DECEASED DISEASES* By DAVID RIESMAN, M.D., SC.D.

PHILADELPHIA

ISEASES, at least many of conditions, but war may revive them. them, are like human be- Of the diseases that have died be- ings. They are born, they cause their causal agent has become flourish and they die. Some spontaneously extinct, the sweating may be eternal or at least coevalsickness with is one of the most interesting Dthe race, but seeing how many have examples. As far as we know this disease disappeared or are in the process of dis- has disappeared utterly. Also known as appearing, it would hardly be a wise the English sweat, it was a devastating prophecy to predict eternity for any of pestilence, of whose symptomatology, them. however, we have little knowledge. One Diseases may die from a variety of of the best descriptive accounts is by causes—thus the agent causing them Dr. John Caius or Kaye. Nor have we may disappear, as in the case of the any ideas as to its etiology. Some have sweating sickness of the Middle Ages. identified it with influenza, but I be- Some have become rare or nearly ex- lieve on insufficient grounds. On the tinct through efficient sanitary meas- Continent, especially in France, the dis- ures of various kinds, as is true of lep- ease was accompanied by an eruption, rosy. In some cases the disappearance is hence the names suer miliaire, suette only apparent, having been brought migliare. about through a change in name. Oth- The sweating sickness appeared first ers have disappeared because they were in England after the battle of Bosworth, really not diseases at all but symptoms August 22, 1485. After a short rigor the wrongly interpreted as clinical entities. body’s powers were prostrated as with a This has been a rather frequent cause blow. Headache, stupor and epigastric of disappearance. Some were entirely pain were present and the whole body fanciful and had to give way before in- was suffused with a fetid perspiration. creasing technical knowledge, and some All this took place in the course of a few have disappeared as the result of a gen- hours and the crisis was over within the eral enlightenment of the people. space of a day or a night. The people The greatest triumphs have un- were seized with consternation when doubtedly been achieved in the infec- they saw that scarcely one in a hundred tious diseases. Theoretically these are escaped. Many who had been in perfect all conquerable and we may hope to health at night were on the following banish most of them in time. Leprosy morning numbered among the dead. and plague, yellow fever and cholera, The physicians could do little or noth- have lost their terrors; typhus fever, re- ing for the people in their extremity. lapsing fever, smallpox are now rare Several epidemics swept over Eng- in civilized countries under civilized land, one in the reign of Henry vm, * Read at the meeting of the History Section of the American Medical Association, At lantic City, N. J., June 13, 1935. when Cardinal Wolsey had the disease. see the disease one has to go to outlying Erasmus, then a resident of England, places in the world, particularly to also seems to have passed through an China, where in the province of Kwang- attack. tung there are from 50,000 to 100,000 It was remarkable that the disease did lepers. Only rarely does an accidental not spread to Scotland, Ireland, or circumstance bring a case to our doors. Calais, which then belonged to Britain. While the disappearance of leprosy Hamburg was visited by the sweating is largely due to the strict isolation prac- sickness in 1529. Within the space of ticed in the Middle Ages and later twenty-two days 1100 inhabitants died times, it must be remembered that the “for such was the number of coffins word leprosy in all probability desig- ■which were at this time manufactured nated a variety of unrelated diseases— by the undertaker.” In Augsburg syphilis in its destructive forms being within six days 1500 inhabitants were one of them. The extensive use of mer- attacked of whom about 800 died. Co- cury is therefore another factor in the logne, Strassburg, Frankfurt had simi- disappearance of what was called lep- lar experiences. rosy. As I have said nothing is known of The plague, both bubonic and pneu- the cause of the malady and the specu- monic, is a disease with which only lations of contemporary writers are of physicians in certain areas in Asia have no value. any real acquaintance, although a spo- The petechial fever of Italy is an- radic case may from time to time be other curious disease about which little seen in other parts of the world. For all is known. It is described by Fracastoro practical purposes plague is one of the as the first plague of the kind to occur deceased diseases, yet at one time it was in his country. It was not a very con- the greatest scourge of mankind, killing tagious disease and did not seem to be during one of its visits to Europe, one- carried by fomites. The sick “lay upon quarter of the population. Hardly any- their backs with an oppressed brain, thing has happened in the world that blunted senses, delirious, with blood- has made an equally profound change shot eyes.” The urine, clear and copi- in the general social structure. In Eng- ous at the beginning, became red and land in the fourteenth century through turbid or resembled pomegranate wine. the death of the majority of teachers, The pulse was small and on the fourth who were largely French, the French or seventh day red and purple spots like language, until then widely spoken, flea bites or larger, resembling lentils died out and gave place to English. (lenticula—which also became a name In an indirect way the plague was of the disorder) broke out. also a factor in the creation of Italian Of the diseases that have yielded to as a spoken language. It happened in improvement in sanitation the best ex- this way. When the plague broke out in ample is leprosy. This disease, terrible Florence, Boccaccio fled with his hu- in its social implications and its destruc- manistic friends and in his voluntary tive effects, has disappeared from the exile wrote the famous “Decameron,” civilized world. At one time there were which soon acquired an extraordinary in France and Germany nearly 10,000 popularity. Being widely read by all leper houses or leprosaria, and in France classes of people, it helped to fix the alone 20,000 lepers. Now in order to Italian language which has undergone less change in six hundred years than their nakedness. They love to be tossed to any other European tongue. Petrarch and again into the air. There are some with his sonnets and Dante with his that will roll themselves in the dirt like “Vita nuova” also had a share in popu- swine. Others again you cannot please un- larizing the lingua volgare. less they be soundly drubbed on the Plague was practically the first dis- breech, heels, feet, back, etc. There are some that take a great pleasure in running. ease recognized as infectious, and for the first time in history methods of iso- That the tarantula itself does dance lation and disinfection were employed at the sound of music is what some have by the public authorities. At Ragusa on believed. A wasp being stung by the the Dalmatian coast, ships and travelers tarantula fell into dancing with it and were detained for forty days (quaranta- a cock happening to be in the way was giorni), whence our word quarantine. by the same means brought in for com- A different group of diseases is repre- pany. With regard to the dancing of the sented by tarantism and the dancing tarantula Baglivi is willing to believe manias of the Middle Ages. it, only he thinks “the matter needs a Tarantism got its name from Taren- little further proof.” tum, the town in Apulia where the Professor Sigerist has advanced the malady had its chief center, and from interesting suggestion that tarantism which the spider, the Tarantula, also de- was a revival of the Dionysiac cult of rives its name. Baglivi1 writes of the Magna Graecia. disease as follows: The best treatment in the popular The tarantula attacks persons asleep as mind was music, a special melody for well as awake without any provocation as special cases or special spiders. Hecker well as when ’tis irritated and in both in his book on “The Epidemics of the cases its bites are venomous. A few hours Middle Ages” gives some of these tunes. after the bite the patient is seized with The Italians even today apply the word great difficulty of breathing, a heavy an- Tarantella to a special dance and to the guish of heart, a prodigious sadness, his music of this dance. voice is sorrowful and querulous, his eyes There is no evidence that tarantism disturbed. The symptoms vary, however, was ever caused by the bite of the different tarantulas producing different tarantula. This spider is no more poi- symptoms. After the violent symptoms of sonous than any other spider.2 the first days are over the disease ends in A convulsive disease also appeared in a peculiar kind of melancholy which con- Scotland. It was noticed first in Forfar- tinually hangs upon the sick person until shire. It was called leaping ague and by dancing or singing or change of air bore so close an analogy to the original those violent impressions are quite ex- St. Vitus’ dance or to tarantism that it tricated from the blood and the fluid of seemed only to want the “foull fiend” the nerves. A person once stung very rarely is perfectly cured. Some are never or the dreaded bite as a cause and a well but among graves and solitary places. Scotch reel or Strathspey as a cure to They lay themselves along as on a bier as render the resemblance quite complete. if they were really dead. They throw Cold bathing was found to be the most themselves into a pit. Modest women oth- effectual remedy but when the fit of erwise chaste enough, without any regard dancing, leaping or running came on for modesty, fall asighing, howling and nothing tended so much to abate the into very indecent motions discovering violence of the disease “as allowing them free scope to exercise themselves Plica Polonica, a strange chronic dis- till nature was exhausted.” It seemed ease called Weichselzopf by the Ger- to be hereditary in some families. A mans, no longer figures in our text- similar disease prevailed for a time in books but there was a time when it the Shetlands. loomed quite large and achieved a con- The Dancing Mania. The great siderable literature. It is a chronic con- plague of the fourteenth century was tagious filth disease of the hairy parts of followed by a curious expression of the the body and of the nails in which terror that had seized humanity. First through the gluing together of the hair in the Rhenish towns of Germany and with a glutenous lymph the hair is in the Netherlands people, gathered to- transformed into unsightly braids; the gether in crowds, would without warn- nails also undergo a peculiar degenera- ing fall to the ground in convulsive tion. It may come on gradually over a seizures and panting for breath. Froth- period of months or years or more or ing at the mouth and suddenly spring- less abruptly, being precipitated by ing up, they began a mad dance amid acute catarrhal and rheumatic disturb- strange contortions. A curious tympany ances and by bone pains resembling of the abdomen accompanied the seiz- those of syphilis. Headache, dizziness, ures for which relief was obtained by tinnitus, tearing eyes, diminution of tight bandaging or more often from the vision and hearing, mania, convulsions, kicks and blows given by willing by- shortness of breath, vomiting, hemor- standers. The dancers rapidly increased rhoidal attacks, skin eruptions, glan- in number and soon took possession of dular and joint swellings, ulcers, the religious houses and intimidated leucorrhea, blood spitting and finally the clergy, who resorted to exorcism to pneumonia are some of the bizarre arrest the spread of the evil. In a short manifestations attributed to plica polo- time the St. John’s dance, as it was nica. Some considered it a syphilitic called, lost its religious or devotional manifestation; others looked upon it as character and degenerated into wild an acute metastasis, whatever that may revels; “peasants left their plows, me- mean. Joseph Frank maintained that it chanics their workshops, housewives was a form of leprosy. Mercury had no their domestic duties, girls and boys beneficial effects, but the disease was quitted their parents to take part in the curable by general measures. orgies.” The outbreak of the St. John’s A disease of ancient lineage that is dance which, I take it, was a form of practically extinct, at least no cases are major hysteria, lasted nearly four seen in this country, is ergotism, in the months. A similar mass dance appeared literature called most frequently St. in Strassburg and other cities about Anthony’s fire, ignis sacer or feu sacré. fifty years later, in the early part of the There are over forty names in different fifteenth century. It differed from the languages for this disease. It was widely St. John’s dance in that it was more joy- prevalent in Spain and in Germany, ous, less contrite, the dancers being ac- twenty-eight epidemics being recorded companied by musicians playing on between 857 and 1547. There were two bagpipes. As during this outbreak St. principal types of the disease: the gan- Vitus was first called upon in prayer or grenous and the nervous. In the first was held actually responsible, the dance the limbs, particularly the legs, after a became known as St. Vitus’ dance. period of intense tingling and burning became black and gangrenous. If death sometimes it proceedeth through certain did not supervene, the limbs gradually kinds of worms which do devour the meat became detached from the body. Pic- as it is taken into the stomack as fast as it tures of St. Anthony usually show one is received.3 or more mutilated individuals praying Milk sickness, a supposedly milk- to him for relief. Because of the tin- borne disease, was also conveyed by gling and burning the disease was cheese and butter and the fiesh of ani- known in Germany as Kriebelkrank- mals infected with the trembles. In man heit. The nervous forms were charac- it was characterized by indifferent pre- terized by spasmodic contractures, stu- monitory symptoms: lassitude, pain in por and convulsions. The Medical the head and limbs, anorexia and slight Faculty of Marburg in 1597 expressed nausea. The nausea became more pro- the opinion that the disease was due to nounced and vomiting supervened ac- the use of bread made from spurred rye, companied by intense thirst, obstinate and the Royal Academy of Medicine of constipation and a burning pain in the Paris in 1776 arrived at the same con- epigastrium. The surface temperature clusion. As the toxic character of was low and the internal temperature spurred rye is due to the presence of the not much elevated. The breath was of- well-known fungus ergot, the disease fensive and so characteristic that by was also known as ergotism. means of its peculiar fetor the disease The term St. Anthony’s fire has also could be recognized. Somnolence, coma been applied to erysipelas. It was prob- and convulsions were frequent in the ably the latter disease to which Sir Wal- fatal cases. Death usually was preceded ter Scott refers in his poem “Marmion” by the typhoid state with low muttering when he makes the impatient Blount delirium. Mild cases hardly passed be- address his fellow squire Eustace, who yond the premonitory stage; severe was patiently listening to a long tirade cases often terminated fatally in two or of the Abbess: three days. Most frequently the dura- Saint Anton fire thee! wilt thou stand tion of fatal cases was between five and All day, with bonnet in thy hand, fourteen days. To hear the lady preach? According to Austin Flint,4 it was Another fanciful disease, now totally endemic in Indiana, Ohio, Illinois, extinct in medical literature, is canina Tennessee, Missouri and Michigan; it appetentia or dog-like appetite, which was known to have occurred in Penn- was an immoderate desire of meat and sylvania, Virginia and West Virginia. when It was not observed east of the Alle- ghenies or west of the Great American . . . they cannot refrain their appetite Desert or in the countries of the Old they devour in meat without measure. World, but as it seems to have disap- Then being heavy with a multitude of peared with the disappearance of the meats and the stomack being not able to bear the same, they turn to vomiting; trembles, we can only guess at its cause then afterwards they fill themselves and —perhaps it was an organism belonging turn again to vomiting like dogs. The to the paratyphoid or abortus group. cause is a bad gnawing or biting of the Infantile remittent fever, also called mouth or of the stomack like unto a suck- worm fever, has disappeared from our ing. Sometimes it happeneth through the nosography. Whatever the disease was, cold distemper of the mouth or stomack, it was not due to worms but to some form of infection. I am reminded in by Sydenham whose treatment was the this connection of another vanishing application of the warm body of a liv- disease, namely, infestation by tape- ing puppy to the right iliac fossa. worm. In my early years of practice not Although the first operation for ap- many months would pass without my pendicitis in this country was done by seeing some one who had a tapeworm. Willard Parker in 1864, it took twenty- One of the longest I obtained from a five years before typhlitis disappeared prominent lawyer in Philadelphia. Al- from our medical textbooks; yet there though lawyers have multiplied, tape- were writers who had the correct idea worms are now a great rarity. long before Reginald Fitz. Thus Bris- Some of the conditions that were tow6 wrote as follows: “The most fre- considered diseases have disappeared quent form of fatal typhlitis is no doubt through being relegated to the position that which results from perforation of of mere symptoms; thus the older text- the vermiform appendix, an accident books considered frenzy a disease which which occurs mainly in early life, and was treated by opening a vein in the apparently more frequently in males foot or the salvatella vein in the hand.5 than in females.” Today we look upon frenzy not as a Cholera morbus is not mentioned by disease but as a severe delirium com- recent writers, yet it was a name fre- mon to many affections. quently heard in my youth and occu- Many diseases have disappeared be- pied considerable space in textbooks. cause of a change in nomenclature. Austin Flint, who devotes four pages to Until the latter part of the nineteenth it, objects to the absurdity of append- century the word peripneumonia was ing the Latin word morbus to the frequent in medical literature. It is nat- Greek word cholera, for morbus ex- ural to think that peripneumonia presses no more than is implied in the meant pneumonia around or on the name of any affection, that is, the exist- surface of the lung. That is, however, ence of disease. Cholera morbus has not the meaning of the word. Laënnec nothing to do with real or Asiatic chol- has clearly shown that the prefix peri era and is, as Flint says, indigenous in as used by Hippocrates and later writ- America as it is in the countries of ers does not mean around but indicates Europe. In all probability the disease importance or intensification. The represents a form of food poisoning word, therefore, is nothing more than which has become rare. a synonym of pneumonia. Among diseases that have disap- Peripneumonia notha and bastard peared through correction of faulty pneumonia are also names that are no diagnosis I might mention ptomaine longer in use, but the disease they desig- poisoning which was a very comforta- nated, bronchopneumonia in the aged, ble blanket diagnosis a generation ago. is a common enough affection. Sometimes it was mistakenly applied to Acute hydrocephalus is the old name gallstone colic and in practically all for tuberculous meningitis, a disease conditions it was a misnomer for the that still prevails. disease was not due to ptomaines. Pto- Typhlitis is another disease that no maine poisoning, as we now know, is a longer exists de nomine, but it exists de form of food poisoning due either to facto as appendicitis. Earlier writers bacteria or to their toxins. The name called it iliac passion; it is referred to has vanished from medical literature and the condition that it wrongly desig- cination and general hygienic measures nated, food poisoning, has become rare. have made the disease so rare that there Outbreaks of botulism and paratyphoid has been no death in Philadelphia in infection, the best studied representa- many years and the total death-rate for tives of food poisoning, are no longer the United States is almost infinitesi- common. mal. It is possible that some share in In my earlier years in practice one of this happy result must be attributed to the commonest “diseases” diagnosed by a change in the virus itself for in many doctors and also by superior laymen was other parts of the world only a mild autointoxication. No longer is this a re- type of the disease prevails (variola spectable diagnosis. Like ptomaine poi- minor, also called alastrim). Perhaps soning it covered with a convenient the virus has become attenuated by mantle a multitude of diagnostic errors. having only an immunized population In some recent works on medicine the to feed upon. word autointoxication does not even Chlorosis is one of the most interest- appear in the index, in others it is given ing of the deceased diseases. The dis- merely as a symptom which after all is appearance of the green-sickness is due the only thing that autointoxication to a variety of causes: to a change in our should imply. As a symptom it is com- habits of living—a healthier, freer mode mon to many conditions as is fever or of life, in which women have their full headache. Its disappearance from medi- share, shorter working hours, athletics, cal literature is due therefore not to the the disuse of the tightly laced corset, disappearance of a disease but to a modes of dress and outdoor life giving change in concept. sunlight a better chance, and a better Hydrophobia has always been one of balanced dietary. the most terrifying diseases of mankind With the disappearance of chlorosis for when once established it leads to has come the disappearance of gastric death through frightful torture, but it ulcer in chlorotic young women. now belongs to the vanishing diseases. Scurvy as a disease of adults has be- Personally I have only seen one in- come so rare that many mature phy- dubitable case, that in a boy of fourteen sicians have never seen a case, yet it was years. one of the commonest diseases 150 years Scrophula was a condition which in ago. It also prevailed extensively dur- my early years was very common. Chil- ing the Great War but now it is totally dren with glandular swellings often negligible in Western Europe and suppurating were a daily sight in hos- America.7 We know since the latter pitals and in doctors’ offices, but the days of the eighteenth century that King’s evil has almost vanished and the lemon or lime juice prevents it and Royal Touch that caused it to disap- cures it, although the explanation of pear was the campaign against tubercu- how these juices act, as in the case of so losis, inspection of the school and pre- many other conditions in which em- school child and, in general, better piric knowledge has outrun scientific conditions of living. knowledge, had to wait until our own At one time smallpox was so common time. We are now aware of the indis- that an unmarked face was a rarity. Not pensability of accessory food factors, the only did it mark the face but it killed a vitamins. large proportion of those attacked. Vac- Ptosis, especially gastroptosis, was not only a recognized disease but also one of this mysterious insect. I saw a case that the surgeon thought he could treat and concluded that the young woman successfully by a dramatic operation. In had not been bitten by a bug but was a recently published textbook of medi- suffering from angioneurotic edema. cine neither gastroptosis nor viscerop- Hypochondriasis constituted a very tosis is accorded a place, and where is important disease in an earlier day but the surgeon who today would operate it no longer appears in modern text- for these conditions? They belong to books. “The hypochondriac,” says Tan- the deceased diseases; their extinction is, ner, “is ever walking under the petty however, not due to improved hygiene, despotism of an imaginary evil.” I am vaccination, vitamins or sunlight but not sure that we have improved upon to a better understanding of physiology. either the concept or the word by Gout in its tophaceous form has be- substituting for it neurasthenia, nerv- come a very rare disease not only in this ous prostration or other portmanteau country but even in England. words. Popliteal aneurysm was formerly sec- I have by no means exhausted the list ond only to aortic aneurysm. It is now of deceased or dying diseases; it is, how- a very rare disease. ever, sufficiently large to justify great A. F. Hurst8 calls attention to the optimism for the future. The conquest rarity of mucomembranous colitis of the infectious diseases is almost in which was a common disease up to the sight; that of cancer is within the realm time of the Great War. Those who have of the possible. Only a few diseases re- read Axel Munthe’s book will remem- main or are likely to remain uncon- ber that he found it a very profitable quered and then old age and the haz- disease to diagnose. ards of transportation will be the prin- A number of years ago Philadelphia cipal executioners of the human race. was agitated by the presence of the so- No, I am afraid the greatest of all man’s called “kissing bug.” A curious swelling enemies will remain—his own brother; of the face had appeared in many per- but even that blood-born disease, War, sons and they attributed it to the bite may come to an end. Let us hope!

Ref ere nces 1. The Practice of Physick. London, 1723, p. 5. Baglivi. The Practise of Physick. London, 3*4- 1723, p. 82. 2. Legends seem now to be growing up in 6. Treatise on the Principles and Practice of this country around the black widow Medicine. 1876, p. 626. spider of the West and South. 3. Bayfield, R. Enchiridion Medicum. Lon- 7. During the depression, scurvy has reap- don, 1655, p. 45. peared but only in isolated instances. 4. Treatise on the Principles and Practise of Two cases have come under my obser- Medicine. Ed. 7, rev. by F. P. Henry, vation within the last two months. Phila., 1894, p. 1047. 8. Brit. M. J., p. 629 (April 8), 1933.