH'S LETTER. 103 8. DR. ASH. "Birmingham; Dec. 2, 1775. " The epidemic, of which we had accounts in the public papers from Londonj made its appearance in this place about the middle of November ; and no fresh subjects were attacked with it after the 7th or 8th of December. The period of it did not exceed a month ; there was no distinction of the sexes amongst grown persons ; those who were most in the air were, in general, least affected ; few children diseased. In the town many were suddenly seized, especially in the morning early, with universal rigours, and pains in the limbs and back part of the head, a roughness rather than soreness in the throat, great lassitude and dejection of spirits, great oppression on the prsecordia, and some few with pleuritic pains. Many complained of a nausea, and an inclination to vomit. The tongue was generally moist in the beginning, with a whiteness and sometimes a darker crust toward the back part of it. The skin was seldom hot or dry, and the general temperature of the habit moderate. The appetite, except in the subjects who complained of nausea, was not much affected, but the patients in general complained of a total loss of a distinction of taste of one kind of food from another. The cough was incessant, especially on lying down in bed. In no patient, whom I attended, any hardness or tension in the pulse ; and it never appeared necessary to take any blood away. In some few who had been blooded, on account of the haemorrhage from the nose, through the violence of the cough, the blood appeared florid, and of a tender texture; the urine was secreted generally in small quantities, and, of course, high-coloured ; the state of the bowels uncertain. Where a tendency to a diarrhoea came on, it generally removed the disease; and where a want of stools indicated an aperient in the beginning of the disease, it had, in general, the same happy effects. "An early attention to administer and repeat some mild cathartics, with diluting, cooling liquors and mild diaphoretics, soon brought on an easy expectoration, and removed all the other symptoms except the cough, which generally continued, 104 EPIDEMIC OF 1775. in some degree, ten or twelve days, but was mucli relieved by small doses of anodynes. The aged and diseased patients, especially asthmatics, suffered most, and to some few it proved fatal. In the progress of the disease, when not immediately relieved by the first intentions, many difficult and perplexing symptoms arose that were not easily removed, and often appeared alarming. Gentle and repeated purgatives were of the most certain use ; and, if not early administered, or neglected to be repeated, an obstinate costiveness sometimes came on, that was to be relieved only by clysters frequently repeated ; and, in one case, all efforts of that kind were ineffec- tual ; and although the heat was moderate the whole time, the disease proved fatal, and terminated in a mortification of the bowels. " In these aggravated symptoms of the disorder the nights were, in general, disquiet, the cough continued violent, although the expectoration was plentiful ; and the head was affected. Blisters were generally of good effect, and fomentations and sinapisms to the feet gave great relief. The disease was particularly troublesome to women in the latter part of their pregnancy. A healthy young woman, very near her time, was seized with this disease ; the symptoms were more violent than common ; but no assistance was called to her, on a sup- position that medicines were improper in her present situation ; after her delivery all assistance was in vain, and she died phrenetic on the fifth day. Her child was born, to aU appearance, in a healthful state, but was seized with convulsions the second day after its birth, and died the evening preceding the mother's death. I was called upon to attend two other women in the same situation, and directed for them the usual methods of treatment; they had both a happy delivery, and the cough and all other symptoms ceased soon after, except the dejection of spirits, with some shght palpitations of the heart, which soon gave way to fetid medicines. " The disease, in its decline, often assumed the form of an intermittent; and the Peruvian bark seemed immediately indicated, but it never had its wished-for or expected success : it seemed to aggravate the disease, and threatened to bring on a relapse, and was never of use except it acted as a brisk pur- gative on its being first given, which was often its immediate DR. W. WHITE'S ACCOUNT. 105 effect ; if not, it was highly prejudicial. Besides, the gentle and mild cathartics frequently repeated, with diluting liquors, mild diaphoretics, with small doses of emetic tartar in every form of medicine. Emetics were given with the greatest success, especially when the nausea immediately indicated them ; but if not immediately indicated, were, in general, found to abate the progress of the disease. "The different state of the blood in this place from what you found it in London, deserves our peculiar attention. In a workhouse in a neighbouring town, three died of the Epidemic, who were all blooded ; all the rest recovered who were not bled, but took the repeated purgatives only and the Decoctum Nitrosum." 9. DR. W. WHITE. "York; Dec. 22, 1775. "This epidemic disease seems to have appeared rather earlier with us than in London : it was observed before the end of October, became general in the beginning of November, at which time many whole families were indisposed. Not one dwelling house escaped. I was myself seized with it on the 2d of that month ; and in a very short time, it became the most universal disease that hath been remembered with us. It was much abated by the first week of December, and seems now to have entirely left us. " The attack was generally sadden, with a sense of severe coldness, especially in the back and lower extremities. This, in many, was attended with a giddiness ; in a few with nausea and abhorrence of food, generally uneasiness about the prse- cordia, great anxiety and weariness. The pulse small and contracted, from ten to twenty above the natural rate ; urine pale; body generally costive. Some had more or less sore- ness in the throat, and what is called a stuflflng in the head, and sneezing violently; all had a very bad tickhng cough, which soon caused stitches and soreness in the breast. " These symptoms, as they were more or less violent, were sooner or later followed by feverish heat, but seldom to any high degree ; remarkable soreness all over the body, and slight 106 EPIDEMIC OF 1775. pains in the head, limbs, loins, and breast. The urine, now seldom high-coloured, forming a cloud when cold ; a diarrhoea uncommon here, the contrary state common. Pulse in most one hundred in a minute, in several much quicker, seldom full or strong. Tongue whitish, but moist; little remarkable thirst ; a complaint of a bad taste in the mouth was general, and the breath offensive. " No regular crisis was observable ; the fever was of the re- mittent kind, and gradually subsided in general. All became much worse in the afternoon, and so continued till three or four o'clock the following morning, about which time a moderate sweating relieved the patient, who, after a few hours of quiet sleep, awoke much easier. The disease thus went on several days, without any intervening cold fit. For four days together my pulse was 90 (15 above the natural rate) in the morning; in the evening 115 : the same I observed in several others. " In all, the nervous system was much disordered ; various affections of the spasmodic kind occurred, and the anxiety, despondency, and restlessness were much more remarkable than the general mildness of the vascular irritation gave room to expect. " Regarding the prognosis : — A quick recovery followed such urine as quickly turned milky after making, soon after de- positing a copious sediment; it was always attended with moist skin, an abatement of the cough, the quickness of the pulse, and anxiety. Some had more considerable sweats; I saw no crisis by a spontaneous diarrhoea, nor any recovery without the urine above mentioned. " This epidemic was, with us in general, so mild, as seldom to engage the attention of a physician : yet it brought some aged asthmatics, and young people of a consumptive habit, into im- minent danger. Of such, a few died in this city, especially the former. "As to the curative part, it was seldom necessary here to take away blood : some were relieved by it, but, in general, it did hurt by depressing the patients. An ingenious apothecary, who, from his extensive practice, had a very great number of the 'sick under his care, informed me that this evacuation seemed to relieve some immediately, but that he never saw in any other disease so matiy bad symptoms follow bleeding as in DR. W. WHITE'S ACCOUNT. 107 this epidemic. Gentle cooling purgatives were universally- beneficial in abating the anxiety and raising the spirits. Emetics were seldom indicated ; nor were blisters often re- quired, but were useful in abating the cough and stitches. " The disease was seldom so violent as to call for antimonials; but when used, as I did in several cases, they never failed in their febrifuge effects. I never gave an anodyne until the pulse was considerably reduced, to about 80, then they had every desirable effect ; when given without this rule they often disagreed with the patient, acting as a stimulant. " The appearance of the urine above mentioned, which was always attended with other signs of an apyrexia, was my rule for giving the cortex ; and it never failed in quickly restoring the patient. Without its assistance several continued for some time in a weak and irritable condition, so as to alarm their friends with the apprehension of a consumption. I was called to one patient who had been a month in this situation, weak, languid, dispirited, and worn out with a violent cough and want of sleep ; his urine was as above described : the cortex and an anodyne at night, with riding upon horseback, soon cured him. " But, in general, a few days' confinement, abstinence from flesh meat, and frequent sippings of some tepid pectoral drink, sufficed for the cure. But it was universally found necessary to allow a nutritious diet ; and such as had been accustomed to liquors of the more stimulating kind became worse if de- barred their use ; the anxiety, inquietude, and other nervous affections being increased by such procedure. "Although I kept a journal of weather, I think it unnecessary to relate it ; it agrees pretty much with Dr. Fothergill's account. I shall just observe, that the epidemic was probably checked here by a sudden severe frost and snow. The thermometer, which had been for some time between 40 and 50, fell in one night's time to 22, and continued for some days below the freezing point. It is one of Fahrenheit's, and hangs in a garden behind my house, having an open exposure to the south-west. " The above account of the epidemic, as it appeared at York, may be depended upon for its exactness, being the result of my own and the joint observations of the faculty here, and it will give me pleasure to find it acceptable to Dr. FothergUl." 108 EPIDEMIC OF 1775. 10. DR. HAYGARTH, OF CHESTER. " The epidemical catarrh of 1775 seized, in general, the inhabitants of Chester about the middle of November. From the 15th till the 25th of that month the distemper spread most universally; yet very few were attacked so late as December. Indeed I saw one case on the 2nd of November, of a lady who had suffered manifest symptoms of this epidemic six days before; but I heard of no other instance of its appearing here so early, and the disorder did not become general till near a fortnight later. This epidemic pervaded all North Wales within three or five days after its general seizure of the inhabitants in Chester ; that is, on the 18th or 20th of November, as I have had authentic information from every town and every con- siderable village, and their neighbourhood. I was curious to know how those were affected who were most secluded from the intercourse of society; an intelligent practitioner informs me that in Llyn, the most western and remote corner of Carnar- vonshire, this epidemic began about the 20th of November, was general through every part of this peninsula, and affected all classes of people; that one in a family now and then escaped it, but that he knew no family, however small, among whom it did not make its appearance. My medical correspondents mention that some cases ocurred in one part of Wales so early as October the 27th, and in another the beginning of November. In the western part of Cheshire, and that part of Shropshire which borders on Cheshire, I observed that this disease began soon after the middle of November. However, I am certain that in some Cheshire villages the epidemic had not appeared till more than ten days later, though it afterwards visited these places. These facts, compared with the general seizure, make the theory of this epidemic very difficult. On the whole, I believe people in the country were attacked rather later than in the towns they surrounded, less severely, and less generally; however, not only the inhabitants of villages, but of solitary houses, were seized with this disease. I could not discover that high or low, dry or moist situations, the neighbourhood of mountains, or of the sea, or any other particular exposure, rendered the epidemic either later or milder; though I made very circumstantial inquiries to ascertain these facts. DR. HAYGARTH'S ACCOUNT. 109 " la this epidemic at Chester, the catarrhal and feverish symptoms were most general j yet I saw a few cases of fever without coughj and more of cough without fever. The catar- rhal symptoms were a frequent cough, which generally brought up pellucid phlegm, and in old people a plentiful yellow dis- charge : but in some cases was dry, hard, and violent ; a copious watery defluxion from the eyes and nose, frequent sneezing, hoarseness, and sore throat. The feverish symptoms commenced sometimes before and sometimes after the cough, and began with chilly and hot fits, irregular and alternate, followed by lassitude, inquietude, uncommon loss of strength and spirits, want of sleep and appetite, giddiness, acute pain in the head, chest, or a particular point of the belly, all in- creased by coughing ; also an aching pain in the head, back, hips, and limbs. The pulse was seldom very full or strong, except in peripneumonic cases ; the skin had often no unusual heat, the tongue was generally white and moist, sometimes yellowish and furred; the urine appeared variously, but was commonly high-coloured during the fever. Unless an inflam- mation attacked the lungs, which was a frequent and dangerous termination of the disease, the fever usually ceased in a few days. The cough continued longer, and was of more uncertain duration. The preceding symptoms were by far the most universal, and exhibit the regular appearance of the disease. "The most common anomalous complaint was a diarrhoea, with blackish stools : sickness and vomiting occurred less fre- quently. I saw five patients who had fallen down in a swoon, preceded by a violent headache ; three of these were young women, who had the other symptoms very mildly ; the fourth was a gentleman of an athletic habit, who was never confined by the disease ; and the fifth was a married lady, who, without a preceding cough, had a very violent looseness, succeeded by a phrenitic delirium, and then by a very urgent cough j the looseness, delirium, and cough succeeded alternately to each other twice over in a regular manner, but never existed to- gether; at last a red, rough itching rash covered the whole body, after which no symptom but the cough remained. In a young girl, a smooth redness of the skin covered a great part of her body, exactly like the appearance in scarlet fevers. One case differed entirely from the usual inflammatory type of 110 EPIDEMIC OF 1775. the disease. A young lady at a boarding-school was seized at the same time, and with like symptoms, as twenty-six of her school-fellows. Two days after her first indisposition, a diar- rhoea, with black stools, began, and continued above three weeks, attended with a putrid fever, black dry tongue, fauces, and lips ; sordid teeth, total deafness, and an idiotic delirium ; yet she recovered. Her mother and two other attendants were infected by this fever, in which their heads were principally affected with violent pain and a wild delirium : the fever was fatal to one of the attendants, who died phrenitic. The proof of infection, in this putrid fever, was most evident ; but I saw no instance of the epidemical catarrh that appeared to be communicated by infection. A very large proportion of the inhabitants of Chester were seized with this epidemic ; but, as far as may be concluded from one observation, it appears that there were fewer in the higher than in the lower ranks of society. In the Abbey Square, inhabited by persons who live in ease and affluence, only 73 were attacked out of 97 neigh- bours ; that is, scarcely more than 3 in 4 : at the Cross, in- habited by people in trade that compose the middle rank, 109 had the disease out of 114; that is, nearly 18 in 19: whereas in the House of Industry not one person escaped the disorder out of 175. Other diseases did not preclude this : I saw it accompany measles, consumption, mortification, gout, scurvy, dropsy, jaundice, &c. It attacked many who were confined to their houses, and even to their beds, with other ailments. Young children in general recovered soonest, and had fewest violent complaints; however, I was informed by a person of skin, that he saw one child of two, and another of three, months old, with evident symptoms of this distemper. It was most fatal to the aged, the asthmatic, and those who were de- bilitated by other disorders. "A slight degree of the disease soon went off without con- finement, any particular diet, or medicines; but many aggra- vated both the fever and cough by exposing themselves to cold. With a large number the symptoms were so violent as to confine them to the house, and even to bed. In these cases plenty of cooling and diluting liquids, drank warm, by en- couraging sweats which came on spontaneously, seemed greatly to abate the fever. When the cough was very violent, during DR. R. PULTENEY'S ACCOUNT. Ill or after the fever, bleeding in general manifestly alleviated it, though the blood had seldom a thick sizy crust, and often none at all. In one case, even at so advanced an age as seventy-five, the breathing was so laborious, from a suppression of the cough, and the relief from bleeding was so manifest, and so immediate, that it convinced both my patient and myself that this remedy snatched her out of the very jaws of death. In some cases, antimonials manifestly abated both the fever and cough; in some, blisters were of service ; in general, cooling purgatives and other antiphlogistic remedies and regimen, which it is un- necessary to specify, had a salutary effect. "At Chester, the spring of 1775 (March, April, May, and beginning of June) was remarkably dry, and the three last of these months unusually warm ; on April the 28th, at two p.m., the thermometer was 72° in the shade. July, August, and September, were wet and warm. On the 19th and 20th of October, for forty-eight hours, was a storm of wind from the west, attended with rain. The storm was remarkable both for violence and duration, which wrecked many ships on our coast. The newspapers did not show that it extended to any great distance ; but different storms are mentioned to have happened at different times : their history connected with that of the catarrh may illustrate the question, whether epidemics have any dependance on storms. During November the wind was generally from the east : the air was hazy for an unusual number of days in this month. About August and September, in North Wales, almost all the horses were seized with coughs." 11. DR. R. PULTENEY. " Blandford, Dorsetshire ; Dec. 18, 1775. " This disorder was heard of earlier here than at London. Some were so teased with the cough, as to be obliged to get out of bed and sit by the fire in the night-time : by this method they gained a truce, and thought themselves much relieved. Nothing relieved the patients so much as bleeding. I have not remarked for several years past the same general necessity for bleeding, or the same good efl'ects from it. In several instances I repeated it to the third time, and did not think I ever had reason to repent of it. 11'-' EPIDEMIC OF 1775. " It seems to me that it was by no means so universally felt with us as in Town; and I do not know of one person that died of it. " I heard much of horses and dogs having been affected, before we heard of it among the human race." 12. DR. WILLIAM THOMPSON, OF WORCESTER. "Dec. 20, 1775. " This distemper became general here about the middle of November, and spread gradually in the country around. " In some the head was aflFected to a degree of stupor and delirium, which were relieved as soon as the chest was affected. "A diarrhoea frequently happened, and always moderated the other symptoms. "In most cases where the symptoms were violent, bleeding was necessary, even to the third time ; nor did I observe any inconvenience from it. " The fatal consequences of the disorder to old asthmatic people were frequent hereabouts. " People in general recovered slowly, and, for a good while, suffered great weakness and dejection." 13. G. SKENE, OF ABERDEEN. " It began here near the end of November, and continued for four or five weeks ; the second and third week it was very general. It went regularly northward, but was not universal to the north of this city. It did not visit Fraserburgh, though there was a putrid fever there very fatal at that time. "The disease never assumed the type of an intermittent here • but it is to be observed, that the intermittent fever is not known in Aberdeen. We never see a regular intermittent, except the patients bring it from other climates immediately, or have been great sufferers by it formerly in other countries ; and our fevers very rarely assume that form in their decline." DE. C. J. FLEURY'S ACCOUNT. 113 14. DR. D. CAMPBELL, OF LANCASTER. "Feb. 18, 1776. " When the disorder became so universal here, I think its nature, as a contagious complaint, might (besides its running so generally through whole families) be fairly proved by its pro- gress from London to the North. Every account showed the prevalence of this epidemic in London, for near three weeks before it extended to Lancaster. Even when almost every person at Liverpool was attacked by it, I scarcely remember to have heard, upon the most diligent inquiry, that a greater number of persons were affected with catarrhous symptoms than usual. But I think in about three days after we had been informed of the frequency of the complaint at Liverpool, there was scarcely a family in this town but had one or more persons seized. About this time, I remember to have seen a gentleman from Kirkby Lonsdale, which lies about fourteen miles hence in a north-east direction, who informed me, not a person he then knew of was, at that time, affected there ; but the next week he informed me it was then equally universal as with us ; at the same time he told me, that Kirkby Steven (which lies about the same distance from Kirkby Lonsdale in a similar direction) had yet escaped. In a few days, however, I understood the complaint was equally general there. "These complaints, which in a manner disappeared on the setting in of the frost in the beginning of January, have, since the thaw, which took place the 1st of February, again become rife, though not with the same frequency and violence as in December." 15. DR. C. J. FLEURY.^ " Of the weather I shall only say, that it was, for the season, extremely close, warm, and moist; accordingly, this epidemic cold (which made its appearance here about the middle of last October) was less of an inflammatory nature, and affected the nervous system more sensibly than any I ever remember ; that of May, 1762, was the first which occurred since I began the practice of physic in this city. ' Observations on the Epidemic Cold of 1775. By J. C. Fleury, M.D. Read before the Dublin Medico-Philosophical Society, February 1776. (Dublin Quarterly Medical Journal, February 1848.) 8 114 EPIDEMIC OF 1775. " Exclusive of the common feverish symptoms a great and sudden languor, dejection of spirits, and prostration of strength, was evident in most of the sick ; many complained of a trouble- some pain between the shoulders, a very uneasy sensation of heat from the top of the larynx down through the whole chest; a hard, dry, and frequent cough, in the night-time especially, was a very common symptom; a short, quick, and laborious breathing ; a small, quick pulse, of a deceitful, wiry hardness ; the last two symptoms occurred chiefly in those who were sub- ject to asthma or winter coughs. In most families the servants and children were first attacked ; in the latter the cough was almost incessant. " This epidemic cold set in at the tail, I may say, of a bilious fever, which had been prevalent here during the autumnal season; accordingly the inflammatory stage was, as from this combination and the state of the air might well be expected, but short, and soon yielded to moderate antiphlogistic treat- ment ; indeed the great point on which the cure seemed prin- cipally to turn, was to carry the bilious saburra down through the great cloaca, without debilitating or irritating the nervous system. This eased the breathing, lessened the fever, and relieved the cough. Plentiful dilution too, and saline draughts, with Elix-paragoricum, appeared to me to be amongst the best pectorals. In a city such as this, where the situation, as well as the manner of life of its inhabitants, often diff'er widely, and where the apothecary is so generally applied to in the first instance, no method can be laid down for the cure of any disease from which it will not at times be proper to deviate ; I may venture, however, I think, to affirm that this epidemic did not require repeated bleeding; numbers recovered, and recovered speedily, who were not bled at all, and those who had been much evacuated that way were evidently the worse of it. Long abstinence from generous diet was injurious to some; their cough increased thereby, and their nights were rendered worse. Emetics, I think, in general, were not indicated. "On the 8th of September, 1776, the following communica- tion was made to the Dublin Medico-Philosophical Society, by DR. DANIEL RAINEY. "Remarks upon the Treatment of the Epidemic Cold of 1775. — This trifle having been mislaid for several months, I thought DR. RAINEY'S ACCOUNT. 115 it might prove of some use, and therefore give it to the Society in its present imperfect dress. Whilst the epidemic cold of last year affected such a number of the inhabitants of this city, it is not to be wondered at that it found its way into the House of Industry, — an institution foimded for the suppression of beggars and sturdy vagabonds, situated to the north-west of the city, in an elevated situation, with nothing but gardens and orchards in its rear. At this time the house contained about 367 paupers, of different ages, from 13 to 90, of different constitutions and temperaments, as may well be supposed among such a collection of people. " Above 200 of these were attacked with the prevailing dis- order, and as it manifested in general no violent symptoms among the inhabitants at large, except that several of the lower classes fell victims to their own folly in endeavouring to procure relief by making use of heated, spirituous and malt liquors, I was determined to seize such a favourable opportunity of acting the part of a mere spectator of the operation of nature; as I could act unrestrained by vulgar prejudices, where the patients had no idea that the physician did nothing for them if he did not drench their stomachs with nauseous medicines, I believe too often the case in general practice. And to my entire satis- faction, I found that warm, diluting, sub-acid drink, nothing more than scalded buttermilk, and confinement to bed, brought the whole number through the complaint, without either the aid of medicine or even the lancet, and yet not one fell a sacrifice. In the Infirmary, which is set apart from the other buildings, in which was contained above 51 patients, medical and surgical, with several under a course of mercury, not one was affected, owing, as I at first supposed, to their living in smaller apart- ments, well warmed, and being unable to go about in the open air ; but even this exemption could not be relied on as the cause of their escaping, when I observed that several, occupied in the necessary business of the house, and through the whole day exposed to the action of the air, yet never were attccked with any of the symptoms. Nay, so healthy in other respects were the poor at this period, that the governors bore testimony in the public papers, that fewer died during the prevalence of this disorder than during the same space of time since the opening of the house. Some had it so very slightly, nothing more than 116 EPIDEMIC OF 1775. a sort of languor, with a trifling, tickling cougli, that it was scarce necessary to confine them ; others more severely, as with lassitude, and, as they called it, pain through their bones, very severe cough, headach, and running from the eyes. Those who were subject to the tussis senilis did not appear to suffer more than any of the rest. " The following table is extracted from the ' Meteorological Journal of the Koyal Society.' 1774. Tliermometer without. Thermometer within. Baiometer. ^t Least Mean Mean 1 Mean ■|1, ' Least heiglit. height A.M. height P.M. wnoie day. Jl height. height. |2 height. height. January . 50-5 240 300 37-7 35-3 50'5 27-0 37-4 30'175 28-79 29-57 February . 52-0 24-5 37-6 43'5 40'5 500 ! 33-0 42-4 30-46 29-16 29-806 March . . 60-0 33-5 396 50-5 450 61-5 , 38-0 47-4 30-33 29-14 29-82 April . . . 67-0 36-5 44-9 54-8 49-8 60-0 45-0 51-3 30-24 29-33 29-786 May . . . 690 45-0 49-7 59-9 1 54-8 61-5 i 51-0 55'9 30-175 29-34 29-871 June . . . 77-5 52'0 591 68-4 1 63-7 710 , 59-0 64-6 30-34 29-47 29-90 July . . . 83-5 55-5 59-7 701 64-9 73'5 ' 60-0 65-9 30-36 29-61 30-00 August . . 78-0 73-0 58-2 69'2 63-7 73-0 52-5 65-6 30-32 29-38 29-954 September 73-0 42-5 52-6 621 57-3 69-5 49-5 59-7 30-28 29-11 j 29-795 October . 64-5 360 46-0 56-3 511 61-0 45-5 53-6 30-57 29-47 30-13 November 58-5 41-0 39-2 43-5 41-3 56-0 34-5 43-7 30-225 29-17 29-807 December 53-5 25-0 37-3 40'8 39-7 49-0 30-5 40'8 30-71 29-11 30-09 The quantity of rain in the whole year was 26-328 in., or about 26J inches. 1775. January 54-0 25-5 February 55-0 35-0 Thermometer without. Thermometer within. Least Mean height.' height. March .... April .... May June July August . . . September . . October . . , November . . December . . 1776. January . . . February . . Whole year, beginning with March 1775 58-0 83-5 74-5 81-5 82-0 75-5 75-0 66-0 57-0 58-0 44-5 49-5 28-5 36-5 430 52-0 58-0 52-5 47-0 32-0 28-0 27-0 13-5 14-5 42-7 44-5 43-9 52-8 57-8 66-3 66-1 64-3 61-1 50-5 42-5 41-2 29-3 42-6 52-0 52-5 53-0 69-0 67-5 73-5 74-0 70-5 68-5 68-0 53-0 56-0 Least height. 30-5 41-5 Mean height. 43-5 45-7 37-0 40-0 500 600 61-5 58-0 56-0 41-5 37-0 34-0 46-1 52-7 58-5 67-3 67-3 64-8 62-6 52-4 43-7 430 Barometer. 30-38 30-48 43-5 20-5 1 31-8 46-0 19-0 42-4 51-5 52-7 30-61 30-36 30-43 30-30 30-18 3007 30-15 30-26 30-36 30-57 30-14 29-97 Least height. 29-30 28-89 Mean height. 29-84 29-24 2907 29-50 29-68 29-61 29-59 29-50 29-51 29-16 29-16 28-60 29-21 28-84 29-67 30-026 30-12 29-91 29-88 29-86 29-756 29-86 29-76 30-06 29-687 20-408 29-833 DE. GRAY'S account: ^ 117 THE EPIDEMIC CATARRH OF 1782. EDWARD GRAY, M.D. F.R.S,^ " In the account of an epidemic disease, it may be expected that it should be compared with those of the same species, which have abeady been described ; and that their analogies and distinctions should be pointed out ; but the great number of them upon record is, it is presumed, a sufficient excuse for the omission of such an investigation; especially when it is con- sidered, that it wUl be in the power of any person, by comparing the description of the late epidemic with that of any former one, to find -wherein those analogies and distinctions consist. They who may be inclined to do so will find a very ample cata- logue of them, ranged in chronological order, in Dr. Cullen's ' Synopsis Nosologiae Methodicse/ under the article " Catarrhus a Contagio," to which species the late influenza belongs ; and when the various forms, which in different persons and places it put on, are taken into consideration, it will, no doubt, be found, that some of them were the same as some of those in which it formerly appeared; but, when the more general character of it be considered, it will probably appear to have differed, in some respects, from all the former disorders of the same species ; and with regard to the number of persons affected by it, and the great space of the earth over which it spread its influence, to have been equalled by few of them, perhaps ex- ' Medical Communications, vol. i, p. 1. London, 1784. An Account of the Epi- demic Catarrh of the Year 1782 ; compiled at the request of a Society for promoting Medical Knowledge. By Edward Gray, M.D. F.R.S. " The compiler of the following account, thinks it an acknowledgment due to the gentlemen who favoured the Society with letters on the late epidemic catarrh, to observe, that though many of them would have done honour to the present publica- tion, had they been inserted at full length, yet, when it is considered that great part of their contents were necessarily similar, and that the repetition, which would have been the consequence of that method of publishing them, would have considerably enlarged the account of the disorder, it is hoped the authors of them will excuse the liberty that has been taken to omit, in general, whatever was not immediately con- nected with the disease, and to select and transcribe that which served to establish or elucidate particular facts or opinions, and, consequently, to render its history more complete ; for the same reason he has not thought it necessary to produce authorities for those parts of the account, which, by being conformable to general observation, seemed to him not to require them." 118 ^ EPIDEMIC OF 1782. ceeded by none.^ In particular places, indeed, some of the former epidemics may have been more general ; in one place that of 1775 was thought to have been so,' but upon the whole there will perhaps be found no reason to alter the above opinion. " Very little authentic information has been procured, re- specting the history of the disorder, before the time of its appearance in London ; all that can upon good authority be related, is, that it prevailed at Moscow, in the months of December 1781 and January 1782, and at St. Petersburgh in February 1782; it was traced, from Tobolski, to which place it was supposed to have been brought .from China. " In confirmation of this opinion it may be observed, that several accounts from different parts of the East Indies, mention that a disorder, similar in its symptoms, prevailed in those parts in the months of October and November 1781. It was in Denmark, the latter end of April, or the beginning of May; and many people were said to have died of it at Copenhagen, before the 11th of May. It is not easy to determine with pre- cision the time of its first appearance in London ; that it was here the second week in May, seems very certain ; and though it was thought by some to have been here long before that time,^ the more general opinion is, that the cases then ob- served did not belong to the disorder in question. But what- ever difference of sentiment there may be respecting the time of its arrival in this metropolis, the fourth week in May is very weU known to have been the period of its most universal pre- valence here, which circumstance may surely be considered as a strong argument that the cases observed so early as March, 1 " ' 'With regard to the number affected, it was the most universal disease ever remembered.' — Dr. Anderson, AInvrich. " 'No disease was ever more general.'— Dr. Murray, Norwich. " ' I believe no disease was ever known to be more general.' — Dr. Kirkland, Ashby." = " ' The inhabitants of Dumfries, and the environs, were pretty generally affected by the disorder, yet, I think, not so generally as by the catarrhal fever of 1775.'— Dr. Gilchrist, Dumfries." " " ' Such was the epidemic constitution in the month of March 1782, when the febris epidemica catarrhalis first appeared; and by the middle of April it was spread all over London and its Environs.' — Observations on the late Influenza, by Dr. Grant, p. 18." DR. GEAY'S ACCOUNT. 119 or eveu April, were common catarrhs ; for it seems very im- probable that a disorder, which iu every other place reached its highest pitch of general prevalence in a week or two after its appearance, should in London be two months before it arrived at that period. "According to the accounts received from the different parts of England, it seems that in most of them the influenza did not begin to appear until after its prevalence in London, as in every letter, except two,^ its appearance is dated either from the latter end of May or the beginning of June. In Scotland and in Ireland it seems to have been rather later. It prevailed in France in the months of June and July; in Italy, in July and August; and in Portugal and Spain, in August and Sep- tember. It is said that it was afterwards observed in America; but no authentic information on that head having been obtained, it is mentioned only as common report. " It must here be remarked, that a complaint, similar to the influenza, was taken notice of in some parts of the kingdom several months before that disorder made its progress through it, Mr. Mortimer, surgeon to the North Devonshire regiment of militia, was seized on the 24th of March, at Great Torrington, with a disorder, the symptoms of which were perfectly similar to those of the influenza; after him his family had it, and it then became general in that town. It did not extend to the neighbouring villages, nor could Mr. Mortimer, upon enquiry, find that any such disorder had been observed at any other place in that part of England. At Barnstaple, which is only twelve miles from Torrington, the influenza was common in the beginning of June, when it went through that part of Devon- shire; but the inhabitants of Torrington were not then afl'ected by it.^ This last circumstance seems to show, that the disorder observed in March was of the same species with the influenza ; but admitting it to have been so, it is very extraordinary that ' " ' The late epidemic disease made its appearance in this part of Yorkshire about the beginning of May, but in Thirsk and Northallerton it began some days sooner.' — Dr. Bisset, Knayton. " ' The time that I can name with most certainty of its coming to Greenwich, is the first week in May ; and I think the first patient I saw ill of it was at Deptford, on the first of that month.' — Dr. Leith, Greenwich." ' " These facts, and those mentioned at p. 144, were communicated by Mr. Mortimer to Dr. Blagden, and by him to Dr. Gray." 120 EPIDEHilC OF 1782. its activity should, at that time, have been confined to so small a space. " The fourth week in May was (as is before mentioned) the period at which the disease prevailed most generally in London. From that time it began to decHne, and in the space of two or three weeks ceased to exist as a general disorder. It did not, however, leave the city till the month of September. A family from Portugal landed at Harwich in the beginning of that month, and came directly to London ; the day after their arrival there, the lady, two children, and two maid servants, were seized with evident and unquestionable symptoms of the influenza. No certain instance of it in London, after that time, can be adduced. " In most parts of England it does not appear to have re- mained so long,- but in several places it is said to have con- tinued tUl the month of August,^ and in some tiU the month of September.'^ In the ' London Medical Journal' it is related, that ' the Convert and Lizard ships-of-war, upon their arrival at Gravesend, from the West Indies, in the beginning of September, had three Custom-house officers put on board them, and in a few hours after, the crews of both ships, till then in good health, were seized with symptoms of the influenza; hardly a man in either ship escaped, and some had it very severely.'^ " It does not appear that any attempt was made to ascertain the proportional numbers of persons afl'ected by this disorder. In different places that number was very different, and in some it seems to have been very great.* " Most of the accounts received from the various parts of the ' " ' In the second week in Augnst it began to disappear.' — Dr. Scott, Stam- fordham. " ' It continued tUl the month of August.' — Dr. Kirkland, Ashby. " ' This disorder is still (August 26) in this country.'— Dr. Paterson, Margam." 2 " ' The disorder continued till September, when it gradually disappeared.' — Dr. Scott, Isle of Man." ■> " This circumstance was communicated to Dr. Simmons by Captain Harvey, of the Convert, who at the time he mentioned it (the third week in September) was not quite recovered from the disease." * " ' Hardly one escaped, old or young.' — Mr. Jacob, Feversham. " ' Scarce a family in the town or neighbourhood free.'— Dr. Anderson, Alnwick. " ' Scarcely one adult in a hundred, under fifty years, escaped. About a seventh part of old persons and children escaped.' — Dr. Bissett, Knayton. " ' It was so universal that it may rather be said to have ceased for want of sub- DR. GRAY'S ACCOUNT. 121 kingdom, say only, that it was very general, &c. At Dover Castle, 390 privates of the 59th regiment; and at Dublin, upwards of 700 of the 36th and 77th regiments of foot, were ill of it at the same time. " At London it was also veiy general ; and though a want of proper observation on that head renders it impossible to deter- mine the proportion of persons affected by the disease, it may be safely asserted, that the number of those attacked by it was much greater than that of those who escaped it. With respect to sex, there seemed little or no difference j though in some places it was thought, that the number of men aflFected by it was greater than that of women.' " Dr. Simmons observed, that of ninety-six patients who were admitted under his care at the Westminster Dispensary, on account of the influenza, fifty were females, and forty-six males. But though, upon the whole, it seemed to show no distinction worth remarking, with regard to sex, this was far from being the case with regard to age. Old persons were certainly less subject to the disorder than those of a middle age ; but when attacked, they generally had it very violently.^ jects, than to have lost the power of exerting its deleterious effects.' — Dr. Ruston, Exeter. " ' It prevailed almost universally among the inhabitants of this town ; very few families remained totally free from it, hut some few escaped it entirely. More than 930 persons affected with it applied to the dispensary in the course of three weeks.' — Dr. Houlston, Liverpool. " ' Whole families were affected with it at the same time, so that none remained well to nurse the sick ; and it was extremely difficult to get any assistance, as none remained free from the disease.' — Dr. Binns, Liverpool. " 'Very general, particularly among the soldiers quartered here. In the infirmary, few or none of the patients escaped.' — Dr. Livingston, Aberdeen. " ' At St. Albans, out of three companies quartered in that town, scarcely a single man was fit to do duty ; the officers suffered in like proportion, for only one escaped the complaint.' — Description of the Influenza, by Dr. Hamilton, p. 9." 1 « Latreille, Hist. Nat., xi, 194. ' Observations on tlie influenza as it appeared at Plymouth, in the summer and autumn of the year 1788, by Mr. Vaughan May. (Medical Commentaries for the year X789, vol. xiv.) ' Memoirs of the Life and M'^ritings of J. Coakley Lettsom. By Thomas Joseph Pfittigrew. Vol. iii, pp. 234 ; 1817. 200 EPIDEMIC OF 1789-90. lent as that in the fall. The symptoms^ however, were ex- tremely different, as far at least as they have fallen under my own observation. lu the latter the affection was almost entirely confined to the Schneiderian membrane, insomuch that though the same disease has undoubtedly frequently made its appear- ance in this country before, .yet from its assuming the form of a catarrhal fever, it has never been noticed under any other denomination. In the former this membrane was seldom dis- eased. The attack was for the most part sudden and violent generally, without any cough at this period, without coryza, and without those pungent pains (so remarkable in the in- fluenza), about the frontal sinuses. I do not recollect seeing a single instance of stricture in the antrum highmorianum which in many cases attended the sick in the fall. The predominant complaint at the seizure lyas violent pain in the back and limbs, sometimes with headache, often without, and rarely pre- ceded by very severe rigor. The pulse frequent, seldom very full, sometimes however hard, and attended with peripneu- monic affection ; the tongue oftener dry than in the epidemic of the fall; but, like that, covered with but little saburra. " In this stage an emetic generallj'' removed all the com- plaint in thirty-six or forty-eight hours, except the debility. This was attended with loss of appetite, and frequently con- tinued for several days afterwards. Small doses of emetic tartar, combined with an opiate preparation, were sometimes necessary to determine to the skin, promote expeetoration and relieve a slight cough, with which some were afflicted. Those who did not take the emetic in the beginning were not so completely relieved by it afterwards, and the cure was often protracted to the term of two or three weeks. In no disease do I recollect ever to have met with such immediate and sen- sible success from medicines of this class, as in that which I am describing; and this I may remark was by no means in pro- portion to the quantity of matter evacuated from the stomach, for the relief was as complete when nothing was discharged, but the substances just taken down, as when large quantities of biles were ejected. The efficacy of the emetic seems to have depended upon the relaxation of the cutaneous vessels consequent on the nausea which it excited, and upon the force of re-action in the act of vomiting, produced by the contraction of the diaphragm and of the abdominal muscles. The facility DR. WARREN'S LETTER. 201 with which the severe pain in the breast, and the stitches in the side, experienced by some, yielded to this remedy, seems to confirm the hypothesis that they were doubtless spasmodic, and to remove the spasm was the evident indication. " I must, however, remark that the sweats with which this disease terminated were by no means so profuse as in the autumnal epidemic ; they were rather a moderate and universal diaphoresis ; children under eight years of age commonly escaped it as they did also that of the fall. Few adults were exempt from its ravages, and I cannot find that the aged were less subject to it than others ; most who died were of the latter class, yet the bills of mortality were remarkably enlarged in all ages at the epidemic period. It began about the middle of last month in this town, and spread as imiversally through the country as through the metropolis, and that with such asto- nishing rapidity that it was scarcely possible to notice any circumstances that might lead to the ascertaining the degree of its contagion. It is now about three weeks since it ceased in the capital, and we have not yet obtained any accurate histories of its progress in the country. The first appearance of it is said to have been earlier than here, pretty high up upon the Hudson River ; thence it is said to have proceeded down Con- necticut River, and to have bent its course hither, after which we heard of it at Portsmouth, sixty miles eastward, before it appeared at Salem, which is forty miles on this side the capital of New Hampshire. At New York, as far as I can learn, its appearance was somewhat later than here, and our beloved President Washington is but now on the recovery from a very severe and dangerous attack of it in that city. From all accounts I have been able to collect, bleeding was sometimes but seldom had recourse to; blistering, very commonly and almost always with success, especially in cases where the disease assumed the form, as it was often observed to do, of a rheumatic affection. Whether this is a variety of influenza, or a new disease with us, I am at a loss to determine. Tne first stage of it appears very dissimilar from it, but the last approaches nearer to a likeness. I have not met with any account of it under this form, and can scarcely believe that the difference of season is sufiicient to explain the variation of symptoms, nor so far as I can learn, are there any instances recorded of its return in Europe, at so short an interval as that of the instance 202 EPIDEMIC OF 1803. in question. The periods of 1510^ — 57, 80, 87, and 91 : 1709, — 32 and 33 : 1743, — 63, 67, 75 and 82 are much more distant. The summer, preceding the fall disease, was re- markably hot. Mean height of the thermometer, September, 75° ; October, 63°; in Pennylvania ; which is 10 degrees higher than usual. The last winter was uncommonly mild and rainy. The diseases of that season numerous, both synocha and typhus. I could wish to know whether any such disease has appeared with you, and at what period ? Yoiu- opinion whether it may be considered as a variety of influenza would greatly oblige me. " I am. Sir, " With great respect and esteem, " Your obliged friend, and most obedient servant, "John Warren." EPIDEMIC OF 1803. [The influenza of 1803 prevailed in France, especially in Paris, and in some of the northern departments of the Jlepublic, and in Holland long before it was experienced in England. It seems to have been first observed in London early in January, and to have occupied nearly three months in its diffusion over the kingdom, advancing northwards before it raged to any con- siderable extent in the west of England, but to this statement there are some remarkable exceptions. For example, it appeared in Taunton as early as the 15th of January, and did not reach Chester till the 30th of that month. The adjoining table gives an idea of its course, as deduced from the statements of ob- servers in the different districts specified, and renders it obvious that the disorder did not proceed by orderly and successive steps, but rather alighted at various and distant points with seeming capriciousness. It reached Portsea, Hull, and East Retford, nearly on the same day; but it existed at Doncaster two weeks, and at Newark three weeks earlier, although these places were respectively only eighteen and twenty miles distant from Retford. Six or seven months elapsed betweep the time of its first appear- ance in the country and its cessation; and, as a general rule, although the duration of its virulence might not materially vary, yet it was longest in disappearing at the places where it was first harboured. VARIOUS AUTHORS. 203 It was pretty generally observed, that the disease prevailed in cities before it appeared in the neighbouring villages.] "I remember," says Dr. Callaman of Cork, "our being free from it in town by the time it had reached the remote parts of the country, even the difference of a week, at a distance of less than twelve miles, where the communication with town was not so frequent as in the late epidemic, when the playhouse and assizes brought town and country more in contact."^ Prom Bridgewater, at which place influenza prevailed in the month of February, writes Mr. Symes on the 9th of April, 1803, "There are many places in this neighbourhood, with which the inhabitants have no intercourse, where the influenza has not made its appearance."^ " The epidemic appeared at Manchester at an earlier date than in the neighbouring towns. An interval of about ten days elapsed from its spread here to the time of its reaching Bolton, and some other populous places situated at about twelve miles distance. It seemed to diverge from Manchester, as from a centre, to the surrounding country, but certainly appeared in the more crowded and populous towns, placed at the extremi- ties of the circle, than in the intermediate space, which contains a thinner and more scattered population. This may be ex- plained from the greater intercourse subsisting between the larger manufacturing towns and Manchester ; and likewise from the consideration, that in towns where the inhabitants are crowded together, the propagation of contagion is much more favoured than in the less populous country villages and de- tached dwellings.'^ ^ The same circumstance was noticed in many other places, of which Shrewsbury, Rochester, and Ashbourne, may be specially mentioned. It is, however, fair to give the opinion expressed by Dr. Woodforde, although not in harmony with the statements of other observers: "The disease must naturally attract attention, first in the metropolis and other cities, from their corresponding population and greater number of the sick. This circumstance seems to have given rise to a precipitate conclusion, that these were the places first attacked, and that from these it was diffused progressively through all the others. I Medical and Physical Journal, vol. x, p. 524. » Idem, p. 228. ^ Dr. Bardsley, Medical and Physical Journal, vol. a, p. 211. 204 EPIDEMIC OF 1803. Whereas, it is more probable, that the disease broke out in all these places at or nearly the same time."^ The following table represents as nearly as can be ascer- tained the progress of the epidemic throughout the country. Places. Commencement. Height. Disappearance. London .... Early in Jan. April June Dublin . Jan. July Armagh . Jan. Pontefract Middle of Jan. .... June Taunton 15 Jan. April and May July Yarmouth 22 Jan. 15 March, 20 April 17 June Oxford . End of Jan. 3d week of Feb. 3d week of March Chester . 30 Jan. Middle of Feb. Middle of April Hertford 1 Feb. 10—25 March Beginning of April Stourbridge . . 1 Feb. .... .... Coggleshall . . Begin, of Feb. March End of April Manchester . . 4 Feb. 26 March 26 April Sunderland . . 6 Feb. 9 March .... Halifax .... 8 Feb. .... .... Edinburgh . . . 10 Feb. End of March .... Lincoln .... 15 Feb. 25 March 26 Apri! Ryegate . . . 15 Feb. March May Kidderminster . 15 Feb. End of March Middle of May York .... Feb. March June Minchin Hamp-" ton Stone . 16 Feb. Beginning of May Leicester . . . 18 Feb. 10 April 25 May Cardiff .... 18 Feb. .... .... Worcester . . . 20 Feb. 26 March Beginning of May Rochester . . . 25 Feb. .... .... Lewes .... < ■ • • Middle of March April Liverpool . . . 27 Feb. 3d week of March End of April Ludlow . . . do. Beginning of May .... Aberdeen . . . do. End of March .... Caermarthen . . do. .... Middle of May Honiton . . . 1 March Middle of May Plymouth . . . 2 March .... 12 May Shrewsbury . . 3 March 20 March 20 April Frome .... Begin, of March .... July Almsford . . . Begin, of March Beginning of April June Clifton .... 5 March 18 March .... Swansea . . . 7 March 19 April Gosport . . . 10 March .... End of May Lichfield , . . 10 March 1 April 1 May Newcastle . . . .... Middle of April .... Portsea . . . 18 March .... .... Cork' 20 March 29 April 20 May Hull' . . . . 20 March 10 April End of April Isle of Man . . 24 March .... .... Penzance . . . 25 March .... Fulneck near Leeds End of March End of May July Biddeford . . . 30 March .... June Dumbarton . . Begin, of April .... .... St. Andrew's Middle of April ' Medical and Physical Journal, vol. ix, p. 505. VARIOUS AUTHOES. 205 [^Immunities. — Many remarkable instances of immunity are mentioned by practitioners^ for the most part having reference to schools or other establishments. At Huddersfield, schools are said to have generally escaped.' At Gosport, in a school of about 80j only 4 applied for relief.^ It is difficult to assign any reason for such immunity, which was by no means universal in similar estabhshments.] The influenza first appeared at Brompton, near Rochester, in the evening of the 35th of February, when it seized 28 of Mr. Hulet's scholars.^ In the house of industry at Worcester, containing about 160 persons, nearly one half of whom are children, not more than 5 or 6 were affected, and those slightly.* In a school for young ladies, consisting of 33 residing in the house, not one was indisposed; the day scholars were not equally exempt.^ In a second school of the same nature, con- sisting with the family of 48, more than 20 suffered, but here only one of the pupils had the disorder with any considerable degree of violence, though the grown up individuals of the family had it with that degree of severity which more gene- rally prevailed. In a workhouse at Ryegate, wherein there are 200 people employed in a blanket manufactory wherein oil is used, no decided instance of the influenza occurred !* Within four miles of Pontefract, there is a pottery con- sisting of upwards of 300 souls; they have daily intercourse with the town and every part of the country, yet not a single person of them has suffered from the disease."^ The lunatics in the Hereford Asylum were not affected.^ Some prisons were similarly favoured. "The city gaol at Worcester, including the governor's family, contained on an average 23, all of whom escaped. The county gaol contained men debtors 11, and 1 woman debtor. Men felons 34, women ditto 15, with 3 children. The governor's family 7, in all 61; of these only the governor and his daughter had the complaint, and they very severely. The house of correction contained, ' Dr. Oakley, Mem. Med. Society of London, vol. vi, p. 356. ^ Mr. Harper, idem, p. 566. = Idem, p. 582. * Idem, p. 438. = Idem, p. 436. 6 Idem, p. 580. ' Mr. Jeaffreson, idem, p. 349. * Dr. Blount, Medical and Physical Journal, vol. x, p. 127. 206 EPIDEMIC OF 1803. men 18, women 7, 3 children, and the governor's family 3, in all 30. Of these only the governor had it, and he also very severely."'- There were some places which appeared very long to resist, and some never to admit the disease. Mr. Whateley, of Burton-on-Treut, says: "I feel satisfied the disorder, which was so prevalent in most parts of the kingdom early in the year, was never met with in this place or its immediate vicinity, at least not commonly."^ "The town of Wisbeach had a circumvallum of health, none of the neighbouring villages had been visited by influenza, and many parts of England have not been visited by influenza. How is this to be accounted for? Not surely by saying they had no communication with the diseased. I have seen the disease in the most sequestered situations. It may be worth while to inform you a little as to the country I now inhabit; it is a country sui generis. We have a few inconsiderable rivers moving sluggishly to the sea, but every four or five acres for twenty miles around me, is surrounded by a ditch with stagnated water. When these ditches are filled with water, the people are healthy, and in proportion as water diminishes, our epidemic diseases increase. We had very little rain here during the Winter and Spring, but much dry weather and unusual warmth in the Spring months. These are the reasons, in my opinion, why influenza was complicated with our endemics; and they lead me also to believe, that influenza is a weed of our own growth, that is, that it would have appeared here without communication with any other place."^ " The epidemic, in its genuine form, exhibited the follovnng symptoms : spontaneous weariness and languor, succeeded by slight shiverings, with alternate flushings of heat, first attack the patient ; he then complains of a deep-seated pain in the course of the frontal sinuses, accompanied, for the most part, with sneezing, and a profuse discharge of lymph from the nose and eyes. In the space of an hour, acute, darting pain in the muscles subservient to respiration, attended with a tickling cough, and hoarseness, frequently occur ; as the disease ad- I Mr. Rayment, Mem. Med. Soc, vol. vi, pp. 435-6. ' Medical and Physical Journal, vol. vi, p. 521. ' Dr. Frazer, June 12, 1803 ; idem, vol. x, p. 207. VARIOUS AUTHORS. 207 vances, the patient complains of mucli anxiety about the pre- cordia, dull, aching pains in the back and knee-joints, and of great debility, languor, and depression of spirits. The pulse is small and quick, seldom if ever hard and full; the tongue is covered with an extremely white mucus, and has the appear- ance of having been suffused with milk. The tongue being moist, little or no complaint is made of thirst. The appetite is not only entirely lost, but a fixed loathing of any solid food is expressed : on the third day, and sometimes as late as the fourth, the disease seems to have attained its acme. The above description is only intended to apply to the genuine unmixed form of the epidemic. Modified by age, sex, and temperament, and (admitting it to be contagious) by the circumstances under which contagion was communicated, it exhibited a remarkable diversity in its effects, upon different subjects ; yet in every case some degree of resemblance might be observed. Its distinctive character was never completely lost. In most delicate females, either sickness or diarrhoea, with transient shiverings and de- bility, unaccompanied with any catarrhal affection, formed the prominent symptoms of the disease. " In some the mucous membrane was but slightly inflamed ; in others, great pain and difficulty of breathing, with a sense of rawness and soreness of the trachea and chest, indicated more extensive inflammation. Members of the same family were differently afliicted, — some were solely affected with the almost pathognomonic symptoms of intense pain in the head and general debility J others chiefly suflPered from the catarrhal affection, attended with unusual languor, and derangement of the stomach and bowels."! " There was considerable diversity of symptoms in different constitutions, and perhaps in different localities. The pulse, for example, was sometimes full and tense, but generally be- came soft on the occurrence of free perspiration."^ [There was another variety of pulse not unfrequent, this was extreme slowness, accompanied with weakness; in several persons there were only 60 pulsations in the minute ; and in one lady, not naturally subject to slow pulse, it was at 58 for many days, and did not amount to 65 for three weeks.' ' Mem. Med. Society of London, vol. vi, pp. 359-61. " Idem, p. 306. ^ Idem, p. 509. 208 EPIDEMIC OF 1803. Mr. Hodson of Lewes met with two or three cases, ia which the pulse was remarkably slow; one was in a robust lad, about eighteen, whose pulse, soon after the commencement of the attack, was only 40 in a minute. He, however, very soon got well under simple treatment.^] " The pains in the chest or sides^ were often very acute and violent, much increased on coughing, or on any motion of the body ; but they seldom continued long fixed in one part, and though increased, on making a full inspiration, were certainly not attended with that great and permanent dyspnoea so usually attending genuine pneumonia." " Often there was not so much fixed pain as general dis- comfort. The patients complained of universal uneasiness, and when they were asked what part was most afi'ected, they said they could not tell for they had not a free part about them."^ " A great loss of appetite commonly occurred, with a loss of distinction of taste. In many cases there was a disagreeable saccharine odour in the breath, which remained for weeks."* " Under circumstances of aggravation the patient was aflFected with nausea, anorexia, bilious vomiting, and purging, icteric discoloration of the skin and of the eyes, a sense of fulness in the right hypochondriura, laborious breathing, bloody expecto- ration, epistaxis, muttering delirium, and extreme depression of mental energy."^ "When diarrhoea occurred, which was not common, the cough was usually slight. When the weather became warmer, the disease did not abate; but, on the contrary, vomiting occurred more frequently."* " The patients in general, if they gave a false step, or bent their head forward or sideways, imagined, to use their own ex- pressions, that their brains were likely to fall out. Deafness and tinnitus aurium were not alike common to all. Rheumatic persons, or that had been previously subject to intermittents, had a fixed pain in one of the temples, vulgarly called megrim, which, as usual, put on remittent exacerbations ; a sharp, cold rheum or fluid, as clear as rock water, run from one or both nostrils ; a total want of taste and smell for upwards of three I Mem. Med. Soc. of London, vol. vi, p. 593. ' Idem, p. 534. "■ Idem, p. 398. " Idem, p. 426. » Idem, p. 546. « Idem, p. 595. VARIOUS AUTHORS. 209 weeks, affected some of my patients, quick pulse, tightness across the sternum, laborious respiration, preceded by rigor, and all the other leading symptoms of pyrexia ; these, in most cases, terminated in four days, with lassitude, feebleness of the knees, stiffness of all the joints, and great decay of strength, — some actually fainted away, and continued cold so long as to give concern for the event." ''The affection of the head sometimes amounted to delirium, especially during the night ; in a few instances a certain degree of stupor took place."^ " This affection of the head was perhaps most frequently ob- served in robust young people."' " In some the countenance swelled with a bloated puffy appearance."^ " In many instances the fever was exceedingly high for two or three days ; but, about the fourth day, usually abated."* " The sweat in the night, independently of the use of sudo- rifics, was often more profuse than in an ague fit."^ " Towards the close of the disease it evidently assumed in many cases, though not in all, an intermittent type, at which time the cough gradually abated ; the expectoration became more free, and the sputa more consistent."^ "The disorder sometimes terminated in perspiration, some- times in spontaneous diarrhoea ; but after the feverish symptoms vanished in that way, a cough, want of appetite, with a bad taste in the mouth often remained behind, which were removed by an emetic, and suitable remedies for a cough. When com- bined with exquisite pleurisy or peripneumony, it required medical assistance ; its resolution was expedited by bloodletting, general and local blistering, mucilaginous and acid expectorants, attenuating, diluting regimen, &c. In cases of inflammatory pneumonic affection, where adequate bloodletting had not been employed, the disease sometimes terminated in vomica, and often in death.'''''^ " The urine in some cases was very much diminished, some- times very high-coloured ; and, during the height of the disease, deposited a pink-coloured sediment."* ' Mem. Med. Society of London, vol. vi, p. 422. ' Idem, p. 428. ' Idem, p. 273. ■* Idem, p. 294. ' Idem, p. 399. « Idem, p. 382. ' Idem, p. 278. " Idem, p. 417, 14 210 EPIDEMIC OF 1803. " In cases attended with decidedly inflammatory symptoms the blood was sizy or buffed ; but did not exhibit this character in uncomplicated cases."^ " The young, plethoric, and robust of the male sex were the most severely affected with thoracic and pneumonic affections ; the female sex, with affections of the abdominal viscera, bilious and obstinate constipations of the bowels, which, if not removed, the sick became yellow, and died in great distress."^ " In general it happened that whatever might be the indis- positions to which certain persons were habitually affected, these were aggravated even where no appearance of influenza existed; but when it took place, and continued for some days, it seemed to participate of typhus."^ " In some an acrid discharge from the nose and eyes gave them an appearance not unhke that which they have in the measles."* " Together with cough and hoarseness many of the younger or middle-aged patients had more or less inflammation of the mucous membrane of the fauces ; in a few instances suppura- tion took place in one or both tonsils, in others it attacked the Eustachian tube and ear, and then formed a very unpleasant part of the disease, producing temporary tinnitus and deaf- ness."' " Many complained of great soreness in the throat ; when upon inspecting the fauces, no morbid appearance could be perceived."^ [Some diversity of opinion existed regarding the influence of sex and age, in modifying the liability to the disease. Of 188 cases, recorded by Mr. Rayment of Worcester, 80 were males, 108 females.'' At Leicester, under Mr. Bishop's observation, four fifths were females f and Dr. Bardsley found female servants pecu- liarly liable to the complaint. At many places, as at Fulneck,® Dublin,^" Cork,^^ and ' Mem. Med. Society of London, vol. vi, pp. 393, 328. ' Idem, p. 274. ' Medical and Physical Journal, vol. x, p. 402. * Mem. Med. Society of London, vol. vi, p. 340. * Idem, pp. 396-7. « Medical and Physical Journal, vol. x, p. 195. ' Mem. Med. Society of London, vol. vi, p. 433. " Idem, p. 391. ' Idem, p. 327. '° Hem, p. 290. " Idem, p. 295. VARIOUS AUTHOES. 211 Oxford' the proportions were equal ; probably the observation of Dr. M'Can of Armagh may assist in explaining the discre- pancy ; ' the young, plethoric, and robust of the male sex were the most severely affected with thoracic and pneumonic com- plications; the female sex with affections of the abdominal viscera/*] " More males died than females, owing to their being more exposed to the inclemency of the weather, and not from any other predisposition."^ Dr. Dixon says, "the proportion of females was greater than that of males when it first appeared ; but, afterwards, vice versd."* " Heads of families, and very young children, form a com- parative exception to its indiscriminate attack ; but those who were most obnoxious to the complaint, and felt it most fatally and severely, were old, asthmatic, or otherwise debilitated sub- jects. It would appear that puerperal women were highly pre- disposed to, and fatally afflicted with, this malady. One in- telligent midwife lost five patients within ten days; and one puerperal patient died of the epidemic in our lying-in hospital. This is so important a fact, and shews the necessity of strict seclusion, from the risk of personal infection, in all puerperal cases, that it cannot be too generally promulgated."' " Relapses appear to have been very frequent at Fulneck and Leeds, but not at Manchester."* [At Cork'' they were very frequent when the weather became cold, which happened from about the 9th of April to the 18th, when the thermometer fell to 48. Convalescents recovered very slowly, and relapses were common on exposure to cold air.^ On a careful comparison of the recorded experience of different practitioners, there is ground for concluding that relapses were decidedly least frequent amongst the patients of those who used calomel pretty freely; and were common when opium, bark, and stimulants were given at an early period of the disease. The influence of the lunar phases upon the human con- stitution in producing and modifying disease has been main- ' Mem. Med. Society of London, vol. vi, p. 524. " Idem, p. 274. ' Idem, p. 320. * Idem, p. 307. = Idem, pp. 361 ' Idem, p. 320. ' Idem, p. 307. = Idem, p] = Idem, pp. 329, 366. ' Idem, p. 296. « Idem, p. ). 361-2. . 296. 213 EPIDEMIC OF 1803. tamed by many authors : it may upon this account be not improper to remark that, at the period (viz., about the 20th of April) when the influenza raged most powerfully, the Moon was in perigee, or nearest to the Earth. Several evenings pre- viously to the accession of this disease, slight appearances of aurora borealis had been observed. In some parts of Norfolk the oats were much blighted by parching winds, and it was found necessary to sow barley again. Dr. Turton of Swansea inquires whether these results did not follow the line of the earthquake, and whether the earth- quake, some few years ago, was not succeeded by a similar national affection ?^ At Whitehaven, during the continuance of the influenza, the wind was generally from the North, whilst at Sunderland, the south and south-east wind, dry and excessive cold at first prevailed, and latterly it veered about to the west and north- west to which this place lies exposed. With persons residing on hills, and exposed to all winds, the disease was very prevalent and troublesome.^ On the 26th of April a remarkable shower of two or three thousand meteoric stones, the largest weighing 17^ lbs., oc- curred at L'Aigle, in Normandy. In the previous year, about June and July, the sheep-farms of Tweedale were dreadfully infested by a caterpillar which was probably the larva of the Chareas Graminis, the capricious lepidopterous insect said not to touch the fox-tail grass. Spots of a mile square were totally covered by these caterpillars, and the grass devoured to the root. They made their first appearance in the dry, benty ground, consuming everything green, and though thousands of crows and other birds constantly fed upon them, they gradually spread into the boggy and finer pastures. The only plants spared were the Calluna vulgaris, Juncus squarrosus, and Galium saxatile. Some heavy rains at length drowned or swept them into the drains, many of which were literally stopped. They again made their appearance, but in diminished numbers, during the years 1812, 1824, and 1826.'] ' Medical and Physical Journal, vol. x, p. 202. ' Mem. Med. Society of London, vol. vi, pp. 312-21. ' Records of Parish of Yarrow, in Farmer's Magazine, vol. i, p. 124. VARIOUS AUTHORS. 213 {.Contemporaneous Disease amongst lower Animals. — There is considerable evidence of the prevalence of disease amongst the lower animals shortly before or simultaneously with the prevalence of the influenza. Mr. Webster of Denham observes, "Previous to the ap- pearance of influenza, I understood there was some contagious disease among the horses."] " At Gosport many cows died this spring."'^ " At Armagh, horses had a disorder similar to the influenza, in the Spring of 1802, attended with severe, hard cough, laborious difiicult respiration, fever, and great prostration of strength. I had two of my own so affected ; they were plen- tifully blooded, kept on soft mashes, got a ball composed of Aloes, Sal Polychrest, Extractum Glycyrrhizse, aa ^ ss; Calomel, Kermes Mineral, aa 3j, twice a week; of Jss Nitre and grana x, of Tartar Emetic, three times a day, the days on which the purging-ball was not given ; it terminated favorably by a plentiful discharge by the nostrils ; with some it terminated in farcin, and heart strangles, so called; and some it killed. Calves were very differently reared then, and many of them died in the attempt ; the bloody murrain prevailed much among horned cattle this spring and summer ; and many of them have died of it; calves also die in the rearing."^ At Cork, " many horses during the prevalence of this dis- order were attacked with ophthalmia and cough. "3 The previous year " many horses died of what the farriers termed the mad staggers ; but which, upon dissection, appeared to be occasioned by an inflammation of the lungs and substance of the heart, proving fatal in 36 hours, and within these few weeks this has re-appeared, but less frequent, and infinitely milder."^ " Influenza prevailed at this place from the beginning of March to the beginning of May."^ " About January a great number of cats in Shrewsbury were seized with what is commonly called the houst, swelled heads, defluxion from the nose and eyes, with vomiting, sometimes purging, and sometimes costiveness. Some died and others ' Mem. Med. Society of London, vol. vi, p. 576. ' Dr. Mi^Can, idem, p. 288. ' Idem, p. 297. ' Idem, p. 414. '■ Mr. Hickman, of Burslem, July 3, 1803. 214 EPIDEMIC OF 1803, were relieved by means of opening medicines. At the time the human species became a prey to the influenza, the dogs and horses were evidently affected ; many dogs were killed as mad dogs which were not hydrophobic."' " A disease called the black quarter' was more than usually prevalent this Spring amongst black cattle in the neighbour- hood of Whitehaven, and was always fatal. Horses also suffered a slight degree of catarrh."^ [At Droitwich influenza was stated to be by no means so general in the town as in the country. During its prevalence the cattle were unhealthy, cows and sheep in particular, and the farmers lost a great number of lambs. Cats also were affected, many of which died. At Worcester, seven miles south, no epizootic disease was observed.* A disease among cats and cows was noticed at Gosport, four or five months before the outbreak of influenza at that place.^ At Dublin dogs had sore eyes, whilst influenza prevailed.^ At Garstang, in the month of February, two months before the appearance of influenza in that place, " a very fatal epidemic was predominant among the swine ; in the town and neighbour- hood whole herds were swept off by it."^] " It has been often observed during the prevalence or pre- vious to these epidemics, that various animals and birds have been affected and destroyed ; and, if I am not much mistaken, even an impression on the vegetable creation has been some- where mentioned. I have just learnt, and I have no doubt the information is perfectly correct, that several horses died in this neighbourhood very suddenly during the time the late influenza was at the worst with us. That during the close of the last year and the early months of this, horses were everywhere unusually diseased, that very many died, (I knew a ' Dugard, Mem. Med. Society of London, vol. vi, p. 426 ; Medical and Physical Journal, vol. x, p. 217. ' " This incurable distemper consists in a powerful inflammation of the lower ex- tremities, which terminates in gangrene. The progress of the disease is very rapid, and young cattle are most liable to it." » Dr. Joshua Dixon, Mem. Med. Society of London, vol. vi, p. 316. * Idem, p. 445. ° Idem, p. 576. " Dr. Percival, idem, p. 292. ' Mr. William Knipe, idem, p. 379. VARIOUS AUTHORS. 215 neighbouring farmef who lost three, and with difficulty saved several others,) and that such were the apprehensions of the farmers for their horses at this time, it was a practice with those who thought the distemper infectious, to put large patches of tar upon the breasts of them by way of preservation ; but many attributed, however, these disorders to the horses having eaten insects, which for many weeks were innumerable, and covered the fields in the most extraordinary manner, wherever there was any length of grass, and this, from the mildness of the season, was general in almost every field. These were covered with a sort of spider's web ; and wherever you stepped, these insects flew off in vast numbers. I noticed them many times ; they were a long-legged, indeed a sort of winged spider, I believe, of the class Diptera, named Oleracea. A respectable gentleman-farmer, living near Modbxiry, on whose veracity I have the most perfect reliance, assures me that toward the end of March last and beginning of April, during the prevalence of the influenza, that many of his horses and those of his neigh- bours were very much disordered ; the disease among them was called the squinsy, and was marked with the following symptoms : running at the nostrils, cough, sudden weakness, and loss of flesh (these are his own words), none died; ab- scesses frequently formed and broke externally, between the cheek-bones, about the root of the tongue, and sometimes in- ternally about the same situation. The same intelligent person, Mr. Parsons, tells me, that in November and December last, dogs were generally afl'ected with a disease, termed of them the houst ; which, he observed, seems to consist of a continual effort to vomit, and that froth and slime were thrown up by these efforts in considerable quantities ; many of these animals were ill several weeks, and many died. In the advanced period of this distemper they were very subject to fits, as they call it, running here and there, and into pools and ponds ; several ran off, and have not been since heard of ; they never attempted to bite ; and, therefore, apprehensions which were at first enter- tained that they were mad, were soon removed."^ [.Relation of the Epidemic to other diseases. — An important inquiry arises regarding the relation of influenza to other dis- ' Mr. Dunning, Medical and Physical Journal, vol. x, p. 137. 216 EPIDEMIC OF 1803. easeSj and this inquiry resolves itself into two questions. 1st. Whether there be a transition more or less gradual, from a state of atmosphere favorable to influenza, to states of atmo- sphere tending to produce other special diseases? 3dly. Whether the presence of the influence inducing influenza pro- duces in the system a greater susceptibility to any other dis- eased actions ? As respects the visitation of 1803, this inquiry particularly points to pleurisy, inflammation of the lungs, typhus, dysentery, cholera, quinsy, and exauthematous fevers,] " The young, strong, and plethoric sufi'ered most from ex- quisite pleui-isy and peripneumony; the elderly, plethoric, and asthmatic, from apoplectic and pneumonic afi'ections, both true and spurious. The weak, languid, and relaxed, from low fevers. The concomitant seemed to be connected with the constitutional predisposition of the patient, and made its greatest impression on the most irritable and susceptible organ or part of the system."^ "When the disease was protracted beyond the tenth day, the pulse became gradually weaker and quicker, and brought on a typhus state." ^ " The influenza made its appearance again in May. About tlie same time, also, a most malignant fever, having some sym- ptoms in common with the influenza, began to rage in that part of Lincolnshire contiguous to us, which has proved fatal to hundreds."'' At Holywell, near Chester, on the other hand, "on the appearance of the influenza, the typhus entirely ceased, and only one case of fever subsequently occurred ;"* and at Navan, after the influenza, " a low fever, almost constantly prevailing in the town, disappeared for a considerable time."^ "A number were afi'ected in the latter stages of the disease, and some even in the beginning, with severe griping pains in the belly, tenesmus, and considerable discharge of slimy matter tinged with blood."^ " During the months of November and December last, the winds prevailed in the eastern quarter, which continued in January and part of Pebruai'y of the present year. In this ' Dr. M'^Can, Mem. Med. Society of London, vol. vi, p. 275. ^ Mr. Hunter, Dumbarton ; Medical and Physical Journal, vol. x, p. 234. ' Dr. Frazer, Wisbech; idem, p. 206. * Dr. Currie, Chester; idem, p. 214. ' Idem, p. 527. " Mr. Hunter, Dumbarton; idem, p. 234. VARIOUS AUTHORS. 317 period, diarrhoea and cholera were very prevalent : so nearly- similar to that preceding the influenza of 1788, that to many of my friends I hazarded a pretty confident opinion of an ex- pected return. In this I was not deceived."^ " Some had violent and sudden attacks of vomiting and purg- ing nearly resembling cholera morbus, though the evacuations did not indicate so much error in the biHary secretion either in quantity or quality, yet the majority were, in most of the catarrhal cases, costive. Others, agaiu, had considerable affec- tions of the tonsils constituting the cynanche tonsillaris, which, however, most commonly terminated in resqrption. "Although it may seem objectionable to include those seemingly distinct disorders under one name, yet I do it from a firm, conviction of their being difi'erent types of the same disorder, and occasioned by the same cause, as I cannot trace that more than one of the above train of symptoms existed in the same person, either at the same time or in succession, during the whole prevalence of the epidemic."^ At Swansea "the disease was preceded by sore throat, and other diseases of debility."^ Mr. Goodwin, of Framlinghara, says, " Typhus, scarlet fever, measles, and mumps prevailed."* "And now I will add, by way of supplement, a short account of the diseases which I have observed to follow the influenza, without endeavouring in the least to shew their connection with it. Catarrh and pneumonia have ever since occurred sporadically, as have likewise cynanche tonsillaris, cynanche pharyngsea, and cynanche parotidaea. From about the begin- ning of June till the middle of July an exanthematous fever prevailed, and was evidently contagious — although I have not been able to learn that it attacked any except those whom the influenza spared. Some called it a scarlet fever, but a scarlet fever it was not ; for there was no florid redness of the skin, nor any desquamation of the cuticle."^ • " I said in general, as I think I have observed for about 1 Dr. Vaughan May, Plymouth Dock, June 1803 ; Medical and Physical Journal, vol. X, p. 291. 2 Dr. Bertram, Hull j Mem. Med. Society of London, vol. vi, pp. 331-2. " Dr. Turton, Swansea; Medical and Physical Journal, vol. x, p. 201. * Idem, vol. ix, p. 509. ' Dr. Vaughan, Rochester; Mem. Med. Society of London, vol. vi, p. 591. 218 EPIDEMIC OF 1803. five years past, what is called influenza to partake much of an erysipelatous nature, the fever attending being much of that kind, and local attaclis of erysipelas occurring exteriorly on many parts of the body when the lungs were quickly relieved. I have not the smallest doubt but that this type of disease often occurs unobserved, or is mistaken for real inflammation."^ Scarlatina and ophthalmia prevailed at nearly the same time at Gosport.^ "In the workhouse none of the patients were bled, the disease in the men having taken on the appearance of typhus. They recovered more slowly, while the women were more mildly affected, except in two or three instances, where the disease terminated in phthisis. In these, however, a pre- disposition to cough seemed to exist prior to the attack of the disease. Children in general, especially those under eight or ten years of age, were but little affected with this complaint ; and, what is not a little remarkable, this was the case with those in the workhouses, of which there were a great many. Several had laboured under the hooping-cough, and, as the warm weather advanced in July and August, many were seized with measles, and some with scarlatina anginosa, from which they recovered with little or no medicine."* [The relation of succession appears to have been noticed by many observers. One or two examples may be added. Typhus was peculiarly prevalent at St. Neot's during the three months preceding the visitation of Influenza.*] " Before the influenza had run half its career, the scarlatina anginosa became very frequent among our children, and, con- trary to the above assertion (viz., that Biddeford is peculiarly happy in resisting epidemics), became the most general epi- demic I have ever seen in this town."^ At Hutton Bushell, near Scarborough, " scarlatina anginosa and pertussis succeeded the first appearance of the influenza; the former continued to prevail about three weeks ; of the latter there are still some instances (Sept. 18th), two of them are in the same house, a child and an adult. In this house the in- ' Dr. Doyle, of Ross, Ireland; Medical and Physical Journal, vol. x, p. 194. ' Mr. Walter, Mem. Med. Society of London, vol. vi, p. 575. ' Mr. "Wilkinson, Sunderland ; Medical and Physical Journal, vol. x, p. 401. * Dr. Alvey, Mem. Med. Society of London, vol. vi, p. 462. ' Mr. Smith, Biddeford ; Medical and Physical Journal, vol. x, p. 104. VARIOUS AUTHORS. 219 fluenza prevailed in tlie spring, but neither of my present patients had it, nor do T recollect that any patient has had the influenza who had been previously attacked by scarlatina or hooping-cough, or vice versd."^ [It is worthy of remark, that in villages near the sea the scarlatina prevailed before the influenza began, seemed sus- pended during the epidemic, and first appeared again in those very villages.^] " Influenza did not shew itself among the children, either in the seminaries or workhouses. Scarlatina anginosa had been very general amongst children.''^ " For many months the scarlet fever had been pretty pre- . valent amongst us, and attacking chiefly female children. The report of a contagious catarrh or influenza existing in various parts of the kingdom called forth my greatest attention; and about the end of April I met with a few instances of catarrh in which the febrile symptoms were for a day or two severe, especially pain of head and back.'"* [The substitution of one disease for another is favorable to the idea of some similarity of the cause.] " This influenza seems to have superseded or deferred the usual diseases of the spring, as the measles and scarlatina."^ "At Bury St. Edmunds the common diseases in the months of January and February, previous to the influenza, were catarrh, rheumatism (both chronic and acute), measles, and a few slight remaining attacks of scarlet fever." ^ " In a few instances of the disease on the second or third day, an eruption like measles came out."^ Dr. Thorp of Ludlow writes (June 3d), "The influenza made its appearance here about the latter end of February, and still continues. It has been gradually declining for more than three weeks." "The measles have prevailed to a greater degree in this part of the country within these last two months than ever was known ; and elderly people, who had before escaped, have been ' Mr. Shann, Medical and Physical Journal, vol. x, p. 394. ' Idem. ' Mr. Judson, Ware, Herts ; Mem. Med. Society of London, vol. vi, p. 516. •• Mr. J. Whateley, Burton-on-Trent ; idem, p. 405. 5 Mr. Robinson, idem, p. 520. * Dr. White, idem, p. 491. ' Medical and Physical Journal, vol. x, p. 117. 220 EPIDEMIC OF 1803. very generally affected. I have had one patient of 89 years of age, and great numhers of from 50 to 70."^ " Since the summer solstice the influenza seemed to be in some measure succeeded by the measles and smallpox, which, however, were not very general, nor of long continuance. They seem to have taken their flight along with the influenza. T have not seen or heard of either measles or smallpox these three weeks past. I have seen but one serious case of influenza during the month of July: it was since the measles and small- pox made their exit ; it is hoped it has now made its exit also not to return again with its late concomitants."— August 6th. '^ [At Aberdeen, influenza was succeeded by a violent epidemic of measles.' It would appear from the above statements that a previous influenza exerted no marked effect in modifying measles, but that the latter disease, as well as scarlatina, mate- rially diminished the susceptibility to influenza.] "In a boarding-school consisting of seventy-two boys and eight domestics, one only of the latter, and not more than five boys, were attacked with the common symptoms, two of whom kept their beds for a day or two at the onset. In another school of thirty, with domestics, not more than four ; and in a third of fifty young ladies, with teachers and household servants, no more than three, all very slightly affected. Each of these houses had not long before been visited with the measles. Day- scholars were indiscriminately admitted, several of which class were affected with the epidemic."* [The last disease claiming our attention in connection with this inquiry, is pulmonary consumption. The general testimony is favorable to the opinion, that this visitation had a tendency to elicit any existing aptitude to that disease.] "When the influenza attacked subjects apparently predisposed to phthisis, it never failed to increase and call into action the latent seeds of that disease, and in several instances to induce speedily a confirmed state of it, which quickly proved fatal. Of this I saw one case a few days since ; it was a female aged 23, ' Medical and Physical Journal, vol. x, p. 220. " Dr. L. M<:Can, Armagh ; Mem. Med. Society of London, vol. vi, p. 289. ' Medical and Physical Journal, vol. x, p. 233. * Mem. Med. Society of J^ondon, vol. vi, p. 494. VARIOUS AUTHORS. 221 and born of consumptive parents, but who at the time she was seized with influenza, three months ago, was free from any evident phthisical symptoms."^ " There cannot be a doubt that it has laid the foundation of phthisis pulmonalis in many habits, particularly in those pre- disposed to this disorder. I have under my care this moment three cases of it in the incipient stage, evidently originating in this source, and not the slightest tendency to pulmonary con- sumption appeared in any one of them previous to the appear- ance of the influenza."^ "Amongst the lower orders, from inattention to the in- flammation along the mucous membrane extending down the bronchia, I can perceive symptoms of phthisis. Of these I have seen above a hundred, who began their tale with — ' Sir, about six weeks ago I had the complaint, but thought nothing of it at the time.'^^^ " Since the appearance of my pamphlet on Consumption, I have had very numerous applications for the cure of that dis- ease, and more especially since the prevalence of the influenza. Seven out of ten of my phthisical patients dated their complaint from the attack of the epidemic in question, and certainly I think that there is a greater tendency to fatality in the cases originating in the influenza than in those which have sprung from other causes. I find extreme difiiculty in combating the symptoms. The powers which I employ successfully in other cases, do not efi'ect the same relief from phthisis arising from the influenza. This is curious, but I have no doubt of the fact."* A few observers, however, express a contradictory opinion : for example. Dr. Woolcombe of Plymouth writes, " During the prevalence of this epidemic I observed with some surprise that the complaints of consumptive patients, in the various stages of phthisis, were not affected by it in the slightest degree, nor has phthisis been more frequent since. I have met with but one instance of this disease originating in the influenza -"^ and a practitioner at Ryegate observes, that " the patients were left ' Dr. Woodford, Alrasford ; Mem. Med. Society of London, vol. vi, p. 538. ' Dr. Ryan, Kilkenny; Medical and Physical Journal, vol. x, p. 301. 3 Dr. Alderson, Hull ; idem, p. 126. * Dr. Mossman, Bradford; idem, p. 388. » Mem. Med. Society of London, vol. vi, p. 563. 232 EPIDEMIC OF 1803. very weak and debilitated, and some complained of rheumatic aflfections, others of a continuance of the cough, but I know of no instance of phthisis pulmonaHs succeeding it. . «i [.Contaffion. — There is no department of the subject re- garding which there is so great a diversity of opinion among observers, as on the much-vexed question of contagion ; it seems, therefore, desirable to present the most definite state- ments made on each side of the question.] " The influenza appears to me to be infectious, and the con- tagion to operate in about twenty-four hours."^ " Though at first of a contrary opinion, I was soon convinced that the disorder was of a very contagious nature. It appeared very clearly to me, and to the heads of all the very numerous families where I attended, that the complaint did pass from person to person, and the proof is very suflScient, no one family having been affected en masse, where the disease did not first appear in some individual of it."^ " In whatever house it appeared it almost invariably attacked every individual comprehending the family, notwithstanding ■every precaution to guard them against the application of cold and other causes, commonly producing catarrh, and that the complaint appeared to me more prevalent with those using these means of defence, but who were within the influence of infec- tion, than with those who were more frequently or constantly exposed to the atmosphere, and yet out of the reach of con- tagion. It has made its appearance where the subject has not been exposed to the common air for several months, but with whom others seized with this disorder have had frequent com- munication : further, in a family where the sick were so nu- merous that it became necessary to call in the assistance of a nurse, the woman, although in perfect health when she com- menced her attendance, and during the same, was never ex- posed to the cold, yet took the complaint, and died."* "It appeared to me to be contagious as it did not seize families all at once ; for first one individual was attacked, and ' Mem. Med. Society of London, vol. vi, p. 578. ^ Mr. Du Gard, Shrewsbury; Medical and Physical Journal, vol. x, p. 216. " Mr. Hall, of Bridgenorth ; idem, p. 220. * Mr. Yeo and Mr. Burroughs, of Clifton; idem, p. 224. VARIOUS AUTHORS. 223 in a few days after more were, and so on, until all susceptible of the disease had been affected by it."^ " The following fact likewise disposed me to consider the complaint as contagious. A gentleman and lady came, in the beginning of March, upon a visit to a gentleman's house in the neighbourhood of Britton Ferry, where some of the family were labouring under the influenza ; they came from a part of Carmarthenshire, where the disease had not shewed itself. The lady was seized in the course of a few days after her arrival, and the gentleman a few days afterwards."^ "The first case of well-marked influenza I saw, I believe was on the 5th of March; it happened to be a robust and healthy farmer, who the week before, on a journey into Essex, passed twice through London : he lives in a village about five mi]es from hence, where, at that period, the influenza had not appeared, but was then universal in London. Many cases come now daily before me, for it very much prevails at this time in this town, and in the neighbouring village."^ " Two ladies of this place spent a few days at Exeter, and slept at a friend's house, where the family had been ill of the influenza (and indeed some part of it then laboured under the complaint) ; one of them was seized as she was returning, and the other two days after; and the whole family, where they lodged, had the complaint within ten days. About the same time, a person coming from Plymouth Dock, where the in- fluenza was very prevalent, was seized at a friend's house at a difl'erent part of the town from the ladies just mentioned. The family of this house, likewise, soon became infected. These were the first instances of the complaint in this town, but it soon became general."* " One large family in the country, and who had little com- munication with others, escaped the disease till June (i. e. for two months). They thought they caught it from their music- master. Seven persons, who attended in succession a lady who had it severely, were attacked with it. Her daughters, who were kept away from her, escaped. Several instances of a ' Mr. Bond, of Glastonbury; Medical and Physical Journal, vol. x, p. 226. = Dr. Hobbes, Swansea ; idem, p. 290. ' Mr. Lawrence, Cirencester; idem, p. 200. •• Mr. Harness, Tavistock; idem, p. 291. 224 EPIDEMIC OF 1803. similar kind occurred. Nothing that I witnessed authorised me to say positively that the disease was contagious; hut I thought it right to separate as much as possible the sick from the well. — Sept. 18."' "Mr. M'Donald, with his wife, his son, and his daughter, were in London in the beginning of 1803 ; they left London on the 3d of February, at which time the influenza was very prevalent there ; but they did not know of their having been in any house where there were individuals subjected to that disease. When they set out on their journey they were all in perfect health. They arrived at Berwick-upon-Tweed on the 8th of February, and were there in a house where there were several persons subjected to influenza. They arrived at Powder Hall, situated within a mile of Edinburgh on the 9tli of February. The next day Mr. M'Donald himself was attacked with severe febrile symptoms, attended with uncommon prostra- tion of strength, and all the other appearances which most fre- quently occur in influenza. Soon after Mr. M'Donald was at- tacked with this disease, almost every other person in his family, amounting to near a dozen, were attacked in succession; but its progress, as far as I could learn, was not immediately afterwards very rapid in the city of Edinburgh, and I did not myself attend any case where the disease was distinctly marked till the 23d of February, when I was called to a gentleman dangerously ill of the disease, several of whose family had before been afiiected with it in a much slighter manner " The contagion of influenza is not indeed conveyed on the point of a lancet to be intentionally communicated like small- pox ; but from all that I have been able to learn of the history of this disease, as recorded by eminent writers for many cen- turies past, from all that I have seen of it during former epidemics, from its progress during the present epidemic, with very diff'erent states of the atmosphere when passed from Paris to London, and from London to Edinburgh, &c. ; from its pro- gress in Edinburgh after it appeared in this city; and, finally, from its progress in my own family, after its introduction into my house ; I have no more doubt of the contagious nature of the ' Dr. Fowler, Sarum ; Medical and Physical Journal, vol. x, p. 386. VARIOUS AUTHORS. 225 influenza than I have of the contagious nature of the measles, chin-coughj or typhus fever ."^ Mr. Smart of Hutton Bushel observes, that "one person employed to shave another, beginning in the influenza, although this circumstance was unknown to him, went home, and com- plained of the disagreeable smell of his customer's breath, and in less than three hours was attacked with the disease ; had it very violently ; but his wife, who slept with him the whole time of his illness, escaped." Mr. Smart met with several similar instances.^ "A cat was attacked with what I supposed to be the in- fluenza ; it was caressed by a little boy during the time of its illness, and the child became indisposed in about twenty-four hours. He was removed to another house, where he infected his two attendants in about the same time : these three cases were severe. The cat was costive, and by the advice of one of the family, had an injection. It was held by six people, five of whom were seized, in the course of forty-eight hours, by the influenza. Is it prpbable that these people were infected by the cat, or was it only a coincidence ?"^ Dr. Magennis of Plymouth mentions the following circum- stance as the only one which disturbed his opinion of the non- contagiousness of the disease. In a gentleman's family with which he was intimate, the man-servant was first attacked with severe catarrhal symptoms. " The complaint continuing to in- crease in violence, and being a married man, it was judged necessary that he should go home to be nursed by his wife. The cook was then seized, and likewise obliged to quit his service. The woman who succeeded the cook, as a temporary substitute, was, in less than forty-eight hours, also attacked with similar symptoms j and, shortly after, the gentleman's daughter. In the mean time the man-servant recovered and returned to duty ; but he had not been many days in the house when he was again seized, from which he recovered very slowly, and has continued ever since in a very debilitated state, not- withstanding the use of the most powerful tonics."* " The first case that I perceived, (says Mr. Du Gard of Shrewsbury,) was, on the 20th of February, in a little boy at ' Dr. Duncan, sen., of Edinburgh; Med. and Physical Journal, vol. x, pp. 406-7. 'Idem, p. 397. » Mr. Du Gard, Shrewsbury; idem, p. 218. * Idem, p. 122. 15 226 EPIDEMIC OF 1803. the public Grammar School in this town. He was seized with the symptoms of influenza, and was ill a week. His bedfellow was not infected by him, nor were any of the boys in the room, and there were twenty in the same apartment, nor did any one in the house become attacked with the disease till this boy had been well eleven days, at which time five or six were taken ill, and the same number daily, till four fifths of the school were afiected."^ Mr. Fieldhouse of Stafford writes: "Mr. Ward and myself are fully convinced of its being highly infectious, and ground our opinions on the following circumstance, among many others which occurred, Mr. "Ward's family, living in the country, and detached from any house, continued free from the complaint, until a late period, when Mrs. Ward paid a visit to some ladies who were ill in Brewood. She was attacked in three days after being in the family, and returned home ; about the same distance of time a little niece that they kept was seized ; the child hanging upon Mr. Ward, he was taken ill, with a lady, and the rest of the family. A schoolmaster in Brewood (a small town) kept his scholars and family unconnected with the rest of the inhabitants for a considerable time, until the com- plaint had nearly disappeared : during this period they con- tinued perfectly free, but taking off that restriction and mixing with the people they were all soon attacked."^ " It appeared to us, (observes Dr. Longfield, of Cork,) to be very contagious, as some boarding-schools in the country, remained free until visited by some person who brought it from the neighbouring towns : its progress was evidently traced from England to Waterford, where it raged before it reached us. Some schools which had little or no communication with large towns, escaped. It did not extend much beyond this city to the south-west : in most instances it went through boarding-schools and manufactories, but progressively and gra- dually. Three physicians, who attend the house of recovery in this city, were almost immediately attacked after visiting a patient ill of this epidemic in that charity."^ Whatever be the nature of the morbid influence capable of producing the disease, it would seem to have been most virulent ' Medical and Physical Journal, vol. x, p. 215. ' Idem, p. 399. ' Mem. Med. -Society of London, vol. vi, pp. 296-7. VARIOUS AUTHORS. 227 in cities, especially where individuals were congregated together in considerable numhers. " During the Lent Assizes the in- fluenza was exceedingly prevalent in Shrewsburj"-: most of the country-gentlemen, composing the grand-jury, came to town in health, but very few returned without taking the disease along with them. At these Assizes a case was tried from Clun, twenty-seven miles south-west of Shrewsbury. Most of those who came here on that account were taken ill of the disease on their return, and spread it all over that little retired town."^ " The first case, (says Mr. Hugo of Crediton,) which came under my observation, was on the 23d of March, in the family of a gentleman who resides about three miles west of this town. He had been attending, with his lady, the assizes at Exeter the whole of the preceding week, at which time the influenza was very general there. They came home both ill of the disease. On the next day the servant who returned with them was seized with it, and by the 25th, it had been communicated to every other person in the house. Some labourers who re- sided at an adjoining farm, were afiected about the same time ; but a woman who had been employed at Exeter was the first attacked by it. It appeared very soon afterwards in the town of Crediton ; and here, also, the first case I visited was a gen- tleman who had been attending at the Assize. It spread very rapidly, and in a short time became general in the town and adjoiaing villages."^ " In some country-places, isolated and detached from any adjacent dwelling, I have known the whole family continue exempt from the influenza, until one of them happened to come to town, bring it home, and, after a few days' confinement, communicate it to the remainder. Though this epidemic dif- fused itself very extensively through all ranks and descriptions of people, I have notwithstanding known many entire families to escape that must have been constantly exposed to infection, supposing it to exist; nay I have remarked, that some who acted in the quality of nurse-tenders in the family-way did not take it ; but these were few indeed when compared with the immense numbers who caught it by their attendance of the sick."' ' Mr. Du Gard, Shrewsbury; Medical and Physical Journal, vol. i, p. 217. 2 Idem, p. 311. ' Dr. Ryan, Kilkenny; idem, p. 297. 338 EPIDEMIC OF 1803. "That the influenza is a contagious disease arising from a specific materies morbi, and readily communicable from one person to another, is rendered probable from various facts, as well as from its analogy to other contagious disorders. Its appearance here, although rapid, was progressive. It spread, like other infectious maladies, more particularly among those exposed by their greater intercourse with each other to the danger of contagion. Female domestics and the inhabitants of the nursery seldom escaped its influence. A gentleman of this town returned from London in the third week of May, while labouring under influenza. He found his family in the country all well; and, unconscious of the infectious nature of his com- plaint, he bestowed the usual caresses upon his children. Three of them sickened the next day, and two more on the fol- lowing. The nurses of the house of recovery fell sick soon after the reception of the first cases of the malady, notwithstanding the usual preventive rules against infection were strictly followed. "At Rochdale, I am assured, the origin of the disease was distinctly traced to some gentlemen who had brought it from Lancaster, where they had attended at the Assizes. But the most complete and satisfactory evidence of the propagation of this disease by contagion (I had almost said the only mode by which it is communicated), is derived from what happened in the Manchester Lunatic Asylum. None of the patients were affected with the epidemic (although permitted to walk out daily in the airing grounds), until the keeper and matron became aff'ected. In consequence of their attention, while labouring under the influenza, to some elderly patients, whose situation demanded more than common care, they communicated the in- fection to five of the persons thus circumstanced, while all the rest, to the amount of eighty and upwards, entirely escaped the complaint.^ "Well-marked examples often presented of its personal com- munication. It occurred to me often to remark, that when the disease had been unduly protracted, and had proved unusually violent, that those who were the most occupied in the cure of the patient successively sufi'ered. This fact was so striking, that it soon confirmed me in the propriety of analogically extending ' Dr. Bardsley, Manchester ; Mem, Med. Society of London, vol. vi, pp. 367-9. VARIOUS AUTHORS. 239 to the disease my general persuasion of all morbid action being more or less contagious according to the degree of the malady, personal proximity, existing temperature, and temperamental susceptibility for diseased impression. In short, my opinion is, that the late influenza, in common with every variety of epi- demic disease, not excepting even the plague, originated from the morbid influence of variable temperature, by which the salutary conditions of vital motion became at length so distem- pered, as to generate and evolve from every part of the system an halitus, or materies morbi, proving infectious or not according to its degree of concentration, and the existing temperamental aptitude for being impressed by it. In many instances it may be efiicient, while in others it may be quite inert. A similar operation of cause and efifect obtains in every description of disease that disturbs vital motions sufficiently to vitiate its salutary processes or functions. The principle of contagion con- sisting of a specific arrangement of matter issues from every conceivable disease, but it amounts to operative force in com- paratively few instances."^ The opinion that the disease could be communicated through the medium of clothes was not absolutely without an ad- vocate. "1 am happy to give you an instance where the influenza was brought from Dublin by parcels which were made up by a person very ill of that disorder, and sent to a lady of quality here. As soon as the parcels were unpacked, the person who unpacked them was first seized, then the lady herself, and the whole family were infected, as was the neighbourhood."** On the subject of prophylactic measures the following re- marks may not be uninteresting: "Those drinking port wine in moderation, and living much in the open air, appeared less liable to the infection."^ "A ladies' school that I attended kept perfectly free by the constant use of the Nitr. and 01. Vitriol, notwithstanding the complaint raged at the next door."* "1 have considerable reliance from many and repeated trials ' Dr. Kinglake, Taunton ; Medical and Physical Journal, vol. x, p. 307. ' Mr. Edgeworth, Edgeworth Town ; idem, p. 302. ' Dr. Thorp, Ludlow; idem, p. 220. * Mr. Fieldhonor, Stafford ; idem, p. 399. 230 EPIDEMIC OF 1803. ou the power of acid fumes to weaken the force of, if not alto- gether to destroy, febrile contagion."^ "In a school for ladies in this town of near thirty hoarders, two of the children had the influenza; but by carefully sepa- rating them from the rest, and keeping the fumes of Henry's vinegar constantly in the room and about the bed, all the rest of the family escaped it; but this is the only instance of pre- Tention I knew practised."^ "It was seldom confined to one individual in a house, except where the acid fumes were used."^ "Fumigating is employed to purify the air in the Salop infirmary, and the floors are mopped with lime water some hours previous to the first process; it did not, however, prevent the introduction of the influenza : indeed how should it, when the friends of the sick are perpetually visiting them from the town?"* The belief in the contagiousness of the disease, although widely prevalent, was yet, as formerly observed, not universal. "Many individuals have taken the disorder without any in- tercourse with the sick. I have seen some instances of one in- dividual in a full family ill of the disease, and all the rest escaped. I have known wives sleep with their disordered husbands with- out being infected, and husbands sleep with their sick wives with equal impunity. I cannot say that any sickened by im- mediate contagion or intercourse with the sick, but as they hap- pened to be constitutionally predisposed, and incurred, or were exposed to the exciting cause, which, when closely investigated, could in general be traced up to some evident cause, as exposure to cold air, change of bed, laying aside heavy cloathes and put- ting on lighter, overheating and getting cold afterwards, fatigue, a wetting, or some such cause. The hurtful impression of cold, however incurred, was the most general occasional cause both of the primary disease and subsequent relapse. I cannot say that human effluvia had any eff'ect in propagating qr multiplying the epidemic. Many more of the inhabitants of the most remote and thinly peopled parts of the country, in proportion to their number, were ill of the epidemic, and suffered a much greater ' Dr. Bardsley ; Medical and Physical Journal, vol. a, p. 210. ' Mr. Baddeley, of Newport, Shropshire; idem, p. 215. ' Dr. Thorp, Ludlow; idem, p. 219. * Mr. Dugard ; idem, p. 399. VARIOUS AUTHORS. 231 fatality from it than the inhabitants of the most populous streets and closest lanes and alleys. In general^ collections of people who were immured or inaccessible to the inclemencies or vicis- situdes of the weather, escaped the disease better than those who were at large, and exposed to its hurtful influence. The influenza was not known in the jail, or county infirmary of this place. Of upwards of 400 men of the 18th regiment, who lived in their barracks here for ten months past, paraded, messed, and slept promiscuously, but were kept to regular hours, no more than eight of them had the influenza; while, at the same time, upwards of ten times that number of the county militia regiment that were recruiting here for about three months past, billeted about the county, straggling aud exposed to all weather, got ill of the disease. Their surgeons assured me they could not consider it contagious from intercourse with the sick. * * * * Of upwards of 70 boarders of the Rev. Dr. Carpendale's school here, who all past the day in school to- gether, messed and played promiscuously, continued to sleep in their respective dormitories without any removal or se- paration, 35 had the influenza so slightly as not to require medical assistance, and all in succession; some at the interval of one, two, and three days, some after ten days or a fort- night, since any had been ill of it. Dr. Carpendale could not observe that those who slept in beds contiguous to the sick were more disposed to take the disease than those who slept in beds the most remote from them."^ "The cavalry barracks at Eastborne, occupying a square of about four acres, is situated within a mile of the sea and fifteen yards of the town, but being built on an acclivity is more exposed than Eastborne, particularly to the rage of the S.W. winds, which are very prevalent, and blow at times over Beachy Head with tremendous violence. The officers' apartments are separated by a brick wall from those appropriated for the accommodation of the non-commissioned officers and privates; the latter, consisting of ten rooms, are on the same floor. During the month of March last, the influenza was very pre- valent at Eastborne, and was epidemic in the town and neigh- bourhood some time before it made its appearance in the barracks. " On March 19th, in the evening, two private dragoons in ' Dr. M<:Can, Armagh; Mem. Med. Soc. of London, vol. vi, pp. 279-81. 232 EPIDEMIC OF 1803. rooms 4 and 7 complained of violent pain in the head and over the eyes; and every symptom of influenza, as described by Dr. R. Pearson, who all followed the treatment laid down in his publication. One was discharged to his duty on March 24th, the other not till April the 2d, cough and debility resisting the usual remedies. A third dragoon, in room 3, was attacked on March 31st, and remained incapable of doing his duty till May 25th, A fourth private was also attacked on that day in room No. 6, and remained on the sick list till the 27th. The farrier's wife and a child, who was, if I recollect rightly, in the same room, also went through the disease about the same time. All those persons continued in the barrack -room, an hospital not having been then built. The subjoined account will shew at one view the number of persons in each room, and the pro- portion those attacked bore to those who escaped the disease. I am not prepared to give it as my decided opinion, that the epidemic which lately prevailed was not contagious; but from its appearance in Eastborne barracks, and all the information I have been able to collect, I am inclined to think that it was not. And I believe that its cause must be sought in the state and variations of the atmosphere, and great and sudden changes of temperature. " An Account of the number of Persons who were attacked by or escaped the Influenza in the Commissioned-Officers^ and Private-Soldiers' rooms, Eastborne Barracks, March, 1803.^ a 1 ^ 2 i 1 s g J^ s ^ >% ■a i, t4-l ■0 1 s 13 .9 1 1^ 1 1 o II Quarter-master's room .9 1 1 i 11 i 1 "S^ §1 1 1 2 4 — — 4 Barrack-sergeant's room 1 — — 1 — — — — 1 Sergeant's room 3 1 2 6 — — — — 6 Soldiers' room, No. 1. 7 1 1 9 — — — — 9 — No. 2. 7 1 1 9 — — — — 9 — No. 3. 4 1 1 6 1 — — 1 5 — No. 4. 8 1 1 10 1 1 1 3 7 — No. 5. 8 — — 8 — — — 8 — No. 6. 8 1 1 10 1 1 9 — No. 7. 8 1 1 10 1 — — 1 9 55 8 10 73 4 1 1 6 67" ' Mr. Luscombe, of Eastbourne; Medical and Physical Journal, vol. x, p. 107. VARIOUS AUTHORS. 233 A large proportion of the observers express themselves un- decidedly as respects the question of contagion. " I am not obliged to determine, from my own observations, whether the influenza is contagious, or otherwise. I think it may be communicated from one person to another, yet my observations lead me to consider its powers in that way to be weak."^ "Whether the influenza has been a contagious disease or not I really cannot satisfactorily determine. I am of Sir Roger de Coverley's opinion, when he so wisely decided, on another occasion, ' that much might be said on both sides j' however, upon the whole, I think that the preponderance of probability is in the scale of contagion,"^ [Some consider it to be contagious only when it degenerates into typhus. Treatment. — By most practitioners who have reported on the subject, emetics are recommended, often in strong terms.] " I almost invariably found that, where an emetic was given in the first, or early in the second day, the disease was cut short; and the patient, after experiencing a slight degree of debility, recovered."' " Emetics were found highly beneficial on the first attack ; indeed the frequent occurrence of spontaneous nausea and sickness pointed out their use.''* " The influenza seized 38 of Mr. Hulet's scholars; out of this number 16 were immediately sent home; and to the 13 who remained, an emetic was administered. * * * The twelve scholars who had been vomiting, and who drank plentifully during the night of weak wine whey, were quite well by the next morning; but the sixteen who were conveyed home were all of them worse; and, indeed, the least attentive observers agree in this, that the influenza, if left to itself, came to its height on the second day."^ " The sickness was always reheved by a gentle emetic, some- ' Mr. Lawrence, Cirencester ; Medical and Physical Journal, vol. x, p. 199. ' Mr. Constance, Kidderminster ; idem, p. 200. ' Dr. Thorp, Ludlow ; idem, p. 219. ■■ Dr. Bardsley, Mem. Med. Society of London, vol. vi, p. 362. ■■' Dr. Vaughan, Rochester ; idem, p. 582. 234 EPIDEMIC OF 1803. times a cupful of strong green-tea proved an useful and gentle puke."^ [Calomel was, by some practitioners, employed conjointly with emetics;^ by others, as a substitute.] " If called in within a few hours after its first attack, the administering a brisk calomel cathartic generally checked its progress, insomuch that, afterwards, not anything more was required. An emetic was attended with nearly the same ad- vantage, but did not so eifectually check the progress of the disorder as a calomel purge."^ " In some cases, when rigorously attacked in its commence- ment with an active medicine that operated briskly in every direction, qua datd portd, it was cut short, and, as it were, choaked in its cradle, at least as to its febrile symptoms."* [Others employed calomel in small doses repeated from time to time.] "The best mode of medical treatment of this complaint, according to my observations, consisted in the early employment of antimonial and calomel in small and repeated doses, so as to act gently on the whole alimentary canal."^ " To cleanse the primm via, moderate doses of calomel, with rhubarb and antimonial powders combined, were given and repeated occasionally with excellent effects."* [It may probably be accepted as a general rule that relapses were least frequent in the patients of those practitioners who employed repeated small doses of calomel. When we consider the variety of symptoms attending the complaint, it is not surprising that considerable discrepancy should have existed on the subject of bleeding.] Dr. Thorp, of Ludlow, says " wherever the lancet was used after the first day, the disease became tedious ; debility exces- sive, almost constant nausea, pain in the head violent, and fre- quently delirium." Mr. Waiblinger, of Fulneck, observes,'' " I ' Dr. James Flint, St. Andrew's ; Mem. Med. Society of London, vol. vi, p. 302. ' Dr. Bardsley, idem, p. 362. 'I Dr. Robinson, Newcastle, Stafford; Medical and Physical Journal,vol. x,p. 110. ■* Dr. Mi^Can, Armagh ; Mem. Med. Society of London, vol. vi, p. 273. » Dr. Wall, Oxford! idem, p. 524. • Dr. Bardsley, Manchester; idem, p. 362. ' Idem, p. 328. VARIOUS AUTHORS. 235 seldom bledj and when I did it^ did not perceive any good effect ; though sometimes symptoms ran so high as to appre- hend violent pulmonic inflammation^ yet I seldom found any buff on the crassamentum, or relief ensuing from bleeding." On the other hand Mr. Bishop, of Leicester, remarks,^ that "in those who appeared to labour under phlegmonic inflammation of the chest in whom recourse was had to general bloodletting in the first instance, pulse being hard, -frequent, and oppressed, the evacuation was of considerable advantage in relieving the chest, and abating the hardness of the pulse;" (and he pro- ceeds to show that, in such cases, the blood is occasionally cupped and buffed,) " Small, close, hot rooms were always injurious ; many received great benefit by opening the windows, or permitting them to go out into the air."^ Dr. Kinglake remarks: that a cold temperature was highly gratifying and beneficial; he recommends a temperature of from 40° — 45° of Fahrenheit, and thinks the complaint was always aggravated when it rose to 60°. [The prevaiUng opinion was in favour of consulting the feelings of patients, and inclining to cool, free air. The opinions entertained respecting the use of opium do not perfectly coincide.] "Opiates, (says Mr. Swan, of Lincoln,) did much good, and were given pretty generally, when no inflammatory or other symptom indicated their use. They quieted the cough, and abated many of the other symptoms."* Dr. James Flint, of St. Andrew's, writes, " it was necessary to command the cough by gentle opiates as the Elixir Paregor. of the Edinb. Pharmac. Syr. Diacodii, and Sydenham's Tinct. Opii. I never saw any harm from opiates when properly ad- ministered."* By others opium was considered injurious, especially if given in large doses,^ or at the beginning of the disease. Dr. Longfield, Cork,^ and Dr. Martin Wall, Oxford,'' found that ' Mem. Med. Society of London, vol. vi, p. 392. ' Dr. Wall, Oxford; idem, p. 526. ^ Idem, p. 400. * Idem, p. 304. ' Dr. Joshua Dixon, of Whitehaven, idem, p. 309 ; Mr. J. C. Melhurst, Tiverton, idem, p. 544 ; Dr. Bertram, Hull, idem, p. 333. Idem, p. 295. ' Idem, p. 524. 236 EPIDEMIC OF 1803. they increased dyspnoea, and produced confusion of the head and costiveness. In one patient, a lady of very weak habit, a few spoonfuls of Syr. Papav. Alb. very nearly produced sujQfocation. The most judicious practitioners, for the most part, de- ferred the use of opiates till after the abatement of any inflam- matory symptoms.^ By some they were considered safe in combination with such medicines as Ipec. and Antim.^ The external application of opium was employed by some. Mr. Evans, of Ketley,' found the following embrocation, when rubbed on to the back and sides of the patient at bedtime, never fail to procure a comfortable night's sleep : R Tinct. Opii, Spir.Ammon., Comp. Lin. Saponis C, aa gij. Misce. [Most practitioners agreed in considering the acetate of ammonia a very useful medicine in this disorder ; and, for the first two or three days, antimonials were employed with con- siderable benefit in lessening the feverish state.* By others ipecacuanha was thought more appropriate.^ Various observers say that oleous medicines were in general ungrateful to the stomach ; but many administered Squill, combined with Ammo- niacum, or Limoniated Kali (after the inflammatory excitement had abated). Pediluvia were often very useful, especially when used about the time of the accession of the natural evening paroxysm." Blisters were particularly serviceable in relieving topical pain and dyspnoea,'' but were not considered harmless by all practitioners.* "When the disease assumed the intermitting type, recourse was had to red bark as soon as the intermission was complete j and, if taken to the extent of half an ounce in sixteen hours, never failed to prevent the recurrence of the fit.' A very different opinion was entertained by others regarding this medicine. > Dr. Woodford, Almsford ; Mem. Med. Society of London, vol. vi, p. 537. ' Mr. Bush, of Frome ; idem, p. 542. ^ Idem, p. 418. * Dr. Longfield, Cork; idem, p. 295. » Medical and Physical Journal, vol. x, p. 521. * Idem, p. 227. ' Mem. Med. Society of London, vol. vi, p. 394. « Mr. Ward, Woodchester ; Medical and Physical Journal, vol. *, p. 521. » Mr. Bond, Glastonburyj idem, p. 228. VARIOUS AUTHORS. 237 The bark, in any form, according to Mr. Dixon, of White- haven, was never beneficial, but always hurtful.^] " Bark, in all its forms, seemed in many cases not only of no advantage, but oftentimes prejudicial; the bowels were thrown into inordinate action; and the languor and debility much increased by the too powerful purgings occasioned by its use ; under such circumstances I administered diluted Sulphuric Acid and Tincture of Rhubarb, with Infusion of Cascarilla and Camphor Mixture."^ Mr. Rowe, of Portsea, administered nitre in free doses, namely half a drachm every hour and a half in a cup of barley-water.s Oranges were found very grateful to most people;* but wine was too heating in general, except cowslip, which was an agreeable cordial at bedtime. Whey, made of orange-juice, was occasionally ordered.^ The greatest number of children (who were under my directions) required no other medicine than as many oranges as they chose to suck.® When the cough was incessant and sharp, wandering pains affected the breast and muscles subservient to respiration, attended with a rapid and somewhat hard pulse ; the addition in small doses of Tincture of Digitalis, to saline and diaphoretic medicines, not only instigated the cough, but likewise promoted expectoration and induced sleep.^ " Saltpetre. — In the evening of March 18th I was desired to attend a female about twenty years of age. She complained of sudden chillings, which were succeeded by faintness, giddiness, throbbing pains in the head, flushes in the jaw, restlessness, weariness, and depression of spirits. Ordered her i drachm of Sal Nitri every hour and a half, dissolved in a cup of barley-water, which she drank of copiously; her extremities were bathed in warm water. When I visited her in the morning of the 19th, I found she had perspired very much through the night ; the pain in the head was much relieved; the flushes in the face and the weariness were gone ofi', and she was in every respect much ' Mem. Med, Society of London, vol. vi, p. 310. - Dr. Thomas Hull, Retfori ; idem, p. 385. a Idem, p. 571. ■* Idem, p. 418. ' Dr. Vaughan, Kochester ; idem, p. 588. • Dr. Girdlestone, Yarmouth ; idem, p. 474. ' Idem, p. 364. 238 EPIDEMIC OF 1803. better. She had now taken about ten drachms of nitre, and con- tinued to take half a drachm every third or fourth hour. On the 20th, she said she was now quite comfortable, but rather costive; discontinued' the use of the nitre, and ordered her to take one ounce of vitriolated natron, dissolved in a cup of warm water- gruel, which operated very well. On the 31st all the symptoms were removed, leaving a debility which was removed by a nu- tritious diet and moderate exercise ; several other cases I have met with, which I treated in a similar manner. I have gene- rally found the good effects of Sal. Nitri freely administered in their diluting drinks."^ This summary of the treatment must not be closed without introducing the Remarks of Mr. Hunter, of Dumbarton, on the eflBcacy of tobacco.^ " Tobacco. — A young man who had been affected with in- fluenza for twelve days, had been advised by some acquaint- ance to drink a considerable quantity of whiskey. This had ex- asperated all his symptoms, and brought on so severe a vomiting, that everything he took was instantaneously rejected ; his belly was bound, skin dry, and his pulse 130, weak and intermitting. Before I saw him a number of injections had been given, some of them very stimulant, but without effect. I ordered an injection of Nicotiana 5ij, Infus. in Aq. Bullient ^xi], to be given; it pro- duced an immediate evacuation of a considerable quantity of indurated fseces, caused severe vertigo, faintishness, and at last a copious perspiration, followed by sound and refreshing sleep : when he awoke his fever was greatly diminished, and the vomiting did not again come on; and without any other ap- phcation, except a plentiful use of wine, in which a small quantity of Rad. Gentian was infused ; he quickly recovered. " As this remedy had been so useful in this case I deter- mined to try it in others; and, as in the beginning of the disease, costiveness was frequent, I began by giving the in- jection, of a strength in proportion to the state of the patient, but always wished that, besides emptying the bowels, nausea, or even vomiting, might be excited; whenever this took place it was followed by a profuse sweat and sound sleep. " After having found the beneficial effects of the medicine ' Mr. Rowe, of Portsea; Mem. Med. Society of London, toI. vi, p. 571. ' Mr. Hunter, of Dumbarton j Med. and Physical Journal, vol. x, pp. 234-6. DR. PEARSON'S ACCOUNT. 239 in injections, it& internal use by the mouth was tried ; the pre- paration made use of was the Vinum Nicotianse, given at first in small doses, frequently repeated, combined with some aro- matic water, or tincture ; it was always pushed so far as to produce giddiness of the head, or nausea, and when carried this length, it almost in every instance brought on a large dis- charge by the skin and kidneys, and sound sleep ; it also caused a considerable increase of expectoration, and relieved the cough; indeed, in my opinion, its anodyne effects were equal to those of opium j and, as it aided the discharge from the breast, which the other retarded, it was undoubtedly preferable. " Since I first became acquainted with the sudorific and nar- cotic powers of the nicotiana, it has been used in every case that came under my management, except those where gripes, and bloody, slimy stools took place, and always with evident advantage, nor did I see in any one instance the least dis- agreeable circumstance arise from its use. " When after the first exhibition of the medicine any fever remained, and the cough was troublesome, a second dose was given in the course of two or three days after the first, and managed just in the same way ; the operation was equally suc- cessful as before, and the symptoms proportionally diminished ; a third application I never had occasion to make. I wish, however, to remark, that during the course of a month that the medicines, as mentioned in the beginning of this paper, were used, my practice was tolerably successful, but not equal to what it was afterwards, as my patients both recovered with less pain, and in a much shorter period, by the use of nicotiana than by all the other remedies formerly employed." DR. RICHARD PEARSON.^ "The catarrhal fever, or influenza, which has lately spread itself over the whole metropolis, and has since made its way to almost every part of the kingdom, first shewed itself here about the middle of February, when a damp and mild state of the atmosphere had succeeded to severe cold. This again was fol- lowed by frost, and keen northerly and easterly winds during the ' Observations on the Epidemic Catarrhal Fever, or Influenza, of 1803. By Richard Pearson, M.D. London, 1803. 240 EPIDEMIC OF 1803. first part of March, the latter part of which was very warm. In the beginning of April, the weather was mild and rainy; in the middle dry and fine, the noon-days remarkably warm, but the mornings and evenings cold. Wind east. The latter part of the month was cloudy, windy, and very cold, with showers of rain and hail. Wind westerly and northerly. The last week of this month was unusually cold. This severe weather occasioned a great aggravation of the pulmonary symptoms. "Like all former catarrhal epidemics, the present influenza has exhibited various degrees of morbid affection; having been in some instances so slight, as not to incapacitate persons from continuing their ordinary occupations and pursuits, and scarcely to require the aid of medicine; while, in others, the attack has been of such a malignant nature, as to endanger and even destroy life. ^ "The following is its most frequent mode of attack: — After some alternations of chilliness and heat, the patient is seized with a heaviness or pain of the head, with sneezing, wateriness of the eyes,^ hoarseness, and cough. These symptoms come on in the order here stated. In the course of a few hours the headach increases, the skin becomes hot, with pains in the back and limbs, or transitory stitches across the chest. The tongue is white; the pTilse quick or frequent, and for the most part soft. There is more or less of sickness at the stomach, and sometimes vomiting. The bowels are generally costive; and considerable uneasiness, or even a distressing pain, is felt in some part of the abdomen in many instances. By the second or third night, the cough and fever become greatly aggravated. The former, viz., the cough, is strong and incessant, sometimes dry, but often • " Between these epidemics, and the condition of the atmosphere, there seems to be a connection different from that which depends upon a mere alteration of tempe- rature, or of dryness and moisture ; but what that peculiar connection is, we shall not attempt to explain. Yet it is proper to notice the changes of temperature, and other sensible qualities of the atmosphere, as giving rise to the predominance of a certain set of symptoms at one time more than another. Thus in frosty weather, and during northerly and easterly winds, the catarrhal and peripneumonic affection will be mo^ conspicuous ; while in warm weather, and during westerly and southerly winds, the headach, sickness, disordered bowels, glandular swellings, &c., will con- stitute the most urgent symptoms. All these modifications have been observed during the changes of the weather in the present epidemic." " " In some, an inflammatory appearance of the vessels of the tunica conjunctiva, and a puflfy swelling of the eyelids." DR. PEARSON'S ACCOUNT. 241 accompanied (even at its first coming on) with an expectoration of thin sharp mucus; the latter, viz., the fever, is attended with increased heat, and with extreme restlessness and anxiety. There is also some confusion of the head. At this time the pulse is often from 110 to 120. In the morning there is a con- siderable remission of the febrile symptoms; but the cough (with more or less dyspnoea) still continues urgent, and the patient complains of excessive languor and dejection of spirits. "After the third or fifth day, where early perspirations have come on, or sufiicient evacuations have been procured by the stomach and bowels, the fever declines; and although the cough continues, the expectoration is more free, the sputum being of a thicker consistence and milder quality. The urine, which before was high-coloured and clear, now becomes turbid, or throws down a sediment. In other instances the cough con- tinues very troublesome for many days, or even some weeks, after the abatement or cessation of the fever, and goes off very tediously without any remarkable degree of expectoration. "The lassitude and depression of spirits, with restless nights, harass the patient for many days after the decline of the fever; which, indeed, in several instances, does not entirely go ofi" after the fifth day, but becomes intermittent, the patient feeling him- self worse every other day. "Such is the most common form of this epidemic. Its modifications, however, as we have before observed, are ex- tremely numerous, so that in some there is a violent headach, with little catarrhal affection, in others a sore throat, in others a peripneumonic condition, and in others a disordered state of the stomach and bowels.^ In several instances, swellings of the parotid, maxillary, and cervical glands have been observed, especially during the month of April; i. e., towards the decline of the epidemic. These and other varieties have been parti- cularly noticed in the histories of former epidemic catarrhal fevers, to which (in order to avoid repetition) the reader is referred. Relapses were not uncommon. In such cases the mucous covering of the tongue was generally yellow or brown, (not white, as in the first attack,) and the whole condition of the patients resembled that of low fever. ' " The stools are more or less bilious in all instances. In some they are of a very dark colour and extremely offensive." 16 242 EPIDEMIC OF 1803. "From this sketcli of the disorder, it is evident that this epidemic differs from a common catarrh, in the degree and kind of fever with which it is accompanied j and that, as it is the fever which constitutes the essence of this disease, and not the catarrh, it should be denominated epidemic catarrhal fever, or synochus catarrhalis, and not simply epidemic catarrh. i Its infectious nature can scarcely be doubted; but how long its contagion is capable of being applied before it takes effect, and what are the circumstances most favorable to its action, are points which have not yet been duly investigated. "As it is the fever which constitutes the essence of this disease, our first attention should be directed to it, and not to the cough (except when it is accompanied with pneumonic in- flammation); otherwise, by prescribing only for one of its symptoms, we shall make but little impression upon the general morbid affection, "We are not, therefore, to begin the cure with pectoral medicines, but with such, remedies as are capable of acting upon the system at large through the medium of ±he stomach and intestinal canal. Such are emetics, and mercurial and anti- monial cathartics. "A bad taste in the mouth, oppression about the epigastric region, and nausea, indicate the use of an emetic, which even where some of these symptoms are wanting, should seldom be omitted. But, whether an emetic be administered or not, the bowels should be moved by a dose of calomel, joined with about half its weight of the Pulv. Antimonalis, Ph. Lond. "If, after some hours, this medicine shall not appear to be sufficiently active, its operation should be promoted by a solution of the Kali Tartarisatum, Magnesia Vitriolata, or some other neutral salt, the patient all the while diluting freely with some tepid mucilaginous drink. "Before the purgative operation takes place, this combi- nation of calomel and antimonial powder produces a marked effect upon the skin, and a general diaphoresis breaks out. Nor does this appear to be checked in any considerable degree by the subsequent discharge from the bowels; before the coming on of which, a pediluvium may sometimes be used with ad- vantage. ' " In certain situations the fever degenerates into tlie typhus kind." DE. PEARSON'S ACCOUNT. 243 "As the calomel and antimonial powder produce their effect, the headach, anxiety, and heat of the skin abate. The cough, however, and dyspnoea, are little altered, and require the appli- cation of a blister. They are also further relieved by draughts composed of Aqua Ammonia Acetatis, and ^ther, or Sp. ^th. Nitros., mixed with a proper quantity of common water, or mint water.^ "After evacuations by stool have been procured, opiates afford relief; but they should be prescribed in very small quantities, a full dose producing great mischief in this stage of the disorder. The Syrupus Papav. Alb. is a convenient preparation. Of this one drachm may be given to an adult, joined with five or six drops of the Tinctura Opii. To young persons a double quan- tity of the syrup may be given, without the opiate tincture.^ "The day after the operation of the mercurial and anti- monial purge, the patient should drink freely of a solution of crystals of tartar in common water, unless (a circumstance whjch we have rarely observed in the present epidemic) a loose state of the bowels should come on.^ "The solution of this acidulous salt (the crystals of tartar) forms a pleasant and refreshing beveragej aud, along with its beneficial action upon the bowels, promotes a flow of urine, a mode of operation which contributes in no small degree to the removal of the fever. " Where the bowels are not readily acted upon by the medi- cines above mentioned, it will be necessary to have recourse to clysters, which indeed are most indispensable in the case of children. "In the course of this disorder, the calomel should be repeated 2 or 3 times, without the antimonial,* and in smaller doses. ' " The inhalation of sether-vapour is not so benaficial in this epidemic as it is in simple catarrh. Where, however, the cough is dry, and the dyspnoea urgent, with- out being accompanied with pneumonic inflammation, it may be resorted to with ^ " The dose of the opiate tincture may be increased towards the decline of the fever ; but even in the advanced stage of the complaint it will seldom be proper to exceed fifteen drops. I wish to call the attention of practitioners to the difference between small and large doses of opium in this epidemic." ' " In that case the spontaneous evacuation is not to be checked. Plentiful dilu- tion, with blisters and mild opiates, will form the whole of the cure." * " Without the antimonial, if there be no peripneumonic affection ; if there be, either with it or with small doses of ipecacuanha." 21i EPIDEMIC OF 1803. "To promote expectoratioiij squill, in some form or other, will now be proper, provided the heat of the skin and frequency of the pulse shall have been greatly abated; i. e., provided the fever shall, for the most part, have subsided. It may be joined with the Aq. Ammon. Acetat. and Sp. ^ther. Nitros; but oily medicines, and the common pectoral emulsions, are of very little use. Mucilages, however, such as gum arable or tragacanth, may, in some instances, be advantageously joined with the squill. Also small doses of ipecacuanha. "In the beginning of the attack a moisture upon the skin is doubtless salutary; but after the second or third day, it is not desirable to excite a perspiration by keeping the patient in bed, and giving him strong sudorific medicines and warm liquors, as in the case of a common catarrh. The heat which accompanies such a sweating process aggravates the fever, and the forced diaphoresis is constantly followed by increased languor and dejection of spirits. The recovery, under such circumstances, is extremely tedious. "Paying less attention, therefore, to the catarrhal symptoms than to the general febrile affection, we should avoid all accu- mulation of external heat; and after the third day (except in those few cases where violent pneumonic inflammation occurs), direct the patient to sit out of bed, allowing him cool drinks, and taking care to have the room kept cool, and properly ven- tilated, especially when the temperature of the atmosphere exceeds 45 or 50° of Fahrenheit's thermometer.^ "Whether the fever goes off entirely, or puts on an inter- mittent form, great languor and depression of spirits, with want of appetite, remain for many days. Contrary to what is ob- served in other cases of febrile debility, the Peruvian bark and mineral acids are here of no avail. They even do harm. But ' "As the weather grew warmer, the symptoms of the influenza in 1782 were more severe, and the recoveries more tedious ; and the inhabitants of low and close situations had the disease worse than the inhabitants of high ones. In some hospital patients it wore a maUgnant aspect. See the account drawn up by Dr. Gray. In like manner it is recorded by Sir G. Baker (on the authority of Dr. Petrie), that in the neighbourhood of Lincoln the epidemic of 1762 raged with unusual violence in low situations ; that is, in places where a due ventilation was wanting. (Baker, 'De Catarrho Epidemico.') And in the present epidemic, persons employed in heated and crowded workshops have had the disorder in its severest forms." DR. PEARSON'S ACCOUNT. 245 infusions of the simple bitters, or a solution of myrrhj may be prescribed with good effect, especially when joined with the acetated kali, or prepared natron. This last combination agi-ees best with young subjects. "At this period a less restrained use of opium is admissible, in order to counteract the disturbed nights. "During the convalescence, the bowels are liable to occa- sional irregularity; which, if it incline to costiveness, will require a repetition of the calomel, in a smaller dose, with the addition of a grain or two of aloes ; or the Pil. Aloes cum Myrrhi may in some cases be given without the calomel. "Throughout the whole progress of the disorder, the diet should consist of mucilaginous vegetable decoctions, and of animal jellies, flavoured with subacid vegetable juices. Broths should not be allowed during the feverish state, as they tend to keep up an unsalutary perspiration, and never fail to increase the headach, nausea, and languor. "When the disease is complicated with pulmonary inflam- mation, the same remedies are to be employed (the lancet, however, not quite so freely,) as in the case of simple peri- pneumony; but after the removal of the local inflammation, calomel should be given in small doses, together with the saline diuretics before mentioned, in order to counteract the morbid condition of the system at large. It is to be remarked, however, that free and brisk purging is not so well suited to the cases of this fever which are complicated with pneumonic inflammation, as to the other forms of the epidemic;^ but early and gentle evacuations by the bowels are serviceable, even in the first-mentioned cases. When venesection is judged necessary, it should be resorted to in the beginning of the at- tack ; for after three or four days have elapsed, the period for employing the lancet with advantage, or perhaps with safety, is past. A middle aged patient who, in the month of Mai'ch last, had the catarrhal fever complicated with pneumonia and diaphragmitis, was blooded on the fourth day of the disorder, and again on the following day. The blood exhibited a strong bufiy coat ; but the case terminated fatally on the sixth day. ' " In like manner brisk and copious purging was not suited to very old people nor to consumptive subjects. In these a gentle and moderate catharsis answered best." 246 EPIDEMIC OF 1803. Those who have seen much of this epidemic will easUy bring to their recollection many similar instances of the unsuccessful employment of bloodletting in the advanced stage of the dis- order, though accompanied with symptoms of local inflammation, "Recapitulation of the Nocentia and Juvantia in this Epidemic. "things hurtful. "things useful. 1. Bleeding, except in those few cases I. That degree of diaphoresis, which ■where there is evident pneumonic either comes on spontaneously, or inflammation; and even then, unless is consequent to the mercurial and employed in the beginning. antimonial medicine given at the beginning of the attack. 2. Forcing out sweats by accumulation of 2. Copious evacuations by stool. external beat and strong sudorifics. 3. Emulsions, and other oily pectoral 3. Blisters and sether, or Sp. seth. uitros- medicines. 4. Large doses of opium in the beginning 4. Small doses of opium (after the bowels of the disorder. have been acted upon), gradually in- creased as the fever declines. 5. A close and unventilated room. 5. Promoting a flow of urine by a solu- tion of crystals of tartar. 6. Broths and warm animal decoctions, 6. A cool and well ventilated room. while the febrile state subsists. 7. The Peruvian bark, with very few ex- 7. Infusions of the simple bitters, joined ceptions, even in the advanced stage with the acetated kali or prepared of the disorder. natron.'' 3. DR. CARRICK.^ " 1. The first case of influenza that occurred to me with symptoms distinctly marked, from the very frequent catarrhal affections of the season, was on the 5th of March. In the course of a single week from that period, the disorder had become remarkably general, and continued with unabating frequency a fortnight longer. It then speedily declined both in frequency and severity, and very soon ceased to be epidemic, although a few insulated cases continued to occur for a length of time. " 2. The complaint was at first generally (I may say uni- ' Observations on the Influenza, as it appeared at Bristol in the year 1803. By Dr. A. Carrick. Being Answers to certain Questions respecting that Disease, trans- mitted to him by Dr. Richard Pearson, Physician, London. (Annals of Medicine, vol, iii, p. 410.) DR. CARRICK'S OBSERVATIONS. 247 formly) accompanied with inflammatory symptoms. The nearer the commencement of the epidemic, these were the more con- siderable, and continued to decline during its progress, so that, in the latter instances, they were scarcely, if at all, perceptible. As this change of symptoms might be influenced by the tem- perature of the atmosphere, I shall subjoin a register of the weather at Clifton for the months of February, March, and April. "3. The cases in which no sensible affection of the lungs took place, were, about the commencement of the disorder, not more than one in twenty. The cases attended with ithminent pulmonic inflammation, (pleurisy or peripneumony in a high degree,) so as to indicate the use of the lancet, were at no time more than one in thirty. In the progress of the complaint, these proportions varied exceedingly. " 4. The influenza was in general accompanied with a greater degree of languor than usually attends inflammatory disorders ; and the pains in the back, and headache, bore some resemblance to typhus. These symptoms were particularly striking, when the throat happened to be inflamed and ulcerated ; but latterly I have observed this languor and dejection to a very great degree in cases where no inflammation or ulceration of the throat took place. " 5. The actions of the stomach and bowels were not in general disturbed, at least not in any particular or unusual manner. Constipation was not unfrequent at the commence- ment of the attack. In some cases, bile was evacuated in large quantities by stool; but, in the majority of cases, the stools were not unnatural ; neither was vomiting a frequent symptom. " 6. The expectoration was in general proportionable to the degree of pulmonic affection. " 7. It is not easy rigidly to prove or to disprove the con- tagious nature of this epidemic. The opposing facts and argu- ments are numerous. But I must decline giving any opinion of my own. It is not opinions you ask, but facts. In many cases, a whole family, of a dozen persons and upwards, have been seized with the disorder, one after another, in such a manner as to induce the belief that they caught it of each other, while in many other families, similarly circumstanced, (as to situation, exposure, age, &c.), only one or two have been affected, while all the rest escaped. In the first-mentioned 248 EPIDEMIC OF 1803. caseSj the intervals of attack in the different individuals were from one to two or three days, in women, which, although a shorter period than usually takes place in most infectious disorders, is by no means without example in the history of contagion. Even in cases where two or three individuals of a family were seized with the complaint at nearly the same moment, we have not an absolute disproof of infection; for while the disease was so extremely prevalent, it was impossible to conjecture, with any degree of certainty, from whence or at what precise time the infection (supposing it to be infectious) took place. The slow progression of the disorder from one place to another seems to oppose the supposition of its arising from the constitution of the atmosphere, or from anything wafted in it. The influenza was certainly prevalent in London, at least two or three weeks before it made its appearance in this neighbourhood; although the course and velocity of the ■wind, during that period, were such as to bring the whole atmosphere across the country in one day. By such accounts as I have been able to procure from Edinburgh, nearly a mouth must have elapsed from the first appearance of the disease in London before it reached that place, although the wind was for many days of that interval pretty violent from the south-west. Moreover, if the disease depended on the atmosphere, or on anything carried along with it from the e istern countries, it ought to have made its appearance equally soon on the east coast of Scotland as that of England; whereas the history of its progress, the periods at which it commenced or became general in various parts of the kingdom, seem to favour the supposition of its having been originally imported into London, and the parts adjacent, by the Straits of Dover, and thence propagated to different parts of the island according to their respective distances and intercourse. On the other hand, it must not be denied, that many cir- cumstances were observable, which tend to invalidate this supposition, and to induce a behef that the disorder arose entirely from the condition and temperature of the atmosphere. The epidemic, whatsoever might be its nature, was evidently regulated in au imminent degree by the degree of exposure to cold, and to the sharp east winds which at that time prevailed. Those persons, who by choice or accident, remained in the DR. CARRICK'S OBSERVATIONS. 249 house, either in general escaped the disease entirely, or had it much more slightly than those who exposed themselves, par- ticularly if the house was warm and comfortable, or in a low and sheltered situation, and screened by adjacent heights from the north-east wind. In that part of Clifton, called the Hot- Wells, which is sheltered in a very great degree from the north and east, the influenza was comparatively rare, as well as mild. In the low, confined, and ill-ventilated houses in the Hot-well road, where typhus often abounds, the influenza was likewise very unfrequentj while in the exposed high-lying buildings on Clifton-hill, it was almost universal. One of the most open and exposed of these is Richmond Terrace, which forms three sides of a parallelogram, fronting respectively the east, south, and west. On the east side of this Terrace, not one family, and scarcely an individual, escaped the complaint; while on the south side a great majority, both of persons and families, in all other respects similarly circumstanced, escaped entirely. That the catarrhal and pneumonic symptoms were chiefly owing to cold, appears, from their having been more or less frequent and severe, according to the degree of cold at the time. After the breaking up of the frost, very few instances of the complaint were accompanied with catarrhal or pneu- monic symptoms ; and the most recent cases have been uni- formly exempted from them. In these the attack could hardly be distinguished from that of ordinary typhus; but in their progress and general habits, they bore an exact resemblance (in all other respects) to the late epidemic. " 8. No opportunity occurred to me, of observing the ap- pearances after death. Indeed very few died of the disorder in this neighbourhood : and of these, most, or perhaps all, seemed to fall victims to the accompanying pneumonia. " 9. The inflammatory symptoms yielded in general to the combined action of antimonials, diluents, purgatives, and blisters, even where they were considerable. But it is equally true, that in other cases the inflammation resisted these ; and when the lancet was altogether or too long withheld, death was the cousequence. " Several instances occurred to me of pneumonia in its most violent degree, superinduced by the influsnza, where the lancet was imperiously called for, and repeatedly employed; twice. 250 EPIDEMIC OF 1803. thrice, and, in one case, five times, with as liberal a hand as in ordinary pneumonia, and with as eminent and uniform ad- vantage. The loss of blood was borne every bit as well as in other diseases, where bleeding is indicated. No case so treated terminated fatally. But, on the other hand, I witnessed the unfortunate termination of several, where the patients, I am fully persuaded, fell victims to an unfounded terror of vense- section in all cases of the influenza; derived, I suspect, from some foolish paragraphs in newspapers, which not only mate- rially influenced the opinion of the pubhc at large, but likewise that of many medical practitioners. " 10. In the milder cases of this epidemic, perspiration was in general very easily excited, and sometimes, likewise, easily and unintentionally protracted beyond the duration of any apparent febrile action. As under these circumstances it could not be expected to do any good, it was of course discouraged. And although it was certainly possible in such cases to carry per- spiration, and detention in bed, to an hurtful extreme ; yet this could scarcely be supposed ever to happen where any prac- titioner of common sense was consulted. Upon the whole I have no hesitation in declaring, that decided advantage seemed to be derived from keeping up a moderate diaphoresis for one, two, or three days, by means of the more gentle, aqueous, saline, and antimonial diaphoretics, with a room and bed of moderate temperature. Powerful sudorifics, or great external heat, were seldom employed or necessary. "11. The liberal use of purgatives was always beneficial, particularly in relieving the distressing headache, which so fre- quently attended this disorder. The choice of the medicine seemed to be of but small importance. Calomel, being taste- less, and little liable to excite nausea, was perhaps in general the most eligible. But the common senna mixture, or neutral salts, or castor-oil, seemed to be of equal utility in those cases where they were employed. " 13. There cannot be a doubt that full doses of opium in the commencement of the disorder, where the inflammatory action was considerable, with much heat, dyspnoea, headache, and constipated bowels, must have proved highly injurious. But on this point! cannot speak from experience; common sense must have forbid it. I have, however, frequently ob- DR. CARRICK'S OBSERVATIONS. 351 served very great relief from moderate anodyneSj given to allay cough in every stage of the complaint, where their exhibition was not particularly counter-indicated, — such as syrup or extract of poppies, extract of hyoscyamus, or even opium. Although I had little or no opportunity of ohserving per- nicious effects from the injudicious administration of opiates, it was not so with regard to wine and animal food. The pro- pensity of human nature, to search for and to frame some reason or excuse, for what it likes and relishes, together with the idle paragraphs in newspapers formerly mentioned, had induced a pretty general bias in favour of a generous regimen in this disease, which in some cases it was not easy to remove. It was, however, in almost every instance, evidently pernicious, particularly in the early stages, and near the commencement of the epidemic; and as this disorder was at that period so universally of an inflammatory nature it could not possibly be otherwise. " Some, to be sure, did survive such a regimen, but that is no proof of its propriety; for it is very well known that patients in almost all diseases will sometimes struggle through in spite of any bad treatment. 31 47 56 29 9 29 9 w w 1 foggy fine •368 Moon 1803. Thermometer Barometer Winds. Weather. and Kain. AprU. 8 a.m. 2 p.m. 8 a.m. 2p .m. 8 a.m. Str. 2pja. Str. 8 a.m. 2 p.m. 1 47 64 29 9 29 7 SE 1 SE 1 fine fine 2 60 54 29 5 29 4 SW 1 S 2 cloudy cloudy 3 44 66 29 4 29 4 SW 1 S 1 cloudy fine 4 48 63 29 4 29 6 S 2 SE 2 cloudy cloudy 5 49 66 29 6 29 8 S 3 SW 2 showery showery O 6 50 66 29 8 29 8 S 2 SW 1 cloudy cloudy 7 50 65 29 6 29 4 SE 2 SE I cloudy showery 8 48 54 29 6 29 6 E 1 cloudy showery 9 47 56 29 8 29 8 NE 1 cloudy cloudy 10 49 58 29 9 30 NW 1 fine fine 11 47 62 30 2 30 2 NE 1 fine fine 12 60 62 30 2 30 3 NE 1 fine fine 13 48 68 30 3 30 1 E 1 fine fine 14 48 70 30 2 30 2 SE 1 foggy fine € 16 51 72 30 1 30 fine fine 16 66 66 30 29 8 SE 2 fine fine 17 50 64 29 7 29 7 SW 3 SW 1 showery showery 18 42 48 29 6 29 7 W 2 w 2 hall showery 19 49 60 29 6 29 5 w 3 w 3 showery showery 20 42 48 29 4 29 6 w 2 w 2 showery showery 21 48 46 29 29 w 4 w 3 showery showery 22 40 47 29 29 w 3 w 1 showery showery T> 23 40 52 29 2 29 3 w w 1 showery fine 24 45 60 29 4 29 4 w w 2 fine fine 26 41 61 29 7 29 7 w 1 fine fine 26 40 49 29 7 29 7 w w 2 fine fine 27 40 48 29 6 29 6 NE NE 2 rainy showery 28 42 48 29 7 29 7 NW N I cloudy cloudy 29 43 64 29 8 29 8 w I cloudy fine » 30 46 61 20 » 29 6 SW SE 2 fine showery 1-095 DR. FALCONER'S ACCOUNT. 253 4. DR. FALCONER.^ " The first appearance of the influenzaj in such a form as to admit of no doubt respecting its nature^ took place, as far as I can learn, about the middle of February 1803. " The access of this epidemic was not, I believe, distinguished by any symptoms essentially diflferent from those that usually mark the coming on of feverish complaints, especially those which incline to an inflammatory diathesis. Chilliness, shiver- ing, a sensation resembling that of cold water running down the spine of the back, and often considerable pain in that part, together with a sensation of weariness and stiffness in the limbs, were, in general, the first symptoms. In some the ap- proach of these was gradual ; but in many they came on with such suddenness, as to be almost instantaneous, and were in general more vehement than those of a similar kind which mark the approach of the usual catarrhal complaints of the season. " The above symptoms were soon followed by feverish heat, headache, cough, and difSculty of respiration ; together with an acrid distillation from the nose, great pain and throbbing of the temples, and great desire to spit, or throw off, by efforts of that kind, the mucus which collected in an inordinate quantity on the bronchial glands, and those of the faiices. The cough was in some subjects slight and inconsiderable, in others loud and oppressive; and nevertheless often ineffectual to produce relief by the expectoration of mucus. The skin was at this period, in general, hot and dry, though in some persons sweats came on early in the complaint. In some bad cases, the peripneumonic symptoms increased to a great degree, the pulse rose to 100, 120 and 150, and were scarcely to be kept under by the most powerful remedies. Such cases, however, though not of extraordinary occurrence, were not, I believe, very frequent. Out of more than 100 patients at the Bath Hospital, who were seized with the influenza, only six were attended with peripneumonic symptoms to any considerable degree. I must however own, that, in my private practice, the I An Account of the Epidemic Catarrhal Fever, commonly called the Influenza, as it appeared at Bath in the Winter and Spring of the year 1803. By William Falconer, M.D. F.R.S. Bath, 1803. 254 EPIDEMIC OF 1803. proportion of severe peripneumonic cases exceeded considerably what appeared in the Bath Hospital^ probably because the advice of a physician was seldom asked in this disease, except in cases that were attended with some anxiety respecting the event. "VertigOj and that to a considerable degree, was, in some persons, one of the first signs of the disease, and, in several instances, very alarming and distressful. I saw a lady affected to such a degree as not to be able to raise her head from the pillow without losing all sense, and to whom all objects ap- peared thrice multiplied; and these uncouth symptoms con- tinued four days in their full extent. I observed in several persons, that where the vertigo was most troublesome, and appeared early in the disease, the peripneumonic symptoms were but slight, and vice-versd. Two of the worst cases of the peripneumonic kind that I saw, were not attended with any symptoms of vertigo. Those who were affected with vertigo, even to a less degree than in the case above described, were nevertheless unable to read a letter or a few lines in a book; and in several a degree of delirium took place during the night, but not, as I saw, to any violent degree.' " The expectoration, in ordinary cases, differed little from what is spit up in a common catarrh; but in those instances where the peripneumonic symptoms were much aggravated, it was very large, of a yellow colour, and scarcely to be distin- guished from simple pus; it was, however, thrown up with difficulty in several persons, and their inability to cough it up completely, was one of the most alarming symptoms, and what I saw, in some instances, prove fatal. The breath was frequently much oppressed, and a great source of uneasiness : I counted it, in several instances, to be more than forty-five respirations in a minute. " Several persons, at the beginning of the disease, com- plained of soreness of the throat ; but no particular appearance in the fauces was observable, and in a few days it either went off altogether, or became so inconsiderable as to be nearly dis- regarded among so many other distressful symptoms. The catarrh or d^fluxion was, towards the beginning of the disease, ' " Dr. Haygarth has since informed me, that he saw one case attended with strong delirium." DR. FALCONER'S ACCOUNT. 255 thin and acrimonious ; but in a few days disappeared, especially in such cases as were combined with peripneumonyj being probably carried off by the expectoration. " Pains of the limbs, especially about the joints, occurred to a considerable degree, in some instances in which the other symptoms were moderate, but generally went off in a few days. In one instance, however, they continued, in a very trouble- some degree, several weeks after the symptoms of the original disease had ceased. The body was, in those instances, I had an opportunity of observing, inclined to be costive during the course of the disease ; and I find that to have been the case with the patients at the Bath Hospital. I have, however, been informed, that a purging came on in some persons early in the complaint ; nothing, however, remarkable was observed in the appearance of this evacuation. " The urine was in quantity nearly as in health, but generally of a dark reddish colour, clear, and depositing no sediment. As the disease declined, it became tinged with a pink or whitish sediment, and paler in colour. In some cases the amendment was marked merely by the increase of quantity and change of colour in the urine to a pale amber hue, without any sediment being deposited. " The tongue was, at the beginning of the disease, hot and dry, and of a deep red hue. It soon, however, became moist, and of a whitish brown colour, and in some covered with a foul thick crust. In some instances, and those not the most favorable, the tongue was little affected, which I have often observed to be the case, even where the symptoms were very pressing, in cases accompanied with large expectoration. " The skin was at first hot and dry, but this soon gave way to gentle perspiration, which took place pretty universally over the body as the disease abated. The appetite was, in the cases I saw, almost entirely destroyed, and the thirst pretty considerable. Acid juices of fruits were to some particularly agreeable J but after a few days' use, seamed to create dis- gust. Iced creams, moderately taken, were highly acceptable, and served to cool the mouth and fauces ; the heat and dryness of which were among the most uneasy symptoms. " The pulse was variable, in some very quick, even to 150 in a minute 5 in others, not exceeding 80 or 90. Out of 256 EPIDEMIC OF 1803. upwards of 100 persons afflicted with this complaint at the hospital, the pulse in no instance exceeded 100 beats in a minute. " In one of the worst cases I saw, the pulse never exceeded 72 beats in a minute, which was the usual number in health. Yet the patient at that time had every other symptom of peripneumonic fever, great heat, thirst and cough, with expec- toration so difficult that I apprehended suffocation would speedily take place ; and when, to relieve these urgent sym- ptoms, she was bled, as she was, twice in one day, to fourteen ounces, the blood drawn was so tenacious as to bear being lifted entire with a pin out of the cup of the crust, without affording more than a few drops of serum. " The debility that followed this complaint marked it very strongly. Few persons recovered their strength in less than three weeks, and several persons were so reduced as to be sensible of its weakening effects for a longer time after the fever had entirely ceased. In some a dimness of vision con- tinued sometime after the strength was pretty well recovered. " I have not had an opportunity of personally inspecting the body of any one who died of this disease, which was opened; but the following account, authenticated by several medical persons of respectable character, was communicated to me by a gentleman who was an eye-witness, and whose accuracy and judgment may safely be trusted. I shall, therefore, make no scruple of giving the detail of the case in his own words. " Dr. Broderip's Account of a Case of Influenza, and what was observed on opening the Body. " ' I was desired to visit M. Ditcher, a young woman, in the 21st year of her age, who was indisposed with the prevailing epidemic disease; it was on the ninth day of her indisposition; and I found her in imminent danger. Upon inquiry into the origin of her complaint, and the symptoms which attended the incipient state of it, she informed me, that she was first seized with cold shivering over the whole body, drowsiness, and fre- quent chiUs, passing in the direction of the vertebrse; this was succeeded by feverish heat, a violent pain in her head, prin- cipally across her forehead, and immediately above the eyes ; throbbing at the temples, an acrid discharge from the nostrils. DR. FALCONER'S ACCOUNT. 257 troublesome cough, and difficulty of breathing. The following day she was troubled with an internal pain, which she de- scribed as directly underneath the left mamma ; her respiration was more hurried, and she became more thirsty; her urine was very high-coloured, and, after standing a short time, threw down a considerable lateritious sediment ; her tongue was much furred; and the phlegm which she attempted to expectorate was so tenacious, that she could not loosen it from the fauces. With remissions in the day, but returning with more violence towards evening, the train of the chief symptoms continued to the day of my seeing her. "When I called, she was sitting in her bed, gasping for breath, and apprehensive of syncope. Her cough was incessant, and of a peculiar kind; she expectorated a small quantity of mucus tinged with blood, her pulse was at 140, low, small and tremulous. Her tongue was foul, but not dry; the coating different from what is usual in febrile affections, and more resembling the appearance which we generally find in cases of croup. She complained of unusual pain; but particularly at the back part of the head, and across her chest; in short, her situation presented one of those distressing cases which result from inflammation, protracted from the omission of timely bleeding, &c. Immediately on leaving the room I expressed my concern that she had not applied earUer to the medical gentleman who was then attending her ; and submitted to him my opinion of the morbid state in which the thoracic viscera would probably be found, upon dissection, after death. " Soothing and such medicines as appeared to me the best calculated to relieve the pressure of the various symptoms, were administered till the 13th day, when she was suddenly seized with general spasm, and expired. The following day the body was opened by Mr. Cam, in the presence of Dr. Davis. When the contents of the thorax were exposed to view, the anterior part presented nothing remarkable ; but in attempting to take up the long lobe of the left lung, we found that adhesive in- flammation had taken place over the whole posterior surface of that lobe. The adhesive exudation was considerable, and had attached that part of the lungs to the corresponding costal pleura, though the pleura itself was not inflamed; but the connecting medium, being newly farmed, readily gave way to 17 258 EPIDEMIC OF 1803. the pressure of the hand, and enabled us to examine the pos- terior part of the lobe, which we found in a condition highly- morbid. That part of the pleura, which is reflected over the lungs for its external membrane, peeled off in the same manner as the cuticle of a foetus does, which has been some time dead in the uterus ; the substance of the lung was of a dark, livid colour, and appeared in a gangrenous state ; some vessels had given way in the diseased part, and about three ounces of extravasated serum, and some coagula, were found in the de- pending part of the thorax. Upon cutting into the lungs we found a good deal of extravasated coagulable lymph in its substance, and a very extraordinary quantity of blood was con- gealed in the vessels. The ramifications of the bronchia were loaded with puriform matterj and upon removing and dividing a portion of the trachea, just above the beginning of the bronchia, we found its inner lining in a high state of inflam- mation ; the whole surface of the membrane putting on the ap- pearance of what is usually termed 'great vascularity,' or, could we associate the idea of beauty with a destructive morbid action, I should say, that it. looked like a beautiful preparation of a membrane, where the vessels designed to carry lymph had been filled with a vermilion injection. On viewing the inner membrane of the trachea with a magnifying glass, ulcers were clearly perceived at the edges of the small holes which supply the trachea with mucus, to defend it from the acrimony of the air. " Upon dividing the pericardium the heart appeared natural ; but, on the posterior or lower side, the coronary veins were remarkably turgid with blood. The water in the pericardium was more than usual, but not exceeding what is sometimes met with in subjects unconnected with disease. " We were not permitted to extend our examination to the other viscera, — a circumstance which would have been a cause of much regret, had not the morbid state of the thoracic ' viscera so clearly evinced the nature and principal seat of the disease. " It may be proper to remark that the costal pleura, not being inflamed, accounts, in some measure, for the little relief aff'orded by blisters ; and it may not be undeserving of notice, that the patient's description of the seat of pain is deceptive; DR. FALCONER'S ACCOUNT. 259 for notwithstanding the disease was at the posterior part of the lungs, the sensation of pain was uniformly described as imme- diately beneath the anterior part of the chest." " We have perused the above accurate description, and find it perfectly conformable to the appearances presented by the *^^''^''*^o°- "J. F.Davis, M.D. " Thomas C. Cam, Surgeon." " But notwithstanding this formidable detail of symptoms, the mortality that followed was not so great as might be ap- prehended, though greater than was commonly imagined. At the general hospital, in this city, where upwards of 100 persons had the disease, not one died, though several suffered severely. Four persons of those I attended died, and all of them peri- pneumonic; but one of them had been subject to pulmonary complaints, and in a valetudinary state for the last six months; another was in the decline of life and debilitated by repeated gouty attacks, and had his end hastened by a suppression of urine, which, though relieved by the catheter, introduced without much trouble by an able surgeon, produced so much distress as to contribute in no small degree to his death. All whose cases terminated unfortunately were considerably past the meridian of life. " What proportion of people in society were attacked with this disease, I am unable to say. A large number were cer- tainly affected ; and it appeared to make no distinction in age, sex, habit of body, or state of health. The general hospital, which contained, at the time when the disease made its appear- ance, about 125 patients, had upwards of 100, or about 4 out of 5 seized with this complaint. " It will now be asked by what marks or symptoms is this epidemic distinguished, at or near its first appearance, from the usual complaints of the winter season, which it is acknowledged much to resemble? I wish I could answer this question satis- factorily; but I really know of no positive distinction, except in those cases wherein vertigo was among the first symptoms; which, though often occurring, was by no means a constant attendant on this disease.^ The suddenness of the attack, ' "Dr. Haygarth observed to me, that the prostration of strength was much greater than in a common catarrh ; but I did not myself observe this to be the case at its first coming on.'' 260 EPrDEMIC OF 1803. indeed, afforded a pretty strong presumption; but the epidemic spreading of the complaint afforded the strongest indication. All the symptoms, the vertigo excepted, which rarely occurs in catarrhs, and never I believe at their first coming on, are common to those complaints that accompany an inclement season of the year ; and it is more from the frequent appearance of the malady, and its aggravation of symptoms beyond a catarrh of the season, than from any specific diagnostic, that our judgmeut must be formed. " It is a matter of doubt with some, if this epidemic catarrh be a contagious disorder; or propagated from one person to another by infection, as the smallpox or measles; or whether it be owing to a general cause, as a particular disposition, or, as it was formerly called, constitution of air; affecting a large ■number of persons at the same time, which is the correct sense in which the word epidemical is used. " I have no doubt myself that it is contagious, in the strictest sense of the word. It has scarcely ever appeared without spreading to a vast extent; and has affected equally countries in the greatest variety, both in point of climate, and in the manners, diet, and habits of life of the inhabitants. But still there has always been a perceptible and, indeed, sufficiently- marked interval between its appearance in one country and another; and it has never appeared in all parts at once, as it would have done, had it been produced in each individual by some generally operating cause. " I proceed now to speak of the signs of amendment, or the contrary, that attend this disease. " The peripneumony has g,ppeared to me by far the most threatening symptom of any. The abatement, therefore, of the cough, and some relief of the breath, are primary objects; and except these can be attained, all other marks of amendment, even such as are drawn from the diminution of the numbers of the pulse, are fallacious, as I have experienced. A free and plentiful expectoration, if accompanied with the abatement of the difficulty of respiration, is a primary circumstance ; and next in importance to that, is an increased urinary discharge, which I have seen accompany the other, and prove, as it should seem, particularly serviceable. It is long before any appetite for solid food returns ; but some inclination for liquid nourish- ment is among the first marks of amendment, DR. FALCONER'S ACCOUNT. 261 " On the other hand^ when the difficulty and frequency of respiration both concur, in spite of the remedies used, the danger is increased ; notwithstanding, as I have just before observed, the number of the beats of the pulse be diminished. " I have not noticed any bad consequences that seemed con- nected with the vertigo, which, though threatening generally, went off in a few days. I shall now speak, as briefly as I can, of the practice which appeared to me most conducive to the cure. " And here I must freely own, that there appeared, in several instances, a strong necessity for active operations. The peripneumonic symptoms were so urgent as to supersede all general cautions respecting bleeding, and admitted of no alter- native. Nor have I observed, that the persons on whom this operation was practised, even to a considerable extent, suffered from any consequences that might be supposed to attend the excess of this evacuation. On the contrary, I found that those persons who were bled to such a degree as effectually to relieve, not merely to palliate, the more urgent symptoms, sooner recovered strength, than those on whom this operation had been most sparingly practised.^ In short, my decided opinion is, that, when it appears, in a threatening peripneumonic form, it must be treated in the same manner as is found effectual in that disease, without regard to any speculative opinions that may be entertained respecting its specific nature or character. " I freely own, that on the first appearance of this epidemic, I was somewhat deceived by the general opinion; and, indeed, by some recollection of the same complaint in 1782, when bleeding appeared in some instances rather to aggravate than relieve the symptoms. The weakness, too, which this epidemic almost universally left behind, undoubtedly ought to suggest caution in the use of this evacuation. But, on the other hand, the urgency of the symptoms, the nature of the parts affected, and their immediate importance to life, superseded these con- siderations; and my observation of the relief which bleeding afforded, encouraged me to apply this remedy; and I have the satisfaction to reflect, with the success I hoped for. " The application of leeches, in cases where the symptoms ' " Cleghorn makes nearly llie same remark. ' Diseases of Minorca,' pp. 261-62." 262 EPIDEMIC OF 1803. were pressing, I found inadequate to the purpose. They, indeed, when put on in considerable numbers (as to eight or ten) seemed to afford a present alleviation of the symptoms; but the relief was transitory, only; and bleeding by the arm was found to be the only means of imparting effectual assistance. It should, however, be considered that it is only in cases where the symptoms threaten life, that bleeding by the arm is neces- sary. In common cases,^ where the breath is little affected, other remedies supersede its use, or at least render the applica- tion of leeches suf&cient. " Emetics have, in my observation, been found particularly serviceable. If administered at the beginning of the complaint, they served to obviate the peripneumonic symptoms altogether, by throwing off with more ease the profusion of mucus, that in a good measure characterises this disease. But in the advanced state I was sorry to find the use of emetics less successful. When the breathing was greatly oppressed, it was difficult to make them operate upwards; but they were subject to run off by stool, — an operation which did not afford the same relief with an emetic, and which, by diminishing the strength, without proportionably relieving the symptoms, seemed rather prejudicial than otherwise. " Diaphoretic, or rather sudorific, remedies seemed to succeed very well; and, indeed, this seems to be the method pointed out by nature for the cure. The vol. sal. draught, with the pulv. antimon. or the vin. antimon. succeeded in most instances; and in slight cases soon put an end to the complaint. With the same view I found moderate warmth, as that of a bed, highly necessary; together with the frequent administration of thin diluting liquors. I observed, however, that much heat, either of fires or of bed- clothes, was prejudicial, and prevented rather than encouraged the salutary evacuation. The access of cold sharp air I found essentially necessary to be guarded against), as it immediately aggravated the cough and other morbid symptoms. " In one bad case, the excitement of the urinary discharge was particularly serviceable. A small quantity of the dulcified spirit of nitre was administered with a different view, and ' " None were bled at the hospital, except with leeches, although more than 100 persons were attacked, and all recovered." DR. B'ALCONER'S ACCOUNT. 263 chanced to excite this evacuation very powerfully, and as it should seem with great advantage to the patient. " The medicines, usually called expectorants, as lac ammo- niacum and squills, could not in bad cases be employed ; and in the slighter attacks, there was no necessity for their use. The former was too heating and stimulant; and the latter was apt to run off by stool. I must own, that nothing which I tried with this intent succeeded to my wishes, except the volatile alkaline, which, in the proportion of thirty or forty drops of spirits of hartshorn, taken pretty frequently in any warm vehicle, seemed to be of service. I had some expectation that the steam of warm water drawn in by the breath, by means of some of the inhalers, might have answered this purpose, but was deceived. The breath was too short to admit of its being used effectually in bad cases, and in others it was superfluous. " Purgatives, taken by the mouth, were not so useful as might have been expected. When given in any effectual dose they seemed to weaken the patient more than to diminish the fever, and relieve the most distressful symptoms. " Clysters, however, were of great service in preserving a due regularity of evacuation, and also in encouraging the secre- tion of urine, which I before observed was of considerable service. " Blisters were, I believe, pretty freely tried ; but, in the cases that fell under my observation, I cannot say that they were as serviceable as I expected. In some bad cases they seemed to give a temporary relief to the difficulty of breathing; but, in several instances, no good effect whatever was produced by them. I did not however find, except in one instance, that they were productive of any mischief. It should, however, be noticed, that I speak here of peripneumonia cases; for in those where vertigo was the leading symptom, blisters were of great use; and, indeed, I think the principal cause of its abatement, even after leeches had been tried with little advantage. " Opiates, I constantly found to be, among the most ne- cessary remedies. They were of the utmost service in abating the cough when convulsive and violent, and gave time for the expectoration to thicken into a consistence fit to be easily spit up. I never observed them to have any ill effect in checking the expectoration. Some inconvenience, indeed, accrued from 264 EPIDEMIC OF 1803. the costiveness which opiates occasioned; but I saw no instance where this was not easily obviated by clysters. The black drop, called the Asiatic Balsam, seemed to me, in some instances, superior to the common Tincfura Opii; but its particular ad- vantages were not very considerable. "Having thus concluded my own observations, I wish to speak of the French account of the disease, as it appeared in the Moniteur of the 10th of February, 1803, rather before (I think) its shewing itself at this place. This account is published under the inspection of the Societe de Medecine, at Paris, and signed by the President and Secretary-General. " The general symptoms of the disease that they recite, are as follow; and, probably, meant to be understood in the order in which they usually occurred. " General indisposition, want of appetite for some days, shiverings of longer or shorter continuance, and subject to be renewed by the slightest motion of the body, even when in bed, and alternating with a brisk heat; heavy pain in the head, in the forehead; and above the eyebrows ; drowsiness, sense of weight, and weakness of the body; inward heat; partial sweats; total loss of appetite; tongue white, or inclining to yellow; renewal of the fever at the coming on of the night; and, some- times, after midnight; abatement of the symptoms in the morning; quick, hard pulse, often very low, and becoming stronger, as the disease advanced to a favorable termination, and still preserved its original nature and character. The fever continued three, five, seven, twelve, fifteen days, and some- times longer, but then changed its character. "It terminated either by urine, highly loaded, and depositing a compact brick-coloured sediment; or by plentiful and universal sweats; or by expectoration of something resembling matter, which continued a shorter or longer time. Or, lastly, by mucous or bilious stools, and sometimes by a combination of several of the above-mentioned evacuations. " This disease is divided into seven varieties, each distin- guished by the parts principally affected. The first is the nasal catarrh, or rhume de cerveau, much the same as we mean by a cold in the head. This is marked in addition to the symptoms before mentioned, by a stoppage of the nose; vertigo; tingling in the ears, and sharp pain in that part; swelling of the parotid DB. FALCONER'S ACCOUNT. 265 glands; difficulty of breathing through the nostrils; face swelled, red, painful, and of a bloated appearance, not unlike an erysi- pelatous eruption; the eyes watery and red; discharge of a serous fluid more or less acrid from the eyes and nostrils, often swell- ing, inflaming, and even excoriating the nostrils and lips; and sometimes a sufl'ocating obstruction of every serous discharge whatever. "The next or second variety is, catarre guttural, or esqui- nancie catarrhale, or what I believe we call the angina ton- sillaris, or common sore throat. The signs of this are a com- plaint of the throat, attended with shivering, swelling, and slight inflammation of the back part of the mouth, of the septum palati, of the uvula, and of the tonsils ; a painful sensation along the course of the trachea; difficulty both of swallowing and of respiration; hoarseness; difficulty of speaking; and the back part of the mouth covered with mucus, more or less thick. "The third variety is what is called catarre bronchial, rhume peripneumonic catarrhale. This is distinguished by a sharp dry cough, difficulty of respiration, sense of oppression; a sharp pain in the side, felt principally near the false rib, and seemingly very superficial; flying pains resembling rheumatism, moving up and down through the breast and the loins; saliva difficult to be collected, and frothy, often bloody; bleeding from the nose, the lungs, or the hsemorrhoidal vessels, sometimes symptomatic of the disease, and sometimes critical, but almost always relieving the pain of the head. This kind is often difficult to be distin- guished from the simple peripneumony, which can only be done by considering the severity of the symptoms, and the particular seat of the pain. This variety terminated by expectoration, or by sweats; the spitting became easier to be discharged, and thicker in consistence, and of a white colour resembling matter. Sometimes the disease seemed to be translated by a kind of imperfect crisis to the limbs, where it appeared in rheumatic affections. "The fourth variety is called catarre suffoquant, and was fortunately very rare. It principally attacked old people, and such as were of a bad habit of body, and was sometimes the consequence of improper regimen of living. It was apt to put an end to life at a time when danger was little apprehended. 266 EPIDEMIC OF 1803. It was distinguished by a sensation of great weight about the chest, much oppression, and a wheezing sound from the bronchia; the strength decreased rapidly, the powers of nature sunk, and a sudden congestion of mucus in the lungs soon finished the tragedy by suffocation. "The fifth variety is what they call catarre intestinal, which happened when the disease took a course to the bowels, and appeared there in form of a mucous or dysenteric evacuation, which quickly exhausted the patient." [The French physicians observe, that the above varieties are not all of them found distinct and separate, but are often much intermixed or combined mth one another.] "Another variety or distinction is said to be drawn from the nature of the disease, and is called catarre inflammUtoire. The symptoms were a deep-seated pleuritic pain, occupying a fixed point about the middle of the third true rib; considerable oppression of breathing; frequent hard and compressed pulse; great difficulty of respiration; urine red; the face swelled and inflamed. It attacked young, plethoric, and vigorous subjects, and was generally owing to the admission of cold air to the body, when in a heated state. "Another distinction is taken from the complication of the epidemic catarrh with typhus; or, as it is called, catarre gas- trique, catarre complique de fievre putride ou adynamique. This variety is described as common among those persons who gain their livelihood by their labour, and amongst artisans in the civil and military hospitals. It particularly attacked poor people who lived on bad food, those who were subject to excessive labour, and in want of the common resources and comforts in sickness; persons weak exhausted, of bad habit of body, lying-in women, &c. Its distinguishing symptoms were prostration of strength; tongue foul and bilious; derangement and confusion of the intellectual functions; low spirits; loss of appetite; flatulence; heavy paleness of the countenance; dislike of animal food; nausea; vomiting; nervous symptoms; pulse frequent and depressed; signs of worms in the alimentary canal. "Prognostic or judgment respecting the termination of the disease. — The fever, when simple and properly treated, ceased about the fourth, or from thence to the seventh day, though it DR. FALCONER'S ACCOUNT. 267 sometimes was protracted longer. The catarrh continued some- times after the fever was gone. Persons so affected were very liable to relapses, and their recovery was often difficult. These circumstances are recommended to be early attended to, as the catarrh may end in a consumption. Turbid and muddy urine, more or less of a brick colour, indicated the termination of the disease, at least of the fever, and the same often took place from sweating and expectoration. "This disease is declared not to be of itself dangerous, but liable to become so from the following circumstances: "1. When those who were seized with it, persevered in refusing to change their manner of life, but continued to expose them- selves to the action of the same causes which gave rise to it. In such cases the irritation was increased, the inflammation of the chest shewed itself, and the catarrh became combined with a nervous or putrid fever. "2. When those seized with it, mistaking the nature of the attack, attempted its cure by the exhibition of hot stimulating remedies, with a view to restore perspiration, which method of treatment was apt to convert a simple catarrh into a mortal peripneumony. "3. A third source of danger is said to originate from too large bleeding, when the quantity of blood drawn was regulated by the entire cessation of the local pleuritic pain, the relief of the breathing, and the disappearance of the inflammatory crust on the blood, which last circumstance is condemned as extremely fallacious. "The immoderate use of syrups, and of oily lohocks or linctuses, is also condemned as prejudicial, and even dangerous, as is the early and inconsiderate administration of purgatives, especially when given at a time when nature was preparing for the crisis of the disease by another channel. The medical treatment of the disease consisted in a recommendation to avoid animal food, to keep in bed, and to preserve a moderate degree of warmth; to use pectoral drinks, either sweetened with honey or otherwise, and taken pretty warm frequently, and in small quantities at a timej to drink a decoction of bran, broths of veal, with onions and turnips, to inspire the steam of hot water through the mouth and nostrils; in the evening, to take small quantities of the infusion of wild poppy, sweetened with syrup of 268 EPIDEMIC OF 1803. marsh-mallows, and with diacodioiij provided the patient is in want of sleep; to use the pediluvium, and emollient or gently laxative clysters. As the disease goes off, gentle purgatives are recommended, and afterwards mild tonic remedies. "Such is the general treatment, which they assure us, in general, is not less simple than efficacious towards the cure. In that variety of the disease that is accompanied with sore-throat, the use of leeches to the part affected is advised, together with emollient cataplasms round the jaws. If the pulse become weak, the stomach sick, and the glands loaded with mucus, an emetic of 15 or 20 grains of ipecacuanha is recommended; and if that does not relieve the symptoms, a blister or sinapism applied round the throat, to be employed, however, as rubefacients, and removed as soon as symptoms of inflammation of the part come on. "In the third variety, called the catarrhal peripneumony , they advise leeches to be put on the seat of the pleuritic pain, and these to be followed with the applications of emollient cata- plasms, or bladders half filled with warm milk; and if these do not relieve, to have immediate recourse to a blister or a sina- pism. If, besides the pain in the side, the tongue be foul, if the patient complains of a bad taste in the mouth, an emetic of ipecacuanha often affords relief. Opiates are also recom- mended, as fulfilling all the indications. If the expectoration stops, and the breathing becomes oppressed, blisters between the shoulders, and to the legs and arms, are advised. " In the fourth variety, or catarre suffoquant, they recommend not to lose a moment of time. Warm inciding draughts are advised, with large doses of oxymel scilliticum; ipecacuanha and antimonial vomits to be repeated till a discharge be ob- tained. Blisters are also advised as before. " In the fifth variety, or the catarre intestinal, ipecacuanha is advised to be given as an emetic at the beginning of the disease, with pectoral draughts, mucilaginous clysters, gentle purgatives, bolusses with opium, ipecacuanha, or the Peruvian bark, according to circumstances. " In the catarre inflammatoire they recommend bleeding at the beginning, and to be repeated as the symptoms seem manifestly to indicate. We are cautioned, however, to attend carefully to the state of the pulse, both before and after this DR. FALCONER'S ACCOUNT. 269 operation, and to keep in mind the observation that a great prostration of strength attends the frequent repetition of bleeding in the generality of epidemical complaints. " When the catarrh is complicated with typhus, we are advised, at the beginning of the complaint, to use ipecacuanha and tartarised antimony. To keep the body open by mild evacuants; to use pectoral drinks, rendered gently emetic; vermifuge remedies; mild antimonial preparations; oxymel of squills; camphorated juleps; sinapisms and blisters to different parts; gentle purgatives, and slight tonic preparations, which last are directed to be continued for a considerable time during the recovery of the patient." " Such is the abstract which I have given from the account of this disease, published by the Faculty of Medicine in Paris. The symptoms are much the same with those observed in this country; but I suspect, if these were as urgent as here de- scribed, that the mortality must have been greater than they seem willing to allow. The vertigo seems to have been more general and more distressful in the cases that fell under my observation, than it is represented to have been in the French accounts. " The method of cure seems to be, as far as respects the general indications, judicious and proper, but encumbered with a farrago of decoctions and pectoral drinks, which were in use in the old French practice; and which the modern practitioners, notwithstanding their pretences to lay aside old prejudices, have not yet reformed. " Probably the greatest improvement that could be suggested, would be the more free use of emetics at the beginning of the complaint. The recommendation of this remedy, together with bleeding and blisters early in the disease, is however a proof that they attended to its leading symptoms, and to the indications which they suggested. "The Editor of the last edition of M. Sauvage's 'Nosologia Methodica'^ has described this disease as it appeared at Paris, A.D. 1743, under the name of rheuma epidemicum, anni 1743, — la grippe, — which is the name by which it is at present distinguished in France. ' Vol. iii, p. 225, edit. 1795 ; Lipsise. 270 EPIDEMIC OF 1803. " It came on about the beginning of Lent, which appears that year to have taken place on the 5th of March, not very different from the season when the late epidemic came on in this country. Its symptoms were a dry cough, pain of the limbs, fever during the day-time, and headache; but, in young subjects, these symptoms did not continue longer than the fourth day, and were relieved by increase of spitting and ex- pectoration. In old people, these symptoms came on with greater violence; and when accompanied with a hissing noise attending the cough, carried the patients off, about the ninth or the eleventh day. On dissection, the lungs were found either gangrenous, or much charged and distended with blood. In many persons a haemorrhage from the nose had come on before death, and sometimes afterwards, notwithstanding the patient had been bled two or three times. Forty persons died daily of this disease, for some time, in the Hospital of the Invalids at Paris. " The most successful method of treating this disease was as follows: on the first day, two bleedings; on the second, an emetic or purgative; on the third, bleeding again; and in the evening, an opiate julep; from the fourth day to the ninth, a medicine was given, composed of three grains of Kermes mineral, with half a drachm of vitriolated tartar, and the like quantity of diaphoretic antimony. This quantity was divided into six doses, of which one was taken every three hours: about the tenth day the recovery was perfected by the accompanying expectoration. " This practice seems in the main judicious, though some of the remedies advised are now rather out of date. By the recommendation of repeated bleeding, I am apt to suspect it resembled the late epidemic, which last certainly partook more of an inflammatory disposition than those in 1775 and 1782. That in 1788, more resembled the late influenza in this respect; but the inflammation of the throat was in that more common and more vehement, and the peripneumonic symptoms less urgent. Bleeding, however, which, in those of 1775 and 1782, had been less necessary, was in that indispensable, as it was in the one with which we have been lately visited. " The state of the lungs appeared, on dissection, according to the account in the ' Nosologia Methodica,' to resemble that DR. NELSON SCOTT'S OBSERVATIONS. 271 above described by Dr. Broderip; and these circumstances argue strongly for decisive measures towards the cure being adopted early in the complaint, should it appear again in a similar form to that of the years 1783 and 1803. " I'here subjoin an extract from the registers of the funerals in this city, which will prove that this disease was by no means so insignificant as it has been represented : — "PARISH OF ST. PETER AND ST. PAUL. From November 15 to December 15, 1802 . „ December 15 to January 15, 1803 „ January 15 to February 15 . „ February 15 to March 15 . , „ March 15 to April 15 PARISH OF ST. JAMES. From NoTember 15, 1802, to December 15 „ December 15 to January 15, 1803 „ January 15 to February 15 . „ February 15 to March 15 March 15 to April 15 . PARISH OF ST. MICHAEL. From November 15, 1802, to December 15 „ December 15 to January 15, 1803 „ January 15 to February 15 . „ February 15 to March 15 „ March 15 to April 15 WALCOT PARISH. From November 1, 1802, to December 1 „ December 1 to January 1, 1803 „ January 1 to February 1 „ February 1 to March 1 „ March 1 to April 1 „ April 1 to April 14 Died. 3 2 1 1 7—U 12 9 13 12 21-67 4 4 11 9 9—37 31 33 28 30 44 22—188" DR. JOHN NELSON SCOTT.^ " Observing, in your interesting volume of Annals for this year, that you intend in your next to present some account of ' Observations on the Influenza as it appeared in the Isle of Man, in Spring, 1803. By Dr. John Nelson Scott, in a Letter to Dr. Duncan, Senior. ' Annals of Medicine,' vol. iii, p. 424. 272 EPIDEMIC OF 1803. the influenza, permit me, residing in this detached spot of the British empire, to trouble you with my observations on the late epidemic, premising, that the climate of the Isle of Man very much agrees with the description of that of Ireland, as fur- nished by the ingenious Rutty. Our weather is very vicissitu- dinous, and our atmosphere exceedingly moist. The latter quality it very peculiarly possessed this last winter. Patients under typhus were in a greater proportion. The pertussis had been among us, and we met with some sporadic instances of scarlatina simplex. " In detailing my experience of the influenza, I shall suppose that you have proposed the questions which Dr. Richard Pearson did in his circular letter; not that I had the honour of receiving one from him; but, I presume, you approve of the plan of queries, by your adding two very apposite ones to the doctors. " 1. The influenza appeared among us towards the end of March. The first patient I saw was on the 24th, who had received the infection from a gentleman, who, two days before, had arrived from Park-gate, and who had been seized with the complaint in London, and was still labouring under it. In a few days after, one of our Liverpool packets arrived, having many passengers on board under the epidemic. From my inquiries, I have every reason to think that thus it was im- ported among us. "2. It was not generally attended with symptoms which shewed an inflammatory tendency; and even much less so, in this respect, than in the epidemic of 1782. By referring to my late father's notes, I am clear on this point. " 3. The proportion of pneumonia cases was very small. They amounted to a few, indeed, when compared to the number of other patients. Stout young men, who were exposed to wet, &c., had strong pneumonic symptoms. Pregnant women were also much afi'ected with pain in the side (particularly the left) ; had great cough, and difficulty of breathing, and, on the whole, suffered much from the complaint. But, except in these two sets of patients, genuine marks of inflammation in the lungs and pleura were seldom to be met with. "4. In the generality of my patients, the attack of the disease, and its progress for a day or two, were much alike to DR. NELSON SCOTT'S OBSERVATIONS. 273 what we observe in typhus. In so much so was this the case, that at the first breaking out of the disorder, we were difficulted in the diagnosisj for the typhus here often comes on attended with some of the phlegmasise, particularly simple catarrh and cynanche tonsillaris; and I am confident that much harm ensues in practice, in paying too much respect to the presence of such phlegmasise, as in a day or two they very generally disappear, at least are not so material in themselves, as is the withholding the proper remedies for typhus, especially the cold affusion. None complained of acute pains on the attack, except the few in whom the pulmonic symptoms were high; then the side, or middle and upper part of the chest, were the parts specified. I had some patients under acute rheumatism, who had lost much blood, and who were attacked with the influenza in their bed. In all of these, but more remarkably in one, (a gentleman of plethoric habit, and who had had a violent rheumatic fever three years before,) the violent pains of rheumatism subsided for a few days on the first seizure of the epidemic ; instead of which he complained of the usual un- hinged sensations in the head, back, and limbs, attendant on influenza : on the declining of which, that is, in three or four days, the rheumatism returned, and, owing to the violent pains in the joints, required further evacuations of blood. There could not possibly be a finer elucidation of the state of the system, induced by the influenza supervening on a rheumatic diathesis, than this gentleman's case afi'orded. "5. The stomach was very commonly much out of order from the first, with nausea, inclination to vomit, and, as I suppose, arising from this state of the stomach, there was a disagreeable heat, and unpleasant taste in the mouth. This last was a very much complained-of symptom and continued, with a furred tongue, in some far advanced in convalescence. Except where the disease was very^ light indeed, patients were not inclined to take anything but drinks; and those of the acidu- lated kind were most grateful. Many, by this way, found a temporary relief to the heat in mouth, and nausea, from half a piut of Henry's soda-water, and from equal parts of porter and water, which were never interdicted. The bowels commonly were much inclined to be constipated; but, in some, the super- vention of a diarrhoea, on the fifth or sixth day, seemed critical. 18 274 EPIDEMIC OF 1803. In such cases the faeces were surcharged with bile, otherwise there seemed a deficiency of that secretion by the clayey appear- ance. Few complained of pain in the bowels. "6. In a number of cases, the complaint terminated with very trifling expectoration. Where the pneumonic symptoms were high, and the patient doing well, we had the sputum album et bonum. I remarked that the sputum, where the pain in the side was violent, was generally streaked with blood. In some patients, where the disease had not been severe in any respect, a copious viscid expectoration, with a trifling hawking cough, supervened, and continued for a week or two, after the person might be said to be well. Such were relieved by bark and equitation. "7. I feel quite satisfied as to the infectious nature of the influenza. I had many opportunities of observing the most incontestible proofs of it, from the persons who first imported the complaint, to the infection of the distant mountaineer, I have reason to suppose, that the contagion often exerts its influence much sooner than is commonly imagined. I have witnessed its specific action in the course of a few hours. It is curious to remark the insusceptibility shown by some consti- tutions to take on the disease: one or two very striking instances I had an opportunity of observing, in the members of large famihes. "8. From the superstitious notions annexed to the opening of dead bodies in this country, my curiosity in this respect is never gratified. I should much sooner be pardoned for mur- dering a man, than opening him afterwards, "9. With the class of strong and athletic males, especially those resident in high and mountainous situations, the lancet could be used pretty freely. In general, bloodletting from ten to fifteen oimces was required at first; and it often was necessary to repeat it a second time, but not to such an extent. With pregnant women, I found the French practice of bleeding fre- quently repeated; but very small bleedings, the most advisable. But however violent the cough, pain in the breast, and other pneumonic symptoms were, neither males nor females could bear with impunity such a loss of blood, as may be sustained in genuine pneumonia with advantage. I know it for a fact, that several fell victims to the immoderate use of the lancet, as pre- DR. NELSON SCOTT'S OBSERVATIONS. 275 scribed and practised by old wives and rustic phlebotomists. Antimonials and blisters I found of great and special use^ con- joined and separate, in many cases, and were great auxiliaries to tbe lancet, particularly the latter. But where the pneumonic symptoms were high, they were not sufficient of themselves. I cannot speak much of the calomel alone (except as a purgative). When combined with opium, as recommended by the late Dr. Hamilton, I am in the habit of using it in cases of catarrhus senilis, and with decided benefit. But I cannot say so much for its effects in influenza. "10. Profuse sweating was exceedingly hurtful at any period, particularly if excited by strong diaphoreticsj but I invariably kept the patients to bed for some days, if the complaint was not very trifling indeed, and this practice I hold to be of the first importance. In the first days, I looked on the bed as half the cure; and when we consider the less irritation there is thus offered to the system, and the freedom with which the vessels of the skin act, we are not to be surprised. I do not of course mean that the patients were closely covered in bed, and under much perspiration. I attended assiduously to the temperature of the chamber, and I continually observed, that where it was cool, and ventilation practised, that it contributed much to the comfort of the sick, and tended to accelerate their recovery. In the habitations of the poor, where ventilation, &c., were not well attended to, their sufferings were in pro- portion greater; and where, as I often had occasion to observe it, a man, his wife, and three or four grown-up children were crowded in a small dirty apartment, I thought it a charity to order the window to be taken out, and to remain so night and day. This practice seldom failed to relieve the stuffing of the head, dejection of spirits, &c. When the pneumonic symptoms were high, this was had recourse to with more caution. "11. I found it necessary to keep the bowels soluble. But I did not find that the symptoms were relieved by a hyper- catharsis ; neither was I sensible that more benefit accrued in effecting the purpose of a purgative, by using the decoct. Tamarind, cum Sen. and such like, or by having recourse to the more drastic means of Calomel, which alone, and with Jalap, I tried freely. As a purgative and stomachic, I used 276 EPIDEMIC OF 1803. with advantage a large dose of Calcined Magnesia and Pulv. Rhei, with a drop of 01. Gin., to be taken over night in a large draught of any simple water. " 12. I seldom administered Opium by itself at first ; but when the complaint was farther advanced, and it became necessary from a teasing cough, &c., I exhibited Tinct. Opii in large doses, finding that small ones manifestly did harm, by adding to the irritability of the system. Many, on being at- tacked, took Tinct. Opii camphorat. of their own accord, with various effects. In general, they were prepossessed in its favour, and continued its use. " I shall now proceed to answer the queries proposed by yourselves; first observing, that we have in this town about 6000 inhabitants, and in the island about 35,000. " 1. I have seen a very large number of persons under in- fluenza, amounting certainly to some thousands. Not that I mean to be understood that I was called in to the greater number, but that with a view of observing the symptoms of the disorder on different constitutions, and in different parts of the island, I put myself to much extra trouble. Of patients immediately under my own care, I lost five of pure influenza; they all died with symptoms of pneumonia typhodes. No petechise appeared that I could discover on any. In two there was an eruption, but it seemed of the miliary kind, and arose, I beUeve, from their being kept too warm, in bed, very much contrary to my orders. " Two (in whom was the miliary appearance) were bled, but with evident bad effect ; but, indeed, I was in a manner com- pelled to it, by the violent pain in the side, and tremendous cough. Strong soups, wine and stimuli, including blisters, were the means used. " The subjects were all above 20, and under 55. " The mortality, in an indirect way, was truly very consider- able; in which class I include persons who had been long tottering over the grave from age. Old people, I observed, had not the complaint unusually violent, but it was so, relatively considered with their frail constitution. " Though a little out of place, I must remark, that I had no infant patients, nor many very young people, and those labouring under various chronic ills, as asthma, catarrhus DR. NELSON SCOTT'S OBSERVATIONS. 277 senilis, hydropic affections, &c.; and one, (a much regretted friend, a captain in dragoons,) a martyr for some years to angina pectoris, and who, by the way, had been greatly bene- fited in this dreadful malady by the use of issues. " The influenza, also, most manifestly hurried off many who were in different stages of phthisis. This effect, I observe, is doubted by some, and denied by others, in the full history of the influenza of 1782, given in the first volume of 'Medical Communications.' But my own experience leads me to a per- fectly contrary conclusion; and surely it seems as probable, that tubercles in the lungs will be irritated as much by a cough induced by a specific cause, as by one arising from cold. " 3. In scrofulous habits, the influenza often is followed by phthisical symptoms; and when consumption is a sequel, it runs on to its fatal termination with greater celerity than I have observed as arising from other excitatives. Some, I am sorry to say, have become victims to phthisis this autumn, in whom no symptom of the disease had appeared previous to the attack of influenza last spring; a very short course for a com- plaint, as often lingering as it is certainly mortal. " The epidemic left, in many males above 50, a great liability to be affected with cold, in the way of cough, which may eventually become catarrhus senilis, or may give an aptitude to an attack of peripneumonia notha. "A frequent immediate consequence of influenza in pregnant women was to induce miscarriage, which in the latter months was attended with the most dreadful floodings. On reasoning on this consequence of the influenza, it seems to me, that perhaps the epidemic exerts an analogous, though not so violent an influence on the pregnant female, as variola, however favorable, is known to do; and that thus, and not from the mechanical effect of the cough, &c., are we to account for so serious an occurrence. " Some few patients had epiphora and inflamed eyes, as we observe in measles, for a considerable time after the influenza had gone off. Some were afflicted with repeated attacks of epistaxis; and one patient had hsemoptoe to a serious degree after the epidemic had left him, who had never before been subject to such an ailment. The patient with hsemoptoe had no hereditary claim to phthisis. Perhaps all these cases arose 378 EPIDEMIC OF 1831. from the debility occasioned by the previous increased action in the vessels of the head and lungs. [In reference to the meteorological phenomena of the year, it may be interesting to mention that, on the night of the 5th and 7th of March, red snow was observed on the mountain Tolmezzo in Frioul. Red rain and snow fell at the same time in Vienna, and passed over Italy and Sicily, falhng from a dark red cloud, coming from the south-east, and attended with light- ning, thunder, and hail. The cinnamon-coloured dust with which this was associated contained eighteen species of polygastric animalcule, one of which, namely the Synedra entomon, is known only in South America.^] EPIDEMIC OP 1831. DR. BUENE.^ " The present influenza — a disorder according exactly with the Tussis epidemica of Sydenham, and the influenza of later authors, — has prevailed epidemically for the last two weeks in this metropolis, affecting all ages, and supervening without any assignable cause. Of seventy patients who presented them- selves at the public Dispensary, on Thursday, the 23d inst. (June), more than one half were suffering from the influenza. The influenza may be said to centre in the chest, although the whole body is affected by it, the head particularly. When at its height it consists in a severe, hard, harsh, dry cough, recurring more or less in paroxysms, with great soreness behind the sternum or a fixed pain on one side of it. The whole mucous lining of the throat, nares, and eyes, participating in the affection, the eyes being vascular, the nose stuffed, and the throat slightly sore. The head, too, is heavy and painful, and it jarred distressingly by the paroxyms of coughing, which gives the sensation as if the head was splitting. Withal, there is an unusual languor and debility disproportionate to the local affection. The skin is generally very hot, and at the same time chilliness is felt on exposure to a current of air, ' Ehrenberg Passat-Staub und Blutregen, pp. 107, 129. ' Dispensary Keports by John Burue, M.D., Physician to the Public Dispensary, Chancery Lane. London, ' Medical Gazette,' 1831, vol. viii, p. 430. DR. BURNE'S REPORTS. 279 The tongue is foul, the taste impaired, and the appetite gone. The urine is scanty and high coloured, and there is a great and general malaise. The pulse is accelerated, and increased in volume and force, yet it is by no means full or strong. The attack commences with a sense of rawness, with irritation, and at the same time constriction in the trachea, extending down- wards to the chest, which provokes a cough of the character above described. In addition to which is a heaviness of the head and dullness of the sensorial powers, and great bodily languor. The eye soon feels stiff and weak, the nares dry and stuffed, and the throat rather full and sore. There is also this circumstance pecuhar in the attack, namely, that the patient is not sensible of having taken cold, nor of any cause that can have produced his illness. The invasion does not depend on the usual exciting cause — cold, but must be considered spon- taneous. Some persons, it is true, date the attack from a particular chill or exposure, but this is rare compared with the number affected. The influenza generally goes off with an abundant nocturnal perspiration, about the third or fourth day, and with a considerable discharge from the nostrils, but not by an abundant expectoration; the cough continuing nearly dry to the last, and there being only a little thick, tenacious expectoration, which is detached with diflSculty. Cases of this description in which the pneumonic signs are severe, require the antiphlogistic treatment of bloodletting and antimony ; but I have not been induced to bleed largely on account of the great depression of the strength and dullness of the sensorial powers, nor have I in any instance had occasion to draw blood a second time. I have found the abstraction of eight, ten or twelve ounces of blood suflBcient, in the worst cases, to mitigate the severe symptoms immediately, and with the assistance of the Tartarized Antimony and the Tinctura Camphoratse Comp., and a blister, or warm plaister, to remove them altogether in a few days, leaving the patient, however, weak and languid. In the milder cases of the influenza the pneumonic symptoms are less urgent, while the pain and heaviness of the head, with the depression of strength and dullness of the sensorial powers, is greater than in the descriptioa above given. Indeed many of these patients present the aspect of persons attacked with the adynamic fever, so much are the vital powers depressed. The 280 EPIDEMIC OF 1831. pneumonic symptoms in these miilder cases, consisting of a tickling sensation in the trachea, with a dry, troublesome cough, are relieved by saline medicines and the Compound Tincture of Camphor, and warm plaisters to the chest ; but so prominent is the prostration of the powers of the muscular and nervous systems, that I have, in many instances, been obliged to commence at once with the Carbonate of Ammonia, which has been followed by the best effects. With this various treat- ment, adapted to the peculiarities of the case, the patients have all done well. " Case I. — A young man, about 22 years of age, presented himself at the Dispensary, on Monday the 19th inst. He com- plained of a sense of rawness and irritation in the trachea, with a dry and rather harsh cough recurring by fits. His eyes were very vascular, but dull and heavy. His nares felt stuffed, his skin was dry and hot; the tongue foul, the appetite gone, and the urine scanty and high coloured ; his head also was heavy and painful. The most prominent feature, however, was a very great muscular debility and dullness of the sensorial powers, which deprived his face of expression, and himself almost of the power of supporting his body. The character of the feb- rile movement was markedly adynamic. I directed a warm plaister to be applied to the chest, and one drachm of the Liquor Ammoniae Subcarb., to be taken every four hours, with 20 drops of the Spir. Lavaud. Comp. in peppermint water. By this treatment he improved speedily, the cough abated gradually, the headache and heaviness diminished, and his strength began to return. He is now convalescent. " Case II. — On the 23d inst., early in the morning, I was called in haste to visit a medical friend, who although rather subject to colds, felt himself now unusually ill. He was lying in bed, distressed by a hard, harsh, dry cough, which jarred his head excessively, as well as aggravated a fixed pain on the right of the sternum. The cough recurred in paroxysms, during which he suffered more from its effect upon the head than upon the chest. He had, in addition, considerable pain in the head, with depression of strength and spirits, believing himself to be very ill, and having feelings of apprehension which he had not experienced on other occasions. The pulse was accelerated, and somewhat increased in force and volume, MR. GEORGE BENNETT'S ACCOUNT. 281 but it was neither full nor strong ; the tongue was foul, the skin hot. He was restless, and had been indisposed for two or three days, with pain of the head, and wandering pains about the chest. He was bled immediately to twelve ounces, and began to take one sixth of a grain of the Antimon. Tartariz. every two hours, with 20 drops of the Tinct. Camph. Comp. By the evening he was much relieved; the severity of the pneumonic signs was checked by the loss of blood, and effec- tually relieved as soon as the antimony produced nausea, which happened in a few hours, his stomach being easily acted upon by that remedy. Still, however, he felt ill at ease ; his head was light from the loss of blood; he was weak, and anxious about himself. The antimony was discontinued, and after having passed a tranquil and refreshing night, he was next day in a more comfortable state, and free from apprehension. From this time he has recovered rapidly." [About the same time that influenza visited London it also prevailed at Plymouth, where delirium was not an uncommon symptom; and at a later period some of the cases terminated in diarrhoea. The complaints of this Spring, as well as of the previous year, were considered peculiar in character, as though from some unusual atmospheric influence.^] " The disease first appeared, as related by Mr. Lawson,^ on board the Hon. Comp. ship ' Inglis,' while at China, on the 25th of January 1830, on which day eight or nine men were suddenly seized; on the following day twenty-four were attacked; on the 27th eight or ten; and on the 28th and 29th six more cases are recorded, after which there were no new cases. The attack was sudden, and the disease, within two hour.s, as severe as during any time of its continuance. The symptoms were pain in the head, more especially over the frontal sinus. Cough, discharge from the nose, sense of raw- ness in the throat and chest, rather than severe pain; great prostration of strength; in some of the cases there was pain in the epigastrium, as well as across the loins, with severe aching pains in the limbs; pulse frequent, but generally soft. The febrile symptoms in most cases had entirely subsided on the ' On the Epidemic Catarrh which prevailed at ManUla, &c. By George Bennett, M.R.C.S. London Med. Gazette, vol. viii, p. 522. ' Med. Gazette, 1831, vol. viu, p. 525. ^^^ EPIDEMIC OF 1831. third or fourth day, and the cough, in the majority of instances, in about the space of a week from the commencement. There were, however, some exceptions, where a troublesome cough remained for two or three weeks. The remedy employed at the commencement was an emetic- of 3j Pulv. Ipecac, with subsequently febrifuges and purgatives. One man who had for a length of time been confined to his hammock with swelled testicle, was also attacked among the rest; but it left him about the usual time, his other complaint having been in no way aflfected by it. " The disease prevailed again in China during the month of September, and at the same time visited Manilla, where it had also raged in the year 1810, and exhibited similar symptoms to those which were presented in China. "Previous to the appearance of the epidemic catarrh at Manilla, the weather had been unusually hot and dry for the season of the year, which combined with a very variable atmo- sphere, during the day and night, was considered by the inha- bitants to forebode a severe hurricane or an earthquake. * * * The crew of the ship 'Charles Forbes,' which arrived at Manilla from China, on the 18th of September, was attacked with the epidemic during the voyage. "During the month of May the weather was unusually variable; the barometer rising and falling suddenly, and the thermometer standing one day at 80° Fahrenheit, and a few days afterwards at 32. The wind was prevailing steadily from the north-east. The month commenced with heavy clouds, murky storms, copious precipitations of rain, and remote thunder ; the thermometer ranged from 55 to 60 degrees, and the wind blew for a few days from the west, and then shifted round to the north. This condition of atmosphere was suc- ceeded by an overcast sky, with intervals of sunshine'; a keen, cutting wind from the north-east, frost, ice, and snow ; the thermometer rapidly sinking to 33 degrees. Greatcoats which had been thrown off were resumed, and the fire-hearth became acceptable. By the middle of the month the weather cleared, and became warmer; the sky brightening, a high blustering wind prevailed from the north-east, drifting before it clouds of the dust from the roads ; the thermometer ranging with celerity between 63 and 33 degrees. During the severest intervals of ADMIRALTY REPOETS. 283 this weather ice was formed upon the ponds at night; the early fruits were partially blighted; the petals of the new- blown rose dropped from the shrub, and the hedge-row box seemed as it were singed; 'the frosty air burnt froze.' The north-east wind was heightened into a gale, by which several vessels were drifted from their moorings in the port of the Thames, and a heavy atmosphere, a calm, and a soaking rain followed. From this time, the 20th, to the end of the month, either a grey mist, with a hot sun, 80°, occa- sionally gave way before a gelid wind, 40° from the north- east, the usual forerunner of storms and thunder, or the soil became dry and dusty under a light sunshine, with fleeting cloudlets, or a sultry sun gleamed through a hazy atmosphere. The thermometer stood at 32°, and, in the day, varied between 50° and 80°. A pelting rain, north 50°, and a fine, clear, breezy day, west 60°, closed the month. Then followed the month of June, remarkable only for a high temperature, a singular humidity of air, a soft wind from the south-west, and a bright, hot, summer sun. During the first days of the month the sunshine was interrupted by a light rain, once by clouds, rain, and a gale from the north 40 degrees, and occa- sionally by transient hail-storms, and remote thunder. The thermometer ranged between 40° and 80°; but it generally varied between 75° and 60° ; and this was the month in which the influenza made its appearance."^ " Additional evidence of the unhealthy character of this year is afi^orded in the following extract from the 'Statistical Reports on the Health of the Navy' for the years 1830-6.^ ' In certain positions within the tropics, or on their confines, little surprise is excited when an unhealthy succeeds a healthy year, or when a series of years in which there is much mortality follows a number in which there had been comparatively little; because we are prepared by experience for the eruption of sweeping epi- demics there, which leave no room to question the cause of difference, whatever doubt there may be as to the origin of the epidemic on which the difference evidently depends ; but in the > 3. A. Hingeston, in London Medical Gazette, vol. yiii, 1831, p. 587. '' Part II. Africa. Home and various forces, p. 157. The preceding tables in these reports present results which differ strikingly from those of the year 1830, and for which there are no means of accounting satisfactorily. 284 EPIDEMIC OF 1831. force under review, embracing the ports and shores of Great Britain and Ireland, and the adjacent sens, and in the absence of any uncommon, generally-diffused, or epidemic disease, it is surprising that the mortality of one year should more than double that of the year which immediately preceded it. In 1830 the rate of dying, from all causes and in both sections of force, the home and various, was 7-5, while in 1831 it was nearly 16 per 1000 of the number employed. The former is lower than that of any foreign station in any one year, excepting two years in South America, and is under the annual average of seven years there : the latter is within 4 per 1000 of the annual rate of dying, on seven years average, in the West Indies and North American command, and nearly double the annual average of the South American The aug- mented mortality depended chiefly on increase of force in the causes of febrile disease, and that not only of idiopathic fevers, but also of other diseases in which there are febrile manifestations.' There was no adequate meteoric or other cause discovered. " The pervading influenza which occasioned increased mor- tality among the citizens and the shore-residents appears to have been extended to the harbours and coasts of these islands, giving to common forms of disease, as on shore, more than ordinary degree of fatal force. During the following year the cause of malignant cholera became operative in many parts of the United Kingdom, with great concentration of power, and proved fatal in a very high proportion of the number attacked. Whether the same, or an altered agency, with less concentra- tion and more diffusion, co-operated with the common causes of disease during the year in question, and endowed them with greater destructive agency, cannot be determined; but looking at all the circumstances, and bearing in mind the peculiar power of endemic, epidemic agency in some other cases, it is reasonable to conclude that it did." [A large proportion of the cases of catarrhal fever noticed in these reports were from the receiving-ship off the Tower of London. During the prevalence of influenza many other diseases ex- hibit more than the ordinary degree of fatality. On the continent, during the year 1830, intermittent fevers VARIOUS AUTHORS. 285 prevailed, succeeded by remittent and gastric fever. At the beginning of 1831 tbe prevailing type was again intermittent. InMayinfluenza appeared, to be followed in Summer by cholera.^ There were great variations in the duration and severity of this visitation in different places. Thus for example it did not increase the mortality in Paris, but at Berlin was as fatal as cholera. At Berlin it lasted only a few weeks, at Moscow and St. Petersburgh two months, but at Paris it hung about for a year.^ Dr. Lombard observed that the symptoms in Geneva were similar to those in England. That physician found emetics so useful that patients often felt cured the day after their employ- ment. The pulse sinking from 100 to 80 or 70, and the headache, whatever its intensity, disappearing as if by enchant- ment.* Adynamic fever, influenza, dysenteric diarrhoea and cholera succeeded each other, and indeed, to a certain extent, prevailed together in the year 1831, so as to present a resemblance to the epidemic constitution described by Sydenham as prevaihng from the year 1675 to 1679. The disease prevailed very extensively amongst horses, affecting the whole system, and often making its attack whilst they were under a medical regimen adapted for its removal. In the months of August, September, and October many horses in the neighbourhood of Chester were affected with dysentery, and the same disease was very widely diffused amongst dogs.* A similar transition was observed in epidemic influence exerted on the human subject, especially at Paris. In that city, during the month of July, which was even hotter than usual, diarrhoea and dysentery took the place of influenza ; and in August the intestinal catarrh was called cholerine. Some degree of intestinal irritation, indeed, attended some of the cases of influeuza.' In the year 1833 epidemic diseases extensively affected the lower animals. Chickens, in various parts of Prance, had an affection analogous to cholera. They were thirsty, suffered I Medicinische Zeitung, pp. 242, 247. '' Gazette Medicale, 1833. ' Idem, p. 729. * Veterinarian, 1831, pp. 185, 217, 223. = Chomelj Gazette Medicale, 1831, p. 314. 286 EPIDEMIC OF 1833. from spasm, sought the sun, and crowded together for warmth, and their blood was darker than natural. Great mortality was also observed amongst fish, especially carp, and their spinal chord was found in a state of great congestion.^ On the 15th of May 1830, during the prevalence of the Sirocco, red-dust fell on the ship ' Revenge' at Malta. This dust was accompanied by rain, and the atmosphere was at the time thick, and of a yellow colour. The wind was east-south-east. On the 27th of October similar dust fell on board the Prussian merchant-ship ' Princess Louisa,' to the west of Africa, and at the Cape de Verd Islands.^] EPIDEMIC OF 1833. MR. HINGESTON.' ''The passing features of disease are quickly lost and for- gotten if we do not pause and depict their aspect while yet they are present. He who has not made the experiment, or who is not accustomed to require rigorous accuracy from him- self, will scarcely believe how much a few hours take from certainty of knowledge and distinctness of imagery, — how the succession of objects will be broken, — how separate parts wiU be confused, — and how many particular features and discrimina- tions will be compressed and conglomerated into one gross and general idea. (Dr. Johnson, Western Isles, &c.. Inch Kenneth.) The following sketch of the influenza, so lately prevalent in London, has been drawn with a rapid pencil from a distinct survey of many cases, and a characteristic outline of the disease is presented as it appeared to one within the circuit of his own recognition. " In the middle of the month of March, several persons were attacked with the affections of the bronchia and larynx common ' Groguier, Recueil de M^d. V^terinaire, vol. ix. Olivier, Gazette M^dicale, No. 27, 8th May, 1832. ' Ebrenberg, op. cit., p. 116. ' London Medical Gazette, vol. xii, p. 199. MR. HINGESTON'S REMARKS. 287 in the spring of the year, but it was not till the 6th of April that the influenza developed its pathognomonic character, and within the city started up widely on a sudden, manifesting itself in three different forms ; each of these forms arose in succession, the active preceding the passive, and thus it hap- pened : "1. Bronchitis with acute fever and keen arterial action, which presented itself in single cases towards the end of the month of March, and in the beginning of April. It yielded to the ordinary antiphlogistic treatment, and ended in a copious pituitous expectoration. " 2. A catarrh of all the air passages, announced by sneezing, heaviness of the forehead, suffusion of the eyes, running at the nose, and a teaziug cough. There were fugitive pains along all the great muscles of the limbs, pain of the hypochondria, and loins, and nape of the neck; perspiration and soreness pervaded the skin, but the perspiration was not critical. The bowels were naturally relieved, the tongue was clean, but the urine was scanty. In healthy persons this attack lasted from three to six days, and yielded to salines, nephritics, rest, absti- nence, and sudorifics. "3. Adynamic catarrh, announced like the former by sneezing and the usual symptoms of a common cold, but distinguished by deep nervous depression and a subacute fever, running on, in some instances, to twenty- one days. The tongue was foul and loaded, and there was nausea, a complete loss of taste and appetite and smell, a pale languid countenance, torpor of the bowels, prsecordial distension, and a deficiency of bile. In some cases there was a sudden and very marked prostration of all the vital powers. The sleep was broken and interrupted, with frightful and fantastic dreams ; the cellular tissue was lax, and the skin humid and universally sore ; the urine was scanty, high coloured, and turbid. In this form of the disease the thorax was internally sore, with an incessant cough, and a teazing glutinous expectoration; and occasionally by fits and starts, there would be a fixed pain in the head or abdomen, simu- lating inflammation ; the pulse being at the same time quick, and often accelerated. The patient was cast back on his bed, and appeared alarmed at his own situation. " This form of the influenza obeyed no simple febrifuge, but 288 EPIDEMIC OF 1833. seemed to run a certain course, and then expire of itself, leaving a very characteristic lassitude, so as to depress the patient greatly. It was aggravated by bleeding and active antiphlo- gistic treatment; it was alleviated by mild purgations of mercury, rhubarb, and colocynth ; but the chief means of relief, was by acting on the kidneys, and causing a copious flow of urine. The soreness at the chest might be removed by a blister, and as soon as the febrile condition had passed away, the quinine was serviceable. It was always proper to impose abstinence and absolute rest under the bed-clothes, but all patients were not submissive. The muscular languor continued for some time after the outward restoration to health and vigour of aspect had apparently returned, and the patient was still re- minded of his weakness by a lurking pain which tarried in the loins. The expectoration became chronic, plentiful, and incon- venient, the appetite might fade, the stomach and bowels falter, and a relapse occasionally ensue. The animal spirits drobped, and some invalids felt and confessed an unaccountable sense of woe ; and so much for the three forms of this malady. Under the influence of this epidemic, asthmatic old people gradually became ill, and the medical man's attention was attracted at first to the stomach. There was vomiting of all the ingesta, pains in the hypochondria and shoulder, bladder and loins, a rapid pulse, often irregular costive bowels, and restlessness. Gradually the respiration became high and laborious, the breath wheezing audibly, a stifling cough being incessant, and the air tubes becoming choked up with froth and tough mucus. The patient fixed his hands and shoulders, and assumed various erect or reclining attitudes, always indicative of the greatest uneasiness. The urine was diminished or entirely suppressed, the lips darkened, the countenance expressed alarm and anguish; the pulse in some was quick, large, and bounding, in others rapid, little, and irregular; the skin was hot and dry, the tongue clammy, the thirst great, and the appetite gone, and so the patient might die suffocated. The disease seemed to have its seat in the air-tubes, the smaller ramifications of which were filled with a tough yellow phlegm, causing an incessant short cough, so as to clear them for the permeation of air, and the indispensable oxygenation of the blood. Here lay the disease : 1st, in tough phlegm which MR. HINGESTON'S REMAKKS. 289 could be thrown off only by cougbing ; 2dj in an imperfect and impeded oxygenation of tbe blood. The liver was always deranged, either as a sequence or a cause. The object of treatment was : — 1, to give the lungs less work to do, therefore to bleed once; 3, to reheve the lungs by external irritants, by blisters ; 3, to loosen the phlegm by warm expectorants ; and, 4, to act on the bowels, kidneys, and skin. As far as my experience has gone, any treatment was fal- lacious. One bleeding from the arm was beneficial, but it could not be repeated, for though the blood might be both cupped and buffed, yet the crassamentum was weak, and the serum abundant. Diffusive stimulants and generous food, when it could be taken, were more useful than depressants, and the difficulty seemed to lie in making the kidneys act efficiently. Vomiting was unfavorable, but a spontaneous purging seemed to be beneficial and decisive. The restlessness and vigilance could be opposed by opium, only towards convalescence. " These patients might linger for the space of two or three weeks and then get up well, or they might die in the same num- ber of days. Children of ten months old were also afflicted with pulmonary disease about this same period. Now their symptoms were those of pneumonia notha, and they looked like little old persons labouring under asthma. Leeches, Ipecacuanha, and Mercury specifically, killed them ; but relief seemed to be pro- cured by mild doses of Rhubarb, with half-grain doses of Calomel as a purge, and a combination of Oxymel of Squills with the Ace- tate of Ammonia. A bland milk food was the best. Many died. " And so much for the influenza manifested in its three forms, and in its particular modes of attack upon the old and the young. " The disease was ushered into London during the prevalence of a bleak wind and a cold vernal atmosphere succeeding to a long, warm, moist winter. Storms of hail, snow, sleet, thunder, and rain, from dark fragments of clouds, were alternated only by currents of gelid air and harsh squalls from the north and north-east. Under these coarse rude flaws of heaven, the pul- monary organs of man, so susceptible of atmospheric changes, were excited and parched or moistened and depressed, and the whole surface of the skin must have suffered universally in its functions. Those persons were the least liable to the influenza who were the most exposed to the outward changes of the 19 290 EPIDEMIC OF 1833. weatherj and those had it the worst who were irregularly exposed, as servants and kitchen-maids. The valetudinarian, the epicurean, and the profligate, seemed to fall readily under the distemper; and it was both curious and interesting to remark in the mingled population of this immense city, w^en all were equally exposed to the same evil, the patience of the poor and the impatience of the rich. Disease may he modified or aggravated by any native or acquired irritability of tempera- ment, and the sudden and unexpected accumulation of wealth often inflicts upon its surprised possessor a restlessness of spirit which, in animated nature, is the attribute only of birds and children. The patience of the poor is founded upon hope; they anticipate death as a refuge, a port, a harbour of safety; they foresee in the end of their days the only certainty in life. But the oflensive intrusion of illness sullies the furniture of a handsome apartment; and death is bitter to a man in the midst of his possessions. ' Un malade degoute,' says Voltaire, speaking of happiness in prosperity, 'ne mange rien d'un grand festin prepare pour lui.^ {Articles de Litterature tr^s Interessans.) — He who is engaged in the active pursuits of merchandise and money, or who exhausts his intellect in schemes of worldly parade and ostentation, brooks not the imperative restraints of sickness and pain, and seems astonished that his will no longer commands the servile functions of his limbs. Pride, proper to man and fostered in polite society, may be checked by adversity, but can be extinguished only by disease and the visible approach or vicinity of death. The physician beholds the commonalty of human nature, and hears the same words and the same phrases expressive of the same sensations, as if the rich and the poor, the foolish and the wise, had previously met by concert and agreed to speak the same language in their separate habitations. But as soon as health is again confirmed, the distinctions of wealth, rank, and intel- lect, become again paramount, and all equally defer the end of life, the certainty of which is equally unacceptable to all. — At length the canopy of clouds was withdrawn, and the Summer sun shone brightly as the disease faded." [The previous visitation of 1831, occurring in Summer, and attacking subjects exhausted by heat, was attended with more debility: this of 1833, occurring in Spring, was attended MR. YOUATT'S OBSERVATIONS. 291 with greater nervous disturbance, and the convalescence was more tardy: nearly four fifths of the inhabitants of Paris were affected. In this city it appeared under three varieties : — 1st, the form complicated with Angina, Pleurisy, or Pneumonia; 2dly, with fever and local disturbance j 3dly, with Malaise and hoarseness. Tic Douloureux, Neuralgia, and Rheumatism, prevailed shortly before the onset of the epidemic, especially at Geneva; indeed, an eminently nervous constitution of atmosphere seemed. to prevail in the year 1833 as well as in 1831.^ It was observed by many continental practitioners, that if purgatives were not administered, the appetite was slow to return. The most approved treatment was to administer emetics at the onset, and afterwards purgatives.^ In London, concurrently with the prevalence of the disease in man, horses were affected with Influenza; but for some time, whilst those in the low parts suffered, those in the upper and North- West districts escaped. Not many weeks afterwards, there was not a mews in Marylebone which did not contain some patients, while Westminster was exempt from disease, and in Marylebone, observes Mr. Youatt, " I have known it to be confined to a district not a furlong square. In one extraordinary case, a fifth part of the horses in a certain mews died, while there was no vestige of disease elsewhere. I recol- lect, that in one of our barracks, the majority of the horses on one side of the yard were attacked by epidemic catarrh, while there was not a sick horse on the other side. These prevalences and these exceptions are altogether unaccountable. The stables and the system of stable management have been most carefully inquired into in the infected and healthy districts, and no satis- factory difference could be ascertained. One very important fact, however, has been established, namely, that the probability of the disease seemed to be in a tenfold ratio with the number of horses inhabiting a stable. Two or three shut up in a com- paratively close stable would escape. Out of 30 distributed through 10 or 15 little stables, not one would be affected; but in a stable containing 10 or 13, although proportionably larger and more ventilated, the disease would assuredly appear; and, if it does enter one of the largest stables, almost every horse wiU be affected."' 1 Gazette M^dicale, pp. 345, 729. " Idem. ' Mr. Youatt, Veterinarian, p. 1 1 7, 1833. 293 EPIDEMIC OF 1836-37. At Alfort, many horses convalescent from internal diseaseSj or affected with surgical maladies, were in the hospital suffering from Anorexia, weight and heat of head, weakness, red conjunc- tivae, and dry cough; and many previously in good health became affected, when brought into the neighbourhood of the sick.'^ In the Spring of 1834, a minute species of ant so swarmed in London and Brighton, that many of the inhabitants were obliged to quit their houses.^ In 1835, the Turnip suffered from the ravages of the wire- worm {elater segetes), the favorite food of the water-wagtail/ but the general failure of the crop, which occurred in the Southern and Midland counties, was attributed to the incursions of the 'Altica Nemorura,' the glossy, tiny, skipping, hopping, merry- Andrew kind of beetle, called the Turnip-fly.* During the space of about three weeks, namely, from the 16th of January to the 8th of February, the wind being north- easterly and the atmosphere hazy, that the visible horizon was only one mile distant, a peculiar dust fell at St. Jago in the Cape de Verd Islands. Much of this dust, which was of a reddish-brown colour, yielded a blackish or greyish bead to the blow-pipe, and did not effervesce with acids, was collected on the deck of the ship 'Beagle.' The dust was excessively fine grained, and so constantly falling as to roughen, and in some degree injure, the astronomical instruments.^] EPIDEMIC CATARRH OP 1836-37. DE. STREETEN.^ " At the close of the Epidemic Catarrh which prevailed so extensively in the months of January, February, and March, of the year 1837, the Council of the Provincial Medical Association issued a circular to the members, requesting ' Rec. de Med. Vet&., vol. x, p. 530. = Entomol. Magazine, vol. ii, p. 310. ' Fanner's Magazine, vol. iv, p. 28. ■* Entomol. Magazine, vol. i, p. 363 ; vol. iv, p. 338 ; vol. v, p. 342. ' An account of the dust which fell in the Atlantic, by C. Darwin, F.K.S. ; ' Geological Transactions,' 1845, p. 27. ° Report upon the Influenza or Epidemic Catarrh of the Winter of 1836-37. By Robert J. N. Streeten, M.D. With Observations upon the Meteorological Pheno- mena, by Wm. Addison, Esq., F.L.S. ' Transactions of Provincial Medical Association,' vol. vi, London, 1838, p. 67. DR. STREETEN'S REPORT. 293 information respecting the origin, progress, and duration of the epidemic, its symptoms and treatment, the atmospheric pheno- mena attending and preceding it, together with such other particulars as might be necessary for the elucidation of many questions of interest immediately connected with it. The following were the questions to which the Council more espe- cially directed the attention of the Society, and upon which they were desirous of obtaining explicit information : " 1. When did the Influenza appear in your neighbour- hood ? and how long did it prevail there ? '' 2. Did it attack a great many individuals at the same time? " 3. Did it appear partial to any age, sex, or temperament ? or did it appear to attack all indiscriminately? " 4. Was it milder when it attacked children ? " 5. What age appeared to sufi'er most from it ? "6. Was the spread of the distemper very extensive in your neighbourhood ? " 7. What was the proportion of deaths to the number attacked ? " 8. What circumstances predisposed the patients to a fatal termination of the disease ? " 9. What was the ordinary duration of the disease ? " 10. W^ere relapses common ? "11. Were persons whose occupations exposed them to the vicissitudes of the weather in the open air, more liable to the distemper than those who were confined chiefly to the house ? " 12. Are you in possession of any proof of its having been communicated from one person to another? " 13. In persons attacked by the epidemic, who at the time laboured under pulmonary disease, was the former malady found to be aggravated on the subsidence of the Influenza ? " 14. Were there any circumstances that appeared to exempt individuals from an attack of the disease ? and, in particular, did the having been attacked during the last similar epidemic of the year 1834, appear to aff'ord any protection ? " 15. What were the usual symptoms of the complaint ? "16. What unusual symptoms occurred in your practice? " 17. What was your mode of treating the disease? " 18. Did any pecuUar atmospheric phenomena precede or accompany this epidemic ? 294 EPIDEMIC OF 1836-37. " At the anniversary meeting held at Cheltenham, ia the month of July last, a Committee was appointed to take this subject into consideration, and to draw up a report from the answers sent in reply to the foregoing questions. These answers, though not so numerous as could have been wished, are yet suflaciently so to afford valuable information, at the same time, having been received from nearly all parts of the kingdom, they furnish data from which the influence of locality, and other causes depending thereon, in modifying the general features of the disease, may be inferred. " In collating and comparing the various particulars con- tained in these replies, the authors of this report are of opinion, that they cannot proceed better in this inquiry than by following the plan already laid down, taking the questions in the order in which they were proposed by the Council. " 1. When did the Influenza appear in your neighbourhood, and how long did it prevail there ? — The answers to this question present considerable discrepancies, some of them dating the first appearance of the epidemic as early as the third week of November ; others giving the second, third, and fourth weeks of January, and one assigning for its commence- ment a period as late as the 2d of February. The dates of cessation are also as indefinite, varying from the first week in February to the month of May. All accounts, however, coin- cide in referring its greatest prevalence to a period extending from the middle of January to the end of the first week in February. " The following table exhibits the range of the dates assigned for the commencement and termination of the epidemic in various parts of the kingdom, which we have denominated, respectively, the Northern, Midland, Western, Southern, and Eastern Districts : Siatrict. Commencement. Termination. Northern . November ; middle of January. February 8 ; April. Midland November; January 16. Middle of February ; May 1. Western . End of December; February 2. Feb. ; beginning of April. Southern . Middle of Dec. ; middle of Jan. Middle of February ; May. Eastern End of Dec. ; beginning of Jan. Beginning of February; mid- dle of March. DR. STREETEN'S REPORT. 295 "Prom the preceding table it is obvious, that no conclusion can be drawn as to there having been any regular progression of the disease from one part of the kingdom to another; and, indeed, the individual details from which it is drawn up are too imperfect and too discrepant to warrant such a conclusion, even had the general summary of them appeared to favour it. Thus, in the northern district, in which the range of appearance in the various localities comprised within the district is, according to the answers, from November to the middle of January, nearly the same diversity exists in the statements of diiferent individuals residing in the same town, — Dr. Macrorie assigning November as the date of commencement, and April as that of termination at Liverpool; while Dr. Baird and Dr. Ramsay assign the month of January as being the period of commencement, and from the 8th to the middle of February as that of termination. To prevent any imputation from resting upon the general cor- rectness and fidelity of the answers, it may be desirable to make some extracts from such of the replies as throw light upon the causes of this diversity of opinion. One of these causes would seem to be the latitude in which the term Influenza is made use of by different medical men. Dr. Baird says: 'The first decided case of influenza which I met with occurred on the 3d day of January, and the last on the 8th of February: catarrhal com- plaints continued to be prevalent amongst the resident in- habitants for the three succeeding months, but their systems had either become proof against the distemper, or it had lost its intensity, for in no case could it be fairly said to be an attack of influenza. That the atmosphere of Liverpool, however, was still contaminated by the epidemic influence up to the middle and latter end of April was apparent, from the fact that many of the officers and men of the American ships, and generally the most robust, were violently attacked shortly after their arrival in port.' The same also is stated to have occurred among the black sailors of ships coming from South America and the coast of Africa. It is not an unwarrantable assumption, that the catarrhal affections here spoken of by Dr. Baird, may have been considered by other observers as connected with the prevaiUng epidemic. Many of the replies from other parts afford illustrations of the preceding remarks. Dr. Hastings, of Worcester, states that he had observed several more than ordi- 296 EPIDEMIC OF 1836-37. narily severe attacks of bronchitis, frequently complicated with pleuritis, during the month of December, 1836, these attacks being more fatal than in former winters, but that he did not notice any decided case of influenza until the 13th day of January, 1837. Other practitioners, residing in the counties of Worcester and Warwick, seem to have considered that these bronchial attacks partook more or less of the character of influenza, as may be inferred from the nature of their replies to this question; and it would appear that, notwithstanding that the chief prevalence of influenza was during the months of January and February, cases of catarrhal disease, amounting even to a partial epidemic, may have occurred in some lo- calities previous to the general outbreak throughout the kingdom. "The greater number of the replies from all parts agree in assigning the early part of January (from the 3d to the 13th) as the period of this outbreak; but setting aside those answers in which the information upon this point is less explicit, and confined merely to the announcement of a certain date or period as that upon which the epidemic made its appearance, there is evidence to show, or at least to lead to the inference as above stated, that a partial, and, as it were, preliminary epidemic, may, in certain localities, have been the forerunner of the more general one. Mr. Rice, of Stratford-upon-Avon, distinctly states this as the result of his observation: 'The influenza,' he says, 'appeared in this neighbourhood at two distinct periods, the first commencing the third week in November, when it continued about five weeks; the second about the 10th of January, when it continued epidemic in this town and the neighbouring villages up to the first week in March. A few cases occurred in the interval ; and some cases have occurred since, and still continue (June 30th) to present themselves occasionally. "Another of the causes tending to give rise to a degree of uncertainty upon this point in the replies, is the diff'erent manner in which diff'erent individuals would regard the question. Some in their answers have simply stated the date of the first c^se to which they themselves were called, while others appear to have given a more extended signification to the terms of the question, and have thus stated the results of general obser- vation, rather than of their own immediate experience. In the DR. STREETEN'S REPORT. 397 Ctichester report, which contains the results of the united experience of the medical profession of that place, this source of ambiguity is avoided; and it may, therefore, be taken as affording the most correct information as to the outbreak of the epidemic in the southern and south-eastern part of the kingdom. Ac- cording to this report, 'The influenza began about the middle of December, 1836, was at its height during the latter half of January and beginning of February, 1837, and ended about the first week in March. There were, however, a few cases bearing all the characters of the epidemic as early as the middle of November, but they were detached, both in regard to time and place, and, therefore, not mentioned in the account.' Mr. Maul, of Southampton, bears similar testimony to the occurrence of sporadic cases previous to the general outbreak of the epidemic, to which, however, he assigns a date somewhat later than that given in the Chichester report. 'A few scattered cases,' he observes, 'of anomalous catarrh and bronchitis occurred in my practice at the end of December, 1836. These cases increased in number at the beginning of January, 1837; by the end of the first week the disease prevailed more generally, and assumed the character of an epidemic. During the second, third, and fourth weeks in January, and the first and second weeks in February, the cases became most numerous, and far exceeded anything that I had ever before met with. In the last two weeks in February, they declined in number, but many individuals were more severely assailed. In March, the disease again mani- fested itself, but rather in a modified form, and .prevailed with diminished consequences through the month of April.' This last statement of the reappearance of the epidemic in the months of March and April, is consonant with the observations of several other practitioners, and may perhaps afford an ex- planation of the extended range given to the whole epidemic, in the replies from some of those gentlemen who have not entered into particulars upon this point. "2. Did it attack a great many individuals at the same time ? — The replies to this question are uniformly in the affirmative, and by far the greater portion of them speak decidedly as to the simultaneous outbreak of the disorder throughout the localities to which they severally refer. Dr. Davis, of Presteign, observes, that within his district, comprising 298 EIDEMIC OF 1836-37. a circle, the diameter of which is ahout fourteen miles, it was impossible to mark any progression — cases in every part of it occurring simultaneously. Mr. May, of Reading, and several other gentlemen make the same remark. Dr. Shapter, of Exeter, however, states, that for the first ten days occasional cases only occurred, hut that on the 18th, 19th, 20th, and 21st of January, it was a most prevailing epidemic. Mr. Bree, of Stowmarket, Mr. Maul, and some others, also refer to sporadic cases preceding the general attack. The terms in which the very great prevalence of the epidemic in all parts of kingdom are spoken of, are most decided. " 8. Did it appear partial to any age, sex, or temperament ? or did it appear to attack all indiscriminately ? — A consider- able portion, amounting to more than half of the returns, answer the latter part of this question affirmatively, stating that the epidemic in its attacks was irrespective of age, sex, or temperament. Others, however, point out a certain degree of exemption, or an increased liability, as attaching to one or other of the conditions mentioned in the former part of the question: — And first, as respects age, there seems to be a very general impression that infants and young children were less the sub- jects of this epidemic than adults or those advanced in life. Dr. Davis states, as the result of his experience, that persons of all ages were attacked by the epidemic, except young children, those under six years of age almost entirely escaping. Dr. Baird, Mr. May, Mr. Maul, Mr. Davis of Tenbury, Mr. Gwynne Bird of Swansea, Mr. Fletcher of Croydon, Dr. Grove and Mr. Sampson of Salisbury, Dr. Barlow and Mr. Godfrey of Bath, and other practitioners, express, in terras more or less decided, the entire or comparative immunity of children from attack during the late epidemic. Mr. Appleton, of Evesham, says, that of ninety-niae cases occurring during the month of January, there were only five under five years of age. Mr. Pritchard, of Leamington, gives the following state- ment of the ages in 170 cases occurring in his practice : Under 14 years 26 cases, about one sixth. Between 14 and 65 . . . . 119 1 ^^^^^ ^^^ ^j^^,,^ Above 65 25 J "The Chichester report, however, makes the subjoined DR. STREETEN'S REPORT. 299 statement in reply to this question, ' In regard to age, it seems almost equally to have attacked young and old. Of cases recorded, the greater number appears to be at the periods under ten, and from thirty to forty, but the difference in the intermediate decades was trifling, and the uniformly decreasing numbers beyond forty would probably about tally with the small population of those ages.' " It does not fall within the province of the authors of this report to decide which of these views, — that children were equally liable to, or comparatively exempt from, the attacks of the late epidemic, — is the correct one; but they may observe, that notwithstanding the high value to be placed upon the Chichester report, as embracing the united experience of the medical practitioners of that city and neighbourhood, and the support which this obtains from the experience of Dr. Brown, of Sunderland, Dr. Hastings, and other eminent individuals, who state unreservedly, that persons of all ages were attacked indiscriminately, their own experience would lead them to say that young children had manifested less liability to the attacks of the recent epidemic catarrh, than individuals more advanced in life. With one or two exceptions, it does not appear from the replies that the aged were the subjects of the influenza more than adults of an earlier period of life. " Secondly, as respects sex and temperament, there seems to have been, for the most part, no appreciable diff'erence in respect of liability to the disease. Mr. Myles, of Warrington, indeed, in his reply to this question, says, that ' those in the meridian of life, whose temperament was melancholic, princi- pally males,' were more liable than others ; and Dr. Macrorie considers the feeble and those of the lymphatic temperament to have been most subject to attack. The Chichester report gives the following statement : — ' In regard to sex it seems to have had no great partiality. Of the entire number of recorded cases, the males to the females are as fourteen to nineteen; but the reports of parish practice give a very nearly equal share of each. It should perhaps be mentioned, that of one hundred and fifty-five cases in the parishes of Chichester and its suburbs (population between nine and ten thousand), eighty- two were males and seventy-three females. In the Manhood (?) district (population four thousand), of twenty-two cases, nine- 300 EPIDEMIC OF 1836-37. teen were males and three females. In this district not one patient was under thirty. In the Donnington district (popula- tion three thousand), of sixty cases,'twenty-two were males and thirty-eight females : twenty-six were under thirty, and nine- teen under ten years.' This statement is in itself quite suffi- cient to show, in accordance with an ascertained principle in statistical inquiries, that the apparent exceptions derived from the limited experience of one individual, or one locality, must not be taken into account in deriving the general conclusion. It is only the accumulation of facts by numerous observers from a great extent of country, or a considerable period of time, which can enable us to correct the errors of a partial or limited experience, and to arrive at conclusions founded on truth. " It should, perhaps, be mentioned, in connection with this question, that some of the replies state the liability to the dis- ease to have been greater in those subject to chronic bronchitis, and in those of debilitated constitutions generally. " 4. TVas it milder when it attacked children ? — At least three fourths of the returns answer this question in the affirma- tive. There are, however, some exceptions of importance. Dr. Fife, of Newcastle-upon-Tyne, states, that some of the most severe cases which he witnessed occurred during the period of dentition, from the age of six months to the third year; and Dr. Shapter says, that it was certainly not milder among children, but was, on the contrary, very fatal to them. Mr. Ceeley, of Aylesbury, reports that, except in very young children, it appeared to him to be rather milder in the young than in those more advanced in life. Mr. Nott, of Bew Regis, makes a similar exception ; and Dr. Clendinning, of London, states, in reply to this question, that ' except in the cases of very young or of unhealthy children, it was mild.' It would seem, therefore, upon the whole, that the epidemic generally assumed a mild character when it attacked the young, but that cases of considerable severity were not uncommon among very young children and infants. This is readily accounted for by the predisposition which exists at an early age to bronchitis and to convulsive attacks. Thus, at Reading, according to the report of Mr. May, the disease appears to have assumed amongst children the characters of severe bronchitis or pneii- DR. STEEETEN'S REPORT. 301 moniaj while Dr. Brown reports that he beheld the death of three infants, and heard of other fatal cases at this period of life, all of whom died with symptoms of cerebral congestion. "5. What age appeared to suffer most from it?- — The answers to this question are almost unanimous in the state- ment, that the aged suffered most from the attacks of the epidemic; and next to the aged, it is remarked in several of the replies, that infants or very young children were most severely affected. Some practitioners, however, make a dis- tinction between the severity of the symptoms and the fatality of the disease; and, according to these gentlemen, the actual suffering would appear to have been greater among the robust and adults of middle age, although, at the same time, they state the disease to have been most fatal to the aged. It is proper to observe, that this severity of suffering in the robust and those of middle age, was by no means general, as the subjoined extract from the replies sent in by Dr. Hastings sufficiently testifies. In answer to this query he says, 'From sixty upwards. I answer this question most unhesitatingly. Under the age of sixty, persons, male as well as female, re- quired many of them but slight attention to get safely, and in a few days, through the malady; but all of those, indiscrimi- nately, male and female, who were so far advanced as sixty, suffered most severely, and had a long and dangerous illness, being confined to bed with cough and copious expectoration for some time. Of twelve persons above the age of sixty- attacked, all were in bed for a week, all suffered most severely from profuse muco-purulent expectoration, all became con- siderably emaciated ; eight were in bed for a fortnight, and had a dry tongue, with small feeble pulsej four were in bed for a month, all the time so critically ill that I scarcely ex- pected them to live from day to day; and two died within nine days of the attack. The four old persons who were in bed a month have not yet^ quite recovered, and neither of them left the house till the month of June. Among the per- sons attacked below sixty, although in number thirteen times more than those above that age, I had comparatively few that ' " The communication bears no date, but we believe it to have been forwarded to the Committee in July or August last." 302 EPIDEMIC OF 1836-37. were in bed a week, and those were persons who had been previously ill, either with pulmonary or other complaints. "6. Was the spread of the distemper very extensive in your neighbmrhood ? — The answers to this question are uniformly in the affirmative ; the terms in which the prevalence of the epidemic in all parts of the kingdom is spoken of, being most decided. ' I never knew an epidemic prevail so extensively/ 'Whole families in bed together/ ' It was, indeed, a general disease.' ' Very few persons, indeed, that escaped.' 'Almost general.' 'It would be difficult to point out an individual who had not the disease,' &c., are expressions taken indis- criminately from the replies, and furnish most conclusive evidence as to the wide spread and almost universal influence of the causes which gave rise to this epidemic. " 7. What was the proportion of deatlis to the numbers attacked? — The replies to this question, as might be expected from the circumstances of accurate numerical records not having been in every instance preserved, are extremely in- definite. It will still appear, however, that an approximation to the correct ratio is capable of being deduced. Several of the returns afford numerical details, giving the number of cases attended, and the number of deaths which ensued. Others afford a mere statement of the proportion which the deaths bore to the cases ; — a statement which although less satisfactory than the more explicit details, may be presumed, for the most part, to have been made with due consideration. In those returns in which the actual numbers are given, the total of the cases is 2347 ; of the deaths, 54, These were dis- tributed in the usual districts as follows : — District. Death. Cases. Proportion. Northern . Midland Western Southern . Total . 3 22 4 25 171 932 73 1171 1 in 57, or 1-7 percent. 1 in 42, or 2-3 „ 1 in 18, or 5-5 „ 1 in 47, or 2-1 54 2347 1 in 43, or 23 „ " The returns from the eastern district do not give any pre- cise numerical statements. DR. STREETEN'S REPORT. 303 " Omitting the western district, in which the number of cases actually reported is so small, there is no great difference in the general result, and thus, as far as these data go, the conclusion may be drawn, that the proportional mortality of the epidemic was about one in fifty of those attacked. This agrees remarkably with the estimate formed by the greater number of those who have not given a precise numerical statement. Thus in two of the returns from the eastern part of the country, Kenninghall and Burnham, the deaths are stated to be about one in fifty, and about two and a half per cent, of the cases; and the Chichester report estimates them as being from about one in forty to about one in fifty. Others of the returns give the proportion of about one in a hundred, or even a smaller ratio, while Mr. Bree did not see a single fatal case, although he thinks he could not have attended less than five hundred persons affected with the disease. The general result, however, as we have stated, affords a ratio of mortality of from two to two and a half per cent, of those attacked, whether the numerical statements are taken as a guide, or the estimate deduced from the aggregate experience of those who have furnished the replies. " In two or three of the returns an attempt is made to throw some light upon the actual mortality resulting from Influenza, by comparison of the parish registers for the period during which it was prevalent, with the corresponding period of one or more preceding years. Dr. Brown states ' that the funerals in the different parish churches of Sunderland were doubled in January, during the height of the epidemic; but that in February, when it was declining, though still existing, they exceeded but little the ordinary average.' From a valuable statistical table sent by Dr. Black, of Bolton, it appears that there were four hundred and twenty burials at the parish church of Bolton during the months of January, February, and March, of the year 1837, being an excess of one hundred and thirty-two over the average for the same months of the five preceding years. In Bolton, however, this increase in the number of burials seems to have occurred for the most part during the month of February, as is shewn by the following table : — 304 EPIDEMIC OF 1836-37. Januai-y .... February March - . Total 1837. Average of Five preceding Yrs. Excess. 115 205 100 111-2 79-0 97-8 3-8 126-0 2-2 420 288-0 132-0 " The only other return which furnishes any information of a similar character is that of Dr. Shapter, who says that in the two large burial-grounds belonging to the city of Exeter, the registered number of burials during the months of January and Pebruary, 1837, were two hundred and twenty- seven, whilst in the corresponding mouths of the year 1836, they were only one hundred and twenty-five, giving an in- crease of one hundred and two as probably owing to the prevalence of influenza during that period. " 8. What circumstances predisposed the patient to a fatal termination of the disease? — The circumstances enumerated in the replies to this question may be resolved into those which are connected with the age of the patient, the previous general health, and the presence of or predisposition to actual disease. Nearly all the returns state old age to be the chief circumstance predisposing towards a fatal termination, and several of them add infancy as next in importance to old age. Many of the returns specify debility of constitution, without evident disease, from whatever cause arising, as materially con- ducing to a fatal result. But next to old age, previously existing disease of the pulmonary organs would seem, from the returns, to afford grounds for an unfavorable prognosis. Chronic pulmonary disease, chronic thoracic disease, affections of the lungs and heart generally, are mentioned as circum- stances rendering the attacks of the epidemic more likely to prove fatal ; and among those diseases which are more speci- ficially characterised, bronchitis and asthma hold the first place. Some difi'erence, however, in this respect would seem to have existed at different periods of life. Dr. Shapter observes, that 'the circumstances which particularly predisposed to a fatal termination were, amongst children, hooping-cough, and the recently having had some of the infantile eruptive diseases. DR. STREETEN'S REPORT. 305 which prevailed very much during the preceding November and December; amongst the more advanced in life, pectoral weaknesses generally, but more especially asthma.' Dr. Brown, again, remarks : ' Besides the time of life, old age, and infancy, already mentioned, chronic thoracic disease, or peculiar prone- ness to such disease, predisposed the patients to a fatal termination. Of the aged persons who died, in almost all there was some previously- existing disease, generally chronic bronchitis, affection of the heart, or both conjointly. Of the young and middle-aged who ultimately fell victims, the ma- jority died of phthisis, leading me to suppose that a tubercular diathesis pre-existed, and in such cases there were either previous indications of pulmonary disease, or a family tendency to it.' Dr. Brown adds that ' of all circumstances which pre- disposed to a fatal event, neglect, or mismanagement of the disease, in its early stage, was the most influential,' a statement confirmed by Dr. M'Cabe, of Cheltenham, who forcibly points out the mischiefs which arose from the empirical use of stimulants and other remedies recommended at the time in the public press. " 9. What was the ordinary duration of the disease? — From a careful consideration of the answers to this query, it appears that the disease may be divided into two stages, — one which may be termed the acute stage, lasting generally from two to four or five days, the disease frequently terminating altogether at the end of this period; and a second or more chronic stage, in which the symptoms continued in a sUghter form for a period, varying from five to ten days, or even a fortnight more. In addition to this, however, a state of debility seems to have hung over many of those who suffered, for an indefinite period. These circumstances, taken in connection with relapses and sequelae, will sufficiently account for the extreme variation in the replies to this question, the greater number of which, how- ever, give in general terms from five days or a week to a fort- night as the ordinary duration of the symptoms. Dr. Hastings, Mr. Rice, and several other gentlemen observed, that the dura- tion of the disease was very various in different individuals, and Dr. Baird states that it was much longer in the aged, than in persons of the middle period of life. " 10. Were Relapses common? — This is one of the queries, 20 306 EPIDEMIC OF 1836-37. in the replies to which much difference exists. The diversity is probably owing, in many instances, to the vague and indefinite nature of all information of the kind which is not founded upon numerical data. The language of the Chichester report, which bears every evidence of having been drawn up from such data, although in the present instance it does not give the details, is strongly corroborative of this remark. ' Relapses/ it is stated, ' were very frequent, but probably in relation to the entire number of attacks, not very numerous; when they occurred they were generally severe.' One only of the returns gives a proportionate statement, that of Dr. Hastings, who assigns one in twenty-one as the proportion borne by the relapses to the primary attacks in his practice. The following are among the chief localities in which relapses are stated to have been of frequent occurrence : — Sunderland, Newcastle- upon-Tyne, Leicester, Stratford-upon-Avon, Stroud, Holywell, Presteign, Hereford, Kenninghall, Framlingham, Bm'nham, Chichester, Southampton, and Bath. Dr. Fife and Dr. Davis state, that in some of their cases relapses occurred as many as three and even four times. At Liverpool, also, according to Dr. Ramsay, secondary attacks were very frequent; but Dr. Baird is of a different opinion, and Dr. Macrorie, whose opportunities of observation are very extensive, states, that in his practice relapses were not common. In the Midland counties generally, secondary attacks of the epidemic appear to have been of less frequent occurrence; the greater portion of the replies to this question, from the Midland district, being decidedly in the negative, " The symptoms are stated in several of the returns to have been more severe in the relapses than in the primary attacks ; and Dr. Shapter thinks that they were modified also in their nature. " Were persons, whose occupations exposed them to the vicis- situdes of the weather in the open air, more liable to the dis- temper, than those who were confined chiefly to the house? — The answers from all parts of the country are, with scarcely an exception, in the negative, and from the expressions made use of in several of the returns, it would even seem that those exposed to the vicissitudes of the weather had been somewhat less liable to the attack than those whose occupation did not DR. STREETEN'S REPORT. 307 subject them to such exposure. 'I do not think (says Dr. Brown) that seclusion from vicissitudes of the weather in the open air, diminished at all the liability to attacks; indeed the few instances of exemption from this epidemic which fell under my observation, appeared generally to be in the instance of persons very constantly exposed to such vicis- situdes, excepting during the hours of repose.' Dr. Baird states that some of the most severe cases which he met with, were in aged females previously confined to the house. Dr. Hastings saw one lady, eighty years of age, who had not been down-stairs for forty years, who had the disease very severely, though she ultimately recovered. Mr. Davis, of Tenbury, observes, ' that exposure to atmospheric changes did not appear to exert any influence in. rendering the person liable to the disorder, some of the worst cases occurring in those who led sedentary lives.' Mr. Smith, of Stroud, says, ' I think those most exposed to the vicissitudes of the weather, that is, those continually in the open air, were less susceptible of it.' Dr. Davis, of Presteign, writes, that as far as his observations went, exposure made little difference, and, indeed, that a majority of the cases requiring medical treatment, were delicate persons shut up in houses on account of the cold. " The exceptions to this very general statement" are few, but at the same time sufficiently important to require notice. Thus, Mr. Ceeley reports that ' persons exposed to the vicissi- tudes of the weather in the open air, were certainly more liable to attacks; yet a slight exposure to cold, in numerous instances, appeared sufficient to give rise to an attack.' He adds, ' a few cases occurred in patients confined to bed with other disorders.' Mr. Bird, of Hereford, says, ' From the disease attacking a greater number of males than females, I should say those persons whose occupations exposed them to the vicissitudes of the weather in the open air were more liable to the distemper than those who were confined chiefly to the house.' Dr. Clendinning also enumerates exposure to the vicissitudes of the weather among the causes which rendered persons predisposed or liable to the attacks of the epidemic; and Mr. Myles thinks that the exposed suffered more severely. But, however we may feel disposed to place reliance upon the observations and opinions of these gentlemen, the very general 308 EPIDEMIC OF 1836-37. testimony of others, no less competent, must lead us to the conclusion that some circumstances, accidental or otherwise, have interfered in rendering the results at which they have arrived less to be relied upon in this particular than would otherwise have been the case. " 13. Are you in possession of any proof of its having been communicated from one person to another? — The answers to this question are also of an almost uniform tenour, the opinion of nearly all those who had the most extensive opportunities of investigating the disease, and the best means of arriving at a definite conclusion, being, that there is no proof of the existence of any contagious principle by which it was pro- pagated from one individual to another. ' A gentleman (says Dr. Brown) subject to very severe bronchial affection, and in whom I apprehended that influenza would prove very severe, if he were attacked, escaped it altogether, and attributed his escape to avoiding all close intercourse with the members of his family when it prevailed among them; but as there were ex- ceptions when no such precaution was adopted, I did not think myself justified in coming to the same conclusion.' In the Chichester report it is stated, ' We have no proof of the disease having been communicated from one person to another, though the patients often suspected it themselves. Our ob- servations, however, incline us to the opposite belief. It was no uncommon circumstance for the persons who had nursed a number of influenza patients to escape it themselves entirely.' " With these statements the greater number of the returns agree; those which express any difierence of opinion are the following : — Mr. Williams, of Holywell, writes, that he had no decided proof of the disease being communicated from one person to another, but very strong suspicions that such might be the case. Mr. Smith, of Stroud, observes, ' In some fami- lies I thought it contagious, as it afifected one after another, vuatil it had gone through the whole of a large family. I have known from seven to nine affected in this way; in other large families, only one, two, or three had the disease, the other parts of the family not being in the least affected by it.' The following statement, made by Mr. Fox, of Cerne, affords an instance of this progression in the time of attack, although that gentleman does not seem disposed to give much weight to evidence of this DR. STREETEN'S REPORT. 309 description : — ' In a family of ten persons residing in a small and generally healthy parish, one was first attacked, on the third day two more, another on the fourth, two more on the sixth, on the ninth two ; these were all children. The mother, who had been in constant attendance, and had not left the house during the whole time, was seized on the tenth day, and on the twelfth the father was seized, and had a very slight attack. He had during the preceding eleven days been con- stantly exposed on horseback. Many such instances could be produced, but they scarcely deserve to be called proofs.^ Dr. Shapte* seems to lean to the idea of a contagious influence. He says, ' Though in many instances it appeared not improbable that the disease was communicated by one person to another, yet from the very general prevalence of the epidemic, any such conclusion cannot be positive.' It is obvious, however, that nothing approaching to tangible evidence is afforded by any of these statements ; and the only really important observation in any way favouring the idea of contagion or infection, is made by Mr. Maul, who remarked, that ' if an individual came from a distance with the disease, the inhabitants of the house into which he arrived were usually attacked.' Mr. Maul, however, draws no conclusion from this fact, contenting himself with simply stating it ; and standing alone, as it does, the observa- tion in itself carries little weight. " 13. In persons attacked by the epidemic, who at the time laboured under pulmonary disease, was the former malady aggra- vated on the subsidence of the influenza ? — This seems to have been decidedly the case, and generally speaking with but few exceptions. According to some of the returns, however, per- sons affected with certain forms of pulmonary disease, would appear to have especially suffered, particularly those hibouring under phthisis pulraonalis and bronchial affections. Dr. Baird, in his reply, states, that it was only the purely phthisical cases which were aggravated on the subsidence of the attack. The testimony of Mr. Appleton, of Evesham, and Mr. Smith, of Stroud, is to the same effect; and Mr. Rice says, that in the only instance of this kind (previous pulmonary disease) which he attended, a case of hsewoptysis, the attack proved speedily fatal. Mr. Bree, Dr. Shapter, and Dr. Clendinning, observed that the attack of the epidemic seemed to hasten the develop- 810 EPIDEMIC OF 1836-37. ment of phthisis or other pulmonary disease, when it had Keen previously latent, or when a predisposition had existed. Dr. Hastings, at the same time that he bears testimpny to the facts above stated, says, ' I may also remark that this is not confined to pectoral cor&plaints, I find muco- gastritis and muco- enteritis of long standing, referred in its commencement by patients to the influenza. Wherever, in short, (he continues,) any latent disorder existed in the system, the effect of the disturbance of the functions of the body by the epidemic seems frequently to have been, to call into activity disease which had been previously for a length of time dormant.' " In two only of the replies is this question answered alto- gether in the negative, and in one of these, from Mr. Welch- man, of Kineton, it is even stated that certain cases of pulmonary disease were decidedly benefited after recovering from the epidemic. ' I do not think, (he observes,) any of my patients who were attacked by the epidemic, who at the time laboured under pulmonary disease, had their former malady aggravated by the more recent affection ; two or three who had previously had chronic bronchitis, were decidedly free from it after recovery from influenza.' Dr. Hastings refers to a case in which he observed the same circumstance. ' In a lady, who has for years been very liable to bronchial attacks, and has for many winters been under the necessity of taking great precau- tions as to exposure to weather, the influenza came on with great severity, and much aggravation of the usual pectoral symptoms. They did not, however, contimie longer than a week, and this lady has ever since that time been more free from pectoral complaiuts than for three years previously.' These, however, are obviously but exceptions to the general rule. " 14. Were there any circumstances that appeared to exempt individuals from an attack of the disease ? and, in particular, did the having been attacked during the last similar epidemic of the year 1834, appear to afford any protection ? — Several of the returns are expressed in very doubtful language in the reply to these questions, and in some of the returns they are passed over altogether. The greater number, however, agree in stating that the having undergone an attack of the previous epidemic, afforded no protection, and that there were no circumstances which appeared to exempt from an attack of the disease. With DR. STREETEN'S REPORT. 311 respect to the influence of the former epidemic, some practi- tioners would seem to think that those who had suffered from it, shewed themselves even more liable to the late epidemic than those who had escaped its attacks. Dr. Fife says, ' Many of those who suffered most severely from the former epidemic, were violently affected during the late visitation. In fact, (he continues,) I was almost led to believe them even more prone to attack •' and Mr. Smart, of Cranbourne, expressly states it as his opinion, ' that the influenza of 1834 had rather left a susceptibility to, than protected the constitution from, the attack of the late epidemic.^ In many of the returns, instances are adduced of individuals having suffered severely from both epidemics ; still, however, there are some few in which the op- posite opinion is stated. Mr. Appleton remarks, that persons who had had the disease before, either escaped it altogether, or were but slightly affected. He adds, however, ' I notice this, not as the result of my own observations in many cases.' Dr. Grove, of Salisbury, states, that he knew several persons for- merly attacked, who were not attacked by the late epidemic ; and Mr. Ceeley observes, that he met with several instances of apparent exemption from an attack of the disease of 1836-7, or of a much milder attack, in those who had suffered from the influenza of 1834, or in the intervening period between the two epidemics. Mr. Ashwin, of Abergavenny, also thinks that the attack was milder in those who had the disease during the previous epidemic. Mr. May and Mr. Maul notice that it was the popular belief that such as had been attacked previously, were protected in consequence from the recent visitation ; but it does not appear that this belief received any confirmation from the personal experience of either of these gentlemen. Among the very few circumstances mentioned in addition to an attack of the previous epidemic, as affording exemption in some cases, and modifying the severity of the symptoms in .others, are, — the actual existence of other severe disease, noticed by Dr. Fife of Newcastle, and Mr. Bloxam of Newport; general strength of constitution and regular habits of life, by Dr. Davis and Dr. Clendinning; and the age of infancy, by Mr. Gwynne Bird. "15. What were the usual symptoms of the complaint? — Of the answers to this question, some are expressed in general 312 EPIDEMIC OF 1836-37. terms, while others go into considerahle detail. From a careful consideration of the valuable information thus given, and a com- parison of the several accounts, we have not been able to arrive at the conclusion that any very appreciable variation exists in the general features of the disease as it occurred in the different localities to which the returns refer. The symptoms enumerated as constituting the usual course of the complaint, may be divided into those indicating the existence of a general febrile condition of greater or less intensity, and those more immediately charac- teristic of the epidemic, whether purely catarrhal and resulting from an affection of the mucous lining of the pulmonary organs and air-passages, or connected with one or more of the other organs or systems of the body. "The symptoms referable to a general febrile state were very much the same as those observed, either as precursors, or as arising in the progress of mild febrile diseases in general. Such of the returns as enter into any lengthened account of the symptoms, almost uniformly describe the disease as commencing in mild cases, with indistinct chills: in the more severe ones, with shivering, or even actual rigor. In some instances the rigors appear not to have occurred until the second or third day of the disease; in others, to have arisen suddenly, affording the first indication of attack, and to have continued to recur at in- tervals during two or three days, or even for a longer period. The chills and rigors are described as alternating with heat of skin and flushing, until the febrile state became completely developed, at which time the more peculiar features of the disorder seem in general to have shewed themselves. The fever from this period appears to have been usually of a mild open character, attended with some heat of the skin, and, occasionally, a dry impcrspirable state; but more frequently there was a ten- dency to perspiration, which, when free, gave considerable relief. In more severe cases, the morbid temperature was more urgent, the skin hot and dry, the face flushed, with mild delirium at night, and there was considerable feverish restlessness and anxiety; at the s;.me time there was great debility and languor, with an overpowering sense of sinking and depression of spirits. In some few cases the fever seems to have assumed a typhoid character, but no very definite account of this modification is given. Nearly all the returns mention general pains, or pain DR. STREETEN'S REPORT. 313 and soreness of tlie back and limbsj and of other parts of the body, as among the most well-marked symptoms. These pains may, in part at least, be considered as appertaining to the general febrile state; but the pain of the back and loins in par- ticular was so very generally felt, was in many cases of such extreme severity, and so prolonged in its duration, and, in almost all, gave rise to so much inconvenience and distress, being com- plained of more than any other symptom, that it is certainly to be classed rather as one of the symptoms especially characteristic of the epidemic, than as connected merely with an ordinary febrile condition. "The catarrhal symptoms, to which we have next to direct attention, were, according to the returns, a suffused state of the eyes with discharge of tears; sneezing; tingling of and acrid discharge from the nostrils; sense of weight and pain of fore- head; soreness of the fauces; hoarseness; cough; expectoration; dyspnoea; and pain and sense of constriction about the throat and chest. Several of these symptoms are lightly passed over, and appear to have been either not of very general occurrence, or so trivial as to be thought not of sufficient consequence to be recorded. The suffused state of the eyes does not appear to have been commonly observed; sneezing and watery discharge from the nostrils are more frequently mentioned ; but the sense of weight and frontal headache were very prominently marked, being recorded in almost all the returns. In many cases the pain was exceedingly severe and distressing to the patient, and by no means confined to the frontal region, extending to the vertex and occiput, and over the head generally. It is in con- nection with this severe form that giddiness, delirium at night, and, in one instance, deafness, were noticed. The headache is variously described as violent, severe, intense, oppressive, &c. Mr. Ceeley says : ' It was frequently complained of as unlike in nature and degree to anything ever before experienced.' Mr. Bree remarks : ' The pain in the head was generally supra- orbital, and for a short time very severe ; in three cases there was delirium, and in one decided meningitis.' "The soreness or rawness of the fauces is only occasionally alluded to, and, in some cases at least, seems to have been observed more particularly in conuection with the more marked symptoms of coryza. The Chichester report, in which ' de- 314 EPIDEMIC OF 1836-37. fluxion at the nose and eyes, sneezing, and frequent epistaxis, are mentioned as prominent symptoms of the disease as it ap- peared in that city and neighbourhood, describes the fauces as being ' generally red and tender,' which state in some cases ended in quinsey. Dr. Fife also noticed inflamed pharynx and tonsils as being among the symptoms of the disease observed at Newcastle ; and Dr. Shapter alludes, among other symptoms, to a sensation of painful rawness of the fauces and trachea as quickly following frontal pain, sneezing, and ' a very copious flow of a thin acrid discharge, chiefly from the membrane of the nose.' " The sense of tightness or constriction about the throat and chest, with more or less soreness beneath the sternum, is very generally noticed in the replies ; but the symptom to which the greatest prominence is given is the cough, which is variously described as being short and harassing, troublesome and fre- quent, harassing and incessant, preventing sleep, very distressing from its aggravating the pain of the head, sometimes as severe, violent, or coming on in frequent paroxysms of long duration. Mr. Smith, of Stroud, mentions, that in two cases occurring in his practice, it produced htemoptysis to an alarming extent, and that premature confinement followed in two others. The expectoration is by no means so generally noticed ; but when it is mentioned, is stated to have been scanty, difficult, and con- sisting of clear viscid mucus at the commencement, afterwards becoming more copious and free, opaque and muco-purulent in its character, and occasionally tinged with blood. In some cases it is described as excessive and profuse. The respiration seems to have been very generally more or less afi'ected ; in some cases short and hurried, or uneasy and oppressed, in others difficult. Pains in the chest are mentioned in some of the returns in addi- tion to the soreness under the sternum, and in one these pains are described as having been acute and lancinating. Examination by the stethoscope, according to Dr. Shapter, revealed the existence of sonorous and sibilous rdles, and for the most part also a well-marked crepitation in some part of the thorax, gene- rally in the lower portion. " The symptoms of disturbance in other organs of the body, may be briefly noticed under the following heads, — those con- nected with the organs of circulation, — those indicative of a DR. STREETEN'S REPORT. 315 disordered state of the digestive and urinary system^ and those which may be referred to the nervous system. The circulation seems in almost every instance to have been in a state of depression rather than of excitement; accordingly the pulse, although usually characterised in the replies, as accelerated, frequent, quick, is at the same time stated to have been variable, small, and feeble ; in two only of the returns is it stated to have been occasionally full but soft. Mr. Ceeley remarks, that in the decline of the disease in simple cases it was slow and occasionally intermitting; and Dr. Brown also observes, that during the convalescence it was frequently slow and feeble. " The symptoms which may be referred to a deranged state of the digestive and urinary systems, are pain and tension, with tenderness at the epigastrium and upper part of the abdo- men ; loss of appetite ; thirst; nausea and vomiting ; a furred state of the tongue, and a morbid state of the alvine and urinary secretions. The oppression and tenderness of the upper part of the abdomen is noticed in several of the returns, and seems to have been often accompanied with nausea and vomiting. Dr. Barlow remarks, that when the chest affections were of trifling importance, the special irritation of the epidemic appeared to be seated in the stomach and bowels, and mentions a case in which a fit of spontaneous vomiting carried off the attack, all the constitutional disturbance being well-marked but mild, without any cough or bronchial disorder. Thirst does not appear to have been a very urgent symptom. The tongue is described either as furred, white, and moist ; or as loaded with a thick coating of moist yellowish fur. Occasionally it became, in the progress of the disease, brown and dry, or as stated by Mr. Dent, of Kenninghall, 'morbidly red and shining,' in which case ' there was a good deal of tenderness about the right iliac region.' The bowels are very generally reported to have been constipated, though occasionally a relaxed state was observed. In the Chichester report is the following observation relative to this point : — ' Bowels not much affected. It is, however, right to say, that previous to the accession of the epidemic in the latter part of the last year, diarrhoea was rather prevalent, but ceased with the increased violence of the distemper.' The urine was observed, according to such of the returns as afford information as to the characters of this secre- 316 EPIDEMIC OF 1836-37. tioiij to be, for the most part, scanty and high-coloured, — rarely abundant and limpid, — sometimes becoming, during the progress of the disease, thick and reddish, or of a whey-like appearance, and depositing a copious sediment. " Among the symptoms which appear to have depended upon or been connected with a disordered state of the brain, spinal marrow, and nerves, may be enumerated, in addition to the delirium, &c., before alhided to, prostration of strength, pain of the back and loins, and various neuralgic and rheumatic affec- tions. The extreme prostration of strength, which, in many of the reports, is stated to have arisen suddenly at the very commencement of the attack, is, in almost all of tlem, charac- terised as presenting a striking feature in the disease. It seems even in some situations to have approached the collapse of the late visitation of cholera ; and to have been accompanied also, notwithstanding the generally observed torpor of. the intestinal canal, with a relaxed state of the bowels. Dr. Davis, of Presteign, observes, that the prostration of strength was instant and universal, and attended with extreme depression of spirits, and, in a vast majority of cases, spontaneous diarrhoea. Another peculiarity in the character of this symptom, is the length of time which the patients continued to labour under it, even after the cessation of the other symptoms of the disease. The pain of the back and loins is also very generally described as of peculiar severity, and seems to have been scarcely of the same nature as the pain and sense of weariness usually attend- ant upon febrile disease ; or if of the same nature, certainly of much greater intensity than what is commonly observed in diseases of this character. In addition to this pain, and the general pains of the limbs and soreness of the trunk before mentioned, some of the returns enumerate among the usual symptoms of the epidemic, either as attending its progress, or making their appearance upon the decline of the more acute symptoms, certain painful affections, which are variously termed rheumatic, neuralgic, or local rheumatic neuralgia. These, however, do not seem to have been of very general occurrence, and may possibly be connected with some local peculiarity : Salisbury and Aylesbury are the places in which they appear to have been most frequently observed among the ordinary symptoms. DR. STREETEN'S REPORT. 317 " Such is a condensed account of the usual characters of the epidemic, as far as we have been able to ascertain from the several returns : and in these characters there is little differ- ence, upon the whole, in the statements received from different places. The most important variation is one to which no allusion has been made in the preceding statement, mentioned by Dr. Fife, who remarked that, in several cases, ' the parotid gland was enlarged to such an extent, as to lead to the belief that the patient was actually suffering from cynanche parotidea.' This, however, does not seem to have been observed elsewhere, and must, therefore, we think, be placed among the 'unusual symptoms' to which the next question refers. " We cannot better conclude this summary of the general features of the epidemic, than by extracting the following account of its progress as it presented itself at two widely separated localities, Exeter and Sunderland, with the view of exemplifying the course of the disease. ' The usual symptoms of this epidemic, (says Dr. Shapter,) were: — First, oppressive pains of the head, especially over the region of the frontal sinuses ; diffused muscular pains of the shoulders, loins, and legs ; constant sneezing, early followed by a very copious flow of thin acrid discharge, chiefly from the membrane of the nose ; (the membranes of the eyes were not so greatly affected as in the influenza of 1831 and 1834.) Secondly, these symptoms were quickly followed by an overwhelming feehng of lassitude and prostration of strength, with, in many cases, a loss of all muscular power, together with great anxiety of the prsecordia, and agonising fears of death ; a sensation of painful rawness of the fauces and trachea, a voice hoarse and hollow, frequent short cough, for the most part dry, stricture and acute lancinating pains of the chest. By the stethoscope, there were heard r^les, sonorous and sibilous, and almost always in some part of the thorax, generally the lower portion, a well- marked crepitation. Tongue covered with a copious white mucus, with inflamed elevated papillse showing themselves at the tip and edges. Bowels not confined, and easily acted upon : in fact, there was rather a tendency to diarrhoea than other- wise ; appetite gone ; occasional thirst ; pulse small, quick, but soft. Paroxysm generally severe during the night. In this stage of the disease I was sensible of a peculiar and very 318 EPIDEMIC OF 1836-37. characteristic odour proceeding from those affected; though not able properly to describe it, I may state its general character to have been that of a flat musty smell. Thirdly, about the fifth or sixth day a mucous discharge from the nose came on, together with a muco-piurulent expectoration in coughing. The various symptoms now gradually declined, leaving the patients in a state of great general weakness, to- gether with a peculiar aching feel, and loss of power in the muscles of the legs.^ "Dr. Brown's statement is as follows: — 'The tongue was white, and considerably swollen; the fauces were inflamed; the eyes were often injected; the nostrils felt hot and irritated, with abundant thin secretion; and there was pain across the forehead in the situation of the frontal sinuses. A sense of heat and irritation extended down the trachea to the thorax, where besides, there was a feeling of constriction; there was cough, very distressing from its aggravating the pain of the head J it was dry at first, but soon became attended by a copious mucous secretion, often opaque and straw-coloured, sometimes with slight streaks of blood; and, in some cases, there was a considerable degree of dyspnoea. Sickness and vomiting were very common symptoms, especially at the com- mencement of the disease; and there was sometimes (especially in relapsed attacks) acute pain in the lower part of the ab- domen, aggravated by pressure. There was much thirst, total want of appetite, and the sense of taste was impaired and vitiated. The urine was scanty and high-coloured, and, on standing, speedily deposited a very abundant lateritious sedi- ment. The pulse was in general soft, but not deficient in strength; it was frequent, but not considerably so, from 80 to 100 being its average range. When convalescence was ap- proaching or had taken place, it often became unusually slow, even below 50, and was feeble. There were the ordinary febrile feelings of bodily and mental oppression, and pain and weariness in the back and limbs. The skin, in the early stage of the disease, was warm and generally moist; towards the close, cool, if not cold, and moist. In bad cases, where the dyspnoea was considerable, the advanced stage of the disease, with the cold and wet skin, and blueish hue of the countenance, often recalled to my mind the collapsed stage of cholera. DR. STREETEN'S REPORT. 319 " ' This description will be understood to apply, where excep- tions are not stated, to cases of the ordinary severity. Like all epidemics, influenza has a wide range of intensity, being, in many cases, a very dangerous disease, in others, little more severe than an ordinary catarrh.' "16. WTiat unusual symptoms occurred in your practice? — As might be anticipated, certain symptoms enumerated as of occasional occurrence in some of the replies to the former question, are mentioned in others under the present question as unusual symptoms of the complaint. This is especially the case with the more severe cerebral affections, and also with acute bronchial and pneumonic inflammations, with certain abdominal affections, and with rheumatic and neuralgic pains. On this account it might perhaps have been advisable to throw the answers to this and the preceding question into one : still, however, it seemed desirable to preserve the mode of inquiry pointed out by the council imbroken, and a comparison of the statements severally drawn up from the answers to these questions, will sufficiently fulfil the object of pointing out those symptoms which, upon a general view of the whole phenomena, may be considered as unusual. At the same time the occurrence of such symptoms among the usual characteristics of the dis- ease, indicates that under certain circumstances, and in certain situations, they assumed such a degree of prevalence as in some measure to modify its general type. " Among the most prominent and important of these un- usual symptoms of the complaint, or rather of the variations from the usual type presented by the epidemic, must be classed those indicative of severe affection of the cerebral organs. Dr. Brown mentions the occurrence of three fatal cases of meningitis in adults, to which he had been summoned in the advanced stage, and which appeared to him to have originated in a neglected inflammatory affection of the lining of the nostrils and frontal sinuses. Dr. Hastings knew of one instance of meningitis, in which, however, the disease was subdued by the use of bleeding and purgatives, and other appropriate remedies. In this case the individual had been in a state of considerable anxiety of mind previous to the attack. Another instance is also referred to, where insanity succeeded to the attack of the epidemic, and lasted several weeks, Mr. Godfrey, 320 EPIDEMIC OF 1836-37. of Bathj mentions acute pain in the head, in a few cases so severe as to last above a week, and then only relieved by a copious discharge of pus from the ear; and Mr. Pox, of Cerne Abbas, notices abscesses of the ear among the unusual sym- ptoms. Symptoms of pressure on the brain are also enumerated as of occasional occurrence. The Chichester report, in answer to the question, is as follows : ' There was delirium occasionally. In some cases the speech was alfected, so that the patient was unable to articulate; in a few cases there was coma at the outset which soon went oS.' 'In one case,' (writes Dr. Fife,) the disease at its commencement appeared to be apoplexy; in another, partial paralysis existed. In this case,' he adds, 'per- haps the term paralysis may not be justified, as it rather con- sisted in the inordinate or spasmodic action of the extremes of the fingers and thumbs of the hands, than in loss of power in the flexors.' Dr. Hastings also saw one instance in which apoplectic symptoms occurred, but without subsequent paralysis. Mr. Ceeley observed, ' that in a few old and feeble persons, the primary effect on the sensorium resembled a sudden apo- plectic seizure, from which, by sinapisms and diffusible stimu- lants, they slowly recovered, with fever and the usual affection of the mucous membrane of the air-passages; one of these cases, however, proved fatal in four days from its commence- ment.' And Mr. Fox states, ' that in a few cases there was sudden insensibility, continuing from one to two hours. The same gentleman also observes that there were some instances of boys dropping down in the fields while ploughing, — a cir- cumstance, however, to be attributed rather to sudden exhaus- tion, or to the shock upon the nervous system generally, than to any influence acting more immediately upon the brain alone. Convulsive attacks were noticed in some instances by Dr. Ramsay; and Mr. Appleton mentions inflammation of the spinal marrow as having occurred in some cases which had not received early attention. " Inflammatory affections of the lungs are included in certain of the returns, under the unusual symptoms of the disease. These affections, however, appear for the most part to have arisen, either in neglected cases, in those previously disposed to pulmonary disease, or in aged persons, and are perhaps rather to be regarded as the effects of the disease acting upon DR. STREETEN'S REPORT. 321 unfavorable constitutions. It may be observed, in connection with this subject, that Mr. Godfrey saw three cases of pneu- monia, in which he used the lancet freely, and upon the sub- sidence of the inflammatory symptoms, the usual symptoms of the influenza continued. "Among the symptoms indicating unusual aff'ection of the circulatory system as connected with this epidemic, are syncope and intermittent pulse. Dr. Ramsay states, that syncope was not an unusual occurrence in his practice, and Mr. Godfrey noticed the same symptom. Intermittent pulse is mentioned by Dr. Baird only. " Unusual symptoms connected with the abdominal organs are more frequently alluded to. Dr. Brown mentions excessive pain in the abdomen, generally situated mid-way between the umbilicus and symphisis pubis, as of frequent occurrence in relapsed cases. It was sometimes associated with obstinate constipation, at others with mucous and sanguinolent stools, resembling, in their appearance and the manner of their ex- pulsion, those of dysentery. " Mr. Appleton observed, amongst the ill-fed and ill-clothed, considerable disturbance of the biliary functions, with loose- ness, in the early onset of the disorder. In others of the returns, however, this relaxed state in the commencement of the disease was noticed as of usual occurrence, although the greater number agree in stating that the bowels were generally constipated, Mr. Ceeley remarks, that in his practice a few cases occurred in which there was more affection of the mucous membrane of the intestines than of that of the bronchi. Diarrhoea is also enumerated among the unusual symptoms attendant upon the epidemic by Mr. Bloxam and Mr. Sampson, and Dr. Shapter notices three cases of gastro-enteric afiection as the only peculiarity occurring in his experience of the epidemic. Mr. Bird, of Hereford, observed pain of the pubic region and retention of urine ; these last symptoms, however, are probably to be considered only as an accidental complication. " Rheumatic and neuralgic pains were mentioned under the preceding question, as constituting, in certain situations, a usual feature in the disease. In other localities, symptoms of this description were also observed to occur in some instances, and are noticed in the returns in reply to the question now 21 323 EPIDEMIC OF 1836-37. under consideration. Dr. Brown mentions as an irregularity next in point of frequency to the abdominal affections, ' pain of the head, often wearing the aspect of neuralgia of the branches of the fifth pair. It remitted,^ he observes, 'but never totally intermitted. It was often associated with in- flammation of the lining of the nostrils and frontal sinuses; indeed, it was not always easy to discover whether the pain did not purely depend on this inflammation. In some cases it yielded to arsenical solution or other remedies of neuralgia.' Intermittent pain in the head and temples, and sudden attacks of pain in different parts of the body in a most acute degree are mentioned by Mr. Rice, and were probably of a similar character. Mr. Bree writes, ' a frequent symptom, in females only, I found to be a neuralgic affection on one side of the face, similar to that produced by decayed teeth, and which also affected the hearing of the same side. I had in several cases also a similar pain though more acute, affecting the parietes of the chest, which produced disorder of the respiration, and if not carefully observed might have been mistaken for pleuritis.' Mr. Davis, of Tenbury, states, 'that in three or four cases, he observed acute rheumatism as an accompaniment of the disease ; and Mr. Gwynne Bird, that it was often followed by rheumatism. Rheumatic or neuralgic pains were also observed by Mr. Smart, of Cranbourne, who considers that the disease assumed three different types. ' In one there was merely a spasmodic cough, with symptoms of a common cold; in a second, all these symptoms were increased so as to resemble bronchitis or fever; in a third, there were rheumatic or neu- ralgic pains of the head or neck/ " The only other peculiarity requiring notice here, is soreness of the lips, mouth, and fauces, of unusual severity, which both Mr. Godfrey and Mr. Rice mention as having occurred in their practice. The latter of these gentlemen also observed spon- taneous ptyalism in connection with the tenderness of the gums and mucous membrane of the mouth and fauces. " It should be observed, that a considerable number of the replies state, in answer to this question, that no unusual sym- ptoms occurred in the experience of the writer. " 17. What was your mode of treating the disease ? — In the general plan of management adopted during the epidemic, there DR. STREETEN'S REPORT. 323 appears to have been little difference, certain principles of treatment being laid down in nearly all tbe returns. The main features of this plan are, a very cautious employment of evacuant remedies in general^ the use of diaphoretics and mild aperients in the earlier stage, with a diluent diet, regulated temperature, and cessation from all active pursuits; iu the more severe cases, occasional local bleeding and counter-irri- tants to the throat and chest, and confinement to bed. In the second stage, expectorant and anodyne medicines, with sulphate of quinine or mild tonics, where there was much debility remaining, are most commonly recommended ; in the relapses, a more active treatment, with a freer use of evacuant remedies ; and in complications with acute bronchitis, pneunionia, muco- enteritis, or cerebral disease, — venesection, leeches, blisters, mercurials, cathartics, or other remedies called for by the nature of the symptoms complicating the disease, though per- haps, as far as depletion is concerned, with less freedom than would have been required had no epidemic influence existed. " The abstraction of blood by venesection was very rarely had recourse to, and is almost always spoken of as a measure of doubtful propriety; in some instances as having proved positively injurious. " Dr. Fife says, ' General bloodletting, in the abstract, I am decidedly of opinion is seldom required, and very frequently most injurious in its effect.' Mr. Rice writes, ' I very seldom used the lancet, in not more than six cases, and in only two of them am I satisfied that it did not do mischief.' Dr. Davis observes, 'Venesection was always mischievous, and even local bleeding, by leeches and cupping, was not well borne.' Mr. Ashwin says, ' Bleeding was always regretted when used.' ' In no case,' says Dr. Shapter, ' did depleting or severe purging hold out encouragement for a continuance of such means;' and Dr. Barlow remarks that 'for the ordinary disease bloodletting was neither required nor borne. Some practitioners,' he continues, ' bled in the beginning, but were soon obliged to desist, faintness being induced by small loss of blood, and great weakness ensuing. Cases did occur, however, which required bleeding, and when the disease passed into pneumonia, as occasionally happened, as active treatment was necessary as if no epidemic existed.' Dr. Baird, Mr. Davis 334 EPIDEMIC OF 1836-37. of Tenburyj Mr. Prichard, Mr. Bree, and other practitioners, never employed general bloodletting, and the almost unanimous testimony is, that this measure was seldom had recourse to, except in active inflammation of the pulmonary organs. The following is the statement of the Chichester report upon this question : ' Except in severe attacks bloodletting was not required, and when it was tried, it frequently seemed to weaken without benefit. Detraction of blood was, however, practised with benefit in some cases where the pulse indicated an active and acute state of inflammation. The number of severe cases, however, calling for active treatment, was very small. It is right to state that a very small quantity of blood drawn from the Schneiderian membrane, relieved the distressing headache in a marked manner; even a few drops accidentally flowing, in two cases, gave almost instantaneous relief.' " The local detraction of blood by leeches or cupping, is more frequently recommended; though even in this manner, depletion to any extent is discouraged, and seems to have been rarely practised. The plan of drawing blood from the mucous lining of the nostrils, mentioned in the Chichester report, is also spoken of in terms of commendation by Mr. Prichard. Counter- irritation, by means of blisters, sinapisms, stimulating plasters and liniments, warm cataplasms, &c., is very generally mentioned in the returns as proving of service, more especially in the early stage of the complaint, and in aged persons. These remedies were applied to the throat, chest, pit of the stomach, or inter- scapular region, according to the varying circumstances which called for their use. "Of internal remedies, emetics are spoken of, in a few of the returns, as productive of considerable benefit at the onset of the disease; but the measures most generally recommended, are the exhibition of mild aperients and saline diaphoretics. In some of the returns more active cathartics are stated to have been given with advantage; in others, a combination of antimonials, ipecacuanha, or squill, with the saline diaphoretics. Anodynes are also recommended in some of the returns as of use in allay- ing the cough. Of these, hyoscyamus, acetate and muriate of morphia, and opiates generally, were most frequently employed; but conium and colchicum are also mentioned. Some diflFerence of opinion would seem to exist as to the benefit derived from DR. STREETEN'S REPORT. 325 remedies of this description. Mr. Ashwin gives it as his opinion, that opiates were, at least, useless; and from the silence of a considerable portion of the returns respecting them, it may- be inferred that they were by no means generally employed. Dr. Barlow, however, has the following observation upon the subject: — 'Some practitioners withheld opium, and had pro- tracted disease, as I had occasion to witness. There being no counter- indications I combined it throughout, and with decided advantage.' The exhibition of tonics and stimulants is also a point of practice upon which some diversity of opinion has existed. In consequence of an extensive empirical use of such remedies in the early stage of the disease, arising from the mis- chievous reliance too often placed upon the public press, serious and even fatal effects were in many instances observed. Dr. M'Cabe brings forward examples of this mischief, and other practitioners agree with him in pointing out the injurious ten- dency of the indiscriminate employment of these remedies. From the silence of the returns, it may be inferred that many practitioners, for the most part, withheld tonics and stimulants altogether. Others, however, state that considerable benefit was derived from the use of sulphate of quinine, in the debility re- maining during the decline of the disease, and in the convales- cence; and some even recommend ammonia, wine, and other more active stimulants, in cases where the debility was extreme and in aged persons. Mr. Myles says that in old people, when the cough was a prominent symptom, he found a blister to the chest, with the sulphate of quinine internally, to act as a specific in all the cases which he attended. Dr. Baird was in the habit of administering, in the more severe cases occurring among the aged, asthmatics, or those afi'ccted with chronic pulmonary com- plaints, a grain of the sulphate of quinine at intervals, alternately with calomel and tartarised antimony, continuing the quinine, or some other light tonic, without the mercurial when the mouth became affected; and states, that after the adoption of this plan of treatment, he had no fatal case, nor had occasion to resort, in a single instance, to bleeding, leeching, or cupping. In the intermittent pains again, in which it might have been presumed that quinine would have proved most beneficial, Mr. Rice states that he found it positively injurious, the pains being aggravated rather than alleviated by its employment. 336 EPIDEMIC OF 1836-37. "There are two powerful remedial agents, mercury and anti- mony, wtich, in addition to their respective employment as cathartics and diaphoretics, were occasionally used with other views, either separately, or in combination with each other, or with other remedies. Dr. Baird's practice of giving these medi- cines in combination has been already alluded to; the mode of administration was in the form of powder, three grains of calo- mel, with one grain of tartarised antimony, twice, thrice, or even four times in the twenty-four hours, the sulphate of quinine being given during the interval, as before mentioned. 'The effect of the powder,' he says, 'was to produce extreme nausea for the space of an hour, and frequent vomiting; to cause a vast discharge of purulent-looking matter from the lungs, excite a copious diaphoresis, and procure several dark pitchy evacuations from the bowels. So soon as the mouth became slightly affected by the calomel, and in many instances before this was apparent, the cough and expectoration had been greatly dimi- nished, the restlessness had ceased, the countenance and eyes had assumed a more natural expression, the tongue had begun to clean at the edges, and the pulse returned to its natural state.' Mr. Ceeley was in the habit of giving a combination of calomel, opium, and squill, in similarly severe cases, when the pulmonary organs were much congested; and several of the returns mention calomel, either alone or variously combined with James's powder, ipecacuanha, Dover's powder, opium and hen- bane, as being resorted to in the more severe cases. Antimony was also exhibited alone, either in the form of James's powder or of tartar emetic, to produce its nauseating and sedative effect, as appears from some of the replies. In others, however, a caution is given against its employment in this mode. "In conjunction with these measures, a light, diluent, or farinaceous diet is very generally recommended, though from some of the returns, one rather more nutritious seems to have been occasionally found necessary; regulated temperature, rest, and in the more severe cases, confinement to bed, are also enjoined. "18. Did any peculiar atmospheric phenomena precede or accompany this epidemic ? — It is to be regretted that, with the exception of a valuable meteorological register forwarded by Dr. Black, of Bolton, and some important tables from Dr. DR. STREETEN'S REPORT. 327 Shapter,' the information given in the answers to this question is expressed in general terms. In the subjoined analysis, the division into districts, formerly mentioned, has for obvious reasons been adhered to. " To commence with the Northern District, it appears that in Sunderland and its neighbourhood, the autumn had been cold and wet, with frequent thunder and lightning; and that at Liverpool, according to the statement of Dr. Macrorie, the weather preceding the outbreak was unusually cold and humid. The epidemic commenced at Sunderland during an intense frost, and cold frost and snow prevailed throughout its continuance. A similar state of weather was observed at Warrington, the atmosphere being cold and humid, with winds generally from the east and north-east. Dr. Fife, however, observed no peculiar atmospheric phenomena, the disease pre- vailing at Newcastle during the severest frost, and in the opposite state, without any perceptible mitigation. "In the Midland Counties there is less mention made of the coldness of the weather, but the returns from this district remark very generally upon the extreme humidity of the atmo- sphere immediately preceding or during the epidemic. At Aylesbury, according to Mr. Ceeley, 'the weather was very bleak, cold, and piercing, just before the epidemic, and the breaking up or thawing of the immense fall of snow, seemed to attend the increase of the epidemic ; but,' he adds, ' I look upon these phenomena as merely aggravating causes, since in- fluenza exists in summer, and I have observed it at all periods of the year, sporadically more or less, especially on atmospheric changes, or during the prevalence of south-east and north-east winds.^ At Tenbury, Mr. Davis noticed that the atmosphere was remarkably humid during the prevalence of the epidemic ; and an unusual quantity of rain fell in the months of January and February in that neighbourhood, producing the highest floods which are remembered to have occurred during a period of forty years. The returns from Worcester and Evesham also mention the extreme humidity of the atmosphere, both before and during the prevalence of the disease. Mr. Rice, of Stratford-upon-Avon, remarks, that early in January there ' See page 334. 328 EPIDEMIC OF 1836-37. were two or three days of very mild weather, followed by a cold north-east wind, of which, however, he made no memo- randum at the time; and Mr. Smith says, that at Stroud the epidemic was ushered in with a damp warm atmosphere, which was suddenly changed to cold rain, snow, or hail, scarcely a day passing without several changes of this kind, the disease abating as soon as the weather became more settled and warm. " The returns from the Western District, which includes Wales and the counties of Hereford and Monmouth, mention a similar humid state of the atmosphere. Mr. Ashwin states, that at Abergavenny severe storms of wind from the north, north-west, and north-east, with heavy rains, preceded theout- break of the disease ; and that unusual falls of snow with high winds accompanied it. Mr. Bird, of Hereford, observes, that the weather was wet and damp, with cold winds, and thinks that the disease prevailed most in exposed and elevated situa- tions ; he adds, that the cases were certainly more severe in the country than in the city. At Holywell, there were inces- sant and dense fogs, which prevailed also at Presteign. ' The atmosphere,' says Dr. Davis, ' was throughout dark and gloomy, with frequent fogs, and the wind, for the most part, from the east or north-east.' There are also two circumstances deserving of notice, alluded to in the returns from this part of the kingdom, of which no mention is made as having been observed elsewhere. One is the occurrence of the aurora- borealis, noticed by Mr. Bird, of Swansea. The other is con- tained in the following extract from Dr. Davis's letter: — 'A gentleman in this neighbourhood, who is a naturalist, observed a large quantity of dead flies in hollow lanes and on the sur- face of the ponds, where they had evidently been drifted by the wind during the prevalence of the epidemic. The same thing was observed, I hear, in different places.' As we have just stated, no mention is made of such a phenomenon having been noticed elsewhere, in any of the returns sent in to the Council ; but the circumstance itself deserves to be recorded, especially since a similar occurrence is said to have taken place during other epidemics. "In the replies scut in from the Eastern Counties, it is stated, that previous to the epidemic, the weather was cold DR. STREETEN'S REPORT. 329 and wet, (according to Mr. Priest, of Burnham, cold and dry, with mucli snow,) and the atmosphere hazy, the wind varying from north to north-east and east ; and the disease appears to have made its appearance immediately after the commencement of a thaw, when the atmosphere was saturated with moisture. Mr. Hargraves of Wotton says, that there was a sudden change from cold to warmth, there having heen severe storms of snow for some time previous ; and Mr. Priest remarks, that the snow was succeeded by a mild and damp atmosphere, before which change the disease had not appeared. " In the South-Eastern Counties a similar atmospheric state is noticed as having occurred. ' The epidemic came on,' says the Chichester report,' 'immediately after the melting of the snow, and certainly at a time of year not generally the most sickly, it having disappeared by the end of February, just when, in ordinary circumstances, there is most sickness.' In the Isle of "Wight, however, according to the statement of Mr. Bloxam, the snow appears to have been constantly on the ground, and the temperature of the atmosphere varying a few degrees above or below freezing point ; but this, he observes, continued for some time after the subsidence of the epidemic. Several of the returns from the Southern Counties mention a long continuance of cold winds as preceding or accompanying the disease. At Croydon, Mr. Fletcher observed a moist state of the atmosphere, with a long continuance of cold winds. At Salisbury, Dr. Grove states, that easterly winds, frost and snow, preceded the epidemic; and Mr. Sampson, that those winds continued throughout. Mr. Smart, of Cranbourne, observes, that the outbreak of the epidemic was preceded by a sudden thaw, and its progress attended by easterly winds. At Bew Regis the disease was observed to follow after the occur- rence of easterly winds, and the breaking up of the frost; and Dr. Clendinning says, that he observed no peculiar atmos- pherical phenomena in the neighbourhood of the metropolis, with the exception of an unusual prevalence of winds from the north, east, and north-east. One gentleman, Mr. Fox, of Cerne, states, that the principal atmospheric phenomenon observed to precede the late epidemic in his neighbourhood, was a difference of twenty-six degrees in the temperature in a very few hours, but does not mention whether this diiFerence 330 . EPIDEMIC OF 1836-37. proceeded from a change from a low to a higher temperature, or the reverse. " The tabular reports of Dr. Shapter, referring to this part of the kingdom, and those of Dr. Black from the Northern Districts, will be found at length in the Appendix, and together with the observations of Mr. Addison made at Malvern, in the Midland District, afford valuable materials for comparison. " Observations on the Meteorological Phenomena. " The identity of the Influenza so universally prevalent throughout all parts of Europe in the early months of 1837, with those epidemic catarrhs which, at various periods, have visited this and other parts of the globe, cannot be disputed, and it is highly important to determine, if we can, what are the exciting causes of this widely-extended malady. In en- deavouring to bring this important question to as unexcep- tionable a test as an inquiry so doubtful will admit of, it is requisite that doubtful or uncertain points should be discarded, and those facts only which are established by general testimony and experience be made use of for the purpose. " From all the documents we have seen relating to this sub- ject, it is evident that catarrh, bronchitis, and other inflamma- tory disorders of the chest, were more than usually prevalent in many parts of England in the period just preceding the out- break of influenza, and that this epidemic raged not only throughout the whole of England, but in most other parts of Europe, between the first week of January and the third week of February, forcing itself upon the attention of medical prac- titioners, in some places a little earlier, in others rather later; whilst again, influenced perhaps in some degree by local cir- cumstances, it lingered among the population, in certain situations, for a more extended period than usual. " It is quite uncertain what time elapses between the appli- cation of the exciting cause and the appearance of the disease; but supposing in the first place, that it had its origin solely in the changes of temperature, of pressure, or of weight of the aqueous vapour of the atmosphere, such an origin ought to be detected by examining these phenomena for two consecutive months, the one being the month previous to, and the other the month including, the most active period of the disease, and DR. STREETEN'S REPORT. 331 comparing them with the same phenomena in the same months in preceding years. " With regard to the actual weight or pressure of the air^ this could only have been increased by the introduction of some foreign gaseous, or other extremely attenuated form of matter into the mass of our atmosphere. The quantity and weight of vapour is so closely connected, particularly during the winter season, to which our observations are restricted, with the temperature of the air, that a separate examination of this subject is uncalled for. " It remains, then, to investigate the changes of temperature which took place in December, 1836, and in January, 1837, comparing them with the changes observed in December and January of the two preceding years, in order to discover whether any peculiarities characterise this period. " In the annexed woodcut, the dark line shews the variation of maximum temperature in December, 1836, and January, 1837 ; it may be called the influenza line : the lighter shaded line shews the temperature for December, 1835, and January, 1846, and the dotted line for December, 1834, and January, 1835 :— DECEMBER. JANUARY. 5 10 15 20 25 31 5 10 15 20 3S 30 Upon attentively examining the dark line, there is nothing calling for remark until we arrive at a great depression of temperature between the 23d and 25th of December — a fall of 25° P. in three days. This depression was caused or accom- 333 EPIDEMIC OF 1836-37. panied by a change of wind from west or north-north-west to north-north-east. On the 2.5th the wind blew a gale from the latter point, and during the three subsequent days a very unusual quantity of snow fell, unequalled in this country for duration, severity, and extent. A rapid thaw commenced on the 2d day of January, the influenza appeared in London at the same time, and it was general throughout the country on the 7th, or at farthest on the 10th. " The accounts from all parts of the country, of the disastrous gales, the drifting of the snow, the floods caused by the thaw, and the outbreak of influenza, rapidly succeeded each other. " If we now examine the shaded line, which shews the variation of maximum temperature for December, 1835, and January, 1836, we shall find a great depression of temperature between the 18th and the 24th December, after which the thermometer rose quickly 20° F., and then fell again the last day of the month and during the first three days of January. The temperature then again rose 18° P. in two days, reaching 50° on the 5th. Snow fell on the evening of the 19th and 20th of December, lying nearly two inches deep on the morning of the 21st. The weather was frosty on the 21st and 22d, with a north-east wind, then frosty and foggy until the 27th, when a thaw took place, which continued, with occasional rain and snow, to the 4th of January; and on the 8th I read the following remark, penned at the time in my journal : — ' A particularly sickly time, catarrhs, and other inflammatory afi'ections of the chest and larynx, accompanied, in many instances, with neuralgic pains.' "We will now shortly refer to the dotted line. Here we see a great change of temperature, amounting to 27° F., occurring between the last day of December, 1834, and the 7th of January, 1835. On the former day the thermometer stood at 55°, with rain and a south-west wind ; frost began on the 2d of January, and it continued with fine weather and light north-east wind until the 8th, when the temperature rose rapidly, and rain again fell. There was no snow during these changes. There is another considerable fall of the thermometer shewn between the 15th and 20th of January, and on this occa- sion it both rained and snowed. Scarlet fever prevailed at this time ; but catarrhal diseases were not particularly remarked. DR. STREETEN'S REPORT. 333 " From this examination — indeed, from the most casual survey of the foregoing lines — we may conclude, that very great variations of temperature may and do occur in a short time without producing any influenza, perhaps no unusual in- crease in the ordinary affections of the chest, to which all persons are more or less liable during spring and autumn, except when these sudden alterations are accompanied by melting snow, which does under certain circumstances appear sensibly to increase the prevalence of inflammary affections of the air passages. "This condition, — melting snow, — was operating at the breaking out of influenza in January, 1837; but did it produce the disease, or did it only co-operate in giving greater effect to other causes ? That it did not produce the disease is evident, because this occurred in situations on the continent nearly about the same time, where there was no melting snow, and because the same disease has occurred before, in this and other countries, in summer months. In 1833 it was very general in this country in April and May, and again in June, 1831, par- tially. Dr. Bardsley, speaking of the influenza of 1803, says. The present epidemic cannot have originated from any remark- able severity of the weather or sudden changes in the tem- perature of the atmosphere ; no season has been apparently less unfriendly to the human constitution than the whole of the late winter and early part of spring. The epidemic catarrhs of 1763 and 1783 prevailed during uncommonly warm and steady weather, in the months of May and June. The remarkable epidemic catarrh of 1580, which, according to Sennertus, — ' Totam fere Europam, uno fere omnes mundi regiones per- vagata est,'^ — raged chiefly during the sultry weather of autumn. In the month of September, 1830, influenza prevailed at Manilla, with the thermometer varying from 78° to 93°.^ "Without uselessly multiplying instances or authorities, it must be evident that the exciting cause of influenza cannot be found in sudden vicissitudes of temperature, great heat or cold, damp weather or melting snow, however much all or any of these circumstances may predispose to or originate the more ordinary catarrhs, eruptive fevers, and other disorders of Spiing, Autumn, and Winter." ' Medical and Physical Journal, vol. ix, p. 527. ' Medical Gazette, vol. viii, p. 525. 334 EPIDEMIC OF 1836-37. A Meteorological Register for January, February, and March 1837, with a Nosometrical View of the Epidemic Influenza during the same months, as observed at Bolton-le-Moors. JANUARY. O fj Mean of morning, ."3 >*'B r-H noon, anJ night. 1 i 1 •w "Weather. IH 1 a §• 5 O 1-3 Therm. Baiom. 5 1 30°3 30-27 30° _ _ Fair all day . 2 32-3 30-12 31 Very foggy .... -1 3 40- 30-02 38 A little rain, a.m. and p.m. . 4 38-3 30-02 39 Fair 5 36- 29-62 35 Fair 6 39-3 29-19 38 Rain all day, some hail, p.m. ■5 7 38-3 29-37 38 — — ' Kain and a little hail, a.m. and p.m } 8 38-7 29-82 35 — Rain at night 9 47-3 29-68 46 A little rain, a.m. ■1 10 37-3 29-62 38 Fair .... 11 27-7 29-89 27 Fair . 1-5 12 34-3 29-47 28 — — / Snow, a.m., snow and 1 p.m. rain 1 13 40-7 29-17 38 Rain in the morn. 2 14 33-7 29-94 32 in 16 in 16 Fair . 2-3 15 34- 30-15 30 days days Fair . 3-4 16 38-7 30-05 37 0-15 in. 2-24 in. Very foggy, p.m. . 4-9 17 40- 29-98 38 — — Fair . 9-1 18 38- 29-82 35 — Fair . 14 19 37-7 29-64 35 — — Fair . 18 20 35- 29-46 32 — Fair .... 25 21 37- 29-25 33 — Rain at night 30 22 44- 28-94 43 — Rain all day 40 23 45'3 29-02 43 Rain all day 42 24 41-7 29-30 41 — Rain, a.m. . 50 25 41- 29'45 40 Rain all day 56 26 39-3 29-53 37 Fair . 71 27 37- 29-68 36 Rainy at night 75 28 33- 29-73 33 — — f Snow at night, and a \ a.m. and p.m. littU :} 80 29 32- 29-57 30 in 15 in 15 Snow all day 90 30 36- 29-48 34 days days Snow, a.m. . 92 31 41-7 29-61 40 0-09 in 1-10 in Rain, p.m 93 Max. 49° 30-31 Total, 0-24 in Total, 3-54 in Min. 25° 28-88 Meai i37°5 29-638 35° DR. STREETEN'S REPORT. 335 FEBRUARY. Mean of morning, -t! 1 noon, and niglit. 1 a ci is^ i" Es o 1 l|i ft o S 1 ■s 1 Weather. lis Therm. Barom. 5 P 1 1 41°3 29-79 40° Rain at night 95 2 43-3 29-99 41 — Fair all day 98 3 41-3 30-03 40 — Rain all day 100 4 41- 30-07 40 — — Fair all day 90 5 37-7 30-01 36 — — Rainy, a.m. and p.m. . 82 6 41- 29-98 37 — Fair all day 71 7 41- 29-88 39 — Fair all day 60 8 43- 29-80 41 — — Rain, a.m. and p.m. . 72 9 47- 29-83 44 — Some rain at night 91 10 49- 29-34 50 — — r Rain all day, and stormy 1 p.m. } 69 11 43-3 28-72 50 J Rain and very stormy al t day . . . Rain morning and night } 62 12 39-3 29-02 37 in 14 in 14 60 13 44- 29-82 44 days days Rain, a.m. 55 14 41- 29-21 40 0-27 in. 2-15 in. Fair all day 50 15 43-3 29-62 41 — . — Rainy, p.m. 44 16 52- 29-65 50 — — /Fair all day, stormy a \ night . 1 J 37 17 44-3 29-90 44 — — Fair all day 36 18 41-3 29-44 44 — — J Rain, p.m., rain and hail a 1 night . } 30 19 38-3 28-95 38 — — J Kain and a little snow al I day, hoisterous, p.m. } 23 20 , 42- 29-19 42 — — Rain at night . 21 21 41-3 29-19 41 — — Rain at night and p.m. 14 22 41- 29-51 39 — — f Rain, a.m., rain and snow 1 p.m. . } 9-1 23 39- 2902 43 — — /Rain, hail, and snow, verj \ stormy, p.m. and night } 8 24 39- 29-64 40 — — / Fair all day, but boiste \ rous } 7 25 35-3 29-95 35 Fair all day 6 26 33-7 29-90 30 in 14 in 14 A little snow, p.m. 7 27 39-3 29-74 40 days days Rain at night 4-6 28 38- 29-95 40 0-54 in. 2-25 in. A little rain, p.m. 4 Max. 56° 30-10 Total, 0-81 in. Total, 4-40 in. Min. 30° 28-60 Mear 41°4 29-57 40-9 336 EPIDEMIC OF 1836-37. MARCH. Mean of moruiug -g ll noon and night. ^ g .3 l^o 4 ^ V ■^ M .153 s s S 1 Weather. III Therm. Barom. 5 1 34° 30-19 32° Fair all day .... 3-4 2 37-7 30-10 32 — — r A little rain, p.m., and at I 1 night . . . .J 3-5 3 40- 30-08 41 — — Slight rain, a.m. and p.m. . 4-6 4 39- 29-95 39 — — Fair all day .... 4- 5 37-3 29-71 39 — — Slight rain, a.m. and p.m. 3-5 6 39-3 29-77 37 — — Fair all day .... 3- 7 40- 29-85 37 — — Fair all day .... 2-3 8 42- 29-83 38 — — r Fair all day, but strong wind, "1 \ p.m., and night . . J 2-2 9 45- 29-57 39 — — f Slight rain, p. m., and at 1 1 night . . . .] 2- 10 41-7 29-00 40 — — Rain, p.m., and stormy . 1-2 11 36- 28-95 34 — Snow and rain, p.m. 12 36-3 29-23 35 — Rain and snow at night 13 36-3 29-85 38 in 15 in 15 Snow, a.m 1- 14 37- 30-17 32 days days Fair all day . 15 37- 29-99 33 0-38 in. 0-20 in. Fair all day . 1-2 16 40-3 29-92 36 — Fair all day .... 17 41-7 30-08 38 Fair all day .... 18 37-7 30-02 37 — — Slight sleet at night 19 37-3 29-85 33 — A little snow, a.m. 20 35- 29-78 38 — Snow all day 1-3 21 37-3 29-55 32 — — / Slight snow the whole twenty- 1 \ four hours . . .J 22 32-7 29-50 32 — — f Slight snow, p.m., and at \ \ night . . . ./ 1- 23 32-7 29-47 34 — — / Slight snow the whole twenty- T \ four hours . . .J 24 34- 29-54 35 — — Much snow in the morning . 25 36- 29-46 35 — — Slight rain and snow at night -8 26 34- 29-52 34 — — Slight snow and hail, p.m. . -5 27 32-3 29-66 30 — — Slight snow all day 28 36- 29-47 34 — — f Heavy fall of snow, a.m., "1 \ snow, p.m. . . .J 29 37- 29-36 36 — — Snow, a.m., hail at night ■1 30 36-7 29-57 36 in 16 days in 16 days Fair all day .... A little snow early in the"! \ morning . . . . / 31 36-7 29-64 34 0-25 in. 1-21 in. Max. 51° 30-20 Total, 0-63 in. Total, 1-41 in. Min. 26° 28-90 Mean 37°3 29-697 35°5 DR. STREETEN'S REPORT. 337 Register of 420 Burials at the Parish Church, Bolton, in January, February, and March, 1837; with the average amount of Burials during the same months of the five pre- vious years; and the ratio per cent., buried at the several ages, to the total deaths in the two periods. Age. 1837. ■S ■ r 3 Eatio per cent, at the several a^es to the total burials lor the three mouths. ijl ill III Eatio per cent, at the several ages to the total burials xn the same months of the five for- mer yeax's. January. February March. Under 1 year 21 50 21 92 21-9 76-6 26-6 1 11. 24 7 42 10- 39-8 13-8 2 10 8 2 20 4-8 18-2 6-3 3 1 8 2 11 2-6 8-6 3- 4 3 1 3 7 1-7 9-4 3-24 5 — 9 3 3 4 10 2-4 18- 6-27 10—14 5 8 4 17 4- 7- 2-43 15—19 4 4 1 9 2-1 6-8 2^36 20—24 2 5 6 13 3- 10-2 3-54 25—29 2 6 2 10 2-4 9-4 3-26 30—34 7 10 1 18 4-3 6-8 2-36 35—39 1 5 5 11 2-6 7- 2-43 40 44 6 7 3 16 4- 6-8 2-36 45—49 8 11 7 26 6-2 7-8 2-7 50—54 7 9 3 19 4-5 6- 2- 55—59 1 9 3 13 3- 7'8 2-1 60—64 2 11 6 19 4-5 11-4 i- 65—69 10 11 6 27 6-4 8-6 3- 70—74 2 8 9 19 4-5 11-4 4- 75—79 5 3 2 10 2-4 4-8 1^66 80—84 3 4 2 9 2- i- 1-4 85—89 — — — — — 2-4: •83 90—94 — — — — — •6 •2 95 1 — — 1 •24 •2 •07 100 — — 1 1 •24 — — Total . . . 115 205 100 420 Total average "1 for the five 111-2 79 97-8 288 previousyears J yi 338 EPIDEMIC OF 1836-37. Table I. Mean state of the Thermometer, Barometer, Dew-point, Wind, and amount of Rain, at Exeter, for September, October, November, and December, 1836, and January, February, March, and April, 1837, together with the proper means for these same months. 1836. 1837. Sept. Oct. Nov. Dec. Jan. reb. March. April. 1 1 1836 and 1837 The mean . . 54-8 56-9 51- 55-2 44- 45-5 42- 43-4 36- 39- 40-6 41-7 36-3 44-4 40-3 48-7 1 1836 and 1837 The mean . . 29-77 29-87 29-63 29-94 29-50 29-86 29-68 29-79 29-79 29-85 29-79 29-91 29-79 29-98 29-66 29-83 i n 1836 and 1837 The mean . . 48-3 51- 45-3 45-3 38-6 41-1 33-6 40-4 34-3 36-3 40-3 38-4 30-3 39-3 35- 41-5 1 1836 and 1837 The mean . . S.W. W. S. w. W. W. N. W. N.W. N.E. W. W. W. W. W. W. 1 a S 1836 and 1837 The mean . . 2-9 3- 4-1 3-1 5-6 3-1 2-5 3-6 1-8 2-9 3-3 2-6 1-0 2-1 1-6 2-5 DR. STREETEN'S REPORT. 339 Table II. Being the mean state of the Thermometer, Barometer, Dew- point, Wind, and amount of Rain, for each period of ten days, from September, 1836, to April, 1837, inclusive. Thermometer. Barometer Dew-point. Wind. Eain. 1836. September. Max. Min. Med. Max. Min. Mefl. Max. Min. Med. 1—10 70 44 54 29-75 29-21 29-65 52 47 49 S.&S.W. 2-30 10—20 63 43 53 30-00 29-85 29-91 50 44 47 N.E. — 20—30 69 43 57 30-03 29-23 29-77 56 44 49 S.W. •60 October. 1—10 57 32 47 29-75 28-80 29-21 49 39 42 S.W. 2-12 10—20 61 40 50 30-26 28-72 29-68 54 44 48 S.E. 1-68 20—31 57 24 57 30-25 29-16 30-00 50 28 46 N. •30 November. 1—10 55 30 42 29-90 29-27 29-66 48 34 39 W. 1-20 10—20 55 33 45 29-90 28-96 29-48 48 34 39 S.W. 1-42 20—30 55 28 46 29-80 29-02 29-36 44 32 38 S.W. 3-02 December. 1—10 55 36 48 30-03 28-88 29-56 46 36 42 w. 1-32 10—20 52 34 43 30-10 2907 29-67 44 36 39 N.W. 1-04 20—31 50 28 35 30-25 29-46 29-81 42 20 30 N.E. •14 1837. January. 1—10 48 26 37 30-36 29-51 30-03 40 28 34 N.W. •10 10—20 51 27 31 30-25 29-53 29-89 42 29 32 N. •30 20—31 53 29 40 29-73 29-20 29-45 42 30 37 S.W. 1-44 February. 1—10 50 34 42 30-10 29-53 29-97 48 38 45 S.E. •60 10—20 55 33 40 30-10 29-03 29-63 48 38 41 S.W. 2^14 20—28 49 32 40 30-10 29-50 29-98 42 32 35 W. •60 March. 1—10 48 28 38 30-28 29-20 29-92 38 27 31 N. &W. — 10—20 49 29 37 30-10 29-10 29-83 36 26 31 E. •40 20—31 46 20 35 29-90 29-53 29-64 31 25 29 N.W. 1^00 April. 1—10 48 27 37 30-20 29-46 29-81 38 24 32 N. •16 10—20 56 29 38 29-83 29-33 29-65 40 27 31 N.W. •14 20—30 59 36 46 29-70 29-22 29-52 49 40 42 W. \-iO 340 EPIDEMIC OF 1837. [In proceeding to communicate further particulars re- garding this visitation, it may be mentioned that the disease made its appearance at Sydney in the second week of October, 1836; and at Cape Town, Cape of Good Hope, on the 1st of November : much about the same time it was observed on the shores of the Baltic, and soon afterwards in the North of Scotland. Its simultaneous appearance in countries so distant from one another, and so different in climate, is well worthy of notice, and inconsistent with the opinions of practi- tioners, who would refer the epidemic to any variety of weather. In this country, indeed, it appeared in some places, as in Sunderland, during the frost; in others, as in Bury, not before the occurrence of thaw and sudden alternations of tem- perature, and in Dublin it raged during weather remarkable for its mildness and serenity.^ The following table, given by Dr. Heberden2 from the weekly bills of mortality, exhibits very clearly the progress of the epidemic in London, 1837. Cliristeiimgs. Burials. CbriBteniiiga to Burials. Influ- enza. Age from 30to«. 50 to 60 70 to 80. January 3 363 228 4 to 2-5 14 20 22 „ 10 487 284 4 to 2-5 23 42 30 „ 17 384 477 4 to 5 13 49 70 53 „ 24 520 871 4 to 6-6 106 69 95 122 „ 31 307 860 4 to 11 99 71 54 113 February 7 532 589 4 to 4-4 63 41 69 77 „ 14 474 558 4 to 4-7 35 54 70 59 „ 21 316 350 4 to 4-4 20 36 36 31 „ 28 809 321 4 to 1-6 8 32 24 37 March 7 480 262 4 to 2-2 4 23 23 19 It is apparent from this table, that the disease began in London about the 10th of January, attained its height in about a fortnight, and ceased after six or seven weeks from its first appearance. It is also observable that, whilst the deaths at all ages were increased, those of the old were most sensibly altered.^ The following return supplied by Dr. Graves, of the inter- ments in Prospect Cemetery, Glasnevin, in the suburbs of Dublin, conveys an idea of the severity of the epidemic in that locality :] ' Lund. Med. Gaz., vol. x,\, pp. 114, 118, 129, 224. ' Ibid. p. 786. ' Ibid. p. 51. DR. GREENHOW'S OBSERVATIONS. 341 ' In December, 1835 . . 352 In December, 1836 . . 413 January, 1836 . . 392 January, 1837 . . 821 February „ . 362 February „ . . 537 March „ . 392 March „ . 477." "If, as is probable, less than a fourtb of those dying in Dubhn are buried there, three thousand persons died of in- fluenza in Dublin, besides those who, although they got over the immediate attack, sunk, under diseases induced by this epidemic.'''^ Dr. Greenhow, of North Shields, who was at first inclined to attribute the disease to the influence of the weather, gave up that opinion on observing that comfortable lodging, warm clothing, and good food, afforded no protection against the attack. He adds: "In low situations near the river side, amongst narrow lanes and close alleys, the complaint was neither more fre- quent in its occurrence (in proportion to the population), nor more violent in its form, than it was in the upper town or in the adjacent country, amongst the villages and farm- houses. A gentleman who had been confined for some months to his chamber, the temperature of which never varied so much as one degree, was the only individual of the family who took the disease. "Those people whose occupations were carried on in high temperatures, as the pitmen, glass-blowers, forgemen, and founders, were amongst the first who suffered from the epidemic, and great numbers of them were attacked while at work, and consequently when the skin was in a state of great activity j from which we may fairly infer, that the morbid impression is exerted on the system through the medium of the skin. The people employed in the various soda manufactories, who work and live in an atmosphere impregnated with muriatic acid gas of such strength as to destroy vegetation in the immediate vicinity, enjoyed no exemption, but suffered in an equal pro- portion to the rest of the community, a circumstance calculated to make us a little sceptical as to the disinfecting power of any gaseous fluid. Of sailors, many were attacked at sea, but, as far as I can ascertain, not in harbour, who along with keelmen, watermen, and others, employed upon the river, suffered in a. ' London Medical Gazette, vol. xx, p. 787. 343 EPIDEMIC OF 1837. similar proportion to the rest of the inhabitants. The only class of people who enjoyed immunity from its attack were the dredgers, consisting entirely of females, amounting to about two hundred in number. Their occupation consists in wading up to the arm-pits in salt water for three or four hours at each ebb tide, to collect, with wooden rakes, the coals which fall into the river in loading the ships. These women enjoy a remarkable exemption from sickness, and generally attain to a very ad- vanced age. On the late occasion they escaped the epidemic entirelv."^ DR. GRAVES.^ "The epidemic rarely attacked persons labouring under acute diseases until the period of convalescence arrived, when their immunity ceased, and they became just as liable to its invasion as others. Thus patients labouring under typhus escaped as long as the fever continued; but frequently on the very day the crisis occurred, and symptoms of returning convalescence appeared, they were seized with influenza. " One of the most singular features in the history of the present influenza is the extraordinary degree of dyspnoea wit- nessed in most cases where the lung is extensively engaged, but particularly where the patients had been previously subject to pulmonary affection, and even in many cases where the bronchial mucous membrane is but slightly engaged the amount of dyspnoea is remarkably great. Indeed it might be said with much truth, that the dyspnoea was by no means pro- portioned to the extent of pulmonary inflammation. There is at present in the hospital a woman labouring under influenza whose chest sounds clear on percussion, and in whom every part of the lung is permeable, who presents nothing more than a few sonorous rales in the course of the larger bronchial tubes, and yet she is sufi^ering from considerable dyspnoea, and the respiration amounts to forty-six in a minute. We cannot, therefore, attribute the difiBculty of breathing to mere bron- chitic lesion, for it is not in proportion to this lesion. Another patient, admitted into Sir P. Duu^s hospital, exhibited a similar ' London Medical Gazette, vol. xx, p. 10. Idem, p. 786. ' Idem, p. 856. DR. GRAVES'S OBSERVATIONS. 343 train of symptoms. He was a negro sailor, a native of New Brunswick, and was seized with the epidemic a few days after his ship arrived in Dublin. He was a man of Herculean form and finely-developed chest, and in the prime of life; his suffering from dyspnoea was intense ; his chest heaved, he tossed about in bed in a constant state of agitation and restlessness, and yet the respiratory murmur was everywhere distinctly audible through the lung, and no rk\e could be heard, except here and there a few bronchitic wheezings. He also laboured under insomnia, and, though he had but little fever, his debility was extreme ; indeed his pulse was so weak from the commence- ment, that I could not venture to treat him antiphlogistically, and I accordingly ordered extensive vesication over the chest, with the use of wine stimulants and narcotics. This man sub- sequently recovered, an event which could hardly have occurred under the plan of treatment adopted, had his dyspnoea de- pended on mere bronchitis. It should be also borne in mind that in many bad cases of influenza the dyspnoea is intermittent, or at least undergoes remarkable exacerbations and remissions at certain hours of the day and night. It would appear that the respiratory derangement depends on the same general cause which produces the whole train of symptoms, and that it might exist even where there was no bronchial inflammation at all. It is true, that where the bronchitis is present it adds to the distress of respiration, but the dyspnoea appears to be chiefly attributable to some impression made on the vital activity of the lung. That the lungs are endowed with an inherent vitality necessary to the aeration of the blood has been long acknowledged by the Germans, who have described a dyspnoea from paralysis of the lungs ; and this opinion is now generally adopted in Great Britain since the results of the experiments on the eighth pair of nerves have been duly appre- ciated. We have abundant illustrations of this truth in asthma, in which the greatest dyspnoea is often present without any appreciable lesion of the lung; and it would be a fortunate circumstance for the patients in influenza if this were not the case, for we could then treat the affection of the lung as ordi- nary bronchitis, and should expect to find it amenable to the ordinary remedies. You are aware that the mortality, in cases of ordinary bronchitis, is extremely small, if we except very 344 EPIDEMIC OF 1837. young children and persons advanced in life. In adults, when met by prompt and appropriate treatment, it is in general a very manageable disease, and seldom proves fatal, unless com- bined with other unfavorable conditions. This, however, is not the case in influenza, nor is the pulmonary affection so easily treated, or the dyspnoea so readily controlled. I saw some time ago a fine young woman, servant to a gentleman in Fitzwilliam Street, for whom everything had been done which the best and most skilful practice could devise, — but her con- dition, when I saw her, was desperate, and she died the fol- lowing day ; yet her chest sounded well on percussion, and we could hear nothing over the whole lung except a few sonorous and sibilous rales ; and the respiratory murmur seemed every- where nearly as loud as natural. Of course such a lesion of the nervous influence could not last long without necessarily inducing pulmonary congestion, — an inevitable consequence of imperfect aeration of the blood. When the eighth pair of nerves is divided, the animal is slowly suffocated ; and, on dissection, the lungs are found engorged, and the bronchial mucous mem- brane congested and inflamed. May not the affection of these parts in influenza be sometimes induced by lesions of nervous power in the lungs ? I am indebted to my friend Dr. George Green for the following results of his very numerous post- mortem examinations in this disease ; and I feel great pleasure in being able to give them, as such examinations, at least in this country, are very rare. Dr. Green observes : " ' In the cases which proved fatal at the House of Industry during the late epidemic, influenza occurred principally among the aged inmates of both sexes. I had an opportunity of examining several of these cases, and the following were the principal post-mortem appearances observed : " ' The bronchial mucous membrane was found in every case more or less congested and inflamed. The colour varied con- siderably, being in some of a dull red, and in others of a much darker hue. The inflammation in most cases was found to occupy both the trachea and the bronchial tubes of both lungs ; in other instances it was confined to one lung alone. A sau- guinolent frothy mucus occupied the area of the tubes, and increased in quantity as they were traced to their minuter divisions. The parenchymatous tissue of the lung was invariably DR. GRAVES'S OBSERVATIONS. 345 drscolourecl, being generally of a dark or violet colour; its specific gravity was increased, and it did not crepitate, or at least very feebly, when pressed between the fingers. The surface of its section was not rough to the touch, and when pressed in the hand a quantity of the mucus described above was driven out. In some cases the postero-inferior portions of one or both lungs were very dark coloured, and the finger could be passed easily through its substance. When the surface thus torn was examined, it did not appear to be granulated, it re- sembled more a portion of gangrenous lung, except that there was an absence of fcetor. This last appearance was found principally in very aged persons. It was rare to find any traces of the second or third stages of ordinary pneumonia in these patients ; but in the young and robust, who were received into the Hardwick Fever Hospital from the neighbouring streets, these degenerations of the structure of the lung were observed, together with the same inflammation of the bronchial mucous membrane. In most of the aged patients the blood was found dark coloured and fluid in both cavities of the heart and in every vessel where it was examined. The cases in which fibrous concretions in the cavities of the heart were found were very few, and these invariably in the young or middle aged. In the former classes of patients, also, the lung occasionally appeared to be cedematous ; and, in one or two cases, a considerable effusion of serum had taken place into the pleural cavities. The signs of recent pleuritis were very rare, but old adhesions, as might be expected in such subjects, were very commonly found between the pulmonary and costal pleurse. In one case of a lunatic who survived the immediate attack of influenza, tubercles appeared to have been rapidly developed in both lungs. In another lunatic two tuberculous cavities were found, in addition to the state of the lung and air-tubes already adverted to. " 'With respect to the nature and duration of symptoms of those cases which came under my own management, I have little to say in addition to what is already so familiarly known. The physical signs afforded by percussion and auscultation were almost universally as follows: — Dullness, more or less decidedly marked in the postero-inferior portion of the lungs, sonorous, or some form of the bronchial riiles throughout the chest; or, what 346 EPIDEMIC OF 1837. was more common, a mixed sonorous and crepitating rale; or, in the latter stage, a muco- crepitating r^le. The sputa were sel- dom rusty coloured or tenacious, but rather resembled those of bronchitis. In many cases, the want of power to excrete them appeared to be the immediate cause of death; but in others, the morbid cause, whatever it might be, appeared to have affected the entire respiratory and circulating systems, producing great congestion of the venous system, and a state not unlike asphyxia. The latter cases were almost all among the aged inmates of the House of Industry. " 'The appearances of the other viscera were not such as could in any way account for the result so often fatal, so that, so far as one could hazard a conjecture, the morbid cause appeared to have made its primary impression on the respiratory mucous surface, thereby interfering with the proper aeration of the blood, and inducing the changes in that fluid, and in the structure of the lungs above detailed.' "Such are the appearances observed by Dr. Green in his numerous dissections of persons who died of influenza. They may be relied on as perfectly accurate, for no one is better acquainted with pathological phenomena than Dr. Green; and consequently, no one better able to furnish valuable evi- dence with respect to the appreciable changes produced by influenza in the pulmonary and other tissues. I have already advanced the opinion, that we should not hastily assume that influenza consists essentially in the morbid changes which dissection reveals — we should examine every side of the question, and consider whether it is not possible that the alterations in the pulmonary tissue may not be, to some extent at least, the consequences of the disease. Let us consider for a moment the method we pursue in reasoning about the progress and causes of the symptoms in ordinary bronchitis. Here a patient is seized with a pectoral afi'ection, attended by cough, dyspncea, and more or less of fever. We find certain rtiles, and the expecto- ration is altered in quality and quantity. Further observing a nurnber of such cases, we remark that the danger is proportioned to the degree of dyspnoea, and the dyspnoea to the extent and nature of the r^les, together with the quantity and quality of the expectoration. To these the general constitutional affection, aud the probable results of the disease, have certain definite DR. GRAVES'S OBSERVATIONS. 347 relations, a knowledge of wMch is soon obtained by experience. But these rMes, and this state of the respiration and expecto- ration, we have reason to believe arise from the presence of bronchial inflammation, and to this we refer all the symptoms observed. On this supposition, too, we proceed in our treat- ment, and the result most commonly justifies its correctness; and we have additional evidence of its truth furnished by post- mortem examinations. Now in such instances the chain of inductive evidence is complete; and we feel a conviction, that our practice is founded on correct notions of the nature of the disease. But how different is the case when we assume that influenza is caused by bronchial inflammation! In influenza, the dyspnoea is not always proportioned to the bronchitic affec- tion; nay, in some cases, we have seen that difficulty of breathing was most urgent, in cases where the air entered into all parts of the lung with facility, and where few and unimportant rales existed. Again, although the presence of a copious viscid secretion in the bronchial tubes was sure to aggravate dyspncea, yet it often occurred in patients whose air-passages were very little or not at all obstructed in this way. The effects of reme- dies, antiphlogistic, expectorant, and derivative, were very different from what they would have been, had the disease de- pended on a mere bronchitis. I have already stated my con- viction, that the poison which produced influenza acted on the nervous system in general, and on the pulmonary nerves in par- ticular, in such a way as to produce symptoms of bronchial irritation and dyspnoea, to which bronchial congestion and in- flammation were often superadded. "In this view of the subject I am not singular, for I find that it has been advocated by Dr. Peyton Blakiston, in a short 'Treatise on Influenza,' as it occurred at Birmingham. He states, that his researches have led him to the conclusion, 'that influenza is an affection of the nervous system, with its conco- mitant derangements in the organs of digestion, circulation, &c., commonly known under the name of nervous fever, accompanied, throughout its whole course, by irritation of the pulmonary mucous membrane, which not unfrequently amounts to con- gestion and even to inflammation.' "This distinction between influenza and feverish cold, with bronchitis, is, in a practical point of view, of great importance, 348 EPIDEMIC OF 1837. and should never be lost sight of in the treatment of influenza, for it prevents us from placing our sole confidence in remedies adapted to mere bronchitic inflammation. Thus Dr. Blakiston assertSj and most physicians will agree with him, in this point at least, that it was often necessary to have recourse to diffusible stimulants at the commencement, and to administer tonic medi- cines in an early stage of the disease. " In some cases, even where great dyspnoea exists, the cough is hard and dry, and the expectoration is copious, so as to cause constant efforts to cough it up; and, indeed, it is melancholy to look at the distress which patients suffer in this respect. You will hear the wheezing of the phlegm in the throat and air- passages before you enter the room, and you will see the patient exhausted by successive paroxysms of ccugh and ineffectual attempts to expectorate. In other cases, where the vitality of the lung is less injured, and the general tone of the system less deranged, the sputa, although copious, are expectorated with considerable facility. The sputa bear considerable analogy to those observed in ordinary bronchitis; they consist, at first, of a greyish mucus, which, as the disease proceeds, exhibits a glo- bular appearance, or assumes a puriform character, and does not coalesce; in other cases they are extremely viscid and ropy, like solutions of gum or isinglass. A remarkable fact with respect to the sputa in influenza is, that they are very seldom mixed with air-bubbles. On mentioning this to-day to some persons attending my class, I was shewn some sputa discharged by a patient labouring under influenza, in which there were some air-bubbles: this, however, is extremely rare. "In a lecture which was delivered here some time ago, I took occasion to allude to the secretions of the bronchial mucous membrane, and stated my conviction that this subject had not received, as yet, the attention which its acknowledged importance demands. There is one point in particular, of which no adequate explanation has been as yet given, namely, why it is that in some cases of pulmonary inflammation the sputa are filled with air-bubbles, while in other instances there is no appearance of air-bubbles from the beginning to the end of the disease. The presence of the air- bubbles in the sputa has been explained, by supposing that air becomes incorporated with the mucus, while it is driven up and down in the bronchial tubes, during the acts of DR. GRAVES'S OBSERVATIONS. 349 respiration and coughing, just as if you shake a solution of soap, or any other viscid fluid, in a half-empty bottle, it becomes im- pregnated with air-bubbles. There may be some truth in this, but I think it does not sufficiently explain the presence and inti- mate incorporation of air with the sputa, in certain affections of the lung; and it appears to me that we can scarcely understand this, unless we suppose that the air and mucus are secreted together. You are aware that air is secreted by the bronchial mucous membrane, and that, in some cases, this secretion is morbidly increased, in others morbidly diminished. Now it is not very unreasonable to suppose, that the mucous membrane may secrete air and mucus together in abnormal quantity; and that this, rather than any mechanical agitation, may be the cause of the intimate combination of air with the expectorated fluids. " I need scarcely make any observation on the cough of influenza. It is in general very troublesome, particularly at night. Many persons are not much annoyed by it during the day, but at night it becomes very harassing and prevents them from sleeping. When severe, it continues both night and day, and even when persons have recovered from fever and dyspnoea, and are able to go about, the cough will continue extremely troublesome : this I have observed in the majority of cases. In this state medicines prove of very little service, and one of the best remedies is to change to a mild country air. Cases of cough, in which I had tried every remedy without success, and which had resisted every form of treatment in the city, yielded in a few days to the salubrious influence of change of air. "In influenza the urine is generally much loaded with lithates and superlithates, and contains a large quantity of ery- thric or purpuric acid. It is red when voided, deposits a good deal of sediment, and tinges the vessel in which it lies, with a pink film. It bears some resemblance to the urine which accompanies arthritic and gouty afi'ections. In very bad cases this state of the urine continues up to the period of death. You recollect what I stated with regard to the condition of the blood ; — it is generally buff'ed, even where there is scarcely any febrile excitement in the system, and thus afl'ords a very falla- cious indication. The same observation holds good with 350 EPIDEMIC OF 1837. respect to the state of the urine and the temperature of the skin. I may observe here, that the heat of the skin is very- variable ; it is sometimes very high, sometimes natural, in fact, like the pulse, it falls and rises in a very remarkable manner at certain times of the day. "1 have already spoken of the affection of the mucous membrane of the bowels ; I may observe, that in some cases of influenza the morbid influence is translated to the brain, and symptoms of delirium and coma supervene. Thus, in two instances communicated to me by the surgeon-general, the patients fell into a state resembling coma, during the course of the disease. In three cases witnessed by Mr. Swift, the attack of influenza terminated in a train of symptoms bearing a close analogy to delirium tremens, and requiring the use of blisters to the head and neck, full doses of opium, purgative enemata, wine, and the occasional use of mercurials. The patients complained of great headache, noise in the ears, some intolerance of light, and more or less sleeplessness from the commencement, along with the usual pulmonary symptoms. After five or six days they became excessively nervous, lost all sleep, had continual subsultus and tremors, and talked very incoherently, particularly at night. During the prevalence of the cerebral symptoms, the pulmonary affection partially or wholly disappeared, but returned again in some degree, after the subsidence of the delirium. All these cases terminated favorably. I believe I have already remarked, that many persons who have laboured under very severe pulmonary symptoms, will struggle through the disease ; and I may men- tion here, that I have seen persons recover who have suffered from continued orthopncea for three weeks. Still the mortality, peculiarly among the aged, is very great, and I fear that we shall shortly have but few octogenarians to tell the occurrences of the last century. Indeed, the mortality has not been con- fined exclusively to the aged, for many persons in the vigour of life have sunk under the attack. There have been several deaths among the soldiers in our garrisons, notwithstanding the excellent health which our troups generally enjoy, and the skilful and judicious treatment of our present army- surgeons. The results of the medical treatment and necroscopic obser- vations in the different regiments in London, Dublin, and DR. GRAVES'S OBSERVATIONS. 351 Edinburgh, will form a most valuable document, and I hope it will be made public for the benefit of the whole profession. " It now remains for me to say a few words on treatment. First, as to bleeding. A great deal was expected from general bleeding, because the disease was sudden and violent in its onset, accompanied by symptoms which seemed to require active measures, such as an inflammatory state of the bronchial mucous membrane, accompanied by a quick pulse, hot skin, and high-coloured urine. This led persons to expect much benefit from venesection. The results, however, of its employ- ment are, generally speaking, very unsatisfactory. Where venesection was employed promptly, and in the beginning of the disease, and where it seemed to be strongly indicated by the buffed and cupped state of the blood, even in such cases it failed to afford anything like material or permanent benefit, or to produce a decided amelioration of the existing symptoms. " The general impression among practitioners in Dublin at present seems to be, that bleeding is doubtful in its efi'ects, if not altogether improper. I am much inclined to think that bleeding, unless employed within the first twelve or twenty- four hours, will be likely to do as much or more harm than good. Bleeding on the second or third day, except to relieve congestion of the lungs, seems inadmissible. The same ob- servation holds good with reference to other diseases. Thus, in scarlatina, if you happen to be called in when the rigor com- mences, and while the disease is beginning to form, you will often accomplish much good by bleeding your patient ; but after eighteen or twenty-four hours, when the disease is fully formed, venesection will not do. On this point I can speak from experience. In scarlatina the difierence of a few hours renders venesection inapplicable and even injurious. It is the same thing with respect to influenza; general bleeding is use- ful, only in the commencement; and where the symptoms seem to demand it, it should be employed at least within the first twenty-four hours. Where I have been fortunate enough to find the disease just commencing, I bleed to the amount of twelve or fourteen ounces, order the patient to remain in bed and take some aperient, followed ])y the use of nitre. In this way, by timely bleeding, aperients^ sudorifics, and confinement to bed, the attack generally passes over in two or three days. 352 EPIDEMIC OF 1837. I could mention many instances of the success of this plan of treatment. In one family I treated all the individuals attacked, in this way, and I have done the same thing in many cases of persons somewhat advanced in life. In the case of an old gentleman who was very severely attacked, I succeeded by these means in checking the disease at once. My experience therefore is, that bleeding is of service in the very commence- ment of the disease ; but as it seldom happens that a physician is called in at this period, I would qualify my statement by saying, that, as a general measure, bleeding in influenza is seldom admissible. When you are called in to attend cases, you will most generally find that the patients have been ill for two or three days or more, and then the only mode of ab- stracting blood, which you can have recourse to with safety, is by leeching. About eight or ten leeches applied over the hollow of the neck, just above the sternum, and allowed to bleed pretty freely, will prove very serviceable ; and if you apply them in the evening, you wiU often secvLre to your patient a good night's rest. This plan of leeching the hollow of the neck, in cases of tracheo-bronchial inflammation, is an excellent one : the leeches are applied at a spot which lies close to the trachea, and particularly to that point, to which the irritation accompanying bronchitic afl'ections is chiefly referred. By the aid of leeching, the use of aperients, if necessary, and confine- ment to bed, with sudorifics, you will frequently succeed in removing the fever and bronchial inflammation. You will derive much benefit, particularly in the early stage of influenza, from tartar emetic and nitre; but I must say, that neither leeching, nor tartar emetic and nitre, prove as valuable and as efiicacious in influenza as they do in ordinary bronchitis. Some of my friends who used tartar emetic as a nauseant in the commencement of the disease, inform me that they have derived benefit from its use, and others have told me that they have used tartar emetic and opium in the commencement and during the course of the disease with advantage. I have not employed the first of these, but I have the latter, and with favorable results. You may, therefore, after using antiphlo- gistics for a day or two, proceed to the use of opiates in com- bination with tartar emetic or nitre. In some cases the camphorated tincture of opium will answer very well ; in others DR. GRAVES'S OBSERVATIONS. 353 you will find the acetate or muriate of morphia better. A mixture composed of six ounces of almond emulsion, a drachm of nitre, and half a drachm or more of the liquor muriatis morphise, will be found very useful. The muriate of morphia, which possesses many of the valuable properties of opium with- out its defects, will serve to tranquillise the system and produce sleep, two most important points in a disease like influenza con- nected with increased nervous irritability. A gentleman, on whom I place much reliance, tells me, that he has treated many bad cases successfully with camphor mixture, tincture of opium, and tartar emetic. I need not mention the various remedies which have been recommended in this disease, as Mindererus' spirit, Hoffman's anodyne, ipecacuanha — alone or combined with extract of conium and blue-pill, — and many other reme- dies belonging to the class of diaphoretics or expectorants. They are all more or less serviceable, but they have all the common defect of producing less relief than they usually do in cases where the pulmonary affection is simple and idiopathic. Towards the end of the disease you find it necessary to give stimulant expectorants and light tonics, as decoction of poly- gala, senega, infusion of calumba, &c. Sec. " One word about blisters before I conclude. They are useful in some cases, but in many of the severe ones they do little or no good, and only add to the patient's sufiferings. They do not relieve the pulmonary symptoms, and particularly the dyspnoea, in the manner you would be prepared to expect. I do not know a more remarkable circumstance in the present disease than the failure of blisters, and in many cases I do not employ them at all. Fomenting the trachea and chest with very hot water, appears to be much more serviceable. This has proved extremely valuable in many cases of this as well as other affections of the air-passages; and on referring to the late American journals, I find that the plan of treating croup in its onset, by means of very hot water applied with a sponge to the throat, — a plan which I recommended some time ago in the Dublin Medical Journal, — has been extensively employed in America, and with the most happy results. Sponging the throat and chest with water as hot as it can be borne, has been found, in many instances, capable of arresting all the threatening symptoms of croup at once. Several cases are mentioned in 23 354 EPIDEMIC OF 1837. the American journals, in which the lives of the little patients were evidently saved by this application. I may state also, that not long since a child was saved in Dublin by the same means. By the advice of Mr. Smyly, who suspected the threatened attack, the child's mother had everything prepared, and by her promptitude and care arrested the disease before it had sufficient time to form." DE. CLENDINNING/ "Between Monday, January 9, and Saturday, Feb. 4th, 414 cases of influenza were admitted on the out-patient home list of the Marylebone Infirmary, as stated by Dr. Boyd, namely : Week ending 14th January . ,161 „ 21st „ . . . 139 28th „ . . .84 „ 4th February . .34 and the workhouse practice and morning out-patients' room practice advanced numerically, and receded apparently along with the infirmary and home practices; so that the epidemic would appear to have begun with January, and declined in about the usual period of from five to six weeks. " Symptoms. — Of course amongst such a number, various combinations of symptoms must have happened. Confining my remarks to those that were admitted into the Infirmary, of whom only I had personal cognizance, I should say that the cases varied principally according as they were simple or com- plicated, — the former being tolerably uniform in their symptoms, the latter various as the complicating diseases. Of the former the symptoms are familiar, and require no detailed description from me; namely, at first chilliness, lassitude, and depression or anxiety, followed in some hours by more or less of heat, gravedo, headache, coryza, pain of back and limbs, soreness, ' Notice of the Influenza of January and February, 1837, by Dr. Clendinning, in London Medical Gazette, Feb. 18, 1837, p. 781. DR. CLENDINNING'S OBSERVATIONS. 355 sometimes extreme of the chest and throat, with cough, smart fever, often coated tongue, nausea and vomiting, sometimes gastro-enteritic irritation, with diarrhoea, occasionally transient delirium, generally wandering pains of trunk, especially about the sides. Such were the principal symptoms of the un- complicated cases for twenty-four, thirty-six, or forty-eight hours after admission ; after which expectoration became easier, the skin softer and moister, and the cough and headache less troublesome, when the fever gave way, so that in three or four days nothing but weakness with a tiresome cough remained in the majority of instances, — a weakness, however, greatly dis- proportionate to the duration or danger of the disease. Two fifths of the cases noted as influenza by the house surgeon, were of the kind just glanced at ; the remaining three fifths were complicated as follows, namely: " With pleuropneumonia „ bronchitis, mostly chronic, and combined with emphysema pulm., and morb. cord. 36 52 Phthisis 25 Pleuritis . 5 Fever, in several instances typhoid Rheumatism, chron. 25 2 Morb. chron. ventriculi 3 Croup Ptyalism . Encephalitis Morb. chron. cord. . 3 1 1 3 Pericarditis 1 " Of course the symptoms must have varied very much in the second class or complicated cases. In numerous instances the complicating diseases were at first so masked by the influenza as not to be easily recognisable, — without the aid of the pleximeter or finger and ear tube ; indeed, it appeared to me nearly impossible, in several cases, to arrive at a safe and satis- factory diagnosis, more especially in persons advanced in life. The irregularity observed in the course of the functional signs did not in any material degree of course extend to the physical signs, so that pneumonia, phthisis, diseases of the heart, and hypertrophy of the ramifications of the bronchus (or emphy- sema pulm. cum catarrh, chron.), which were the most fre- quent and formidable complications, were generally as easily 356 EPIDEMIC OF 1837. identified as usual. In every case the influenza, if distinguished at all, was readily detected, whatever its complications, if at- tended to within the first day or two ; after that period, it often in bad cases became absorbed in the effects of the graver complicating disease. " Mortality. — The mortality with us or elsewhere, amongst populations embracing indifferently individuals of all ages, sound and unsound, was very considerable during the period so often specified above. I do not know that any simple case was lost from influenza unaided by previous disease or subse- quent complication ; but so large a portion of the subjects of our influenza had had previously tuberculated lung, diseased bronchial ramifications, or hypertrophy of the heart, and the instances in which pleuropneumonia was excited were so nu- merous, that we lost — " In the six weeks from the 31st Decemher, altogether . . 118 To which must be added deaths in the infirm wards of the workhouse, same period . . . . . .21 In the out-door practice, also, there were some deaths amounting in the same period to . . . . .40 Giving a grand total mortality of 179 " Table of cases of all ages treated in the wards of the St. Mary- lebone Infirmary from the ^Oth of December, 1836, to the lOth of February, 1837.^ Living. Dying. Influenza in Ijoth sexes. Male. Femsle. Male. Female. Under twelve months One to five years . Five to ten years . Ten to twenty years Twenty to thirty . Thirty to forty . . Forty to fifty . . . Fifty to sixty. . . Sixty to seventy . Seventy and upwards 5 15 17 40 21 34 27 36 22 21 4 5 24 33 40 26 27 25 30 11 1 3 3 11 10 14 6 9 2 1 2 . 5 4 7 8 10 2 5 3 15 35 28 33 26 41 35 26 'Remarks on the Table of Ages, — From the preceding ' For corrected Table, vide 'Medical Gazette,' 1837, p. 819. DR. CLENDINNING'S OBSERVATIONS. 357 table it would appear, that aged persons have enjoyed no such immunities during the late epidemic, as they have been found, or, for want of counting, perhaps supposed to do, in former epidemics. More than half of the cases were above forty, while a fourth part nearly were above sixty. But the table represents the case too favorably of the other ex- treme of life, owing to the nursery and school children having usually not been so severely affected as to require hospital treatment. Another generally received opinion, however, is confirmed by our experience, namely, the potency of pectoral disease as a predisposing cause ; this appears strikingly from the table of compHcations. For though the complicated cases were received into the infirmary in much larger proportion, of course, than the simple cases, yet the number of the former is too considerable to be overlooked or attributed to universality of diffusion of the epidemic causes rather than to peculiar susceptibility in the subjects. I have added the deaths of all the diseases, but none for influenza separately, for the obvious reason, that influenza proper produced no deaths. Amongst the causes, I have seen no reason to reckon contagion ; perhaps I have not looked sufficiently, or inquired for it. Like aU other epidemic diseases, the present, whether contagious or not, certainly commenced at first without contagion, and has probably, as I think, been exclusively reproduced and continued by recurrences of one or more of its first causes. What those first and essential causes are, I think with Pringle, (Med. Observ. and Enq., vol. vi,) is still a problem for solution.^ "Morbid appearances. — During the epidemic numerous op- portunities presented themselves of investigating its anatomical characters ; and in every instance I found that the fatal result might be attributed to previous disease, or to organic deteriora- tion from lapse of years. The youngest was a female eight years old, who sank under double pneumonia, supervening on tuberculation. There were a male and a female between twenty and thirty ; a male and a female between thirty and forty ; a male and two females between forty and fifty ; between fifty and sixty were five males and two females ; and between sixty and seventy, six males and one female. ' Vide supra, p. 90. 358 EPIDEMIC OF 1837. " The complicating diseases were : " Chronic disease, with enlargement of the heart and bronchial ramifications, without acute pulmonic disease Chronic disease of the heart and bronchia, with recent pleuro- pneumonia ..... Chronic disease of the heart, with phthisis, or recent pericarditis Pneumonia and pericarditis Phthisis with pneumonia Pneumonia ..... Pneumonia, with suppuration of the kidneys Pneumonia, morb. cord, and arachnitis " I observed nothing constant in the post-mortem appear- ances, but extreme injection of the trachea and all its branches, and in several places thickening of the mucous lining of the passages. But those are nothing more than are, according to my observation, to be met with in a greater or less degree in almost every case of asthma, chronic catarrh, and old disease of the heart. It may be thought singular, that disease of the heart should have occurred so often, much oftener than phthisis, being eighteen times out of twenty-two ; and I should probably, some twelve months or more since, have been struck myself by such a statement. But it is undoubtedly true, that disease of the heart frequently escapes the observer who trusts to his eye as a means of admeasurement, when, as often happens, there is no pericarditis, nor any valvular disease, and when hypertrophy, if existing, is distributed pretty equally over the organ, there is a great chance of its escaping notice, unless very considerable ; more especially if the inspector have defec- tive information respecting the health of the deceased. To guard against error from that quarter, I have for some time weighed every subject inspected on account of disease of the heart, entire in the first instance, and then, after careful examination of the pectoral viscera, weighed the heart sepa- rately after washing, and in this way have satisfied myself that, amongst the labouring classes at least, hypertrophy of that organ is a still more common and fatal disorder than many or most physicians believe." i)R. BRYSON'S REMARKS. 359 DR. BRYSON. [During the month of January^ 1837j influenza prevailed epi- demically in nearly every British vessel of war stationed at the following ports:' namely, Sheerness, Portsmouth, Plymouth, and Palmouth.'^ In February it attacked the ships' companies of the vessels employed on the north coast of Spain and at Lisbon. In March it made its appearance on the south coast of Spain, and subsequently attacked the crews of several vessels at Bar- celona. In April it reached Gibraltar, and in May, Malta. It appears, however, to have been prevalent also in January at Smyrna and at Trieste. With the exception of the 'Thun- derer,' there is no evidence of its having broken out in any vessel at sea, unless the crew had been recently exposed in an infected locality. In the above vessel it suddenly made its appearance while she was on her homeward passage from Malta, four days before she arrived in Plymouth. The weather for some time previously had been wet, the wind varying from north-east to north-west. Catarrhal complaints had been for some weeks more than usually numerous amongst the crew, but they did not assume the epidemic form until the 3d of January. On that day, 3 unequivocal cases of influenza were placed on the sick list; on the 4th, there were 7; on the 5th, 13; on the 6th, 11 j on the 7th, 14; on the 8th, 17. After this the number of cases occurring daily began to decline until the 11th, when there were 3 only. On the following day, however, they again began to increase, and continued increasing until the 17th, when they amounted to 44. After this the number of cases gradually dimiuished, and the disease finally disappeared about the end of the month. It is rather remarkable that influenza did not appear in the 'Stag,' 'San Josef,' 'Talavera,' or 'Cornwallis,' all lying at the same port until about the 11th or 12th of January, eight or nine days after its appearance in the 'Thun- derer' at sea, and four or five after her arrival in port. Fever, apparently of a catarrhal nature, broke out in the ' Sapphire' about the middle of January, shortly after leaving ' Compiled from ' Statistical Reports of the Health of the Navy,' 1837-43, and a MS. communication obligingly supplied by Dr. Bryson. 360 EPIDEMIC OF 1837. Corfu, and while cruizing to the southward, amongst the contiguous islands on the coast of Greece. It was supposed to have been occasioned by cold and moisture. The weather had been previously wet, and the awnings being much worn and defective, the whole of the main deck, and those parts of the lower deck near the hatchways, were almost constantly damp, thus proving a source of much discomfort to the men. Sixty- six cases occurred, all of which were cured on board.^] "Catarrhal complaints prevailed in an epidemic form, and with an unwonted degree of severity in almost every vessel of war stationed on the coasts of Spain and Portugal.^ In the majority of the returns these complaints have therefore been denominated influenza. It is first mentioned as having been prevalent at Lisbon, and amongst the merchant shipping, during the latter part of January. "Early in February it appeared in the 'Russell' (74 guns), then at anchor in the Tagus, (the disease at that time being pre- valent at Lisbon, both in the town and amongst the merchant shipping.) The first man attacked had been exposed the greater part of the day in a boat and on shore. The disease rapidly spread until the cases amounted to 84. The greater number of attacks occurred on the 7th day; namely, on the 23d. The symptoms for the most part yielded readily to mild ca- thartics, sudorifics, and warm diluents. "H.M.S. 'Canopus,' 84 guns, with a complement of 650 men (writes Dr. M'WilHam^), after being three years on the Mediterranean station, left Malta on the 1st January, 1837; and having stopped twenty-four hours at Gibraltar and part of a day at Barcelona, arrived in Plymouth Sound on the 1st of February. The following day the ship proceeded into harbour. The weather was cold, rainy, and boisterous, and the influenza prevailed much on shore; yet the crew, although daily exposed in unrigging the ship, in boat duty and at the dockyard, con- tinued in perfect health until the 15th, when the epidemic struck ' Dming the last quarter, 11 cases of what has been called typhus occurred in the ' Princess Charlotte ;' two of these terminated fatally, after their removal to the Hospital at Malta. Three of the ' Asia's ' men also died in that establishment from febrile disease. '' Erysipelas also prevailed in the ' Caledonia ' and ' Carysfort.' " MS. letter to the Editor, DR. BRYSON'S REMARKS. 361 down two thirds of the men in one day. Men in the prime and vigour of Hfe and health, with their spirits in the highest degree elated at the prospect of being paid off, were in an hour or two prostrated in mind and body, as if by some sudden blow, or un- expected reverse of fortune. During the 16th and 17th, upwards of seventeen men were taken to the hospital at Plymouth. "I was labouring under the disease myself j but the surgeon, and the other assistant-surgeon, being worse than I was, I managed to continue on duty, going to bed in the evening, and producing profuse diaphoresis by drinking plentifully of hot negus. Under this system, I got well in a week without confinement." [In March, the disease raged at Barcelona, so generally that the public business was greatly interrupted, and every place of amusement closed. On the 9th or 10th, it attacked the ship's company of the 'Rodney,' then lying at anchor off the town. The seizures including cases of common catarrh, being at the rate of about three men per hour, for two or three days successively. After the 13th of the month it declined, and in eight more days ceased. At the same port it appeared in the 'Nautilus' on the 15th, culminated on the 17th, and disappeared on the 22d. On the 4th or 5th. of April, it attacked the 'Childers,' three or four days after she sailed from Barcelona, where the germs of the disease were undoubtedly contracted. On the 9th of the month it reached its acme, and on the 14th ceased to extend. This vessel arrived at Gibraltar on the 9th, while the disease was at its worst, and anchored near the ' Jasseur,' the crew of which was then perfectly healthy. They purposely avoided as long as possible having any communication with the 'Childersj' but on the 12th, a signal was made by the latter for assistance, (her crew being, from weakness, unable to weigh the anchor,) when a party of men was sent on board. On the 15th the disease made its appearance in the ' Jasseur,' the first man that suffered being one of the party sent to the affected vessel, thus affording evidence of the propagation of the disease by personal commu- nication. The greatest number of attacks took place on the 21 st and 22d; after the 35th, but few cases occurred, and these were of a mild character. The crew of the 'Asia' contracted the disease at Salamis, about the 15th of April. It attained the highest point of severity on the 23d, and ceased on the 29th. 362 EPIDEMIC OF 1837. The vessel reached Malta on the 30th, but did not communicate the disease to the shore or shipping in the harbour. On the 15th of May, the 'Bellerophon' was affected at Tunis. The disease was at the worst on the 23d, and ceased after the 1st of June. A small vessel, called the ' Hind,^ manned with a detachment from the crew of the 'Bellerophon,' was sent with despatches from the latter to Malta, where she arrived on the 16th, sailing again on the same day, in the course of which fifteen of her crew were attacked with the epidemic. It may be presumed that both these vessels contracted the disease at Tunis. Up to the 16th of May, Malta and the shipping in the harbour were unaffected. On the 1 7th, however, a case was entered on the sick list of the steamer 'Medea,' and the daily number of attacks occurring in her continued to increase till the 23d. After the 29th no fresh cases were entered. In the same anchorage the influenza attacked the crew of the 'Rapid' on the 20th ; the daily number of attacks increasing, during the pre- valence of the sirocco, until the 27th, when tliey began to decrease, and finally ceased about the 2d of June. On the 24th it attacked the ship's company of the ' Caledonia,' and acquired its greatest intensity on the 29th, on which day 73 cases were added to the sick list. After the 31st the daily number of attacks diminished, but the disease did not entirely cease be- fore the 20th of June. The ' Volage' (28 guns), on the 3d of May, sailed from the Bosphorus, arrived at Malta on the 19th, and again sailed on the 23d. On the 28th two cases occurred, thus marking a stage of incubation of at least five days, if the disease was contracted at Malta. Two days later it broke out suddenly in the 'Vanguard' (80 guns), which had sailed from the same harbour, and in the course of forty-eight hours attacked 200 men, so that the ship was obliged to return to Malta. The wind then changing from a bleak north- east to a mild north-west, was supposed to have occasioned a change for the better in the disease, the attacks becoming few and less severe. lu July the disease prevailed in the island of Corfu, where it again attacked the crew of the ' Sapphire.' The first case occurred on the I4th. The number of attacks daily increased till the 26th, and finally ceased on the 30th. The influenza in the Mediterranean fleet was soon followed DR. BRYSON'S REMARKS. 363 by diarrhoea and cholera. The 'Caledonia/ which suflPered from influenza in May and June, was attacked with cholera, on the 7th of July, off the coast of Sicily, when 62 cases occurred. The 'Bellerophon,^ during the same month, lost 10 out of 18 affected with this disease. Some of the facts here related may be viewed in reference to the idea of atmospheric origin. If we were to assume such a source of this disease at Malta, how could we explain its ap- pearance in some of the vessels before it arose in others exposed alike to the same atmosphere j or the fact, that some of the larger vessels, containing the greatest number of men and the greatest variety of constitution, were not the first to suffer ? The exciting cause of the disease did not reach the ' Caledonia'' till nearly a week after it invaded the 'Medea' and ' Rapid.' It does not appear that any advantage was gained by the vessels leaving the ports where they contracted the disease. Both the 'Caledonia' and 'Vanguard' left Malta harbour two days after their crews became affected ; and while the daily number of attacks was on the increase, yet the change from a comparatively confined locality to the open sea, had not the slightest influence in checking the progress of the malady or altering the symptoms. The proportional number of attacks occurring daily, was nearly the same as in the ' Medea' and in other vessels that remained at anchor, whilst the amount of morbid action, judging from the cases in the aggregate, was also the same. Contrary to what might be expected, the num- ber of men and the size of the vessel had no very observable effect in modifying the disease. In the ' Medea' and ' Rapid,' both small vessels, the former with a crew of 130, and the latter with about 60, the number of attacks, allowing for slight cases not entered on the sick list, was in nearly the same ratio as in the 'Caledonia' and 'Vanguard,' having respectively crews of 666 and 598, Although the disease prevailed with different degrees of severity in different vessels, still it seems to have displayed about the same degree of severity in different places. In the ' Rodney,' of 92 guns, there occurred at Barcelona 232 cases ; whilst at Malta, in the 'Vanguard,' of 80 guns, there were 250, the number of cases in each vessel, including cases not entered, being about equal to half the crew. In the 'Nautilus,' a 10-gun brig; in the steam ship 'Salamander/ in the 'Tweed' 364 EPIDEMIC OF 1837. (18 guns), on the north coast of Spain ; in the ' Magicienne' (24 guns), at Lisbon; and in the 'Pique' (36 guns), at Gibraltar, the same proportion of attacks obtained,- still there seems some reason to doubt whether it did not prevail with somewhat greater virulence in the vessels stationed in the ports of Spain and Portugal and in the Mediterranean, than in those stationed in the ports of England. The disease, although rife in the Mediterranean station, was not very fatal. The number of cases of influenza and common catarrh amounted in 1887 to 3114, being 4308 per 1000 of mean strength; 36-5 per 1000 were sent to hospital, but only 0'6 per 1000 died. The symptoms were headache; a sense of tightness across the forehead ; pain in the eyeballs, much increased on motion ; lachrymation, coryza, and, in some cases, epistaxis ; pain of the back and limbs, with languor and debility; inflammation of the fauces, with pain extending along the course of the trachea; dyspnoea; nausea; vomiting. The cough was extremely trouble- some. In some cases, the bowels were constipated, in others, relaxed : rigors, alternating with flushes of heat, followed by profuse perspiration. The state of the pulse varied : in general it was quicker than natural, soft, and easily compressed. The tongue had the appearance of being covered by cream. The treatment usually commenced with the exhibition of a dose of Calomel with Antimonial Powder, followed by a purgative, after the operation of which. Antimony with other diaphoretic and expectorant medicines were prescribed. In the ' BeUerophon ' different degrees of pneumonia so frequently accompanied the disease, that of 150 cases, bleeding was employed in 103, and sometimes repeated a second and a third time, it is said with the best effect. That venesection, and what is called the depletory system, were carried too far in several instances, may be inferred from the success attend- ing the opposite and palliative plan of treatment; the immediate results thus obtained were at least equally satis- factory; in the more remote, there was this remarkable con- trast, that those patients who came out of the disease without great physical prostration from the means used, recovered rapidly and satisfactorily, while those who had been subjected to an opposite plan of treatment, and who had lost much blood, recovered slowly, and unsatisfactorily] DR. 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