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and unaccustomed fever . . . chiefly infestuous to the brain and nervous stock.'' The term
"acute fever with dumbness" was applied to a disease first fully described by Dr. William Butter in
1782. Willis's epidemic had, according to the summary of Creighton, " symptoms which were not quitf
clearly those of enteric fever, spots like fleabites, on the neck and other parts, swelling and suppuration
of the glands in the hinder part of the neck, effusion of fluid on the brain and in the lateral ventricles and
the intestine free from disease." The dumbness, the modern observer will notice, finds its counterpart
in the recent "epidemic lethargy"; the glandular enlargements too, have been said to be so commonly
met with, in 1918, as to justify the application to the whole series of prevalences of the expression "glandu'ar
fever"; but Creighton "s two last criteria are especially noteworthy, the postmortem findings being
reported upon as positive qua hydrocephalus, and negative qua typhoid fever. So that Willis has
helped him to the clear discernment of a group of correlated diseases prevailing epidemically in successive
years, of which influenza is the central figure with cerebrospinal fever on either hand. Sydenham in his
account confirms an important observation of Willis as to the incidence in 1661 upon children and young
people; also the fact that the prevalence was one of a "new disease," and that there were included
among its symptoms, phrensy, coma vigil and in some cases diarrhoea.
Turning next to Sydenham's second constitution, the comatose fevers of 1673-76 (with influenza
in 1675), there is recorded the profound stupor passing into absolute aphonia (the "acute fever with
dumbness" of later writers), as in Willis's account of 1661; there is mention too, of the fact that" during
convalescence the head, through weakness, could not be kept straight, but would incline to one side
and then to the other." Sydenham describes the influenza of 1675 as a febris comatosa, and Creighton
claims that there was a similar outbreak in 1679. This last comes of course in the group of fevers
constituting the return of Sydenham!s intermittent constitution (1678-80), a constitution comparable
as already said to that of 20 years before. The fever of 1679, says Creighton," produced the characteristic
effect of influenza upon the London Weekly Bills and it came in the midst of epidemic agues, just as the
"epidemic catarrhs of 1658 and 1659 had done." He establishes this contention more securely by a
citation from a contemporary work of Dr. Christopher Morley. This group of fevers was followed by
"continued depuratory" fevers, and then in 1685 by the "new fever." The depuratory fevers were
apt to present purple spots, but the fevers were sporadic, says Morton, and not contagious.
Creighton has dissected out Sydenham's epidemic constitutions into eight groups. Of these
the first is included in (a) below ; the 2nd, 3rd and 4th are not germane to the present purpose, as they
deal with plague, smallpox, dysentery, etc., respectively; the 5th becomes (b) below; the 6th becomes
(c); and the 7th and 8th are included with later prevalences in (d).
(a) "Intermittent" constitution of 1661-64 with a continuous fever throughout. The
fevers of 1657-59 which include the influenza of 1658 had preceded these, and Wil'is's nervous
fever of 1661 overlaps upon this constitution.
(b) The "comatose fevers " of 1673-76, with a " new disease " (influenza) interpolated in
1675.
(c) Return of the intermittent constitution (1678-80) Sydenham regards the fevers of
these years as equivalent to those of 1661-64. In the midst of this constitution Creighton was
able to fix the " new disease " (influenza) of 1679.
(d) Depuratory fevers or dregs of the intermittents (1681-84); the new fever of 1685.
Sydenham records nothing after 1686, but Harris in London and Molyneux in Dublin
described a "universal short fever" (doubtless influenza) in 1688 and "spotted" and other
fevers followed later.
This statement may be compared with Creighton's tabular analysis of the constitutions given on
p. 10 of Vol. II. of his Epidemics. The liberty has been taken of adding the last two constitutions
of Creighton's table to a new constitution (d), which then comprises, as (a), (b) and (c) do, intermittents
with influenza interpolated in their midst. Creighton supplies this sequence of epidemics in (a), (b) and
c) and by combining constitutions in (d) that group is made into one comparable with those which
precede it. It has been claimed elsewhere (Proc. Roy. Soc. Med. Vol. IX.) that the new fever of 1685
bears a very close resemblance to the 1915 outbreak (in London) of influenza plus cerebrospinal fever. It
should be observed, moreover, that under heading (c) above, there is included a central influenza not
referred to by Sydenham, but inserted on the strength of Creighton's discovery of a rise typical of
influenza in the London mortality returns, together with his citation of corroborative evidence supplied
by contemporary writings. In one of these by Dr. Morley, the prevalence is thus described." 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 ague fever and in Derbyshire sarcastically the new delight." Again,
another contemporary (Dr. Simpson) describes "chills at the outset, pains in the head and back, in some
with shaking, then intense burning heat, thirst, profuse immoderate sweats and great debility, a general
lassitude, dulness and stupor, which in many were followed by delirium and a comatose state."
The evidence supplied by the four groups (a), (b), (c) and (d) shows that epidemic agues must be
joined with fevers, for the reason that, as Creighton says, "they can hardly be separated, in the earlier part
of the history." He observes in a later passage: "There are periods such as 1657-59, 1678-79 and
1727-29*—when short waves of epidemic catarrhs or catarrhal fevers came in the midst of longer
*It may be added here that, in 1709, Sir David Hamilton records in London a case of malignant fever in a lad
who had "a great difficulty or hindrance of speech, with offensive sweats and red and purple spots ... a deadly
fever with loss of speech from the beginning," which recalls the "acute fever with dumbness" and brings to mind
the "epidemic lethargy" of recent notoriety. It seems to have been, says Creighton, "a common type of fever in
the latter part of the 17th century and early part of the 18th." He adds, "its main features may be said to have
been its incidence upon the earlier years of life, but not to the exclusion of adult ages, its remarkable ataxic symptoms
which led Willis to refer it to the brain and nervous stock (spinal cord), its comatose character, its spots, occasional
miliary eruption, ill-smelling sweats and other foetid evacuations, its protracted course and its hectic sequelae." Any
observer of the London epidemic of 1918 can only marvel that the variously designated botulisms and lethargies of that
year should have been regarded as new diseases,