Part 4

The Oriental Plague, the great devastator of Europe in former times, and still the scourge of some portions of it, is a fever characterized by specific glandular inflammation.

The Sweating Sickness of the 15th and 16th centuries was a fever, with symptoms of acute rheumatism, attended with a fœtid perspiration which poured from the body in streams. “Suddenly,” says Hollingshed, “a deadly burning sweat assailed their bodies and distempered their blood, and all, as soon as the sweat took them, yielded the ghost.”

The Cholera of modern times is a fever, which appears in its true character when the first stroke of the disease does not prove fatal, and time is allowed for the full development of its successive stages.

The common Epidemics of the day—Ordinary as distinguished from Extraordinary Epidemics—typhus, scarlet fever, small-pox, measles,—are so universally recognized as fevers that the popular notion of fever is derived from the external characters which these maladies present.

2. Epidemics resemble each other in the extent of their range. Ordinary diseases attack single individuals, and if, from season or other causes, several cases occur simultaneously, they are still isolated and scattered. They never prevail at the same time among several members of a family, or among the inhabitants generally of a court, street, or town. Epidemics, on the contrary, derive their name from their attacking large numbers at once.

The great Epidemics of all ages have been strikingly characterized by their wide-spread course. The Black Death extended from China to Greenland, and desolated in its course Asia, Europe, and Africa.

The Bubo-Plague of the middle ages often extended beyond its proper seat. In the 15th century it spread seventeen times over different European countries, and extended to the most distant northern nations.

The Sweating Sickness prevailed simultaneously or in rapid succession over England, France, Germany, Prussia, Poland, Russia, Norway, and Sweden. “It extended,” say the chronicles of the day, “like a violent conflagration which spread in all directions; yet the flames did not issue from one focus, but rose up everywhere as if self-ignited.”

The Influenza of the middle ages took a range which may be said to have been universal. In our own day we have seen the same disease attack almost every family, in nearly every city, town, and village; spread within a short period over the whole of Europe, and then extend through the vast continent of the New World.

Cholera traverses the earth in zones, spreads with equal facility through tropical and polar regions, and attacks alike the seats of civilization and the huts of the slave and the savage.

3. Epidemics resemble each other in the rapidity of their course. Sometimes, indeed, they begin slowly, advance haltingly, and gather strength in silence. For some time they give so little indication of their power that the apprehension of their presence is very constantly regarded as a “false alarm.” Now and then, here and there, they strike a sudden and mortal blow; but it is only an individual that falls. After a considerable interval, perhaps at a great distance, another blow is struck; and then one by one, another and another, until at last the fact becomes too manifest to be doubted or denied, that two victims have been seized in one family—several in the same street—three or four on the same day, in distant parts of the town, or in the adjoining town, or it may be in towns separated from each other by the distance of hundreds of miles. At length the terror-stricken nation, startled from its fondly cherished security, sees no place safe from the Plague. When, however, the causes are intense, it may break forth quite suddenly, and spread with astonishing rapidity.

In 1831, when Cholera first appeared in Cairo, it extended within the space of five days over the whole of Lower Egypt, desolating simultaneously all the towns and villages of the Delta.

In 1832 it leaped at one bound from London to Paris, and when once there, spread in five days over thirty-five out of forty-eight quarters of the city.

When Influenza broke out in London in 1847, it spread in one day over every part of the metropolis, and upwards of 500,000 persons suffered from the malady.

4. Epidemics resemble each other in giving distinct and unmistakeable warnings of their approach. These warnings consist of two events: first, the sudden outbreak and general spread of some milder epidemic; and, secondly, the transformation of ordinary diseases into diseases of a new type, more or less resembling the character of the extraordinary disease at hand.

It is a very singular fact that both in the middle ages, and in modern times, the lesser Epidemic which has generally preceded and pre-announced the coming of the greater, is Influenza.

The history of European Epidemics from the 14th century downwards, shows that whenever a new Plague was at hand, destined to become truly European, it was preceded by a sudden outbreak of Influenza, as general as it was violent. This is exemplified with singular uniformity in the Epidemics of the 16th century—the severest epidemic period on record. It is most remarkable that in our own day the first visitation of Epidemic Cholera was preceded by an outbreak of Influenza which resembled, in the most minute particulars, the violent and universal Influenza that ushered in the mortal Sweating Sickness Epidemic of 1517.

So again, on the second visitation of Cholera, in 1848, it was preceded, as we have just seen, by the universal Influenza of 1847.

Footnote 3:

It may be remarked that for some time prior to the Cattle Plague in the autumn of 1865, the disease called pleuro-pneumonia had extensively prevailed among the herds throughout the country. [ED.]

The second circumstance, and a most instructive one it is, premonitory of the advent of a great Epidemic, is a general transformation of the type of ordinary diseases into the characteristic type of the approaching pestilence. Sydenham gives a graphic description of such a transformation in the character of the fevers and inflammatory diseases prevailing in London some months before the outbreak of the Great Plague. He states that this change consisted in an approximation, in several striking features, of the general type of disease, to the distinguishing characters of the Pestilence which had not yet appeared, but was close at hand.

In 1831, in the wards of the London Fever Hospital, I observed and recorded a precisely similar change in the general type of the fevers in London, six months before the first visitation of Cholera. Anterior to that period, fever in London, for a long series of years, had been essentially an acute, inflammatory disease, for which bloodletting and other depleting remedies were indispensable. At this period it ceased to be an inflammatory disease; it became a disease of debility, in which no one could think of bleeding; and so closely did the prevailing fever now put on the general character of the approaching plague, which was as yet six months distant, that the fever into which those Cholera patients fell, who were not killed by the first stroke—the consecutive fever, as it was afterwards called—could not be distinguished from the primary fever in the wards of the Hospital when Cholera was at its height, which had appeared there for the first time six months previously, and which has never disappeared since.

Footnote 4:

This was written in November, 1855.

It is further very remarkable that the Professors of Veterinary Medicine and Surgery in London noted at the same time a similar change in the type of the diseases of the lower animals—horses, cows, sheep, and all domestic creatures;—a change requiring a similar modification of the remedies which they had been in the habit of using.

5. A further character of great Epidemics, partly arising from the last, is this:—they are actually present and in operation some time before they assume their distinct and proper form. Sometimes, indeed, the very first cases are most intense and characteristic, but at others they are scarcely to be distinguished from the severer attacks of ordinary disease of a like nature. Hence doubt is sometimes reasonably entertained of their true character. When at length increasing numbers leave no doubt of the actual presence of the dreaded malady, the first announcement of it is always received with incredulity and sometimes with resentment; and so it is that Epidemics always take a country by surprise—burst suddenly on an unprepared people, who wilfully shut their eyes against the plainest evidence, as if they would avert the event by denying its existence.

6. Again, Epidemics resemble each other in the uniformity of their course. They present, with great regularity, periods of comparative quiescence and activity—periods of well-marked increase, culmination, and decrease.

7. They further resemble each other in the manner of their migration. They advance by leaps. On breaking out in a locality they soon come to their height, decline, and disappear. Then they attack another locality; here they pass through precisely the same process as before, and proceed to a third, fourth, or fifth district, and so on. Sometimes indeed they localize themselves on the same spot for a considerable period, and then several places may be simultaneously affected; but for the most part a large city may be regarded as a cluster of towns, through the several districts of which epidemics advance as if they were proceeding from one town or village to another. Hence the duration of an epidemic in a place is generally proportionate to its size. The several localities attacked being visited in succession, a space of time is required to spread through the whole of them proportionate to the magnitude of the town.