`OUR AUTUMNAL REMITTENT`: DR. JOHN STEDMAN AND THE INFLUENZA EPIDEMIC OF 1758
by Dr Jean Barclay
As our lives are being affected by a viral pandemic, it seems timely to look back to an outbreak of influenza in mid-18th Scotland and its description and treatment by Dr. John Stedman of Dunfermline. According to Dr. Stedman the outbreak was a particularly bad case of `Our Autumn Remittent` (1).
Dr. John Stedman was an interesting character. He was born at West Baldridge, Dunfermline, in 1710, the eighth of the nine children of the Reverend John Stedman, minister of Dalmeny, and Jean, daughter of the Reverend John Kinnaird, minister of East Calder. When John was a baby, his father became minister of the Tron Church, Edinburgh, and the family moved to the city. In the 1730s John Stedman attended the Medical Faculty of the University of Edinburgh, where he obtained the degree of Doctor of Medicine (MD) (2). In 1740 he was appointed surgeon-major to the North British Dragoons or Scots Greys in Holland and was present at the Battle of Dettingen fought against the French in June 1743. By 1750, Dr. Stedman had returned to Scotland and in 1754 he married Margaret or Peggy, daughter of Robert Wellwood of Garvock and Pitliver, and the couple went on to have a son and four daughters (3). From 1754 to the mid-1760s, Dr. Stedman and his growing family lived in Dunfermline, near his sister Marion who was married to William Black, former Clerk of the Regality, and not far from two other sisters, Margaret the wife of John Moubray of Cockairney, and Jane who was married to Adam Rolland of Gask. In Dunfermline, Dr. Stedman built up a successful practice and included among his patients the gentry of the town, such as the Halketts of Pitfirrane. Dr. Stedman was described by a young nephew as a tall, thin, grave person with a great intellect but little patience, with him at least (4).
In the 1750s and 1760s, Dr. Stedman carried out 48 of the 73 smallpox inoculations done in Dunfermline. In this pioneering and sometimes dangerous procedure, the patient was infected with the actual disease and required the constant attendance of a physician. It was mainly taken up by the wealthy except in outbreaks when poorer people, especially the young, were inoculated (5). In about 1762, Dr. Stedman took on an assistant, a local boy, John Mackie, who would himself go on to become a well-known physician (6).
In 1763, Dr. Stedman returned with his family to Edinburgh, where he soon became part of the intelligentsia of the Scottish Enlightenment. He became a Fellow of the Philosophical Society and in 1769 of the Royal College of Physicians. He obtained the position of surgeon to the Merchant Maiden Hospital, a charity school, and was later elected a physicians-in-ordinary to the Edinburgh Royal Infirmary (7). In 1783 he became one of the founders of the Royal Society of Edinburgh.
Dr. Stedman died in 1791, renowned as `an Able Physician and an Elegant Scholar` (8). Having obtained land in Garvock, Dunfermline, and inherited Earneyside near Dollar from an aunt and Little Seggie in Kinross from a cousin, he died a wealthy man, able to leave his daughters and grandsons his four-story house in the prestigious St. John`s Street off the Canongate as well as his landed property (9).
During his career, Dr. Stedman submitted numerous medical and philosophical treatises to the journals of the day. He was particularly known for his Physiological Essays and Observations of 1769, which dealt with the pulse, menstruation, the measurement of heat and `The insalutary constitution of the air, from a Defect of winds of the higher Degree` in which he claimed that a lack of strong winds allowed influenza and other fevers to take hold (10).
Influenza was not new, but nor was it understood, as viruses and bacteria had not yet been identified as vectors of disease. Like other diseases it was attributed to a miasma of bad air for which Dr. Stedman blamed the wind. This in turn affected the humours – blood, bile, black bile and phlegm – which were thought to be allied to character and responsible for maintaining the balance of the body. From the 12th century there had been outbreaks of influenza with pandemics in the 16th century. In the 18th century there were at least four epidemics and descriptions of the disease and its treatment became more precise. From the mid-1750s Dr. John Pringle of Edinburgh and others were beginning to give more credence to the idea of contagion with infections being spread from person to person by some unknown agent rather than coming from outside. With this in mind, Dr. Pringle made a study of several diseases and when an epidemic of influenza broke out in Scotland in 1758, he asked colleagues to send him accounts from their locality. He obtained at least five replies including one from Dr. Stedman (11).
The epidemic of 1758 was mainly limited to the West Indies, France and Scotland, where it was first observed `with the east winds` of mid-September among children but by October affected young and old alike. It followed a `bloody flux` in parts of Scotland in July and August and an outbreak of smallpox, which was particularly severe in Edinburgh and Fife. During October the influenza epidemic was prevalent in Fife and Perthshire, while in Edinburgh `not one out of six or seven escaped`. It continued until the end of the month and lingered into November. Prompt treatment was necessary – if not the disease `assumed the form of a slow fever which sometimes proved mortal` (12).
In the printed extract of his letter to Dr. Pringle, Dr. Stedman does not say how many influenza patients he attended but gives a clear description of their symptoms and his treatment. His account demonstrates the trial-and-error methods that medical men had to employ before the causes of diseases were understood and modern remedies invented.
Dr. Stedman reported that the epidemic in the Dunfermline district started in October, perhaps sooner among `the lower class of people`. The disease began like other fevers with chilliness and an inclination to sit over the fire, pain about the loins and a headache which was sometimes very severe. Upon going to bed the patients became very hot, restless and anxious, and felt that they were dying. Their pulse rose and they had `paroxysms` of sweating after which remission occurred. Many were nauseous while others had sore throats that were so severe at times that bits of skin sloughed away from the tonsils and palate. Between paroxysms, some patients complained of a `dunting` or uneasy throbbing of the heart and some had an intolerable pricking all over their skin, which was the prelude to a rash. The urine was abnormal and the blood was sometimes `fizy` or `lost its natural consistence`.
In keeping with the emphasis on the balance of the humours, Dr. Stedman`s treatment was directed at evacuating whatever was causing the problem. He began by bleeding the patients early in his consultation, then giving emetics, clysters (enemas) and laxative drinks. He gave diaphoretics of acid or saline to induce sweating and, if too much, gave drugs to stop it, including `the Bark`. Dr. Stedman believed, however, that the disease had to follow a certain course and if the sweats were stopped too early by the Bark, the patients developed a tightness of the chest and a cough, whereupon which he would stop the Bark and promote the sweats again.
The epidemic seems to have lasted about two months and was rarely fatal in the Dunfermline district. In Perthshire a great many people died, especially the elderly, and Dr. Stedman speculated that perhaps they had a more malignant strain of the disease or their physicians regarded the disease as `inflammatory` with the consequence that patients were `frequently and plentifully blooded`. This `diverted the sweats` which were `the natural and benign crisis of this fever that had consequences not easily repaired`.
Dr. Stedman exemplified `right` and `wrong` treatments in a case history of a young gentleman of 18 he was called out to. The patient had been ill with fever for eight days and had been bled six times. He was wild and raving with a `starting of the tendons`, a wavering pulse, and stiffened blood. Dr. Stedman opposed further bleeding and, in consultation with another physician, gave the patient some wine which was gradually increased until he consumed two bottles of Madeira in three days after which he dissolved in sweat and began to recover.
Dr. Stedman finished by saying that although this outbreak was worse than usual it might still properly be called `our Autumn Remittent` which rarely failed to appear locally at the beginning of winter (13). Although we have immunisation nowadays, influenza can still be a killer and we are fortunate in having modern remedies like antibiotics to turn to and being spared the blood-letting and other drastic remedies of yesteryear.
NOTES AND SOURCES
(Several of these sources can be viewed on line).
1) `Extract of a Letter from Dr. John Stedman, Physician at Dunfermline, in the shire of Fife, containing an account of the Epidemic fever in that part of the country in the end of autumn 1758; dated Dunfermline, Jan.9 1759`, in Medical Observations and Inquiries, 1762 (2) pp. 206-12.
2) It was not easy to obtain the prestigious degree of M.D. at the Faculty of Medicine at the University of Edinburgh as it involved at least three years` study and could prove expensive. A final thesis had to be written in Latin and defended before the whole Faculty.
3) The Stedman children were Susan (born 1756), John (1757-1781), Jean (1758), Katherine (1759), Marion (1761).
4) Journal of John Gabriel Stedman, edited by S. Thompson, London, 1962, pp. 11-16. John Gabriel Stedman, Dr. Stedman`s nephew, aged 11, had been `shipped off` from Holland in 1755 to be educated by his uncle but was, by his own admission, a tearaway. His room was `up three pairs of stairs` and the house was probably one of the tall old houses in St. Catherine`s Wynd, later removed to make way for new gates into the Pittencrieff Estate. Dr. Stedman`s sister Marion Black lived nearby in the corner house of the Maygate. An entry in the `Burgh Records of Dunfermline`, Vol. 8, May 8 1754 states that when the Provost Sir Peter Halkett was ill there was an attestation by John Steedman, physician, that `Sir Peter Halkett is at present in such a bad State of Health that he cannot be moved out of his Bed Room without immediate danger`.
5) Charles Creighton, A History of Epidemics in Britain, Cambridge, 1894, pp. 353-4. Alexander Monro, `An Account of Smallpox Inoculation in Scotland`, Edinburgh, 1765, pp. 27-29. Dr. Stedman carried out 48 inoculations in Dunfermline, W. Stenhouse, 20 and W.Gulland 5.
6) John Mackie (1748-1831) was educated at Dunfermline Grammar School by his uncle Andrew Donaldson, and accompanied Dr. Stedman to Edinburgh where he attended the university and obtained his M.D. He became a well-known physician, philosopher and author in England and then spent 10 years on the continent where he was consulted by the Queen of Spain and the ex-king of Holland.
7) Some sources say that Stedman was an Honorary Professor at the Medical School, but I have found no proof of this.
8) Bibliotheca Britannica, Index, Vol. 2, Edinburgh, 1824. In the 1770s, although he had left the town, Dr. Stedman became ruling elder to the Presbytery of Dunfermline, probably by virtue of his lands in Kinross, then part of the same Presbytery.
Dr. Stedman died aged 79 from `decay` on the 21st April 1791 at Robertson Stone, Canongate. His wife Peggy and son John had predeceased him. .
9) Testament of John Stedman (Scotlandspeople website). Earneyside had been left to him by his aunt Helen Paton in 1746 and Little Seggie by his cousin Alexander Stedman, Minister of Tillicoultry in 1765.
10) Dr. Stedman`s articles have to be distinguished from those of Mr. John Stedman, surgeon, of Kinross (1703-1781), probably a kinsman, and those of his nephew, John Gabriel Stedman. In addition to his Physiological Essays and Observations of 1769, and his account of the influenza epidemic of 1758, Dr. Stedman`s submissions to medical and philosophical journals include `The effects of Hyoscyamus Albus or White Henbane`, 1750; Thermometrical Tables and Observations`, 1751, `On triangles described in circles and about them`, 1775 and `Of the degrees and the quantity of winds requisite to move heavier kinds of wind machines`, 1777. He is also the attributed author of The History and Statutes of the Royal Infirmary at Edinburgh of 1749, and his classical writings include `Horace`s art of poetry translated`, `A critical inquiry into the constitution of the Roman legion`. Laelius and Hortensia: thoughts on the nature and objects of taste and genius`, 1782 and Moral Fables, 1784
11) Dr (later Sir) John Pringle was said to be the first person in Britain to use the word `influenza` which came from the Italian for `influx`, as diseases were once thought to flow in from the stars. In addition to Dr. Stedman, the physicians who replied to Dr. Pringle were Dr. Robert Whytt of Edinburgh, Dr. John Alves of Inverness, Dr. John Millar of Kelso and Dr. Thomas Simson of St. Andrews. Their accounts appear with Dr. Stedman`s in Medical Observations and Inquiries, op. cit, pp. 192-206.
12) Creighton, op. cit. It was hinted that outbreaks of colds and coughs among horses might be linked to the influenza outbreak. Dr.Whytt: Medical Observations, op. cit, pp. 192,198. 13) Dr. Stedman`s remedies included the Spirit Mindereri and Sal C. C. (common vinegar and salt of Hartshorn) as a diuretic, Sal. Ammon. crud. and elix. vitriol, (aromatic sulphuric acid), for flatulence, and `moderate decoctions of the Bark` for fever. The `bark` was cinchona bark, the source of quinine, which was ground down and put into wine.