It appears, according to modern experience, to admit of no doubt that this disease consisted of an inflammation of the mucous membrane which, accompanied by a secretion of lymph, spread from the œsophagus to the stomach, and likewise through the air passages to the lungs, being thus identical with pharyngeal croup, which was represented a few years ago as a new disease, and has in consequence been designated by a special name[489]. Its subsequent appearance in the memorable year 1557, respecting which we have a still more complete account, gives additional weight to this supposition. In that year it broke out in October, and was observed by Forest, who was himself the subject of it, at Alkmaar, where it attacked whole families, and in the course of a few weeks destroyed more than 200 people. It was not, however, so excessively rapid in its course as in 1517, but began with a slight fever like a common catarrh, and shewed its great malignity only by degrees. Sudden fits of suffocation then came on, and the pain of the chest was so dreadfully distressing that the sufferers imagined they must die in the paroxysm. The complaint was increased still more by a tight convulsive cough, and until this was relieved by a secretion of mucus, proved dangerous, especially to pregnant women, sixteen of whom died within the space of eight days, whilst those who survived were all prematurely brought to bed. The fever which accompanied the inflammation was very various in its course. It was rarely observed to continue without intermission, but where this was the case, was attended with the greatest peril. Yet death did not take place on this visitation until the ninth or fourteenth day, whereas in the year 1517 as many hours would have sufficed to produce a fatal termination. After this period the danger diminished, and those patients were most secure from suffocation, provided they had good medical attendance, whose complaint had been accompanied throughout its course by fever of only an intermittent character. So marked was the influence of the Dutch soil, that until this intermittent passed into continued fever of different gradations, it appeared of the purest and most unmixed type. In these cases the inflammation was less completely formed, so that even bleeding, a remedy otherwise indispensable, was sometimes unnecessary. Those affected all suffered most at night and in the morning, the latter generally bringing with it the inflammation of the larynx and trachea, which, however, they had not at that time experience enough to recognise as such, perceiving as they did only a slight redness in the fauces. The painful affection of the stomach was also in this epidemic very distinctly marked, so that a sense of pressure at the præcordia, accompanied by continual acid eructations, continued to exist even after a succession of six or seven fits of fever; and convalescents were troubled for a long time with dyspepsia, debility and hypochondriasis.