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12
Willis's
outbreaks of
1657-59.
Sydenham's
'' constitutions."
met if he held the association to be one of influenza and cerebrospinal fever, rather than one of
" volatile " and "non-volatile typhus."
Reference must here be made to some further problems presented by the disease nomenclature of
the times. There is, some difficulty in interpreting the term "ague," as used in the 16th and 17th
centuries—it clearly meant originally however, merely acute fever. Dr. Jones regards his " Hot Rotten
Agues" as identical with the Synochus or continued fever of the Greeks. This term and " intermittent,"
"tertian" and more especially "quartan," says Creighton, "can hardly be taken in their modern
sense as restricted to malarial and climatic fevers." Yet another complication arises, for there were the
"pestilent fevers" associated with plague, "burning fevers," "spotted fevers," some of which involved
the houses of the great, while in some so many were ill that the harvest could not be gathered. Here
again "we meet the old difficulty of influenza." There were years of high (non-plague) mortality in
1638-39. In "a parish in Hampshire," a malignant fever raged about harvest time and delayed the
harvesting of 1638; and in the following year the "general sickness all over this country, called the
'new disease,' interfered greatly with public business." Boghurst refers to a country epidemic of
"spotted fever," and Whitmore describes a corresponding prevalence in Cheshire and Shropshire.
"Thus," says Creighton, "we have a remarkable epidemiological phenomenon, somewhat new to
England unless, indeed,we bring all those spotted fevers and the like under the generic name of influenza.
It was in country districts in 1612-13 and from 1623 to 25, it was extensively prevalent in 1638 in places
as far apart as Hampshire, Monmouth and Northampton, it appeared in Berkshire and Oxfordshire
in 1643 in connection with the military movements of the Royalist and Parliamentary armies, it caused
a disastrous loss of life in Tiverton within a few weeks of Essex's army passing through the town in
1644, it is heard of again in Shropshire and Cumberland in 1651-52 and in the same parts in 1658, as
well as in Somerset, and in London steadily from year to year." And then later he proceeds—" The
universality or generality of this incidence was accounted for by assuming, on the one hand, something
common in the state of the air, and on the other hand, some common predisposition in the bodies of men,
which might itself have had seasonal causes. We have now only one name for such common infection
of the air, namely influenza: and it is significant that the catarrhal influenzas of 1658 and 1659 were
regarded by so-ne, at the time, as only the appropriate vernal form of the fever, which in the hot weather
of 1657-8 had prevailed almost in the same general way as influenza, but with the symptoms of typhus."
Truly much that is very suggestive of recent behaviour of influenza and cerebrospinal fever is to hand
in the 16th century outbreaks—the "posting," the "new diseases," the "spotted fever," the involvement
of rich as well as poor, the partiality for troops and for gaols, the prevalence "in the general way as
influenza, but with the symptoms of typhus." As yet, however, there is no specific reference to the
brain and spinal cord, but that will soon follow.
Proceeding meanwhile with the pestilent fevers, there is Willis's war fever of 1643, "betraying
its malignancy by the eruption of wheals and spots." And then there is the "war typhus" at Tiverton
in 1644, which "spread far and near." This outbreak has been held to have been typhoid, but
Creighton's judgment is as follows:—" If there be gradations of type, or approximations of typhus
to sweating sickness (as well as to influenza) then we may perhaps take the Tiverton epidemic as coming
nearer than any other to the sweating sickness, on the strength of the name in the parish register" (for,
as he notes " sweating sickness " was that actually given to it).
The fever and influenza of 1657-58 described by Willis are particularly interesting. First in the
^ spring and summer of 1657 comes this " new disease," spreading widely, " scarce one in a thousand died
of it," but it raged throughout all England. Then second, there is noted in the spring of 1658, " a pure
and unmistakable epidemic of influenza cold," which did not last longer than six weeks, and then third,
in the summer and autumn of 1658, there was again a change of type to that of the original prevalence
of the preceding year. '"The fever was continual in some . . . very many were ill in their
brain and nervous stock. . ." (Creighton holds that this last expression of Willis's signifies spinal cord)
. . "in some there were broad and red spots like the measles . . after which in some came lethargy
and delirium." Creighton remarks "one notable thing in this fever was the exanthem, which reminds
one more of the rash of sweating sickness or dengue (break bone fever) than of the spots of typhus."
Thus once again there is d'fficulty in drawing a line of demarcation between typhus and cerebrospinal
fever. Whitmore described apparently the same sequence of outbreaks ; he speaks of the whole series
as "this Protean-like distemper, whose various shapes render it such a hocus pocus to the amazed and
perplexed people, they being held after most strange and diverse ways with it"; and he adds it is "so
prodigious in its alterations that it seems to outvie even Proteus himself." Creighton dubs these anomalous
fevers "the volatile typhus of the country and the towns ... in some respects like intermittents,
without the clear interval between the fits, but in respect of contagion, spots, pain and other
symptoms like typhus." He says "although this epidemiological phenomenon be a strange one, th re
is no reason to question the correctness of Willis's observations, corroborated as they are by those
of Whitmore. But there are indeed many more experiences of the like kind in the years to follow."
This group of outbreaks certainly exhibits a dovetailing of epidemics of influenza and cerebrospinal
fever beyond all possibility of mistake.
And now the search for association of influenza with cerebrospinal fever can be pursued with
grow'ng confidence right into the very citadel of typhus, in Creighton's great chapter on "Typhus and
continued fevers." He here, at the outset, uses the clue supplied by Willis in endeavouring to thread
the maze of Sydenham's "constitutions." Willis has described the fever of 1661 (with which Sydenham's
first constitution begins) as concisely as he did those of 1657-59, including the influenza of 1658. It
corresponds says Creighton, with "the worm fever, the comatose fever, the remittent fever of children,
the acute fever with dumbness, the convulsive fever," Willis himself describes it as "a certain irregular