The epidemic or Pandemic of Influenza in 1708-1709

The epidemic or pandemic of influenza in SAUL JARCHO * KATHERINE M. RICHARDS There is no remembrance of former things; neither shaü there be any remembrance of things that are to come with those that shaü come after. ECCL. 1.1 1. In the years 1708 and 1709 an outbreak of respiratory disease afflicted almost all of western Europe. It was descnbed by the famous Giovanni Maria Lancisi (1654-1 720), who designated it as epidemia rheumatica, (1) a term which reflects the Hippocratic and Galenic concept that the disease is a rheuma or flow of noxious humors which descend from the brain (2). The outbreak was discussed repeatedly by Lancisi's contemporaries (3) and by writers of subsequent times. Recently the subject was studied anew by the senior author of (4) the present essay, who agreed with several previous com- (1) LANCISI, Johannes Maria (1 7 11). Dissertatio de nativis, degue adventitiis Romani coeli gualitatibus, cui accedit historia epidemiae rheumatuae, yuae per hyemem anni MDCCIX vagata est. Rome, Gonzaga. Through the courtesy of Sig. Angelo Palma, the senior author of the present essay was permitted to examine Lancisi's heavily emended manuscnpt, which is MS no. 157 in the Biblioteca Lancisiana in Rome. The treatise on influenza occupies pp. 209-278 of the bound manuscnpt. In the title the word RHEUMATICA was at first spelled without the H; the missing letter was intercalated with a caret. (2) A similar notion is expressed by the term cata~rh, which appears again and again in descnptions of the disease. (3) To the eighteenth-century Italian sources commonly cited we wish to add two unpublished manuscnpt discussions tentatively attnbuted to Ippolito Francesco Albertini (1 6621738). These are titled respectively Epidemia difébbn ... 1708 and Epidemia difebre con coagolo insigne, e male di petto nell' Znuerno dell' anno 1 709 (University of Bologna MS 2089, vol. 1, pp. 104-107). We thank the library of the University and the Ministero per i Beni Culturali e Arnbientali (Rome) for granting access to these texts. (4) JARCHO, S (1979). The ((epidemia rheumaticm descnbed by Lancisi (171 1). In: ROSENBERG, C. E. (editor). Healing and histoly; essaysfor George Rosen. New York, Neale Watson, pp. 51-58. In view of Prof. Olagüe's subsequent work it is felicitous that the expression ((Spanish influenza» was not used. DYNAMIS Acta Hispanica ad Medicinae Scientiarumgue Historiam Illustrandam. Vol. 5-6, 1985-86, pp. 125-141. ISSN: 021 1-9536 * 11 West 69 st. New York, NY 10023, USA. 126 SAUL JARCHO y KATHERINE M. RICHARDS mentators in characterizing the disease as inJuenza, and by Prof. Guillermo Olagüe de Ros (5), who used such equivalent Spanish terms as brote pipa1 and gripe. The former of these recent authors injudiciously designated the outbreak as 'pandemic', while the latter used more conservative term 'epidemic' and included with his discussion a map, which shows the affected area to have included almost all of western Europe and part of central Europe, including Carniola (in what is now Yugoslavia), as well as Bohemia and westem Poland. Left blank or situated beyond the limits of the map are Great Britain, Norway, Sweden, Iceland, Spain, Portugal, and the Mediterranean islands west of Sicily. (see: Dynamis, vol. 1, page. 72 (1981)). In contemporary United States usage the word 'epidemic' signifies an outbreak of disease -usually, but not always, a large or widespread outbreak. The term 'pandemic' refers to much greater outbreaks, especially those that involve more than one of the world's major land masses (6). By the evidence available when his excellent and thoroughly documented essay was written, Prof. Olagüe was justified in applying the term 'epidemic' to the European outbreak of 1708-1 709. In the present communication we shall offer some new evidence - admittedly fragrnentary and incomplete - as to the extent of the outbreak, with special reference to terrae incongnitae situated beyond the areas of occurrence that have been recognized heretofore. in addition we shall suggest some of the directions in which future scholars may find it profitable to conduct investigation. 1. THE THZRTEEN NORTH AMERICAN COLONZES On the assumption that Lancisi, the overburdened papa1 consultant, investigator, and writer, would not have taken transatlantic affairs seriously into consideration, it seemed desirable to make some preliminary «biopsies» of North American writings about infectious diseases in the years 1708 and 1709. At the outset a passage in Noah Webster's remarkable history yielded the following statement: In November 1708 began a severe and universal catarrh in Europe, which was speedily followed by a series of pestilential diseases. Of this catarrh, of the seasons, and the plagues that followed we have from Europe very (5) OLAGÜE de ROS, G. (1981). La epidemia europea de gripe de 1708-1709. Difusión témporo-espacial e interpretaciones contemporáneas. Dynamis, 1, pp. 5 1-8 6. (6) We offer collective thanks to three epidemiologists who have given us the benefit of their special knowledge of this matter (1983-84). 3 The epidemic or pandemic of infiuenza in 1708-1709 127 correa accounts; but, with &e utmost industry, 1 cannot learn whether the : catarrh extended to America (7). In Webster's treatise this comment is followed by paraphrases of Lanási. Clearly the -early North American epidemiographer had pondered the possibility that the outbreak might have nossed the Atlantic; at the sane time his comment was discouraging, since his diligent inquiry had not obtained a positive result (8). The new investigation continued; ibant obscuri. The next step was an examination of histories of medicine in the thirteen British colonies which later coalesced to form the United States of Arnerica. Blanton's history (9) revealed that on two occasions in the year 1709 the colony of Virginia decreed a public fast because of outbreaks of disease. Whith this guidance it was not difficult to discover in the Executive Journals of the Council of Colonial Virginia the following entry, which records the proceedings of a session held in Williamsburg, the colonial capital, on April 15, 1709: Whereas it hath pleased God to afflict parts of this Country with a pestilential and infectious Sickness which has swept away great numbers of the Inhabitants It is ordered that a solem Fast be observed and kept throughout the whole Colony on Wednesday the 18th of May to implore the divine mercy in removing this grevious and publick Calamity and ordered that a proclamation be prepared accordingly (10). Again, at meeting held on December 8, 1709 the 'Virginia council declared: Whereas it hath pleased God to afflict diverse parts of this Country with a rageing pestilential Distemper. It is Ordered that Wednesday the 1 lth of January be set apaq as a day of publick fasting and humiliation to deprecate the wrath of almighty God and to implore his mercy in removeing this (7) WEBSTER, N. (1 799). A bnefhtstory ofepzdernzc andpestzlentzal dzseases Hartford, vol. 1, pp. 218-219. London, 1800, vol. 1, pp. 352-353. (8) Has anyone even considered the possibility that the disease could have spreadfrom America to Europe? (9) BLANTON, W. B. (1931). Medtczne tn Vtrgznta tn the etghteenth century Richmond, Garrett and Massie, p. 51. (1 0) McILWAINE, H. R. (ed) (1 9251930). Executtve jounzals of the counczl of colontal Vzrgznza Richmond, Bottom, vol. 3, p. 214. 128 SAUL JARCHO y KATHERINE M. RICHARDS grevious Calamity and Ordered that a Proclamation issue accordingly (1 1). The evidence presented thus far reveals that in April 1709 and again in December 1709, widespread disease, causing many deaths, occurred in Vírginia. The nature of the malady or maladies is not disclosed. The volume in which these notices were found contains occasionai mention of shipping, apparently on a modest scale, and limited (during the period under discussion) to England, the ~Western Islands)) (12), i.e. the ,Hebrides, and to Lisbon (1 3) and Barbados (1 4). None of these places is shown in the map as having been affected by the epidemic. Other items in the Virginia executive journals refer to the War of the Spanish Succession, to the recent importation of negroes from Africa, to privateers, and to travels - both by land and sea from Virginia to other British colonies in North America. Opportunities for transmission of infection therefore existed in abundance. These rather small bits of evidence can be supplemented to some extent by referente to the Secret Diary of William Byrd, the Virginia patrician, landowner, public oficial, and author (15). An early entry, dated February 28, 1709, reads as follows: ... the distemper continues with the sarne violence it did, but that about [SO-] people had died of it this winter in the two counties. it was infectious and killed chiefly poor people. The best remedy for it is sweating and the best way to prevent it is to vomit and purge. The distemper never comes but in winter and as the cold weather abates that abates also (16). This report of an acute illness that occurs in winter, attacks especially the poor, and produces fatalities, is too vague for satisfactory inference. Diarrhoea and cutaneous eruptions are not mentioned. The description therefore probably points to an epidemic respiratory disease but this is not certain. On May 18, 1709 Byrd noted that ((this was fast day to remove the fatal illness with which this country has been of late afflicted)) (17). This entry - McILWAINE, H. R. (1925-1930). Ibd., 10, p. 229. McILWAINE, H. R. (1925-1930), op czt, p. 178. McILWAINE, H. R. (1925-1930), op. czt., pp. 179, 181. McILWAINE, H. R. (1925-1930), op. czt., p. 193. BYRD, W. (1941). The sec~et dta~y ofWzllzam Byrd ofwestover 1709-1 712. ~dited by Louis B. Wnght and Manon Tinling. Richmond, Dietz, 2 vols. BYRD, W. (1941), op. czt, vol. 1, p. 9. BYRD. W. (1941),op. czt, p. 36. 1 1 The epidemic or pandemic of influenza in 1708-1709 agrees with the first of the two items already quoted fi-om the Executiue Journals 4th Cmd. It is probable but not certain that the disease which caused trouble during the winter of 1708-09 was the sarne as the disease that ocurred in the spring of 1709. The statement «the fatal illness with which this country has been of late afflicted)) suggests that by May 18, 1709 the out1 break had ended recently. Under date of December 7, 1709 Byrd wrote that ((cathe distemper was very viplent in'the neighborhood)) and on the next day he added «a general fast was appointed on account of the sickness)) (18). The latter note coincides with the second of the two entries already quoted from the Executiue Jouml. Successive notes in Byrd's diary continue to report this outbreak of ((distempem -including the death of four negroesat least as late as February 5, 1710, when he noted that the sickness ((continued about Williamsburg very violentlp (1 9). The evidence from South Carolina is fragmentary and indistinct. In his Epidemics in Colonial America, (20) Dr. John Du*, a highly esteemed historian, quotes reports sent in 1709 to the Society for the Propagation of the Gospel by a missionary, Robert Gaule, who wrote of ((great colds, and indispositions)), which frenquently terminated «in dangerous effects)) (21). 1 The History of Medicine in South Carolina 1670-1825 (22) by the late Dr. -i Joseph 1. Waring says «... a type of respiratory disease, probably of the nature of influenza was present [in or near Charleston] in 1709 and was of serious concem)). Unfortunately for subsequent historians Dr. Waring failed to document this statement and his notes about it are now unavailable. His comment, however, cannot be dismissed, since he was a physician of great ability and wide experience. The problem is additionally complicated by the fact that the high incidence of malaria in South Carolina would tend to obscure descnptions of other febrile diseases. (18) BYRD. W. (1941), o!. czt., pp. 115-116. (19) BYRD. W. (1941), o!. cit., pp. 126-139. (20) DUFFY, J. (1953). Epidemzcs zn colontal America. Baton Rouge, Louisiana State University Press, p. 189 and n. 10. (21) Dr. Dufíj also quotes reports of pleurisies in Charleston in 17 11 and 17 12. (22) Charleston, South Carolina Medical Associauon, 1964, p. 24. l 130 SAUL JARCHO y KATHERINE M. RICHARDS In Canada the low density and wide dispersion of the populatíon might be expected to have resulted in scanty recording. Fortunately these unfavorable factors were counterbalanced in part by the presence of literate or learned administrators, clerical and secular. Consequently records were made and preserved. 'i The following statement appears under the date of 1708 in the annals of the Hotel-Dieu of Québec (23): The pleurisies, having become common since the spring, provided us with a large number of patients, who tested the charity of our sisters during the entire year, and after we had been occupied in succoring them to the best of our ability, two of our nuns were attacked by this sickness at the same time and died of it. The expression ((having become common since the spring)) -the French original reads ((etant devenues populaires des le printems»- refers to the spring of 1708 and is the earliest North American record of acute epidemic respiratory disease that has been found in the course of the present i investigation. I Two additional Canadian reports are judged to be outside the bounds of the inquiry. In April and May, 17 10 athere was a malignant fever, and of the purple kind, that was very general both in Québec and in the surrounding - country, that carried off a vast number of persons)). In 17 1 1 there occurred a large and destructive outbreak of «a malignant Fever, accompanied by purpura)) (24). These brief statements mention no stigmata of respiratory disease and possibly are reports of typhus, hemorrhagic smallpox, or even meningococcemia. A standard history of Canadian medicine devotes a chapter to influenza but makes no mention of an outbreak in 1708-1709 (25). 4 (23) Translated from JUCHEREAU, J. F. and DUPLESSIS, M. A. (1939). Les Annales de l'H6tdl-Dteu de Québec, 1636-1 716. Québec, 1'HBtel-Dieu, p. 334. We are indebted to Mrs. Linda Ordogh of the Osler Library, McGill University, for furnishing photocopies of this text. We also thank Mr. Michel Wyczynski of the Public Archives of Canada and Mrs. Jocelyn McKillop of the Hudson's Bay Company, Winnipeg for bibliographic and other information. (24) THWAITES, R. G. (editor) (1896-1901). Jesuit relattons and allted documents, 1610-1 791. Cleveland, vol. 60, p. 233 and vol. 66, pp. 211-213. (25) HEAGERTY, J. 1. (1928). Four centunes of medrcal hrstoly tn Canada. Toronto, Macmillan, 2 vols. The epidemic or pandemic of influenza in 1708-1709 13 1 ~ Equally unproductive was the examination of a Canadian annalistic collection (26). ~ Of the Canadian data cited in preceding paragraphs it is clearly the first report -the information from Québecthat is most prornising. An examination of cadaveric materials, however fragmentary and old, by means of 1 advanced serological methods, would ofTer at least a slight hope of yielding virological or serological information that might prove etiologically singificant. The obstacles, however, are numerous. Through the courtesy of Mme. Claire Gagnon, archivist of the Monastere de lYH6tel-Dieu de Québec it was learned that the cemetery of that farnous and venerable institution was opened in 1662 and was closed in 1857 by municipal ordinance. In 1863-64 the exhumed bodies -it is not certain that this applies to allwere reinterred in the ~elmont cemetery at Ste-Foy in the suburbs of Québec. In the daily record of hospital patients for the period preceding 1723 the annotations apparently mention deaths simply by the designation deceased, with the date, and it is not possible to determine if such patients were buried in the Belmont cemeteq; many are known to have been buried in the parish of Notre-Dame de Québec. Further study would be needed in order to determine whether any extant burials can be identified reliably as influenzal. An investigator (27) experienced in immunology in its application to paleopathology informs us that antigen-antibody tests have been performed on tissues far older than the twenty-seven decades of the materiais now under discussion. A major problem is that of preservation. Fluorescentantibody techniques are thought to offer no more than a modest prospect of success in the present problem, but complement-fixation and radioimmune assay appear well worthy of exploration. We may point out incidentally the possibility of applying such methods fmitfully in yellow fever. The late Rev. David de Sola Pool (28) has described a cemetery in New York City which contains the grave of a physician who died of yellow fever during the outbreak of 1798; nearby are the graves of (26) AHERN, M. J.; AHERN, G. (1923). Notes pour senizr 6 I'hzstoz~e de la medeczne dans le BasCanada depuzs la fondatzon de Québec. Québec, Laflamme. (27) ALLISON, M. J.: Personal letter to Dr. Jarcho, Miami, Sept. 3, 1984. The reader may also be interested to examine The Influenza Vzmses and Influenza, edited by E. D. Kilbourne. New York, Academic Press, 1975 (see esp. pp. 483-538 on the epidemiology of influenza). (28) POOL, D. (1952). Portrazts etched zn stone. New York, Columbia University Press, pp. 269278. l 132 SAUL JARCHO y KATHERINE M. RICHARDS four of his patients. All are marked, in various languages, ayellow fevem. It is aslo highly probable that many yellow-fever burials are extant in Philadelphia, relics of the famous outbreak of 1793 (29). It is not utterly irrational to suggest that these cadavers may contain evidence of signfificant antibodies. $ 3. GREAT BRITAIN AND IRELAND i i 1 In the map, Ireland is marked as an affected area, while England is : blank. August Hirsch indicated in his tabulation that in the year 1709 there " was ((general diffusion in Italy, France, Belgium, Germany, and Den- , marh (30); he made no mention of occurrence in England. In his history of influenza (3 1) Arthur F. Hopkirk wrote as follows under the heading 1709-12: This was probably a single period of epidemics of wide distribution without particular direction. 1709, Italy, France, Belgium, Germany, Denmark. 17 10, England. He added that in England the symptoms were ((severe cough, quick pulse, headache)). Additional opinion, not well buttressed by evidence, appears in the book by Creighton (32): The very general coughs and catarrhs of 1709 seem to have been really caused by the severity of the memorable hard winter, the frost having begun in October, 1708 and lasted until March, 1709. The evidences of a truly epidemic infectious catarrh or influenza al1 over Europe in 1709 are scanty and ambiguous [sic!]. The possible presence of epidemic respiratory disease in England during 1708-09 involves a minor problem of no little complexity and obscurity. In (29) A list of names is to be found in CAREY, M. (1794). A short account of the malignant fever lately prevalent in Philadelphia. 4th ed., Philadelphia, pnnted by the author, pp. 121-159. (30) HIRSCH, A. op nt, vol. 1, p. 9. (31) HOPKIRK, A. F. (1914). Influenza: tts hzstory, nature, cause, and treatment (London, 1913) London, Scott and New York, Scnbner, p. 35. (32) CREIGHTON, C. H. (1965). A hzstory ofepzdernzcs zn Bntazn. Second edition, New York, Barnes and Noble, vol. 2, pp. 339-340. See also: VAUGHAN, W. T. (1921). Influenza, an epidemiologkal study. Baltimore, Amencan Journal of Hygiene, pp. 8 and 12. The epidemic or pandemic of infiuenza in 17~1709 a3 his Annals of Infmra or Epldem~ Catumhal in B 1837 (33). Theophilus Thompson wrote: Now [August 17091 raged a Malignant Fever, and vq m&d &c. from the communication with foreign parts ... M& &he?- began and reigned two months, an epidemic which missed few, fatally like a plague in France and the low Counmes, and was bmag disbanded soldiers into England, viz. a Catarrhous Fever, called the D~~~ kirk Rant (34), or Dunkirk Ague; it lasted eight, ten, or twelve days. its spp toms were a severe, short, dry couhg, quick pulse, great pain of the hed, and over the whole body, moderate thirst; sweating and diuretics were the cure... Thompson mentioned Short as the source of this information, and here some intricacies were encountered. In A General Chronologzcal History of Air, Weather, Seasons, Meteors, &c. (35). Thomas Short (1690?-1772) wrote as follows: In November [1708] after so many and sudden Changes, began Catarrhs of the Head and Breast, which were so epidemic, that very few escaped. It began with Chilness and Shivering, followed by a feverish Effervescence, intense Pain, or Smpor of the Head, Loss of Strength, and often of Appetite, often a Strangulation of the Jaws, or spurious Pain of the Pleura ... Luc. Schroch. It will be observed that this passage males no mention of any specific country. By using the name «Luc. Schroch)) as a clue it was possible to find the source in a misleadingly titled note by Lucas Schroeckius (1646-1 730), his Constitutio Epedemzca Augustana 1701 et Sequentzum. This was discovered in the amplified posthumous Opera Medica of Thomas Sydenham (36). From the context of Schroeck's essay it is clear that the passage which Short had quoted refers not to England but to Germany! On a later page (37). Short says, referring to August 1709, «Now raged a malignant Fever and very mortal in Harwich, &c. from the Communication (33) London, Sydenham Society, p. 27 (1852). (34) Under the year 1709, Schnurrer states the following (transl. by S. J.): «In England, where famine prevailed dunng this year and the next, and also in the Netherlands and some parts of France, there was generally disseminated fever which was named Dunkirk rano). (SCHNURRER, F. (1823-1825). Chronzk der Seuchen. Tubingen, Osiander, vol. 1, p. 244). Schnurrer cites no source for this statement. (35) London, Longman, and Millar, vol. 1, p. 438 (1749). (36) Geneva, de Tournes, vol. 1, pp. 735-746 (1723) (see p. 744). (37) SHORT, Th. (1749), op. nt., p. 458. 140 SAUL JARCHO y KATHERINE M. RICHARDS I 1 &c.)> This remark suggest a local outbreak, but the me extent remains to investigated. i 1 While severe influenza is known to have occurred in Copenhagen in 1709, we have found no report of the disease from other places in Denrnark. A medical historian has mentioned «gTeat general sickliness)) as having occurred in Sweden at the same time. Further research, including the examination of parish records, is likely to clarify this part of the problem. Our correspondence with Scandinavian libraries yielded no referente to relevant secondary sources. Similar deficiencies exist with respect to the presence or absence of epidemic influenza in Russia at this time. Promising sources of information include the writings of British, Dutch, and German physicians who are known to have worked in Russia in the early eighteenth century. It is also probable that hospital records and military records for this period still exist. For Russia, as for Sweden, the data are likely to be complicated by the concurrent presence of war and plague at this time. No positive information could be obtained either from correspondence or through the use of bibliographies, about influenza in 17081709 in AusJ tria, Poland, Rumania, Turkey, Egypt, Tunisia, or Algeria. An outbreak of a what may well have been influenza -&e identity of the disease is uncertainoccurred in Ethiopia in 1706, but there is no evidence that it 1 was connectec with the European influenza of 1708-1 709. -. For North America the record is not completely blank. In the province of Virginia, which included what is now West Virginia, a widespread severe acute illness, which was probably but not certainly a respiratory infection, started at some time before February 28, 1709 and continued at least until May 18, 1 709. Not demostrably connected with this was another severe outbreak, which was in existence in December, 1709 and continued at least until February, 17 10; its characteristics are not recorded in the documents consulted. Fragmentary evidence, documented only in part, suggets that influenza was present &d seriously troublesome in Charleston, S.C. in 1709. A large outbreak -its exact size is unknownoccurred in (Luébec in 1708 and caused at least a few deaths. This disease was a respiratory infection or cuased complications in the respiratory system, since it is known to have produced pleurisy. The location of some of the burials is known and it is suggested that the application of advanced radio-immunological methods to the cadavers may throw light on the cause of this outbreak. I The epidemic or pandemic of iduenza in 1708-1709 Our investigation has shown that the outbreak in Europe was somewhat wider than previous discussions indicate. Outbreak of acute respiratory infection occurred in North America at the same time but there is no proof that these were connected with one another or with the simultaneous large outbreak in Europe. In its striaest sense the term pandemic cannot be applied to the huge European outbreak described by Lancisi. ACKNOWLEDGEMENTS We thank the following ladies and gentlemen for their kindness in supplying information during the course of the present investigation Jay T. Alexander, Lawrence, Kan; Marvin T. Allison, Miami; John Appleby, London; Gheorghe Bratescu, Bucharest; David L. Cowen, Jamesburg, N. J.; Anne K. Donato, Charleston, S. C.; Inge Dupont, New York; Nancy Frieden, Larchmont, N. Y.; Claire Gagnon, Québec; Luis García Ballester, Santander; Paul Ghalioungui, Cairo; Hallberg Hallmudsson, New York; Dorothy T. Hanks, Bethesda; B. Hapgood, Cardiff; M. Hvardal, Oslo; Samuel Izsak, Cluj; Erna Lesky, Innsbruck; Jocelyn Mckillop. Winnipeg; Salli Morgenstern, New York; Guillermo Olagüe de Ros, Granada; Linda Ordogh, Montreal; Angelo Palma, Rome; G. R. Paterson, Toronto; Robin Price, London; David Williams, Barry; Michel Wyczynski, Ottawa.