The most celebrated ague-curer of the Restoration period was Sir Robert Talbor, who thus describes the high motives that made him a specialist[570]:

Talbor’s first chapter is a fluent account of how agues are produced by “obstructions” of the spleen. This was a matter of theoretical pathology which an empiric could make a show with as well as another. But the empiric betrays himself as soon as he comes to practice. The enlarged spleen of repeated agues, or of the malarial cachexia, is commonly known as the ague-cake. There is no doubt that much of the unhappiness of the aguish habit resides in the ague-cake, and that one of the best pieces of treatment is to apply counter-irritants or the actual cautery to the left side, against which the enlarged spleen presses as a cake-like mass. Talbor, however, desired to free the patient from his “ague-cake” altogether:

Having followed this “good old way of observation and experiment” for several years among the residents of the Essex marshes, Talbor came to London, and set up his sign next door to Gray’s Inn Gate in Holborn. In 1672 (14th July) he issued a small work with a Greek title—the quacks were fond of the Greek character on their title-pages—“Πυρετολογια, a rational account of the cause and cure of agues, with their signs: whereunto is added a short account of the cause and cure of feavers.” He made a bid also for practice in “scurvy,” a disease of landsmen in those times which was more a bogey than ague itself—“a strange monster acting its part upon the stage of this little world in various shapes, counterfeiting the guise of most other diseases ... sometimes it is couchant, other times rampant, so alternately chronic and acute.”

Most of the agues which Talbor professed to have met with in London in those years must have been equally factitious: for Sydenham, who makes more of “intermittents” than other writers of repute, was of opinion that, for thirteen years from 1664 to 1677, fevers of that type had not been seen in London, except some sporadic cases or cases in which the attack had begun in the country. But the air was then full of talk and controversy about Peruvian bark, or Jesuits’ powder (pulvis patrum), or “the cortex,” which was cried up as a specific in agues by some, and cried down by others. Talbor had seized upon this specific, and claimed to have an original way of administering it, whereby its success was assured. We get a glimpse of his practice from Dr Philip Guide, a Frenchman who came to London and practised for many years as a member of the College of Physicians[572]. Talbor had cured the daughter of Lady Mordaunt of an ague, and the cure had reached the ears of Charles II. One of the French princesses having been long afflicted with a quartan ague,

The Peruvian Bark Controversy.

It can hardly be doubted that the conflicting opinions as to the benefit of Peruvian bark in ague, which have been often cited in disparagement of medicine and as an example of its intolerance, arose from the indiscriminate use of it in “agues” diagnosed as such by quacks and pushing practitioners. The bark had been brought first to Spain in 1632 and had been tried medicinally in 1639[573]. It was under the powerful patronage of the Jesuits, especially of Cardinal de Lugo, and most of it at that time found its way to Rome, the centre of a malarious district. In 1652 it failed to cure a “double quartan” in an Austrian archduke, and thereafter fell into some disrepute. A violent controversy on its specific use in agues arose in the Netherlands; it had failed in every case at Brussels, it had not failed in a single case at Delft. Meanwhile it remained, very dear, sixty florins having been paid at Brussels in 1658 for as much as would make twenty doses, to be sent to Paris. The London ‘Mercurius Politicus’ of the week 9-16 December, 1658, contained an advertisement[574] that a supply of it had been brought over by James Thompson, merchant of Antwerp, and was to be had either at his own lodgings at the Black Spotted Eagle in the Old Bailey or at Mr John Crook’s, bookseller, at the sign of the Ship in St Paul’s Churchyard. The London physicians such as Prujean and Brady countenanced it, and Willis, in reprinting his essay on Fevers in 1660, spoke of it as coming into daily use. Sydenham, whose publisher was the same Crook at the sign of the Ship, made a brief reference to it in the first edition (1666) of his Observationes Medicae, in the section upon the epidemic constitution of intermittents during the years 1661-64. He admits that the bark could keep down fermentation for the time being; but the materies which the fermentation would have dissipated if it had been allowed its way, will remain in the system and quickly renew its power. He had known a quartan continue for several years under the use of bark. It had even killed some patients when given immediately before the paroxysm. Prudently and cautiously given, in the decline of such fevers, it had been sometimes useful and had stopped the paroxysms altogether, especially if the aguish fits were occurring at a season when the malady was less epidemical. But it is clear that Sydenham in 1666 inclined strongly to non-interference with the natural depuratory action of the fever upon the materies of the disease. His teaching that the cortex, while it kept down the fermentation of the blood for a time, left the dregs of the fever behind, was thus popularly stated some years after by Roger North in relating the fatal illness of his brother the Lord Keeper Guilford in the summer of 1685[575].

Sydenham having indicated in his edition of 1666 that bark was dangerous when given immediately before a paroxysm, but that it was sometimes useful in the decline of the fever, and that its benefits were greatest in those desultory agues which appeared at, or continued into, a season when agues had become less epidemical, he proceeded in his third edition of 1675 to enlarge these indications for giving bark in ague. He begins, as Talbor had begun in his essay of 1672, and as the empiric Streater had in his advertisement of 1641, by calling quartans the opprobrium medicorum, and he then lays down precisely how bark was to be given in those obstinate fevers, as well as in tertians of the aged or feeble: namely, after the fever had exhausted itself suo Marte, in the intervals between two paroxysms, an ounce of bark (in two ounces of syrup of roses) to be taken in the course of the two free days, a fourth part at a time morning and evening. The dosage may have been borrowed from Talbor, as Sir George Baker alleges[577]; it matters little for anyone’s fame. Sydenham, however, in a letter of October, 1677, thus claimed to have been independent of Talbor so far as concerned the directions for giving bark which he inserted in his edition of 1675:

Talbor was patronised by Charles II., who caused him to be made one of his physicians. On 2 May, 1678, a few months after the date of Sydenham’s letter, Lord Arlington wrote to the president of the College of Physicians[579]: “His Majesty, having received great satisfaction in the abilities and success of Dr Talbor for the cure of agues, has caused him to be admitted and sworn one of his physicians.” Next year, 1679, the king had an attack of the reigning ague, and a recurrence of it in 1680. It is probably to the occasion of one or other of these attacks that an undated letter belongs from the Marquis of Worcester to the marchioness: “The physicians came to the Council to acquaint them that they intend to give the king the Jesuit’s powder five or six times before he goes to Newmarket, which they agreed to. He looks well, eats two meals of meat a day, as he used to do[580].” Evelyn has preserved a story told him by the Marquis of Normanby, which probably relates to the same aguish attack of Charles II.[581]:

What Dr Lower was most likely to have said was, that it went against his principles to give bark in fevers. He was a physiologist, in the sense of an anatomist, the pupil of Willis at Oxford and his successor in practice in London. It was the teaching of Willis that blood was like the juice of vegetables, particularly the juice of the grape, in respect of fermenting, just as it was like milk in respect of curdling. Fever was a sudden access of fermentation, apt to arise in spring and autumn, from internal or constitutional occasions, as well as to come at any time by infection; by this febrile ferment, ebullition or commotion, the blood was purged of certain impurities, comparable to the lees of wine, which were removed from the body in the sweat, the urine or other critical evacuation. Jesuit’s bark was believed to check fermentation, or, in the later phrase of Pringle and others, it was antiseptic; and it was probably because he thought it would check the natural defaecating action of the blood in an ague that Lower refused to prescribe it. Sydenham was more tentative, pliant, empirical. He cavilled at Willis’s doctrine of the ebullition or fermentation of the blood without actually rejecting it; for he held practically the same view of the salutary or depuratory nature of fever, which was indeed the Hippocratic view of it. Accordingly in his first reference to bark, in 1666, he sustains the objection to it, that it interfered with a natural depuratory action; and it was only in following the lead of Talbor, a more empirical person than himself, that Sydenham overcame his doctrinal scruples. Dr Short, to whom Charles II. sent privately for advice, was of Sydenham’s party; soon after that occasion, the latter dedicated to Short his ‘Tractate on Gout and Dropsy’ (1683). It was Short who “went to work with his cortex” upon the Lord Keeper in 1685, after Dr Masters, of the school of Willis, had tried his hand with phlebotomy. The king’s experiences, a few months before the Lord Keeper’s death, had been just the same, and with the same result: the deathbed of Charles II., it is well known, was the scene of ecclesiastical rivalries; but the physicians at the bedside of the king had their rivalries too.

On Monday the 2nd of February, at eight in the morning, the king had a seizure of some kind in his bed-chamber, which was currently said to have been an “apoplectic fit[582],” although there is nothing said of paralysis. A letter of the 3rd February[583] says the king “was seized in his chair and bed-chamber with a surprising convulsion fit which lasted three hours.” Dr King, an expert operator who had assisted Lower in the delicate operation before the Royal Society on 23 November, 1667, of transfusing blood from one body to another, happened to be at hand, and, at once drawing his lancet, bled the king. His promptitude in action, which probably left him little time for diagnosis, was much applauded, and the Privy Council voted him a reward of a thousand pounds, which Burnet says he never received.

Whether the bark would have saved him if the aguish nature of the paroxysms (such as he had in 1679 and again in 1680) had been clear from the first, may be doubted. But his chances of recovery were certainly made worse by the halting and stumbling diagnosis, (according to Evelyn)—now apoplexy, now epilepsy, now fever[585].

The true value of cinchona bark in medicine was not seen until much that was vague in the use of the term “ague” had been swept away. In the last great epidemic period of agues in this country, as we shall see, from 1780 to 1786, bark was found, for some reason, to be ineffective. It is not in the treatment of epidemic agues, but of agues in malarious countries, that the benefits of Jesuits’ bark have been from first to last most obvious.

The practice in so-called agues was long in the hands of empirics, who, like their class in general, made business out of ignorant or lax diagnosis. I shall add here what remains to be said of specialist ague-curers in later times. They are heard of in London in the Queen Anne period, and as late as 1745.

We may now return to the actual history of the epidemic fevers upon which the Peruvian bark was first tried on a large scale in England. The “intermittent” constitution which began in 1677 and lasted year after year until 1781 or even longer was a very remarkable one. It was called at the time the new fever, or the new ague, and it had at least one short interlude of influenza or epidemic catarrhal fever in the winter of 1679, just as the last epidemic of the kind, in 1657-59, had at least one, and probably two, short and swift epidemic catarrhs in spring. But before we come to that epidemic of 1678-81, there falls to be noticed an epidemic in the month of November, 1675, which has always been counted among the influenzas proper. After giving the particulars of it from Sydenham and from the London bills of mortality, I shall show from Sydenham and the bills of mortality that there was an exactly similar epidemic in the month of November, 1679, which has not been admitted into the conventional list of influenzas. Thereafter I shall proceed to the epidemic constitution of 1678-81 as a whole, which has been reckoned among the epidemic agues or malarious epidemics.

The Influenza of 1675.

The first that we hear of the universal cold of 1675 is an entry which Evelyn makes in his diary under 15 October: “I got an extreme cold, such as was afterwards so epidemical as not only to afflict us in this island, but was rife over all Europe, like a plague. It was after an exceeding dry summer and autumn.” It was not until November that the epidemic cold made an impression upon the death-rate in London; the deaths mounted up from 275 in the week ending 2 November, to 420 and 625 in the two weeks following, and thereafter gradually declined to an ordinary level. Part of the excess, but by no means the greater part of it, was set down under fevers, as the following section from the weekly bills of the year will show:

1675

This shows the characteristic rise and fall of an epidemic catarrh both in the article of fever deaths and in the column of deaths from all causes. The other excessive articles besides fever in the two worst weeks are also characteristic of influenza mortality:

Sydenham’s account bears out the figures[586]. At the end of October, he says, the mild, warm weather turned to cold, while catarrhs and coughs became more frequent than at any time within his memory. They lasted until the end of November, when they ceased suddenly. Afterwards he gives a special chapter to the “Epidemic Coughs of the year 1675, with Pleurisies and Pneumonias supervening.” The epidemic spared, he says, hardly anyone of whatever age or temperament; it went through whole families at once. A fever which he calls febris comatosa had been raging far and wide since the beginning of July, with which in the autumn dysenteric and diarrhoeal disorders were mingled (it was an exceedingly dry season). This constitution held the mastery all the autumn, affecting now the head, now the bowels, until the end of October, when catarrhs and coughs became universal and continued for a month. Sydenham’s view of the sequence of events was his usual one, namely, that one constitution, by change of season, passed by transition into another. Whatever the constitution of “comatose” fevers may have been, which prevailed “far and near,” it has left no trace upon the bills of mortality in London, which are remarkably low until the beginning of November. But as soon as the epidemic of coughs begins, the weekly deaths mount up in an unmistakeable manner, so that for two or three weeks in November, the mortality is nearly double that of the weeks preceding or following.

The “severe cold and violent cough,” of 1675, says Thoresby of Leeds[587], who was then a boy, “too young or unobservant to make such remarks as might be of use,” was known in the north of England “profanely” by the name of the “jolly rant.” Thoresby well remembered that it affected all manner of persons, and that so universally that it was impossible, owing to the coughing, to hear distinctly an entire sentence of a sermon. He gives December as the month of it in Leeds, and says that it affected York, Hull, and Halifax, as well as the counties of Westmoreland, Durham, and Northumberland. In Scotland also we find a trace of a strange epidemic sickness. It was the time of the persecution of the Covenanters, whose preachers moved hither and thither among the farm-houses. One of them, John Blackadder, was at the Cow-hill in the parish of Livingstown in August, 1675. He came in one evening from the fields very melancholy, and in reply to questions, he said he was afraid of a very dangerous infectious mist to go through the land that night. He desired the family to close doors and windows, and keep them closed as long as they might, and to take notice where the mist stood thickest and longest, for there they would see the effects saddest. “And it remained longest upon that town called the Craigs, being within their sight, and only a few families; and within four months thereafter, thirty corpses went out of that place[588].” The prophecy was fulfilled within four months, which would bring us to the date of the influenza, although the mortality for a small place is somewhat excessive.

The Influenza of 1679.

For the sake of comparison, I pass at once to an epidemic of coughs and colds in the month of November, 1679, which Sydenham has chronicled, but no one except Cullen[589] has thought of including among the influenzas. It produced the characteristic effect of influenza on the London weekly bills, and it came in the midst of epidemic agues, just as the epidemic catarrhs of 1658 and 1659 had done. The following rise and fall are just as distinctive of an influenza as on the last occasion in 1675:

1679

Sydenham’s account[590] of this remarkable November outburst of sickness in London, written within a few weeks of its occurrence, is almost exactly a repetition of his language concerning the epidemic coughs of November, 1675. The prevailing intermittent fevers, he says, gave place to a new epidemic depending upon a manifest crasis of the air. The new epidemic was one of coughs, which were so much more general than at the same season in other years that in nearly every family they affected nearly every person. In some cases of the cough, the aid of a physician was hardly needed; but in others the chest was so shaken by the violent convulsive cough as to bring on vomiting, and the head was affected with vertigo. For the first few days the cough was almost dry, and so purely paroxysmal as to remind Sydenham of the whooping-cough of children. Everyone was surprised, he says, at the frequency of these coughs in this season. His own suggestion was that the rains of October[591] had filled the blood with crude and watery particles, that the first access of cold had checked transpiration through the skin, and that Nature had contrived to eliminate this serous colluvies either by the branches of the “vena arteriosa” or (as some will have it) by the glands of the trachea, and to explode it by the aid of a cough. Phlebotomy and purging were the best cures; diaphoretics he considered less safe, and he ascribed to their abuse the fever into which some fell, and the pleurisies which were apt to attack patients with great violence during the subsidence of the epidemic catarrh.

The Epidemic Agues of 1678-80.

The other English writer on the epidemic constitution of 1678-79 is Dr Christopher Morley[592]. Like Sydenham, he is occupied almost exclusively with the epidemic agues; but he also records the extraordinary rise of the mortality in London for a few weeks in the last months of the year, and the causes thereof, although it did not occur to him to count that as a separate part of “the new disease,” still less as the principal part, which it really was in London so far as concerned the death-rate. Dating his preface from London, the 31st of December, 1679, he says in the text: “Within the very days of my present writing, it happens that as many as four hundred deaths more than usual have taken place in a fortnight,” the excessive mortality having been due to “coryza, bronchitis, catarrh, cough and fever,” which were the effects of “most pernicious destillations.”

I shall now go back to the beginning of the epidemic constitution in the midst of which this November interlude occurred, and I shall follow it season after season to the end, so as to set forth in historical prominence that which was regarded at the time as “the new disease.” When Sydenham returned to London in the autumn of 1677, after six months’ rest from practice, he was told by his professional friends that intermittents were being seen here and there (after a clear interval of thirteen years), being more frequent in the country than in the city. In the letter of October, 1677, cited above, he speaks of Talbor having made a fortune in two months by his cures of agues with bark.

Sydenham wrote his account of this epidemic of intermittents in compliance with a request from Dr Brady, Master of Gonville and Caius College, Cambridge, that he would continue the method of his ‘Observationes Medicae’ into the years following, and in particular give an account of his method of administering bark. He occupied most of his space with treatment; but he gives here and there the following epidemiological details. The agues were mostly tertians, or quotidians, or duplex forms of these, whereas on a former occasion they had been mostly quartans; after two or three intermissions they were apt to become continual fevers. The agues, which had occurred in the spring of 1678, became more common in the summer and autumn, when they raged so extensively that no other disease deserved the name of epidemic so much. In winter smallpox took the lead; but early in July, 1679, the agues began again, and so increased day by day that in August they were raging excessively and destroying many. It was in August that the king had his “great cold” at Windsor, which afterwards changed to an ague. Sydenham then comes to the November interlude of epidemic catarrhs, which was followed by “a fever without cough” (non penitus deleta, sed manente adhuc in sanguine, malae crasis impressione), lasting to the beginning of 1680. As that year wore on, the intermittent fevers began again, and continued more or less until 1685, becoming indeed less common in London, and less severe, than in the first four years of the constitution, but in other places, now here, now there, not less so than at first[598].

I have kept to the last the special account of this epidemic written by Morley at the end of the second year of it, namely, in December, 1679. He had been a witness of this fever, first at Leyden in the autumn of 1678, and next in England in the autumn of 1679, and he made it the subject of a treatise at the request of an eminent physician in London. It was not so severe by half in England as in Holland, but the English made a great deal more of it, calling it the New Disease, the New Ague, the New Fever, the New Ague Fever, and, in Derbyshire sarcastically, the New Delight. In Holland they called it neither new nor old, neither intermittent nor continued, nor a conjunction of both, but simply morbus epidemicus, or febris epidemica. His master at Leyden, Professor Lucas Schacht, taught very decidedly that it was of a scorbutic nature, and as early as the month of June, 1678, had prophesied the arrival of such an epidemic fever because “tertians were becoming more and more scorbutic,” just as they had done before the great epidemic of fever in Holland in 1669. Morley claims, however, that the fever of 1678 was in some respects different from that of 1669, as well as from that of the year immediately preceding, 1677, when “an incredible multitude of people all over Belgium, and in every city and town, fell sick.” The Dutch, it appears, called these occasional outbreaks simply “the epidemic fever,” neither intermittent nor continued; and certainly that of 1669, which is sometimes counted among the epidemic agues, was a very remarkable “ague.” (See Chapter I. p. 19.)

The epidemic fever of 1678, wherever it may have been bred or engendered, was prevalent in England at the same time as in Holland—in an exceedingly hot and dry autumn. The most constant symptoms, says Morley (and he writes both for Holland[599] in 1678 and for the country districts of England in the autumn of the following year), were nausea, severe vomiting, incredible tightness about the breast, weight in all the limbs, weariness, giddiness, vigils, thirst, restless tossing, and languor remaining after the disease was gone. Among the more remarkable symptoms were the following: Many had aphthae of the mouth, some twice or thrice, some being endangered by the severity and closeness of the patches of thrush. In some there occurred bleeding from the nose, or from piles, stranguary, etc. Round worms were observed, issuing both by the mouth and anus. In some few there were spots on the skin, but hardly ever petechiae or tumours near the ears. It affected all classes equally, all ages and both sexes. Some said it was easier to children than to adults, but others denied this. Some said it was more pernicious in the country than in the towns. In Leyden, the deaths never exceeded 150 in the week, being about twenty in a week above the ordinary level. More died from the coughs, anginas, peripneumonies and pleurisies that followed, than from the disease itself. Schacht says that the wind for nearly two years had been steadily from the North, or veering to the East or West. The Leyden faculty, and the Dutch generally, did not think the disease a malignant one; it was very freely called so, however, in England, the chorus being led by empirics and illiterate persons: “Ac indicio est,” says Morley, “libellus perexiguus nostra lingua ab Empirico conscriptus de hoc morbo.” This seems to refer to the tract by one Simpson, which I shall notice briefly[600].