HISTORIC EPIDEMICS.

A short history of the principal epidemics, including as it does the

description of anomalous diseases, many of which are now extinct, and

the valuable knowledge which finally led to their extinction, the

extraordinary mortalities which these epidemics caused, and many other

associate points of interest would seem fitting to close the

observations gathered in this volume. As the illustrious Hecker says,

in the history of every epidemic, from the earliest times, the spirit

of inquiry was always aroused to learn the machinery of such stupendous

engines of destruction; and even in the earliest times there was

neither deficiency in courage nor in zeal for investigation. "When the

glandular plague first made its appearance as a universal epidemic,

whilst the more pusillanimous, haunted by visionary fears, shut

themselves up in their closets, some physicians at Constantinople,

astonished at the phenomena opened the boils of the deceased. The like

has occurred both in ancient and modern times, not without favorable

results for Science; nay, more mature views excited an eager desire to

become acquainted with similar or still greater visitations among the

ancients, but, as later ages have always been fond of referring to

Grecian antiquity, the learned of those times, from a partial and

meagre predilection, were contented with the descriptions of

Thucydides, even where nature had revealed, in infinite diversity, the

workings of her powers."

There cannot but be a natural interest in every medical mind to-day in

the few descriptions given of the awful ravages of the epidemics which,

fortunately, in our enlightened sanitary era, have entirely

disappeared. In the history of such epidemics the name of Hecker stands

out so prominently that any remarks on this subject must necessarily,

in some measure, find their origin in his writings, which include

exhaustive histories of the black death, the dancing mania, and the

sweating sickness. Few historians have considered worthy of more than a

passing note an event of such magnitude as the black death, which

destroyed millions of the human race in the fourteenth century and was

particularly dreadful in England. Hume has given but a single paragraph

to it and others have been equally brief. Defoe has given us a journal

of the plague, but it is not written in a true scientific spirit; and

Caius, in 1562, gave us a primitive treatise on the sweating sickness.

It is due to the translation of Hecker's "Epidemics of the Middle Ages"

by Babbington, made possible through the good offices of the Sydenham

Society, that a major part of the knowledge on this subject of the

English-reading populace has been derived.

The Black Death, or, as it has been known, the Oriental plague, the

bubonic plague, or in England, simply the plague, and in Italy, "la

Mortalega" (the great mortality) derived its name from the Orient; its

inflammatory boils, tumors of the glands, and black spots, indicative

of putrid decomposition, were such as have been seen in no other

febrile disease. All the symptoms were not found in every case, and in

many cases one symptom alone preceded death. Although afflicted with

all the manifestations of the plague, some patients recovered.

According to Hecker the symptoms of cephalic affliction were seen; many

patients were stupefied and fell into a deep sleep, or became

speechless from palsy of the tongue, while others remained sleepless

and without rest. The fauces and tongue were black and as if suffused

with blood; no beverage could assuage the burning thirst, so that

suffering continued without alleviation until death, which many in

their despair accelerated with their own hands. Contagion was evident,

for attendants caught the disease from their parents and friends, and

many houses were emptied of their inhabitants. In the fourteenth

century this affection caused still deeper sufferings, such as had not

been hitherto experienced. The organs of respiration became the seats

of a putrid inflammation, blood was expectorated, and the breath

possessed a pestiferous odor. In the West an ardent fever, accompanied

by an evacuation of blood, proved fatal in the first three days. It

appears that buboes and inflammatory boils did not at first appear, but

the disease in the form of carbuncular affection of the lungs (anthrax

artigen) caused the fatal issue before the other symptoms developed.

Later on in the history of the plague the inflammatory boils and buboes

in the groins and axillae were recognized at once as prognosticating a

fatal issue.

The history of this plague extends almost to prehistoric times. There

was a pest in Athens in the fifth century before Christ. There was

another in the second century, A.D., under the reign of Marcus

Aurelius, and again in the third century, under the reign of the Gauls;

following this was the terrible epidemic of the sixth century, which,

after having ravaged the territory of the Gauls, extended westward. In

542 a Greek historian, Procopius, born about the year 500, gives a good

description of this plague in a work, "Pestilentia Gravissima," so

called in the Latin translation. Dupouy in "Le Moyen Age Medical," says

that it commenced in the village of Peleuse, in Egypt, and followed a

double course, one branch going to Alexandria and the other to

Palestine. It reached Constantinople in the Spring of 543, and produced

the greatest devastation wherever it appeared. In the course of the

succeeding half century this epidemic became pandemic and spread over

all the inhabited earth. The epidemic lasted four months in

Constantinople, from 5000 to 10,000 people dying each day. In his

"History of France," from 417 to 591, Gregorius speaks of a malady

under the name inguinale which depopulated the Province of Arles. In

another passage this illustrious historian of Tours says that the town

of Narbonne was devastated by a maladie des aines. We have records of

epidemics in France from 567 to 590, in which bubonic symptoms were a

prominent feature. About the middle of the fourteenth century the

bubonic plague made another incursion from the East. In 1333, fifteen

years before the plague appeared in Europe, there were terrible

droughts in China followed by enormous floods in which thousands of

people perished. There are traditions of a plague in Tche in 1334,

following a drought, which is said to have carried off about 5,000,000

people. During the fifteen years before the appearance of the plague in

Europe there were peculiar atmospheric phenomena all over the world,

besides numerous earthquakes. From the description of the stinking

atmosphere of Europe itself at this time it is quite possible that part

of the disease came, not from China, but originated in Southern Europe

itself. From China the route of caravans ran to the north of the

Caspian Sea, through Asia, to Tauris. Here ships were ready to take the

produce of the East to Constantinople, the capital of commerce, and the

medium of communication between Europe, Asia, and Africa. Other

caravans went from Europe to Asia Minor and touched at the cities south

of the Caspian Sea, and lastly there were others from Bagdad through

Arabia to Egypt; the maritime communication on the Red Sea to Arabia

and Egypt was also not inconsiderable. In all these directions

contagion found its way, though doubtless Constantinople and the

harbors of Asia Minor were the chief foci of infection, whence it

radiated to the most distant seaports and islands. As early as 1347 the

Mediterranean shores were visited by the plague, and in January, 1348,

it appeared in the south of France, the north of Italy, and also in

Spain. Place after place was attacked throughout the year, and after

ravishing the whole of France and Germany, the plague appeared in

England, a period of three months elapsing before it reached London.

The northern kingdoms were attacked in 1349, but in Russia it did not

make its appearance before 1351.

As to the mortality of this fearful epidemic Dupony considers that in

the space of four years more than 75,000,000 fell victims, that is,

about half of the population of the countries visited. Hecker estimates

that from 1347 to 1351, 25,000,000 people died, or one-quarter of the

total population of Europe. It was reported to Pope Clement that

throughout the East, probably with the exception of China, nearly

24,000,000 people had fallen victims to the plague. Thirteen millions

are said to have died in China alone. Constantinople lost two-thirds of

its population. When the plague was at its greatest violence Cairo

lost daily from 10,000 to 15,000, as many as modern plagues have

carried off during their whole course. India was depopulated. Tartary,

Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies.

In this latter country Arabian historians mention that Maara el nooman,

Schisur, and Harem in some unaccountable manner remained free. The

shores of the Mediterranean were ravaged and ships were seen on the

high seas without sailors. In "The Decameron" Boccaccio gives a most

graphic description of the plague and states that in Florence, in four

months, 100,000 perished; before the calamity it was hardly supposed to

contain so many inhabitants. According to Hecker, Venice lost 100,000;

London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000;

Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there

were 56,000 victims in Marseilles, and at Montpellier three-quarters of

the population and all the physicians were stricken with the epidemic.

Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II,

Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of

Castile, and other notable persons perished. All the cities of England

suffered incredible losses. Germany seems to have been particularly

spared; according to a probable calculation, only about 1,250,000

dying. Italy was most severely visited, and was said to have lost most

of its inhabitants. In the north of Europe two of the brothers of

Magnus, King of Sweden, died; and in Westgothland alone 466 priests

died. The plague showed no decrease in the northern climates of Iceland

and Greenland, and caused great havoc in those countries.

The moral effect of such a great pandemic plague can be readily

surmised. The mental shock sustained by all nations during the

prevalence of the black plague is beyond parallel and description. An

awful sense of contrition and repentance seized Christians of every

community. They resolved to forsake their vices, and to make

restitution for past offenses; hence extreme religious fanaticism held

full sway throughout Europe. The zeal of the penitents stopped at

nothing. The so-called Brotherhood of the Cross, otherwise known as the

Order of Flagellants, which had arisen in the thirteenth century, but

was suppressed by the mandates and strenuous efforts of the Church, was

revived during the plague, and numbers of these advocates of

self-chastisement roamed through the various countries on their great

pilgrimages. Their power increased to such an extent that the Church

was in considerable danger, for these religious enthusiasts gained more

credit among the people, and operated more strongly on their minds than

the priests from whom they so entirely withdrew that they even absolved

each other. Their strength grew with such rapidity, and their numbers

increased to such an extent daily, that the State and the Church were

forced to combine for their suppression. Degeneracy, however, soon

crept in, crimes were committed, and they went beyond their strength in

attempting the performance of miracles. One of the most fearful

consequences of this frenzy was the persecution of the Jews. This alien

race was given up to the merciless fury and cruelty of the populace.

The persecution of the Jews commenced in September and October, 1348,

at Chillon on Lake Geneva, where criminal proceedings were instituted

against them on the mythic charge of poisoning the public wells. These

persecuted people were summoned before sanguinary tribunals, beheaded

and burned in the most fearful manner. At Strasburg 2000 Jews were

burned alive in their own burial-ground, where a large scaffold had

been erected, their wealth being divided among the people. In Mayence

12,000 Jews were said to have been put to a cruel death. At Eslingen

the whole Jewish community burned themselves in their synagogue, and

mothers were often seen throwing their children on the pile, to prevent

them from being baptized, and then precipitating themselves into the

flames. The cruel and avaricious desires of the monarchs against these

thrifty and industrious people added fuel to the flames of the popular

passion, and even a fanatic zeal arose among the Jews to perish as

martyrs to their ancient religion. When we sum up the actual effects as

well as the after effects of the black death, we are appalled at the

magnitude of such a calamity, the like of which the world had never

seen before.

In the fifteenth and sixteenth centuries the plague was generally

diffused throughout Europe, and in the latter half of the seventeenth

century a final Occidental incursion of the plague took place. From

1603 to 1604 over 30,000 people perished in London from the plague, and

in 1625 the mortality in that city amounted to 35,417 persons. But the

great plague of London did not begin until 1664. In this plague the

patient at first became sensible of great weariness and fatigue, had

slight chills, nausea, vomiting, vertigo, and pains in the loins. The

mental disturbance rapidly increased, and stupor and delirium ensued.

The face was alternately flushed and pallid, and a sense of

constriction was experienced in the region of the heart. Darting pains

were felt all over the body, soon followed by the enlargement of the

lymphatic glands, or by the formation of carbuncles in various parts of

the body. About the third day the tongue became dry and brown, and the

gums, tongue, and teeth were covered with a dark fur, and the

excretions became offensive; paralysis intervened; ecchymosed patches

or stripes due to extravasation appeared on the skin; finally the pulse

sank, the body grew cold and clammy, delirium or coma seized the

victim, and in five or six days, sometimes in two or three, the painful

struggle was at an end.

It was supposed that the disease originated in the Orient and was

brought to London from Holland. In his "Journal of the Plague in

London" Defoe describes its horrors, and tells of the dead-cart which

went through the streets gathering the victims. A few extracts from

Pepys's "Diary," the evidence of an eye-witness and a contemporary,

show the ghastly aspects of this terrible visitation. On August 31st he

writes: "In the City, this week, died 7496, and of them 6102 died of

the plague. But it is found that the true number of the dead this week

is nearer 10,000; partly from the poor who cannot be taken care of

through the greatness of the number, and partly from the Quakers and

others that will not have any bell rung for them." According to Adams,

John Evelyn noted in his "Kalendarium":--"Sept. 7th.--Near 10,000 now

died weekly; however, I went all along the City and suburbs from Kent

street to St. James's, a dismal passage, and dangerous to see so many

coffins exposed in the streets; the streets thin of people, the shops

shut up, and all in silence, no one knowing whose turn might be next."

As the cold weather came on the plague diminished in intensity and the

people regained their confidence and returned to the city. According to

Adams, in the first week of March, 1666, deaths by the plague had

decreased to 42; and by the end of the month it was nearly extinct

after carrying off about 100,000 victims. In our days we can hardly

comprehend the filthy hygienic conditions under which the people in the

cities lived, and it was probably to this fact that the growth and

perpetuation of this plague was due.

As to the bubonic plague recently raging in Camptown, China, Mary Niles

says that it was the same disease as the great London plague, and was

characterized mainly by glandular enlargement. It had not appeared in

the Canton district for forty years or more, though it was endemic in

Yunnan. In some places it began in the winter; and as early as January

she herself found the first case in Canton in an infected house. In no

case was direct contagiousness found to exist. The glands enlarged

twelve hours after the fever began, and sometimes suppurated in

nonfatal cases in a short time. Kitasato has recently announced the

discovery of the specific cause of the bubonic plague.

Sweating Sickness.--According to Hecker, very shortly after Henry's

triumphant march from Bosworth Field, and his entry into the capital on

August 8, 1485, the sweating sickness began its ravages among the

people of the densely populated city. According to Lord Bacon the

disease began about September 21st, and lasted to the end of October,

1485. The physicians could do little or nothing for the people, and

seemed to take no account of the clinical history of the disease,--in

this respect not unlike the Greek physicians who for four hundred years

paid no attention to small-pox because they could find no description

of it in the immortal works of Galen. The causes seemed to be

uncleanliness, gluttony, immoderate drinking, and also severe

inundations leaving decaying vegetation. Richmond's army has been

considered a factor in the germination of the seeds of pestilent

disorder which broke out soon after in the camps of Litchfield, and on

the banks of the Severn.

Sweating sickness was an inflammatory rheumatic fever, with great

disorder of the nervous system, and was characterized by a profuse and

injurious perspiration. In the English epidemic the brain, meninges,

and the nerves were affected in a peculiar manner. The functions of the

pneumogastric nerves were violently disordered in this disease, as was

shown by the oppressed respiration and extreme anxiety, with nausea and

vomiting,--symptoms to which modern physicians attach much importance.

The stupor and profound lethargy show that there was an injury to the

brain, to which, in all probability, was added a stagnation of black

blood in the torpid veins. Probably decomposing blood gave rise to the

offensive odor of the person. The function of the lungs was

considerably impaired. The petechial fever in Italy in 1505 was a form

of the sweating sickness. There were visitations in 1506 and in 1515 in

England. In 1517 the disease lasted full six months and reached its

greatest height about six weeks after its appearance, but was

apparently limited to England. Meningeal symptoms were characteristic

of the third visitation of the disease. In 1528 and 1529 there was a

fourth visitation which resulted in the destruction of the French Army

before Naples. It is said that in 1524 a petechial fever carried off

50,000 people in Milan, and possibly this was the same disease. In 1529

the disease had spread all over Europe, attended with great mortality.

Germany, France, and Italy were visited equally. The famine in Germany,

at this time, is described by authorities in a tone of deep sympathy.

Swabia, Lorraine, Alsace, and provinces on the border of the lower

Rhine, were frightfully affected, so that the disease reached the same

heights there as in France. In England Henry VIII endeavored to avoid

the epidemic by continual traveling, until at last he grew tired of so

unsettled a life and determined to await his destiny at Tytynhangar. It

was not the inhabitants of the land alone who were affected, but even

fish and the fowls of the air sickened. According to Schiller, in the

neighborhood of Freiburg in Breisgau, dead birds were found scattered

under the trees with boils as large as peas under their

wings,--indicating among them a disease, and this extended far beyond

the southern districts of the Rhine. The disease was undoubtedly of a

miasmatic infectious nature, as was proved by its rapid spread and the

occasional absence of a history of contagion. It was particularly

favored in its development by high temperature and humidity.

The moral effect of the sweating sickness, similar to that of the black

plague, was again to increase religious fanaticism and recreate the

zeal of persecution.

On the 15th of April, 1551, there was an outbreak of the fifth and last

epidemic of sweating fever in Shrewsbury, on the Severn. With stinking

mists it gradually spread all over England, and on the 9th of July it

reached London. The mortality was very considerable. The English

residents were particularly susceptible, foreigners being comparatively

exempt. The epidemic terminated about the 30th of September. Since that

time the sweating sickness has never reappeared in England; but in the

beginning of the eighteenth century a disease very similar in symptoms

and course broke out in Picardy, in Northern France. Toward the end of

the century it spread to the South of France, and since that time has

appeared epidemically, 195 distinct outbreaks having been observed in

the course of one hundred and sixty-nine years, from 1618 to 1787. The

disease has frequently appeared in Italy since 1755, and in various

parts of Germany since 1801. In Belgium it has been observed in a few

places within the present century (Rohe).

Chronologic Table of the Principal Plagues.--In December, 1880, H. P.

Potter, F.R.C.S., published a chronologic table of some of the

principal plagues on record. In comments on his table, Potter says that

he has doubtless included mention of many plagues which, although

described under that name, are probably a dissimilar disease, writers

having applied the terms pestilential and pestilent in a generic sense

to diseases specifically different. It must also be remembered that, in

some cases, death must have been due to famine, want, and privation,

which are so frequently coexistent with pestilence. Following the idea

of Hecker, the dancing manias have been included in this table.

{table omitted}

Small-pox.--From certain Chinese records it appears that small-pox, or

a disease with similar symptoms, was known in China before the

Christian era, and it was supposed to have been known at a very early

period in India. Most likely it was introduced into Europe in the

second century by a Roman army returning from Asia. Before the sixth

century, the terrible century of the great plague, there seem to be no

records of small-pox or other eruptive fevers. Neither Hippocrates,

Galen, nor the Greek physicians who practiced at Rome, mention

small-pox, although it is now believed that the Emperor Marcus Aurelius

died of this disease. According to Dupony, the first document

mentioning variola was in 570 A.D., by Marius, a scholar of Avenches,

in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et

variola, Italiam Galliamque valde affecit.") Ten years later Gregory of

Tours describes an epidemic with all the symptoms of small-pox in the

fifth reign of King Childebert (580); it started in the region of

Auvergne, which was inundated by a great flood; he also describes a

similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him,

Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth

century wrote a most celebrated work on small-pox and measles, which is

the earliest accurate description of these diseases, although Rhazes

himself mentions several writers who had previously described them, and

who had formulated rules for their cure. He explained these diseases by

the theory of fermentation, and recommended the cooling treatment.

Adams remarks that although it is probable that small-pox existed for

ages in Hindoostan and China, being completely isolated in those

countries from the European world, it was not introduced into the West

until the close of the seventh century. Imported into Egypt by the

Arabians, it followed in the tracks of their conquests, and was in this

way propagated over Europe. The foregoing statement disagrees with

Dupony and others. It is well known that small-pox was prevalent in

Europe before Rhazes's description of it, and after the Crusades it

spread over Central and Western Europe, but did not extend to the

northern countries until some years later. In 1507 the Spaniards

introduced it into San Domingo, and in 1510 into Mexico, where it

proved a more fatal scourge than the swords of Cortez and his

followers, for according to Robertson it swept away in Mexico three

millions and a half of people. In 1707 it appeared in Iceland, and

carried off more than one-fourth of its inhabitants; in 1733, according

to Collinson, it almost depopulated Greenland. The Samoyeds, Ostiaks,

and other natives of Eastern Siberia, have frequently suffered from

devastating epidemics. In Kamchatka the disease was introduced in 1767,

and many villages were completely depopulated. According to Moore, at

the beginning of the eighteenth century nearly one-fourteenth of the

population died from small-pox in England, and at the end of the

century the number of the victims had increased to one-tenth. In the

last century the statement was made in England that one person in every

three was badly pock-marked. The mortality of the disease at the latter

half of the eighteenth century was about three to every thousand

inhabitants annually. India has always been a fertile ground for the

development of small-pox, and according to Rohe the mortality from

small-pox has been exceedingly great for the past twenty years. From

1866 to 1869, 140,000 persons died in the Presidencies of Bombay and

Calcutta, and several years later, from 1873 to 1876, 700,000 died from

this disease. China, Japan, and the neighboring countries are

frequently visited with small-pox, and nearly all the inhabitants of

Corea are said to bear evidences of the disease. In the Marquesas

Islands one-fourth of the inhabitants had fallen victims to the disease

since 1863. It was first introduced into the Sandwich Islands in 1853,

and it then carried off eight per cent of the natives. Australia,

Tasmania, New Zealand, and the Fiji Archipelago have to the present day

remained exempt from small-pox; although it has been carried to

Australia in vessels, rigorous quarantine methods have promptly checked

it. On the American continent it was believed that small-pox was

unknown until the conquest of Mexico. It has been spread through

various channels to nearly all the Indian tribes of both North and

South America, and among these primitive people, unprotected by

inoculation or vaccination, its ravages have been frightful.

That small-pox a disease so general and so fatal at one time--has,

through the ingenuity of man, in civilized communities at least, become

almost extinct, is one of the greatest triumphs of medicine.

Inoculation was known in Europe about 1700, and in 1717 the famous

letter of Lady Montagu from Adrianople was issued, containing in part

the following statements:--

"The small-pox, so fatal and so general amongst us, is here entirely

harmless, by the invention of ingrafting, which is the term they give

it. There is a set of old women who make it their business to perform

the operation every autumn in the month of September, when the great

heat is abated. People send to one another to know if any of their

family has a mind to have the small-pox; they make parties for this

purpose, and when they are met, the old woman comes with a nut-shell

full of the matter of the best sort of small-pox, and asks what vein

you please to have opened. She immediately rips open that you offer her

with a large needle, and puts into the vein as much matter as can lie

upon the head of her needle, and after that binds up the little wound

with a hollow shell, and in this manner opens four or five veins."

Soon after this letter Lady Montagu had her son inoculated in Turkey,

and four years later her daughter was to be the first subject

inoculated in England. She made rapid progress notwithstanding the

opposition of the medical profession, and the ignorance and credulity

of the public. The clergy vituperated her for the impiety of seeking to

control the designs of Providence. Preaching in 1722, the Rev. Edward

Massey, for example, affirmed that Job's distemper was confluent

small-pox, and that he had been inoculated by the Devil. Lady Montagu,

however, gained many supporters among the higher classes. In 1721 Mead

was requested by the Prince of Wales to superintend the inoculation of

some condemned criminals, the Prince intending afterward to continue

the practice in his own family; the experiment was entirely successful,

and the individuals on whom it was made afterward received their

liberty (Adams).

According to Rohe, inoculation was introduced into this country in 1721

by Dr. Zabdiel Boylston of Boston, who had his attention directed to

the practice by Cotton Mather, the eminent divine. During 1721 and

1722 286 persons were inoculated by Boylston and others in

Massachusetts, and six died. These fatal results rendered the practice

unpopular, and at one time the inoculation hospital in Boston was

closed by order of the Legislature. Toward the end of the century an

inoculating hospital was again opened in that city.

Early in the eighteenth century inoculation was extensively practiced

by Dr. Adam Thomson of Maryland, who was instrumental in spreading a

knowledge of the practice throughout the Middle States.

Despite inoculation, as we have already seen, during the eighteenth

century the mortality from small-pox increased. The disadvantage of

inoculation was that the person inoculated was affected with a mild

form of small-pox, which however, was contagious, and led to a virulent

form in uninoculated persons. As universal inoculation was manifestly

impracticable, any half-way measure was decidedly disadvantageous, and

it was not until vaccination from cow-pox was instituted that the first

decided check on the ravages of small-pox was made.

Vaccination was almost solely due to the persistent efforts of Dr.

Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.

In his comments on the life of Edward Jenner, Adams, in "The Healing

Art," has graphically described his first efforts to institute

vaccination, as follows: "To the ravages of small-pox, and the

possibility of finding some preventive Jenner had long given his

attention. It is likely enough that his thoughts were inclined in this

direction by the remembrance of the sufferings inflicted upon himself

by the process of inoculation. Through six weeks that process lingered.

He was bled, purged, and put on a low diet, until 'this barbarism of

human veterinary practice' had reduced him to a skeleton. He was then

exposed to the contagion of the small-pox. Happily, he had but a mild

attack; yet the disease itself and the inoculating operations, were

probably the causes of the excessive sensitiveness which afflicted him

through life.

"When Jenner was acting as a surgeon's articled pupil at Sudbury, a

young countrywoman applied to him for advice. In her presence some

chance allusion was made to the universal disease, on which she

remarked: 'I shall never take it, for I have had the cow-pox.' The

remark induced him to make inquiries; and he found that a pustular

eruption, derived from infection, appeared on the hands of milkers,

communicated from the teats of cows similarly disordered; this eruption

was regarded as a safeguard against small-pox. The subject occupied his

mind so much that he frequently mentioned it to John Hunter and the

great surgeon occasionally alluded to it in his lectures, but never

seems to have adopted Jenner's idea that it might suggest some

efficacious substitute for inoculation. Jenner, however, continued his

inquiries, and in 1780 he confided to his friend, Edward Gardner, his

hope and prayer that it might be his work in life to extirpate smallpox

by the mode of treatment now so familiar under the name of vaccination.

"At the meetings of the Alveston and Radborough Medical Clubs, of both

of which Jenner was a member, he so frequently enlarged upon his

favorite theme, and so repeatedly insisted upon the value of cow-pox as

a prophylactic, that he was denounced as a nuisance, and in a jest it

was even proposed that if the orator further sinned, he should then and

there be expelled. Nowhere could the prophet find a disciple and

enforce the lesson upon the ignorant; like most benefactors of mankind

he had to do his work unaided. Patiently and perseveringly he pushed

forward his investigations. The aim he had in view was too great for

ridicule to daunt, or indifference to discourage him. When he surveyed

the mental and physical agony inflicted by the disease, and the thought

occurred to him that he was on the point of finding a sure and certain

remedy, his benevolent heart overflowed with unselfish gladness. No

feeling of personal ambition, no hope or desire of fame, sullied the

purity of his noble philanthropy. 'While the vaccine discovery was

progressive,' he writes, 'the joy at the prospect before me of being

the instrument destined to take away from the world one of its greatest

calamities, blended with the fond hope of enjoying independence, and

domestic peace and happiness, were often so excessive, that, in

pursuing my favorite subject among the meadows, I have sometimes found

myself in a kind of reverie. It is pleasant to recollect that those

reflections always ended in devout acknowledgments to that Being from

whom this and all other blessings flow.' At last an opportunity

occurred of putting his theory to the test. On the 14th day of May,

1796,--the day marks an epoch in the Healing Art, and is not less

worthy of being kept as a national thanksgiving than the day of

Waterloo--the cow-pox matter or pus was taken from the hand of one

Sarah Holmes, who had been infected from her master's cows, and was

inserted by two superficial incisions into the arms of James Phipps, a

healthy boy of about eight years of age. The cow-pox ran its ordinary

course without any injurious effect, and the boy was afterward

inoculated for the small-pox,--happily in vain. The protection was

complete; and Jenner thenceforward pursued his experiments with

redoubled ardor. His first summary of them, after having been examined

and approved by several friends, appeared under the title of 'An

Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June,

1798. In this important work he announced the security against the

small-pox afforded by the true cow-pox, and proceeded to trace the

origin of that disease in the cow to a similar affection of the horse's

heel."

This publication produced a great sensation in the medical world, and

vaccination spread so rapidly that in the following summer Jenner had

the indorsement of the majority of the leading surgeons of London.

Vaccination was soon introduced into France, where Napoleon gave

another proof of his far-reaching sagacity by his immediate recognition

of the importance of vaccination. It was then spread all over the

continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it

into America; in 1801, with his sons-in-law, President Jefferson

vaccinated in their own families and those of their friends nearly 200

persons. Quinan has shown that vaccination was introduced into Maryland

at least simultaneously with its introduction into Massachusetts. De

Curco introduced vaccination into Vienna, where its beneficial results

were displayed on a striking scale; previously the average annual

mortality had been about 835; the number now fell to 164 in 1801, 61 in

1802, and 27 in 1803. After the introduction of vaccination in England

the mortality was reduced from nearly 3000 per million inhabitants

annually to 310 per million annually. During the small-pox epidemic in

London in 1863, Seaton and Buchanan examined over 50,000 school

children, and among every thousand without evidences of vaccination

they found 360 with the scars of small-pox, while of every thousand

presenting some evidence of vaccination, only 1.78 had any such traces

of small-pox to exhibit. Where vaccination has been rendered

compulsory, the results are surprising. In 1874 a law was established

in Prussia that every child that had not already had small-pox must be

vaccinated in the first year of its life, and every pupil in a private

or public institution must be revaccinated during the year in which his

or her twelfth birthday occurs. This law virtually stamped small-pox

out of existence; and according to Frolich not a single death from

small-pox occurred in the German army between 1874 and 1882.

Notwithstanding the arguments advanced in this latter day against

vaccination, the remembrance of a few important statistic facts is all

that is necessary to fully appreciate the blessing which Jenner

conferred upon humanity. In the last century, besides the enormous

mortality of small-pox (it was computed that, in the middle of the last

century, 2,000,000 victims perished in Russia from small-pox), the

marks of affliction, blindness, deafness, etc., were plain in at least

one member of every family.

Asiatic cholera probably originated centuries ago in India, where it is

now endemic and rages to such an extent as to destroy 750,000

inhabitants in the space of five years. There is questionable evidence

of the existence of cholera to be found in the writings of some of the

classic Grecian and Indian authors, almost as far back as the beginning

of the Christian era. In the sixteenth and seventeenth centuries

travelers in the East gave accounts of this disease. Sonnerat, a French

traveler, describes a pestilence having all the characteristics of

Asiatic cholera which prevailed in the neighborhood of Pondicherry and

the Coromandel coast from 1768 to 1769, and which, within a year,

carried off 60,000 of those attacked. According to Rohe, Jasper Correa,

an officer in Vasco da Gama's expedition to Calicut, states that

Zamorin, the chief of Calicut, lost 20,000 troops by the disease.

Although cholera has frequently extended to Europe and America, its

ravages have never been nearly as extensive as in the Oriental

outbreaks. An excellent short historic sketch of the epidemics of the

cholera observed beyond the borders of India has been given by Rohe. In

1817 cholera crossed the boundaries of India, advancing southeasterly

to Ceylon, and westerly to Mauritius, reaching the African coast in

1820. In the following two years it devastated the Chinese Empire and

invaded Japan, appearing at the port of Nagasaki in 1822. It advanced

into Asiatic Russia, and appeared as far east as St. Petersburg in

1830, from whence it spread north to Finland. In 1831 it passed through

Germany, invading France and the western borders of Europe, entering

the British Isles in 1832, and crossing the Atlantic Ocean for the

first time, appeared in Canada, having been carried thence by some

Irish emigrants.

From Canada it directly made its way to the United States by way of

Detroit. In the same year (1832) it appeared in New York and rapidly

spread along the Atlantic coast.

"During the winter of 1832 it appeared at New Orleans, and passed

thence up the Mississippi Valley. Extending into the Indian country,

causing sad havoc among the aborigines, it advanced westward until its

further progress was stayed by the shores of the Pacific Ocean. In 1834

it reappeared on the east coast of the United States, but did not gain

much headway, and in the following year New Orleans was again invaded

by way of Cuba. It was again imported into Mexico in 1833. In 1835 it

appeared for the first time in South America, being restricted,

however, to a mild epidemic on the Guiana coast.

"In 1846 the disease again advanced beyond its natural confines,

reaching Europe by way of Turkey, in 1848. In the autumn of this year

it also appeared in Great Britain, Belgium, the Netherlands, Sweden,

and the United States, entering by way of New York and New Orleans. In

the succeeding two years the entire extent of country east of the Rocky

Mountains was invaded. During 1851 and 1852 the disease was frequently

imported by emigrants, who were annually arriving in great numbers from

the various infected countries of Europe. In 1853 and 1854 cholera

again prevailed extensively in this country, being, however, traceable

to renewed importation of infected material from abroad. In the

following two years it also broke out in numerous South American

States, where it prevailed at intervals until 1863. Hardly had this

third great pandemic come to an end before the disease again advanced

from the Ganges, spreading throughout India, and extending to China,

Japan, and the East Indian Archipelago, during the years 1863 to 1865.

In the latter year it reached Europe by way of Malta and Marseilles. It

rapidly spread over the Continent, and in 1866 was imported into this

country by way of Halifax, New York, and New Orleans. This epidemic

prevailed extensively in the Western States, but produced only slight

ravages on the Atlantic Coast, being kept in check by appropriate

sanitary measures. In the same year (1866) the disease was also carried

to South America, and invaded for the first time the states bordering

on the Rio de la Plata and the Pacific coast of the Continent.

"Cholera never entirely disappeared in Russia during the latter half of

the sixth decade, and in 1870 it again broke out with violence,

carrying off a quarter of a million of the inhabitants before dying out

in 1873. It spread from Russia into Germany and France and was

imported, in 1873, into this country, entering by way of New Orleans

and extending up the Mississippi Valley. None of the Atlantic coast

cities suffered from this epidemic in 1873, and since that year the

United States has been entirely free from the disease, with the

exception of a few imported cases in New York harbor in 1887" (and in

1893). In 1883 an epidemic of cholera raged in Egypt and spread to many

of the Mediterranean ports, and reappeared in 1885 with renewed

violence. In Spain alone during this latter epidemic the total number

of cases was over one-third of a million, with nearly 120,000 deaths.

In 1886 cholera caused at least 100,000 deaths in Japan. In the latter

part of 1886 cholera was carried from Genoa to Buenos Ayres, and

crossing the Andean range invaded the Pacific coast for a second time.

In Chili alone there were over 10,000 deaths from cholera in the first

six months of 1887. Since then the entire Western hemisphere has been

virtually free from the disease.

In 1889 there was an epidemic of cholera in the Orient; and in 1892 and

1893 it broke out along the shores of the Mediterranean, invading all

the lines of commerce of Europe, Hamburg in the North and Marseilles in

the South being especially affected. In the summer of 1893 a few cases

appeared in New York Bay and several in New York city, but rigorous

quarantine methods prevented any further spread.

Typhus fever is now a rare disease, and epidemics are quite infrequent.

It has long been known under the names of hospital-fever,

spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the

regular associate of such social disturbances as overcrowding,

excesses, famine, and war. For the past eight centuries epidemics of

typhus have from time to time been noticed, but invariably can be

traced to some social derangement.

Yellow Fever is a disease prevailing endemically in the West Indies and

certain sections of what was formerly known as the Spanish Main.

Guiteras recognizes three areas of infection:--

(1) The focal zone from which the disease is never absent, including

Havana, Vera Cruz, Rio, and the other various Spanish-American points.

(2) The perifocal zone, or regions of periodic epidemics, including the

ports of the tropical Atlantic and Africa.

(3) The zone of accidental epidemics, between the parallels of 45

degrees north and 35 degrees south latitude.

In the seventeenth century Guadaloupe, Dominica, Martinique, and

Barbadoes suffered from epidemics of yellow fever. After the first half

of the seventeenth century the disease was prevalent all through the

West Indies. It first appeared in the United States at the principal

ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it

reappeared in Philadelphia and Charleston, and since that time many

invasions have occurred, chiefly in the Southern States.

The epidemic of 1793 in Philadelphia, so graphically described by

Matthew Carey, was, according to Osler, the most serious that has ever

prevailed in any city of the Middle States. Although the population of

the city was only 40,000, during the months of August, September,

October, and November the mortality, as given by Carey, was 4041, of

whom 3435 died in the months of September and October. During the

following ten years epidemics of a lesser degree occurred along the

coast of the United States, and in 1853 the disease raged throughout

the Southern States, there being a mortality in New Orleans alone of

nearly 8000. In the epidemic of 1878 in the Southern States the

mortality was nearly 16,000. South America was invaded for the first

time in 1740, and since 1849 the disease has been endemic in Brazil.

Peru and the Argentine Republic have also received severe visitations

of yellow fever since 1854. In Cuba the disease is epidemic during

June, July, and August, and it appears with such certainty that the

Revolutionists at the present time count more on the agency of yellow

fever in the destruction of the unacclimated Spanish soldiers than on

their own efforts.

Leprosy is distinctly a malady of Oriental origin, and existed in

prehistoric times in Egypt and Judea. It was supposed to have been

brought into Europe by a Roman army commanded by Pompey, after an

expedition into Palestine. Leprosy was mentioned by several authors in

the Christian era. France was invaded about the second century, and

from that time on to the Crusades the disease gradually increased. At

this epoch, the number of lepers or ladres becoming so large, they were

obliged to confine themselves to certain portions of the country, and

they took for their patron St. Lazare, and small hospitals were built

and dedicated to this saint. Under Louis VIII 2000 of these hospitals

were counted, and later, according to Dupony, there were 19,000 in the

French kingdom. Various laws and regulations were made to prevent the

spread of the contagion. In 1540 it was said that there were as many as

660 lepers in one hospital in Paris.

No mention is made in the Hippocratic writings of elephantiasis

graecorum, which was really a type of leprosy, and is now considered

synonymous with it. According to Rayer, some writers insist that the

affection then existed under the name of the Phoenician disease. Before

the time of Celsus, the poet Lucretius first speaks of elephantiasis

graecorum, and assigns Egypt as the country where it occurs. Celsus

gives the principal characteristics, and adds that the disease is

scarcely known in Italy, but is very common in certain other countries.

Galen supplies us with several particular but imperfect

cases--histories of elephantiasis graecorum, with a view to demonstrate

the value of the flesh of the viper, and in another review he adds that

the disease is common in Alexandria. Aretaeus has left a very accurate

picture of the symptoms of elephantiasis graecorum; and Pliny

recapitulates the principal features and tells us that the disease is

indigenous in Egypt. The opinion of the contagiousness of elephantiasis

graecorum which we find announced in Herodotus and Galen is more

strongly insisted upon by Caelius Aurelianus who recommends isolation

of those affected. Paulus aegenita discusses the disease. The Arabian

writers have described elephantiasis graecorum under the name of juzam,

which their translators have rendered by the word lepra. Later,

Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have

discussed it.

The statistics of leprosy in Europe pale before the numbers affected in

the East. The extent of its former ravages is unknown, but it is

estimated that at the present day there are over 250,000 lepers in

India, and the number in China is possibly beyond computation.

According to Morrow, in 1889 in the Sandwich Islands there were 1100

lepers in the settlement at Molokai. Berger states that there were 100

cases at Key West; and Blanc found 40 cases at New Orleans. Cases of

leprosy are not infrequently found among the Chinese on the Pacific

coast, and an occasional case is seen in the large cities of this

country. At the present day in Europe, where leprosy was once so well

known, it is never found except in Norway and the far East.

Possibly few diseases have caused so much misery and suffering as

leprosy. The banishment from all friends and relatives, the

confiscation of property and seclusion from the world, coupled with

poverty and brutality of treatment,--all emphasize its physical horror

a thousandfold. As to the leper himself, no more graphic description

can be given than that printed in The Ninteenth Century, August, 1884:

"But leprosy! Were I to describe it no one would follow me. More cruel

than the clumsy torturing weapons of old, it distorts, and scars, and

hacks, and maims, and destroys its victim inch by inch, feature by

feature, member by member, joint by joint, sense by sense, leaving him

to cumber the earth and tell the horrid tale of a living death, till

there is nothing left of him. Eyes, voice, nose, toes, fingers, feet,

hands, one after the other are slowly deformed and rot away, until at

the end of ten, fifteen, twenty years, it may be, the wretched leper,

afflicted in every sense himself, and hateful to the sight, smell,

hearing, and touch of others, dies, despised and the most abject of

men."

Syphilis.--Heretofore the best evidence has seemed to prove that

syphilis had its origin in 1494, during the siege of Naples by Charles

VIII of France; but in later days many investigators, prominent among

them Buret, have stated that there is distinct evidence of the

existence of syphilis in prehistoric times. Buret finds evidence of

traces of syphilis among the Chinese five thousand years ago, among the

Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in

biblic times, and among the Greeks and Romans after Christ. Some

American writers claim to have found evidences of syphilitic disease in

the skulls and other bones of the prehistoric Indian mounds, thus

giving further evidence to the advocates of the American origin of

syphilis. The Spaniards claimed that, returning from America in 1493,

Columbus brought with him syphilis. Friend says: "One thing is

remarkable; the Spaniards, upon their first expedition to America,

brought home from thence this contagious disorder, and soon after

carried another affection thither, the small-pox, of which the Indian

Prince Montezuma died." The first descriptions of syphilis are given

under the name of morbus gallicus, while the French in return called it

morbus neapolitanus or mal d'Italie. The name of syphilis was said to

have been first given to it by a physician of Verona, in a poem

describing the disease. Inspired by heroic epics Fracastor places

before us the divinities of paganism, and supposes that a shepherd,

whom he called Syphilus, had addressed words offensive to Apollo, and

had deserted his altars. To punish him the God sent him a disease of

the genitals, which the inhabitants of the country called the disease

of Syphilus.

"Syphilidemque ab eo labem dixere coloni."

Buret traces the origin of the word syphilis from sun, with, and filia,

love, the companion of love; which means in plain language that the pox

is a disease transmitted more especially by venereal relations. The

first great epidemic of syphilis occurred between 1493 and 1496, and

attacked all ranks, neither the Church nor the Crown being spared. The

ravages of this disease were increased by the treatment with mercury

which soon afterward was found in proper doses to be a specific in this

disease. It is possible that the terrible manifestations of syphilis of

which we read in the older writers were in a great measure due to the

enormous doses of mercury. At the present day syphilis is universally

prevalent. In his excellent monograph Sturgis estimated in New York, in

1873, that one out of 18 suffered from it; and White of Philadelphia

pronounces the opinion that "not less than 50,000 people in that city

are affected with syphilis." According to Rohe, on this basis Gihon

estimates the number of syphilitics in the United States at one time as

2,000,000.

To-day no disease, except possibly tuberculosis, is a greater agency in

augmenting the general mortality and furthering sickness than syphilis.

Its hereditary features, the numerous ways in which it may be

communicated outside of the performance of the sexual act, and the

careful way in which it is kept from the sanitary authorities render it

a scourge which, at the present day, we seem to have no method of

successfully repressing.

Modern Mortality from Infectious Diseases.--As to the direct influence

on the mortality of the most common infectious diseases of the present

day, tuberculosis, universally prevalent, is invariably in the lead. No

race or geographic situation is exempt from it. Osler mentions that in

the Blood Indian Reserve of the Canadian Northwest Territories, during

six years, among a population of about 2000 there were 127 deaths from

pulmonary consumption. This enormous death-rate, it is to be

remembered, occurred in a tribe occupying one of the finest climates of

the world, among the foothills of the Rocky Mountains, a region in

which consumption is extremely rare among the white population, and in

which cases of tuberculosis from the Eastern provinces do remarkably

well. Mayo-Smith quotes a table illustrating the annual deaths (based

on the returns from 1887 to 1891) from certain infectious diseases per

10,000 European inhabitants. The figures for each disease give a rough

measure of its prevalence in different countries. The large figures as

to small-pox show the absence in Italy and "Hieronymi Fracastorii,"

Veronae, 1530. Statistics and Sociology, New York, 1885.

Austria of vaccination; diphtheria seems to be very fatal in Germany

and Austria; Italy has a large rate for typhoid fever, and the same is

true of the other fevers; France, Germany, and Austria show a very

large rate for tuberculosis, while Italy has a small rate.

DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS.

Small- Scarlet Diphtheria Typhoid Tuber-

COUNTRY. pox. Measles. fever fever. culosis

Italy, . . . . . 3.86 6.17 2.99 6.08 7.49 13.61

France (cities). 2.3 5.18 3.1 6.66 5.32 33.

England, . . . . 0.11 4.68 2.31 1.74 1.9 16.09

Ireland, . . . . 0.01 2.01 1.22 0.76 2.33 21.15

Germany (cities). 0.04 2.8 2.15 10.21 2.11 31.29

Prussia, . . . . 0.03 3.2 2.46 14.17 2.26 28.06

Austria, . . . . 4.43 5.36 5.57 13.2 5.42 37.2

Switzerland, . . 0.06 1.53 1.22 3.53 1.47 21.07

Belgium, . . . . 1.52 6.2 1.62 5.77 3.83 19.87

Holland, . . . . 0.02 3.93 0.38 1.45 2.5 19.21

Sweden, . . . . . 0.01 2.3 3.69 3.89 2.22 0.

Based upon the Tenth Census Reports, we figure that of every 10,000

inhabitants of the United States the number of deaths for the census

year from similar diseases was as follows:--

Rural. Cities.

Measles, . . . . . . . 1.62 1.54

Scarlet Fever, . . . . 2.84 5.54

Diphtheria, . . . . . 7.53 8.

Croup, . . . . . . . . 3.51 4.08

Typhoid Fever, . . . . 4.75 3.46

Tuberculosis, . . . . 16.29 28.55

The general average of deaths from small-pox was about 0.14.

End of the Project Gutenberg EBook of Anomalies and Curiosities of Medicine, by

George M. Gould and Walter Lytle Pyle

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