Tudor Period Lessons In Disease Survival

We appear to have forgotten many ancient treatments and much ancient logic over time, often replacing it with wholly inadequate but more profitable drugs and surgery.

During the Tudor Period and much earlier, evidence exists that it was not uncommon for people to sleep propped up in a sitting posture, due no doubt to witnessing many peoples demise who became afflicted, went to sleep on a flat bed and never woke again, dieing from an array of plagues over the centuries. Laying down flat to sleep if you were sick with this disease or others often meant that you would be be dead by the morning.

The sweating sickness ravaged Europe on numerous occasions, killing millions of people, rich or poor, physician or royalty, all afflicted suffered a similar fate.

 Physicians in these dark days, even if one could afford their services, generally accelerated the patients demise, by introducing further complications and side effects from powerful concoctions, bleeding and often misguided beliefs.The only protection these unfortunate people had was their power of observation and they learned from those that did not lay down to sleep often survived, and somehow managed to escape the clutches of these lethal diseases. This historic document and others reveal that two guards were placed at a sick persons bed side, to prevent the person from laying flat and to prevent them from sleeping. The guarded person was more likely to survive, while many of the uninformed and afflicted lay down and died in their beds, often due to overheating and sweating profusely.Beds became much shorter and people, no doubt through experience and fear, brought about by countless deaths, dreaded sleep as much as they did the grave and opted for resting in a bed, bolstered by pillows to afford a reclined sitting posture. Sleep at this time was split into several smaller parts, unlike we do today-where it is thought to be normal to sleep 8 hours or more. During the night, activities including conversation, work tasks, and entertainment.

Inclined Bed Therapy (IBT) was born out of a new understanding of circulation. It relies on evaporation from the lungs, skin, and upper respiratory tract to alter fluid density, which gravity acts upon, to enhance and drive our circulation, while we are aligned to it's direction of pull. Even today, the medical profession remains blissfully unaware of how gravity affects all of our circulations, despite abundant evidence from astronauts who age 10 times faster than they do on Earth. In fact NASA and other space programs have conducted many studies into prolonged bed rest and reproduced the same degeneration exhibited in micro gravity in space.

 Having the bed inclined to a five degree angle, affords gravity to maintain all of our bodily functions. Having the bed flat, does the opposite, because our vessels that carry blood, lymph, and cerebrospinal fluid around our body, run from head to toe. If we are horizontal, the direction of gravity is perpendicular or at odds with out vessels, and while it still acts upon fluid density changes, it does not assist our circulation, but it does increase friction by pushing on the denser fluids against the bottom of those vessels, effectively slowing our circulation down.

Add to this that any increase in humidity will also compromise our circulation, and not only by our ability to clear fluid from our lungs and bronchial tubes, but by inhibiting our ability to alter the density of our blood, lymph and csf fluids, and would significantly reduce our blood oxygen levels, causing lethargy.

All of which negatively affects our immune system and ultimately compromises the functions of our organs.Having good circulation, means that we are able to distribute heat more evenly. Exposure to prolonged high humidity does quite the opposite and reduces our ability to keep cool, because it compromises the cooling effect from evaporation.

 Evaporation from our skin, lungs, airways, scalp and eyes, increases fluid density because we retain the minerals and sugars dissolved in our bodies fluids.

 Sweating on the other hand, causes loss of salts sugars and minerals, leading to dehydration by reducing the density of our blood and other fluids. This mineral loss in the blood, inevitably affects circulation and in the case of the blood in the veins, reduces the tension applied by the downward flowing blood in the arteries.

 Every molecule in the blood is linked to surrounding molecules by strong electrical bonds. This we call cohesion. This bond reaches beyond our intestines and stomach walls, connecting to our liquid digested meals, behaving more akin to to string, than to fluids, drawing our digested meals into the blood. If this balance is interrupted by either increasing the density of food in our digestive tract, or decreasing the density of our blood, we effectively alter the whole circulatory process due to pressure changes in the arterial flow and the venous return flow back to the heart.

Here we have rendering the affected person unable to make use of dense food, including salted meats, which the affected often became aware of through bouts of chronic diarrhoea, leading to an obvious conclusion that only diluted foods, such as light broths would bring about improvements.

The disease seemed to be more severe among the rich than among the poor, and the young and healthy were frequent victims. Though the reporting of a wealthy aristocrat meeting his or her demise would be recorded more so than a hundred poor people dying.

It is reported in this historic document that aversions to eating meats were not uncommon during and following infections. There was no refrigeration, so meats were cured with salt.

Add to this the confining of patients to a bed and deliberately inducing sweats by covering them in bedding, even sewing the sheets to the mattress to restrict the patient and heating the home, closing all windows and we have a recipe for a fast death.The people of this time became terrified of sleep, having seen many friends and family die in their beds, sometimes within a few hours.

It was believed that the feather fillings were to blame, so people were advised to remove goose feathers from the upper part of their mattresses. Bedding may well have been a contributing factor, given that unusually damp air and very poor attention to keeping the home clean among the poorer people of this time.

But poor people did not have the luxury of goose down and feathers and there lies a connection with rich people appearing to be more at risk.Black mould spores could well have caused further complications. But given the above photographs and those shortened beds it must also have been realised that laying down flat was not a wise decision in times of widespread germs and diseases.In fact, even today, nurses and doctors remove pillows to accelerate the demise of terminally ill patients, though this is never spoken of. It is also written in the Jewish Code Of Ethics that it is forbidden to remove the pillows of a terminally ill patient in order to speed up the patients demise. I have witnessed this practice in a UK Hospital!

 IBT improves body warmth in our extremities, without causing overheating. Warmer hands and feet, when in bed, means we are metabolising food more effectively and radiating heat from our body more efficiently and therefore avoiding overheating and sweating.

 It is mentioned also that accelerated breathing and a rapid pulse was observed in these disease affected people. IBT lowers the heart rate by 10-12 beats per minute and respiration rate by 4-5 breaths per minute and increases oxygen sats!

I remember those days sleeping flat, when the weather was humid and damp, and feeling very hot, sticky and clammy in a flat bed and sweating profusely. Even without a fever, the tannin from drinking tea, leached out from our skin and stained our mattress. Since our bed was inclined in 1994, our ability to deal with infections and moderate our body temperature has improved greatly, and this is backed up by reports from many others stating the same, including reports from aids patients in Gambia, regaining control of bowels, and returning to good health, simply by tilting the bed to a five degree head up angle. Our immune system is clearly reliant on us maintaining optimum circulation and with good reason. Slowing down our circulation equates to lower oxygen levels in our blood.
Remember and return to these points, when reading through this fascinating full account of the sweating sickness.

More recently, there have been many devastating outbreaks of influenza. In 1918 it is reported that over 50 million died of this disease, some reports suggest a much higher death rate, that caused the lungs to fill with fluid, stained with blood. Effectively drowning it's victims, turning their skin dark as their lungs failed to oxygenate the blood. During this pandemic and others, patients seek refuge in their beds. Soldiers, due to their concentrations, are the first to fall victims to what was unfairly labelled as the Spanish flu, merely because the Spanish were the first to report it. Even though it originated predominantly in the US Military barracks and aboard crowded ships heading for combat.

Rows of hospital beds are shown, all of which are horizontal, and despite the catastrophic loss of life, the insanity of making the same choices and expecting different results continues.  It has long been known, and well documented, that  respiratory diseases and complications respond to raising the head end of the bed.  Yet here we see ill advised practitioners ignoring their own literature and sadly lacking the slightest notion of common sense? Simply sitting patients up against pillows would have offered significant support to the respiratory system.

Head of Bed Elevation and Ventilator-Associated Pneumonia 

Prevention of Respiratory Infections In Elderly Bed Bound Patients

https://www.ndhealth.gov/disease/hai/Presentation/PartOneSSIVAPCLBSI.pdf

VAP Bundle 1. Elevation of the head of the bed (HOB) to between 30 and 45 degrees

2. Daily "sedative interruption" and daily assessment of readiness to extubate

3. Peptic ulcer disease (PUD) prophylaxis 4. Deep venous thrombosis (DVT) prophylaxis (unless contraindicated)

 " Elevation of HOB Elevation of the head of the bed (HOB) to between 30 and 45 degree - patients in the supine position will have lower spontaneous tidal volumes on pressure support ventilation than those seated in an upright position. Although patients may be on mandatory modes of ventilation, the improvement in position may aid ventilatory efforts and minimize atelectasis. 

Changes That Can Result In Improvement HEAD -OF THE BED ELEVATED

Implement a mechanism to ensure head of the bed elevation, such as including this intervention on nursing flow sheets and as a topic at multidisciplinary rounds.

Create an environment where respiratory therapists work collaboratively with nursing to maintain head of the bed elevation.

Involve families in the process by educating them about the importance of head of the bed elevation and encourage them to notify clinical personnel when the bed does not appear to be in the proper position.

Use visual cues so it is easy to identify when the bed is in the proper position, such as a line on the wall that can only be seen if the bed is below a 30 degree angle.

Include this intervention on order sets for initiation and weaning of mechanical ventilation, delivery of tube feedings, and provision of oral care.

Post compliance with the intervention in a prominent place in your ICU to encourage change and motivate staff. 2011 Copyright InCo and Associates Intl" https://www.ndhealth.gov/disease/hai/Presentation/PartOneSSIVAPCLBSI.pdf

HELEN DORE BOYLSTON ISTEE: THE WAR DIARY OF A NURSE NEW YORK IVES WASHBURN, PUBLISHER 1927 April 2}.
I am on my day duty again, working on B i. And how my back does ache! There seem to be gaps in my writing, but it can't be helped. We've been awfully busy, and besides, I feel beastly. The flu is back again and everybody has it, including me. I've run a temperature of one hundred and two for three days, can hardly breathe, and have to sleep on four pillows at night. But I'm not talking about it, because I don't want to be sent to Villa Tino (Sick Sisters’ Hospital,). Kitty thinks I have a cold on my chest not knowing about the temperature though I think! she suspected something last night, when I sat up in bed till four in the morning, breathing asthmatically. I'm so tired of rain and mud. 1918 Helen Survived!

https://babel.hathitrust.org/cgi/pt?id=inu.32000004064699;view=1up;seq=88

Video. Kiss of The Spanish Lady 1918

Ask yourself why some parents in this period placed their babies on an inclined mattress to sleep? And why some adults slept sitting up on shortened beds?

 

 

 

EPIDEMICS OF THE MIDDLE AGES

FROM THE GERMAN OF JFC HECKER MD PROFESSOR AT FREDERICK WILLIAM'S UNIVERSITY AT BERLIN AND MEMBER OF VARIOUS LEARNED SOCIETIES. THE SWEATING SICKNESS CHAPTER I

THE FIRST VISITATION OF THE DISEASE

1485 Sound drums and trumpets boldly and cheerfully God and Saint George Richmond and Victory Shall speak

Sect 1 Eruption

After the fate of England had been decided by the battle of Bosworth on the 22d of August 1485, the joy of the nation was clouded by a mortal disease, which thinned the ranks of the warriors. And following in the rear of Henry's victorious army spread in a few weeks from the distant mountains of Wales to the metropolis of the empire.

It was a violent inflammatory fever which after a short rigor prostrated the powers as with a blow. And amidst painful oppression at the stomach, headache and lethargic stupor, suffused the whole body with a fetid perspiration.

All this took place in the course of a few hours and the crisis was always over within the space of a day and night. The internal heat which the patient suffered was intolerable yet every refrigerant was certain death.

The people were seized with consternation when they saw that scarcely one in a hundred escaped, and their first impression was that-

Grafton Vol II pp 147 155 Hall p 425 c For suddenly a deadly burning sweat so assailed their bodies and distempered their blood with a most ardent heat that scarce one amongst an hundred that sickened did escape with life for all in manner as soon as the sweat took them or within a short time after yielded the ghost Holinshed Vol III p 482 Godwin p 98

-a reign commencing with such horrors were doubtless most inauspicious. At first the new foe was scarcely heeded, citizens and peasants went in joyful processions to meet the victorious army. Henry's march from Bosworth towards London resembled triumph, which was everywhere celebrated by festivals. For the nation after its many years of civil war looked forward to happier days than they had enjoyed under the blood Richard.

Very shortly however, after the king's entry on the 28th of August 11 the Sweating Sickness as it was called began to spread its ravages among the densely peopled streets of the city.

Two lord mayors and six died within one week having scarcely laid aside their robes. Many who had been in perfect health at night were the following morning numbered among the dead.

The disease for the most part marked for its victims robust men and as many noble families lost their chiefs, commercial houses, their principals and wards, their guardians and the festivities were soon converted into grief and mourning.

The coronation of the king which was expected to the scruples that many entertained of his right to the throne was of necessity postponed in this general distress and disease, which in the mean time spread without interruption in the whole kingdom from east to west.

It is agreed that the pestilence did not commence till very beginning of August 1485 and was obvious with the circumstances of the times. To return to their country had long been the ardent desire of the Earl of Richmond and his faithful followers.

At the age of 15 in 1471, having escaped the vengeance of the House of York and assassins of Edward he was overtaken by a storm and fell into the hands of Francis II Duke of Bretagne, who long held him prisoner. But on the death of Edward in 1483 him with means to enforce his claims to the English throne, the last descendant of the House of Lancaster. This first undertaking miscarried A storm drove back the bold Bacon.

p 36 b Fabian p 673 c Swetynge syhenesse in the Chronicle d The Mayors names were Thomas Hylle and William Stocker Fabian loc cit c Until the 30th of Oettber Grafton p 158 Wood loc cit 182 to Dieppe and compelled him once more to throw himself with his five hundred English followers on the hospitality of Duke Francis. Richard's influence with the Duke however, rendered his stay there somewhat dangerous. Richmond withdrew privately and endeavoured to gain over to his cause Charles VIII who was yet a minor. A small subsidy of French troops, some pieces of artillery, and an adequate supply of money were finally granted to his repeated solicitations.

This little band was quickly augmented to 2000 men who were all embarked and on the 25th of July 1485. They weighed anchor at Havre and seven days after the standard of Richmond was raised in Millford Haven, they landed at the village of Dale, on the west side of the harbour and on the evening of their arrival, or very early on the following morning, Richmond hastened to Haverfordwest, where no messenger had yet announced the renewal of the civil war.

 It appears that he reached Cardigan on the northern shore on the 3d of August and for the first time granted to his small but increasing army the repose of an encampment. After a short halt he set forward with confidence crossed the Severn at Shrewsbury, turned from thence to Newport and Stafford and pitched his camp at Litchfield, probably before the 18th of August.

The distance to this place from Milford Haven is 170 miles and the road leads over wooded mountains and cultivated fields, without touching upon any swampy lands.

 Litchfield however, lies low and it was here that the army encamped in a damp situation till it broke up for the neighbouring field of Bosworth. Thither Richmond with scarcely 5000 men and having his right wing covered by a morass, went to meet his deadly foe whose army doubled his own.

to Dieppe and compelled him once more to throw himself with his five hundred English followers on the hospitality of Duke Francis. Richard's influence with the Duke however, rendered his stay there somewhat dangerous. Richmond withdrew privately and endeavoured to gain over to his cause Charles VIII who was yet a minor.

A small subsidy of French troops some pieces of artillery and an adequate supply of money were finally granted to his repeated solicitations. This little band was quickly augmented to 2000 men who were all embarked, and on the 25th of July 1485 they weighed anchor at Havre. And seven days after the standard of Richmond was raised in Milford Haven.

They landed at the village of Dale on the west side of the harbour and on the evening of their arrival or very early on the following morning Richmond hastened to Haverfordwest where no messenger had yet announced the renewal of the civil war.

It appears that he reached Cardigan on the northern shore on the 3d of August and for the first time granted to his small but increasing army the repose of an encampment.

After a short halt he set forward with confidence crossed the Severn at Shrewsbury, turned from thence to Newport and Stafford and pitched his camp at Litchfield, probably before the 18th of August.

The distance to this place from Milford Haven is 170 miles and the road leads over wooded mountains and cultivated fields without touching upon any swampy lands.

Litchfield however lies low and it was here that the army encamped in a damp situation till it broke up for the neighbouring field of Bosworth.

Thither Richmond with scarcely 5000 men, and having his right wing covered by a morass, went to meet his deadly foe whose army doubled his own.

The combat was at first furious, but in two hours Lord Stanley crowned the conqueror with Richard's diadem. All these events so rapidly succeeded each other in the course of three weeks that when the knights and soldiers had recovered, they were again seized by it with equal violence a second and sometimes a third time, so that they had not even the slender consolation enjoyed by sufferers in the plague and small pox of entire immunity after having once surmounted the danger.

Thus by the end of the year the disease had spread over the whole of England and visited every place with the same severity as the metropolis.

Many persons of rank of the ecclesiastical and the civil classes became its victims and great was the consternation when in the month of August it broke out in Oxford.

Professors and students fled in all directions but death overtook many of them and this celebrated university was deserted for six weeks. Three months later it appeared at Croyland and on the 14th of November carried off Lambert Fossedyke abbot of the monastery.

No authentic accounts from other quarters have been handed down to our times but we may infer from the general grief and anxiety which prevailed that the loss of human life was very considerable.

Sect 2 The Physicians

The physicians could do little or nothing for the people in this extremity. They are nowhere alluded to throughout this epidemic and even those who might have come forward to succour their fellow citizens had fallen into the errors of Galen, and their dialectic minds sank under this appalling phenomenon.

This holds good even of the famous Thomas Linacre subsequently physician in ordinary to two monarchs and founder of the College of Physicians in 1518.

In the prime of his youth he had been an eye witness of the events at Oxford and survived even the second and third eruption of the Sweating Sickness. But in none of his writings do we find a single word respecting this disease which is of such permanent importance.

In fact the restorers of the medical science of ancient, the plague can scarcely be said to furnish this immunity for though a second attack is an exception to a pretty general rule it is one of by no means an infrequent occurrence.

Transl note Holinshed Vol III p 482 c Wood p 233 d Histor Croyland p 569 Fell No physick afforded any cure Baker p 254 f Henry VII and Henry VIII Compare the excellent biographical account of this learned man by Aihin 185 Greece who were followed by all the most enlightened men in Europe, with the single exception of Linacre, occupied themselves rather with the ancient terms of art than with actual observation. And in their critical researches overlooked the important events that were passing before their eyes. This reminds us of the later Greek physicians who for four hundred years paid no attention to the small pox because they could find no description of it in the immortal works of Galen.

No resource was therefore left to the terrified people of England but their own good sense and this led them to the adoption of a plan of treatment, than which no physician in the world could have given them a better.

Namely not to resort to any violent medicines, but to apply moderate heat to abstain from food taking only a small quantity of mild drink and quietly to wait for four and twenty hours with the crisis of this formidable malady.

Those who were attacked during the day in order to avoid any chill immediately went to bed in their clothes and those who sickened by night did not rise from their beds in the morning while all carefully avoided exposing to the air even a hand or foot.

Thus they anxiously guarded against heat or cold so as not to excite perspiration by the former nor to check it by the latter for they well knew that either was certain death.

The report of the infallibility of this method soon spread over the whole kingdom and thus towards the commencement of 1486 many were rescued from death.

On New Year's Day a violent tempest arose in the south east and by purifying the atmosphere relieved the oppression under which the people laboured.

And thus to the joy of the whole nation the epidemic was swept away without leaving a trace behind. Erasmus expresses himself on this subject in his usual manner He was on terms of strict friendship with Linacre, whom on other occasions he greatly lauds. This however does not prevent him from lashing him with his satire as a philological pedant. Novi quendam roXvrt torart v grsecum latinum mathematicum philoso 186

Sect 3 Causes

It was thought remarkable even at that time that the Sweating Sickness did not extend beyond the limits of England and that remaining the unenviable property of that nation, it did not even spread to Scotland Ireland or Calais which belonged to Britain.

Much doubtless was owing to the peculiarity of the climate more still to atmospherical changes and something also to the habits of the people and the circumstances of the times. It plainly appeared in the sequel that the English Sweating Sickness was a spirit of the mist which hovered amid the dark clouds.

Even in ordinary years the atmosphere of England is loaded with these clouds during considerable periods and in damp seasons they would prove the more injurious to health, as the English of those times were not accustomed to cleanliness or moderation in their diet or even comfortable refinements. Gluttony was common among the nobility as well as among the lower classes, all were immoderately addicted to drinking and the manners of the age sanctioned this excess at their banquets and their festivities.

If we consider that the disease mostly attacked strong and robust men that portion of the people who abandoned themselves without restraint to all the pleasures of the table, while women old men and children almost entirely escaped, it is obvious that a gross indulgence of the appetite must have had a considerable share in the production of this unparalleled plague.

To this may be added the humidity of the year 1485 which is represented by most chronicles as very remarkable. Throughout the whole of Europe the rain fell in torrents and inundations where frequent.

Damp weather is not prejudicial to health if it be merely temporary. But if the rain be excessive for a series of years so that the ground is completely saturated and the mists attract baneful exhalations out of the earth man must necessarily suffer from the noxious state of the soil and atmosphere.

Under these circumstances epidemics must inevitably follow. The five preceding years had been unusually wet 1485 proved equally so the last hot and drought in the summer was that of 1479.

Extensive inundations of the Tiber the Po the Danube, the Rhine and most of the other great rivers took place in 1480 and were attended with the usual consequences from deterioration of the air- misery and disease.

The greatest inundation ever remembered in England was that of the Severn in October 1483. It was long afterwards called the Duke of Buckingham's Great Water, because it frustrated the rebellion of this powerful subject against Richard III, whom he had been instrumental in placing upon the throne and consequently defeated also the first enterprise of Henry VII.

It lasted full ten days and the tremendous ravages occasioned by the overwhelming torrent dwelt long in the memory of the people.

Sect 4 Other Epidemics

During the whole of this period the nations of Europe were visited with various and destructive plagues. In 1477 the Bubo plague broke out in Italy and raged without interruption till 1485. It was accompanied by striking natural phenomena among which we may reckon an enormous flight of locusts in 1478 and 1482 and remarkable inter-current diseases such as inflammatory pain in the side throughout the whole of Italy in 1482.

In Switzerland and Southern Germany malignant epidemics appeared in the train of drought and famine in 1480 and 1481. While putrid fever accompanied by phre nites prevailed in Westphalia Hesse and Friesland.

There had never been in the memory of the inhabitants of these districts so many ignes fatui as during this period. There too the people suffered from the failure of the harvest so that it was necessary to obtain supplies from Thuringenh France, where under the fearful reign of Louis XI oppression and misery seemed to mock the gifts of heaven became in 1482 after a two years scarcity the scene of a devastating plague.

It was an inflammatory fever with delirium accompanied by such intense pain in the head that many dashed out their brains against the wall or rushed into the water, while others after incessantly running to and fro died in a state of the greatest agony.

According to the notion of the age, this disease was attributed to astral influences, for it could not have been brought on only by famine which left to the poor peasantry south of the Loire-nothing but the roots of wild herbs to support their miserable existence, since the higher classes were also frequently attacked.

This fever was without doubt accompanied by inflammation of the meninges or even of the brain itself and was perhaps identical with that which at the same period desolated the north west of Germany as far as the shores of the North Sea, only that it was heightened by the greater natural vivacity and miserable situation of the French people who were kept in a state of perpetual dread by the cruel executions of Louise.

This pestilence occasioned the king to follow the advice of his morose physici and to keep himself closely confined within the town of Plessis des Tours. It was prohibited under a heavy penalty to speak in his presence of death, which was carrying off its victims in all directions and forty crossbowmen kept guard in the fosse of the castle to put to death every living thing which might approach.

Two years after in 1484 viru In many places women and children were obliged to draw the plough from the want of draught cattle they were obliged too to carry on the cultivation by night that they might not be observed by the king's inhuman revenue officers.

It is expressly affirmed by the historians that many of the higher classes were sleepless from the constant alarm and fear of Tristan's sword.

How greatly must such a condition have predisposed the mind to receive this destructive fever. Jacques Cotier extorted from his patients 10,000 dollars a month but after his master's death was obliged to refund to Charles VIII 100,000 dollars Conines L VI c 12 p 400 e Mezeray loc cit OTHER EPIDEMICS 189

During lent, diseases again visited Germany and Switzerland and thus it seemed as if the nations were everywhere threatened with death and destruction .

Sect 5 Richmond's Army

From these data which might easily be extended it is evident that the Sweating Sickness of 1485 did not make its appearance without great and general premisory events, which for a series of years imparted to the people of England a susceptibility to dangerous and unusual diseases.

If besides this we take into account the gloomy temperament of the English and the general depression of their spirits in consequence of the sanguinary wars of the red and white roses, a series of events which seems to have shaken their faith in an overruling providence.

We may readily conceive that it would require but a very slight impulse to excite a powerful commotion in the mysterious mechanism of the human body.

This impulse was evidently given by the landing of Richmond's army in the very year when great and portentous evils were anticipated for on the 16th of March the same day when Queen Ann the unfortunate wife of Richard III expired, a total eclipse of the sun enveloped all Europe in darkness and gave rise to gloomy prognostications.

Even under ordinary circumstances wars beget pestilential disorders how much more inevitably must these have arisen in the then existing state of affairs.

Richmond's army consisted not of brave men animated by zeal to avenge their dishonoured country or to serve a good cause. It was composed of wandering freebooters vile landskneckte as they were called in Germany.

Who assembled under his banner as Havre sharpshooters, formed under Louis XI who recklessly pillaged Normandy and whom Charles VIII gladly made over to Henry in order to free his own peaceful territories from so great a scourge.

This army may not have been worse than others of the same period but cooped up as they were for a whole week in dirty ships they doubtless carried about with them all the material for germinating the seeds of a pestilential disorder which broke out soon after on the banks of the Severn and in the camp at Litchfield.

Sect 6 Nature of the Sweating Sickness

PRELIMINARY INVESTIGATION

Before we proceed further some account is here required of the nature of this disease. It was an inflammatory rheumatic fever with great disorder of the nervous system. This assumption is supported by the manner of its origin and its especial characteristic of being accompanied by a profuse and injurious perspiration.

From that judgement we are now capable of forming of the pernicious influences which prevailed in the year 1485 it may without hesitation be admitted that the humidity of that and of the preceding years affected the functions of the lungs and of the skin and disturbed the relation of this very important tissue to the internal organs of life.

This is the usual commencement of rheumatic fevers which bear the same relation to the Sweating Sickness as slight symptoms bear to severe ones of the same kind. The predominance of affections of the brain and of the nerves however gave to the English epidemic a pecidiar character.

The functions of the eighth pair of nerves were violently disordered in this disease as was shewn by oppressed respiration and extreme anxiety, with nausea and vomiting symptoms to which the moderns attach much importance.

The stupor and profound lethargy show that there was injury of the brain to which in all probability was added a stagnation of black blood in the torpid veins.

We must also take into the account a previous corruption and decomposition of the blood which even if we should be disinclined to infer their existence from the offensive perspiration of the disease itself were proved by striking phenomena of a similar nature that occurred in Central Europe about the same time, for the scurvy prevailed as an epidemic more especially in Germany in the year 1480 and with such severe and unusual symptoms that people were inclined to regard it as a totally new malady.

Now such is the vital connexion of different functions that every impediment to respiration whether in consequence of pressure from without or through spasm and irritation of the nerves from within.

Or even from a morbid condition of the circulating fluid infallibly calls forth the compensating activity of the skin and the body becomes suffused with an alleviating perspiration.

Thus it plainly appears that the profuse perspiration in the disease of which we are treating notwithstanding its apparently injurious tendency was the result of a commotion, excited on the part of the lungs which was critical with respect to the disease itself. And this is in accordance with all the causes of which we still have any knowledge

Noxious and even stinking fogs penetrated into the organs of respiration and as the blood was thus so much affected in its composition and in its vitality, that its corrupt state was only to be obviated by profuse perspiration. The inevitable consequence was an interference with the extensive functions of the eighth pair of nerves which interference as later writers relate extended in many cases to the spinal marrow and brought on violent convulsions.

We have here only one essential cause out of many for this gigantic disease and one too which accounts for its advance and spread.

It is highly probable for the reasons stated and as according with all human experience that it first broke out in the army of Henry the VIIIth and beyond all doubt that it spread from west to east and afterwards in a retrograde course from east to west.

With the perfectly equable operation of the predisposing causes from which the disease ought indubitably to have broken out all over England at the same time had the condition of the atmosphere been its sole occasion, we must additionally presume a special cause for its progress through towns and villages.

This according to all appearance was to be found in the air impregnated with foul odours which surrounded the sick and abounded in the tents and dwellings in which Henry the VIII ths soldiers after various privations and hard service amid storms and rain were closely crowded together.

Of both causes modern observation furnishes analogous examples. Intermittent fevers spread more easily in air which is contaminated by sick people and bands of soldiers themselves in perfect health have not infrequently conveyed camp fever to remote places.

It signifies very little by what expressions of the schools these occurrences are designated it is best perhaps to abstain from them altogether for they are all inadequate and occasion misconceptions.

Contemporaries however were certainly justified in not admitting the notion of contagion in the same sense as when the term is applied to the plague with which they were well acquainted.

For very frequently cases which were not to be explained on the principle of contagion communicated by persons diseased occurred among people of rank and manifestly arose independently of the usual causes.

In these cases the fear of death which everywhere was the harbinger of the disease and threw the nerves of the chest into spasmodic commotion gave an impulse to the malady for which the quality of the atmosphere and luxury had long made preparation.

Had this view of contemporaries been even less impartial than it really was it would have found the most striking confirmation in the sudden cessation of the pestilence throughout the whole country.

For the destructive spirits of air which would not have been discerned even by the proud naturalists of the nineteenth century dispersed and vanished for half an age in the fury of the tempest which raged on the 1st of January 1486.

CHAPTER II THE SECOND VISITATION OF THE DISEASE 1506

The times were rough and full of mutations and rare incidents At the commencement of the sixteenth century society was very differently constituted from what it was at the period when It was conceived not to be an epidemic disease but to proceed from a malignancy in the constitution of the air gathered by the predispositions of seasons and the speedy cessation declared as much.

Henry the VIIIth unfurled his banner for victory. The darkness of the middle ages had receded as at the approach of a sun still hidden behind a cloud. The mind unconsciously expanded in the unwonted light of day that the whole earth was on the eve of renovation, new energies were to be called into action events more stupendous had never occurred. Nor had more creative ideas ever aroused the spirit of man

The invention of Guttenberg burst through the bonds of mental darkness and gave to freedom of thought imperishable wings unsuspected powers successively developed themselves and while in Western Europe an ardent desire arose boldly to overstep the ancient limits of human activity. The hopes of the more enlightened fell far short of the actual result of such unexpected events

The discovery of the New World and the circumnavigation of Africa laid the foundation for great improvements, yet the events in Central Europe though less striking to contemporaries, were in their consequences infinitely more important and beneficial.

The establishment of civil order among all the nations of the West took place at this period which forms so important a boundary between the middle ages and modern times.

Regal power was fixed on a firm basis and when the castles had fallen before the artillery of the princes and imperial cities so that the petty feudal barons were compelled to swear obedience to the laws an end was put to the incessant predatory feuds which had so long desolated Europe and the establishment of internal peace was followed by the security of life and property the first essential of refinement in manners and of the free development of human society.

This great result of a concatenation of circumstances was not however brought about without violent struggles and innovations the effects of which were felt for centuries. But it was probably the establishment of standing armies which had the greatest influence on European civilization.

They became indeed the pillars of civil order but having proceeded immediately from the pernicious mercenary system they long nourished the seeds of unrestrained depravity and transmitted to later generations the corruptions of the middle ages of France and England, who during the war had joined the smaller branches of the standing army, were homeless adventurers from every country in Europe. And were allured not by military ambition but solely by the prospect of booty.

In whatever country the drum beat to arms they flocked together like swarms of locusts no one knew from whence and defying the feeble restraints of military discipline indulged during the continuance of the war in all the unbridled licence of a predatory life.

Hence the unbounded barbarity of their mode of warfare which was restrained only by the individual exertions of more humane commanders. There was however a decided contrariety between this system and the moral condition of the people of Western Europe a contrariety which was never entirely removed by the subsequent introduction of a more strict military discipline and which has been done away only in modern times by the establishment of regular armies on a system more congenial to the feelings of the people.

Hence the consequences were the more pernicious, for when the armies were disbanded on the conclusion of peace the Landsknechts dispersed in all directions not to follow the plough again or to resume their former occupations, but to pass their time in idleness and dissipation if enriched by booty and if reduced to poverty by intemperance and gambling to infest the country as mendicants or robbers till a new war again summoned them from their dishonourable mode of life.

Probably, very few were ever able to rise from such deep degradation and many fell early victims to their vices while the infection of their example brought fresh accessions from every town and village to the mercenary legions flocking together like flies in summer so that any one would wonder where all these swarms have sprung from and how they are maintained during the winter and truly they are such a miserable crew that one ought rather to pity than envy the kind of life they lead and their precarious fortune.

Sect 2 New Circumstances

It is evident that in such a condition of affairs the effect which the plague produced on civil society must have been different from that of former times. Pernicious influences which during the middle ages had endangered the health of the inhabitants of towns and had often rendered disorders naturally slight in the highest degree malignant, were for ever removed.

Under this head may be mentioned more particularly the ill contrived construction of the houses and streets which even yet in large cities destroys the comfort of the inhabitants of whole districts and those not of the poorest class only. As people acquired confidence in the security of peace it ceased to be necessary to protect every country town by fortifications. The walls were thrown down, the stagnant moats were filled up and as people were no longer limited to a narrow space they built more convenient houses in airy streets, the dark alleys and damp dwellings under ground were gradually abandoned and a more comfortable mode of living superseded the former misery.

By this means, the mortality was considerably diminished and the power of epidemics was checked nor can it be doubted that the better administration of the laws greatly obviated the dissolution of social ties in times of plague and the effects of superstition and religious animosity which had formerly been so frightful.

These inestimable national improvements however took place but gradually and were not a little retarded for a time by the new evil of the employment of mercenaries. For as the germs of vice were scattered in all directions by the wandering Lansquenets so also the infection of noxious diseases found easier entrance into the towns and villages through the medium of this dissolute and widely spread class of men.

The Lansquenets of the sixteenth century as spreaders of contagion supplied the place of the former Romish pilgrims and flagellants they even proved a more permanent scourge than those wanderers of the middle ages who only made their appearance on extraordinary occasions. We need here only call to mind the malignant and beyond measure noisome lues which at the end of the fifteenth century spread with the rapidity of lightning over all Europe.

It was not an importation from the innocent inhabitants of the New World nor was it bred by the ill treated Marrania the victims of the Spanish Inquisition. It was the mercenary army of Charles the VIIIth in Naples 1495 whose excesses gave to the already existing poison a malignity till then unknown and prepared for the deeply rooted depravity a scourge at which all the world shuddered with horror.

It is moreover in place here to observe that in the larger armies which the new military system now brought into the field the ordinary camp diseases to which another very fatal one was added were of course much more extensively propagated than in the less numerous forces of preceding centuries. And consequently that the peaceful inhabitants of the towns and of the country at large were thereby exposed to much danger.

Sect 3

Meantime Europe was frequently and very severely visited by the epidemics of the middle ages the terrors of the constantly recurring plague being borne with gloomy resignation to the inevitable evil, with which as a merited chastisement, the anger of God according to the notion of the times afflicted the human race.

Even the English were not exempt from this fearful visitation, which in the year 1499 carried off 30,000 people in London alone, so that the king found it advisable to retire with all his court to Calaisc. Thus the recollection of the Sweating Sickness of 1485 was gradually obliterated.

No one thought of its possible return and all the world was occupied with other matters, when the old enemy unexpectedly again raised it's head in the summer of 1506 and scared away this comfortable state of false security.

The renewed eruption of the epidemic was not on this occasion connected with any important occurrence so that contemporaries have not even mentioned the month in which it began to rage. Towards the autumn it had again disappeared and as no new symptoms were added to the disease the form of which it was identified by a reference to the old descriptions it was immediately treated by the same means the efficacy of which those who had witnessed.

The epidemic of 1485 lauded with so much resonance. Every exposure to heat or cold was as at that time avoided and the malignant fever was left to the curative powers of nature the patient being kept moderately warm in bed and no powerful medicines being administered.

The result was beyond all expectation favourable for in few houses did any fatal cases occur. The victory over this dreaded enemy was now by a pardonable error attributed more to human skill than to the mildness of the malady on this occasion which even under a less judicious treatment of the sick would certainly not have been marked by any considerable degree of severity.

The disease broke out in London but whether it penetrated to the west or not contemporary writers being soon convinced of its slight character have left us no intelligence. However widely it may have spread it certainly was confined to England and nowhere occasioned any great mortality.

Sect 4 Accompanying Phenomena as the epidemic was on this occasion so very mild it was not accompanied by any remarkable phenomena in England but the case was otherwise in the rest of Europe as will be proved by the following details.

After a wet summer in the year 1505 a severe winter set in. Comets were seen in this as in the following year An eruption of Vesuvius also took place in 1506 which may be mentioned although it is well established that volcanic commotions are to be taken into account only in great pestilences not in less extensive epidemics.

In England there blew a violent storm from the south west from the 15th till the 26th of January 1506 which drove the king of Castille, Philip of Austria with his consort Johanna from the Netherlands to Weymouth, and as some days before a golden eagle falling from St Paul's church in London had crushed a black eagle which ornamented some lower building, evil predictions were promulgated among the people respecting the fate of this son of the emperor. This event however could not be considered as at all connected with the pestilence which broke out about Stow.

Half a year afterwards More consideration is due to the gloom and anxiety which at that time depressed the spirit of the English nation. The reckless avarice of Henry the V11 named the English Solomon gave just ground for doubts regarding the security of property and the pious foundations, those accustomed means of softening the dreaded wrath of heaven, which the king who became gradually more and more broken down by disease established could not efface the recollection of the arbitrary violence and extortions of his corrupt servants.

Although these extortions principally affected the wealthy nobility who were much in need of restraint yet dark mistrust was general and all cheerfulness was banished from the minds of the people This state of feeling might have been favourable to the propagation of the returning disease, but the genius of the year 1506 would not suffer it to be more than a slight and transient reminiscence of a mystically hidden danger the import of which was not apparent to any medical inquirer of the 16th century.

Sect 5 Petechial Fever in Italy 1505 Thus if we paid attention as usual only to the palpable occurrences which take place on the earth and beneath its surface the Sweating Sickness of the above mentioned year might appear to be unconnected with more considerable commotions of organic life.

The powers of nature however are in their operations too subtle to be comprehended by our dull senses and by the coarse mechanism of our organs lay precisely at a time when neither the one nor the other indicate any alteration around us. Say that those operations bring to light the most extraordinary phenomena in the human frame, that most sensitive index of secret influences on life.

This observation was fully confirmed at the time of the first return of the sweating fever For whilst this disease remained confined to England there appeared in the southern and central parts of Europe a new and fatal epidemic which thenceforth visited these nations almost continually with intense malignity. This was the petechial fever a disease unknown to the older physicians which was Bacon p 231 b Empson and Dudley ministers of Henry VII who left behind him treasure to the amount of 1,800,000 sterling.

First observed in 1490 in Granada where it threatened to annihilate the army of Ferdinand the Catholic and made great havoc also among the Saracens. The bubonic plague had immediately preceded it in 1483 1485 1486 1488 1489 and 1490 and it may with no small probability be assumed that the petechial fever had resulted from this as a peculiar variety.

Since in other countries also fifteen years later the bubonic plague degenerated in various ways. And examples are not wanting in which particular forms or constituent parts of great epidemics thus branch off from them. In the same manner as under favourable circumstances these will combine together and united into one destructive whole, multiply the sources of danger.

Yet some contemporaries were of opinion that the petechial fever had been brought over to Granada by Venetian mercenaries from Cyprus where they had fought against the Turks and where this disorder was said to have been indigenous.

Notwithstanding some good works already existing in this matter has need of a more thorough examination, which might bring to light important and instructive results- respecting the rise and spread of the petechial fever, and especially respecting its relation to other plagues.

Whatever may be held with regard to the true origin of this fever, thus much is established. That it was at first an independent European disease and that at the commencement having occupied the southern part of this quarter of the world, it then became connected in a manner, as extraordinary as it was worthy of observation along with the sweating sickness of the north. Since the nearly simultaneous eruption of the sweating fever in England with the great epidemic petechial fever in the year 1505, may be justly attributed to an influence common to both, although unquestionably of greater power in the latter.

The petechial fever epidemic of which we are now treating prevailed principally in Italy and is described by Fracastoro VUlalba Ferdinand's conflicts with the Saracens began in 1481 and ended with the fall of Granada in 1492 The disease is called in Spanish Tabarditto which name however Villalba was not quoted at so early a period as 1490 as the first plague of this kind which ever appeared in that country.

Of this new disease which was placed by this great physician midway between the bubo plague and the non pestilential fever, the contagious quality showed itself from the beginning. Yet it was plainly perceived that the contagion did not take effect so quickly as in the bubo plague that it was not conveyed so easily by means of clothing and other articles and that physicians and attendants on the sick were the only persons who incurred much danger of infection.

The fever began insidiously and with very slight symptoms so that the sick in general did not so much as seek medical aid. Many persons and even physicians among the number suffered themselves to be deceived by this circumstance, and thus not being aware of the danger they hoped to effect an easy cure and were not a little astonished at the sudden development of malignant phenomena.

The heat was inconsiderable in proportion to the fever yet those affected felt a certain inward indisposition a general depression of all the vital powers and a weariness as if after great exertion.

They lay upon their backs with an oppressed brain their senses were blunted and in most cases delirium and gloomy muttering with bloodshot eyes commenced from the fourth to the seventh day.

The urine was usually clear and copious at the beginning it then became red and turbid or resembling pomegranate wine. The pulse was slow and small the evacuations putrid and offensive and either on the fourth or seventh day red or purple spots like flea bites or larger or resembling lentils (lenticulae) which also gave a name to the disorder, broke out on the arms the back and the breast.

There was either no thirst at all or very little, the tongue was loaded and in many cases a lethargic state came on.

Others on the contrary suffered from sleeplessness or from both these symptoms alternately. The disease reached its height on the seventh or on the fourteenth day and in some cases still later,

In many there existed a retention of urine with very unfavourable prognosis. Women seldom died of this fever, elderly people still more rarely, and Jews scarcely ever.

Young people on the other hand and children died in great numbers and especially from among the higher ranks while the plague on the contrary used generally to commit its ravages, only It was called Puncticula or Peticulte also Febris stigmatica Pestis petechiosa Reusner among the poorer classes.

An inordinate loss of power in the commencement betokened death as also a too violent effect from mild aperient means and a failure in alleviation after a complete crisis.

Patients were seen to die who had lost to the extent of three pounds of blood from the nose. It was also a very bad sign when the spots disappeared or broke out tardily or were of a blackish blue colour.

Phenomena of an opposite character on the contrary afforded hope of recovery.

The best physicians were agreed on the importance of the petechiae as an indication of the nature of the crisis for those cases in, which they were abundant and of a good quality were cured much more easily than those in which the eruption was suppressed.

An abundant perspiration also was particularly conducive to recovery whereas all other evacuations especially a flux from the bowels proved to be injurious and even fatal.

If we keep these phenomena in view and consider moreover that in the widely extending lues venerea of those times, cutaneous eruptions predominated over the other symptoms. The English sweating sickness in the north of Europe will appear as in connexion with this circumstance of a very important character and the supposition that the morbid activity of the system- during the whole of this age maintained a decided determination to the skin and may thence be fairly considered as something more than a mere conjecture.

This fact speaks for itself but the causes of this altered temperament of the body it is not an easy matter to discover. Fracastoro who knew much better than his modern followers how to manage his sagacious doctrine of contagion, looked for these causes in the quality of the air, which was manifest by much more evident phenomena in the epidemic petechial fever of 1528 than in that of 1505. And he traced an active connexion between this quality, which he called infection of the atmosphere and the condition of the blood thus indicating unknown influences by an obscure notion.

He considered the altered quality of the blood according to the established views of that period, which the petechial spotted fever seemed clearly to con firm as a putrefaction, and he even assumed that in the non epidemic petechial fevers. Which from the year 1505 forward, there frequently occurred isolated causes, which must have given rise to changes in the blood as well as that quality of the air. To which this great physician attributed the general and continued alterations which take place in the nature of diseases.

The petechial fever made the same impression on the physicians of Italy as new disorders liave ever made, for although they were the best in Europe, their view was bounded by the horizon of Galen, within the limits of which the novel phenomenon was not to be found.

They were therefore soon perplexed and whilst they sought to entrammel the dreaded enemy with scholastic doctrines of repletion and acrimony and occult qualities and betook themselves first to one remedy and then to another, they exposed themselves to the derision of the people, who soon perceived their disagreement and indecision and as usual charged on the whole medical profession, the well merited blame of individuals.

Sect 6 Other Diseases

About the same period in October 1505 a very fatal disease broke out in Lisbon. The further progress of which was marked by the terror, the flight and the confusion of the inhabitants. Of what kind it was, whether a petechial fever or a bubo plague, and what connexion it had with a pestilence in Spain, which had just preceded it, it would perhaps be difficult now to ascertain.

This latter pestilence had spread from Seville following an earthquake and violent storms of wind and rain in 1504 and may very likely have been a bubo plague.

Similar notices are met with pestilences occurring in that country in 1506, the year of the English Sweating Sickness in 1507 and 1508, in which years, mention is made of swarms of locusts in the neighbourhood of Seville, and finally in 1510 the year of a great influenza and 1515.

Exact descriptions however of these disorders are entirely wanting. What was the general judgement of the Italian physicians respecting the spotted fever may be gathered from Nic Massa, whose confused work however contributes nothing to the history of the disease.

With all the above phenomena the epidemics which took place in Germany and France at the commencement of the sixteenth century evidently unite to form a connected whole. Varying in intensity and extent they continued without intermission for a full five years and moreover were accompanied by unusual circumstances such as occur only in the time of great pestilences.

The century was ushered in by the appearance of a comet, which on this occasion seemed to confirm the long cherished belief that the appearance of these heavenly bodies was prognostic of evil. For mankind are in the habit of concluding that phenomena which are simultaneous must have some internal connexion, and many examples were called to mind in which great pestilences, affecting the whole world had been hither preceded or accompanied by comets.

Immediately afterwards a great murrain among cattle took place which may have proceeded from some injurious quality in their food. (Foot & Mouth Disease?)

.A notion immediately arose that the pastures were poisoned and of this there was so firm a conviction that the most violent resentment as of old, in the time of the Black Death, prevailed against the supposed poisoners and in the neighbourhood of Meissen some bose Buben wicked knaves who had fallen under suspicion were actually executed.

A very considerable blight of caterpillars which in the north of Germany stripped the gardens and woods far and wide of their foliage deserves to be here mentioned as a phenomenon appertaining to the lower grades of the animal kingdom. Natural history has shewn that occurrences of this kind are by no means occasioned by new and wonderful influences, but rather by unusual combinations of circumstances appearing to occur together, almost accidentally at a given time, especially by the simultaneous union of warmth and humidity in the atmosphere. Whereby sometimes one and sometimes another of the lower grades of animal existences becomes extraordinarily developed.

It is on this account that unusual phenomena in the insect world, whether it be the appearance or the disappearance of particular kinds take place much more frequently when the order of succession in the seasons and the condition of the atmosphere are in a greater degree than usual and more permanently disturbed.

And thus those phenomena have with much reason ever been considered as forerunners of pestilences whenever the human frame has become through atmospherical causes generally susceptible of disease.

Swarms of locusts have appeared before and during most great pestilences and indeed the exuberant production of this insect appears at least in Europe to require the most unusual combination of causes Sect 7 Blood Spots Of rarer occurrence but quite as important in reference to the general tendencies of life are the luxuriant growths of the minutest cryptogamic plants in the water and on damp things of all kinds which from their spots of various forms and colours produced the utmost horror both before and during great pestilences and excited superstitious fears as appearing to be something miraculous These spots signacula and especially the blood spots were seen at a very early period as for instance during the great general plague in the sixth centurya and again during the plague of the years 786 b and 959 when it is said to have been remarked that those on whose clothes they frequently appeared and seemingly imparted to them a peculiar odour were more susceptible than other people of attack from leprosy on which account this spotted appearance was inconsiderately called the clothes leprosy Lepra vestium not to mention other examples d in which plagues affecting the human species did not take place The same signs also in the years from 1500 to 1503 threw the faithful into great consternation because as on former occasions they fancied they recognised in them the form of the crosse The phenomenon on this occa a Author's History of Medicine Book II p 146 b Sigebert Gembl fol 58 a Spangenberg M Chr fol 66 b c Sigebert Gembl fol 82 a Hermann Contract p 186 Witichind p 34 Compare on this subject Nees v Esenbeck's Supplement to R Brown's Miscellaneous Botanical Writings Book I p 571 and Ehrenberg's New Observations on Bloodlike Appearances in Egypt Arabia and Siberia together with a review and critique on what was earlier known in Poggendorff's Annalen 830 the two best works on this subject wherein is also contained a criticism on Chladni's Hyperme teorological Views e Crusius is the most circumstantial on this point for he gives the names of many BLOOD SPOTS 205

sion spread throughout Germany and France and from its great extent and long duration may be reckoned among the most remarkable of the kind The spots were of different colours principally red but also white yellow grey and black and arose often in a very short time on the roofs of houses on clothes on the veils and neck handkerchiefs of women on various household utensils on the meat in larders &c A historian who speaks also of blood raina recounts that they could not be got rid of in less than ten or twelve days and that they frequently occurred in closed chests on linen and on articles of clothing Much information is not to be expected from the researches of the naturalists of those times but there is no doubt that what is described was some one or more kinds of mould inasmuch as the whole phenomenon evidently corresponds with modern observations Scientific physicians of the sixteenth century among whom the naturalist George Agricola who was born in 1494 and died in 1555 ought especially to be mentioned recognised even then these spots as lichens and without seeking to account for them by supernatural agencies or lending credence to popular superstition they gave them their just interpretation as indications of extensive disease e Should the too bold notion of Nees v Esenbeck that fungi of the most minute forms have their origin in the higher regions of the firmament and descending to the surface of the earth produce spots and stains be confirmed which is not yet the case these signacula would have a much more important connexion with epidemics than can be otherwise conceded to them for though it be highly probable that they have their origin only in the dissemination of persons on whose clothes crosses were visible On a maiden's shawl the instruments of Christ's martyrdom were supposed to have been seen marked In the vicinity of Biberach a miller's lad made rude sport of the painting of crosses but he was seized and burned Book II p 156 Mezeray T II p 819 b Angelus p 261 c Perhaps Sporotrichum vesicarum or a kind of Mycoderma J Vincenzo Sette describes a kind of red mould which in the year 1819 coloured vegetable and animal substances in the province of Padua and excited superstitious apprehensions among the people See his work on this subject e Autumnali vero tempore cum jam vestes lintea culcitrse panes omnis generis obsonia sub dio vel in conclavibus patentibus locata talem situ mucorem contraxerunt qualis oritur in penore in opacis domus cellis collocate aut etiam in ipsis cellis diu non repurgatis pestis prsesentes ad nocendum vires habet LI p 45 Agricola's Treatise on the Plague is among the cleverest which the sixteenth century produced 206

germs in the lower strata of the atmosphere it must yet be granted that if they appear over a considerable space and during a long time as at the commencement of the sixteenth century the causes favouring their generation and spread must be ranked among those of an extraordinary kind and on this very account may exercise an influence over human organism as was then evident For so early as the fruitful year 1503 the plague which had already appeared partially made great advances and France in particular was visited by so fatal a pestilence that the inhabitants of towns and villages in order to escape the infection fled in bodies to the woods and even the house dogs became wild which never happens unless a country be extensively depopulated a They were obliged to establish great hunts in order to free the country from these new beasts of prey and from wolves which appeared in great multitudes b The dry and continued heat of the following year 1504 having given rise to still more extensive sickness and caused a failure in the crops the bubo plague raged in Germany with such violence that in some places a third part and in others as many as half the inhabitants perished Various kinds of fevers accompanied this overwhelming disease among which there was one distinguished by headache and phrensy similar to that which appeared in France in 1482 c Various putrid fevers and putrid inflammations of the lungs with bloody expectoration are also no less plainly discernible from the accounts d This diversified and general sickness throughout the whole of Germany terminated For example at the time of the Justinian Plague and of the Black Death b Mezeray T II p 828 See above p 189 The former mortality was so far from having ceased yea rather in the great heat of summer was still more vehement that in some places a third part and in some even the half of the people were snatched away by death and that not by one only but by various and hitherto unheard of diseases Men caught the burning fever so rapidly and violently that they thought they must be totally consumed Some were seized with such severe and insupportable headache that they were deprived of their senses some with such a violent cough that they expectorated blood incessantly some with such a very rapid flux that it broke their hearts the bodies of some putrefied and were So offensive that no one could remain near them And by reason of such extraordinary diseases it was a most sorrowful and troublous year and there followed a hard winter in the which the cold lasted for three months Spangenberg M Chr fol 402 b Compare Angelus p 263 who following some contemporaries mentions a comet doubted by Pingre I 479 as having appeared in the year 1504 BLOOD SPOTS 207

in the cold winter of 1504 5 and the following summer during which there was a continued murrain among cattle It is certain that at that time the petechial fever in Italy had not yet passed the Alps From all these facts it is a probable conjecture that the Sweating Sickness which visited England in the year 1506 although accompanied in that country itself by no prominent circumstances was not without connexion with the morbid commotion of human and animal life in the south and middle of Europe and may perhaps be regarded as having been the last feeble effort of mysterious agencies in the domain of organised being CHAPTER III THE THIRD VISITATION OF THE DISEASE 1517 This learned Lord this Lord of wit and art This metaphysick Lord holds forth a Glasse Through which we may behold in every part This boisterous prince Howell Sect 1 Poverty The ordinances of Henry the VHth which although adapted to the times bore hard upon the people soon produced their fruits The great diminished the number of their servants and as moreover many of the peasantry were thrown out of employment in consequence of a conversion of large tracts of arable land into pasture b the population of towns increased even to an overflow and the consequent activity of trade gradually rendered the towns flourishing But this change took place too rapidly Wealth and luxury engendered it is true numerous wants which were a source of gain so that the English were at this time considered luxurious and effeminate but there was a general From a Poem on Henry VIII in Herbert of Cherbury b They found grazing more profitable and converted large tracts of arable land into pasture Hume T IV p 277 c Lemnius fol III b 208

scarcity of workmen and artists and hence it happened that from Genoa Lombardy France Germany and Holland innumerable foreigners immigrated and took possession of the most lucrative branches of employment This was a peculiar hardship on the natives who from their imperfect knowledge of the arts could not compete with the more skilful foreigners and were besides treated by them with insolence and contempt The distresses of the poor thus increased yearly and their indignation at length broke out A great insurrection of the English artisans arose throughout London and might have proved destructive to the foreigners had affairs been in a less orderly state The popular commotion was however suppressed without any considerable sacrifice and Henry the VIIIth on a solemn day appointed at Westminster for passing judgement upon the prisoners bestowed a pardon on them for he saw into the causes of their discontent and very soon after caused restrictive alien laws to be enacted a Sect 2 Sweating Sickness All this took place in April and May of the ever memorable year 1517 and London was again indulging in hopes of better days when the Sweating Sickness once more broke out quite unexpectedly in July and in spite of all former experience and the most sedulous attention inexorably demanded its victims On this occasion it was so violent and so rapid in its course that it carried off those who were attacked in two or three hours so that the first shivering fit was regarded as the announcement of certain death It was not ushered in by any precursory symptoms Many who were in good health at noon were numbered among the dead by the evening and thus as great a dread was created at this new peril as ever was felt during the prevalence of the most suddenly destructive epidemic for the thought of being snatched away from the full enjoyment of existence without any preparation without any hope of recovery is appalling even to the bravest and excites secret trepidation and anguish Among the lower classes the deaths were innumerable. The city was moreover crowded with poor but even the ranks of the higher classes were thinned and no precaution averted Grafton p 294 This insurrection is called by the Chroniclers Insurrection of Evill-

May day Hume T IV 274 b Of the common sort they were numberless that perished by it Godwyn p 23 P POVERTY 209

-death from their palaces Ammonius of Lucca a scholar of some celebrity and in this capacity private secretary to the king was cut off in the flower of his age after having boasted to Sir Thomas More only a few hours before his death that by moderation and good management he had secured both himself and his family from the diseasea Also of those immediately about the king Lords Grey and Clinton were carried off besides many knights oflicers and courtiers Mourning supplanted the hilarity and brilliancy of the festivals and the king while in miserable solitude into which he had retired with a few followers received message after message from different towns and villages announcing that in some a third in others even half the inhabitants were swept off by this pestilence It had never before raged with so much fatality The minds of men had never before been so frightfully appalled The festival of Michaelmas 29th September which in England was always kept with much religious pomp was of necessity postponed nor was the solemnity of Christmas observed for there was a dread of collecting together large assemblies of people b on account of the contagion and just about this time when the Sweating Sickness had abated the plague according to the account of some historians began which although probably not very virulent prevailed during the whole winter in most English towns and continued to keep up the distress of the people The king on this occasion also quitted his capital and retreated in company with a few attendants before the contagion frequently shifting his court from place to place It was during this period of trouble llth of February 1518 that the Princess Mary afterwards Queen was born Is valde sibi videbatur adversus contagionem victus moderatione munitus qua factum putavit ut quum in nullum pene incideret cujus non tota familia laboraverat neminem adhuc e suis id malum attigerit id quod et mihi et multis prceterea jactavit non admodum mullis horis antequam extinctus est Erasm Epist L VII ep 4 col 386 The date of the year of this letter from Sir Thomas More to Erasmus 1520 is clearly erroneous as is that of many other letters in this collection for at that time the Sweating Sickness did not prevail in London it is also sufficiently well known from other researches Biographie Universelle General Biographical Dictionary that Ammonius died in 1517 The date of the month however 19th August seems to be correct Sprengel has in consequence of this false date of the year been misled to assume a specific epidemic Sweating Sickness as having taken place in the year 1520 Book II p 686 which is wholly unconfirmed b Grafton p 294 is very detailed Compare Holinshed p 626 Baker 286 Hall p 592 c Godwyn p 23 Stow p 849 210

Thus the Sweating Sickness lasted full six months reached its greatest height a about six weeks after its appearance and probably spread from London over the whole of England In Oxford and Cambridge it raged with no less violence than in the capital Most of the inhabitants of those places were in the course of a few days confined to their beds and the sciences which then flourished for they were never more zealously cultivated in England than at that time suffered severe losses by the death of many able and distinguished scholars.

Scotland Ireland and all other countries beyond sea were on this occasion spared The neighbouring town of Calais alone was reached by the pestilence and according to later observations it may be considered as certain that only the English who resided there and not the French inhabitants were affected as it is also ascertained that the rest of France continued throughout free from the disease Had this not been the case contemporary writers would undoubtedly not have omitted to make mention of so important an occurrence.

Sect 3 Causes

The influences which gave rise to this third eruption of the disorder among the English nation are obscure and do not altogether correspond with those of the years 1485 and 1506 Thus it is especially remarkable that on this occasion there is no express mention of the humidity which had so decided a share in the origin of the two former visitations of the Sweating Sickness and the year 1517 was in most respects one of an ordinary kind The English Chronicles state nothing remarkable on the subject and from those of Germany we only learn that the winter of 1516 was very mild and that a fruitful summer with an abundant vintaged and a cold winter followed The summer of 1517 was unfruitful although not on account of wet a This from the foregoing remark upon the death of Ammonius may be concluded with the greatest probability t _ omnibus fere intra paucos dies decumbentibus amissis plurimis optimis atque honestissimis amicis Th More in Erasmus's Epist L VII ep 4 col 386 c Ibid The only place where the disease is spoken of as having spread across the channel d Spangenberg M Chr fol 408 a 2 CAUSES 211

weather so that in some parts especially in Swabia provision was made against a scarcitya A great comet appeared in 1516 and in 1517 an earthquake was felt at Tubingen Nord lingen and Calw during a violent storm whereupon the Haupt Krankheit c encephalitis accompanied by fever became more prevalent although not remarkably fatald This phenomenon the earthquake was by no means unimportant c in its effects and there is reason to suppose that it was followed by subterraneous commotions of still greater extent for earthquakes occurred also in Spain f As the date of this event is specified as the 16th of June and as earthquakes occurring in unusual localities that is to say in districts not volcanic are frequently cited as prognostics of great diseases although in volcanic districts they evidently betoken nothing of the kind we may hence with some reason assume a telluric influence which perhaps reached the locality of the pestilence that broke out at the beginning of July if not earlier Besides we cannot find any greater phenomenon which according to human conception could have had a more immediate connexion with the English Sweating Sickness and in this instance too inquiry the most circumspect does not penetrate through the thick veil which envelopes the inscrutable causes of epidemics Sect 4 Habits of the English That next to the peculiar constitution which England imparts to her inhabitants the predisposing causes of the Sweating a Crusius T II p 187 b Wintzenbcrger fol 21 a Angelus p 282 Spangenberg loc cit Pingre TI p 483 e Such was the name given in Germany to the already oft mentioned pernicious fever with inflammation of the brain We recognise it for the first time as an epidemic in France in the year 1482 See above p 189 It frequently made its appearance throughout the whole of the sixteenth century Crusius T II p 187 e On the 16th of June 1517 there was a great earthquake and a tremendous storm of wind at Nordlingen so that the parish church at St Emeran was completely forced out of the ground and thrown down and it was reckoned that there were 2000 houses and stables in that place which for a space of two miles long were overthrown and rent and there were few houses there which were not like the church damaged and shaken to pieces Wintzenbcrger fol 21 b In Xativa VUlalba TI p 83 212

Sickness lay in the habits of the English of those times no one can possibly doubt The limitation of the pestilence to England plainly indicates this Not a single ship conveyed it to the French or to the Dutch who breathed a much moister atmosphere and yet the intercourse between the English sea ports and these immediately neighbouring nations was very frequent Of intemperance which most generally lays the foundation for disorders both high and low were at this time accused This vice of the English was proverbial in foreign countries a Flesh meats highly seasoned with spices were indulged in to excess noisy nocturnal carousings were become customary and it was also the practice to drink strong wine b immediately after rising in the morning Cyder which in some parts as for instance in Devonshire is the common beverage was even in those times considered by medical men as injurious for it was observed that its use caused debility with paleness and sapped the vigour of youth in both sexes d Other similar facts respecting the mode of living at that time might perhaps be adduced from which it would appear that owing to the total want of refinement in diet much that was improper was employed in English cookery and that on this account the constitution was much injured Horticulture which the French had already brought to a state of great improvement was still quite in its infancy in England It is even said that Queen Catherine had potherbs brought from Holland for the preparation of salads as they were not procurable in England f Allowing that this account may not be strictly true since it admits of other explanations still it proves in itself what we would here enforce and leaves us to draw conclusions from it beyond the mere fact of there being a scarcity of culinary vegetables Much more important however as respects our subject was the custom of wearing immoderately warm clothing of which we have accounts worthy of credence From youth upwards the head was II est saoul comme un Angloys Rondelet de dign morb fol 35 b b Elyol in his Castell of Health quoted by Aihin p 64 Rondelet loc cit In 1724 which was a great fruit year there arose in this very county from the immoderate use of cyder an epidemic cholic the Colica Damnoniorum Vide Hux ham Opera Lips 1764 Tom III p 34 d Elyot in Aihin p 63 Le Grand d Aussy TI p 143 Hume T IV p 273 Aihin p 59 HABITS OF THE ENGLISH 213

covered with thick caps in order to secure it from every chance of cold and from the least draught of air and as by this injurious practice the brain was subjected to a continual determination of blood and a tenderness of the skin was induced there was no disorder more frequent among the English in this century than catarrh a which was constantly reproduced by relaxing perspirations and heating medicines If this malady be complicated with a scorbutic habit or if it befall persons of debauched habits whose vessels contain nourishment not properly concocted the preservative vital power seeks a vent through the relaxed skin and that which in itself is a needful and alleviating excitement of this tissue becomes a disease the wholesome excretion degenerates into a colliquative drain which forcibly carries off with it unusual animal matters that ought not to pass away through such an outlet and the body yields to an attack to which it has been thus long predisposed When we consider this debilitated state of the skin as the general complaint in England taking into account the prejudicial influence of hot baths b which were much in use and the diaphoretic medicines employed in most disorders when we bear in mind the rare use of soap at that time and the high price of linen as also the extreme indigence of the lower classes which almost always breeds pestilences the utterly miserable condition and truly Scythian filth of the English habitations and finally the crowded state of London in the year 1517 we shall as far as human research can penetrate find the origin of the Sweating Sickness in this very year Now a days if a i oy of seven years of age or a young man of twenty years have not two caps on bis head he and his friends will think that he may not continue in health and yet if the inner cap be not of velvet or satin a serving man feareth to lose his credence Elyot in Aikin p 64 b ubi homines perpetuo in hypocaustis degunt multoque carnium esu se in gurgitant et alimentis piperatis continuo utuntur Quare factum est ut continua hy pocaustorum sestuatione meatuum cutis relaxatio consequeretur quae sudoris promptis sima et potentissima causa esse solet cuius materia in humorum exsuperantia consis tebat quam requens alimentorum multum nutrientium et piperatorum usus coUigerat Mondelet loc cit c The floors of the houses generally are made of nothing but loam and are strewed with rushes which being constantly put on fresh without a removal of the old remain lying there in some cases for twenty years with fish bones broken victuals and other filth underneath and impregnated with the urine of dogs and men JErasm Epist L xxii ep 12 col 1140 This description is in all probability overdrawn and applicable only to the poorest huts It is however certainly not fictitious and is not refuted by Kaye 214

explicable from causes which have long been known to be capable of producing such effects Something remains in the background of which hereafter Sect 5 Contagion The rapid spread of the Sweating Sickness all over England as far as the Scottish borders and across to Calais now demands a more especial consideration Most fevers which are produced by general causes as well transient epidemic as constant and peculiar to the country endemic or a union of both which almost always takes place and was here evidently the case propagate themselves for a time spontaneously The exhalations of the affected become the germs of a similar decomposition in those bodies which receive them and produce in these a like attack upon the internal organs and thus a merely morbid phenomenon of life shews that it possesses the fundamental property of all life that of propagating itself in an appropriate soil On this point there is no doubt the phenomena which prove it have been observed from time immemorial in an endless variety of circumstances but always with a uniform manifestation of the fundamental law All nations too and from the most ancient times have invented ingenious designations for these occurrences which however seldom represent the general notion but commonly only the peculiar propagation of individual diseases Certainly one of the best and the most ingenious is that which is conveyed by the German word Ansteckung setting on fire which compares the exciting a disease in the appropriate body with the inflammation of combustible matter by the application of fire or with the kindling of powder by a spark But how various are these Ansteckungen from the purely mental on the one hand which through the mere sight of a disagreeable nervous malady through an excitement of the senses that shakes the mind penetrates into the nerves those channels of its will and of its feelings and produces the same disorder in the beholder to those on the other hand which propagate diseases that principally operate only upon matter and are distinguishable but little if at all from animal poisons The reader must not here expect all the features of a doctrine which extends through the whole immeasurable domain of life They CONTAGION 215

are clearly derived from the confirmed and well applied experience of the past and have been delineated by men a who had not forgotten like their modern successors to take a comprehensive view of epidemic diseases It may however be permitted me just to call to mind the difference between those infectious diseases which are permanent and for centuries together unchangeable and those which are temporary and transient The infecting matter of the former may aptly be called the perfect or unchangeable in contradistinction to the imperfect or mutable character of the latter The former when once formed whether in diseased persons or inanimate substances fomites are always in existence and are but called into activity by those causes of general disease epidemic constitutions which are favourable to their propagation and it is to be remarked that under all circumstances and at all times they excite the same unchangeable diseases and varying only in particular ramifications or degenerations and mild forms never lose their proper essence Examples are furnished in the smallpox the plague the measles and if we may include diseases not febrile the leprosy the itch and the venereal disease The latter on the other hand are not always in existence they are called forth from nonentity by the causes of general diseases or epidemic constitutions and they disappear again after the extinction of the epidemic diseases by which they were bred they likewise vary in their development and their course in each particular epidemic Examples are found in the yellow fever in catarrh or influenza in nervous and putrid fever and among many other disorders in miliary fever a disease which first grew to a national pestilence in the 17th century and which in the kind and manner of its infecting power approaches nearest to the sweating fever To this latter category the English Sweating Sickness likewise belongs a disease altogether of a temporary character which after its cessation left no infecting material behind and consequently was incapable of propagating itself after the manner of those diseases which are completely contagious The animal matters which were expelled along with the profuse perspiration and spread so horrible a stench around the sick contained amid their alkaline salts probably ammonia in various states of combination and their super Fracastoro Fernel Valleriola Houlier and most of the other learned physicians of the sixteenth century 216

abundant acid the ferment of the disease and this penetrated into the lungs of the bystanders as they breathed and provided they were but predisposed for its reception as above stated continually produced it It may be considered as certain that mere manual contact was not sufficient to communicate the infection and that this was propagated either by the pestilential atmosphere which surrounded the beds of the sick or by exhalations generated in unclean situations, where there was no vent for their escape.

On this account it was that the residence at common inns and public houses was looked upon as dangerous a I would not however be understood to maintain that during the three epidemics with which up to the present stage of our inquiry we have become acquainted the spread of the sweating fever alone was occasioned by infection for if the general epidemic causes were powerful enough to excite the disease without any previously existing poison.

Why might they not produce the same effect still more independently throughout the course of the pestilence since as is the case in all epidemics those causes in all probability continued to increase in intensity.

That the plague grew worse on the occasion of any great assemblages of the people was at that time known and the notion of contagion thence very naturally arose. Yet must it here be taken into account that even without this notion and merely from the assemblage itself of many people in whom the like malady was germinating and already had shown tokens of its approach that might easily be accelerated and the disease increased among those merely slightly indisposed by the reciprocal communication of morbid exhalations.

For as the predisposition to any malady which is an intermediate condition between that malady and the previous state of good health plainly displays the properties of the disease in those whom it threatens to attack so these exhalations or epidemic causes which give rise to Sweating Sickness in the first instance, certainly differ from those which occur in a sweating sickness which has already broken out only in unessential respects. And might consequently stimulate the mere disposition to the disease more and more. quod vulgaria diversoria parum tuta sunt a contagio sceleratce pestis quae nuper ab Anglis in nostras regiones demigravit speaking of the English Sweating Sickness in Germany 1529 Erasm Epist L xxvii ep 16 col 1519 c b Brown's Opport CONTAGION 217

Even to the actual eruption of the disease itself. Yet a contagion was likewise in operation at the same time which was destructive even to the temperate and to those who were apparently in health. Nay even to foreigners who were living in an English atmosphere and on English food as the example of the Italian Ammonius plainly proves.

In all epidemics which increase to such a degree as to become contagious it is of importance to distinguish which of these causes are the more powerful. The predisposing or epidemic causes which to originate the proneness to the disease, or the proximate causes among which in the generality of cases, contagion is the most prominent.

The predisposing were here, evidently the more operative contagion was not added till the disease was at its height. And although it contributed not a little to its spread yet it always remained subordinate to the other sources of the disease, and all the matter of infection vanished without a trace on the cessation of the disorder, so that the subsequent eruptions of it were always produced by the renewal of those general causes, which are in operation upon and under the earth.

It is however as little within the compass of human knowledge to discover the essential foundation of this renewal as the proximate causes of the appearance of the mould spots at the commencement of the sixteenth century. Or any other of those processes which are prepared and brought into activity by the hidden powers of nature.

Sect 6 Influenzas

Several epidemics thus originating in causes beyond human comprehension appeared in the 16th century. Among the most remarkable was a violent and extensive catarrhal fever in 1510, of that kind which the Italians call Influenza, thus recognising an inscrutable influence which affects numberless persons at the same time.

It prevailed principally in France, but probably also over the rest of Europe, of which however the accounts do not inform us. For in those times they took little pains to record the particulars of epidemics, which were not of a character to affect life. According to recent experience we should be warranted even in supposing that this malady had its origin in the remotest parts of the East During the whole of the winter 1 Erasm Epist L vii ep 4 col 386 218

which was very cold violent storms of wind prevailed and the north and middle of Italy were shaken by frequent earthquakes whereupon there followed so general a sickness in France that we are assured by the historians that few of the inhabitants escaped it.

The catarrhal symptoms which on the appearance of disorders of this kind usually form their commencement, seem to have been quite thrown into the background by those of violent rheumatism and inflammation.

The patient was first seized with giddiness and severe headache. Then came on a shooting pain through the shoulders and extending to the thighs. The loins too were affected with intolerably painful dartings, during which an inflammatory fever set in with delirium, and violent excitement.

In some the parotid glands became inflamed and even the digestive organs participated in the deep rooted malady, for those affected had together with constant oppression at the stomach-a great loathing for all animal food and a dislike even to wine.

Among the poor as well as the rich many died and some quite suddenly of this strange disease, in the treatment of which the physicians shortened life not a little, by their purgative treatment and phlebotomy. Seeking an excuse for their ignorance in the influence of the constellations, and alleging that astral diseases were beyond the reach of human art.

From this prejudicial effect of our chief antiphlogistic remedy of bleeding as well as of evacuations from the bowels, we may conclude that the disease though in its commencement rheumatic, yet had an essential tendency to produce relaxation and debility of the nerves. And in this respect as well as in its extension to all classes, accorded with the modern influenzas, in which the same phenomena have manifested themselves only much less vividly and plainly.

The French, who from the levity of their character, have always called serious things by jocose names designate this disease, Coqueluche the monk's hood, because owing to the extreme sensibility of the skin to cold and currents of air, this kind of hood was generally necessary, and was a protection against an attack of the malady, as well as against its increase.

That in the accounts which are to be sure very incomplete there should be no express mention of any affection of the air passages is remarkable since this could not in- Mezeray T II p 863 Fare p 823 Holler Comm II insecund sect Coac Hippoerat p 323 INFLUENZAS 219

-all likelihood have failed to exist although it might perhaps have been only slightly manifested. Nearly a century before 1414 this affection appeared far more prominently on the occurrence of a no less general disorder of the same kind. So that all those who had the complaint suffered from a considerable hoarseness. And all public business in Paris was interrupted on this account.

It was on that very occasion that the name Coqueluche was first employed, and this having, as is well known, been transferred to the whooping cough.

It is easier to suppose with respect to the influenza of 1510, which was similarly named. An omission in the account than the real absence of a symptom, so very generally prevalent, for in these kinds of comparisons and denominations the common sense of the people errs much less than the learned profundity of political historians.

We must not omit here to remark that three years before 1411, and thirteen years afterwards, two diseases entirely similar and equally general made their appearance in France. Of which we nowhere find that any notice has been taken up to the present time.

The first was called lac the second Ladendo, which designations have since entirely gone out of use. Both were accompanied by very severe cough so that in the former ruptures not infrequently occurred, and pregnant women were in consequence prematurely confined, and by the latter from its universality, the public worship was disturbed In the ladendo.

There seems to have been an affection of the kidney of an inflammatory character, and much more severe than in the coqueluche of 1510. A memorable example of epidemic influence and without a parallel in modern times. This pain in the kidneys, which was as severe as a fit of the stone, was followed by fever with loss of appetite and an incessant cough, that terminated in disagreeable eruptions about the mouth and nose.

The disorder ran a course of about fifteen days and was generally prevalent throughout October, being unattended with danger notwithstanding the severity of its symptoms. One might almost be tempted to regard the tac of 1411 as the coqueluche of 1414 which is only slightly alluded to by a Un etrange rhume qu on nomma coqueluche lequel tourmenta toute sorte de personnes et leur rendit la voix si enrouee que le barreau et les colleges en furent mucts Mezeray Compare Diderot et oVAlembert Encyclopedic ou Dictionnaire raisonne des Sciences etc T IV p 182 220

Mezeray and whereof the author from whom we are now quoting has made no mention for a false date might easily occur here. Yet this must remain undecided until we can obtain fuller information for we have experienced even in the most recent times an example of influenzas 1831 and 1833, following each other in quick succession.

Gastric symptoms and an inordinate degree of irritability accompanied the spasmodic cough and the complaint terminated with evacuations of blood. However the disease was unattended with danger and lasted upon the whole only three weeks.

Four other epidemics similar to that of 1510 appeared in the sixteenth century two which were quite general in the years 1557 and 1580 and two less extensively prevalent in the years 1551 and 1564. Of the two former we possess accurate descriptions. It will therefore aid us in forming a correct judgement respecting the influenza of 1510, if we here take a review of these also, since the most experienced contemporaries classed all these disorders together-as of a similar kind.

During the dry unfavourable summer of 1557 invalids-

1 Pasquier Livr IV Ch 28 pp 375,376 The following is the passage En Tan 141 1 y eut une autre sorte de maladie dont une infinité de personnes furent touchez par laquelle on perdoit le boire le manger et le dormir et toutefois et quantes que le malade mangeoit il auoit une forte fièvre ce qu il mangeoit luy sembloit amer ou puant tousiours trembloit et auec ce estoit si las et rompu de ses membres que l on ne l osoit toucher en quelque part que ce fust Aussi estoit ce mal accompagné d une forte toux qui tourmentoit son homme iour et nuit laquelle maladie dura trois semaines entières sans qu une personne en mourust Bien est vray que par la vehemence de la toux plusieurs hommes se rompirent par les genitoires et plusieurs femmes accouchèrent avant le terme Et quand venoit au guerir ils iettoient grande effusion de sang par la bouche le nez et le fondement sans qu aucun médecin peust iuger dont procedoit ce mal sinon d une genérale contagion de l air dont la cause leur estoit cachée Cette maladie fut appellee le Tac et tel autrefois a souhaité par risée ou imprecation le mal du Tac à son compagnon qui ne sçavoit pas que c estoit L an 1427 vers la S Remy 1 Oct cheutun autre air corrompu qui engendra une très mauvaise maladie que l on appelloit Ladendo dit un auteur de ce temps là e n y auoit homme ou femme qui presque ne s en sentist durant le temps qu elle dura Elle commençoit aux reins comme si on eust eu une forte gravelle en après venoient les frissons et estoit en bien huict ou dix iours qu on ne pouvoit bonnement boire ne manger ne dormir Après ce venoit une toux si mauvaise que quand on estoit au Sermon on ne pouvoit entendre ce que le Sermonateur disoit par la grande noise des tousseurs Item elle eust une très forte durée jusques après la Toussaincts 1 Nov bien quinze iours ou plus Et n eussiez gueres veu homme ou femme qui n eust la bouche ou le nez tout esseué de grosse rongne et s entre mocquoit le peuple l un de l autre disant As tu point eu Ladendo b Reusner p 75 INFLUENZAS 221

-were suddenly seized with hoarseness and oppression at the chest, accompanied with a pressure on the head, and followed by shivering and such a violent cough that they thought they should be suffocated, especially during the night.

This cough was dry at first. But about the seventh day, or even later, an abundant secretion took place, either of thick mucus, or of thin frothy fluid.

Upon this the cough somewhat abated and the breathing became freer. During the whole course of the disorder, however patients complained of insufferable languor loss of strength, want of appetite, and even nausea at the sight of food, restlessness and want of sleep.

The malady ended in most cases in abundant perspiration, but occasionally in diarrhoea.

Rich and poor people of every occupation and of all ages were seized with this disease in whole crowds simultaneously and it passed easily from a single case to a whole household. On this occasion death rarely occurred, except in children who had not power to endure the severity of the cough, and medicine was of little avail, either in alleviating the disorder or arresting its destructive course.

The already established name of this disease was immediately called to mind again in France. It was not however confined to that kingdom, but prevailed as generally with some considerable varieties of form in Italy, Germany, Holland, and doubtless over a still wider range of country's.

The same was the case with the influenza of 1580 which spread over the whole of Europe, and seems to have been less severe, thus bearing a closer resemblance to that of 1831 and 1833, which is still in the recollection of most of our readers from their own experience.

A more elaborate research into this very important subject would far surpass the limits of this treatise for phenomena deeply affecting the whole system of human

Valleriola Loc med Comm Append p 45 Schench a Grafenberg Lib VI p 552 Compare Short TI p 221 b Reusner p 72 Some of the synonymes here adduced will shew the medical views of the period respecting these diseases Catarrhus febrilis Febrig catarrhosa Ardores suffocantes Febris suffocativa Catarrhus epidemicus Tussis popularis Cephalaa catarrhosa Cephalalgia contagiosa Gravedo anhelosa Fernel Der bohmische Ziep the Bohemian pip Der schafhusten the sheep cough Die schafkrank heit the sheep disease Die lungensucht phthisis Das Hiihnerweb the poultry cough or chicken contracted to chin cough and many others In the influenza of 1580 violent perspiration was occasionally observed so that some physicians thought that the English sweating sickness was about to return just as in the Groninger intermittent 1826 and in the cholera of 1831 without any knowledge on the subject they talked of the Black Death Schneider I IV c 6 p 203 222

collective life, are here to be considered, which can only become apparent when received as a connected whole. Yet we must at least point out the relation which the influenzas bear to the greater epidemics. This is quite apparent, for as catarrhs are not infrequently the forerunners accompaniments, or sequelae of important diseases in individual cases, excitement of the mucous membrane, being often merely an outward sign of more deeply seated commotion. So also are influenzas usually only the first manifestations, but sometimes also the last remains of extensive epidemics.

The most recent example is still fresh in our memories The influenza of 1831 was immediately followed by the Indian cholera. And scarcely had this, after its revival in Eastern and central Europe, vanished when the influenza of 1833 appeared, as if to announce a general peace.

After the influenza of 1510, a plague followed in the north of Europe, which in Denmark carried off the son of King Johnb. 1551 was the year of the fifth epidemic of sweating sickness. In 1557 the influenza in Holland was followed by a bubo plague, which lasted the following year, and carried off 5000 of the inhabitants at Delft.

In 1564 a very destructive plague raged in Spain of which 10,000 people died at Barcelona and finally in 1580, the last year of influenza in that century, a plague of which 40,000 died in Paris, appeared over the greater part of Europe and in Egypt.

Sect 7 Epidemics of 1517

We now revert to the year 1517 and shall consider the epidemics which accompanied the English sweating sickness. First of all, the Hauptkrankheit that brain fever, which so often recurred in the central parts of Europe, appeared extensively throughout Germany.

Many died of this dangerous disease, and we are assured by contemporaries that other inter-current inflammatory fevers were also very fatal. Such was it that the physicians of the sixteenth century were familiar with this observation, is proved by the following quotation from the-

Houlier Nulla fere corporis humani segritudo est quffi non defluxione humoris alicuius e capite aut excitari aut incrementum accipere possit Morb int LI fol 68 b I Hvitfeldt Danmarks Riges Kronike c Forest Lib VI Obs IX p 159 Webster vol I p 157 165 Villalba TI p 102 117 and Schnurrer e Spangenberg M Chr fol 408 b EPIDEMICS OF 1517 223

-case in Germany at the heart of Europe. Another disease, however much more important, and till that time wholly unknown to medical men, appeared in Holland, which broke out in January 1517. And from its dangerous and quite inexplicable symptoms, spread fear and horror around.

It was a malignant, and according to the assurance of a very respectable medical eye witness, an infectious inflammation of the throat, so rapid in its course, that unless assistance were procured within the first eight hours, the patient was past all hope of recovery before the close of the day.

Sudden pains in the throat and violent oppression of the chest, especially in the region of the heart, threatened suffocation, and at length actually produced it.

During the paroxysms, the muscles of the throat and chest were seized with violent spasm, and there were but short intervals of alleviation, before a repetition of such seizures terminated in death.

Unattended by any premonitory symptoms, the disease began with a severe catarrhal affection of the chest, which speedily advanced to inflammation of the air passages, and where death did not occur on the day of the attack, it ran on to a dangerous inflammation of the lungs, which followed the usual course, but was accompanied by a very high fever.

Occasionally a less perilous transition into intermittent fever was observed. But in no case did a sudden recovery take place. For even when the fever subsided the patient continued to suffer for at least a month from pain in the stomach and great debility, which symptoms admit of easy explanation to a medical man of the present day, from the fissures and small ulcers of the tongue, which appeared when the fever was at its height and obstinately resisted the usual treatment.

The remedies employed show the circumspection and ability of the Dutch physicians. They had recourse as soon as possible, at the latest within six hours to venesection, and followed this up immediately by purgatives. Of which however, some eminent men disapproved and this to the great detriment of their patients, for without the combined effect of both these means, the sudden suffocation could not be averted. Moreover the employment of detergent gargles whereby the extension of the affection to the lungs was prevented as also of demulcent pectoral remedies was decidedly beneficial and it is affirmed that all who were thus treated were easily restored. Tyengius in Forest Lib VI Obs II Schol p 152 224

Extraordinary and peculiar as this disease, for which contemporaries found no name, was its rapid onset and its sudden disappearance were still more so.

Most of those affected were taken ill at the same time and eleven days of suffering and misery had scarcely elapsed, when not another case occurred. The numbers who had fallen victims were buried, and but for the journal of the worthy Tyengiusa no distinct record would have existed of this remarkable epidemic. Which however, it is certain to have spread further than merely over the misty territory of Holland.

And apparently with still greater malignity, for in the same year we find it in Basle, where within the space of eight months it destroyed about 2000 people, and its symptoms would seem to have been still more strongly marked.

Respecting the intermediate countries, which it is highly probable that the disease passed through from Holland before it reached Basle, we unfortunately have no information.

The tongue and gullet were white as if covered with mould the patient had an aversion to food and drink, and suffered from malignant fever, accompanied with continued headache and delirium.

Here also, in addition to an internal method of cure, which has not been particularly detailed, the cleansing of the mouth was perceived to be an essential part of the treatment. The viscous white coating was removed every two hours and the tongue and fauces were afterwards smeared with honey of roses. Whereby patients were restored more easily than when this precaution was omitted.

It appears according to modern experience to admit of no doubt that this disease consisted of an inflammation of the mucous membrane, which accompanied by a secretion of lymph, spread from the oesophagus to the stomach. And likewise through the air passages to the lungs being thus identical.

Forest availed himself of the unprinted and probably lost works of this distinguished physician, of whom but for him, we should have known nothing.

The moderns who prefer powerful remedies, employ for this purpose without any better effect the lunar caustic.

Wurstisen p 707 In this seventeenth year, there arose an unknown epidemic The patients tongues and gullets were white as if coated with mould they could neither eat nor drink but suffered from headache together with a pestilential fever which rendered them delirious By this disease 2000 persons perished in Basle within the space of eight months Besides other means it was found very efficacious to cleanse the mouth and gullet every two hours even to the extent of making the surface bleed and then to soften them with honey of roses Q EPIDEMICS OF 1517 2 5

With pharyngeal croup, which was represented a few years ago as a new disease, and has in consequence been designated by a special name. Its subsequent appearance in the memorable year 1557, respecting which, we have a still more complete account, gives additional weight to this supposition.

In that year it broke out in October and was observed by Forest who, was himself the subject of it at Alkmaar, where it attacked whole families, and in the course of a few weeks destroyed more than 200 people. It was not however so excessively rapid in its course as in 1517. But began with a slight fever like a common catarrh and showed its great malignity only by degrees.

Sudden fits of suffocation then came on and the pain of the chest was so dreadfully distressing that the sufferers imagined they must die in the paroxysm.

The complaint was increased still more by a tight convulsive cough, and until this was relieved by a secretion of mucus proved dangerous, especially to pregnant women, sixteen of whom died within the space of eight days. Whilst those who survived were all prematurely brought to bed

The fever which accompanied the inflammation was very various in its course, It was rarely observed to continue without intermission, but where this was the case it was attended with the greatest peril

Yet death did not take place on this visitation until the ninth or fourteenth day, whereas in the year 1517 as many hours would have sufficed to produce a fatal termination.

After this period the danger diminished and those patients were most secure from suffocation, provided they had good medical attendance, whose complaint had been accompanied throughout its course by fever of only an intermittent character.

So marked was the influence of the Dutch soil that until this intermittent stage passed into continued fever of different gradations, it appeared of the purest and most unmixed type.

In these cases the inflammation was less completely formed so that even bleeding a remedy otherwise indispensable was sometimes unnecessary. Those affected, all suffered most at night and in the morning the latter generally bringing with it the inflammation of the larynx and trachea, which however, they had not at that time experience enough to recognise as such, perceiving as they did only a slight redness in the fauces.

The painful affection of the stomach was also in this epidemic very distinctly

Sretonneau's Piphtheritis Compare Naumann's treatise on the subject in the author's Wissenschaftlichen Annalen der ges Heilkunde Vol XXV II 3 p 271 226

Marked so that a sense of pressure at the pracordia accompanied by continual acid eructations, continued to exist even after a succession of six or seven fits of fever and convalescents were troubled for a long time with dyspepsia debility and hypochondriasis.

The inflammation of the mucous membrane no doubt affected the nervous plexuses of the abdomen as is usually the case and totally changed the secretion. This was proved by the treatment. For by administering the necessary purgative remedies a vast quantity of offensive mucus mixed with bile was evacuated.

Our excellent eye witness assures us that the people sickened as suddenly as if they had inhaled a poisonous blast, so that more than a thousand people in Alkmaar betook themselves to their beds in a single day.

A thick stinking mist, having previously for several days, spread over the land.

This pestilence did not terminate so speedily as that of the year 1517. On the contrary it delayed until the winter and seems to have formed the conclusion of a whole series of morbid phenomena.

Particularly of the already mentioned influenza throughout Europe and of the bubo plague in Holland, which had occurred in the middle of the summer. Phenomena that were accompanied by the usual attendants of epidemics, namely great scarcity and unusual occurrences in the atmosphere, such for instance as electric illuminations of prominent objects and so forth.

The close connexion between this inflammation of the air passages and gullet and the epidemic catarrh is quite apparent. For these are but gradations and gradual transitions in the affection of the mucous membrane. As also in the power of atmospherical causes, which especially influence the organs of respiration.

We believe therefore that we are fully justified in classing the epidemic described to have taken place in Holland and Germany in 1517 with the influenzas. And in declaring the morbid commotion in human collective life, which thus manifested itself to have been a forerunner of the English pestilence. Which was simultaneously prepared by the altered condition of the atmosphere, and broke out a few months later.

We ought not to omit here to mention that in this same year 1517, the small pox and with it as field poppies among corn the measles was conveyed by Europeans to Hispaniola and Forest Lib VI obs ix p 159 EPIDEMICS OF 1517 227

committed dreadful ravages at that time as afterwards among the unfortunate inhabitants.

Whether the eruption of these infectious diseases in the new world was favoured by an epidemic influence or not, can no longer be ascertained.

Yet the affirmative seems probable from the fact that the small pox did not commit its greatest ravages in Hispaniolaa until the following year. And according to recent experience those epidemic influences which extend from Europe westward always require some time to reach the eastern coasts of America.

But even without this phenomenon in the New World which is now for the first time placed within the pale of observations on epidemics, we have facts at hand sufficiently numerous and worthy of credit to prove that the English Sweating Sickness of 1517, made its appearance, not alone but surrounded by a whole group of epidemics. And that these were called forth by general morbific influences of an unknown nature.

CHAPTER IV THE FOURTH VISITATION OF THE DISEASE 1528 1529 Und wenn die Welt voll Teufel war Und wollten uns verschlingen So f iirchten wit uns nicht so sehr Es soil uns doch gelingen I LdtheR Sect 1

Destruction of the French Army before Naples 1528.

The events to which we are now about to allude demonstrate by their surprising course that the fate of nations is at times far more dependent on the laws of physical life than on the will of potentates. Or by the collective efforts of human action and that these prove utterly impotent when opposed to the unfettered powers of nature.

These powers inscrutable in their dominion, destructive in their effects, stay the course of events, baffle the grandest plans, paralyse the boldest flights of the mind and Petr Martyr Dec IV cap 10 p 321 Compare Moore p 106 228

when victory seemed within their grasp have often annihilated embattled hosts with the flaming sword of the angel of death.

To obliterate the disgrace of Paviaa Francis I in league with England, Switzerland, Rome, Genoa, and Venice against the too powerful Emperor of Germany sent a fine army into Italy.

The emperor's troops gave way wherever the French plumes appeared. And victory seemed faithful only to the banners of France and to the military experience of a tried leader. Every thing promised a glorious issue. Naples alone weakly defended by German lansquenets and Spaniards remained still to be vanquished.

The siege was opened on the 1st of May 1528 and the general confidently pledged his honour for the conquest of this strong city, which had once been so destructive to the French. It was easy with an army of 30,000 veteran warriors to overpower the imperialists. And a small body of English seemed to have come merely to partake in the festivals after the expected victory.

The city too suffered from a scarcity for it was blockaded by Doria with his Genoese galleys and water fit to drink failed after Lautrec had turned off the aqueducts of Poggio reale, so that the plague, which had never entirely ceased among the Germans since the sacking of Rome, began to spread.

But amidst this confidence in the success of the French arms, means for ensuring it were gradually neglected. The valour of the intrepid and prudent commander, was doubtless equal to the minor vicissitudes of war. But whilst the length of the delay paralysed his activity, nature herself suddenly proved fatal to this hitherto victorious army. Pestilences began to rage among the troops and human courage could no longer withstand the far shooting arrows of the god of day.

The consequence was that within the space of seven weeks out of the whole host which up to that period had been eager for combat, a mere handful remained. Consisting of a few thousands of cadaverous figures, who were almost incapable of bearing arms, or of following the commands of their sick leaders. On the 29th of August the

24th of Feb 1525 Lautrec c At first under Hugo de Moneada afterwards under the Prince of Orange d 1495 the year of the epidemic Lues Among them some regiments of Swiss f Two hundred knights under Sir Robert Jerningham and afterwards under Carew both died of the Camp Fever Herbert of Cherbury p 212 seq The 6th of May 1527 DESTRUCTION OF THE FRENCH ARMY 1528 229

siege was raised fifteen days after the heroic Lautrec bowed down by chagrin and disease, had resigned his breath. The wreck of the army retreated amid thunder and heavy rain and were soon captured by the imperialists. So that but few of them ever saw their native land again.

This siege brought still greater misery upon France than even the fatal battle of Pavia. For about 5000 of the French nobility some from the most distinguished families had perished under the walls of Naples. Its remoter consequences too were humiliating to the king and the people, since owing to its failure all those hitherto feasible schemes were blighted which had for their object the establishment of French dominion beyond the Alps.

It behoves us therefore to pay so much the more attention to those essential causes of this event which fall within the province of medical research. The mortality which occurred in the camp began probably as early as June, after the usual calamities which surround an army in an enemy's country.

The French and Swiss were insatiable in their indulgence in fruit, which the gardens and fields furnished them in abundance, whilst there was a scarcity of bread and of other proper food. Hence fevers soon broke out which increased in malignity the longer they existed.

Accompanied no doubt by debilitating diarrhoeas which never fail to make their appearance under circumstances of this kind, and are in themselves among the most pernicious of camp diseases, since they not only destroy in the individual case by the exhaustion which they occasion, by infecting the air, prepare the way for the worst pestilences.

These diseases, were however, little noticed and there was consequently no attempt made to diminish their causes. It became daily more and more apparent that the cutting off of the sources near Poggio reale, which Lautrec had commanded in order to compel the besieged to a more speedy surrender, was in the highest degree injurious to the besiegers themselves.

For the water having now no outlet, spread over the plain, where the camp was situated, which it converted into a swamp, whence it rose morning and evening in the form of thick fogs. From this cause and while a southerly wind continued to prevail the sickness soon became general Those soldiers who were

Jovius L XXVI Tom II p 129 Ibid p 114 230

not already confined to bed in their tents were seen with pallid visages, swelled legs and bloated bellies scarcely able to crawl so that weary of nightly watching they were often plundered by the marauding Neapolitans.

The great mortality did not commence until about the 15th of July but so dreadful was its ravages that about three weeks were sufficient to complete the almost entire destruction of the army.

Around and within the tents vacated by the death of their inmates noxious weeds sprang up. Thousands perished without help either in a state of stupor or in the raving delirium of fever. In the entrenchments in the tents and wherever death had overtaken his victims, there unburied corpses lay and the dead that were interred swollen with putridity, burst their shallow graves and spread a poisonous stench far and wide over the camp.

There was no longer any thought of order or military discipline and many of the commanders and captains were either sick themselves or had fled to the neighbouring towns in order to avoid the contagion. The glory of the French arms was departed and her proud banners cowered beneath an unhallowed spectre.

Meanwhile the pestilence broke out among the Venetian galleys under Pietro.

Lando Doria had already gone over to the Emperor and thus was this expedition begun-under the most favourable auspices, frustrated on every side by the malignant influence of the season.

No medical contemporary has described the nature of this violent disease and historians have on this point preserved only general outlines, which do not afford sufficient materials to ground an investigation.

Certain it is that in the year 1528 a very malignant petechial fever extended throughout Italy. And in the proper sense of the word, prevailed so decidedly that it even followed the Italians abroad in the same way as the Sweating Sickness with the English is proved.

According to Mezeray, the pestilence was at its height at the end of July. This is in accordance with Jovius who fixes the termination of the great mortality with rather too much precision perhaps on the 7th of August. With reference to this seemingly inflammatory state of excitement, it is perhaps worthy of notice that the commander in chief himself is stated to have been twice bled.

Jovius loc cit p 125 Jovius loc cit p 116 118 Mezeray T II p 963 1528 231

Learned Venetian Naugerio, who being dispatched on an embassy to Francis the 1^st, died at Blois on the Loire of this very disease with which the French had yet no acquaintance.

Contemporaries assure us that this epidemic committed great ravages in the country already distracted by wars and feuds. And it is therefore hardly to be doubted that occurring as it did in those same years, it was the disease of which we have been treating the malignity, of which was increased on extraordinary occasions.

A pestilence which just before the siege of Naples, destroyed one third of the inhabitants of Cremona, was in all probability the petechial fever. Yet here and there the old bubo plague made its appearance.

This it was which in the year 1524 carried off 50,000 people in Milan and this appears likewise to have been the disease which after the sacking of Rome broke out among the German lansquenets. And in a short time annihilated two thirds of these troops.

Contemporaries saw therein God's just punishment of their desecration of the Holy City.

For in the succeeding years all the remaining participators in the storming of the eternal city also met with an end worthy of their crimes. They did not take into account however the beastly intemperance and excesses of the soldiery, whose eagerness after plunder, led them to encounter the plague poison in the most secret holes and corners.

Nor did they reflect that the plague penetrated the Castle of St Angelo itself and destroyed some of the courtiers almost under the eyes of the Pope.

Of these lansquenets many went to Naples in the following year under the Prince of Orange and it may, with good ground, be supposed that they took with them to that city fresh germs of plague. To which may be added the, by no means incredible story, that the besieged sent infected and sick soldiers to the French in order to cause poisonous pestilences to break out among them.

This very circumstance tells in favour of bubo plague for the decided certainty of its contagious nature was known and seemed beyond all comparison greater than the more conditional communicability of the new disease.

Fracastor Morb Contag L II c 6 p 155 156 b It broke out in the beginning of February and prevailed throughout the following month Campo p 151 c Guicciardini p 1054 6 Mezeray T II p 957 Guicciardini p 1276 Ibid p 1315 e See above p 201 232 THK SWEATING SICKNESS

More over, the same attempt at impestation had been already often made in earlier times.

It is however also to be considered on the other side, that the French army was more exposed to the epidemic influence of the air the water and the general powers of nature, than any other assemblage of men. And that this influence was probably more powerful in the year 1529 than at any other time during the sixteenth century.

The formation of fog in the heat of summer is at all times an extraordinary phenomenon, which decidedly indicates a disproportion in the mutual action of the components and powers of the lower strata of the atmosphere.

This was not dependent merely on the local peculiarities of Naples, for during the summer of 1528, grey fogs were observed throughout Italy, which rendered the unwholesome quality of the air visible to the eye.

This was increased by the prevalence of southerly winds which are always, in Italy, prejudicial to health, as also by the thousand privations of a camp. So that a disease which was already prevalent all over Italy, which we have alluded to the petechial fever, might well break out on the damp soil of Poggio reale .

In the history of national diseases we find a moral proof of the predominance of epidemic influence, which plainly and intelligibly manifests itself under the greatest variety of circumstances. This is a belief that the water and even the air is poisoned. Nor is this proof wanting in the deplorable history of the French army before Naples.

For it was generally believed that some Spaniards of Moorish descent to whom was attributed an especial degree of skill in the management of poison and some Jews from Germany, who for the sake of gain had followed the lansquenets to truckle for their booty, had stolen out of the city under cover of the night in order to poison the water in the neighbourhood of the camp.

It was also surmised that an Italian apothecary had administered to the French knights poison in their medicine. We will not anticipate on this occasion the researches of naturalists whose experiments on air and water during important epidemics have not yet led to any results, it is however not improbable that pond and spring water under such circumstances as are here described.

It was also observed as is well known in the summer of 1831 before the breaking out of the cholera

Gratiot p 129 130 c See above p 204 Jovius loe cit p 1 15 c Mezeray p 963 1528 233

to have occurred, might become impregnated with a noxious quality not inherent in it, which would very naturally give rise to the belief that a poison had been thrown into it.

On the whole this accusation may certainly be judged according to the same views which have been stated in our treatise on the Black Death.

From all these circumstances the notion is highly probable that it was the petechial fever which raged in the French camp.

And if we may attach any importance to the incidental accounts of historians, it may perhaps be to the purpose to state that Pru dencio de Sandoval, who has written from authentic materials, calls the disease las bubas. This name it is true presupposes a rather strange confusion of petechial fever with lues, and indeed the diseases among the French troops from 1495 to 1528 have been oddly jumbled together by Sandoval.

It shows however that there still existed a recollection of the prevalent eruptions which occurred in the pestilence of 1528. And therefore this whole account might perhaps be the more justly applied to petechial fever, as this same historian states that the French called the disease after the village of Poggio reale les Poches, by which name the well known bubo plague would hardly have been designated.

If however we choose to suppose that at one and the same time different diseases prevailed in the French army this notion is not only supported by the express testimony of a contemporary, but also by many observations, ancient and modern that have been made in cases where the circumstances have been similar to those which then prevailed.

It is ever to be regretted that there was no intelligent Machaon to be found in the camp before Naples, such a one would undoubtedly have left us some pithy observations on the combination and affinity of petechial fever and bubo plague.

The Spanish name for the lues venerea which it obtained in consequence of the prevailing eruptions It corresponds with the French la v role and with the German franzbsische Pocken We must not therefore think that it means buboes

Sandoval Part II pp 12 14 Compare Aslruc TI p 4 In the Madrid edition of the same work 1675 fol L XVII p 232 b c Auster namque ventus per eos dies perflare et mortiferum crassioris nebulae va porem ex palustri ortum uligine per castra dissipare et circumferre ita coeperat ut alii ex causis conceptce febres in contagiosum morbum verterentur Joviiis L XXVI p 127 In Torgau where in 1813 and 1814 30,000 Frenchmen found their graves there prevailed two diseases typhus and diarrhoea altogether distinct from one another See Richter 231

Sect 2 Tkousse Galant in France 1528 and the following years.

Deeply as the irreparable loss of such an army was felt by the French yet were they destined to suffer still greater misfortunes at home. The dark power which threatened all Europe regarded neither distance nor limits. It seized on the French nation in their own country whilst their military youth were destroyed before Naples.

The cold spring and wet summer of 1528 destroyed the growing corn and a famine was thus produced throughout France. Even more grievous on account of its duration than the period of scarcity in the time of Louis the XII, for the failure of the harvest continued for five years in succession, during which all order of the seasons seemed to have ceased.

A damp summer heat prevailed in autumn and winter a frost of a single day only occasionally intervening. The summer on the other hand was cloudy damp and un-genial. The length of the days alone distinguished one month from another. It appears plainly from detached accounts how much the usual course of vegetation was disturbed.

Scarcely had the fruit trees shed their leaves in the autumn, when they began to bud again and to bear fruitless blossoms. No returns rewarded the toil of the husband-man and the longed for harvest again and again deceived the hopes of the people.

Thus even during the first of these calamitous years the distress became general and the increasing indigence was no longer to be checked by human aid. Bands of beggars wandered over the country in lamentable procession.

The bonds of civil order became more and more relaxed and people soon had to fear not only robbery and plunder on the part of these unfortunate beings, but the contagion of a pestilence the offspring of their distress which followed in their train.

This disease was a new production of the French soil, and when it spread generally throughout the country was the more sensibly felt as it especially carried off young and robust men on which account it was designated by the very significant name of Trousse Galantc.

It consisted of a highly inflammatory fever which destroyed its victims in a very short time even within the space of a few hours or if they escaped with their

Schwelin p 143 b See page 189 c Trousser in an obsolete sense signifies to cause speedy death TR0USSE GALANT IN FRANCE 235

lives deprived them of their hair and nails, and from a long continued disinclination for all animal food, left behind it as sequelae of protracted debility and diseases. Which endangered the recovery of the sick whose constitutions were already so much shaken. Hence it appears that this fever was combined with a great decomposition of the fluids and a very morbid condition of the functions of the bowels not to mention the effects produced by continued hunger which contemporaries paint in the most dreadful colours The stock of provisions was already so far consumed in the first year that people made bread of acorns and sought with avidity all kinds of harmless roots merely to appease hunger These miserable sufferers wandered about houseless and more like corpses than living beings and finally failing even to excite commiseration perished on dunghills or in out houses The larger towns shut their gates against them and the various charitable institutions proved of necessity insufficient to afford relief in this frightful extremity It was the lot of very few to obtain the tender care and attendance of the Sisters of Charity In most of those affected their livid swollen countenances and the dropsical swelling of their limbs betrayed the sickly condition in which they dragged on their languishing existence Every one fled from these pestiferous spectres for they were saturated with the poison of this deadly disease and the remark was no doubt made a thousand times over that this poison might be conveyed to persons in health without affecting the carrier since want and ill health occasionally afford a miserable protection against disease of this kind The necessary data for furnishing a complete account of the Trousse galant of 1528 do not exist for physicians passed over this epidemic with the same coolness and indifference which unfortunately they may be justly accused of having shewn with respect to other important phenomena But it returned once again in 1545 46 appearing in Savoy and over a great part of France and we possess from Pareb and from Sander a Flemish physician though still a defective yet a more a Mezeray T II p 965 where the best notices of it are to be found His account applies to the town of Puy in the Auvergne where he seems himself to have seen the disease Livr XXII c 5 p 823 c Forest L VI obs 7 p 156 Sander writes from numerous observations which he made in and about Cambray 2

satisfactory description of its symptons on this occasion Its course was as before very rapid so that it destroyed the patient in two or three days again it attacked the strong rather than the weak as if in justification of its old name and those who recovered remained for a long time distinguishable by the loss of their hair and their wretched appearance Patients felt at the commencement an insufferable weight in the body with extremely violent headache which soon deprived them of all consciousness and passed into a profound stupor even the sphincter muscles losing their power In other cases a continued state of sleeplessness was followed by feverish delirium so violent that it was necessary to have recourse to means of restraint Such opposite states are usual in all typhous fevers Sander expressly mentions that in most of those affected eruptions made their appearance He does not however state their nature or describe the course and crisis of the disease otherwise than that it terminated about the fourth or the eleventh day Even the eruptions that did appear which were probably petechiae and perhaps also rother friesel red miliary vesicles came at an indefinite period either at the commencement when they afforded an unfavourable prognosis or later when they betokened a favourable crisis Thread worms in great numbers were evacuated alive under great torment and generally increased the sufferings of the patient The disease was scarcely less contagious than plague and with respect to its treatment bleeding copious and even ad deliquium was decidedly successful which coupled with the attacks on the head just describeda leads to the conclusion that there existed a fulness of blood and an inflammatory state of circulation together perhaps with inflammation of the brain We must not omit to observe that during the pestilence of 1546 the bubo plague made its appearance here and there especially in the Netherlands b and in the following year broke out and spread to a greater extent in France c whence it seems to follow with respect to the malady of which we are now 1 Sauvages TI p 487 hence calls the Trousse galant Cephalitis verminosa although neither inflammation of the brain nor worms existed in all cases and takes his description from Sander as again Ozanam has taken it from Sauvages T III p 27 Forest p 157 Schol c Pari loc cit TROUSSE GALANT IN FRANCE 237

treating that its nature resembled the petechial fever since that disease usually precedes the occurrence of pestilencesa The assertion of historians that in 1528 and the following years France lost a fourth part of her inhabitants by famine and pestilence seems according to our representation not to be by any means exaggerated The consequences as regarded the future destinies of that country were likewise very important For Francis the 1st saw that no new sacrifices could be borne by his people who were already so sorely afflicted and therefore abandoned his schemes of greatness and foreign power consenting on the 5th of August 1529 to the disadvantageous treaty of Cambray Sect 3 Sweating Sickness in England 1528 Whoever following the above facts will represent to himself the state of Europe in 1528 will readily believe that a poisonous atmosphere enveloped this quarter of the globe and continually brought destruction and death over its nations Ruin broke in upon them in a thousand forms destroying their bodies and benighting their minds and if to this we add the discord and the deadly party hatred which at that time prevailed in the world it seems as if every circumstance that could affect mankind was implicated in this gigantic conflict which threatened in its fatal result to annihilate all traces of the times that were past A heavier affliction than has yet been described was in store for England for in the latter end of May the Sweating Fever broke out there in the midst of the most populous part of the capital spreading rapidly over the whole kingdom and fourteen months later brought a scene of horror upon all the nations of northern Europe scarcely equalled during any other epidemic It appeared at once with the same intensity as it had shewn eleven years before was ushered in by no previous indications and between health and death there lay but a brief term of five or six hours Public business was postponed the courts were closed and four weeks after the pestilence broke out the festival of St Johnb was stopped to the great sorrow of the people who certainly would not have dispensed with its celebration So small pox and measles it is well known are the forerunners of plague Fabian p 699 238

had they recovered from the consternation arising from the great mortality The king's court was again deserted and to the various passions and mental emotions which had been clashing there since the year 1517 as for instance those arising from the theological zeal which had been excited by Henry VHIth's defence of the faith was added once more the old alarm and distress which seemed to be justified by the death of some favoured courtiers particularly of two chamberlains a and of Sir Francis Poynes who had just returned from an embassy to Spain The king left London immediately and endeavoured to avoid the epidemic by continually travelling until at last he grew tired of so unsettled a life and determined to await his destiny at Tytyn hangar Here with his first wife and a few confidents he resided quietly apart from the world surrounded by fires for the purification of the air and guarded by the precautions of his physician who had the satisfaction to find that the pestilence kept aloof from this lonely residence h How many lives were lost in this which some historians have called the great mortality can be estimated only by the facts which have been stated and which betoken an uncommonly violent degree of agitation in men's minds Accurate data are altogether wanting yet it is quite evident that the whole English nation from the monarch to the meanest peasant was impressed with a feeling of alarm at the uncertainty of life to which neither the rude state of society nor a constant familiarity with the effects of laws written in blood had blunted their sensibility Such a state does not exist without very numerous cases of mortality which bring the danger home to every individual so that it is to be presumed that the churchyards were everywhere abundantly filled Nor did this destructive epidemic come alone Provisions were scarce and dear and whilst hundreds of thousands lay stretched upon the bed of death many perished with hunger and the same scenes would Sir William Compton and William Carew besides many other distinguished persons who are not named

Grafton p 412 the principal passage Compare Hotinshed p 735 Baker p 293 HaU p 750 Herbert of Cherbury p 215 c During Henry the Eighth's reign 1509 to 1547 72,000 malefactors were according to Harrison executed for theft and robbery making nearly 2000 for each year Hume T IV p 275 Stow p 885 SWEATING SICKNESS IN ENGLAND 1528 239

have been experienced as in France had not the corn trade afforded some relief As soon as the occurrences of this unfortunate year could be more closely surveyed a conviction was at once felt that it was one and the same general cause of disease which called forth the poisonous pestilence in the French camp before Naples the putrid fever among the youth in France and the sweating sickness in England and that the varying nature of these diseases depended only on the conditions of the soil and the qualities of the atmosphere in the countries which were visited If in opposition to these notions a narrow view of human life in the aggregate should raise a doubt this would be strikingly refuted by the wonderful coincidence in point of time of all these phenomena occurring in such various parts of Europe for while the French army after an exposure of four weeks to the miseries and poisonous vapours of its camp before Naples perceived the first forebodings of its destruction the great famine with the Trousse galant in its train was in full advance on the other side the Alps and almost on the same day the Sweating Sickness broke out upon the Thames Sect 4 Natural Occurrences Prognostics The chronicles of all the nations of Europe are full of remarkable notices respecting the commotions of nature in these particular years which were so utterly hostile to the animal and vegetable kingdoms In England the period of distress was already approaching towards the end of the year 1527 Throughout the whole winter November and December 1527 and January 1528 heavy rains deluged the country the rivers overflowed their banks and the winter seed was thus rotted The weather then remained dry until April but scarcely was the summer seed sown when the rain again set in and continued day and night for full eight weeks so that the last hope of a harvest was now destroyed and the soaked earth in the thick mists that arose from its surface hatched the well known demon of the Sweating a Fabian loc cit h it seeming to be but the same contagion of the aire varied according to the clime Herbert of Cherbury loc cit c Stow loc cit 240

Disease It was now of no avail that the torrents of rain ceased for the softened soil gave the pestilence constant nourishment and the damp warmth which alternating with unseasonable cold remained prevalent during the following years all over Europe rendered men's bodies more and more susceptible to severe diseases The historians of that time were too much occupied with the intricate affairs of the court and of the church to devote any attention to nature and on this account they have left us no satisfactory information of the state of the weather and the course of the seasons of those years in England yet there is no reason to suppose that they were essentially different from those of the rest of Europe This may be proved by the following collection of important natural occurrences when taken in conjunction with the circumstances already stated respecting France and Italy In Upper Italy such considerable floods occurred in all the river districts in the year 1527 that the astrologers announced a new Deluge There was a repetition of them to an equal extent and with equal damage in the following year so that it may have been concluded not without some ground that there was an accumulation of snow on the highest mountain ranges of Europe On the 3rd of July 1529 there followed a violent earthquake in Upper Italy and immediately afterwards a blood rain as it was called in Cremona a In October 1530 the Tiber rose so much above its banks that in Rome and its neighbourhood about 12,000 people were drowned A month later in the Netherlands the sea broke through the dykes and Holland Zealand and Brabant suffered very considerably from the overflow of the waters which again took place two years afterwards b In 1528 there appeared in the March of Brandenburg during the prevalence of a south east wind and a great drought the rains did not commence in Germany before 1529 swarms of locusts d as if this prognostic too of great epidemics was not to be wanting Of fiery meteors which also frequently appeared in the following years and in the aggregate plainly indicated an unusual condition of the atmosphere much notice after the Campo pp 150 151 Grafton p 481 Wagenaar Vol II p 516 Haftitz p 130 Annales Berolino Marchici no numbers to the pages R NATURAL OCCURRENCES PROGNOSTICS 241

manner of the times is occasionally taken a Particular attention was excited by a long fiery train which was seen on the 7th of January 1529 at seven o clock in the morning throughout Mecklenburg and Pomerania Another fiery sign chasma was seen in the March on the 9th of January at ten o clock at night as likewise similar atmospherical phenomena in other localities Comets appeared in the course of this year in unusual numberd The first on the 11th of August 1527 before daybreak it was seen throughout Europe and it has often been confounded by more recent writers with an atmospherical phenomenon resembling a comet which appeared on the 11th of Octobere The second was seen in July and August 1529 in Germany France and Italy Four other comets are also said to have made their appearance this year at the same time but it is probable that these were only fiery meteors of an unknown kindf The third was in 1531 and was visible in Europe from the 1st of August till the 3rd of September This was the great comet of Halley which returned in the year 1835 e The fourth was in 1532 visible from the 2nd of October to the 8th of November it appeared again in 1661 h Lastly the fifth in 1533 seen from the middle of June till August Contemporaries agree remarkably in their accounts of the insufferable state of the weather in the eventful year 1529 The winter was particularly mild and the vegetation was far too early so that all the world was rejoicing at the mildness and beauty of the spring The people wore violets at Erfurt on St Matthew's day the 24th of February little expecting a Magnus Hundt fol 4 b and many others b Bonn p 148 A girl in Liibeck died of fright at this meteor c Haftitz p 131 Angelas p 317 d It must not be thought that the author because he has brought forward these notices has any pre formed opinions whatever respecting the import of these heavenly bodies The historian cannot pass over contemporaneous occurrences whatever may be the conclusion which the limited extent of our knowledge enables us to draw from them e Pingre TI p 485 Spangenberg M Chr fol 410 a Pingre p 486 Angelus p 318 Crusius Vol II p 223 Pingre p 487 Campo p 154 Angelus p 320 and numerous other accounts It performs its revolution in 76 years and was observed in 1456 1531 1607 1682 and 1759 Pingre p 491 Spangenberg M Chr fol 433 b 1 Pingre p 496 Angelus p 822 Spangenberg M Chr fol 435 a 242 THK SWEATING SICKNESS

this notion be rejected that a disordered condition of life such as must be supposed to have existed in a great famine rendered fish prejudicial to health in the same way as sometimes occurs after protracted intermittent fevers when the functions of the bowels are disturbed in a manner peculiar to this disease But it was not the inhabitants of the water alone which were affected by hidden causes of excitement in collective organic life the fowls of the air likewise sickened who in their delicate and irritable organs of respiration feel the injurious influence of the atmosphere much earlier and more sensitively than any of the unfeathered tribes and have often been the harbingers of great danger ere man was aware of its approach In the neighbourhood of Freyburg in the Breisgau dead birds were found scattered under the trees with boils as large as peas under their wings which indicated among them a disease that in all probability extended far beyond the southern districts of the Rhine a The famine in Germany during this year is described by respectable authorities in a tone of deep sympathy Swabia Lorraine Alsace and the other southern countries bordering on the Rhine were especially visited so that misery there reached the same frightful height as in France The poor emigrated and roved over the country solely to prolong their wretched existence Above a thousand of these half starved mendicants came to Strasburg out of Swabia They obtained shelter in a monastery and attempts were made to revive them yet many were unable to bear the food that was placed before them Attention and nourishment did but hasten their death Another body of more than eight hundred came in the autumn from Lorraine These unfortunate people were kept in the city and fed during the whole winter yet it is easy to conceive that this benevolence which was no doubt likewise exercised in other cities for when was humanity ever found wanting in Germany could only occasionally alleviate this deeply rooted calamity In the Venetian territories many hundreds are said to have perished with hunger and a like distress probably prevailed all over Upper Italy In the north of Germany including the extensive sandy Schiller sect I cap 2 fol 3 b b Franch fol 243 b Basle among others was particularly distinguished Stettler part II p 34 244

plains on which wet weather is not so injurious in its effect as on a heavy clayey soil the state of the country was upon the whole more tolerable a yet independently of the innumerable evils to which a scarcity gives rise suicide was more frequent b which was certainly a rarity in the sixteenth century and only explicable by supposing that the powers of the mind became exhausted by the many and various passions which in every individual locality excited a spirit of hatred and party feeling The consequence of such a state of turmoil is a cold disgust of life which finds in the first adverse event that may occur a pretext for self destruction that want alone would seldom if ever occasion for man if his spirit be unbroken runs the chance of starvation in times of famine and trusts to the faintest gleam of hope rather than of his own accord abandon the enjoyment of life It is no less in point here to notice a kind of faint lassitude which to the great astonishment of the people was felt especially in Pomerania in June and July up to the very period when the Sweating Sickness broke out In the midst of their work and without any conceivable cause people became palsied in their hands and feet so that even if their lives had depended upon it they were incapable of the slightest exertion d The treatment which was found successful was to cover the patients warmly and to supply them with nourishing food of which they ate plentifully and thus recovered again in three or four days Phenomena of this kind which in the present instance evidently depended on atmospherical influence are but the extreme gradations of a generally morbid dulness of vital feeling which might easily pass into an actual disgust of fife such as would lead to suicide The following years were by no means all marked by a complete failure in produce The year 1530 was on the contrary plentiful there being only some partial failures as for example that which arose from a great flood in the district of the Saal Spangenberg loc cit b Leuthinger p 89 From Whitsuntide till towards St James's day the 25th of July Klemzen p 254 d Two masters of vessels who had quitted the helm from a sudden attack of this kind were in danger of grounding upon the Mole Their situation was however noticed and they were saved Klemzen NATURAL OCCURRENCES PROGNOSTICS 245

which occurred in the midst of the harvest time A very cold spring and a wet cold summer followed in 1531 with only occasional fine days yet the ground was not altogether unproductive and the great distress which would otherwise have been felt in Thuringia and Saxony was checked by the establishment of granaries so that the people were not obliged as they often were in Swabia to mow the green corn that they might dry the ears in ovens and support life upon the yet unripe grain The years 1532 and 1533 were again very sterile as also 1534 in consequence of the great heat and dryness of the summer Finally in the year 1535 the regular change of the seasons and with it a prosperous state of cultivation seemed to be restored and the scarcity ceased The reports from different localities in Germany vary much but the scarcity prevailed for full seven years from 1528 to 1534 and since its causes were not discoverable because it was only seen by each observer in his own narrow circle the old German adage was often called to mind If there is to be a scarcity it is of no avail even should all the mountains be made of flour d Sect 5 Sweating Sickness in Germany 1529 These facts are sufficient for a preliminary sketch of the background on which moved the spectre of England to which we now return How long the sweating sickness may have raged there after Henry the VIHth quitted his secluded place of refuge in order to return to his capital no one has left any written account to show That it spread very rapidly over the whole kingdom is decidedly to be presumed and might probably still be easily ascertainable from the written records of different places The notion that it did not rage violently in any town more than a few weeks is justified by corresponding phenomena of more recent occurrence yet no doubt it continued to exist among the people though in a mitigated degree till the mild winter season But there are not even the slightest data Spangenberg M Chr fol 432 a Ibid fol 433 a 435 b Schwelin pp 149 150 c A Chronicler of the Marches even assures us that it lasted until 1546 Annates Dcrol Marchic but the other contemporary writers contradict this i Spangenberg fol 432 a 246

by which it can be made out that it was still in England during the summer of 1529 As an epidemic it certainly existed no longer yet on a consideration of the state of the air in that year it is not to be denied that isolated cases of Sweating Fever may have appeared for in pestilences of this kind provided their original causes continue there always occur some straggling cases 1 The Sweating Sickness did not advance westward to Ireland nor did it pass the Scottish border the historians who would certainly have recorded so calamitous an event are entirely silent respecting such an occurrence The tragedy was however destined to be enacted elsewhere other nations were to play their part in it Hamburgh was the first place on the continent in which the Sweating Sickness broke out Men's minds were still in great excitement there in consequence of the events of the few preceding months The Protestants had after long and stormy contests at length vanquished the Papists Under the wise direction of Bugenhagen the great work of Reformation was just completed The monasteries were abolished the monks dismissed schools were established and peace again returned with the enjoyment of ecclesiastical freedom Just at this moment11 the dreaded pestilence of which wonderful accounts had been so long and so often heard unexpectedly made its appearance It immediately excited as it had ever done in England general dismay and before any instructions as to its treatment could be obtained either from the English or from Germans who had been in England it destroyed daily from forty to sixty and altogether within the space of twenty two days about 1100 inhabitants for such was the number of coffins which were at this time manufactured by the undertakers The duration of the great mortality for thus we would designate the more violent raging of this pestilence was however much shorter and may be roughly estimated at about 1 Newenar indeed maintains that the Sweating Fever used to break out in England every year fol 68 b but such general and unsupported assertions coming from foreigners the Graf Hermann von Newenar was provost of Cologne are wholly unworthy of credence b About the 25th of July c From St James's day the 25th of July until the Assumption of the Blessed Virgin Mary on the 15th of August Staphorst SWEATING SICKNESS IN GERMANY 247

nine days for from the fragment of a letter received from Hamburgh which was dispatched to Wittenberg on the 8th of August by a person who was at that time burgomaster it appears that for some days past no one had died of the Sweating Fever excepting one or two drunkards and that the citizens were then beginning to take breath again We may thus judge from the unauthenticated account here mentioned that the disease lasted about a fortnight longer and that the loss of lives amounted to 2000 At all events however the pestilence manifested itself on the continent with the same malignity which was peculiar to it from the first and if the assertion made at a distance respecting the mortality in Hamburgh were overcharged yet there certainly existed sufficient foundation for exaggerations of this sort which are never wanting in times of such great danger The historians of this even at that time powerful and civilized commercial town have on the whole said but little regarding this important event a circumstance easily explicable from the constant occupation of men's minds in religious affairs and from the well known short visitation of the epidemic which like a transient meteor needed quick and cautious observation if any valuable information respecting the occurrence was to be transmitted to posterity Some particulars of its first origin have however been preserved amid a mass of general assertions which convey no information Thus it appears that the Sweating Sickness did not show itself in the town until a Captain Hermann Evers just about the time mentioned the 25th of July returned from England bringing on board with him a number of young people probably travellers as well as sailors of whom at least twelve died of this disease within two days b It appears for instance somewhere in the second volume of Leibnitz Scriptores rerum Brunsvicensium that 8000 people had died of the Sweating Fever in Hamburgh An unknown Chronicler in Staphorst Part II vol I p 85 states 2000 Moreover in the year 1529 about St James's day Almighty God sent a ter rible disease upon the city of Hamburgh it was the Sweating Sickness which showed itself in a different manner and began when Captain Hermann Evers came from England on St James's day with many young companions of whom in the course of two days twelve died of this disease which was unknown as well in Hamburgh as in other countries so that the oldest person did not recollect to have seen a similar disease An unknown eye witness quoted in Staphorst Part II Vol I p 83 Another person expresses himself to the same effect p 85 The disease had its origin in England for the people were there attacked in the street when they came on shore and those who came in contact with them many of whom were of the lower class 248

According to another account those who died were not taken ill in England but on the voyage and the pestilence broke out after the rest of the crew had disembarked On this point we have further a most respectable testimony to the fact that in the night after the landing of Hermann Evers four men died in Hamburgh of the Sweating Sickness1 If we examine a little more closely these very valuable accounts the credibility of which there is no reason to doubt it must especially be taken into account that at this time the Sweating Sickness had ceased to exist as an epidemic in England for at least half a year that its appearance in single cases although not contradictory to general views is nevertheless by no means borne out by proof from historical evidence and that thus it is a gratuitous and unsupported assumption that the return of Hermann Evers crew was connected with any Sweating Sickness at all in England If we consider on the other hand that the North Sea even in ordinary years is very foggy so that owing to the prevalence of north west winds it precipitates very heavy rain clouds over Germany and if we bear in mind that in the year 1529 it produced far heavier fogs than usual we shall perceive in its waters the principal cause why the English Sweating Sickness was then developed in its greatest violence and we may thence assume with a greater degree of probability that this pestilence broke out among the crew of Hermann Evers spontaneously and without any connexion with England in the same way perhaps as it did formerly on board Henry the Vllth's fleet This supposition is strengthened by the circumstance that the ships of those times were excessively filthy and the kind of life spent on board them was independently of the wretched provision uncomfortable in the highest degree nay almost insupportable so that even in short voyages the scurvy which was the dread of sailors in those days was of very common occurrence Finally we still possess the most distinct accounts that unusual occurrences took place in the North Seas Thus during Lent it was observed with took it Notices of uncertain date to be found in Addung at p 77 Steltzner Part II p 219 In the abbrev Hamb Chron p 45 and elsewhere As soon as the ship arrived in Hamburgh people began to die throughout the city and in the morning it was rumoured that four persons had died of it From Reimar Kock's MS Chron of Liibeck For the extract from it the author is indebted to the kindness of Professor Ackermann of Liibeck SWEATING SICKNESS IN GERMANY 249

Astonishment at Stettin that porpoises came in numbers up the frische Haff as far as the bridge and that the Baltic cast on its shores many dead animals of this kinda so that we are fully justified in concluding that there existed at that time a more intense development than usual of morbific influences in the marine atmosphere With respect however to the influence which the companions of Hermann Evers impregnated as they were with the odour of the Sweating Sickness had on the inhabitants of Hamburgh it cannot be denied that their intercourse with those inhabitants in the filthy and narrow lanes of that commercial city may have given an impulse to the eruption of the pestilence so far as to make the already existing fuel more inflammable or to furnish the first sparks for its ignition yet it is equally undeniable that under the existing circumstances the epidemic Sweating Sickness would have broken out in Germany even without the presence of Captain Evers although it might perhaps have been some weeks later and not have made its first appearance in Hamburgh whose inhabitants owing to the constant prevalence of the North Sea fog were to all appearance already prepared for the first reception of this fatal disease To determine to a day when epidemics which have been long in preparation have broken out is even for an observer who is present exceedingly difficult nay sometimes under the most favourable circumstances impossible for there occur in these visitations certain transitions into the epidemic form of diseases which are allied to it as well as a gradual conversion into it of morbid phenomena which have usually begun some time before Unless we are greatly mistaken such was the case in the pestilence of which we are now treating although it must be confessed that we can obtain no precise information on this point from the physicians of those times The following statements for the absolute precision of which we cannot pledge ourselves after a lapse of 300 years must therefore be judged according to this general experience and though singly they may prove little yet taken altogether they are capable of demonstrating the peculiar and almost wonderful manner in which the Sweating Fever spread over Germany In Ltibeck the next city in the Baltic the Sweating Sickness Klemzen p 254 It was thought that the waters of the Baltic were poisoned 250

appeared about the same time for so early as the Friday before St Peter in vinculis 30th of July it was known that on the preceding night a woman had died of it a On the following days cases of death fearfully increased and the disorder soon raged so violently that people were again reminded of the Black Death of 1349 The inhabitants died without number as well in the city as in the environs and the consternation was equal to that felt in Hamburgh b In general as was everywhere the case robust young people of the better classes were affected while on the other hand children and poor people living in cellars and garrets almost all of them escapede Now one might either on the supposition of a progressive alteration in the atmosphere such as occurs in the influenza or on that of a communication of the disease from man to man which however cannot be considered as a principal cause of this epidemic have expected a gradual extension of the Sweating Sickness from Hamburgh and Liibeck to the surrounding country This did not however in fact take place for the disease next broke out at Twickau at the foot of the Krzgebirge distant from Hamburgh fifty German miles and without having previously visited the rich commercial city of Leipzig By the 14th of August nineteen persons who had died of it were buried at Twickau and on one of the following nights above a hundred d sickened whence it is to be deduced that the pestilence was severe at that place Possibly the great storm on the 10th of August may have given an impulse to the development of this very remarkable epidemic for an highly electrical state of the atmosphere increases the susceptibility for diseases It is likewise not to be overlooked that on the 24th of August while the sky was overcast there came on an insufferable heat e which must have debilitated the body after such long continued cold wet weather At all events in the beginning of September we find that the Sweating Fever broke out at the same time at Stettin Dantzig and other Prussian cities at Augsburg far to the south on the 1 Reimar Kock's Chronicle of Liibeck b In the year 1529 this violent disease passed in a very short time all over Germany and in Liibeck many of its most distinguished citizens died on the vigil of St Peter in Vinculis Reghman p 135 Compare Kirchring p 143 Bonn p 144 0 Reimar Koch Schmidt p 307 See above p 243 and Klemxen p 254 SWEATING SICKNESS IN GERMANY 251

other side of the Danube at Cologne on the Rhine at Strasbourg at Frankfort on the Maine at Marburg tt at Gbttingen and at Hanover b The position of these cities gives an impressive notion of the extent of country of which the English Sweating Sickness took possession as it were by a magic stroke It was like a violent conflagration which spread in all directions the flames however did not issue from one focus but rose up everywhere as if self ignited and whilst all this occurred in Germany and Prussia the inhabitants of the other northern countries Denmark Norway and Sweden perhaps also Lithuania Poland and Russia were likewise visited by this violent disease The malady appeared in Stettin on the 31st of August among the servants of the Dukec On the 1st of September the Duchess herself sickened in common with many people about the court and burgesses in the city A few days afterwards several thousands were affected by the disease so that there was not a street from which some corpses were not daily carried out This dreadful period of terror however did not last much longer than a week for about the 8th of September the pestilence abated in its violence so as no longer to be regarded with terror and after this time only a few isolated cases occurredd On the same day namely the 1st of September the disease appeared in Dantzig fifty German miles further to the eastward and was here also so destructive that it carried off in a short time 3000 inhabitants some say even 6000 but this seems certainly too high an estimate for Dantzig and probably includes the greater part of Prussia If we were to give credence to an anonymous reporter f this plague abated in Jive days and relieved the inhabitants from the mortal anxiety which until they recovered their senses led them everywhere to commit acts of injustice and injury to avert the danger In Augsburg we find the Sweating Sickness on the 6th of September It lasted there also only six days affected about Euric Cordus b Gruner It p 23 c Namely on the Tuesday after the Beheading of John the Baptist 29th Aug which fell on a Sunday for S iEgidius was on the Wednesday The dates are given throughout according to Pilgrim's Calendarium chronologicum Ktemzen p 255 e Caricke p 271 Kronica der Preussen fbl 191 b 252

1500 of the inhabitants and destroyed more than half that number or as it is said about 800 a At Cologne it appeared precisely at the same time as we learn from the expressions of the Count von Newenar a prelate of that place who finished his account of this disorder on the 7th of September b At Strasburg it broke out some ten or twelve days earlier namely on the 24th of August In this place about 3000 people sickened in one week but very few of them diedc At Frankfort on the Maine they were holding the autumn fair which began on the 7th of September just at the time when the Sweating Sickness prevailedd whence arose the opinion which has been broached again in more modern times that the traders on their return carried the disease thence throughout the whole of Germany and that in the intercourse by means of this fair the main cause of the spread of the epidemic was to be found After the facts which have been brought forward such a narrow view needs no refutation The Sweating Sickness was fleeter than the conveyances of goods and people which at that time made their way along the pathless and unbeaten roads for no sooner did a rumour of the approach of the disease reach anyplace than the disease itself accompanied it f Between the boundaries which have been indicated only a few isolated towns and villages escaped and there are probably few of the chronicles of that age so prolific of great events in which the dreadful scourge of the year 1529 is not expressly mentioned yet the sweating fever like other great epidemics spread doubtless very unequally and it is ascertained that the further south it extended the milder it was upon the whole and also that all those places where it broke out late suffered beyond comparison less than those which were visited early in September and in the latter part of August for not to lay much stress on the sultry heat from the 24th of August which probably did not last long the chief cause of its great malignity at first was the violent method resorted to in the treatment of the sick the inapplicability of which was fortunately soon perceived Only one citizen was affected with the Sweating Sick Stettler 11 p 33 In GratoroL fol 74 b Gruner It p 25 according to MS Chronicles Franch fol 253 a e By Joseph Franck in the latest edition of his Praxeos Medicse Universse Prse cepta Compare Gruner It p 28 Klemzen p 254 SWEATING SICKNESS IN GERMANY 253

ness in Marburg and even he recovereda whilst at Leipzig the pestilence either never broke out at all or very much later perhaps in October or November for the physicians of that place gave it clearly to be understood in their pamphlets that they knew nothing of the disease from their own observations b and no sooner did the report get abroad that the dreaded enemy had not penetrated within the walls of this commercial city than crowds of fugitives came thither from far and near in order to seek protection and security although the place in itself was by no means fitted for a place of refuge for the swampy atmosphere which rose from the city ditches begot even in those days in the narrow and dark streets many lingering diseasese Sect 6 In the Netherlands It is remarkable that the Netherlands were visited by the Sweating Fever d full four weeks later although the commercial intercourse with England if we were to attach any especial importance to this circumstance was far more considerable than that of the German cities in the North Sea It appeared for the first time in Amsterdam on the 27th of September in the forenoon whilst the city was enveloped in a thick fog and just at the same time perhaps a day earlier in Antwerp where on the 29th of September they made a solemn procession in order by prayer to avert greater harm from the city for in the last days of September 400 to 500 people died of the English Sweating Sickness at that place f It might have been supposed that the damp soil of Holland and its impenetrable fogs would invite the pestilence much earlier than the high and serene country between the Alps and the Danube or the far distant land of Prussia but the development of epidemics follows no human calculation or medical views In the towns around Amsterdam the Sweating Fever appears not to have broken out until the This appears from a letter of Euricius Cordus to the Hessian private secretary Joh Ran von Nordeck at the end of the 2d edition of his Regimen b Magnus Hundt closed his on the 7th October c Bayer von Elbogen cap 7 d It was called there the Ingelsche Sweetsieckte or the Sweating Sickness Forest L VI Obs VII Schol p 157 Obs VIII c Schol p 158 Wagenaar T II p 508 Pontan p 762 Haraeus TI p 581 Antwerpsch Chronykje p 31 Ditmar p 473 254

mortality had ceased in that city that is to say five days after the 27th of September so that we cannot be far wrong in assuming that in the latter end of that month and the commencement of October it had spread over the whole territory of the Netherlands including Belgium a Alkmaar and Waterland remained free b as doubtless had been the case with particular places both in England and Germany Tlie exceedingly short time that the Sweating Sickness lasted in the different places that it visited was as astonishing as its original appearance For since it raged in Amsterdam for only five days and not much longer as we have shewn in Antwerp and many German towns it could hardly have continued more than fifteen days in any other places thus displaying the same peculiarity on this occasion by which it had already been marked in its former visitations This short period however must not be understood to include the sporadic occurrence of the disease otherwise as a contemporary of credit assures us that the sweating fever attacked some persons twice and others three or even four times we might thence conclude that although perhaps in some places the pestilence did after raging for a certain number of days suddenly cease so that no isolated cases afterwards occurred yet that the general duration of its prevalence was longer than has been stated Sect 7 Denmark Sweden and Norway The eruption of the Sweating Fever in Denmark d took place at the latter end of September for on the 29th of that month four hundred of the inhabitants died of it at Copenhagen e Elsinore was likewise severely visited f and probably about the same time most of the towns and villages in that kingdom But the accounts on this subject in the Danish Chronicles are extremely a Laquelle sa suette s estendit par le pays d Oostlande de Hollande Zeelande et autres des pays bas on en etoit endedens vingt et quatre heures mort ou guarry elle ne dura in Zeelande pour le plus que 15 jours dont plusieurs en moururent Le Petit TI Livr VII p 81 b Forest loc cit c Erasm Epist Lib XXVI ep 58 col 1477 b At Zerbst the Sweating Fever lasted in like manner only five days Gruner It p 29 d It was called there den engelske Sved e Frederick I Histor p 181 The same words in Huitfeld T II p 1315 f Boesens Beskrivelse over Helsingber For this statement the author has to thank Dr Manita regimental physician at Copenhagen DENMARK SWEDEN AND NORWAY 255

defective a as owing to the extraordinary rapidity of this mortal malady contemporary writers neglected to record for the information of posterity the details of a phenomenon which there as in other countries must certainly have been striking from its general prevalence Even from the imperfect notices that were given respecting it thus much however is clearly perceptible that it was the same well known disease as elsewhere which was now observed to pass through Denmark In proof of this it was principally young and strong people as had been originally the case in England who sickened the old and infirm being less affected and in the course of four and twenty hours or at most within two days the life or death of the patient was decided At the same period as in Denmark the Sweating Sickness spread over the Scandinavian Peninsula and was productive of the same violent symptoms in the sick the same terror and the same mortal anguish in those who were affected by it not only in the capital of Sweden where Magnus Erikson brother of king Gustavus Wasa died of it but also over the whole kingdom and in Norway The northern historians gave graphic accounts of it which on a careful examination of manuscript documents might perhaps gain still more in colouring and spirit b That the Sweating Sickness likewise penetrated into Lithuania Poland and Livonia if not into a part of Russia we know only in a general way but doubtless there are written a Dr Baden DCL took much pains at the request of Gruner in making researches but has elicited nothing more than Huitfeld has given A copy of his Latin letter to Gruner on this subject has likewise reached the author through Dr Mansa b Dalin D III p 221 Engclshe Svetten In TegeVs History of king Gustavus I Part I p 267 general notices only are to be found respecting the English Sweating Sickness in Sweden without any exact date autumn of 1529 or description of the disease such as are met with without number in the German Chronicles Sven Hedin clearly estimates the mortality in the epidemic sweating fever too highly when he compares it p 27 with the depopulation caused by the Black Death He gives p 47 a striking passage on the Sweating Sickness from Linneus's pathological prselections The great naturalist has however allowed free scope to his imagination and like all the physicians of modern times who have delivered their sentiments on the English Sweating Sickness knows far too little of the facts to be able to form a right judgment on the subject Supplement till Handboken for Praktiska Lakare vetenskapen rorande epidemiska och smittosamma sjukdomar i allmanhet och sardeles de Pestilentialiska 1 sta St Stockholm 1805 8vo e From Reimar Koch's M S Chronicle of Liibeck and Forest loc cit Compare Gruner's Itinerarium which is prepared throughout with laudable and even tedious diligence but which met with so little acknowledgment in the Brunonian age that it has already become a rare work 256

documents still in existence in these countries which only need some careful enquirer to bring them to light In the mean time however it is to be presumed from the early appearance of the disorder in Prussia that it prevailed in those countries at the same time as in Germany Denmark and the Scandinavian Peninsula No certain trace is anywhere to be discovered that the Sweating Sickness appeared so late as December 1529 or in January of the following year so that after having lasted upon the whole a quarter of a year it disappeared everywhere without leaving behind it any sign of its existence or giving rise to the development of any other diseases Among these it pursued its course as a comet among planets without interfering either with the French Hunger Fever or the Italian Petechia Fever proving a striking example to all succeeding ages of those general shocks to which the lives of the human race are subject and a fearful scourge to the generation which it visited Sect 8 Terror The alarm which prevailed in Germany surpasses all description and bordered upon maniacal despair As soon as the pestilence appeared on the continent horrifying accounts of the unheard of sufferings of those affected and the certainty of their death passed like wild fire from mouth to mouth Men's minds were paralysed with terror and the imagination exaggerated the calamity which seemed to have come upon them like a last judgement The English Sweating Sickness was the theme of discourse everywhere and if any one happened to be taken ill of fever no matter of what kind it was immediately converted into this demon whose spectre form continually haunted the oppressed spirit.

At the same time the unfortunate delusion existed that whoever wished to escape death when seized with the English pestilence must perspire for twenty four hours without intermission So they put the patients whether they had the Sweating Sickness or not for who had calmness enough to distinguish it instantly to bed covered them with feather beds and furs and whilst the stove was heated to the utmost closed the doors and windows with the greatest According to which it was given out by some that a sweat must be kept up for twenty four hours in succession and in the mean time that no air should be admitted to the patient This treatment sent many to their graves

Erfurt Chronicle S TERROR 257

care to prevent all access of cool air In order moreover to prevent the sufferer should he be somewhat impatient from throwing off his hot load some persons in health likewise lay upon him and thus oppressed him to such a degree that he could neither stir hand nor foot and finally in this rehearsal of hell being bathed in an agonizing sweat gave up the ghost when perhaps if his too officious relatives had manifested a little discretion he might have been saved without difficulty a There dwelt a physician in Zwickau we no longer know the name of this estimable man who full of zeal for the good of mankind opposed this destructive folly He went from house to house and wherever he found a patient buried in a hot bed dragged him out with his own hands everywhere forbad that the sick should thus be tortured with heat and saved by his decisive conduct many who but for him must have been smothered like the rest b It often happened at this time that amidst a circle of friends if the Sweating Sickness was only brought to mind by a single word first one and then another was seized with a tormenting anguish their blood curdled and certain of their destruction they quietly slunk away home and there actually became a prey to death c This mortal fear is a heavy addition to the scourge of rapidly fatal epidemics and is properly speaking an inflammatory disease of the mind which in its proximate effects upon the spirits bears some resemblance to the nightmare It confuses the understanding so as to render it incapable of estimating external circumstances according to their true relations to each other it magnifies a gnat into a monster a distant improbable danger into a horrible spectre which takes a firm hold of the imagination all actions are perverted and if during this state of distraction any other disease break out the patient conceives that he is the devoted Erfurt Chronicle and in the same strain Spangenberg M Chr fol 402 b Pomarius p 617 and Schmidt p 305 Gemma writes of the Netherlands LI c 8 p 1 89 having received his account from his father who was himself the subject of the Sweating Sickness Consuti sewn up et violenter operti clamitabant misere obtestabantur Deum atque hominum fidem sese dimitterent se suffocari iniectis molibus sese vitam in summis angustiis exhalare sed assistentes has querelas ex rabie proficisci medicorum opinione persuasi urgebant continue usque ad 24 horas etc b Schmidt loc cit Animos omnium terrore perculit adeo ut multis metus et imaginatio morbum conciliarit Erasm Epist L XXVI cp 56 c 1476 a Spangenbefg loc cit 258

victim of the much dreaded epidemic like those unfortunate persons who having been bitten by a harmless animal nevertheless become the subjects of an imaginary hydrophobia Thus during the calamitous autumn of 1529 many may have been seized with only an imaginary Sweating Sickness and under the towering heap of clothing on their loaded beds have met with their graves Others among these brain sick people who had the good fortune to remain exempt from bodily ailments many of them even boasting of their firmness fell through the violent commotions in their nerves into a state of chronic hypochondriasis which under circumstances of this sort is marked by shuddering and a feeling of uneasiness and dread at the bare mention of the original cause of terror even when there is no longer any trace of its existence b A person thus disordered in his mind was recently seen to destroy himselfc on receiving false intelligence of the return of the late epidemic thus betraying conduct even more dastardly than those cowardly soldiers who when the cannon begin to roar inflict on themselves slight wounds that they may avoid sharing the dangers of the battle To have a full notion how men's minds were previously prepared for this state we have but to think on the monstrous events which took place in Germany Twelve years earlier the gigantic work of the reformation had been begun by the greatest German of that age and with the Divine power of the gospel triumphantly carried through up to that period The excitement was beyond all bounds The new doctrine took root in towns and villages but nevertheless the most mortal party hatred raged on all sides and as usually happens in times of such empassioned commotion selfishness was the animating spirit which ruled on both sides and seized the torch of faith in order for her unholy purposes to envelop the world in fire and flames So early as the year 1521 during Luther's concealment Many an one sweats for fear and thinks he has the English sweat and when he afterwards hath slept it off acknowledges that it was all nonsense Bayer v Elbogen cap 8 b The author could adduce some extraordinary instances of this kind which have occurred in his own practice c It was a greengrocer in Paris Berliner Vossische Zeitung Sept 2 1 833 s 2 TERROR 259

within the walls of Wartburg false prophets 1 arose and desired without the aid of their great Master who was the soul of that age to complete a work with the spirit of which they were not imbued They brought the wildest passions into action but destitute of innate firmness and incapable of curbing themselves they became incendiaries and iconoclasts Immediately upon this the unhappy peasant war broke out a consequence of the arbitrary conduct and oppression practised from times of old for which the abettors of Dr Eck's sentiments would charge Luther himself as answerable not perceiving that it was the excitement of the times and of the false prophets which had given occasion to the rebellion Events occurred from the recollection of which human feeling still recoils Never was the fair soil of Germany the scene of more atrocious cruelties and after vengeance had played her insane part without opposition the melancholy result was that hundreds of thousands of once peaceful and for the most part misled peasants fell by the sword of the Lansquenets and of the executioner while their numerous survivors became a prey to the dearth which visited the country in the following years The battle of Frankenhausen on the 15th of May 1525 and Miin zer's subsequent execution closed this bloody scene The consequences of such intestine commotions continued however to be felt long after and considered apart from their highly prejudicial influence on the prosperity of the people conduced not a little to break the spirit of mankind signs of which the wise men of those times have plainly pointed outb Carlstadt Nic Storch Marcus Thomd Marus Stubner Martin Cellarius and Thomas Miinzer For all love hath grown cold in all nations the axe lieth at the root of the tree the rope is already applied no one observeth it For the world is stricken with thick blindness faith is extinguished All singleness and Godly fear hath withdrawn from the land for ever and nothing but false hypocritical make believe work is to be found among the Baptists and at most a false fictitious fruitless dead tottering faith in the other sects and yet the world thinks notwithstanding that she sees and sits in light In short for the one devil of the Baptists whom she has driven out she is beset with seven more subtle and wickeder spirits though she think that she be freed and that they all be gone forth Franck fol 248 a This same Chronicle contains a very lively description of the Peasant war 260

Sect 9 Moral Consequences The dejection was increased by the universally active spirit of persecution with which it was still hoped to eradicate the new doctrine Even whilst the English pestilence was raging two Protestants were burnt at Cologne a In the same year faggots blazed at Mecklin Verden and Paris by the flames of which the ancient faith was to be protected against the pestilence of freedom of thought Sentences of death were also quite commonly pronounced against the Anabaptists in Protestant countries The University of Leipzig pronounced a condemnation of this sort in the year 1529 and in Freistadt eleven women were drowned after a nominal trial and sentence because they acknowledged that they were of this sect b Amidst these dissensions and when the empire was in this helpless condition came the fear of the barbarians of the south who had already conquered Hungary under their Sultan Soli man and whilst the English Sweat was raging in the countries of the Danube threatened to overwhelm Germany It was a time of distress and lamentations in which even the most undaunted could scarcely sustain their courage c but to the everlasting honour of the Germans it must be acknowledged that they withstood this purifying fire with unsullied honour and in a manner worthy of themselves For their noble spirits were aroused to unheard of exertions of energy and whilst the pusillanimous gave themselves up to despair they impressed on the gigantic work of their age the stamp of imperishable truth The siege of Vienna began on the 22d of September after the English pestilence had broken out in this capital of Austria yet nobody regarded this internal danger The repeated attempts made by the Turks to storm the town were repulsed with great courage and on the 15th of October Soliman raised the siege after the Sweating Sickness had raged with as much violence among his troops as among the besieged d There is a Ad Clarenbach and Peter Flistedt b Schmidt p 308 c Nusqua n pax nullum iter tutum est rerum charitate penuria fame pestilenli laboritur uUque sectis dissecta sunt omnia ad tantam malorum lernam accessit letali sudor multos intra horas octo tollens e medio etc Erasm Epist L XXVI ep 58 o 1477 b d Fuhrmann Part IT p 745 MORAL CONSEQUENCES 261

no accurate intelligence extant upon this subject because the pestilence was less regarded here than elsewhere in consequence of the great distress of the country from other causes yet the mortality in Austria under such unfavourable circumstances was doubtless more considerable than in the neighbouring states a In the north of Germany another struggle was to be decided The evangelical party wished to declare their faith before the empire and its ruler to reveal the object of their efforts and to defend the purity of their creed against danger and assault For this purpose they prepared themselves with wise discretion and in the measures taken by the reformers for the fortification of the great work not the slightest trace was to be observed of the anxiety which at that time agitated the people In the midst of a country whose inhabitants trembled at the new disease and were perhaps already severely afflicted with it did Luther whilst at Marburg b sketch the first outlines of a profession of faith which as filled up by Melancthon has become the foundation stone of the evangelical church and in the following spring during his stay at Cobourg he composed his sublime hymn Eine feste burg ist unser Gott a strong fortress is our God It could not but happen that in the religious struggles which took place in these years especial importance would be attributed to the English pestilence Epidemics readily appear to man in the narrow circle of his view as scourges of God and indeed this representation of them has ever been the prevailing one in all religions For it is easier to estimate the ever existing sins of humanity than the grand commotions comprehending both mind and body of a terrestrial organism which can only be perceived by a superior insight into things and the mean selfishness of mankind and their delusions respecting their own qualities induce them to adopt the more easily the partial view that the Supreme Being allows pestilences to exist only to destroy their enemies of another faith On this account not only do most contemporary writers speak of the just wrath of God and of the chastisement thus prepared for the sins of the world but the papal party took every pos Chronicon Monasterii Mellicensis In Pez TI col 285 b The Assembly of the Reformers began there on the 2nd of October The pamphlet written by Magnus Hundt is ornamented with a wood cut where 262 burg the evangelical faith notwithstanding great obstacles spread every day more and more and the Catholic priests soon found themselves deserted Just as the Sweating Sickness broke out at Friedeberg in the Newmark a curate there delivered a sermon full of enthusiasm and passion and endeavoured to convince his apostate congregation that God had invented a new plague in order to chastise the new heresy A solemn procession according to ancient usage and orthodox prescription was to be held on the following day and thus the congregation was to be led back into the bosom of the only true church But behold in the course of the night the zealous curate died of some sudden disease and as mankind are ever ready to interpret even the thunders of the Eternal according to their own wishes and narrow notions the Protestants it seems did not fail in their turn to represent this event as a miracle a Sect 10 The Physicians Under these circumstances the faculty had a very difficult problem before them for the very imperfect solution of which they cannot justly be reproached A learned and active physician is certainly one of the noblest of the diversified forms of humanity for he unites in himself the power arising from an insight into the works of nature with the exercise of a pure philanthropy inseparable from his office Few men however of this ideal perfection lived in those times and their mitigating influence over the violence of the epidemic which was generally past before they could closely examine their new enemy and give any deliberate advice was doubtless but very inconsiderable By so much the more busy were the ignorant and covetous who from time immemorial the more numerous body in the profession have always injured it in its moral dignity They attacked the disease with bold assertions alarmed the people with inconsiderate representations lauded the infallibility of their remedies and were the promulgators of injurious prejudices In the Netherlands as we are assured by Tyen gius a physician whom we reckon among the learned and benevolent a vast number of patients died of the effects produced by the distribution of pernicious pamphlets with which the a Haftitz p 131 Angelus p 319 Cramer Book III p 76 and many others

Sweating Sickness was to be combated by those ignorant interlopers who many of them gave it out that they had been in England boasting to the inhabitants of their experience and skill and with their pills and their hellish electuaries flitting about from place to place a especially where rich merchants were to be found from whom should they be restored they obtained the promise of mines of gold b The like occurred in Germany where at the commencement the sound sense of the people was overcome by this officiousness and violent remedies were recommended as certain means of cure in a deluge of pamphlets some of which were written by persons not in the profession From this impure source was derived the prescription of the compulsory c perspiration for twenty four hours which in the districts of the Rhine was called the Netherlands regimend and it is unpardonable that the physicians either with blind pride disregarded or were totally unacquainted with the prior experience of the English which advocated discretion and the most appropriate line of treatment This neglect which was not compensated until thousands had already fallen may possibly have arisen from the blameable silence of the English physicians of whom as if England had not yet been enlightened by the dawn of science hot an individual had written on the Sweating Sickness or proposed a reasonable line of treatment since the year 1485 Between England and Germany there existed nevertheless a constant intercourse and it is incredible that that mode of procedure which did not originate from a formal medical school but from the sound sense of the people should not have become earlier known on this side of the North Sea 1 Verum quamplurimi tain nobiles quam populares viri ac mulieres hoc morbo misere suffocati sunt ob Ubellos erroneos ab indoctissimis hominibus in vulgus emissos qui in eiusmodi lue curanda peritiam et experientiam jactabant multosque in Anglia aliisque regionibus sese curasse dicebant cum omnia falsa essent Tales inquam minima pietate fulti erga segrotos Morum loculos tantum expilabant ac in sui commodum convertebant nullam de aliorum damnis nee morte ipsa curam gerentes sed quae sua sunt tantum curantes nulla arte instructi miseros acgros passim sua ignorantia truci dabant Forest L VI obs 8 p 158 a b Ditissimi negociatores lectis adfixi medicos ad se vocabant montes auri promit tentes si curarentur Ditmar p 473 c Nam occlusis rimis omnibus et excitato igne copioso opertisque stragulis quo magis tutiusque suderent aestu prcefocati sunt Forest loc cit p 157 b Wild in BaUinger p 278 THE PHYSICIANS 265

We must not here overlook the habits and domestic manners of the Germans for these favoured not a little the baneful prejudice with regard to heat for which we would not altogether make the physicians responsible Housewives even at that time set far too much store by high beds which annually received the feathers of the geese consumed at the table The comforts of a warm feather bed were highly appreciated and least of all were they disposed to deny them to the sick Thus all inflammatory disorders were stimulated to much greater malignity because such a bed either caused a dry heat even to the extent of burning fever or a useless debilitating perspiration To this effect the very extensive misuse of hot baths conduced and no less so the custom of clothing much too warmly Upon the whole the notion was prevalent as well with the people as with medical men that diseases were to be combated by warmth and sudorifics To new epidemics however the prevailing notions and customs are always applied for the great mass of mankind among whom may be included medical men are entirely ruled by them so that in this instance the Sweating Sickness fell upon a country in which its utmost malignity would be called forth Yet after the first few days in which many unfortunate cases occurred people became aware of the error they had committed An advocate of the twenty four hours sudation who though not a medical man had lauded this practice in a pamphlet on the subject a died in Zwickau on the 5th of September the victim of his own imprudence A few days after him died an apothecary likewise treated with the heated bed Upon this the physicians immediately abandoned the practice directed that their patients should be sweated only for five or six hours and in a more moderate degree and the estimable anonymous writer to whom we have already alluded thus seemed to meet with converts to his belief In Hamburgh also men became convinced of the pernicious effects of feather beds and gave the preference to coverings of blankets b for the English plan of treatment was presently known and intelligent philanthropists who saw its curative powers made it public c in all quarters through the medium of their correspondence In Liibeck there lived at the time of the Sweating The printer Frantz Schmidt p 307 b Stehner Part II p 219 This appears from the Wittenberg regimen 266

Fever a learned Protestant Englishman Dr Anthony Barns who with great kindness made known everywhere the English treatment of the disease He was however after the cessation of the pestilence banished the city because he had petitioned the bigoted Catholic senate to tolerate his Protestant brethren Many were saved by him for it was the practice in this city also to stew to death those affected with the disease In Stettin the English treatment was promulgated in good time and two travelling artisans who had come thither from Hamburgh were of the greatest assistance to the inhabitants of this city by advising them to take the feathers out of their upper beds they made known likewise how the sickness had been treated with success They had seen cases themselves and could therefore distinguish by their odour those who were suffering from the true sweating epidemic from those who were seized with fever arising from panic They were constantly besieged by persons asking questions and seeking assistance and when the disease was at its greatest height the streets were quite illuminated at night by the lights of the relatives of the patients who were running in all directions in a state of distraction The abhorrence of feather beds and the hot plan now followed so quickly the blind recommendation of the twenty four hours sweat that by the middle of September and in many places still earlier more correct views were generally adopted and some intelligent men after the sad experience which had been gained seized the opportunity of doing more good to the public than their noisy predecessors who had by this time so abundantly supplied the churchyards with bodies Among these literally and truly beneficent physicians may be reckoned Peter Wild at Worms who warned his countrymen against the Netherlands practice d as also an anonymous person the names of the best often remain unknown in times of confusion who in popular language strenuously dissuaded the people against the use of feather beds e It also a Reimar Kock's Chronicle of Liibeck b Klemzen p 235 In Gratoroli Petrus proto medicus fol 90 d See his pamphlet c I here give the whole pamphlet which only occupies five pages It is entitled The Remedy Advice Succour and Consolation against the dreadful and as yet by us Germans unheard of speedy and mortal Disease called the English Sweating Sickness from which may Almighty God mercifully protect us When the disease and sweating sets in ask what o clock it is and note it

THE PHYSICIANS 267

soon became a common saying the Sweating Sickness will bear no medicine If any one be afflicted with this pestilence may God protect us from it. It attacks him either with heat or with cold and he will sweat violently and this will take place all over his body Some take the disease with sudden eructations and do not sweat and to those who do not sweat a flower of mace with warm beer is given and then they sweat But if the pestilence and disease from which may God preserve us attack any one after he has lain down in bed he must be left there but if he has a feather bed though a thin one over him cut it open and take the feathers out that it may consist only of the ticking or covering If it be too thin add a cool coverlet and let the patient lie under that covered up to the neck and take care that the air do not touch or strike upon his breast or under his arms and the soles of his feet and let him not toss about Item Two men should attend the patient to prevent him from uncovering himself and from going to sleep Item The same two men must watch the patient and guard him against sleeping if they neglect this and do not so prevent him and the patient sleep he will lose his senses and go raving mad In order however that he may be prevented from sleeping take a little rose water and by means of a sponge or clean napkin bathe his temples with it between the eyes and the ears and by means of a sponge or napkin apply pungent wine or beer vinegar to his nose and talk constantly to him so that he fall not asleep If he would drink give him a thin beverage which should be a little warm and he ought not to be given more than two spoonfuls at a time Item On the patient's head should be placed a linen night cap and a woollen one over it Item A warm towel should be taken and with it the sweat wiped from the face Item Whoever is attacked in the day time must be put to bed if it be a man in his stockings and breeches if a woman in her clothes and let them be covered over with not more than two thin coverings and above all things no feather bed and then treat them as above written Item The disease attacks most people from great dread and from irregular living from which a man should guard himself with great pains Once for all the patient must not have his own way what he would have you do for him that must not be done Item With respect to those whom it attacks in the night and who lie naked if they will not lie still let them be sewn up in the sheets and let the sheets be sewn to the bed so that no air can come from beneath and then cover them as before Summa Whoever can thus endure for twenty four hours l y the blessing of God will be cured of the sickness and get well If a man has held out for twenty four hours let him be taken up and wrapped in a warm sheet lest he become cold and throw something over his feet and bring him to the fire and above all things let him not go into the air for four days and let him avoid much and cold drink If he would sleep provided twenty four hours have been passed let him sleep freely and may God preserve him The Lord is Almighty over us Amen The place of publication is wanting It was probably either Leipzig or Wittenberg Magnus Hundt fol 27 a Nullis vero aliis medicamentis utuntur adversus ipsam quam expectatione sudoris nam quibus advenit omnes fere evadunt quibus autcm re tinetur maxima pars perit Forest loc cit p 159 a Schol 268

There is no ground for supposing that the influence of the faculty was much greater in the country where the Sweating Sickness originated than it was in Germany for the number of learned physicians there was still fewer and the knowledge of medicine not nearly so extended as it was in Italy Germany and France The learned Linacre had already died in the year 1524 John Chambre a Edward Wottonb and George Owen were the King's body physicians about the time of the fourth epidemic visitation of the Sweating Sickness William Buttsd of whom Shakespeare e has made honourable mention in all probability likewise held a similar office These were certainly distinguished and worthy men f but posterity has gained nothing from them on the subject of the English Sweating Sickness All these physicians were well informed zealous and doubtless also cautious followers of the ancient Greek school of medicine but their merits were of no advantage to the people who when they departed from the dictates of their own understanding and did not content themselves with domestic remedies to which they had been accustomed fell into the hands of a set of surgeons so rude and ignorant that they could only exist in the state of society which then prevailed & Born about 1483 died 1549 b Bora 1492 died 1555 c Died 1558 1 Died 1545 Vir gravis eximia litterarum cognitione singulari judicio gumma experientia et prudenti consilio Doctor Aikin p 47 In Henry VIII f See their biography in Aikin 8 Thomas Gale's description of this class of medical practitioners gives the best notion of their abilities I remember says he when I was in the wars at Montreuil 1544 in the time of that most famous Prince Henry VIII there was agreat rabble ment there that took upon them to be surgeons Some were sow gelders and some horse gelders with tinkers and cobblers This noble sect did such great cures that they got themselves a perpetual name for like as Thessalus sect were called Thes salions so was this noble rabblement for their notorious cures called dog leaches for in two dressings they did commonly make their cures whole and sound for ever so that they neither felt heat nor cold nor no manner of pain after But when the Duke of Norfolk who was then general understood how the people did die and that of small wounds he sent for me and certain other surgeons commanding us to make search how these men came to their death whether it were by the grievousness of their wounds or by the lack of knowledge of the surgeons and we according to our commandment made search through all the camp and found many of the same good fellows which took upon them the names of surgeons not only the names but the wages also We asking of them whether they were surgeons or no they said they were we demanded with whom they were brought up and they with shameless faces would answer either with one cunning man or another which was dead Then we demanded of them what chirurgery stuff they had to cure men withal and they would show us a pot or a box which they had in a budget wherein was such trumpery as they did use to grease horses heels withal and laid upon scabbed horses backs with THE PHYSICIANS 269

Sect 11 Pamphlets Inexplicable as the silence of the learned physicians of England on the Sweating Sickness appears at first view for where is the use of learning if it fail to throw any light on the stormy phenomena of life we may yet find perhaps its cause in a perfectly simple external circumstance The reformation had not yet begun in England the Catholic Church still stood on its ancient foundations and an intellectual intercourse between the learned and the people was not by any means among the acknowledged desiderata The faculty would hence have been able to treat of the new disorder only in ponderous Latin works for they wrote unwillingly in their own language and the subject could not seem to them an appropriate one for this purpose because they found it unnoticed and uninvestigated by their highly revered masters the Greeks They were ignorant that a sweating fever had ever appeared among the ancients which otherwise might have incited them to make researches of their own on the subject for Aurelian who describes it to the life was either unknown to them or what at that time was a valid ground was despised by them on account of his bad unclassical language In Germany on the contrary the intellectual wants of the people and of the educated classes had already manifested themselves very differently Twelve years before the age of pamphlets had there commenced The thoughts of Luther and of his disciples as also of his opposers were winged by the rapid press and the people took an impassioned part in the endeavours of the learned to affect their conviction and by this verval and such like And others that were cobblers and tinkers they used shoemakers wax with the rust of old pans and made therewithal a noble salve as they did term it But in the end this worthy rabblement was committed to the Marshal sea and threatened by the Duke's Grace to be hanged for their worthy deeds except they would declare the truth what they were and of what occupations and in the end they did confess as I have declared to you before In another place Gale says I have myself in the time of King Henry VIII holpe to furnish out of London in one year which served by sea and land three score and twelve surgeons which were good workmen and well able to serve and all English men At this present day there are not thirty four of all the whole company of Englishmen and yet the most part of them be in noblemen's service so that if we should have need I do not know where to find twelve sufficient men What do I say sufficient men nay I would there were ten amongst all the company worthy to be called surgeons 270

altogether novel and authoritative mode of religious instruction became gradually educated and guided Hence it is not to be wondered at that people began to investigate in pamphlets other important subjects likewise and thus we see this weighty branch of intellectual commerce with all its advantages and defects also turned towards the discussion of popular diseases and for the first time unfolding its numerous leaves on the subject of the English epidemic In the maritime cities nothing of this kind happened because the eruption of the pestilence took them by surprise and as it was over again in the course of a few weeks it seemed no longer worth while to instruct the people respecting it This surprise was very plainly shewn in the answer of the doctors and licentiates who were assembled together at the bedside of the Duchess at Stettin the disease was new and unknown to them they were at a loss what to advise excepting strengthening medicines a In the central parts of Germany on the contrary where as early as the month of August the report of the new plague had excited the utmost alarm and where an eruption of the pestilence in Zwickau had caused a general flight publications on the Sweating Sickness were even within that month and still more numerously in September disseminated in all directions As scientific productions they are almost all of them worthless Many of them indeed did harm and but very few promulgated correct views Most of them are now lost as for example that which was published by the printer Frantz at Zwickau on the 3rd of September but in what vast numbers they were published appears from the circumstance that Dr Bayer at Leipzig who brought out his own on the 4th of September states that he has read many of them and expresses his indignation against these new unfounded little books by which the people were misled to their own soitow and suffering b This same Dr Bayer writes in the style of an intelligent practical physician inveighs boldly against the prejudices of mankind and the ignorance of medical journeymen and against their senseless bleedings whenever they see the barber's basin and his pole Some of his advice too is not bad especially where he is speaking of the Arabian use of harmless syrups He however religiously preserves all the rubbish of his age and has a great opinion of preventive Klemzen p 255 b Part I cap 8 PAMPHLETS 271

bleedings purgatives and powerful medicines of which he prescribes so many that his reader is necessarily confused by their multiplicity His precepts respecting the sweat are very appropriate for he gives a caution against forcing perspiration prescribes according to the circumstances and even commences the treatment with an emetic if the state of the stomach seems to indicate its employment In order to guard against contagion he recommends at the approaching autumnal fair that foreigners from dying lands should be accommodated in distinct inns that fumigation should be carefully employed and that before each booth at the fair a fire should be kept up Another pamphlet by Caspar Kegeler of Leipzig is a melancholy monument of the credulity which from Herophilus to the present day has pervaded the whole medical art It is a regular pharmacopoeia for the Sweating Sickness thrown together at a venture without any insight into the nature of the disease A mine of wonderful pills and electuaries composed of numberless ingredients wherewith this mysterious worthy undertakes to raise a commotion in the bodies of his patients If he had but seen even a single case of the disease he would at least have known how impossible it would be to administer within the space of four and twenty hours the hundredth part of his pills and draughts With what approbation this little pharmacopoeia was received by physicians of equal penetration and understanding as himself is shewn by the eight editions which it passed through and the melancholy reflection is therefore forced upon us that possibly thousands of sick persons were maltreated and sacrificed from the employment of Kegeler's medicines A third physician at Leipzig Dr John Hellwetter states in his pamphlet that he has become acquainted with the Sweating Fever in foreign countries and on the subject of perspiration gives some very good advice evidently the result of his own experience which reminds us of the original English mode of treatment His notion that fish is injurious seems to have originated in the fact that the continued employment of fish as an article of diet gives rise to offensive perspirations and his admonition to his medical brethren not to flee from the sick but to visit them sedulously and give them consolation furnishes ground for supposing that some of them had been pusillanimous Gruner Script p 11 272 TITK SWEATING SICKNESS

and dishonourable enough to withdraw themselves or to refuse their assistance to the poor Almost all the medical men of those times were in possession of arcana which they employed either in all or at least in most diseases in a very unprofessional manner and the efficacy of which the sweet delusions of self interest did not permit them to call in question The severe metallic remedies of the Spa gyric school which was then in its infancy were not yet introduced but there were not wanting strong heating medicines from the ancient stores of the empyrics which almost universally obtained the preference over the mild potions and syrups of the Arabians Hellwetter sold a powder of unknown composition and a number of distilled waters which Dr Magnus Hundt of Leipzig notices with much approbation The pamphlet of this physician is in every respect of the most ordinary kind it affords no proof that the author had any sound comprehension of the disease and belongs to that class of low medical compositions which in times of danger is so easily derided by the public and so much diminishes the estimation of the profession to the material injury of the general welfare It must not however be supposed that the people who in such times of commotion often confound together the good and the bad listened everywhere so readily to these pamphleteers The composition of one Dr Klump at Ueberlingen who on the breaking out of the disease attacked his patients with theriac and all kinds of heating plague powders excited great derisiona and it cannot be denied that the people had on their side at least occasionally the advantage of sound sense as opposed to the endless prescriptions of the physicians and it is gratifying to observe how this sound sense which doubtless was guided by respectable medical men operated in a great many towns to the advantage of those affected This is proved by a pamphlet written in popular language by a physician in Wittenberg b which contains such correct medical views that our highest approbation is even now justly due to its unknown author as shewing throughout great judgment and a very competent knowledge of the Sweating Fever His Vix malevolorum cachinnos morsusque prffiteriit Schiller Epist nuncupator the title which Gruner Script p 12 gives to the original work still existing in the library at Strasburg and a Latin extract from it Gratoroli fbl 89 6 See the Catalogue in the Appendix Ein Regiment &c PAMPHLETS 273

whole treatment is mild and cautious he forbids the use of feather beds but strongly inculcates the necessity of avoiding every kind of chill and therefore recommends a practice in use at that time called the sewing of the sick that is to say fastening the edge of the bed clothes to the bed with a needle and thread He orders his patients a moderate quantity of warm but not heating beverage a refreshes them with syrup of roses and impresses upon his readers that the majority of those affected will recover without medicine In order to guard against the stupor which was so exceedingly fatal in addition to continual conversation refreshing odours of rose water and aromatic vinegar were held before the patient's nose in a moderately damp cloth or their temples were cautiously bathed with them Convalescents were watched with great care and it is not the least excellence of this very sterling pamphlet that it likewise combated the timidity of the sick with the inculcation of mild but manly religious principles such as corresponded with the spirit of that age The rules here laid down are in essentials the original English precepts which had already broken the force of the epidemic Sweating Sickness in the year 1485 and the author does not conceal his having in this matter received information from Hamburgh so far back as the 7th of August That by this mode of treatment not only individual patients b were saved but also that whole cities were protected against any very great mortality we are willing with the author to believe and on this account we cannot but lament the more that the medical science of the rigid schools of those days so completely mistook its office as the guardian of life and that it caused greater sacrifices by its hazardous remedies than the pestilence would otherwise have occasioned How soon the English treatment met with the recognition which it deserved may be gathered from a Latin composition nearly of the same tenour as the above and which appears to be an extract from some German pamphletse Besides aromatic odoriferous waters the very harmless and only remedies Any kind of weak beer with the chill off Warm beer was a beverage in general use in the north of Germany The beer of Eimbeck and Bernau was stronger and was recommended by medical men during the convalescence I had in my house seven lying ill with the same disease of which thank God none died From the letter of an inhabitant of Hamburgh given in the same pamphlet Ein Regiment &c c Gratorol fol 87 b 274

therein recommended are pearls and corals given internally by tablespoonfuls in warm rose water As a prophylactic treacle which was in very common use was recommended to be taken in the juice of roasted onions but only in very small doses Similar just views with respect to the excitement of perspiration were also subscribed to by other physicians a and finally the great council at Berne on the 18th of December published an exhortation to patience and unshaken courage in which the use of feather beds and of all medicines except cinnamon water was earnestly deprecated b during the disease The court of Holland also recommended a method of curec apparently English these two documents being the only traces on the part of any governments of a paternal solicitude for their subjects The learned and accomplished Euricius Cordusi of Marburg had when he wrote no information respecting the successful English mode of treatment and with all his celebrity only followed in the ranks of ordinary advisers He could not free himself from the medical precepts which he brought from Italy and gave to the only patient at Marburg who was the subject of the Sweating Sickness the very disagreeable though much employed potion of Benedetto His prophylactic ordinances were very burthensome though with respect to the frequent employment of purgatives which at that time almost all physicians recommended it must be taken into account that the intemperance so prevalent in those days rendered them in general more necessary perhaps than they are at the present time Bishop Ditmar of Merseburg has betrayed to posterity that this celebrated man had a great dread of the new disorder and did not conceal his anxiety There is still extant a very complicated prescription of Achilles Gasserh the learned physieian of Augsburg which he employed with childish confidence during the prevalence of GratoroL foL 90 b Stettler Part II p 33 c Wagenaar op cit p 509 d His proper name was Henry Spaten German Spilt in English late whereof Cordus the last born or late born seems to have been a translation The second of September f R Pulveris cardiaci very complex containing precious stones and many other ingredients 3ij Pulveris cornu cervi 3j Seminis Santonici Myrrhse aa 3ft V ft Pulv Sum 3j in warm wine vinegar Chronicle p 473 h Born 1505 died 1577 1 It is the Electuarium liberans Gasseri R Spec liberant Galen Spec de gemm aa 3j Pulveris Dictamn Tormentill Serpentinse aS 3iv Pimpinell PAMPHLETS 275

the sweating pestilence We might class this with a thousand others of a similar character were it not evident how little medical art at that time in its ancient Greek garb was suited to the exigency of the age being dull inefficient and long since robbed of its original spirit for thus alone was it taught in the universities In the copious epistle of Simon Riquinus to the Count of Newenar at Cologne traces of better principles are indeed observable which were soon disseminated from Hamburgh all over Germany yet the prophylactic measures recommended are not much better than those in use in the time of the Emperor Antoninus when the Theriaca of Andromachus was among the necessaries at the Roman court Riquinus incidentally tells a story of a peasant in the neighbourhood of Cleve who having become affected by the English Sweating Sickness crept as quickly as he could into a baker's oven that was still hot and after some time again made his appearance in an exhausted stateb This very circumstance proves that the man laboured under only an imaginary and not a real sweating fever but the belief that the bread which was afterwards baked in this oven was infected with the poison can only be attributed to the credulity of the learned physician The Count of Newenarc expresses himself on the subject of the sweating fever like a person well informed and not unacquainted with medical subjects and endeavours to prove the critical nature of the sweat by the frequent practice of the empyrics to throw persons afflicted with the plague at the very beginning of the attack into a profuse perspiration d He takes the opportunity to relate of an unprincipled physician that he freed himself in this manner from the plague in a public bath while those who came after him became every one of them affected with the disease and died According to his account Zedoariae a5 3Cs Bol Armen lot Terr sigillat aa 9ij Rasur Cornu cervin 9j Zingiber 3ft Conserv Rosar rec Jft Theriac veteris 5j Syrup acetositatis citri q a utft electuar spiss Velseh p 19 Gasser states in his Augsburg Chronicle that there were more than 3000 cases of the disease there but that not more than 600 died See Mencken Scriptores rerum Germanicarum m Gratorol fol 74 b b Gratorol fol 85 Probably this epistle does not differ essentially from the Latin work of this author on the sweating fever which appeared separately De i Sjjti jitoJ seu sudatories febris curatione Liber Colonise 1529 4 c Gratorol fol 64 Gratorol fol 69 b 276

the English Sweating Sickness was by no means fatal in and about Cologne yet we find it with all its original malignity on the banks of the Scheldt and in the maritime towns of the Netherlands This plainly appears from the pamphlet of a physician in great practice at Ghent Tertius Damianus from Vissenaecken near Tirlemontb whose own wife fell sick of the sweating fever and fortunately was again restorede The cases whereof Damianus gives an account are among the most marked of which any mention is made and it also seems that the disease contrary to the opinion of many arose from fear alone and manifested in the Netherlands a much greater power of contagion than in Germany to which the hot treatment may have contributed d The manner in which Damianus restrained his patients from indulging in their propensity to sleep is worthy of notice When the usual means failed he directed that their hair should be torn out that their limbs should be tied together in painful positions and that vinegar should be dropped into their eyesc the danger justified these means but violence does not easily attain its end For the rest the views of this physician do not differ from those commonly entertained and if he complains f of the great extortions of the apothecaries this was a natural effect of the customary prescriptions whereof he himself recommends many that are very objectionable Whatever the science of medicine of the sixteenth century could oppose to so fearful an enemy is set forth in the very excellent treatise of Joachim Schiller of Freiburg which however did not appear until two years later and unfortunately does not give the wished for information on the development of the pestilence in the Briesgau Schiller is moderate in his views and shews throughout that he is a very well informed physician and well versed in Greek literature and although he cannot steer clear of the rubbish of clumsy remedies yet the Videmus quam multi de sudore convalescant fol 66 a k This town is called in Flemish Tienen Thense in Montibus translated by Damianus Decicopolis Fol 117 a Fol 109 a e Fol 116 b Fol 118 a Damianus wrote his by no means unimportant treatise during the prevalence of the epidemic sweating fever in Ghent He styles himself Schiller von Herderen from an estate in the village of that name close to Freiburg PAMPHLETS 277

fault should not be charged on him but on the age in which he lived This like every other had its evils and enveloped in clouds and darkness the genius of medicine which free great and elevated above human short sightedness is respected only by the intellectual servants of nature Sect 12 Form of the Disease The notions of contemporary writers respecting the phenomena and the course of the sweating epidemic are it is true individually unsatisfactory and defective 1 yet collectively we may gather from them a lively and complete picture of its effect on the human frame especially from the German observers who reported truly and honestly their own as well as the general experience of their age for the English had up to that period described little more than the external appearances of this epidemic which had already attacked them for the fourth time It is ascertained that the Sweating Fever was in general very inflammatory and leaving out of the account its sequel came to a crisis at most in four and twenty hours yet within this narrow limit as to time very various symptoms occurred b so that by a more exact observation than could be expected from the physicians of those days several gradations of its development and violence might have been distinguished from each other Thus one form of this disease appeared that was wanting in precisely that symptom which was the most essential namely the colliquative sweating as in the most dangerous form of cholera neither vomiting nor purging takes place and which by its overpowering attack either destroyed life within a few hours or perhaps took some other turn of a nature unknown to us Premonitory symptoms were wanting altogether unless we may reckon as such first an anguish combined with palpitation of the heart which may not have been of corporeal origin but may Schiller says with great naivete that the symptoms of the disease are evident and that those which he has not indicated must be imagined Sect II c 1 fol 206 b Habet inconstantes notas morbus Schiller Diversos diversimode adoritur Damian fol 115 b c See above the remedium p 267 note e Sudoris absentia plurimum nocebat Forest p 158 Schol 278

have proceeded from the general alarm or secondly an irresistible sinking of the powers resembling a swoon which perhaps preceded the disorder in the same manner as it had preceded the general eruption of the plague in northern Germany or thirdly rheumatic pains of various kinds which were frequently felt in the summer of 1529b or finally a disagreeable taste in the mouth and foul breath which were very commonly the subject of complaint at that timee In most instances the disease set in like the generality of fevers with a short shivering ifiti and trembling which in very malignant cases even passed into convulsions of the extremities in many it began with a moderate and constantly increasing heatf either without any evident occasion even in the midst of sleep so that the patients on waking lay in a state of perspiration or from a state of intoxication and during hard work especially in the morning at sunrise h Many patients experienced at the commencement a disagreeable creeping sensation or formication on their hands and feet which passed into pricking pains and an exceedingly painful sensation under the nails At times likewise it was combined with rheumatic cramps and with such a weariness in the upper part of the body that the sufferers were totally incapable of raising their armsk Some were seen during these attacks especially women and those who were weak with their hands and feet swolleni Serious affections of the brain quickly followed many fell into a state of violent feverish delirium m and these generally diedTM All complained of obscure pain in the head and it was not See above p 245 Klemzen p 254 b Bayer cap 6 M Hundt fol 5 a c Bayer loc cit Angelus p 819 Schiller Stettler locis cit and many others Damian fol 1 15 b Schiller y loc cit 8 The Regimen of Wittenberg h Damian fol 1 15 b i Klemzen p 255 k Ungues potissimum excruciat alas ita comprimit ut etiam si velis non posses at tollere Forest p 157 Schol In extremitatibus puncturis retorquentur doloro sis extremitates obstupefiunt dolet orificium ventrieuli nervorum contractiones nas cuntur plantarum pedumque dolores Damian fol 116 a 1 Damian loc cit Klemzen loc cit Nec quenquam vidimus ita deliranteni restitutum incolumitati Damian fol 116 a 0 Schiller Stealer FOEM OF THE DISEASE 279

long before an alarming lethargy supervened which if it was not firmly resisted led to inevitable death by apoplexy Thus the unconscious sufferers were at least relieved from the pain of separation from their friends which would have been much more distressing to them in this than in any other complaint since they lay as it were in a stinking swamp tortured with suffering This mortal anguish accompanied them so long as they were in possession of their senses throughout the whole disease b In many the countenance was bloated and livid or at least the lips and cavities of the eyes were of a leaden tint whence it evidently appears that the passage of the blood through the lungs was obstructed in the same way as in violent asthmac hence they breathed with great difficulty as if their lungs were seized with a violent spasm or incipient paralysis at the same time the heart trembled and palpitated constantly under the oppressive feeling of inward burning which in the most malignant cases flew to the head and excited fatal delirium d In the course of a short time and in many cases at the very commencement the stinking sweat broke out in streams over the whole body either proving salutary when life was able to obtain the mastery over the disease or prejudicial when it was subdued by it as is the case in every ineffectual effort of nature to produce a cure And in this respect as in diseases of less importance great differences appeared according to the constitution of the patient for some perspired very easily others on the contrary with great difficulty especially the phlegmatic who in consequence were threatened with the greatest danger e In this severe struggle the spinal marrow was sometimes at a later stage so much affected that even convulsions came on and it happened not unfrequently that in consequence of the a Somnolentia et inevitabUis sopor Schiller a deep sleep in almost all the chroniclers b Schiller c Aliis mox tument manus et pedes aliis facies qua et in pluribus livet nonnul lis sola labia et superciliorum loca mulieribus etiam inguina inflantur Damian fol 116 a d Maximus denique calor haud procul a corde sentitur qui ad cerebrum devolans delirium adducit internecionis nuncium Damian loc cit Damian loc cit 280

constriction of the chest the stomach indicated its excited condition by nausea and vomiting These symptoms however manifested themselves principally in those who were attacked with the disease upon a full stomach Such is the testimony of the contemporary writers of 1529 to whose accounts but little is added by Kaye an English eyewitness of the epidemic Sweating Sickness of 1551 The observations of this perfectly trustworthy physician so far as they relate to the form of the disorder may be here annexed since no essential differences between the diseases on these two occasions can be discovered At the first onset the disease in some attacked the neck or shoulders and in others one leg or one arm with dragging pains b others felt at the same time a warm glow that spread itself over the limbs immediately after which without any visible cause the perspiration broke out accompanied by constant and increasing heat of the inward parts gradually extending towards the surface The patients suffered from a very quick and irritable pulse and great thirst and threw themselves about in the utmost restlessness Under the violent headache which they suffered they frequently fell into a talkative state of wandering yet this did not generally happen before the ninth hour and in very various gradations of mental aberration d after which the drowsiness commenced In others the sweating was longer delayed while in the mean time a slight rigor of the limbs existed it then broke out profusely but did not always trickle down the skin in equal abundance but alternately sometimes more sometimes less It was thick and of various colours but in all cases of a very disagreeable odour which when it broke out again after any interruption to its flow was still more penetrating f Schiller loc cit b Primo insultu aliis cervices aut scapulas aliis cms aut brachium occupavit p 15 Kaye does not state what he precisely means by this occupare From an analogous more modern observation it appears however that by it are meant tearing rheumatic pains Add to this that the patients complained one and all some more some less of a tearing pain in the neck Sinner p 10 c Pulsus concitatior frequentior The only remark upon the pulse which is to be found in all the writers Cuius p 16 Probably most of the physicians were afraid of contagion and on this account omitted to examine the pulse d Page 252 c Odoris teterrimi Tyengius in Forest p 158 Newenar fol 72 b FORM OF THE DISEASE 281

Kaye adds to what we already know of the oppression of the chest the very important statement that those affected were observed to have a whining sighing voice whence we have every reason to conclude that there was a serious affection of the eighth pair of nerves He moreover describes a very mild form of the disease such as was prevalent in the south of Germany in 1529 It passed off under proper care without any danger in the very short period of fifteen hours and was brought to a termination by moderate heat through the medium of a very gentle perspiration It is remarkable that during this violent disorder neither the activity of the kidneys nor the evacuation by stool was entirely interrupted for there passed continually turbid and dark urine although as may be conceived in small quantity and with great uncertainty as to the prognosis whereupon those physicians who judged by the urine were not a little perplexedb It was observed too sometimes in the more easily curable cases that patients at the moment when the perspiration broke out upon them passed urine in great quantity c on which account a French physician proposed to draw off the water in those who suffered from this disease d yet this practice has no higher therapeutical worth than the excitement of perspiration in diabetes or in cholera and is moreover much less practicable That occasionally diarrhoea supervened and even to a degree which was not to be restrained may be gathered from the frequent medical directions as to how it ought to be arrested which Kaye also repeats e In some patients likewise nature appears to have effected a simultaneous crisis by the skin the kidneys and the bowels Much more important however is the observation of a respectable Dutch physician that after the perspiration was over there appeared on the limbs small vesicles f which were not con a Page 190 b Schiller Kaye loc cit c cum alvi solutione ac lotii haud modica eiectione in ea morbi specie quse curatum itura est Damian fol 116 a Rondelet de dignosc morbis loc cit To avoid exposure to cold they preferred allowing the patient to pass his evacuations in bed Bed pans were unknown Kaye p 110 and most of the other writers f Tyengius in Forest p 158 b Febrem sudor finiebat post se telinquens in extremitatibus corporis pustulas parvus admodum exasperantes divevsas et malignas secundum humorum malignitatem 282

fluent but rendered the skin uneven and these were not noticed by any other medical observer but are spoken of by the author of an old Hamburgh chronicle and with this addition that they had been seen on the dead a By these it is very likely that a miliary eruption and perhaps spots also are to be understood yet every thing militates against the supposition that this phenomenon was constant or that the Sweating Fever was an eruptive disorder b For in that case some mention would have been made of it in the numerous accounts of historians many of whom doubtless had themselves seen the disease and the eruptions would have been more evidently and decidedly formed in the numerous relapses of those who recovered They certainly indicate a relationship with the miliary fever but only in so far as that both diseases are of rheumatic origin and this slight participation in the nature of an eruptive disease would seem to have been observed in the English Sweating Sickness only in perfectly isolated cases What would have taken place under such an indication had the Sweating Sickness run a longer course whether in fact it might not possibly have passed into a regular miliary fever is a question unsolved by the past since even later transitions of this kind have never been observed The two diseases are both in their course and their nature perfectly distinct from each other and the miliary fever was not developed as an independent epidemic until the following cen tury under circumstances altogether different and its more decided precursors are not to be discovered until a period posterior to the five eruptions of the Sweating Sickness The powers of the constitution were much shaken by the Sweating Sickness so that a rapid recovery was observed to take place only in the mildest form of this disease Those however whom it attacked more severely remained very feeble and powerless for at least a week and their restoration was but gra When care was not taken that the hands and feet were kept under the clothes they died and their bodies became as black as a coal all over and were covered with vesicles and stunk so that it was necessary to bury them deep in the earth by reason of the stench Staphorst Part II Vol I p 83 b Spots maculse quas ronchas vocant which were on other occasions considered as signs of approaching death or which did not come out until death had occurred broke out after a return of sweating which had been repressed all over the body of the learned Margaretha Roper the eldest daughter of Thomas More who was the subject of sweating fever in 1517 or 1528 and recovered Th Stapleton Vita et obitus Thomse Mori c 6 p 26 See Mori Opera FORM OF THE DISEASE 283

dual and effected only by great care and strengthening diet After the perspiration had passed off the patient was taken carefully from his bed cautiously dried in a warm chamber placed by the fireside and as a first restorative usually fed with egg soup yet the generality could not entirely get over the effects of the fever for a long time Those who had recovered could seldom go out so early as the second or third day a Those patients were placed in still greater danger in whom the perspiration was in any way suppressed most of them were consigned to inevitable death the popular voice ever since the year 1485 confirms this Over those however in whom the powers of life were roused to a renewed effort there broke out after a short period a new perspiration far more offensive than the first so that the body dripped as it were with a foul fluid and it seemed as if the inward parts wanted to disburthen themselves at once of their putridity by an immoderate effort b It is clear that this repetition of the attack must have been destructive to many who had it not been for an obstruction of the crisis would have been saved for nothing is more dangerous in inflammatory diseases than when those secretions are interrupted which Nature has ordained as the only means of relief Relapses were frequent because convalescents after the disease was subdued remained for a long time very excitable These were seen for the third and fourth time seized with the Sweating Sickness nay later writers notice a repetition of the disease even to the twelfth time d whereby at least the health was completely shattered for dropsy or some other destructive sequelae supervened until death put a period to incurable sufferings and it is important to observe that even the bowels participated in the great excitability of the system for too early an exposure to the air easily brought on diarrhoea e How great the decomposition of the organic matter was is convincingly proved from all the testimony hitherto adduced And certainly only after very appropriate and careful treatment See the Wittenberg Regimen Kaye loc cit Schmidt p 307 and Klemzer p 256 b Newenar fol 72 b e Erasm Epist L XXVI Ep 58 p 1477 b Et crebro quos reliquit brevi intervallo repetens nec id semel sed bis ter quater donee in hydropem aut aliud morbi genus versus tandem extinguat miseris excarnificatum modis d Kaye p 110 Idem p 113 284

but it might have been inferred from the very rapid putrefaction of the body which rendered it necessary everywhere to use the greatest despatch in the performance of burials a and fortunately did away with all fear of being buried alive Of post mortem examinations we have no information and even if they could have been instituted they would from the manner of conducting researches in those times scarcely have thrown any important light on the disease Hardly any physicians but those who had studied in Italy knew the inward structure of the body from their own observation superficial as it was the rest learned it only from Galenic manuals how could they with such slender knowledge have distinguished between healthy and diseased parts Moreover the Sweating Sickness could not in so short a period cause such a palpable and substantial destruction of the viscera as they would alone have sought for Details respecting the condition of the blood in the dead body which after such an enormous loss of watery fluid such severe oppression at the chest and so great an impediment to the function of respiration would in all probability be thickened and darkened in colour as well as respecting the condition of the lungs and of the heart it would be highly desirable to obtain but these likewise are wanting altogether and after the lapse of so long a period there only remains room for conjectures The observation was repeated in Germany which had been so frequently made since the year 1485 that the middle period of life was especially exposed to the Sweating Fever Children on the contrary remained almost entirely exempt from this disease and when the aged were affected by it it was as individual exceptions to a general rule h and this as it would appear only during the height of the epidemic as for example at Zwickau where a woman of 112 years of age was carried off by it c We have already in part discovered the cause of this perfectly constant phenomenon in the luxurious mode of living of robust young men and if we look back to the moral condition of the Germans in the 16th century we find among Staphorst Part II vol 1 p 83 Immunes erant pueri et senes ab hoc malo Ditmar p 473 Pueri infra decem annos rarissime hac febre corripiuntur Newenar fbl 72 a Senibus solis quandoque pepercit prseternavigavit etiam magna ex parte atrabilarios et emaciates corpora quoniam et horum corpora putris succi expertia erant Schiller fol 4 a Schmidt p 307 FORM OF THE DISEASE 285

them the same immoderate luxury as among the English the same drunkenness the same intemperance at their frequent banquets where the wine cups and beer jugs were emptied with but too eager draughts finally also the same relaxation of skin consequent upon the use of warm baths and warm clothing All contemporary writers mention these circumstances a and our bold forefathers with respect to these matters were not in the best repute with their southern neighbours But we have moreover to survey the disease in another point of view namely in relation to its peculiar character In the outset we designated the Sweating Sickness as a rheumatic fever and if we take the notion of a rheumatic affection as in propriety we ought in its widest acceptation weighty and convincing grounds have been adduced in the course of our whole inquiry in confirmation of this view When we observe that those very nations were visited by the Sweating Fever which are characterized by a fair skin blue eyes and light hair the marks of the German race it may with justice be assumed that even this peculiarity in the structure of the body rendered it susceptible of this extraordinary disease It is this which causes the proneness to fluxes of all kinds and which makes these diseases endemic in the north of Europe whilst the dark haired southern nations and the blacks in the tropical climates remain under similar circumstances h more free from them If it be remembered further how overcharged with water were the lower strata of the atmosphere in which the pestilent Sweating Fevers existed what thick and even offensive mists prepared the way for the disease and indicated its approach what rapid alternations of freezing cold and excessive heat took place in the summer of 1529 and moreover how frequent all kinds of fluxes were in this very year the complete form of the rheumatic constitution will be recognised in every individual feature Did we possess in the showy systems of modern times a ma turer knowledge of the electricity of living bodies much light would of necessity hence be thrown on the great object of our research We should not then be compelled to rest satisfied As for instance Schiller to name but one among thousands Juvit etiam aux itque malum frequens multaque crapula et in potationibus otiosa vita nostra fol 3 b b Let it be observed under similar circumstances It ought not to be affirmed that they are free from rheumatic diseases but only that they are less disposed to be affected by them 286

with the fact that a cloudy atmosphere abstracts electricity from the body robs the skin and lungs of their electrical atmosphere disturbs their mutual electrical relation with the external world and by this disturbance prepares the body for rheumatic indisposition with all that peculiar decomposition of the fluids irritable tension of the nerves fever and painful affection of particular parts with which it is accompanied If this disturbance be represented according to certain new and inviting hypotheses supported by some important facts a as being perhaps an accumulation of electricity in the interior of the body owing to a morbid isolating activity of the skin we may expect a more perfect knowledge of the nature of rheumatism through the medium of future diligent researches and until these be made some evident signs of connexion between rheumatic affections and the English Sweating Sickness will perhaps be sufficient to demonstrate the rheumatic nature of this latter disease In the first place the very great susceptibility of those affected with the Sweating Fever to every change of temperature the decidedly great danger of chill In no known disease does this irritability of the skin shew itself in so prominent a degree as in rheumatic fevers and in those non febrile fluxes in which there even exists a very evident sensitiveness to metallic action Secondly The tendency of the rheumatic diathesis to come to a crisis through the medium of a profuse sour and offensive perspiration without any assistance from artb The English Sweating Sickness manifests this commotion of the organism in the most exquisite form hitherto known for it admits of no kind of doubt that the sweat in this disease was of itself and in itself critical in the fullest acceptation of the term That a rheumatic state makes the body an isolator A von Humboldt discovered as early as 1793 and be found that the observation was confirmed by subsequent experiments I have observed in myself that when labouring under a severe attack of catarrhal fever I was unable by the most powerful metals to excite the galvanic flash before my eyes that I interrupted every connecting link between the muscular and nervous apparatus As the rheumatic malady lessens the irritability of organs so also it seems to diminish their conducting power How is this As yet nothing is known about it I have every now and then met with isolating persons who were in perfect health but can we not yet amidst such an ocean of uncertainty discover a condition by which we may determine every case Versuche in Vol I p 159 iya f believes that during the existence of rheumatic diseases the proper electricity of the body sinks down to nothing See his Essay on the peculiar Electricity of the Human Body in Meckel's Archiv Vol Ill No 2 p 161 b The author has at times made extraordinary experiments of this kind upon himself FORM OF THE DISEASE c287

Thirdly The peculiar alteration in the fundamental composition of organic matter in rheumatic diseases in consequence of which volatile acids of a strange odour are prevalent in the sweat and urine and animal excretions The English Sweating Sickness exhibits also this result of morbid activity in a greater and more striking manner than any other disease Nor can we regard the tendency to putridity which has been observed as any thing but an increased degree of this condition Fourthly The shooting pains in the limbs the most decided sign of rheumatism were not wanting in the English Sweating Sickness nay they became developed even to the extent of an incipient paralysis and even the convulsions of those affected with this disease may not unjustly be attributed to the same source Fifthly The tendency of rheumatism when it takes an unfavourable course to pass into regular dropsy which is a consequence of the peculiar decomposition manifested itself in the Sweating Fever in so marked a manner that the dropsy itself gradually destroyed the patient Should the sceptical still need another link in the comparison we may adduce the miliary fever a disease of decidedly rheumatic character We must not however take as our standard the degenerate forms of miliary fever existing in modem times but those grand and fully developed forms of the disease which occurred in the 17th and 18th centuries and in which we find a similar odour in the perspiration the same oppression and the same inexpressible anguish with palpitation and restlessness The arms became enfeebled as if seized with paralysis violent pains of the limbs set in and unpleasant pricking sensations in the fingers and toes resembling in all these particulars the Sweating Sickness only pursuing a more lengthened and irregular course and becoming developed altogether in a different manner According to this representation the English Sweating Sickness appears as a rheumatic fever in the most exquisite form that has ever yet been seen in the world violently affecting the vitality of the brain and spinal marrow with their nerves without however at all molesting the plexuses of the abdomen The immoderate excretion of watery fluid which in the mild cases alone took place through a spontaneous curative power while in the malignant forms it betokened paralysis of the vessels 288

sels and an actual colliquation directs our attention further to the consequent state of inanition which very probably passed into a stagnation of the circulation in the same manner as takes place after every other sudden loss of the fluids whether from sanguineous effusion or evacuations by vomit and stool Hence the uncommonly rapid course of the disease and partly too the fatal stupora hence likewise the very pardonable misconception with respect to the nature of the Sweating Fever existing even in more modern times The sequela was more important and more fatal than the original rheumatic affection itself which in its minor forms was mild and easily managed And thus is explained the wonderfully fortunate result of the old English treatment which prevented this sequela and avoided increasing the already too powerful efforts of nature to effect a cure We have therefore nothing further to add to this judicious and truly scientific practice but our unqualified approbation for it is the part of the physician in diseases which have a spontaneous power of curing themselves to leave this power free scope to act and merely by fostering care to remove all obstacles to its exercise Should it be the destiny of mankind to be again visited by the disease of the sixteenth century and it is by no means impossible that at some time or other similar events may recur we would recommend our posterity to bear in mind this eternal truth and to treasure up the golden words of the Wittenberg pamphlet namely to guard the healing art from strange and unnatural farragos for it is only when it is subordinate to nature that it bears the stamp of reason the mistress of all earthly things This phenomenon may justly be compared with the very similar but more enduring morbid sequela of cholera Paralysis and a repletion of the returning vessels must be regarded in the same light in both FORM OF THE DISEASE 289

CHAPTER V FIFTH VISITATION OF THE DISEASE 1561 Ubique lugubris eret lamentatio fletui mcerens acerbus luctus Kaye Sect 1 Eruption Full three and twenty years had now elapsed no trace of the Sweating Sickness had shewn itself anywhere in this long interval and England had by its rapid advancement assumed quite another aspect a when the old enemy of that people again and for the last time burst forth in Shrewsbury the capital of Shropshire b Here during the spring there arose impenetrable fogs from the banks of the Severn which from their unusually bad odour led to a fear of their injurious consequencesc It was not long before the Sweating Sickness suddenly broke out on the 15th of April To many it was entirely unknown or but obscurely recollected for amidst the commotions of Henry's reign the old malady had long since been forgotten The visitation was so very general in Shrewsbury and the places in its neighbourhood that every one must have believed that the atmosphere was poisoned for no caution availed no closing of the doors and windows every individual dwelling became an hospital and the aged and the young who could contribute nothing towards the care of their relatives alone remained unaffected by the pestilence d The disease came as unexpectedly and as completely without all warning as it had ever done on former occasions at table during sleep on journeys in the midst of amusement and at all times of the day and so little had it lost of its old malignity that in a few hours it After Henry VHIth's death in 1347 Edward VI who was only nine years old came to the throne He died in 1558 Caius p 2 c Ibid p 2& 4 Godwyn p 142 Stow p 1023 290

summoned some of its victims from the ranks of the living and even destroyed others in less than one Four and twenty hours neither more nor less were decisive as to the event the disease had thus undergone no change In proportion as the pestilence increased in its baneful violence the condition of the people became more and more miserable and forlorn the townspeople fled to the country the peasants to the towns some sought lonely places of refuge others shut themselves up in their houses Ireland and Scotland received crowds of the fugitives Others embarked for France or the Netherlands but security was nowhere to be found so that people at last resigned themselves to that fate which had so long and heavily oppressed the country Women ran about negligently clad as if they had lost their senses and filled the streets with lamentations and loud prayers all business was at a stand no one thought of his daily occupations and the funeral bells tolled day and night as if all the living ought to be reminded of their near and inevitable endb There died within a few days nine hundred and sixty of the inhabitants of Shrewsbury the greater part of them robust men and heads of families from which circumstance we may judge of the profound sorrow that was felt in this city Sect 2 Extension and Duration The epidemic spread itself rapidly over all England as far as the Scottish borders and on all sides to the sea coasts under more extraordinary and memorable phenomena than had been observed in almost any other epidemic In fact it seemed that the banks of the Severn were the focus of the malady and that from hence a true impestation of the atmosphere was diffused in every direction Whithersoever the winds wafted the stinking mist the inhabitants became infected with the Sweating Sickness and more or less the same scenes of horrpx and of affliction which had occurred in Shrewsbury were repeated These poisonous clouds of mist were observed moving from place to place with the disease in their trairt affecting one town after another and morning and evening Caius p a Ibid p 7 v 2 EXTENSION AND DURATION 291

spreading their nauseating insufferable stencha At greater distances these clouds being dispersed by the wind became gradually attenuated yet their dispersion set no bounds to the pestilence and it was as if they had imparted to the lower strata of the atmosphere a kind of ferment which went on engendering itself even without the presence of the thick misty vapour and being received into men's lungs produced the frightful disease every where b Noxious exhalations from dung pits stagnant waters swamps impure canals and the odour of foul rushes which were in general use in the dwellings in England together with all kinds of offensive rubbish seemed not a little to contribute to it and it was remarked universally that where ever such offensive odours prevailed the Sweating Sickness appeared more malignant c It is a known fact that in a certain state of the atmosphere which is perhaps principally dependent on electrical conditions and the degree of heat mephitic odours exhale more easily and powerfully To the quality of the air at that time prevalent in England this peculiarity may certainly be attributed although it must be confessed that upon this point there are no accurate data to be discovered The disease lasted upon the whole almost half a year namely from the 15th of April to the 30fh of September d it thus passed but gradually from place to place and we do not observe here that it spread with that rapidity which in the autumn of 1529 had excited such great wonder in Germany It is much to be regretted that contemporary writers either gave no intelligence respecting the irruption or course of the epidemic Sweating Sickness in individual towns or if they did so that this has not been made use of by subsequent writers Doubtless a very considerable diversity of circumstances would here present themselves and the very peculiar manner in which the corruption of the atmosphere spread on this occa Which miste in the countrie wher it began was sene flie from toune to toune with suche a stincke in morninges and evenings that men could scarcely abide it Kaye See Appendix also Lat edit pp 28 29 It is to be remarked here that in the year 1529 Damianus observed in Ghent that more people sickened in the morning at sun rise than at any other time p 115 b b Hosack admits in cases of this kind a fermentative or assimilating process in the atmosphere T L p 312 Laws of Contagion Lucretius had already expressed the same thought in poetry L VI v 1118 to 1123 e Caius p 29 Ibid pp 2 8 292

sion might perhaps have been estimated from certain facts and not from mere suppositions Thus the only fact that has been handed down is very remarkable namely that the Sweating Sickness required a whole quarter of a year to traverse the short distance from Shrewsbury to London for it did not break out there until the 9th of July and in a few days according to its former mode reached its height so that the rapid increase of deaths excited terror throughout the whole city1 Yet the mortality was considerably less than at Shrewsbury for there died in the whole of the first week only eight hundred inhabitants b and we may consider it decided although all the contemporaries are silent on this very essential question that the pestilence nowhere lasted longer than fifteen days and perhaps in most places as formerly only five or six The deaths throughout the kingdom were very numerous so that one historian actually calls it a depopulation c No rank of life remained exempt but the Sweating Sickness raged with equal violence in the foul huts of the poor and in the palaces of the nobility. The piety which in the general dejection was displayed by the whole nation giving birth to innumerable works of Christian benevolence and philanthropy whereby undoubtedly many tears were dried up many orphans and widows protected from distress and want is hence explained for this phenomenon highly delightful as it is in itself occurs only under great afflictions and a general fear of death as we are taught by the universal history of epidemics We are willing to believe to the honour of the English that the religious impulse which they derived from their ecclesiastical reformation may have had no small share in its production yet unfortunately such is the nature of human society that no sooner is the calamity over than virtue relaxes Scarcely were the funeral obsequies performed when every thing returned to the usual routine e in like manner the Byzantines once during a great earthquake were seized with a fear of God such as they had never before felt day and night they flocked to Holinshed p 1031 and others b Stow p 1023 Baker p 332 c Godwyn p 142 Among others the Duke of Suffolk and his brother Godwyn loc cit And the same being whote and terrible inforced the people greatly to call upon God and to do many deedes of charity but as the disease ceased so the devotion quickly decayed Grafton p 525 EXTENSION AND DURATION 293

the churches nothing was to be seen but Christian virtue self denial and works of benevolence but these only lasted until the earth again became firma The very remarkable observation was made in this year that the Sweating Sickness uniformly spared foreigners in England and on the other hand follotved the English into foreign countries so that those who were in the Netherlands and France and even in Spain were carried off in no inconsiderable numbers by their indigenous pestilence which was nowhere caught by the natives Not a single French inhabitant of the neighbouring town of Calais was affected and neither the Scotch inhabitants of the same island nor the Irish were visited by the Sweating Sickness so that we cannot get rid of the notion that there was some peculiarity in the whole constitution of the English which rendered them exclusively susceptible of this disease To make this out accurately would be so much the more difficult because in the original year of the Sweating Sickness foreigners were the very persons among whom the English disease broke out and again because English persons who had lived a year in France on their return home in the summer of 1551 became the subjects of Sweating Sicknesse Contemporaries indeed find a cause in the gluttony and rude mode of life of the English In short in all those remote causes with which we have already become acquainted and which doubtless also had their part in preparing the same scourge for the Germans and Flemings in 1529 Kaye the most efficient eye witness even brings in proof of this view that the temperate in England remained exempt from the Sweating Sickness and on the contrary that some Frenchmen at Calais who were too much devoted to English manners were seized with it d To this alone however this susceptibility cannot be attributed unless we would History of Medicine Vol II p 136 b Caius p 30 and at other places quoted And it so folowed the Englishmen that such marchants of England as were in Flaunders and Spaine and other countries beyond the sea were visited therewithall and none other nation infected therewith Grafton loc cit Compare Baker p 332 Holinshed p 1031 c Caius p 48 i See Appendix these thre eontiyes England the Netherlands and Germany whiche destroy more meates and drynckes without al order convenient time reason or necessitie then either Scotlande or all other countries under the sunne to the great annoyance of their owne bodies and wittes &c Compare p 46 of the Lat edit i 94

be content with the antiquated system of giving too much weight to remote causes opposed to which we are met by the striking fact that the Germans and Netherlanders who had scarcely much improved in their manners since 1529 were not again visited by their old enemy Sect 8 Causes Natural Phenomena It is easy to perceive or rather we have no alternative but to suppose an unknown something in the English atmosphere which imparted to the inhabitants the rheumatic diathesis or if we will so penetrated their bodies overcharged as they were with crude juicesa that their constitutions had the so called opportunity that is were changed in such a manner as to fit them for the reception of the Sweating Sickness Under such a condition the common and more peculiar causes of this disease were not absolutely necessary in order to induce its attack in a constitution thus long prepared for it but the general causes of disease were sufficient of themselves to give it its last stimulus although this should be in an entirely different climate as in the present instance was the case with the English who were living in Spain and with the Venetian ambassador Naugerio who in the year 1528 fell ill of the petechial fever when far from Italy and living in France b It has no doubt struck the reader that each of the five eruptions in England lasted much longer than the single one which occurred in Germany and the north of Europe This too might well depend upon peculiarities in the English soil But let us now endeavour to render manifest by means of phenomena actually observed that unknown something in the atmosphere of 1551 the dsiov of the great Hippocrates which announces its presence by the sickening of the people for beyond this it is not granted that human researches should penetrate The winter of 1550 51 was dry and warm in England the spring dry and cold the summer and autumn hot and moist c The weather of the whole year was uncommon in many particulars without however in Godwyn loc cit expressly assures us that gluttons who were taken with the disease when their stomachs were full fell victims to it j and Kaye states that besides aged persons and children the poor who from necessity lived frugally and endured hardships either remained free or bore the disease more easily p 51 k See above pp 231 232 c Caius See Appendix CAUSES NATURAL PHENOMENA 295

fluencing the lives of plants and animals so much or through so great a range as at the time of the fourth epidemic Sweating Sickness It was even in some places praised as fruitful On the 10th of January a violent tempest occurred which in Germany left no small traces h of its effects on houses and towers The same day brought considerable floods in the river district of the Lahn which must be noticed on account of the very unusual season of the yearc On the 13th of January again at an unusual season there followed a great storm with heavy rains d which spread over the north of Germany and on the 28th of January there occurred a considerable earthquake in Lisbon whereby about two hundred houses were overthrown and nearly a thousand people were destroyed whilst a fiery meteor appeared which according to the unsatisfactory descriptions of the time resembled most a northern light and therefore was in all probability of electrical origin e This was succeeded in Germany by a great frost in February On the 21st of March at seven o clock in the morning two mock suns with three rainbows were seen at Magdeburg and in its vicinity and in the evening two mock moons The same mock suns were also observed at Wittenberg but without the rainbows A similar phenomenon with two rainbows was again seen on the 27th of March h and mock suns had been observed at Antwerp as early as the 28th of February1 About the same time 21st of March the Oder overflowed its banks k and floods followed after continued rains during the month of May in Thuringia and Franconiai Great tempests were not wanting and after considerable heat there occurred on the 26th of June a thick summer fog in the districts of the Elbe which deprived the besiegers of Magdeburg of the sight of that city It may therefore be supposed that this phenomenon took place throughout a greater extent of country On the 22nd of September a meteor like a northern light was again seen and on the 29th Schwelin p 177 b Spangenberg fol 463 a c Chron Chron p 401 Ibid and Spangenberg loc cit e Chron Chron loc cit f Spangenberg fol 463 b Angelus p 344 Spangenberg fol 464 a Chron Chron p 401 h Spangenberg fol 464 a i Chron Chron p 402 Haftitz p 167 Angelus p 344 i Chron Chron p 403 Leuthinger p 248 m Angelus loc cit Spangenberg fol 465 a Magdeburg was besieged at this time for having refused to accept the Interim 296 THE 8WEATINO SICKNESS

of that month after some clear weather a heavy fall of snow was followed by continued cold a These facts are sufficient plainly to prove that the course of the year 1551 was unusual that the atmosphere was overcharged with water and that the electrical conditions of it were considerably disturbed nor must we omit to notice that for the first time since 1547 mould spots again appeared in Germany on clothes and red discolourations of water as likewise an exuberance of the lowest cryptogamic species of vegetation b Sect 4 Diseases During the years of scarcity from 1528 to 1534 it excited general surprise that malignant fevers more especially the plague petechial fever and encephalitis which in the individual accounts we can seldom sufficiently distinguish from each other were constantly recurring and creeping slowly as they did from place to place had no sooner finished their wandering visitations of whole districts of country than they again made their appearance where they had broken out in former years It was a century of putrid malignant affections in which typhous diseases were continually prevailing a century replete with grand phenomena affecting human life in general and continuing so long after the period to which our researches refer There existed also an epidemic flux which during a cold summer tl in 1538 spread over a great part of Europe and especially over France so that according to the assurance of an eminent physician there was scarcely any town exempt from it e Of this flux we have unfortunately but very defective reports Wurstisen p 624 Spangenberg fol 466 a b In the March of Brandenburg crosses as they were called were seen upon clothes in the year 1547 Leuthinger p 216 red water was seen at Ziirbig in the year 1549 Ibid p 231 and frequently likewise in the year 1551 Chron Chron p 402 Agricola seems to point to these connected phenomena in the passage already quoted see p 206 note e Pcstis insuper in certis sseviebat Germanise provinciis 1533 prsesertim Nnren bergse et Babenbergse et villis oppidisque per girum Et est stupenda res quod hsec plaga nunquam totaliter cessat sed omni anno regnat jam hie nunc alibi de loco in locum de provincia in provinciam migrando et si recedit aliquamdiu tamen post paucos annos et circuitum revertitur et juventutem interim natam in ipso flore pro parte majore amputat Jo Lange Chron Nuremburgens eccles in Mencken T II col 88 6 Spangenberg fol 369 b Fernel de abditis rerum causis L II p 107 DISEASES 297

among which we find a statement not without importance that there were no extraordinary forerunners such as are observed in phenomena of this kind to account for this epidemic a Two years earlier however 12th of July 1586 Erasmus died of the flux b This disease seldom occurs sporadically but usually as an epidemic and thus perhaps slighter visitations of this rheumatic malady may be assumed to have preceded that greater one which took place in 1588 A period remarkable for plague followed in the year 1540 and ended about 1543 The summer of the first named year is especially mentioned in the chronicles as having been hot and throughout the whole century it continued to be in great repute on account of the excellent wine it produced c A spontaneous conflagration of the woods was frequent and an earthquake was felt in Germany on the 14th of December d Thereupon in 1541 there followed in Constantinople a great plague e which in the year 1542 spread by means of a Turkish invasion into Hungary its superior importance being indicated by the presence of accompanying phenomena among which the swarms of locusts that appeared this year are especially worthy of note They came from the interior of Asia and travelled in dense masses over Europe passing northward over the Elbe f and southward as far as Spain Kaye saw a cloud of locusts of this description in Padua their passage lasted full two hours and they extended further than the eye could reach h The plague quickly spread in Hungary and caused a similar destruction to the imperial army which was fighting against the Turks under Joachim the Second Elector of Brandenburg as it had formerly caused the French before Naples Whether this pestilence may have been the original oriental glandular plague or whether we may assume that it had already degenerated into the Hungarian Petechial Fever such as likewise broke out in the year 1566 in the camp near Komorn during the campaign of 1 See Fernel Wurstisen p 618 however states that the preceding winter had been very warm Thus Aph 12 sect III would hold good b Wurstisen loc cit L annee des vins rostis of the French Stettler p 119 Spangenberg fol 439 a Chron Chron p 375 Kircher p 147 f Spangenberg fol 439 b Villalba TI p 93 They committed great ravages in Spain h See Appendix and p 25 of the Latin edition Compare Hqftitz p 149 and others 1 Spangenberg fol 439 b 298

Maximilian the Second and thence by means of the disbanded lansquenets spread in all directions cannot now well be determined for want of ascertained facts In the following year 1 543 however this plague broke out in Germany namely in the Harz districts in the provinces of the Saaleb and still more malignantly at Metz yet upon the whole it did not cause any considerable loss of life In the years 1545 and 1546 we again find the Trousse galant in Franced It proved fatal to the Duke of Orleans second son of Francis the First in the neigbourhood of Boulogne and according to the testimony of French historians to ten thousand English in that fort so that the garrison was obliged to pitch a camp outside the town and the reluctant reinforcements felt that they were encountering certain death e The disease spread itself also among the French troops and we have seen that it extended its dominion beyond the Alps of Savoy f It thus appears that up to the period of which we have been speaking the year 1544 alone was free from great visitations of disease but it would be difficult from thenceforth satisfactorily to define the individual groups of epidemics if the connexion of the epidemic Sweating Sickness of the year 1551 with them is to be made out for there was to use an expression of the schools a continued typhous constitution which extended throughout this whole period manifesting itself on the slightest causes by malignant diseases so that the visitations of sickness which we have hitherto been describing do but appear as exacerbations of them with a predominance sometimes of one and sometimes of another set of symptoms The camp fever which prevailed in the spring of 1547 among the imperial troops there is good ground for considering to have been petechial A great many soldiers fell sick of it and it was so much the more malignant because the imperial army was composed of a variety of soldiery Spaniards Germans Hungarians and Bohemians Those who were seized complained as in encephalitis of insufferable heat of the head their eyes were swollen and started glistening from their sockets a Jordan Tr I c 19 p 220 Spangenberg fol 440 b Villaba TI p 94 The author has not been able to obtain the work of Sixtus Kepser an observer of this disease Consultatio saluberrima de causis et re mediis epidemise sive pestiferi morbi Bambergensium civitatem tum infostantis Bambergse 1544 4to See p 286 Mezeray p 1036 See p 236 DISEASES 299

their offensive breath poisoned the atmosphere around them their tongues were covered with a brown crust they vomited bile their skin was of a leaden hue and a deep puq le eruption broke forth upon it The disease the fresh seeds of which the imperial hussars had brought with them out of Hungary proved fatal as early as the second or third day and it may be taken for granted that both before and after the battle of Muhl bcrg 24th of April it made no small ravages in Saxonya yet it did not become general After a short interval the unusual phenomena of 1 549 again increased the chronicles of central Germany record blights and murrains in that year They speak likewise of a northern light seen on the 21st of September and of a malignant disease which till the winter set in carried off young people in no small numbersb According to all appearance this disease was a petechial fever which in the following year 1550 likewise visited the March of Brandenburg Thuringia and Saxony c The mortality was particularly great at Eisleben where in less than four weeks from the 14th September 257 fell a sacrifice to it and after this period it happened often that from twenty to twenty four bodies were buried in one day so that the loss in this little town may be reckoned at least at 500 d From this slight example the great malignity of the plagues of the sixteenth century will be perceived and it would be still more evident if the physicians of those times had made more careful observations and historians had more accurately recorded facts of this kind In 1551 there prevailed in Swabia a disease of the nature of plague which determined the Duke Christoph of Wiirtemburg to withdraw himself from Stuttgard It did not spread and seems to have remained unknown to the rest of Germany e In Spain too the plague f shewed itself and if to this be added the influenza of the same year as well as the numerous cases of malignant fevers in Germany and Switzerland which were spoken of as still existing in the two following years h it will again be seen quite evidently that the fifth epidemic Sweating Sickness Thuan L IV p 73 b Spangenberg fol 458 ab 459 a c Leuthinger p 241 d Spangenberg fol 460 a Crusius p 280 Villalba TI p 95 6 See above p 221 Wurstisen 1552 pestilential epidemic in Basle p 627 Spangenberg fol 467 b 468 a Pestilence and Phrenitis 300

appeared accompanied by a group of various epidemic diseases which might be considered as resulting from general influences The disease which is the subject of our research thus took its departure from Europe similarly accompanied as when it originally sprang up there while in the interval it thrice repeated its deadly attacks Sect 5 John Kaye Let us dedicate a few moments to the observer of the fifth sweating pestilence whose life presents a lively image of the peculiarities and tendencies of his age He was born at Norwich on the 6th of October 1510 and received his education at Gonville Hall Cambridge He had early evinced by some productions his great knowledge of the Greek language and his zeal for theological investigations At a maturer age he went to Italy at that time the seat of scientific learning where Bap tista Mont anus and Vesalius at Padua initiated him in the healing art He took his Doctor's degree at Bologna and in 1542 he lectured on Aristotle in conjunction with Realdus Columbus with great approbation The following year he travelled throughout Italy and with much diligence collated manuscripts for the emendation of Galen and Celsus attended the preelections of Matthaeus Curtius at Pisa and then returned through France and Germany to his own country After being admitted as a doctor of medicine at Cambridge he practised with great distinction at Shrewsbury and Norwich but was soon summoned by Henry the Eighth to deliver anatomical lectures to the surgeons in London He was much honoured at the court of Edward the Sixth and the appointment of body physician which this monarch bestowed on him he retained also under Queen Mary and Elizabeth In 1547 he became a Fellow of the College of Physicians over which at a later period he presided for seven years He constantly supported the honour of this body with great zeal compiled its Annals from the period of its foundation by Linacre to the end of his own presidentship and originated an establishment the first of the kind in England for annually performing two public dissections of human bodies That he was thus established in London before the year 1551 is certain yet he was present in Shrewsbury during the Aikin p 103 et seq JOHN KAYE 301

Sweating Sickness His pamphleta upon this disease the first and last published in England did not however appear before 1552 after all was over It is written in strong language and a popular style and with a laudable frankness for Kaye blames in it without any reserve the gross mode of living of his countrymen and does not fatigue his reader with too much book learning which neither he nor his contemporaries could refrain from displaying on other occasions He reserved this for the Latin version of his pamphlet which was published four years later b and although judged according to a modern standard it is far from being satisfactory yet it contains an abundance of valuable matter and proves its author to be a good observer and in this we can nowhere mistake that he is an Englishman of the sixteenth century however numerous the terms he may borrow from Celsus His doctrines are of the old Greek school throughout of which the physicians of those times were staunch supporters hence the term ephemera c pestilens his comparison of the disease with the similar fevers of the ancients d and his accurate appreciation of the important doctrine of sethereal spirits to which he refers its chief causes and according to which the corrupted atmosphere spiritus corrupti becomes mixed in the lungs with the spirits of blood spiritus sanguinis whence it at once appears explicable to him why many persons may be attacked with the Sweating Sickness at the same time and even in different places and why the parts of the body in which according to the ancient Greek notion the aethereal spirits developed themselves were most violently affected with this disease e From the relationship of the infected air to the aethereal spirits in the body polluted by intemperance it also appears explicable to him why foreigners in England in whom this pollution took place in a less degree were only in cases of individual exception attacked by the Sweating Sickness not to mention other theoretical notions On malaria in general as he was an observant naturalist he was enabled to turn to good account his experience in Italy and his knowledge of the ancients and his estimation of the a See Appendix b 1556 This edition is very rare and is probably not to be found in Germany The edition brought out by the author 1833 is taken from a very good London reprint of 1721 c In the German sometimes called eiries Tags pestilentziehes Fieber a P 15 Lat edit II lx im Tvip m Ibid p 17 seq Ibid p 49 302

subordinate causes with regard to which he takes up the same position as Agricola who was also a good naturalist is likewise on the whole worthy of approbation a The immoderate use of beer amongst the English was considered by many as the principal reason why the Sweating Sickness was confined to this nation On this subject he enlarges even to prolixity with evident English predilection for this beverage which manifestly contributed to the morbid repletion of the people and he himself acknowledged this as a principal cause of the Sweating Sickness The injurious quality of salt fish as alleged by Erasmus and the German physician Hellwetterb he would not altogether have ventured to reject for it caused constant and abundant fetid perspirations and might thus have contributed to pave the way for the Sweating Sickness A similar source was to be found in the dirty rush floors in the English houses d and other subordinate causes of the disease of which mention has been made in the course of this treatise As a zealous advocate of temperance it were to be wished that he had met with more attention but the words of a good physician are given to the winds when they are directed against vices and habits of sensual indulgence people require from him an infallible preservative and not a lecture on morality His precepts on food and beverage are circumstantial after the manner of the ancients and he recommends such a variety that it is difficult to make a choice while nothing but the greatest simplicity can be of any avail Purifying Jires which were kindled everywhere in times of plague are also much lauded by him and we here learn incidentally that the smiths and cooks remained free e from the Sweating Sickness Fumigations with odoriferous substances of all kinds even the most costly Indian spices were everywhere employed in the houses of the rich and no one stirred out without having with him some one of the thousand scents recommended from time immemorial during the plague The medicines which he recommends are those that were then in vogue among which Theriaca Armenian Bole and Pearls occur in various combinations yet most of the prophylactics which he advises for obviating any defect in the constitution are not very violent a P 81 Lat edit See above p 272 c P 48 Lat edit P 44 Lat edit See above p 214 Ibid p 74 JOHN KAYE 303

Kaye's treatment of the Sweating Sickness is according to the mild old English plan which is very judiciously and perspicuously laid down He kept himself on the whole free from the influence of the schools in this instance and the only remedy which he approved in case of necessity was a harmless and very favourite preparation of pearls and odoriferous substances which was called Manus Christi a or in Germany sugar of pearls It had its origin in the fifteenth century and was the invention of Guainerus b and there were various receipts for compounding it c He also sometimes prescribed at the commencement of the attack d bole or terra sigillata for how could a physician of the sixteenth century doubt the antipoison ous effect of this overrated remedy Restlessness in the patient debility a too thick skin and thick blood are set forth by him as the chief impediments to the critical sweat and in order to remove them he sets to work with great and laudable caution ordering according to circumstances even mulled wine and greater warmth Sometimes too he could not refrain from employing Theriac and Mithridate but he did not use these remedies to any great extent For dropsical and rheumatic patients who became the subjects of the Sweating Sickness he prescribed a beverage of Guaiacum he also recommended as a sudorific the China root which was at that time much in use When the perspiration broke out he positively prohibited the urging it beyond the proper point all medicines were thence laid aside and he trusted to aromatic vinegar and gentle succus sion alone for keeping off the lethargy without considering with Damianus that more severe measures were essential e As a learned patron of the sciences Kaye ranks amongst the most distinguished men of his country Through his interest Gonville Hall was in the reign of Queen Mary elevated to the rank of a college better established and more richly endowed To the end of his life he continued to preside over this his favourite institution and passed his old age there not in P 94 Lat edit Practica fol 43 a 263 a c FaUop de compos medic cap 41 p 208 P 102 Lat edit c P 106 7 Ibid f Shortly before his death he resigned the Mastership but continued to reside in the College as a fellow commoner See Aikin p 109 Transl note f He gave for a new building to this establishment more than 1,800 a very considerable sum for those times 304

Monkish contemplation like Linacre but zealously devoted to study as the great number of his writings testifies He was accused of having changed his faith according to circumstances This pliability served it is true to retain him in favour with sovereigns of very opposite modes of thinking it is not however a sign of elevation of mind and can only be explained in part by the spirit of the English Reformation Kaye was a reformer in fact inasmuch as he was a promoter of instruction and perhaps laid no stress on outward profession His versatility as a scholar is extraordinary and would be worthy of the highest admiration had he entirely avoided the reproach of credulity had he not been too prolix in subordinate matters and had he shown more decided signs of genius At one time he translated and illustrated the writings of Galen at another he wrote on philology or the medical art it must be confessed without much originality for he took Galen and Montanus as his patternsa But where could physicians be found at that time who did not follow established doctrines Some essays on History and English Archaeology are found among his writings b and his works on Natural History dedicated to Conrad Gesner are among the best of his age because he imparted his observations in them quite plainly and naturally free from the trammels of any school He died at Cambridge on the 29th of July 1573 and ordered for himself the following epitaph Fui Caius a De medendi methodo ex CI Galeni Pergameni et Joh Bapt Montani Vero nensis principum medicorum sententia Libri duo Basil 1554 8 He dedicated this frivolous book to the court physician in ordinary Butts See Baleeus fol 232 b b Compare his own work De Libris Propriis in J ebb which is a similar imitation of Galen and is written in nearly the same spirit c De canibus Britannicis et de rariorum animalium et stirpium historia in Jebb JOHN KAYE 305

CHAPTER VI SWEATING SICKNESSES Erri ya to witti Xwrif rZt 2trfi v rvf III o vvecfiw kKT TX VS Sect 1 The Cardiac Disease of the Ancients Morbus Cardiacus Thus by the autumn of 1551 the Sweating Sickness had vanished from the earth it has never since appeared as it did then and at earlier periods and it is not to be supposed that it will ever again break forth as a great epidemic in the same form and limited to a four and twenty hours course for it is manifest that the mode of living of the people had a great share in its origin and this will never again be the same as in those days Yet nature is not wanting in similar phenomena which have appeared in ancient and modern times and if we take into the account the great frequency of cognate rheumatic maladies it is possible that isolated cases may have sometimes occurred in which repletion of impure fluids and violently inflammatory treatment have augmented a rheumatic fever even to the destruction of nervous vitality by means of profuse perspiration only perhaps that they ran a longer course which does not constitute an essential difference and under totally different names whereby attention is misled Of all the diseases that have ever appeared which can in any way be compared to the English Sweating Sickness we have principally three to look back upon the cardiac disease of the ancients the Picardy sweat and the sweating fever of Rotingen The first was for reasons which have been already mentioned almost unknown to the learned of the sixteenth century and it is matter of surprise that Kaye himself who had chosen for his favourite the best Roman physician we mean Celsus could have so entirely over See p 270 306 SWEATING SICKNESSES

looked his by no means unimportant statements respecting this disease Houlier is the only author who ventures a comparison of the English Sweating Sickness with the ancient cardiac disease his few and almost lost wordsa remained however unheeded nor are the differences between the two diseases small but to return The disease of which we are speaking appeared for a period of 500 years from 300 BC to 200 after Christ and was a common almost every day occurrence which is often mentioned even by non medical writers Tt was exceedingly dangerous and even esteemed fatal and as it was far above the reach of Greek physiology there were not wanting extraordinary opinions respecting its nature and bold and singular modes of treatment to which those who were attacked were subjected The name Cardiac disease morbus cardiacus voVo Kapitecm and probably also voVoj HapSfoif was not bestowed by medical men but by the people who in the fourth century before Christ for the name is as ancient as that period could not know that the learned would dispute on that subject Some affirmed and among them men of great authority such as Erasistratus Asclepiades and Aretmus that the people were in the right so to call the disease that the heart was actually the part affected and that their knowledge of the heart's functions was by no means small b Others on the contrary would only acknowledge in that name an expression indicative not of the particular seat of the disease but only of its importance inasmuch as the heart is well adapted as the centre and source of life to indicate thisc Others again who attempted more refined conjectures wished to represent the pericardium as the seat of the malady because darting pains were sometimes feltd in the region of the heart or the diaphragm or the lungs or even the liver The opinions were numerous the actual knowledge was small e 1 Sudor anglicus fere similis ei sudori quem cardiacum dicebamus De morb int L II fol 60 a b Est autem cor prsestans atque salutaris corpori partieula prseministrans omnibus sanguinem membris atque spiritum C el Aurel Acut L II c 34 p 154 Compare the Author's Doctrine of the circulation before Harvey Berlin 1831 8 c Ceel Aurel cap 30 p 146 Ibid cap 34 p 156 The whole 34th chapter loc cit Aurelian gives from the 30th to the 40th cap the fullest information respecting the Morbus cardiacus THE CARDIAC DISEASE OF THE ANCIENTS 307

The cardiac disease began with rigors and a numbness in the limbs a and sometimes even throughout the whole body The pulse then took on the worst condition was small weak frequent empty and as if dissolving in a more advanced stage unequal and fluttering until it became completely extinct Patients were affected with hallucinationsb they were sleepless despaired of their recovery and were usually covered suddenly with an ill savoured perspiration over the whole body whence the disorder was likewise called Diaphoresis Sometimes however a washy sweat broke out first on the face and neck This then spread itself over the whole body assumed a very disagreeable odour became clammy and like water in which flesh had been macerated and ran through the bed clothes in streams so that the patient seemed to be melting away c The breath was short and panting almost to annihilation insustentabilis Those affected were in continual fear of suffocation d tossed to and fro in the greatest anguish and with a very thin and trembling voice uttered forth only broken words They constantly felt an insufferable oppression in the left side or even over the whole chest e and in the paroxysms which were ushered in with a fainting fit or were followed by one the heart was tumultuous and palpitated without any alteration in the smallness of the pulse f The countenance was pale as death the eyes sunk in their sockets and when the disease took a fatal turn all was darkness around them The hands and feel turned blue and whilst the heart notwithstanding the universal coldness of the body still beat violently they for the most part retained possession of their senses A few only wandered a short time before death while others were even seized with convulsions and endowed with the power of prophecy Finally the nails became curved on their cold hands the skin was wrinkled and thus the sufferers resigned their spirit without any mitigation of their miserable condition h A striking resemblance is plainly perceived from this description between the ancient cardiac disease and the English Sweating Sickness in the most exquisite cases of each In both the same palpitation of the heart the same alteration of the voice the same anxiety the same impediment to respiration and Torpor frigidus C 33 p 157 Hallucinatio c Cal Aurel p 157 Spiratio prsefocabilis e C 34 p 154 Thoracis gravedo C 35 p 156 Aretaus L II c 3 p 30 Ctrl Aurel loc cit 308 SWEATING SICKNESSES

thence the same affection of the nerves of the chest the same ill scented sweat and by means of this sweat the same fatal evacuation in short all the essential symptoms arising from the same circle of functions For in the sweating pestilences of the ancients tt as well as the moderns the nerves of the abdomen remained unaffected the liver intestines and kidneys took no part in the primary affection the diaphragm as in the English Sweating Sickness formed the partition Hence the acute Aretceus did not hesitate to call the cardiac disease fainting syncope with certainly an unusual extension of the notion implied by this term which in its common acceptation excludes the turbulent commotion of the heart In the affection of the brain some difference occurs for though the hallucination afforded an unfavourable prognostic in both diseases yet the fatal stupor was peculiar to the English Sweating Sickness no observer having made mention of it in the cardiac disease Greater and altogether essential differences between this affection and the English Sweating Sickness appear in another respect There is every reason to suppose that the cardiac disease first appeared in the time of Alexander the Great that is to say at the end of the fourth century before Christ for the Hippocratic physicians were unacquainted with it Erasistratus who was body physician to Seleucus Nicator and was a universally celebrated professor at Alexandria under the first Ptolemy being the first to mention it If that age be compared even superficially with that of Henry the Vllth and Henry the Vlllth and Africa Asia Minor and the South of Europe with England we shall easily be convinced that the two diseases notwithstanding the agreement in their main symptoms could not be the same moreover much was comprehended by the ancients under the name of morbus cardiacus which on a nearer examination proves not to be one and the same definite form of morbid action for sometimes this affection is spoken of as an independent disease sometimes it is mentioned only as a symptom superadded to others as a kind of transition from other very various diseases such as has occurred in modern times Soranus mentions as such diseases continued fevers accompanied by much heat b and reckons among them the Causus that is an inflammatory bilious fever to which Areteeus also 1 Diaphoretici cardiaci b Febres continuas flammatse Cod Aurel c 31 p 147 THE CARDIAC DISEASE OF THE ANCIENTS 309

saw the cardiac disease superadded These fevers passed on the fifth or sixth day into the cardiac disease and such a transition occurred chiefly on the critical daysa In a similar sense Celsus speaks even of Phrenitis under which name we are here to understand all inflammatory fevers accompanied by violent delirium with the exception of actual inflammation of the brain Thus we see that the cardiac disease arose and increased on a very different soil from other diseases and was to furnish an ancient example as far from being independent under these circumstances as lethargy was in similar cases But Hhere was doubtless an independent idiopathic form of the cardiac disease Whether this was febrile or not the most celebrated physicians of ancient times were not agreed Now how could they ever have differed upon the subject if the cardiac disease had always appeared only as a sequela on the fifth or sixth day of inflammatory fevers Apollophanes a disciple of Erasistratus and physician to Antiochus the First considered it with his master as constantly febrile and his opinion prevailed for a long time perhaps he was in the right for it is probable that in the first half of the third century the disorder was much more violent than at a subsequent period His celebrated contemporary Demetrius of Apamea disciple of Herophilus affirmed that he had recognised fever only in the beginning of the disease and that it disappeared in its further progress Very soon most physicians decided that it was not febrile but Asclepiades distinguished a febrile and a non febrile form of the cardiac disease and it is certain that this physician was a very accurate observer Themison and Thessalus also agreed with him Aretceus described in a cursory manner the febrile form only and perhaps was not acquainted with any other Soranus followed in the essential points Asclepiades the founder of his school and later writers generally regarded the inward heat the hot breath and the burning thirst symptoms which were occasionally less marked as proofs of the febrile nature of the disease Numerous theoretical views belonging to particular schools of which we do not here treat were intermingled with these and upon the whole that form seems to have been esteemed as non febrile in which the signs of feverish excitement appeared less marked In all cases the cardiac a Aretceus Cur ac L II c 3 p 188 310 SWEATING SICKNESSES

disease set in with external coldness and with a small contracted quick pulse symptoms which with certainty indicate fever a Respecting the course of the cardiac disease we are not furnished with sufficient information It was no doubt very rapid for the frame could not long endure symptoms of so violent a kind and the disorder must of necessity soon have come to a crisis yet from the ample directions for treatment we may conclude that it lasted at least some days If the perspiration was well surmounted patients seemed to recover rapidly and their sufferings appeared to them according to the expressions of Aretaus like a dream out of which they awoke to a consciousness of the increased acumen of their senses b But the termination was not always so fortunate The disease was very dangerous and in many after the occurrence of an incomplete crisis an insidious fever remained behind which ended in a consumptionc The whole phenomenon was altogether peculiar and among existing diseases there are none which bear any comparison with it There must therefore have been something in the whole state of existence among the ancients which favoured the formation of the cardiac disease That it arose oftener in summer than in winter that it attacked men more frequently than women and especially young people full of life and hot blooded plethoric persons who used much bodily exercise we learn from credible observersd In this respect therefore it bore a resemblance to the English Sweating Sickness We may also add that indigestion repletion drunkenness as likewise grief and fear but especially vomiting and the employment of the bath after dinner occasioned an attack of the malady e Let us call to mind the habits of the ancients It was in the time of Alexander that oriental luxury was first introduced Gluttony became a part of the enjoyment of life and warm baths a necessary refinement in sensuality which just at this time were philosophically established by Epicurus nor was this the last instance in which philosophers encouraged the errors and infirmities of human society 1 Coal Aurel c 33 p 150 c Aret Cur ac L II c 3 p 193 Cal AureL c 31 p 146 L II c 3 p 30 A Cal Aurel c 31 p 146 THE CARDIAC DISEASE OF THE ANCIENTS 311

Here again therefore as in the English Sweating Sickness we meet with the relaxed state of skin and the foul repletion engendered by the same indulgence in sensuality which we have found to exist in the sixteenth century How this corruption of morals increased and to what a frightful height it was carried among the Romans it is not necessary here further to elucidate and we may take it for a fact that in consequence of it the general constitution of the ancients underwent a peculiar modification that this relaxation of skin and gross repletion were propagated from generation to generation and that as among chronic diseases those of a gouty character were its more frequent results so among the inflammatory the cardiac disease made its appearance as the general effect of this kind of life Where however such a system of life existed among whole communities the original and peculiar occasion was not needed in every individual case to bring the pre disposition for a disease which propagated itself by hereditary taint to an actual eruption Shocks to the constitution of quite a different kind were often sufficient for the purpose Thus among the Romans it was by no means always the case that gluttony and relaxation of the skin immediately gave rise to the cardiac disease while on the other hand the usual faintness induced by too copious blood letting passed into this impetuous agitation of the heart accompanied by colliquative sweats and all over Tiolent perspirations in other diseases were apt to take the same dangerous course b We must here also take into account a practice among the Romans which was very injurious and yet rendered sacred by the laws namely visiting the public baths late in the evening just after the principal meal and awaiting the digestion of their food in these places of soft indulgencec How much must the tendency of sweating disorders have been favoured by these means Surmises founded on the facts already stated can alone be a CtBl Aurd c 33 p 153 A perfectly similar observation is made in the present day on the increasing frequency of liver complaints in England Parents who have been a long time in the East Indies entail the predisposition to these diseases which are altogether foreign to the temperate zones on their posterity among whom there is no need of a tropical heat but merely common causes acting in their own country to call forth various liver complaints See Bell George Hamilton 6 Ccd Aurel c 36 p 159 c On this subject read the classical work of JBaccius 312 SWEATING SICKNESSES

offered respecting the nature of the ancient cardiac disease The ancients give us no certain intelligence upon it for their mode of observing did not lead to that object at which modern medicine aims That the cardiac disease was not of a rheumatic character seems deducible from several circumstances from the quality of the atmosphere in southern climates which is not so favourable to rheumatic maladies as to give rise to a distinctly denned form of that complaint throughout a period of five hundred years from the nature of the so called inflammatory fever which exhibited no rheumatic symptoms in its course and lastly from the treatment of the cardiac disease for it was a common practice to cool down the diaphoretic patients in the midst of their perspiration by sponging them with cold water to expose them to the air and some physicians went so far as to advise cold baths and affusions a How could they have ventured upon such remedies if the cardiac disease had been of a rheumatic nature In the sweating fevers of the sixteenth century every abrupt refrigeration every exposure of the skin was fatal It is thence to be inferred that the English Sweating Sickness differed from the ancient cardiac disease in its rheumatic character even although both diseases were founded in common on an impure gross repletion and relaxation of skin and the essential phenomena of both went through the same course not to advert to other differences which are manifest from what has been stated The remaining treatment of the cardiac disorder should not be altogether passed over in this place because it shews very clearly the general style of thinking of the medical profession as also certain metaphysical excitations which are innate in that profession and of which there is therefore a repetition in all ages For whilst some proceeded with commendable care and caution and Armteus feared ba fatal result from the slightest error others again would fain render excited nature obedient to their rough command by means of the most violent remedies It therefore occasionally happened that in their over hasty activity they were unable to distinguish between a salutary per Cekus L III c 19 p 140 Cal Aurel from c 37 on b Hv yecf i rt ffvyKOXy xat afitK o afiagrwn fai iwi tit aSw VfiXU Cur ac L II c 3 p 188 THE CARDIAC DISEASE OF THE ANCIENTS 313

spiration and a dangerous diaphoresis This they suppressed at all hazards and thus sent their patients to the shades of their fathers Others forthwith flew to Chrysippic bandaging the great means of suppressing profuse evacuations and even violent spasms Others were for obviating the debility as quickly as possible by means of nourishing diet and overloaded the stomach as if the recovery of strength depended entirely upon eating Others allowed as much wine as possible to be drunk for twenty four hours together even to the extent of producing intoxication b and Asclepiades selected for this extraordinary death bed carousal the Greek salt wine for the sake of bringing on a diarrhoea whereby the opened pores of the skin might again close and the too mobile atoms might be carried towards the bowels With the same object he ordered active clysters d for if they succeeded in causing a full evacuation he maintained that the perspiration must necessarily be arrested Endemus of the Methodic sect recommended even clysters of cold water and whatever else the rashness of medical men had fool hardily contrived acting on the ancient notion that severe diseases always required violent remedies Aretceus recommended blood letting which others pronounced to be nothing short of certain death f He had however a notion that the Causus was the foundation of the cardiac disease and perhaps he was right A cautious employment of wine was apparently of great use e and what may excite surprise physicians gave detailed and frivolous precepts on the choice and enjoyment of food If the irritable stomach rejected this repeatedly they even went so far according to the Roman method as to make the patient vomit both before and after his meals in order that the organ might thus bear the repeated use of nourishment It was also asserted that the stomach retained food and wine better if the Cal AureL c 87 p 169 1 Cal Aurel c 38 p 171 c Grsecum salsum omt nlnXttmruitiim a mixture of wine and sea water which was very much in use Cal AureL c 39 pp 174 175 e Cal Aurel c 38 p 171 nihil jugulatione differre Ibid 8 Celsus recommended a sextarium and a half a day which is about 42 cubic inches loc cit Cardiacorum morbo unicam spem in vino esse certum est Plin Hist Nat L xxiii c 2 T II p 303 Bibere et sudare vita cardiaci est Senec Epist 15 T II p 68 Ed Ruhkopf Cardiaco cyathum nunquam mixturus amico Juvenal Sat v 32 314 SWEATING SICKNESSES

body were previously rubbed all over with bruised onions a All this affords us an insight into the nature of this remarkable disease which has now so completely vanished from the world Finally when astringent decoctions proved fruitless particular confidence was placed in the application of various powders b to the surface of the body conjointly with the use of light bed clothes and the avoidance of feather beds which the effeminacy of the ancients had already introducedc As astringents they selected pomegranate bark the leaves of roses blackberries and myrtles as also fullers earth gypsum alum litharge slaked lime d and when nothing else was at hand even common road duste The efficacy of some of these extraordinary remedies cannot be denied At least it has been proved in modern times with respect to alkalies which are of a somewhat similar nature that they are of great service where there is an abundant determi nation of acid towards the skin and it is very probable that the perspiration of these diaphoretic patients contained much acid Sect 2 The Picardy Sweat SUETTE DES PlCARDS StJETTE MlLIAIRE The Picardy Sweat is a decided miliary fever which has often prevailed not only in Picardy but also in other provinces of France for more than a hundred years and even at the present time exists in some places as an endemic disease f We have pointed out the affinity between the English Sweating Sickness and miliary fever Both are rheumatic fevers the former of twenty four hours duration the latter running a course of at least seven days In the former there was no eruption or if in isolated cases an eruption made its appearance it was doubtless subordinate not essential In the miliary fever on the contrary the eruption is so essential that this disease may be considered as a completely exanthematous form of rheumatic fever The history of miliary fever is full of important facts and the sweating fever of Picardy forms but a variety of it The eruption in itself is of very ancient occurrence and was most probably as at Celsus b Aspergines sympasmata diapasmata Cad Aurel c 38 p 171 Cad Aurel c 37 p 161 Aretaeus p 192 Celsus loc cit For instance in the villages of Rue Saint Pierre and Neuville en Hez between Beauvais and Clermont Rayer Suette j 74 THE PICARDY SWEAT 315

present observed time immemorial in conjunction with petechia occurring as a critical metastasis in the oriental glandular plague perhaps even in the ancient plague recorded by Thucydides It also occasionally accompanied petechial fever as unquestionably it did small pox and many other diseases in the same manner as we now see for the miliary eruption is a very common symptom which is easily induced and increases the danger of various other accidental complications This is different however from the idiopathic miliary fever which did not exist either before or even at the period of the English Sweating Sickness but occurred as an epidemic frequently mentioned in Saxony a hundred years latera 1652 We cannot therefore consider this eruptive disease as having proceeded from the English Sweating Sickness in the same manner as the petechial fever had its probable origin in the glandular plague even supposing a more decided inclination of the Sweating Sickness to the eruptive character could be proved than is possible from the facts afforded A whole century intervened and what vast national revolutions This same separation of so long a period makes also against the supposition that the English Sweating Sickness was an interrupted miliary fever which exhausted its power by a too luxuriant activity of the skin on the first day before the eruption made its appearance Moreover the similarity and isolation of all the five epidemic sweating fevers as regards the brevity of the course of the disease and the absence of all transition forms of any duration which certainly would have existed had nature intended gradually to form a miliary fever out of the English Sweating Sickness lead to the same conclusion But to return to the miliary fever Some forms of this disease have been observed in which a profuse perspiration in combination with nervous symptoms has endangered life on the first day of the attack equally often too the eruption has appeared fully formed on the very first day and if we duly consider as we ought the regular course of miliary fever whenever it has assumed an epidemic character we shall always find even in that development of symptoms differing fun 1 Godofredi Welschii Historia medica novum puerperarum morbum continens Disp d 20 April 1655 Lipsiae 4to The principal work upon the first visitation of miliary fever in Germany 316 SWEATING SICKNESSES

damentally from those of the English Sweating Sickness If occasionally instances of miliary fever occurred in which no eruption came out as was the case recently in 1821 they were to be considered in the same light as other acute eruptive diseases as for example scarlet fever in which nature indulges in a like irregularity without however altering the essence of those diseases And since finally it has been observed in many casesa that the miliary eruption could be prevented by the application of cold at the commencement a distinguished modern physician has attached great consequence to this circumstance as showing that miliary fever and the English Sweating Sickness were the same disease b but a check of this kind is at all events impossible in those miliary fevers where the eruption breaks forth on the first or second day and moreover experience tells us that many other diseases also such as inflammations rheumatisms gastric fevers and even abdominal typhus may be arrested in their course and confined within narrower bounds so as not to manifest all their symptoms We are therefore completely entitled to consider the appearance of the miliary sweating fevers as altogether a novelty originating in the middle of the 17th century and having no discoverable connexion with the English Sweating Sickness There have been in Germany since the year 1652 many visitations of miliary fever but this disease did not increase much in extent until about the year 1715 when it spread into France and the neighbouring countries particularly Piedmontc whilst England remained almost entirely free from it The French For example in the epidemic of 1782 which during the course of a few months carried off in Languedoc upwards of 30,000 people Pujol observed in that epidemic four forms of exanthem 1 A Purpura urticata elevated rose like spots or papulae of smaller circumference it was very favourable and sometimes passed off without fever 2 Spots consisting of very small miliary vesicles and pustules which ran into each other less favourable 3 Small hemispherical pimples from the size of a mustard seed to that of a corn of maize They were surmounted by a white point before they died away and the large kind became converted into pustules filled with matter or greyish semitransparent phlyctsense with red inflamed bases This form was the commonest and extended mixed with the others over the whole surface especially the trunk 4 An exanthem resembling flea bites of a bright red with a small grey miliary vesicle in the middle almost invisible except through a lens this form was the worst Pujol CEuvres diverses de Medecine Pratique 4 vols Castres 1801 8vo Fodere III p 222 c On this point see Allioni who drew his classical description of miliary fever from the Piedmont epidemics THE PICARDY SWEAT 317

epidemics were upon the whole much more severe than the German and on this account we select one of the most ancient and also the most recent of them in order to give a general view of miliary fever as compared with the English Sweating Sickness The miliary fever first appeared in Picardy in the year 1718 in le Vimeux Vinnemacus pagus a district on the north of the Somme and on the south of the Bresle and the department of the Lower Seine It increased annually in extent most places in Picardy were visited by it and it was not long before it was seen in Flandersa We are still in possession of a very distinct account which we will here detail of an epidemic at Abbeville in the year 1733 where the miliary fever had existed fifteen years previously There were scarcely any premonitory symptoms but the disease commenced at once with pinching pains in the stomach extreme prostration of strength dull headache and difficulty of breathing interrupted by sighing Patients complained of violent heat and were bathed in a pungent sweat of foul odour while nausea was occasionally felt Sparks appeared before the eyes and the countenance became flushed Patients were tormented with burning thirst and yet the tongue was as moist as in perfect health The pulse was frequent and undulating without hardness and in the course of a few hours an insufferable itching came on over the whole body accompanied by distressing jactitation upon this thickly studded red round pustules not bigger than mustard seeds broke out wherefrom patients emitted an extremely disagreeable urinous odour which was imparted to those who were about their persons Sometimes they had evacuations at other times they suffered from constipation but all complained of want of sleep and when they felt an inclination to doze they were again aroused by fresh chilliness Many bled at the nose till they fainted and with women the menstrual discharge often apT peared though not at the proper time The urine was at times deficient in quantity at others discharged in abundance and without any critical signs if pale and plentiful it betokened delirium then the eyelids twitched convulsively a humming noise commenced in the ears and the patient tossed about Bellot An febri putridse Picardis Suette dictse sudorifera Diss prses Ott Cos Barfeknecht Paris 1733 4to 318 SWEATING SICKNESSES

restlessly The pulse became strong irregular and like the breathing very quick The countenance grew redder and redder and soon after the sufferers as though struck by lightning were seized with lethargy and expired generally in the act of coughing and spitting blood Such was the nature of the disease when it attacked many at once there were however several varieties With some the miliary vesicles broke out on the second day with others not before the third and if all went on favourably they lost their redness on the seventh day and the skin all over the body scaled off like bran The fever was sometimes extremely violent at others without apparent cause very mild at least one might be deceived at the commencement of the attack by the apparently favourable symptoms for those who in the morning had scarcely any notable degree of fever who neither suffered from any anxious sensation nor violent heat in whom no subsultus tendi num was perceptible no want of perspiration nor any retrocession of the eruption were sometimes towards evening seized with phrenzy and died in a state of lethargy Evacuations which alleviate other diseases made this miliary fever worse Favourable symptoms could never be depended on In the midst of profuse perspiration the patient died either from constipation or diarrhoea A copious discharge of urine was a bad sign composure was succeeded by delirium cheerfulness by lethargy the disease was throughout treacherous and disguised It was particularly necessary for those suffering from pleurisy or any inflammatory fevers to be guarded against its approach Many fell sacrifices to this epidemic who thought themselves in a state of convalescence and with such it was easier to foretell than to prevent the consequences In cases of this kind the miliary vesicles were less red and grew pale sooner but if the disease attacked a healthy person then they were redder and continued longer Of those who recovered not a few suffered for many months nay even for a whole year from night perspirations without fever or sleeplessness but with an eruption of little miliary vesicles which disappeared a again on the slightest exposure to cold The later miliary epidemic fevers in France which are distinguished by the name of the Picardy Rayer Suette p 426 where the principal passage of Bellot's dissertation is reprinted word for word THE PICARDY SWEAT 319

Sweating Sickness are generally very well described a so much so that we have few epidemics of modern times whose course and succession we can trace so well But the epidemic of 1821 which raged in the departments of the Oise and of the Seine and Oise from March to October has been observed by all with the greatest care including men of distinguished talent b We shall give the description of this disease There were no constant premonitory symptoms it often broke out quite suddenly but many complained some days before of debility despondency want of appetite nausea headache sometimes also of giddiness and slight chilliness Many retired to rest in health and awoke during the night with the disease covered with a perspiration which ceased only with death or recovery With some the sweating was preceded for some hours or even only for some moments by a scarcely perceptible feverish commotion accompanied with burning heat or with a sensation of pain which ran through every limb and nearly always with spasms in the stomach With others the disease announced itself by lacerating rheumatic pains which gradually increasing they became bed ridden The mouth was foul the taste at times bitter the tongue white more rarely tinged with yellow and thus it remained till the patient was restored The sufferer was shortly covered with a thick peculiarly fetid sweat that certainly produced alleviation but became very intolerable to him from its unpleasant stench which was even communicated to the clothes of the bystanders In the mean time it was discovered by the pulse that the fever had considerably abated but on the third day the patient was seized with convulsive spasms in the stomach great oppression at the chest and a sensation of suffocation symptoms which caused him insupportable anguish These attacks accompanied by hiccup and eructation continued for several hours and returned from time to time an eruption partly papular simultaneously breaking out first on the neck then on the shoulders down to the hands and breast less frequently on the thighs and face The little pimples were of a pale red colour and conical with glistening heads and between them appeared innumerable small miliary pustules a Best in Mayer p 421 Not so well in Ozanam T iii p 105 The writers are very numerous Rayer Mazet Bally Franfois Pariset and many others 320 SWEATING SICKNESSES

filled with transparent serous fluid which soon thickened and assumed a whiter hue At the time and previous to the breaking out of the exanthem the patient experienced a very severe burning and pricking sensation in the skin which nevertheless sometimes occurred on the second or fourth day and which increased sometimes in one part sometimes in another when the sweating declined Towards the fifth day however after the sweating had entirely ceased the complaint grew worse again The spasms and paroxysms of suffocation returned and they were succeeded by renewed eruptions of the exanthem a decided improvement however shortly took place the little pimples lost their redness the miliary vesicles dried away and at a period from the seventh to the tenth day recovery commenced under a general exfoliation of the cuticle Sometimes the eruption did not appear whether the patients were under medical treatment or left to their own guidance but with those few in whom there was an absence of miliary vesicles that peculiar pricking and itching of the skin did not take place Between the fifth and seventh day the patients usually complained of great weakness and had a desire to eat A few table spoonfuls of wine then agreed with them very well for the rest neither thirst nor lethargy was observable but it was particularly remarkable that the urine was clear and abundant Up to the seventh day a confined state of bowels was usual and with the exception of the already mentioned attacks of tightness and oppression the breathing remained free though with great sleeplessness during the whole malady Nothing morbid was to be observed in the chest and the patients lay stretched out at full length so that there was no occasion at any time to raise their heads Such was the regular course of this miliary fever but its progress was often accelerated by very dangerous symptoms and occasionally it proved fatal within a very few hours If at the time of the attack the patients were very restless and talkative the eyes glistening the pulse without being hard tumultuous and the edges of the tongue reddened delirium soon succeeded and then convulsions and death Great depression of the spirits was a very bad symptom bleeding was never of any avail yet the menstrual discharge did not interrupt the course of the disease There was in general a great degree of malignancy perceptible in the malady as was also rendered apparent y THE PICARDY SWEAT 321

by the course of the epidemic If the miliary Sweating Fever broke out in a fresh place two or three persons only were thereupon attacked and that favourably which led to a supposition that the evil had all passed away for during the next fifteen or twenty days not any fresh attacks were heard of Suddenly however the epidemic reappeared with increased virulence The great number of the sufferers spread consternation and terror amongst the inhabitants and the cases of death became frequent After this first burst of fury the epidemic grew more mild again so that many patients were not confined to their beds at all This mitigation of the miliary fever was likewise manifested by the prolongation of its course beyond the seventh day If we compare this epidemic with the one observed at Abbeville in 1 773 we shall find between them but very trifling differences which would appear still more clearly in some of the intermediate visitations thus conforming to what has been observed in other eruptive maladies It is consequently evident that the miliary fevers b which have appeared in France in recent times do not differ in any essential point from those of more ancient date The surest proof of their identity is their persistence for nearly two centuries and from the manner in which they have presented themselves to observation they are to be considered as distinct from the English Sweating Sickness though certainly allied to it It would exceed our limits to pursue this inquiry further but it may be as well to give the following short cataloguec of the most important miliary epidemics 1652 Leipzig 1689 Philippsburg I860 Augsburg 1690 Stuttgard 1666 Bavaria Diisseldorf 1672 Hungary Erfurt 1675 Hamburgh Jena 1680 Germany to a great extent 1694 Berlin Bally and Francois in the Journal General de M decine T LXXVII p 204 Compare Fodere T III p 227 Ozanam T III p 116 Mayer Suette p 148 Mai d 1 p TI p 320 b We may add to them also those observed in the south of Germany in the oetio logy of which Schonlein lays much stress on the contamination of the air in the process of steeping hemp Vorlesungen II p 324 e It is not complete but may render apparent the power and extent of the disease See Rayer Suette p 465 322 SWEATING SICKNESSES

1700 Breslau 1709 Dantzic Marienburg 1712 Miimpelgart 1713 Saint Valery Somme 1714 15 Laybach 1715 Breslau Turin 1718 Tubingen Abbeville Somme 1720 Canton de Bray Lower Seine 1723 Francfort on the Maine 1724 Turin Vercelli 172C Acqui Guise Aisne 1728 Chambery Annecy St Jean de Maurienne Savoy Carmagnola Vercelli Ivrea Biella 1729 Vienna Austria 1730 Pignerol 1731 Fossano 1732 Nizza Rivoli 1733 Fossano Asti Lanti Acqui Basle Silesia 1734 Strasburg Lower Rhine Acqui Lanti 1735 Trino Lanti Fresneuse Lower Seine Vimeux Seine et Oise Orleans Loiret Pluviers Loiret Meaux Villeneuvo 1735 Saint George Seine et Marne Bohemia Denmark Sweden Russia 1738 Luzarches Royaumont Seine et Oise Susa Crescentino 1740 Caen Calvados Provins Seine et Marne Vire Calvados Berthonville Eure Falaise Calvados 1741 Rouen Lower Seine Tartana Valencia Alexandria London 1742 Caudebec Lower Seine Ceva Turin Sorillano Alba Ivrea Cherasco Fossano 1743 Villafranca 1744 Acqui 174C Zurich 1747 Paris Seine Beaumont Seine et Oise Chambly Oise Modena Lodi Mantua Piacenza 1750 Schaffhausen Bern Geneva Beauvais Oise 1751 Villafranca Y 2 THE PICARDY SWEAT 323

1752 Fernaise Seine et Oise 1753 Susa 1754 Valepuiseux Seine et Oise 1755 Novara 1756 Cusset Allier Boulogne Pas de Calais 1757 Montaigu les Combrailles Puy dc Dome 1758 Amiens environs Somme 1759 Paris Seine Guise Aisne Caudebcc Lower Seine 1760 Alencon Orne 1763 Vire Calvados 1763 64 Bayeux Calvados 1765 Balleroy Bosoques Calvados Saint George Saint Quen tin Calvados 1766 Campagny Calvados 1 767 Thinchcbray Truttemer Orne 17G8 69 St Quentin Aisne 1770 Louviers Eure 1771 Montargis Loiret 1772 Hardivilliers environs 1773 Hardivilliers Oise 1776 Laigle Orne 1777 Jouy Seine et Oise 1782 Castelnaudary Aude Boissy Saint Leger Seine et Oise 1783 Beaumont Seine et Oise 1791 Meru Oise 1810 Nourare Villotran Oise 1812 Rosheim and many other places Lower Rhine 1821 La Chapelle Saint Pierre and sixty places around Oise Seine et Oise Sect 3 The Roettingen Sweating Sickness We now come to a phenomenon which notwithstanding its short duration and very limited extension is one of the most memorable of this century Up to the present time its real importance has not been recognised because the clouds of self sufficient ignorance have prevented our taking a survey of the formation of diseases throughout long periods of time It has been sunk for an age in the sea of oblivion from whence we will now draw it forth to the light of day In November 1802 a very hot and dry summer had been succeeded by incessant rain Thick fogs spread over the country and enveloped such places in central Germany as were inaccessible to ventilation Amongst others the small Franco nian town of Roettingen situated on the river Tauber and surrounded by mountains a Scarcely had a few weeks elapsed 1 At that time inhabited by about two hundred and fifty country people Sinner p 7 324 SWEATING SICKNESSES

when unexpectedly towards the 25th of November an extremely fatal disease broke out in the town which was without example in the memory of its inhabitants and totally unknown to the physicians of the country Strong vigorous young men were suddenly seized with unspeakable dread the heart became agitated and beat violently against the ribs a profuse sour ill smelling perspiration broke out over the whole body and at the same time they experienced a lacerating pain in the nape of the neck as if a violent rheumatic fever had taken possession of the tendinous tissues This pain ceased sometimes very quickly and if it then shifted to the chest the distressing palpitation of the heart recommenced a spasmodic trembling of the whole body ensued the sufferers fainted their limbs became rigid and thus they breathed their last In most cases all this occurred within four and twenty hours They did not all however succumb under the first attack but as soon as the accelerated pulse had sunk to the lowest ebb of smallness and feebleness a corresponding effect being observable in the respiration the violent pain would in some cases return to the outward parts The patient then felt a benumbing pressure and stiffness in the nape of the neck and the pulse and respiration became restored again as in health but the perspiration continued to pour incessantly down the skin This apparent safety was however very deceptive for a renewed palpitation of the heart unexpectedly commenced accompanied by a feeble pulse and then death was often inevitable It was remarkable that the patients though bathed in perspiration had very little thirst and the tongue was not dry nor ever even foul but retained its natural moisture With most however the urine was scanty as the skin under the increasing debility permitted too much fluid to stream forth through its pores If the disease passed off without heating sudorifics then in general no eruption made its appearance The malady then continued till the sixth day but on the first only did it display its malignant symptoms for by the second the sweating diminished and lost every unfavourable quality so that increased transpiration of the skin without any other symptoms of importance alone remained and on the sixth day the patient was perfectly restored THE BOETTINGEN SWEATING SICKNESS 325

Had there been in Roettingen a physician at hand from the commencement well skilled in medical history and who would have adopted the old English treatment of the Sweating Sickness this new fever would have appeared but as a perfectly mild disease and would certainly have carried off but few of the inhabitants of this peaceful little town As it was however the scenes of Liibeck and Zwickau were renewed and it seemed as if the innumerable victims to the hot treatment and to Kegeler's truculent medical work had descended to the grave in vain The sufferers were as in the sixteenth century literally stewed to death for the moment the people imagined that they knew how nature meant to escape they ordered feather beds to be heaped on the perspiring patient so that the mouth and nose alone remained uncovered Doors and windows were tightly closed and the stove emitted a glowing heat whilst a most intolerable odour of perspiration streamed forth from beneath the broad and lofty beds added to which that two and even more patients were often lying in the same room nay even stowed together under the same mountain of feathers and in order that inward heat might not be wanting pots of theriaca were swallowed and the patient was incessantly plied with elder electuary Thus the bad humours were expelled together with the perspiration and whether the sufferers were suffocated or surmounted as by a miracle this mal treatment of nature a conviction was felt that the most salutary remedies had been employed and when at last eruptions of various colours broke out it was considered as certain that the poison had been carried off in them The citizens of Roettingen therefore fell into the same erroneous opinion which upheld by medical schools had time immemorial increased inflammatory diseases particularly the exantheuiatous and caused them to become malignant The above mentioned eruptions were of various sorts miliary vesicles of every form and colour filled with an acrid fluid actual blistery eruptions pemphigus and even petechiae and it is to be observed that the patients during the first days of the sweating fever never suffered from that peculiar pricking sensation over the whole body which precedes the eruption of miliaria but complained only and that not always of a local itching where the eruption had broken out It wasequally rare to observe a regular desquamation of the skin 326 SWEATING SICKNESSES

and it is therefore to be assumed that the eruptions were only symptomatic and not by any means necessarily connected with the disease as in the decidedly miliary fevers The disease excited from its very commencement the greatest consternation and as it was increased even from the first days of its appearance by the sudorific system of treatment deaths were multiplied the continual peal of funeral bells struck mortal terror as of old at Shrewsbury into the hearts of both sick and healthy and this oppressed little town was shunned as a pesthole by the inhabitants of the surrounding neighbourhood At the commencement of the disease they were entirely without medical advice till a skilful physician arrived from the vicinity and as most of the inhabitants were already attacked with the sweating fever he immediately prescribed the proper treatment But the powers of one man are not sufficient amid such confusion to contend with the deeply rooted prejudices of the people and so they continued in most houses to expel by heat and theriaca both perspiration and life together till at last on the third of December Dr Sinner of Wiirzburg arrived without whom the remembrance of this remarkable disease would have been obliterated and conjointly with his gallant colleague like the anonymous physician formerly in Zwickau subdued the destructive prejudices of the people He found eighty four patientsi under piles of feather beds who when pure air was admitted breathed once more freely and by a prudent cooling system all recovered easily and without danger one only excepted His method reminds us of the old English treatment c The disease was confined entirely to Roettingen it did not make its appearance anywhere beyond the gates of this little town On the fifth of December however clear frosty weather set in from that time no new cases occurred and all traces of this Roettingen sweating fever which was never either Dr Thein government physician of the town of Aub b The whole number of cases and of deaths is not stated Dr Sinner found nine bodies none of which had been opened shortly before the cessation of the disease c Every thing heating was avoided the air was cautiously purified cooling beverage was given and contrary to the method of Brown at that time in vogue few medicines such as valerian spirits of hartshorn Hoffman's drops &c were employed Blisters were of service and likewise under some circumstances camphor The convalescents were well nourished THE ROETTINGEN SWEATING SICKNESS 327

preceded or followed by miliary fever in any part of Franconia have from that time disappeared The resemblance of this fever to the English Sweating Sickness is manifest and is proved even by the short only ten days duration of the visitation which as we have stated is a most essential characteristic of the English sweating epidemic at least as it appeared in Germany the miliary epidemics always having lasted a much longer period But if we confine ourselves merely to the symptoms of the disease we shall find that in the Roettingen sweating fever there are throughout none that can be considered essential except the palpitation of the heart accompanied with anguish the profuse perspiration and the rheumatic pains in the nape of the neck which never were wanting in any case and the very same symptoms are clearly and perceptibly to be discerned in like proportion as compared with others in the representation of the English Sweating Sickness whereas the eruptions were altogether as unessential as in the epidemic of the sixteenth century The irritability of the skin and tendency to dangerous metastases were less marked in the Roettingen fever than in the English Sweating Sickness for the patients could without injury change their linen in the midst of the perspiration which in the English Sweating Sickness could not have been done without fatal consequences but this difference can easily be accounted for from the greater degree of suffering in the latter disease than in the former It only now remains to examine the duration of the disease and here we plainly perceive that the principal paroxysm was over in the Roettingen epidemic within the first four and twenty hours at least when it was undisturbed by treatment and the sole symptom which continued until the sixth day the increased perspiration we speak here only of perfectly pure cases could only reasonably be regarded as a sequela The crisis did not occur all on a sudden as in the English Sweating Sickness but this cannot constitute any essential difference We do not hesitate therefore to pronounce the Roettingen fever to have been the same disease as the English Sweating Sickness To give however this phenomenon its proper interpretation to have a clear conception of the causes which again drew down from the clouds into the midst of Germany this mist bora spectre of 1529 and allowed it to expend its brief fury upon SWEATING SICKNESSES

a single place is beyond the power of human wisdom Science is not comprehensive enough to discover in the crossings of these unknown comet paths the moving causes of this visitation of disease But as all insight into the works of nature must be preceded by a strict investigation and search after phenomena in all countries at all times and under all circumstances of development so an improved knowledge of diseases and of the whole human system will not fail to follow when the investigations of epidemics throughout extensive periods have increased in number and success The present age demands such a knoivledge of medical men whose vocation it is to investigate life minutely in all its bearings It demands of them an historical pathology and to this branch of the study of nature is the present work intended to contribute THE ROETTINGEN SWEATING SICKNESS 329

GENERAL PREFACE The Council of the Sydenham Society having deemed Hecker's three treatises on different Epidemics occurring in the Middle Ages worthy of being collected into a volume and laid before its members in an English dress I have felt much pleasure iu presenting them with the copyright of the Black Death in negotiating for them the purchase of that of the Dancing Mania whereof I could resign only my share of a joint interest and in preparing for the press these productions together with a translation now for the first time made public of the Sweating Sickness This last work from its greater length and from the immediate relation of its chief subject to our own country may be considered the most interesting and important of the series Professor Hecker is generally acknowledged to be the most learned medical historian and one of the most able medical writers in Germany His numerous works suffice to show not only with what zeal he has laboured but also how highly his labours have been appreciated by his countrymen and when I state that with one trifling exception they have all been translated into other languages I furnish a fair proof of the estimation in which they are held in foreign countries and so far at least as regards the originals a full justification of the Council of the Sydenham Society in their choice on the present occasion The Schwarze Tod or Black Death was published in 1832 and I was prompted to undertake its translation from a belief that it would prove interesting at a moment when another fearful epidemic the Cholera with which it admitted of comparison in several particulars was fresh in the memory of men The Tanzwuth or Dancing Mania came out shortly afterwards and as it appeared to me that though relating to a less terrific visitation it possessed an equal share of interest and holding a kind of middle place between a physical and a moral pestilence furnished subject of contemplation for the general as well as the professional reader I determined on adding it also to our common stock of medical literature When the EngHsche Schweiss or Sweating Sickness which contained much collateral matter little known in England and which completed the history of the principal epidemics of the middle ages appeared in 1834 1 proceeded to finish my task but failing in the accomplishment of certain arrangements connected with its publication I laid aside my translation for the time under a hope which has at length been fulfilled that at some future more auspicious moment it might yet see the light It must not be supposed that the author in thus taking up the history of three of the most important epidemics of the middle ages although he has illustrated them by less detailed notices of several others considers that he has exhausted his subject on the contrary it is his belief that in order to come at the secret springs of these general morbific influences a most minute as well as a most extended survey of them such as can be made only by the united efforts of many is required He would seem to aim at collecting together such a number of facts from the medical history of all countries and of all ages as may at length enable us to deal with epidemics in the same way as Louis has dealt with individual diseases and thus by a numerical arrangement of data together with a just consideration of their relative value to arrive at the discovery of general laws The present work therefore is but one stone of an edifice for the construction of which he invites medical men in all parts of the world to furnish materials a Whether the information which could be collected even by a I might here enlarge on the general importance of the study of epidemics but this has been so fully set forth in the author's Address to the Physicians of Germany which immediately follows as well as in the Preface to the Sweating Sickness at p 177 that any further observations on this subject would be superfluous on my part

the most diligent and extensive research would prove sufficiently copious and accurate to enable us to pursue this method with complete success may be a matter of doubt but it is at least probable that many valuable facts now buried in oblivion would thus be brought to light and the incidental results as often occurs in the pursuit of science might prove as serviceable as those which were the direct object of discovery Of what immense importance for instance in the fourteenth century would a general knowledge have been of the simple but universal circumstance that in all severe epidemics from the time of Thucydidesa to the present day a false suspicion has been entertained by the vulgar that the springs or provisions have been poisoned or the air infected by some supposed enemies to the common weal How many thousands of innocent lives would thus have been spared which were barbarously sacrificed under this absurd notion Whether Hecker's call for aid in his undertaking has in any instance been answered by the physicians of Germany I know not but he will be as much pleased to learn as I am to inform him that it was the perusal of the Black Death which suggested to Dr Simpson of Edinburgh the idea of collecting materials for a history of the Leprosy as it existed in Great Britain during the middle ages and that this author's very learned and interesting antiquarian researches on that subject as published in the Edinburgh Medical and Surgical Journal have been the valuable and I trust will not prove the solitary result As the three treatises now comprised for the first time under the title of The Epidemics of the Middle Ages came out at different periods I have thought it best to prefix to each the original preface of the author and to the two which have already been published in English that of the translator also while Hecker's Address to the Physicians of Germany although written before the publication of the Englische Schweiss forms an appropriate substitute for an author's general preface to the whole volume a urTt xtKi tkt 0n vr eturuv ui c III Xvravrhetot tpagftatica tff 3t 3Xl xa v If r if iia ru Thucyd Hist B ii 49 The disease was attributed by the people to poison and nothing apparently could be more authentic than the reports that were spread of miscreants taken in the act of putting poisonous drugs into the food and drink of the common people Observations on the Cholera in St Petersburg p 9 by GW Lefevre MD 8vo 1831 GENERAL PREFACE vii

At the end of the Black Death I had originally given as No III of the Appendix some copious extracts from Caius Boke or Counseill against the Disease commonly called the Sweate or Sweatyng Sicknesse but tins little treatise is so characteristic of the times in which it was written so curious so short and so very scarce that I have thought it worth while with the permission of the council of our Society to reprint it entire and to add it in its more appropriate place as an Appendix to the Sweating Sickness Only two copies are known to exist one in the British Museum and one in the library of the College of Physicians viii