The same use of ague is continued in the first native English book on fevers, Dr John Jones’s ‘Dyall of Agues,’ which has chapters on plague as well as on pestilential fever and on all other fevers including intermittents. In Ireland the name of ague was applied until a comparatively late period to the indigenous typhus of the country, as if in literal translation of the febris acuta first spoken of by Giraldus in the 12th century. Ague in early English meant any sharp fever, and most commonly a continued fever. The special limitation to intermittents appears to have followed the revival of the study of the Graeco-Roman writers on medicine, Galen above all, in the sixteenth century. But Jones, who was freer than the more academical physicians of his time from classical influences, is shrewd enough to see that it was a mistake to transfer the experiences of Greece verbatim to England and to make them our standard of authority: he is speaking, however, not of intermittents but of the simple ephemeral fever, or inflammatory fever of one day:

At a later date, when the Hippocratic tradition had displaced the Galenic, Rogers of Cork, perhaps the earliest writer on fevers whose observations are essentially modern, has occasion thus to reflect upon the extreme deference of Sydenham to his Greek model: “Again we learn from Hippocrates that fevers in the warmer climates of Greece, at Naxos, Thasos or Paros, ran their course in certain periods of time, which no ways answers in regions removed at a farther distance from the sun,”—Rogers himself having had no experience of intermittents among all the fevers and dysenteries that he saw from 1708 to 1734, although Cork was surrounded by marshes[535].

At the time of the Latin translations of Greek medical writings by Linacre and Caius in the Tudor period, there were in this country actual experiences of strange fevers, which were interpreted according to the Greek teaching of quotidians, tertians and quartans, with their several bastard or hybrid or larval forms. These, as I have said, were certainly not the endemic fevers of malarious districts; they were, on the contrary, widely prevalent all over the country during one or more seasons in succession and more occasional for a few years longer; then there would be a clear interval of years, and again an universal epidemic of “the new fever,” “the new acquaintance,” “the new ague” or the like.

Sydenham, for example, has much to say of agues or intermittents prevalent in town and country for a series of years, and then disappearing for as long a period as thirteen years at a stretch. But he does not count these as the agues of the marsh; his single reference to the latter is in his essay on Hysteria, where he interpolates a remark that, if one spends two or three days in a locality of marshes and lakes, the blood is in the first instance impressed with a certain spirituous miasma, which produces quartan ague, and that in turn is apt to be followed, especially in the more aged, by a permanent cachectic state[536]. If Sydenham had intended to bring all the intermittents of his experience into that class, he would not have left the paludal origin of them to a casual interpolated remark. On the other hand, he refers the epidemic agues, which occupy his pen so much, to emanations from the bowels of the earth, according to a theory of his friend Robert Boyle, applied by the latter to epidemical infections in general and to epidemic colds or influenzas in particular. Sydenham and his learned colleagues were not ignorant of the endemic agues of marshy localities, but they made little account of them in comparison with the aguish or intermittent fevers that came in epidemics all over England.

In admitting the reality of such agues, we must be careful not to ascribe them to such conditions as Talbor, the ague-curer, found in one village in Essex. We must be careful not to do so, because there are plausible reasons for doing so. The ground is much better drained now than formerly; there is less standing water, fewer marshes, a much smaller extent of water-logged soil. But the malarious parts of England have been tolerably well defined at all times; and at all times the greater part of the country was as little malarious as it is now. It is the frequent reference to agues in old medical writings that has led some modern authors to construct a picture of a marshy or water-logged England, for which there is no warrant. Cromwell died of a tertian ague which he caught at Hampton Court; therefore “the country round London in Cromwell’s time” must needs have been “as marshy as the fens of Lincolnshire are now.” The country round London was much the same then as now, or as in John Stow’s time, or as in the medieval monk Fitzstephen’s time, or as it has ever been since the last geological change. The ague of which Cromwell died in the autumn of 1658 was one of those which raged all over England from 1657 to 1659—so extensively that Morton, who was himself ill of the same for three months, says the country was “one vast hospital.” Whatever was the cause of that great epidemic of “agues,” and of others like it, we have no warrant to assume that “the country round London,” or wherever else the epidemic malady prevailed, was then as marshy as the fens of Lincolnshire[537].

The other name in the title of this chapter, influenza, appeared comparatively late in the history. It is an Italian name, which is usually taken to mean the influence of the stars. It may have got that sense by popular usage, but the original etymology was probably different. As early as the year 1554 the Venetian ambassador in London called the sweating sickness of 1551 an influsso, which is the Italian form of influxio. The latter is the correct classical term for a humour, catarrh, or defluxion, the Latin defluxio itself having a more special limited meaning. It was not astrology, but humoral pathology, that brought in the words influxio and influsso; and I suspect that influenza grew out of the latter, but not out of the notion of an influence rained down by the heavenly bodies.

It was in 1743 that the Italian name of “influenza” first came to England[538], the rumour of a great epidemic, so called, at Rome and elsewhere in Italy having reached London a month or two before the disease itself. The epidemic of 1743 was soon over and the Italian name forgotten; so that when the same malady became common in 1762, some one with a good memory or a turn for history remarked that it resembled “the disease called influenza” nearly twenty years before. After the epidemic of 1782, the Italian name came into more general use, and from the beginning of the present century it became at once popular and vague. The great epidemics of it in 1833 and 1847 fixed its associations so closely with catarrh that an “influenza cold” became an admitted synonym for coryza or any common cold attended with sharp fever. Lastly, the series of epidemics from 1889 to 1893 effectually broke the association with coryza or catarrh.

Before influenza became adopted as the common English name towards the end of last century, what were the names popularly given to the malady in this country? The earliest references to it are in the medieval Latin chronicles under the name of tussis or cough, or in some periphrasis. In the fifteenth century the English name was “mure” or “murre,” which appears to be the same root as in murrain. Thus the St Albans Chronicle, under the year 1427, enters a certain “infirmitas rheumigata,” which in English was called “mure”; and the obituary of the monks of Canterbury abbey has two deaths from “empemata, id est, tussis et le murra[539].” In the Tudor period there is no single distinctive name, unless it be “hot ague”: in 1558 the name is “the new burning ague,” in 1562 “the new acquaintance,” in 1580 “the gentle correction,” and at various times in the 17th century “the new disease,” “the new ague,” “the strange fever,” “the new delight,” “the jolly rant.” Robert Boyle called one sudden outbreak “a great cold.” Molyneux, of Dublin, mentions “a universal cold” in one year (1688), and “a universal transient fever” in another (1693). The earlier 18th century writers mostly use the word catarrh or catarrhal fever, either in Latin or in English, the popular names probably continuing fanciful as before, as for example Horace Walpole’s “blue plagues.” That which stands out most clearly in the English naming from the earliest times is the idea of something new or strange; but the newness or strangeness pertained quite as much to the agues as to the catarrhs. The notion of ague may be said to be uppermost in the 16th and 17th centuries, that of catarrh in the 18th and 19th; while our very latest experiences have once more brought a suggestion of ague to the front.

Retrospect of Influenzas and Epidemic Agues in the 16th and 17th centuries.

In the former volume of this history I have dealt with the various epidemics of “hot ague,” “new disease” or the like down to the epidemic of 1657-59. It will be convenient to go over some of that ground again, with a view to distinguish, if possible, the catarrhal types from the aguish, and to illustrate the use of the word ague as applied to a universal epidemic. Two of the epidemic seasons in the 16th century, 1510 and 1539, are too vaguely recorded for our purpose; but I shall review briefly the seasons from 1557-58 onwards.

The English names of the epidemic sickness in the summers and autumns of 1557 and 1558 are all in the class of agues—“this new burning ague,” “a strange fever,” “divers strange and new sicknesses taking men and women in their heads, as strange agues and fevers,” “quartan agues.” One medical writer, Dr John Jones, says in a certain place that “quartans were reigning everywhere,” and in another place, still referring to 1558, that he himself had the sickness near Southampton, that it was attended by a great sweat, and that it was the same disease as the sweating sickness of 1551. There were certainly two seasons of these agues, 1557 and 1558, the latter being the worst; and it is probable from Short’s abstracts of a few parish registers in town and country that there was a third season of them in 1559. The year 1557 has been made an influenza year, perhaps because the Italian writers have emphasized catarrhal symptoms here or there in the epidemic of that year; while both the years 1557 and 1558 have been received into the chronology of epidemic or pandemic agues or malarial fevers[546]. There are perhaps a dozen English references in letters and chronicles to the sicknesses of those years, either to particular cases or to a general prevalence, but they do not enable us to distinguish a catarrhal type in 1557 from the aguish type which they assert for both 1557 and 1558.

Four years after, another very characteristic influenza was prevalent in Edinburgh.

It is not improbable that the interval between 1558 and 1562 may have been occupied with milder revivals of the original great epidemic, the one at Edinburgh counting in the series.

It appears from a Brabant almanack for the year 1561 that a sudden catarrhal epidemic was quite on the cards in those years: the astronomer foretells for the month of September, 1561: “Coughs innumerable, which shall show such power of contagion as to leave few persons unaffected, especially towards the end of the month[548].” There is an actual record from more than one country (Italy, Barcelona, as well as Edinburgh) of such universal catarrhs and coughs a year later than the one foretold. The Italian writers assign the universal catarrhs and coughs to the autumn of 1562, the Barcelona writer to the winter solstice of that year, and the letter from Edinburgh to “the laste of November.”

The next undoubted influenza, that of 1580, was compared abroad to the English sweat:

Two such epidemics in England as those of 1557-8 and 1580-82, of hot agues or strange fevers, taking the forms of simple tertian or double tertian or quartan or other of the classical types, would have made ague a familiar disease, and its name a household word. For not only were there two or more aguish seasons (usually the summer and autumn) in succession, but to judge by later experience there would have been desultory cases in the years following, and in many of the seizures acquired during the height of the epidemic, relapses or recurrences would have happened from time to time or lingering effects would have remained. Hence it is unnecessary to assume that the agues that we hear casual mention of had been acquired by residence in a malarious locality. They may have been, and most probably were, the agues of some epidemic prevalent in all parts of the country. These epidemics were the great opportunities of the ague-curers, as we shall see more fully in the sequel. It is to the bargaining of such an empiric with a patient that Clowes refers in 1579: “He did compound for fifteen pound to rid him within three fits of his ague, and to make him as whole as a fish of all diseases.”

There were more sicknesses of that kind, perhaps not without a sweating character, in the last ten years of the 16th century[552]. But they are indefinitely given as compared with earlier and later epidemics, and I shall pass to the next authentic instance.

The first half of the 17th century is a period which is almost a blank in the conventional annals of “influenza” in Europe. But that period, which was the period of the Thirty Years’ War, had many widespread sicknesses. I do not wish to claim these as influenzas, or to contend that they were infections equivalent thereto in diffusiveness. We may, however, find a place for them in this context; for they were certainly as mysterious as any epidemics admitted into the canon of influenzas. So far as concerns Britain, the first was the epidemic ague, or “new disease,” of 1612 and 1613, probably recurring until 1616. The second was the universal spotted fever of 1623 and 1624, of which I have given an account in the chapter on typhus. That was followed by the plague of 1625, and that again by a harvest ague in the country in the end of the same year. The next epidemic ague or “general sickness, called the new disease,” fell mostly in England upon the two years 1638 and 1639. It was in part a harvest ague, “a malignant fever raging so fiercely about harvest that there appeared scarce hands enough to take in the corn[563]”; but it was also a winter disease. I pass over the war-typhus of 1643, to which the name of “new disease” was also given, and the widespread fever of the year following. In 1651 we hear again of a strange ague, which “first broke out by the seaside in Cheshire, Lancashire and North Wales,” eighty or a hundred being sick of it at once in small villages. Whitmore, who saw this epidemic in Cheshire, identified it with the Protean disease which he described in 1657-58, and hazarded the theory that the former was a diluted or “more remiss” infection carried by the wind from Ireland, where the plague was then raging, in Dublin, Galway, Limerick and other places, after their sieges or occupations by the army of the Commonwealth.

Thus in the first half of the 17th century we have more or less full evidence of epidemics of “new disease” in 1612-13, 1623-24, 1625, 1638-9, 1643-4 and 1651, not one of which was an influenza as we understand the term[564].

We come at length to the years 1657-59, in the course of which one catarrhal epidemic, or perhaps two, did prevail for a few weeks. The hot agues or “new disease” had been raging all over the country from the summer of 1657; then in April, 1658, there came suddenly universal coughs and catarrhs, “as if a blast from the stars”; they ceased, and the hot agues dragged on through the summer and autumn. A letter from London, 26 October, 1658, says: “A world of sickness in all countries round about London: London is now held to be the wholesomest place,” and adds that “there is a great death of coach-horses almost in every place, and it is come into our fields[565].” It was after this, in the spring of 1659, if Whitmore has made no mistake in his dates, that coughs and catarrhs “universally infested London, scarce leaving a family where any store were, without some being ill of this distemper.” The details have been given fully in the former volume[566]. I wish merely to remark here that the two catarrhal epidemics, or influenzas proper, in two successive springs, were sharply defined episodes in the midst of a period of epidemic agues, and that the “new disease” as a whole, during the two or three years that it lasted, had such an effect in the way of ill health and mortality that it was afterwards viewed as a “little plague” worthy of being set in comparison with the Great Plague of 1665.

Willis does not say that the epidemic agues lasted after 1658, perhaps because his essay was printed early in 1659; but Whitmore, whose preface is dated November, 1659, says, without distinguishing the hot ague from the catarrhal fever but speaking of them both as one Protean malady: “it now begins again, seizing on all sorts of people of different nature, which shows that it is epidemic.” Sydenham does not appear upon the scene until 1661; but when his epidemic constitutions do begin, it is with intermittents or agues, which lasted, according to him, until 1664. Perhaps if Sydenham’s experience had extended back to 1657 he would have made his aguish constitution to begin with that year, and to go on continuously until 1664. At all events it does not appear that the year 1660 was a clear interval between Willis’s and Whitmore’s period of 1657-59, Sydenham’s period of 1661-64; for it so happens that John Evelyn has left the following note of his own illness:

Sydenham makes the “constitution” which began for him in 1661 to decline gradually, and to end definitely in 1664, after which he finds intermittents wholly absent for thirteen years, or until 1677. This clear interval will make a convenient break in the chronology, whereat we may bring in the popular and professional notions of ague then current, and the popular practice in that disease by empirics.

The Ague-Curers of the 17th Century.

It is to be observed that all the respectable writers of the profession speak of agues or intermittents as epidemic over the country for a definite period, and as disappearing thereafter for years together. At the same time they say little or nothing of the endemic malarious fevers of marshy localities. Further, it appears that the professed ague-curers, although they would wish to represent ague as a perennial disease, are really basing upon the same experiences of occasional epidemics which Willis, Whitmore and Sydenham recorded as occasional. The best instance of this is the ‘Pyretologia’ by Drage of Hitchin. It was published for practice in 1665, being designed to show forth the author’s skill as an ague-curer[567]. When we examine its generalities closely, we find that they all come from the sickly season of 1657, the first of those described by Willis.

Drage must have had a real experience of aguish distempers of one kind or another during the sickly seasons of 1657-59. But it is clear from the essays or advertisements of empirics that agues were discovered in many forms of sickness that were neither intermittent fevers nor fevers of any distinctive type. One of these practitioners in the time of Charles I. claims to be “the king’s majesty’s servant in ordinary[568]”; which is not incredible, as Sir Robert Talbor, whom Charles II. deigned to honour, was an ague-curer of the same class.

Let us take next the advertisement of an apothecary a generation after, who professed to cure Kentish agues,—“the description and cure of Kentish and all other agues ... and humbly showing (in a measure) the author’s judgment why so many are not cured, with advice in relation thereunto, whether it be Quotidian, Tertian or Quartan, simple, double or triple[569].” Before the Fire of London he had practised in Mark Lane, but after his house was destroyed he removed to Kent, attending Maidstone market every Thursday, and residing at Rochester, a city which, “besides being subject to diseases in common with others, hath two diseases more epidemical, namely, the Scurvey for one but the Ague in special.” The symptoms of scurvy, as he gives them, cover perhaps the one moiety of disease, and those of ague the other.