THE

CYCLOPÆDIA

OF

PRACTICAL MEDICINE.

Sydenham and Etmuller have described the epidemic catarrh of 1675, which began in Germany in September, and in England in October. Malta was afflicted by the plague the same year, from which it remained free till the last severe visitation of this scourge in 1813.

in August was followed by a fatal epidemic fever. | demico anni 1762," who records its appearance (Short's Hist. vol. i. p. 331; and Webster's Hist. in London about the 4th of April. Razoux, a 310.) physician of Nismes, has given an account of the same disease, which was epidemic in Europe generally in the spring. (Dict. art. Grippe.) It attacked Breslau at the end of February; Vienna was visited in March, and Hamburg in April. In Venice it was more fatal than in other places. It spared, however, Paris and the greatest part of France; nor can we find any particular cause for this exemption. Nismes most probably was visited; and Webster says that «Toulon lost one third of its inhabitants by an epidemic in 1761." The influenza of 1762 appeared sooner in London than in any other part of England, namely, the beginning of April. It was not observed in Edinburgh and Dublin till May; but in June it was general and severe, according to Sir G. Baker, being seen no where earlier than February nor later than July. It had prevailed in America the preceding year. (Webster's Hist. i. p. 410.) It was not till July that it attacked the British sailors in the Mediterranean. It was immediately followed in London by an epidemic dysentery, which raged till November. While the influenza prevailed, the deaths in London scarcely exceeded the usual number. In Manchester they were even fewer than common; and at Norwich far more died of it than fell victims to the more severe influenza of 1743. (Baker, de Catarrho, p. 33.)

The epidemic catarrhal fever which raged during the autumn and winter of 1729, in the space of five months' time visiting almost every part of Europe, was very fatal in many large cities, such as Paris and London. Loew says that in the latter more persons died than at any one time since the plague of 1665, about one thousand being cut off weekly in September. In the beginning of winter it reached France. A few weeks after, it visited the upper part of Italy with great mortality. In February it afflicted Rome and the Rhine. Turin and Milan suffered extremely. It reached Naples in March, and after this disappeared.(Short, ii. p. 54. Hoffmann, Opera, tom. ii. p. 109.)

The influenza of 1732-3 is described in the second volume of the Edinburgh Medical Essays, and by Huxham; and was so far remarkable that it affected the mucous membrane of the alimentary canal as well as that of the organs of respiration. It spread over all Europe, and appeared also in America. It was first noticed about the middle of November in different parts of Germany. Edinburgh appears to have been the first place attacked in Britain, viz. on the 17th of December, and it raged at the same time in Switzerland, at Basle. It appeared at London and in Flanders the first week in January; towards the middle of the same month it reached Paris, and Ireland towards the end. Cornwall and Devonshire were visited about the beginning of February; few only were attacked at Plymouth, where Huxham practised, so soon as this: but in March it prevailed on all sides. In February Leghorn was attacked, and near the end of it Naples and Madrid suffered. New England in America was invaded by the distemper about the middle of October, which travelled southward to Barbadoes, Jamaica, Mexico, and Peru, much at the same rate as it had done in Europe. It appears to have been at Paris early in the year. "Elle se manifesta, dit de Jussieu, à la suite de brouillards fétides, plus épais que les ténèbres de l'Egypte." (Edinb. Med. Essays, vol. ii. p. 31. Huxham, de Aere, &c. tom. i. Dict. des Scien. Méd. art. Grippe.)

The next epidemic catarrh, in order of time, was that noticed in London and different parts of the nation by Dr. Fothergill and some of his friends in the latter end of the year 1775. It was observed also in France, Holland and Germany, and was supposed to be more fatal in those countries than in Britain, (Lettsom's Memoir of the Life of Fothergill, 4to.; and Med. Obs. and Inquiries, vol. vi.)

The influenza of 1782 was general over England, Scotland, and Ireland, between the months of May and July inclusive. A full account of it is given in the second volume of Memoirs of the London Medical Society, by Dr. R. Hamilton, which is the groundwork of the article "Influenza" in the Edinburgh Medical and Surgical Dictionary; an account is also given in the first volume of Medical Communications by Dr. Gray, compiled from papers in the British Museum, which is the basis of a like article in the Cyclopædia of Dr. Rees. (See also the third volume of Transactions of the College of Physicians, London.)

The influenza of 1782 seems to have pursued The epidemic catarrh of 1733 was followed by a course from the east, not very different from that those of 1741 and 1742; the first described by of the epidemic cholera which is now (1832) disHaller, and the second by Sauvages and Huxham. playing its ravages in Great Britain and France. In 1743, towards the end of April, Huxham says It is reported to have broken out in September that it was general in England, and in the spring 1780, and to have become very general in the spread over all Europe under the name of "influ- crew of the Atlas East Indiaman, whilst that enza," or "grippe." This epidemic was the pre-ship was sailing from Malacca to Canton. When cursor of the plague of Messina in Sicily the same year; and it was more fatal in the southern parts of Europe than in England, though it increased the deaths in London in one week to a thousand. (De Aere, &c. tom. ii. p. 104.)

the ship left Malacca, there was no epidemic disease in the place; when it arrived at Canton, it was found that at the very time when they had the influenza on board the Atlas in the China seas, it had raged at Canton with as much vioThe next remarkable visitation of the influenza lence as it did in London in June 1782, and with was in 1762; and an elegant description of it is the very same symptoms. In October and Nogiven by Sir George Baker, "De Catarrho Epi-vember 1781 it appeared in the East Indies, and

was said to have attacked the British army while it was besieging Negapatam in November 1781. Its progress is stated by Webster, to have been from Siberia and Tartary westward. At Moscow it prevailed in December 1781; at Petersburgh in February 1782; and it was traced to Tobolski. It was in Denmark in the latter end of April. From the shores of the Baltic it spread to Holland and the Low Countries, and thence to England. London was said to be attacked sooner than the west and north; Ireland a few weeks later, and the south of Europe later still; for it prevailed in France in the months of June and July, in Italy in July and August, and in Portugal and Spain in August and September; seldom continuing longer than six weeks in any place.*

19

1782, a complaint, similar to the influenza, was taken notice of in some parts of the kingdom several months before that disorder made its progress through it. (Med. Commun. vol. i. p. 6.)

generally mild in its character, was almost uniThe influenza of last year (1831), though versal; for it would seem to have prevailed in both hemispheres in the same year. have been received of its appearance in India as well as in the United States of America. (AmeriAccounts can Journ. of Science, &c. vol. xxi. No. 44, p. 407.) In many places it has been the precursor of the epidemic cholera. About a month before the latter disease broke out in Warsaw, it prevailed in that city. (Brierre de Boismont sur le Cholera, p. 110.) It also swept over great part of England, Scotland, and Ireland, in the spring and autumn, and preceded the milder visitation of epidemic cholera which many parts of Great Britain experienced the same year. Late in the autumn it attacked Paris, the south of Spain, Gibraltar, and Italy, with more severity than it did the British islands. At Rome it was said to occasion great alarm. It has certainly skipped over many countries of Europe in its march from Poland to France through England, so far as we can judge negatively from the want of official reports; but, with this exception, it has pursued a course not widely different from that of similar former epidemics, and has proved to be a true herald of the epidemic cholera in many places.

The influenza of the spring of 1803 afforded an occasion for collecting a great number of notices from different parts of the country on the subject of this epidemic. The London Medical Society set a laudable example by proposing a set of queries to its corresponding members in a circular letter; and the sixth volume of "Memoirs" contains reports from nearly sixty practitioners in England, Scotland, and Ireland, as to the date of its first appearance, its symptoms, treatment, &c. in their respective neighbourhoods. Dr. Beddoes also interested himself very zealously on the same occasion, and procured various testimonies from his friends and others, which, to the number of one hundred and twenty-four, are inserted in the ninth and tenth volumes of the "London Medical and Physical Journal." These documents contain (art. INFLUENZA, in Encyclop. der gesammt. Medi[In the epidemic of 1831, according to Most, a mass of very useful information. This epidemic cin. und Chirurg. Praxis, Leip. 1836,) 30,000 was observed at Paris and in other parts of France people, it was asserted, were suffering at the same and in Holland some weeks before it appeared in time in Berlin; and, at a later period, 45,000 in London; and Dr. Bardsley says "the same length Paris. Another severe epidemic prevailed in Euof time was occupied in its progress from the lat-rope and the United States in 1837; and another ter city to Manchester." (Med. and Phys. Journ. in 1843. Of the European epidemics of 1831, vol. ix. p. 529.) Its course seemed to be from S. 1833, and 1837, the two first were less severe, to N. It was in Cork and Dublin before it reached and attacked fewer individuals than the last.] the north of Ireland, immediately after a S. E. wind. An epidemic ophthalmia followed it inhibited a greater variety of symptoms, in its difFrance, (Dict. ut supra,) and a severe dysentery, such as had not been known for thirty years, in some parts of the United States, which it visited the same spring. (New York Med. Repos. 2d Hex. vol. ii. p. 141.) It was observed to be epidemic in Sussex, and some of the counties in the S. W. as early as February; in Shropshire, Nottinghamshire, &c. in March; in Yorkshire and Lancashire in April; and at Sunderland in May. (Mem. of Med. Soc. of London, vol. vi.) It was evident that there was a degree of progressive movement northward, by marking the time when it was at the height in each place; yet many of the accounts above alluded to inform us clearly that sporadic or solitary cases exhibiting the true characters of influenza, occurred in several places long before the disease became established, so as to manifest a universal tendency to that form of complaints over the country, in some cases weeks before it was quite developed. It is worthy of notice that this has been remarkably the case with the epidemic cholera. Dr. Gray observes that, in

Transactions of the College of Phys. vol. iii., and Med. Communications, vol. i. Rees' Cyclopædia, Art. Influenza; and Trotter's Med. Nautica, i. 362. Observations on Dis. of Seamen, by G. Blane, M. D., p. 151.

II. The influenza does not seem to have exhi

ferent visitations, than other epidemics. It has varied a little in town and country, in spring and autumn, at the beginning and end of the epidemic, in different persons, and according to the particular genus or tendency of the epidemic constitution; but still it has maintained some prominent characteristics of its identity at different periods. has been marked by the following symptoms :-it The ordinary course of the disease usually commenced with slight chills, amounting sometimes to shiverings, and alternate flushings of heat, with languor and sense of extreme wearicourse of the frontal sinuses: these were quickly ness: then, soreness over the eyes, or pain in the followed by frequent sneezing, a copious discharge of lymph or thin clear fluid from the nose and eyes, sometimes so acrid as to excoriate the upper lip; heat and soreness in the top of the larynx and oesophagus, and along the course of the windpipe, with hoarseness and dry cough; sense of stricture in the chest and difficulty of breathing, sometimes attended with darting pain in the anxiety about the præcordia, flying pains in the muscles subservient to respiration; weight and back, knees, calves of the legs, and various parts of the body; depression of spirits, and sudden

and extraordinary prostration of strength, The tongue was mostly covered, at an early period of the complaint, with extremely white mucus, like cream-a symptom particularly noticed. by Hux-ferent visitations of the distemper. And this has ham, Baker, Pettit, and others: there was loss of appetite, the thirst was inconsiderable, and the pulse generally quick, weak, and soft.

and Phys. Journal, vol. x. p. 309.) If this was the case, the symptoms might be expected to vary considerably in different places, as well as in dif

happened accordingly. The rarer occurrences were, an unusual disposition to sleep, strangury and bloody urine independent of blisters, peculiar slow and strong pulse, with excessive debility, as at Newark; ringing in the ears and abscess, and abscess in the frontal sinus; of which last Dr. Rush had three cases in 1790. (Trans. of Col. of Phys. iii. 68, and Rush's Med. Inquir. ii. 354. Mem. of Med. Soc. vol. vi. p. 383.)

The duration of influenza in any one place seldom has exceeded six weeks. Upon the whole few have died of this complaint, although it has often attacked more than one-half or even threefourths of a whole community. The chief victims have been the aged and asthmatic, those of tender lungs and of full oppressed habits. Those of middle age were more liable to be affected than old persons and children; and persons exposed to the air than those who were confined. Many recovered their strength very slowly, and some, especially in 1762, fell into incurable consumption.

The preceding symptoms appeared in various degrees and combinations, as the violence of the disease fell more particularly upon the mucous membrane, in the head, in the throat and chest, or in the stomach and bowels. When the disease chiefly affected the head, vertigo, violent headach, greatly increased by the cough, and delirium, were not unfrequent: there was hemorrhage from the nose, and pain in the ears; from which, in one case, a clear fluid was poured out like that from the nostrils. (Med. Trans. of the College of Physicians, vol. iii. p. 69.) In some rare cases the tonsils and back part of the throat were inflamed, so that suppuration was the consequence. When the violence of the disease fell upon the lungs, as in old people, asthmatic patients, and those predisposed to phthisis, hemoptoe was not uncommon, and frequent troublesome cough which prevented sleep. It often degenerated into pleurisy and peripneumony. In common cases the cough became loose in three or four days. The stomach was affected with nausea in many, and vomiting in some; and a spontaneous diarrhoea relieved both head and lungs, and speedily cut short the complaint. But in many instances, and in several visitations of the epidemic catarrh, a morbid determination to the intestinal canal was manifest from the beginning; which, so far from being considered a salutary effort of nature to relieve the system in that way, required especial care in the treatment, and the utmost caution in the use of purgatives. The fever was generally mild in the day-time, and it increased in the evening; and it seldom abated till some critical amendment took place by perspiration or otherwise. There was little remarkable in the urinary secretion. The duration of the complaint was from a day or two to a week or fortnight. In some, the symptoms, after abating in two or three days, returned and raged with violence. The far greater part had critical sweats about the third day, which, attended with free expectoration, banished the fever on the fifth day. One of the most remarkable features of influenza is the debility; so that many could not rise from the horizontal posture without sudden faintings, even in the state of convalescence; and the debility often remained for a considerable time. The suddenness of the invasion, the pain and tightness in the forehead, with pain in the back, knees, and muscles, and singular prostration of strength, were thought to be distinguishing marks between the influenza and common catarrh. Indeed, the pain or soreness in the face, temples, and cheekbones, was considered the most certain pathognomonic symptom in 1782; "and now and then was felt previously to the catarrh, and not unfrequently was followed by very little or no catarrhal affection."

In one district in Gloucestershire, a practitioner states that "in no two persons in 1803 did he observe precisely the same symptoms." (Med.

[Some epidemics have, however, proved extremely fatal. The mortality of the epidemic of 1837 in Europe was greater than that from cholera, although the disease was by no means so severe, or so rapidly fatal. This was owing to its attacking almost every one, whilst the ravages of cholera were comparatively limited. It has been estimated by Dr. Graves (Clinical Lectures) that in Dublin alone, 4,000 persons died of the influenza of 1837.]

III. One general observation seems to apply to almost every epidemic disease, including even those of a pestilential nature, viz. that during its prevalence numbers are attacked in so slight a manner as to require but little medical care. Hence the influenza, which in all its visitations has had a favourable character in the majority of cases, has been easily removed by mild diluents, rest, and abstinence for a few days from animal food and fermented liquors. Besides this, a complaint so various not only in its symptoms but in the degrees of their intensity, modified too at different periods by season, climate, and epidemic constitution, would of necessity call for the exercise of much discretion in the employment of remedies. But, making due allowance for all this variety of character in the complaint, and for the judicious adaptation of a corresponding treatment, physicians of eminence, in different countries, seem to have agreed remarkably in their testimony as to the general rules and principles of their practice; and from the very beginning of the sixteenth century, in their reports, with respect to bloodletting, to the caution about active purgatives, to the employment of a cold regimen, and to the restricted use of opiates, there is a very striking and satisfactory coincidence.

In the mild attacks of the disorder, few if any medicines have been required. In severe cases, emetics at the beginning relieved the sufferings of the head and chest, and, combined with gentle aperients and antimonial or saline medicines, were found useful in mitigating the fever and promoting a salutary diaphoresis.

64

21

No observation is to be found more general in | be useful; while, on the contrary, warm rooms, practical writers in this disease than that blood- hot drinks, and cordial sudorifics, aggravated the letting could rarely be employed with safety, far violence of the disorder. Blisters to the chest, less with benefit, on account of the alarming de- sides, or back, often greatly relieved the stitches bility and weakness of the pulse; and when it and cough; and ipecacuanha was much extolled, was strongly indicated, practitioners were sparing especially in France, for its efficacy, when given in the quantity of blood, and cautious in repeating in small doses, in assisting expectoration, relievthe remedy. In the epidemic of 1510, Dr. Short ing the oppressed lungs, and correcting the tentells us that "bleeding and purging did harm." dency to irritation of the mucous membrane of In 1557, bleeding was said to be so fatal, that in the bowels. A medicine often used with good a small town near Madrid two thousand persons effect to ease the cough when attended with viscid died after it in September. In 1580, Sennertus phlegm, was the solution of gum ammoniac comascribes the death of two thousand persons in bined with oxymel of squills. When recovery Rome to venesection, and states that, where it was omitted, the mortality was not greater than one was tedious and the strength much impaired, in a thousand. even long before the cough was removed, some Experientia enim hoc compro- bitter infusion, such as that of calumba, cascarilla, bavit, omnes fere mortuos esse, quibus vena ape- or Peruvian bark, with wine-whey and some nuriebatur." Forestus, in his Scholia on the same tritious diet was of great service. The reason epidemic, suggests a good practical hint, that we why purgatives have been so generally reprobated ought to distinguish very carefully those cases by practitioners in the influenza, appears to have which might require, from those which might not depended on the fact, that a morbid state of the bear this remedy. Huxham, who had no preju- mucous tissue of the internal surfaces exposed to dice against bloodletting, remarks, peripneumoniæ aliquid subesset, minime largam, bid tendency in that of the alimentary canal; Imo, si vel the air, was often closely connected with a morsine maxima virium ruina, plus vice simplici and, therefore, drastic purgatives, though they venæsectionem tolerabat: nec in hac solum, sed might relieve one system or set of organs, yet too in omni febre catarrhali epidemica hoc fere per- often only transferred the disease, as it were, to petuum notavi.” (De Aere, &c. ii. 102.) In another, and produced a dangerous debility. Edinburgh it was noticed that those who were bled, in 1733 and 1782, “recovered more slow-wright of Natchez, (Medico-Chirurg. Rev. for [Lobelia inflata was recommended by Dr. Cartly;" though others at the commencement seemed to be relieved by the lancet. (Med. Essays, vol. vi. p. 29.) In the influenzas of 1733, 1775, and 1803, in France, bloodletting was generally injurious. (Dict. des Sc. Méd. Grippe, pp. 356, 359, 363.) Dr. Glass reports that at Exeter, in 1775, venesection "weakened the patient without reliev-dicine, 2d. edit. i. 263, Philad. 1844,) is certainly ing the pain;" and Dr. Ash considered that "it was never necessary to bleed at Birmingham; that in a neighbouring town, three died who were bled, and all recovered who were not bled." (Lettsom's Mem. of Dr. Fothergill, 4to. p. 627.) Dr. Gray gives it as a general inference from the accounts transmitted to a "Society of Physicians" in 1782, that bloodletting was by no means conducive to the general cure of the disease." (Med. Com. vol. i. p. 80.) Many physicians bear testimony to the same good rule of practice in the influenza of 1803, as Dr. Bardsley of Manchester, Dr. Kinglake of Taunton, Dr. Rutter of Liverpool, and others. (Med. and Phys. Journ. vol. ix. and x.) Notwithstanding the foregoing authorities, it is admitted by some eminent physicians, that cascs now and then occurred in which this remedy was useful. Sir George Baker made this observation in 1762, in London (p. 29); and in the same city it is somewhat remarkable that in the epidemic of 1775 it was less hurtful than in other places, which was perhaps owing to the more frequent complication of the disease that year with pleurisy and peripneumony, at all times no unusual circumstance.

Opiates at the commencement of the disease almost invariably increased the febrile heat, aggravated the headach, in some cases even to delirium, tightened the chest, and stopped the expectoration: but in the decline they proved salutary. A cool temperature, both in drinks, in the air of rooms, and in the quantity of bed-clothes, was found to

April, 1837, p. 586,) for the not very cogent reason, that "in those diseases affecting the mucous lining of the bronchial tubes, the lobelia inflata comes as near being a specific [?] as tartaremetic and the lancet in pneumonia and pleurisy." Lobelia, as elsewhere said, (Practice of Me

a valuable sedative, but not deserving of the elevated rank that has been assigned to it. The diseases of the bronchial tubes differ, and no one remedy can be applicable to every pathological condition. When there was more than usual inflammation of the bronchia, in the epidemic of 1837, large doses of the ethereal tincture of lobelia, repeated at short intervals, with counter-irritation, seemed, according to Dr. Blakiston, to be useful.]

weather, which seem to have had a connection IV. Among the phenomena relating to the with epidemic catarrh, either as precursor or attendant, signs, we may notice extraordinary vicissitudes, easterly winds, thick or offensive fogs, and diseases, often of a similar kind, among horses, dogs, and cattle. Epidemic catarrh is a disease either of spring or autumn. The spring influenzas have sometimes occurred when the first heat suddenly followed the winter's cold; and the autumnal, when the cold moisture and raw fogs of November have succeeded to the heat of a dry harvest; yet there has not been a uniform connection between any one sensible quality of the atmosphere as to heat or cold, rain or drought, for in different places it has maintained itself unwind or calm, and the prevalence of this epidemic; der the dominion of each of these states of the weather, "et tempori frigidiori et calidiori, et flante tam austro quam Borea, et pluvioso et sereno cœlo, peragravit hasce omnes Europæ regiones, et omnia loca indiscriminatim." (Salius Diversus, cited by Dunning, Med. and Phys. Journ. x. p.