Summary in these terms, the reconciliation seems to have no other conclusion than the separation nosological of the two suets.
Such, however, is not M. Guerin’s feeling, and I regret to disagree with him, in spite of my usual deference to his authority.
My honored colleague has understood that, in such matters, we must refrain from all too absolute affirmation, and he expresses with a certain reserve, his way of seeing, implicitly very fixed.
“The comparative examination of the various epidemics of English suet and Picard suette suggests that it is fundamentally the same disease, differing only in degree of intensity . The absence and the presence of the miliary eruption, of an abusive importance from the nosological point of view, disappears before this etiological consideration that, in the first case, the intoxication is such that it strikes, so to speak, patients, and prevents any reaction of the body; while in the second, it leaves the eliminatory action of the skin, the time and the means to manifest itself, as it does in all febrile eruptive affections. “
As a general principle, when two diseases are compared, their respective lethality is not a fundamentally distinctive trait . A simple and discrete smallpox is, basically, the same morbid entity, as a confluent and malignant smallpox. A pernicious fever and a simple intermittent fever, represent the same affection, curable by cinchona. But here, unlike gravity, come to add the other characters that imply the identity of nature. Whatever their apparent divergence, the two orders of diseases rally on the common basis of etiology, virulent for the former, effluvienne for others.
It is not the same for the two suets, and one could translate the radical contrast of their prognosis, saying that it does not depend on accidental complications, on circumstances peculiar to subjects, & c. The source can only be found in the primordial tendencies of their respective modalities.
It is not that the miliary suette, in turn, counts, like the most benign diseases, its days of gravity . It is unusual, of which we are reduced, for want of anything better, to accuse the influence of the epidemic genius.
In the memorable invasion of Languedoc, the number of deaths, according to statistics collected by Fouquet, rose to more than thirty thousand . But it must not be forgotten that this large figure, dependent to some extent on exciting treatment, has been found in a very extensive district.
The truth is that in general, the prognosis was not very alarming. Pujol asserts that during the six days when the illness which he observed at Castres was in all the force of its development and propagation, out of about 900 patients, only 12 perished .
In the epidemic recounted by M. Rayer, the total mortality of the infected communes, from the origin to the end, was 116 out of 2,657 patients. This amounts to saying that he died, in fact, only one patient out of 22 9/10.
Certainly, when one remembers that the English suet, in its paroxysms of fury, removed 99 patients out of 100, one can not make cheap such a contrast.
If I grant to M. Guerin that the relative lethality of the two diseases does not resound on their intimate nature , I will be less accommodating on the value of the eruption, as an element of nosological delimitation.
For the doctor of Paris, the defect of exanthem in the manifestations of the old suette, would not be only a matter of time. But can we fix, in this respect, the limits indispensable to morbid reactions? Do not they vary according to a multitude of causes, whose life keeps the secret? Does the eruption of certain suspicious smallpoxes not be very near to the prodromes of invasion? Do not we frequently see fever, angina, and exanthema in scarlet fever? Lastly, did we not learn from Procopius, not only that the buboes of the groin and armpit arose often from the first day, in the plague of the sixth century.century; but that a certain number of patients died in the first hour, the body all covered with black spots ?
Note again that the English suet was not always lightning or quickly mortal. A glance at its history shows that it often exceeded this term, even affecting the chronic march. What becomes, in cases of this kind, the interpretation of M. Guerin? Since nature was no longer hampered in its operations, why then is it sweat alone, which has invariably accomplished the eliminative act, of which one would like to leave the whole load to the miliary eruption?
M. Guerin recalls, not without intention, that on some subjects red spots had been seen , similar, he says, to those preceding the miliary. How is it, then, that this cutaneous flux, already activated by the sudoral raptus, has only resulted in this abortive draft? Why did the pathognomonic militia stop so well? Not to mention that these pretended eruption preludes have been verified only on a very small number of patients, and that everything indicates that they were nothing but petechiae or purple spots , frequent companions of severe fevers.
I can not close this discussion, perhaps too prolonged, without invoking the assistance of Mr. Hecker, who is always found in the field of historical medicine.
This scholar has studied the sweating sickness of the XV th and XVI th centuries in dealing with diseases which approach their appearances .
After having drawn from the sources the features of his description, he does not hide the fact that the old malady was very much like Picardian suette; but he formally declares that the eruption has drawn between them a line of demarcation which can not be erased.
He even went further in his analysis, and sought to better specify the nosological mode of non-eruptive suette, which would be for him only a rheumatic fever ( Rhumatische Fieber ).
It should be known that the German School gives this qualification to morbid states, generally characterized by flows, whose initial cause would be the action of damp cold, and which would tend to end in abundant and acid sweats. These attributes correspond in every respect to our catarrhal affections , and I imagine that at bottom the word rheumatic has no other meaning for German physicians.
Be that as it may, M. Hecker would find these principal characters in the English suet, where the action of the cold was so powerful, that his fugitive impression, during the flow of sweat, brought death almost for sure.
I would have no objection to this way of understanding suette. Only one will suffice.
It is incontestable that the great popular malady, considered in its general pathogenesis, bears in the highest degree, like all other diseases of the same order, the impress of the most striking spontaneity. That cold has influenced the development, the march, the termination of individual attacks, is what experience has put beyond doubt. But in the presence of the plague and its intermittent occasions, the idea can not come from bringing the generation back to external conditions, no more cold than any other. We know about it my way of thinking. In any case, the theory as it is of M. Hecker posits in fact the separation of the two suets, and I insisted on using it.
If we would now compare them more closely, we would have no trouble discovering, apart from the eruption, other dissimilarities which have their semeiotic value.
I do not have to go back to the difference of their lethality. I do not alléguerai, like some authors, the sweating sickness of the XV th century was contagious , while that of the XVII th is exclusively epidemic . I can not accept such an absolute proposition which would contradict the principles I profess in contagion. What I can say is that I believe, by analogy, the transmissibility of the two diseases, under the conditions required for its exercise. I confess, however, that this is just a prejudice that is not based on any demonstrative evidence .
I will be more positive about other facts, which are far from indifferent.
In the English suet, sweat was essentially critical and had to be delivered to itself. In the suet of our time, this excretion is purely symptomatic , without resolutive influence, and it is a general precept to moderate or better prevent its flow.
In spite of the assurances of contemporary physicians, the first suet foiled all the resources of art, not only by its unbridled march, but also by its natural ferocity. The suffrages which the temperate method seems to have reconciled compared to its antagonist, have not been able to weaken the sad eloquence of obituaries. It may well be said that he has remained to us on his therapeutics, only a confused mass of recipes and formulas whose very multiplicity, incoherence, and imaginary virtues, betray the over-proven scarcity of really efficacious medications.
The treatment of the Picardy suette spares us this painful confession. Not that there have been in the presence of several curative methods, and that we must accept on our word the apology of the preachers concerned; but in judging them at work, it can not be denied that they were, according to the case, very powerful; and art has not been deceived, by rationally attributing itself a legitimate share, in the happy outcome of the disease .
Finally, I add as a last trait alleged by some authors, that haemorrhages, a rare and exceptional symptom of the old suette, frequently associate themselves with the modern suette.
It is time to formulate my final conclusion, which expresses my whole thought.
The great popular disease, known as the English suet, which first appeared in 1480, was a new disease. After five epidemic recurrences, spaced in a period of sixty-five years, she struck her last blows in 1551, and withdrew herself among the extinct diseases, whose human pathology has only to engrave, in her archives , the historical memory.
The study that I am pursuing, a serious omission, could be blamed if I remained silent on a communication by Dr. Hecker, who recommends himself from several points of view, for the attention of pathologists.
In the introduction of his beautiful Latin dissertation on the Antonine Plague, my colleague from Berlin, after highlighting the services rendered by the history of medicine, and the brilliance of the lights it projects on the age-old evolutions of the pathology, is led to say a word in passing, certain feeder fever ( febrium sudatoriarum ) that currently occur in central Germany, mainly on the banks of the Mein, and who would, he says, a marked resemblance to English suet .
This last affection was for the author, the subject of a learned monograph, and it is there that we must seek precise clarifications on these fevers , the very existence of which was almost ignored, before his revelation. To be brief, I am satisfied to extract from this work, the relation of a singular disease that invaded a German village, in 1802. A little known doctor, named Sinner, gave the description the following year, in a special working where Mr. Hecker was exhumed in favor of contemporary pathology .
“After a hot and very dry summer, followed in November, 1802, by continual rains, Röttingen, on the Tauber, a small town in Franconia, surrounded on all sides by mountains, was attacked on the 25th of the same month, from an illness very murderous, without example in the memory of the inhabitants, and quite unknown to the physicians of the country.
Young men full of strength were suddenly seized with indescribable anguish. The heart throbbed strongly beneath the ribs. Immediately, torrents of acidic and foul sweat were exhaled all over their bodies. At the same time, they felt a heartbreaking pain in the back. This pain sometimes disappeared very quickly, and if it spread to the chest, the palpitations and anguish were renewed. The sick fainted, and the members stiffening, they gave up the soul. Most of them ended in twenty-four hours. All, however, did not succumb to the first attack; but in some, after the pulse had fallen to extreme weakness and smallness, and that the respiration had followed the same diminution, the heart-rending pain was felt again in the outer parts; they felt heaviness and stiffness in the back; the pulse and respiration resumed their regularity; but sweat continued to trickle down. This calm was excessively deceptive; for, unexpectedly, the palpitations and the smallness of the pulse reappeared, and then, more often than not, death was inevitable. Striking thing! The patients, though swollen with sweat, were very little altered; their tongue was not dry, not even dirty, and it kept its natural moisture; in most, there was little urine.
When the disease went on without any remedies, there was no rash. These eruptions, when they were manifested, were of different natures: miliary vesicles of all shapes and colors, real bubbles of pemphigus or even petechiae. It should be noted that the patients never felt the general itching which preceded the eruption of the miliary suette, nor did they ever undergo regular desquamation. “From which Mr. Hecker concludes, and I share his that these rashes were purely symptomatic in Rottingen’s disease, and that they were not an essential part of it, as they are in Picardy’s Suck.
“When the issue was to be happy, the sweat diminished from the second day, and lost all its bad qualities. So that there was nothing left but abundant perspiration without disturbing accidents, and everything was about the sixth day.
The treatment followed by the people made much worse the evil. Since the XV th century, as in modern miliary, intending to turn sweat, it warmed the sick by all means, risking their lives. It was under the influence of this method that various species of eruption occurred.
In the first days, the mortality was frightening, and the inhabitants of the localities near the theater of the epidemic avoided the approaches, as if it were a plague town. Dr. Sinner, without whom the memory of this pathological event would probably have been lost, brought the help of his art, protested energetically against the method in vogue, and saved, by milder means, all the patients who were engaged in him.
It should be noted that the epidemic was confined exclusively to Röttingen, and that there was not a single case outside. On December 5, with good weather, accompanied by a strong frost, she disappeared entirely. ”
The simple exposition just read is sufficient to establish a great resemblance between this malady and the English suet. Mr. Sinner assigns him a rheumatic nature , and I have said that Mr. Hecker does not otherwise understand the suet. But it is none the less true that, in order to pronounce oneself in the sense of complete identity, one should close one’s eyes to important differences.
Röttingen’s disease has been stubbornly concentrated in its enclosure; it was accompanied by a symptomatic eruption; its common duration was six days.
These characters are in opposition to the corresponding features, inscribed in the description of the English suet: rapid and distant radiation, absence of eruption, suddenness of attacks or ephemeral evolution , in the literal sense of the word.
Whatever the opinion of this confrontation , we must agree that this isolated and transient fact of an illness, falling unexpectedly on a small town in Germany, with the main symptoms of English suet, and an air of novelty which surprises the doctors and the inhabitants of the invaded locality, represents a most curious observation. It could not be separated from the history of the suette, even if one would remain unresolved on the nature of the relationship that would link the two morbid entities, compared to three hundred years apart.
When I thought it set the end of the XV th century, the first known outbreak of the great epidemic of sweating sickness, I did not foresee a restriction that, in the mind of some authors, could insinuate doubts about the authenticity of this date. Although I am far from recognizing this significance, it is indispensable that I give some explanations.
In some ancient medical books, there is a description of a special disease called cardiac disease , characterized by abundant sweat excretion, and bringing together many of the manifestations of English Sue. This disease interests doubly, as we will see, the subject of my studies.
M. Hecker, who leaf through the writings of the old masters with such a sure hand, did not fail to stop this original morbid species, which he proposed to check with the Swiss.
But it is not only from this point of view that this disease deserves our attention. It offers us one more example, of those affections which merely pass into the nosological series, and of which we can also note the entry and the exit, in a limited period of our medical history.
It is positive that the most serious research do not show any trace of it in the works of Hippocrates, who would not have neglected to mention it, had he had occasion to observe it.
On the other hand, one can be sure that after having taken place, for the first time perhaps, in the writings of Erasistrate, three centuries BC, his memory will fade away moreover in addition from Galen; so that this disease, in all likelihood, have been born under the successors of Alexander, and stop at the II th century AD.
So here again a morbid affection which would have appeared at a given moment on the medical scene, would have remained there for a certain time, and would have finally deserted it, leaving us only the tradition of a kind of pathological curiosity.
This interpretation already prejudges the conclusion that I propose to draw from the parallel of heart disease and suette. After having carefully weighed the pros and cons, I have not left the slightest doubt about their nosological distinction, and I hope to win the reader’s adhesion by putting before him the essential elements of this differential diagnosis.
The documents which I am about to use are all the more valuable, since the malady they concern has been completely neglected by the moderns, who have probably found, in their want of actuality, the excuse of their silence. We can say that when we start this study today, we are going down a path barely cleared.